Original Article
Rev. Latino-Am. Enfermagem 2013 May-June;21(3):655-62 www.eerp.usp.br/rlae
Teaching of the Integrated Management of Childhood Illness strategy in undergraduate nursing programs1 Elizabeth Fujimori2 Cinthia Hiroko Higuchi3 Emília Gallindo Cursino4 Maria De La Ó Ramallo Veríssimo5 Ana Luiza Vilela Borges5
Débora Falleiros de Mello6 Lucila Castanheira Nascimento6 Verónica Behn7 Lynda Law Wilson8
Objective: To describe and analyze the teaching of the Integrated Management of Childhood Illness (IMCI) strategy on Brazilian undergraduate nursing programs. Method: Integrating an international multicentric study, a cross-sectional online survey was conducted between May and October 2010 with 571 undergraduate nursing programs in Brazil Results: Responses were received from 142 programs, 75% private and 25% public. 64% of them included the IMCI strategy in the theoretical content, and 50% of the programs included IMCI as part of the students’ practical experience. The locations most used for practical teaching were primary health care units. The ‘treatment’ module was taught by the fewest number of programs, and few programs had access to the IMCI instructional manuals. All programs used exams for evaluation, and private institutions were more likely to include class participation as part of the evaluation. Teaching staff in public institutions were more likely to have received training in teaching IMCI. Conclusion: In spite of the relevance of the IMCI strategy in care of the child, its content is not addressed in all undergraduate programs in Brazil, and many programs do not have access to the IMCI teaching manuals and have not provide training in IMCI to their teaching staff. Descriptors: Integrated Management of Childhood Illness; Child Health (Public Health); Nursing; Education, Higher.
1
Supported by Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico (CNPq), process # 479475/2010-5.
2
PhD, Associate Professor, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brasil.
3
Undergraduate Student in Nursing, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil. Scholarship holder of the Programa Institucional de Bolsas de Iniciação Científica do Conselho Nacional de Desenvolvimento Científico e Tecnológico (PIBIC/CNPq).
4
PhD, Adjunct Professor, Escola de Enfermagem, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil.
5
PhD, Professor, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brasil.
6
PhD, Associate Professor, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, WHO Collaborating Centre for Nursing Research
7
MSc, Full Professor, Universidad de Concepción, Concepción, Chile.
8
PhD, Professor, School of Nursing, University of Alabama, Birmingham, USA.
Development, Ribeirão Preto, SP, Brasil.
Corresponding Author: Elizabeth Fujimori Universidade de São Paulo. Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 Bairro: Cerqueira César CEP: 05403-000, São Paulo, SP, Brasil E-mail:
[email protected]
656
Rev. Latino-Am. Enfermagem 2013 May-June;21(3):655-62.
Introduction
However, the curricula in many nursing programs remain linked to the biomedical model, and many do
The Integrated Management of Childhood Illness
not include concepts of critical thinking and current
(IMCI) strategy was proposed in the 1990’s by the
pedagogical practices due to inadequate preparation of
World Health Organization (WHO), the Pan American
faculty(12). The current literature addresses benefits of
Health Organization (PAHO) and the United Nations
IMCI strategy for children and caregivers(13); however
Children’s Fund (UNICEF), to address the alarming rates
no
of childhood morbidity and mortality. The IMCI was
how IMCI strategy is taught to nursing students. The
officially introduced in Brazil in 1996(1).
present study, therefore, contributes to the literature by
The strategy consists of a set of criteria for assessing, classifying and treating the prevalent illnesses that can progress to become serious and kill children under five
recent
publications
were
identified
evaluating
examining the approaches used to teach IMCI strategy in schools of nursing in Brazil. Due
to
the
IMCI’s
importance
in
improving
years old. The purpose of the IMCI is not to establish a
child health, the PAHO continues to encourage the
diagnosis, but to systematically and integrally evaluate
governments of Latin-American countries to incorporate
positive predictive clinical signs which define the need
this strategy into their health programs and into
to initiate treatment in primary care or the home, or to
curricula of health professional educational programs.
refer appropriately to a unit providing higher level care.
