Creative Education
2013. Vol.4, No.12B, 66-74
Published Online December 2013 in SciRes (http://www.scirp.org/journal/ce) http://dx.doi.org/10.4236/ce.2013.412A2010
Open Access 66
Integrated Nursing Curriculum in Brazil:
A 13-Year Experience
Mara Lúcia Garanhani1, Marli Terezinha Oliveira Vannuchi1, Anaísa Cristina Pinto2*,
Thayane Roberto Simões2, Maria Helena Dantas de Menezes Guariente1
1Department of Nursing of the State University of Londrina, Paraná, Brazil
2The State University of Londrina, Paraná, Brazil
Received October 28th, 2013; revised November 28th, 2013; accepted December 5th, 2013
Copyright © 2013 Mara Lúcia Garanhani et al. This is an open access article distributed under the Creative
Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited. In accordance of the Creative Commons Attribution License all
Copyrights © 2013 are reserved for SCIRP and the owner of the intellectual property Mara Lúcia Garanhani et
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This article aims to describe the guiding principles and the operationalization of the integrated curriculum
of the undergraduate course in Nursing of a public university in southern Brazil. This is an experience re-
port by 3 curriculum managing professors and 2 graduate students in Nursing, who experience the peda-
gogical proposal. The analysis comprised official documents and 2 books on this integrated Nursing cur-
riculum, which has been developed for 13 years; it is presented in 4 topics: guiding principles; curricular
structure; role of the professor and student; and collegiate management. We present reflections on the
curriculum, expressing the framework supporting the proposal and the developmental strategies adopted.
This experience points out the dialogical movement of participants in this education action, i.e. professors
and students, from a critical and innovative perspective of nurse’s training. We conclude that the pathway
reported highlights key themes of the pedagogical proposal, such as inseparability of theory and practice;
the diversification of teaching strategies; the successive close approaches between contents in interdisci-
plinary modules; learning evaluation from a two-dimensional perspective; early introduction of the stu-
dent to different settings of professional practice; and the democratic and participatory management proc-
ess in a collective construction. We hope to contribute to other institutions trying to develop an innovative
methodology for nurse’s training.
Keywords: Nursing Education; Curriculum; Teaching-Learning Process
Introduction
Changes in the political, economic, and social scenarios of
education and health care in Brazil and in the world have re-
quired transformations in nurse’s profile. There is a need for
integration between the health care field and education, in order
to rethink nurse’s training, aimed at developing a citizen who is
more critical, flexible, versatile, thoughtful, and capable of
facing challenges of modernity with regard to health promotion
(Martinelli et al., 2011).
Thus, teaching in universities has favored curricula which
involve more active learning processes, encouraging exchange
of information between professors, students, health care profes-
sionals, and users of health care services, in order to develop
student’s ability to properly act when faced by situations posed
by professional practice, stimulating creativity (de Almeida,
2003).
The construction of the integrated curriculum of the under-
graduate course in Nursing of the State University of Londrina
(UEL), Paraná, Brazil, implemented in 2000, involves the
commitment of professors to pursue a professional training
which considers the comprehensiveness of care for the individ-
ual, family, and community; the determining factors of the
health-illness process; the social and economic factors related
to the syllabus; continued multiprofessional and interdiscipli-
nary activities, instead of occasional ones; integration between
the services and the community; and, also, the idea that the
student is a citizen who construes her/his knowledge and is in
charge of developing her/his technical, political, and ethical
competences in an active, critical, and thoughtful way.
The process for constructing the integrated curriculum was
permeated with many doubts, but, also, some convictions. One
of them, theoretically supported by Sacristán (1998), is the
premise that a curriculum is something constructed by means of
an intense participatory action, in an open deliberation process
involving the participating actors, with no imposed decisions.
Even when these actors used their own resources, values, and
beliefs in debates and discussions, the aim was establishing
partnership and consensus.
Another conviction was that the more legitimate and negoti-
ated the agreement between actors involved in the daily prac-
tice, the greater the possibility of joining forces to make it come
true and turn this practice into the curricular organization.
Throughout the curriculum construction process, we wished for
change and were afraid of an uncertain future. However, the
*Corresponding author.

M. L. GARANHANI ET AL.
group went on, defining its pathway, daring to think and start a
new stage in its pedagogical practice, always guided by the
Nursing Collegiate, the legitimate body representing the whole
course, responsible for driving the process of curriculum trans-
formation, observing the collective construction process.
In this context, the Pedagogical Political Project of the inte-
grated curriculum of the nursing course of UEL was con-
structed and approved, on December 10, 1999, and its deploy-
ment was scheduled to take place in the first half of 2000—at
the dawn of the XXI century. New century, new curriculum!
