doi: 10.56294/hl202341

 

ORIGINAL

 

Historical analysis of the formation of professional skills in the Bachelor’s degree in Nursing

 

Análisis histórico de la formación de competencias profesionales en la carrera de Licenciatura en Enfermería

 

Reudis Durán Rodríguez1  *, Raúl Hernández Heredia2  *, Irayma Cazull Imbert3  *, Rosilé Obret Orphee2  *

 

1Hospital General Docente de Baracoa. Guantánamo, Cuba

2Universidad de Guantánamo. Guantánamo, Cuba.

3Hospital General Docente Agostinho Neto. Guantánamo, Cuba.

 

Cite as: Durán Rodríguez R, Hernández Heredia R, Cazull Imbert I, Obret Orphee R. Historical analysis of the formation of professional skills in the Bachelor’s degree in Nursing. Health Leadership and Quality of Life. 2023; 3:41. https://doi.org/10.56294/hl202341

 

Submitted: 23-07-2023          Revised: 01-09-2023          Accepted: 18-11-2023          Published: 19-11-2023

 

Editor: Dra. Mileydis Cruz Quevedo  

*Translated by: Cristhian Alejandro Pérez Pacheco *

 

ABSTRACT

 

The history of the formation of professional competencies in the Bachelor’s Degree in Nursing in Cuba is an exciting area of study. However, it is challenging to summarize in a limited space the historical evolution of this topic. The main objective of this study is to describe the process of formation of professional competencies in the Bachelor’s Degree in Nursing. To achieve this objective, we carried out an exhaustive documentary and bibliographic review related to the topic, in addition to conducting interviews with professors prominent in the training of nursing professionals. Throughout the paper, the historical evolution of the formation of professional competencies in the Nursing career is presented. It is concluded that professional training in nursing requires both a theoretical and practical construction of the training process. In addition, it must be sensitive to the demands imposed by current social and economic policies. In this context, the commitment to integrate content related to professional competencies in the Bachelor’s Degree in Nursing programs, with a focus on patient safety, is highlighted. The training of nurses is oriented towards the maintenance and recovery of health, the prevention of diseases and the rehabilitation of people with sequelae. These approaches will guide the content developed in the curriculum that prepares students to manage patient safety in acute care. In addition, the authors analyze how this training process is congruently adapted to the care model developed in health services.

 

Keywords: Nursing; Training; Professional Competence; Patient Safety.

 

RESUMEN

 

La historia de la formación de competencias profesionales en la Licenciatura en Enfermería en Cuba es un área de estudio apasionante. Sin embargo, resulta desafiante resumir en un espacio limitado la evolución histórica de este tema. El objetivo principal de este estudio es describir el proceso de formación de competencias profesionales en la Licenciatura en Enfermería. Para alcanzar este objetivo, llevamos a cabo una exhaustiva revisión documental y bibliográfica relacionada con el tema, además de realizar entrevistas con profesores destacados en la formación de profesionales de Enfermería. A lo largo del artículo, se presenta la evolución histórica de la formación de competencias profesionales en la carrera de Enfermería. Se concluye que la formación profesional en Enfermería requiere una construcción tanto teórica como práctica del proceso de formación. Además, debe ser sensible a las demandas impuestas por las políticas sociales y económicas

vigentes. En este contexto, se destaca el compromiso de integrar contenidos relacionados con las competencias profesionales en los programas de la Licenciatura en Enfermería, con un enfoque en la seguridad del paciente. La formación de enfermeras y enfermeros se orienta hacia el mantenimiento y la recuperación de la salud, la prevención de enfermedades y la rehabilitación de personas con secuelas. Estos enfoques guiarán los contenidos desarrollados en el plan de estudios que prepara a los estudiantes para gestionar la seguridad del paciente en cuidados intensivos. Además, los autores analizan cómo este proceso formativo se adapta de manera congruente al modelo asistencial que se desarrolla en los servicios de salud.

 

Palabras clave: Enfermería; Formación; Competencia Profesional; Seguridad del Paciente.

 

 

 

INTRODUCTION

The history of the formation of professional competencies within the Bachelor's Degree in Nursing, provides an exciting field of study. However, it is challenging to summarize in a limited space the historical evolution of events in this topic. An extensive period of the labor of nursing professionals is examined, spanning from the wars of independence to the present day.

