Curricular Analysis of CPPs in Nursing

The CPPs' assessment of undergraduate courses in Nursing, Physiotherapy and Nutrition of the UPE Petrolina Campus, regarding the presence of BLS content in the curriculum, showed that only the Nursing course contemplates the teaching of this theme. In this course, the content of BLS is included in the compulsory discipline Nursing Care in Emergencies and Traumas, offered in the 7th period, with a workload of 120 hours; however, the BLS is approached only in a class of Advanced Cardiovascular Life Support Principles (ACLS)with a theoretical workload of 4 hours and 4 practical hours. Table 2 shows the analysed criteria separated by HEI.

A similar result was observed in the analysis of CPPs of nursing courses offered by other Ies (Chart 2). All courses presented the content of BLS in their curricular matrices in mandatory disciplines; and in the federal institution, the theme is addressed in an 8-hour workload (4h theoretical and 4h practical) within the discipline Critical Patient I, in the 8th period. In private institutions, the BLS is offered in the discipline of Urgency and Emergency, in the 7th period, with a workload similar to the other courses evaluated.

In general, all undergraduate nursing courses evaluated address the content of BLS alone or together with FVO, in the final periods of the courses, that is, already in the professional cycle, contemplate the theoretical referential in the curricular component and have a relation of theoretical and practical workload, that is, theoretical 4h and practical 4h.

It is essential that nursing graduates are stimulated and trained in BVS to provide adequate and quality care, by witnessing a victim of CRP, reducing or avoiding sequelae, decreasing the mortality rate. To this end, this theme needs to be the subject of discussion at graduation, in order to train professionals committed to the health problems of the population regardless of their specialty and field of action since, the nurse acts in direct care to the patient and is usually the first to identify the CRA (^{DA SILVA et al., 2015}).

Curricular Analysis of CPPs of Physical Therapy

The analysis of the CPPs of the Physiotherapy courses offered by the five HEI selected in this research, showed that exclusively the private institution 1 contemplates the content of BLS in its curriculum, in the discipline of Urgency and Emergency, early in the 2nd period. This finding corroborates with ^{Kawakame and Miyadahira (2015}), when they state that early exposure of health students to this theme is significant, in order to develop the necessary skills right at the beginning of graduation and that can be reinforced in the following years. It is important to warn the scarce knowledge and dexterity of the majority of students in the area of health related to the BLS, being reason for alert and concern. Table 3 shows the analysed criteria separated by HEI.

It is important to point out that the absence of BLS content in the programs of the other undergraduate courses in Physiotherapy evaluated here, contrasts Resolution 501, of ^{December 26, 2018} of the Federal Council of Physiotherapy and Occupational Therapy (COFFITO), which recognizes the role of the Physiotherapist in health care in the Emergency and Emergency Units. Therefore, once this professional is part of the multidisciplinary health team, his training in BVS and VAS is recommended. It is worth noting that, due to the affinity with the theme, the discipline Cardiovascular and Pneumofunctional Physiotherapy could contemplate the content of the BLS, however, it is necessary to include it in the program menu, as well as in the theoretical framework of the discipline.

Curricular Analysis of CPPs of Nutrition

When analyzing the CPPs of the undergraduate courses in Nutrition offered by the five selected HEI, there was a lack of BLS content in all curricular grades (Chart 4).

This result is worrying, because it conflicts with the understanding of the nutritionist as a health professional inserted in the context of the multidisciplinary team. In accordance with this concept, ^{DA SILVA et al. (2019}) states that health professionals, regardless of their specialty, should have mastery over the knowledge of BLS needed to attend CRA, as this is recognized as the most serious clinical emergency, can occur at any time and anywhere, and causes the team a lot of stress, tiredness, anxiety and exhaustion. Thus, skills should be acquired that enable them to act quickly and effectively during this emergency.

According to the Federal Constitution of 1998, in its art. 200, the Brazilian Unified Health System (SUS) is responsible for training human resources in health. In view of this, with the purpose of offering a training that enables the qualification of health care care, including the principles of SUS, the Ministry of Education (GUY) and the Ministry of Health (MH) established the National Curriculum Guidelines (Dcns) for 14 health professions (DO BRASIL, 2010; ^{Costaa et al., 2018}). Dcns are used by Ies throughout the country, as a standard reference for the elaboration of their CPPs from an Inter-disciplinary perspective that directs the teaching-learning process, and should include the elements on profile, skills and skills of graduates, where the curricular contents present interrelationship between society, culture and education, in such a way that the organization of the course meets the demands of the SUS (Costaa et al., 2018).

With regard to the BLS, it is essential that the students of the health courses hold theoretical and practical knowledge in order to perform the care to the victim of CRA with safety and dexterity. To this end, it is considered fundamental that the higher education institutions establish in their curricular matrices, disciplines relevant to emergency care that contemplate the BLS as the main theme, and not only insert it as content of only one class with minimum workload. These disciplines should also bring students closer to the concepts and behaviors for the BLS, as well as to the CPR protocol based on the guidelines of cardiology societies and organs as recommended by the AHA and the SBC (^{DA SILVA et al., 2019}).