In order to facilitate teaching IMCI in schools of nursing,
The program involves families, and includes a focus on
PAHO produced a manual in Spanish for undergraduate
integrating curative, preventative, and health promotion
nursing programs in 2009*. Simultaneously, it proposed
activities(2). The strategy reinforces the concept of
to the Red Internacional de Enfermería en Salud Infantil
integrality and strengthens the capacity for planning
(Red ENSI) (International Network of Nursing in Child
and resolution of problems at the primary level of care,
Health) to evaluate the teaching of child health in
making available the most appropriate tools for dealing
nursing training, so as to identify the situation of the
with the illnesses prevalent in childhood(2).
incorporation of the IMCI strategy into undergraduate
Since 1998, the Brazilian Ministry of Health(3)
nursing courses(14) prior to the manual’s release, so as
has recommended inclusion of the IMCI strategy in
to analyze its later effect. The Red ENSI brings together
the Medicine and Nursing curricula, in order to train
nursing researchers and nursing professionals from
professionals who are competent to care for the child in the context of primary care, the family, and the community(4). Studies on the strategy’s insertion in the teaching of pediatrics in medical schools have evidenced good acceptance on the part of the students and improvement in their knowledge of child health(5-8). In the clinical field, improvement in the quality of care was observed, as an effect of the professionals’ training in IMCI(9). In spite of this, in the case of nursing, only 37% of the teaching staff of 140 schools in 16 countries in Latin America had been trained in the strategy ten years ago(10). Recent
publications
have
highlighted
the
various countries** who are experts in the care and teaching of child’s health. Red ENSI is also responsible for coordinating the multicentric study entitled “The teaching of care for illnesses prevalent in childhood in schools and colleges of Latin America and the Caribbean”. The present study reports findings from data collected for this larger multicentric study in Brazil. The general objective of the study was to describe and analyze the teaching of IMCI strategy in Brazilian undergraduate nursing programs.
Methods
importance of the development of global standards of
This research has a quantitative and descriptive
education in nursing, in order to strengthen nursing
cross-sectional approach, and was approved by the
education. Nursing programs must train culturally
Research Ethics Committee of the University of São
competent undergraduate students who understand the
Paulo Nursing School (n°825/2009/CEP-EEUSP) and
social determinants of health and who are trained to
by the Brazilian National Research Ethics Commission
practice and to meet the population’s health needs(11).
(Decision CONEP nº 15531).
* http://www.bvsde.paho.org/texcom/AIEPI/AIEPIClinico.pdf ** Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, El Salvador, Equador, Spain, the United States, Guatemala, Honduras, Mexico, Nicaragua, Panama, Peru, Puerto Rico, Portugal, the Dominican Republic, Uruguay, Venezuela.
www.eerp.usp.br/rlae
657
Fujimori E, Higuchi CH, Cursino EG, Veríssimo MLÓR, Borges ALV, Mello DF, et al. The
study
population
included
all
of
the
the software Statistical Package for Social Sciences
undergraduate nursing programs in Brazil. In 2009*,
(SPSS® version 15.0). For the descriptive analysis,
the Ministry of Education’s website indicated the
frequency tables were constructed using absolute
registration of 782 courses; however, the researchers
numbers, proportions, minimum and maximum values,
were only able to obtain contact information for 571 of
averages and standard deviation. Public institutions were
these programs. An email was sent to a contact in each
compared with private, which included “philanthropic”,
of these programs, inviting them to participate in the
“mixed”, and “others”, using Fisher’s exact test for
research. All of the campuses belonging to the same
the categorical variables, and the t test for continuous
institutions were considered, due to the possibility of the
variables, both with a 5% level of significance.
