Processo ensino-aprendizagem em programas de residência de enfermagem: desafios para a prática reflexiva

Abstract

The research was based on the premise that nursing residency programs’ teaching-learning process presents few spaces and movements that encourage reflective practice. It is assumed that the teaching-learning process is aimed at demonstrating and repeating techniques according to the dynamics of services, with insufficient moments of active experimentation. Objective: to analyze reflective practice in the teaching-learning process of nurses in residency programs in Belo Horizonte, Minas Gerais. Methodology: this is a single case study, qualitative in nature, anchored in the theoretical framework of Donald Schön’s reflective practice. Data production took place in the context of Residency Programs in the Professional Area of Health, uni-professional and multi-professional modalities. Analysis units were two teaching hospitals, located in Minas Gerais. Data collection took place between August 2022 and July 2023 through documentary analysis of the regulations published by the Ministries of Health and Education regarding Residency Programs in the Professional Area of Health and the documentation that guides the residency programs under study. The second phase of this study was participant observation of five resident nurses for a total of 156 hours and ten minutes. Finally, the third phase began with interviews with the five observed residents and the ten preceptors and three tutors of the respective residents, totaling 5 hours, 16 minutes and 54 seconds. Data from observations were subjected to absolute and relative frequency distribution analysis and documents and interviews to critical discourse analysis. Results: in 519 activities observed, elements of reflective practice were identified in 22.2%. The elements of reflection most expressed by residents were listening with operational attention, expressing doubts and saying or criticizing something about the activity, with the residents themselves as the main actors enhancing this reflection, followed by preceptors. The speeches indicate practical activity as the best moment for teaching-learning due to its potential to produce reflections. They point out learning by doing and discussion of clinical cases as potential strategies for reflective learning. They highlight unusual situations and errors as the moments that most encourage reflection, with preceptors being the first reference when faced with doubts. Conclusion: reflection of the knowing-in-action type was evident as the predominant one in the training of residents with few opportunities for reflection on reflection-in-action. Teaching-learning situations need to be promoted in order to increase the likelihood of students experiencing different experiences. This diversity provides residents with an accumulation of knowledge and experience that makes them capable of dealing with the demands that their work routine imposes on them. Reflection on reflection-in-action is what is expected from a professional at this level of expertise who can act in unpredictable contexts.