The articulation of the nursing profession in Cuba,(1,2,3) is a subject of extensive development, controversial assessments, and especially it is related to the healthcare contexts and strategies, whether or not they addressed the prevailing health situation in each stage.(4,5,6) Definitely, the formative processes(7,8) within this specialty of medicine, are not geared towards competencies per se but rather towards skills. In this regard, the content exposed in this work aims to integrate some of the aforementioned elements with the purpose of acknowledging the historical significance that professional competences hold in the training of Nurse Practitioners.

Objective: To describe the process of formation of professional competencies in the Bachelor's Degree in Nursing through a historical trend analysis.

 

METHODS

A comprehensive documentary and bibliographic review related to the topic was conducted, in conjunction with interviews featuring prominent professors in the training of nursing professionals.

In this research, the study of the historical evolution of the process of formation of professional competencies in the Nursing career was conducted by considering as criterion the sequence of curricula through which the professional training process has evolved.

Accordingly, three distinct stages were identified, considering the validity of curricula:

·      First stage (1976-1998): Approximation to the formation of professional competencies as a social need.

·      Second stage (1998-2006): Integration and consolidation of the formation of professional competencies.

·      Third stage (2006-present): Strengthening of the formation of professional competencies.

·      The analysis of these stages was formulated, considering the following indicators:

·      Conception of the formation of professional competencies in curricula. (9,10)

·      Cooperation between disciplines for the formation of competencies.

·      Suggestion of learning methods and strategies.

·      Recognition of the need to address patient safety management content.

 

RESULTS AND DISCUSSION

It is challenging to summarize within a limited space the historical evolution of any event related to human activity. If the period spans as many years as the events to be recounted, the task becomes even more complex and challenging. Nonetheless, the intent and determination to unveil significant and truly historical moments can surmount these barriers, transforming the arduous into the enjoyable. The evolution of the Nursing career formation in Cuba is a subject marked by extensive exploration, controversial assessments, and a notable connection to healthcare contexts and strategies, whether responsive or not to the prevailing health situation in each stage. Undoubtedly, training processes must align with societal demands in every part of the world, and in the case of content related to the formation of professional competences in the nursing career, this alignment is both pertinent and unavoidable.

 

First stage (1976-1998): Approximation to the formation of professional competencies as a social need.

It begins with the inception of the Bachelor's Degree in Nursing (11- 13) with a four-year duration in the face-to-face modality (through regular daytime courses) for workers, employing Curriculum A, in the academic year 1976-1977, characterized by a formation concept within a narrow profile. Curriculum B, which was implemented in the academic year 1983-1984, also corresponds to this stage; its implementation was driven by the imperative to qualitatively enhance the availability of nursing staff with university education, following the same narrow profile concept.

This stage was characterized by the following regularities:

·      In this stage, the conception of the formation of professional competences had the vision to cultivate a proficient professional under the study-work principle, a decisive combination influencing the development of skills and modes of action and contributing to the transformation produced in the interconnection of the university-industry-research triad. The objectives for this stage were not articulated with a primary focus on the formation of professional competences; instead, they were based on the general and specific skills inherent to the profession, a conception that did not facilitate the formation of professional competences.

·      Cooperation between disciplines for the education of nursing professionals was notably restricted. Despite the incorporation of the study-work combination principle into the training, practical experiences were not integrated into the disciplines and their respective subjects, resulting in a non-systemic orientation.

·      In this first stage, learning methods and strategies were not clearly defined. However, as curricula underwent enhancements during this period, a system of methodological guidelines started to be referenced and developed. These guidelines suggested the utilization of learning methods and strategies within discipline and subject programs; with the primary objective of preserving or restoring health, preventing diseases, and rehabilitating individuals with sequelae. This approach emphasized a comprehensive perspective encompassing historical, philosophical, socio-economic, political, cultural, ethical, and environmental dimensions, utilizing diverse languages and communicative supports.

·      With the curriculum modifications implemented in this first stage, elements related to the need to work towards ensuring patient safety began to surface.

 

Second stage (1998-2006): Integration and consolidation of the formation of professional competencies as a social need.

In the academic year 1998-1999, the implementation of curriculum C commenced, introducing a new feature: the conception of broad-profile training across the three spheres of Cuban healthcare. This initiative aimed to rectify deficiencies observed in the preceding stage and cultivate a competitive professional capable of effectively meeting the evolving needs of society in the 21st century.