curricular matrix or the course programs differing. The
invitation
included
a
brief
explanation
Results
of the study’s objective, and an access link to the SurveyMonkey server, which hosted the questionnaire. The addressee was requested to re-direct the message to the member of staff responsible for teaching child health. Participation was voluntary, confirmed through acceptance of the terms of free and informed consent, with confidentiality and the anonymity of the institution guaranteed. The structured and self-administered instrument used for the data collection was initially constructed in Spanish, based on a review of the literature on the area and the experience of the Red ENSI members. It was translated into Portuguese by the authors and back-translated by a professional fluent in both Spanish and Brazilian Portuguese, who was unfamiliar with the original document and the details of the research. After the comparison between the two versions and final consensus on the Brazilian version, the instrument was converted into a questionnaire for the participants to access online using the SurveyMonkey website**. The instrument included questions regarding demographic
Table 1 presents information about the total number of institutions contacted by region (N) and the number of institutions which responded (n). Proportionately, there was greater participation from institutions in the Southern region, followed by the Southeast and CentralWest regions. Over three-quarters of the responding institutions were private, the majority conferred the title of Bachelor in Nursing (69.0%) and had programs with over 4000 hours (55.6%). Table 1 - Distribution of the number of undergraduate nursing courses contacted, and responses obtained by region. Brazil, 2010 Regions of Brazil
Undergraduate nursing courses N
n
%
South
101
37
36.6
Southeast
251
63
25.1
64
16
25.0
122
24
19.7
North
33
2
6.0
Total
571
142
100.0
Center-West Northeast
data, information about the academic program, and information about teaching nursing care for children
Tables 2 and 4 present the results obtained
under age five. Respondents were also asked to provide
compared to type of institution – private or public – with
information about the incorporation of IMCI strategy in
the total of institutions which responded (N), and the
their nursing undergraduate programs and resources
responses obtained for each item (n). The theoretical
available for teaching it; and space for comments and
content of the IMCI was incorporated into the curricula
clarifications concerning filling out the instrument.
of 64.1% of the courses, there being no statistical
Data collection took place between May and October
difference between public and private institutions.
2010. Messages with reminders about the research were
Equally, there was no difference in relation to the
sent out every 15 days, over a period of 45 days. Of
teaching strategies used, in which theoretical lessons
the total, 253 institutions started the process of filling
predominated (100.0%), followed by case studies
out the questionnaire, and 142 finished (24.9% of the
(97.0%). As an evaluative strategy, all used theoretical
total).
tests, but there was a difference concerning participation
The data were abstracted from SurveyMonkey, recorded onto an Excel spreadsheet, and analyzed using
* http://emec.mec.gov.br ** http:// www.surveymonkey.com
www.eerp.usp.br/rlae
in theoretical lessons, which were considered more important in private institutions (Table 2).
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Rev. Latino-Am. Enfermagem 2013 May-June;21(3):655-62.
Table 2 - Characterization of the theoretical teaching of IMCI regarding teaching and evaluative strategies, in public and private institutions. Brazil, 2010 Theory teaching
Public institutions
Private institutions
Total
N
n
%
N
n
%
N
n
%
33
23
69.7
98
61
62.2
131
84
64.1
Theory lessons
22
22
100.0
60
60
100.0
82
82
100.0
Case studies
17
16
94.1
53
52
98.1
70
68
97.1
Bibliographic research
16
14
87.5
47
39
83.0
63
53
84.1
Group study
14
11
78.6
52
44
84.6
66
55
83.3
Individual study
14
11
78.6
44
36
81.8
58
47
81.0
Seminars
11
7
63.6
46
35
76.1
57
42
73.7
Videos
14
10
71.4
48
33
68.8
62
43
69.4
Theory tests
19
19
100.0
54
54
100.0
73
73
100.0
Participation in theory lessons*
17
14
82.4
55
55
100.0
72
69
95.8
Case studies
18
16
88.9
56
53
94.6
74
69
93.2
Group study
15
11
73.3
51
47
92.2
66
58
87.9
Individual work
11
9
81.8
48
38
79.2
59
47
79.7
Incorporation of IMCI Teaching strategy
Evaluative strategies
*p