In this perspective, the main focus of the SBC has been the training of health professionals in BLS with the objective of reversing CRP through adequate care, free of malpractice, minimizing morbidity and mortality and favoring greater probability of Whtr. Thus, in 2013, following the guidelines of the AHA, the SBC published the I Guideline for Cardiovascular Resuscitation and Emergency Cardiovascular Care, with adaptations aimed at meeting the Brazilian reality (^{DA SILVA SALAZAR, 2017}; ^{BERNOCHE et al., 2019}).

Success in CRA care depends not only on the availability and functionality of the resuscitation equipment, but also on the training of the multiprofessional team. In this sense, the creation of teams specialized in emergency care was conceived with the aim of providing fast and effective care to victims of CRP. In these situations, a team of professionals is triggered and moves immediately to the place of occurrence.

Based on this concept, the Institute for Healthcare Improvement (IHI) recommended in 2004 the implementation of the Rapid Response Teams (RRT) in hospitals that are triggered by the Blue Code as part of a strategy to prevent the occurrence of Pcrs and, consequently, reduce hospital mortality (^{GONÇALES et al, 2012}; ^{SANTANA-SANTOS, 2017}).

The Blue Code is a model of RRT activation for intrahospital CRP care outside critical units (intensive care unit, emergency room or surgical center). The RRT is composed of health professionals and aims at the identification and early treatment of patients, adults and pediatrics, who present clinical deterioration or are at risk of death, outside the critical units’ environment (^{DE LIMA LOPES et al., 2012}). In 2003, the SBC considered the physician and nurse as health professionals who were members of the RRT and directly responsible for the care of CRP in the in-hospital environment, but in addition recommended the training of other professionals who were not directly involved in the care, namely the physiotherapist in BLS and FVO and the nutritionist in BLS (^{GOMES et al., 2003}).

In the 2004 Code of Ethics of Nutrition Professionals, Chapter IV, which provided for professional responsibility, the nutritionist, in art. 6th Item IV, provide assistance even in emergency and emergency sectors, when it was your obligation to do so. In 2018, the Federal Council of Nutritionists (CFN) amended the code of ethics and revoked art.6, which does not agree with the Dcns of the Nutrition course that, according to Costa^a et al. (2018), recognize that the professional needs to perform actions according to the health needs of the individual, family and/or society, from the perspective of integrality in all levels of complexity of the system.

The minimum curriculum for several undergraduate courses in the country was established in the 1960s by the Federal Council of Education (CFE), listing subjects that should compose the full curriculum of undergraduate courses offered in each institution. In 1970, the minimum curriculum of the Nutrition course underwent a review under the criticism of not following the technical and scientific development and not meeting the needs of the Brazilian reality. Finally, Resolution nº 5/2001 instituted the Dcns of the undergraduate course in Nutrition in replacement to the minimum curriculum, structuring a more qualitative approach of the course, aimed at making the student able to understand and act in front of the health needs of the population (^{SOARES; AGUIAR, 2010}).

Still regarding the undergraduate course in Nutrition, with regard to the teaching of the BLS, it is necessary to move towards a review of the national curricular matrix. ^{Santos et al. (2015}) emphasize that to achieve this goal a change in national policy may be necessary, as in developed countries. This is because, although basic BLS skills are considered mandatory in all health professions, it is very difficult to ensure that this is the case in Brazil. In this context, Santos et al. (2015) reiterate the importance of including the content of BVS in the curriculum of undergraduate courses, regardless of the area of study, such is the importance of this knowledge for public health.

On the other hand, there have been advances in the attributions and competencies of the physiotherapy professional in the care of CRP in an intra-hospital environment. COFFITO’s Resolution 501 not only recognizes the role of the physiotherapist in health care in the emergency sector, but endorses the international recognition regarding the presence of the physiotherapist as a professional qualified to compose the RRT; The training of this professional in BLS and FVO is recommended according to AHA guidelines.

This recognition of COFITTO was legitimized by the SBC which, in September 2019, published the Update of the Directive on Cardiovascular Resuscitation and Emergency Cardiovascular Care of the Brazilian Society of Cardiology 2019, ratifying not only Resolution 501, as what has been implemented worldwide, like Australia, many countries in Europe and the United States, regarding the insertion of the physiotherapist, together with the doctor and nurse, as a multiprofessional team that makes up the RRT (^{BERNOCHE et al. 2019}). At this juncture, Ies that offer the undergraduate course in Physiotherapy should readjust their CPPs to meet this legal precedent, ensuring the student the development of skills and skills in BLS and SAV still in graduation, as well as their improvement during their professional career, in the form of continuing education resources.