With the design and implementation of this curriculum, which underwent transformations, it was decided to redesign the nursing career with the introduction of a new pedagogical model. Spanning a duration of 5 years, its distinctive feature lies in the intermediate exit profiles: basic nurse (1 year), higher technician (additional 2 years), and bachelor's degree (additional 2 years). In this curriculum, the particularities required by nursing education were more precisely delineated, outlining distinctive features of the profile. Consequently, this marked a substantial contribution to the social recognition and legitimization of professional practice within the field.

The regularities of this stage were:

·      It presents elements that align with the cultivation of professional competences. The needs of the patient, community, and institutions serve as pivotal factors in the professional’s training. It is characterized by a new philosophy that emphasizes the active, creative, and independent participation of the student.

·      It commenced with an analysis of integration and the proper interplay between disciplines to strengthen the dynamics and relationships among the subjects that composed it. Additionally, there was a focus on fostering interdisciplinary and transdisciplinary relationships to promote the formation of professional competences. Nevertheless, despite these efforts, the attainment of a competent graduate capable of working across all three health spheres was not realized.

·      In the methodological guidelines of this stage, there is a section titled “About Teaching Methods and Forms”, introducing substantial changes that reflect scenarios of urgency, emergency, and care of critically ill patients in the Cuban public health context and it is emphasized the treatment of social reality problems through a critical approach. Consequently, it demands the utilization of new active and creative methods in the education of nursing professionals, aiming to promote the integration and appropriate relationships between an understanding of real-world challenges and the assimilation of theoretical-methodological references derived from the state-of-the-art knowledge across various fields of action. All of this is intended to be applied in the pursuit of solutions for transformation, social advancement, collaborative teamwork, and the construction of collective knowledge.

 

The incorporation of active, creative teaching methods that facilitate the integration and establishment of appropriate relationships between the understanding of real-world issues is deemed a priority in addressing work within disciplines, enhancing the dynamics and relationships among subjects through the implementation of practical exercises and comprehensive evaluative tasks.

·      In this stage, the subject of Emergency Nursing introduces aspects related to patient safety; however, even then, it is not achieved that these professionals manage patient safety in the intensive care sphere, given that teachers fail to address the topic, either in the classroom system or in practice.

 

Third stage (2006-present): Strengthening of the formation of professional competencies as a social need.

This stage commences with the implementation of Curriculum D in the academic year 2006-2007, with the objective of transforming the Bachelor's degree in Nursing. The overarching goals include the formation of more competent professionals, cost reduction, decreased morbidity and mortality rates, and the enhancement of the quality of life for both patients and the community.

This stage was characterized by the following regularities:

·      While there is an expansion of potentialities for the formation of professional competences, there remains a deficiency in content that serves as invariants for addressing patient safety across all three levels of patient care, including intensive care.

·      Interdisciplinary and transdisciplinary cooperation for the formation of professional competences is evident. However, the graduation of a competent student capable of effectively operating across all three levels of patient care within society has not been realized.

·      Various methods and learning strategies are proposed, emphasizing the strengthening of the work link, the computerization of the training process, and assessment systems focusing on qualitative and integrative performance. All these initiatives are directed towards seeking solutions for transformation, social improvement, teamwork, and the construction of collective knowledge. Despite the incorporation of these elements in this stage, the attainment of a sufficiently competent professional has not been actualized.

·      This stage exhibits numerous strengths aligned with the objective of this research; nevertheless, there persists a gap in the logical framework for training nursing professionals, specifically in linking them to the management of patient safety in intensive care.

This implies a heightened level of generality in the education of nursing professionals and an expansion of their ability to respond to the needs of patients, society, and each institution through the training of nursing professionals specialized in various fields, yet with increased flexibility in their exit profiles; due to all of this, there is a notable absence of emphasis on patient safety in intensive care.

Based on the analysis of the observed regularities in each stage, it becomes feasible to delineate the primary trends in the process of cultivating professional competences within the Bachelor’s degree in Nursing.

This analysis exposes the evolutionary trajectory of the Bachelor’s degree in Nursing, transitioning from a traditionalist approach in professional formation with limited integration of theory and practice, to the empowerment of self-preparation. The work focused on the development of the planned skills did not facilitate the formation of professional competences. However, with the improvement of these curricula, there is a shift towards incorporating content proposals that favor the formation of these competences.

Despite the implicit inclusion of the study-work principle in the curriculum A, students did not establish a direct connection to healthcare praxis. This study-work principle began to be implemented with increased flexibility in the curriculum B, yet the designated skills were still inadequate to produce a competent professional. In the third stage, this crucial principle for the formation of professional competences began to be more intensively implemented; however, there is still a deficiency in the planned skills to produce a well-rounded professional capable of working across all three levels of healthcare.

In the first stage, within the curriculum B, content related to the imperative of working towards ensuring patient safety emerged within the Medical-Surgical Nursing subject. Moving to the second stage, Curriculum C introduced this crucial element within the Emergency Nursing subject. In the third stage, with the implementation of the curriculum D, despite the implicit inclusion of the significant topic of patient safety, there is a lack of intentional focus on addressing patient safety based on this content. This renders the achievement of a competent professional capable of ensuring patient safety in intensive care.

 

CONCLUSIONS

The professional formation in Nursing necessitates a theoretical and practical construction of the training process, and it will have to respond to the demands imposed by prevailing social and economic policies. In this regard, there is a commitment to incorporating contents related to professional competences in Bachelor's degree programs in Nursing, specially focusing on patient safety. The predominant emphasis in the Nursing career on maintaining or restoring health, preventing diseases, and rehabilitating individuals with sequelae, will guide the content to be developed in the curriculum, steering the preparation process for students of this career in managing patient security, particularly in intensive care.

In the research, the authors analyzed the congruent response of a formative process to the care model developed in health services.

 

BIBLIOGRAPHIC REFERENCES

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5. Barrera Breijo, M. E., Hernández Rodríguez, I. M., & García Andarcio, T. Determinantes para la enseñanza de la Historia de Cuba en el contexto de formación médica. Mendive. Revista De Educación, 2019;17(2):183–192.

 

6. Vela-Valdés J, Salas-Perea RS, Quintana-Galende ML, Pujals-Victoria N, González Pérez J, Díaz Hernández L, et al. Formación del capital humano para la salud en Cuba. Rev Panam Salud Pública. 2018; 42:e33. https://doi.org/10.26633/RPSP.2018.33.  

 

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9. Ramos-Vives M, Mena-Lorenzo J, Ferro-González B, Márquez-Márquez D, Blanco-Herrera I. Fundamentos teóricos del proceso de formación pedagógica de los estudiantes de licenciatura en Enfermería. Revista de Ciencias Médicas de Pinar del Río. 2020; 24(5).

 

10. Planes de estudio de la carrera de Enfermería. Centros de educación Médica Superior. Cuba. Cuidad de la Habana; 2008.

 

11. Cuba. Ministerio de Salud Pública (2010). Diseño Curricular para la formación de Licenciados en Enfermería. La Habana: MINSAP.

 

12. Barrera Breijo, M. E., Hernández Rodríguez, I. M., & García Andarcio, T. Determinantes para la enseñanza de la Historia de Cuba en el contexto de formación médica. Mendive. Revista De Educación. 2019;17(2):183–192.

 

13. Ministerio de Salud Pública de Cuba. Plan de estudios de la Carrera de Licenciatura en Enfermería. La Habana: MINSAP; 1993.

 

FINANCING

No financing.

 

CONFLICT OF INTEREST

The authors declare that there is no conflict of interest.

 

AUTHORSHIP CONTRIBUTIONS

Conceptualization: Reudis Durán Rodríguez.

Data curation: Reudis Durán Rodríguez, Raúl Hernández Heredia, Irayma Cazull Imbert.

Formal analysis: Reudis Durán Rodríguez, Raúl Hernández Heredia, Irayma Cazull Imbert.

Acquisition of funds: Reudis Durán Rodríguez, Raúl Hernández Heredia, Irayma Cazull Imbert.

Research: Reudis Durán Rodríguez, Irayma Cazull Imbert.

Methodology: Reudis Duran Rodriguez, Raul Hernandez Heredia, Irayma Cazull Imbert

Project Administration: Reudis Durán Rodríguez.

Supervision: Reudis Duran Rodriguez, Raul Hernandez Heredia, Irayma Cazull Imbert.

Validation: Reudis Durán Rodríguez, Raúl Hernández Heredia, Irayma Cazull Imbert.

Visualization: Reudis Durán Rodríguez, Raúl Hernández Heredia, Irayma Cazull Imbert.

Drafting - original draft: Reudis Durán Rodríguez, Raúl Hernández Heredia, Irayma Cazull Imbert.

Writing - proofreading and editing: Reudis Durán Rodríguez, Raúl Hernández Heredia, Irayma Cazull Imbert.