Thirteen years after the deployment of this curriculum, revis-
iting its history allows us to report the routes taken and contrib-
ute to other education institutions which are undergoing a cur-
riculum change process. It also enables us to have a collective
reflection by actors involved in this construction, providing
other people with the possibility of taking a critical look at the
need for facing together the challenge of achieving the quality
required in nurse’s education.
Thus, this article aims to describe the guiding principles and
the operationalization of an integrated curriculum of an under-
graduate course in Nursing of a public university in southern
Brazil.
Methodological Pathway
This is an experience report of the process experienced in the
Nursing course of UEL since the construction of the integrated
curriculum.
Londrina is a town with around 500,000 inhabitants, in the
state of Paraná, southern Brazil. UEL is located at this town; it
has 53 courses, among them the undergraduate course in Nurs-
ing, created in 1971, and its first group of students joined in
1972.
Most professors of the Nursing course are allocated in the
Departments of Nursing and the Department of Collective
Health of the Center for Health Sciences of UEL, and there are
other professors working in departments of the centers for Bio-
logical Sciences and Humanities. The faculty is characterized
as a group constantly involved in discussions, struggles, and
proposals for curricular changes in nurse’s training, committed
to improving the quality of teaching and the provision of health
services to the population.
In the quest for quality of teaching and professional training,
the course underwent seven curricular reforms until 2012;
among them, stand out the creation of the nursing internship, in
the curriculum for 1992, and the deployment of the integrated
curriculum since 2000. In 2012, the Nursing course of UEL
celebrated 40 years of activities and 13 years since the imple-
mentation of the integrated curriculum. It enrolls 60 students
per year, who undergo the so-called “vestibular”, lasting four
years in full-time, totaling 4152 hours of free education to the
student.
The preparation of this report was based on the perception of
3 curriculum managing professors and 2 graduate students in
Nursing, who experienced the pedagogical proposal. We also
used some official documents and 2 books produced within this
13-year period (Dellaroza & Vannuchi, 2005; Kikuchi; Guari-
ente, 2012). Access to the documents was sought after approval
and authorization by the course collegiate. The authors agreed
to use the confidential information accessed only for scientific
purposes, ensuring confidentiality and secrecy. This report is
part of the research project “Integrated curriculum of a Nursing
course: pedagogical management and professional training”,
approved by the Research Ethics Committee of the institution,
under the Protocol 0323.0.268.000-11.
Development
The development of the integrated curriculum is presented in
4 topics: guiding principles; curricular structure; role of the
professor and student; and collegiate management. Reflections
on the theme are expressed, allowing us to think through the
perspective of those who teach and those who learn in a prob-
lem-solving and meaningful way, aimed at professional training
in Nursing and Health Care.
Guiding Principles of the Integrated Curriculum
The pedagogical principles guiding the integrated Nursing
curriculum are based on the paradigmatic crisis of science and
education, where the discussion on the agenda involves the
need to go beyond a practice which reaffirms the fragmentation
of knowledge, breaking down the boundaries between special-
ties of each discipline, in search of a comprehensive integra-
tion.
In this context, in the pedagogical proposal of the integrated
curriculum, the human being is defined as being able to trans-
form the conditions of her/his existence by means of her/his
worldview, which permeates her/his social relations. These, in
turn, determine the organizational structure and the production
in society. The insertion of the human being in the productive
process may determine the health-illness process.
In this proposal, nursing is understood as a socially, politi-
cally, and historically determined practice, which aims to care
for the human being in all life cycles, contributing to health
promotion, prevention, recovery, and rehabilitation. So, the
nurse’s profile aimed by this curriculum consists in an ethical
and humanistic professional, politically responsible and able to
perform an intentional work, becoming a social transformation
agent.
In the integrated Nursing curriculum, education is understood
as a social practice and it must contribute to the development of
the human being as a whole, enabling transformative actions in
the construction of citizenship and society.
The integrated curriculum is defined as that which organizes
knowledge, integrating the contents that keep a relation to each
other. For this, there is a subordination of the kinds of knowl-
edge previously isolated to a central idea. There are four prince-
ples guiding an integrated curriculum: comprehensiveness,
interdisciplinarity, relationship between theory and practice,
and curriculum as a process (Romano, 2000).
The principle of comprehensiveness means that the whole
and the parts are analyzed at a single moment and together,
interconnecting concepts and inter-relating contents which
come from various knowledge areas, addressed in the curricular
disciplines. Edgar Morin, an educator of contemporary times,
reinforces this principle of comprehensiveness by claiming that
the whole is included into the parts, and the parts are included
into the whole (Morin, 2001). Thus, in the integrated curricu-
lum this principle means that the whole is simultaneously con-
structed by the parts, assuming the principles of interdiscipli-
narity and the relationship between theory and practice.
The principle of interdisciplinary approaches the inter-rela-
tionship and dialogue between the various disciplines, preserve-
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M. L. GARANHANI ET AL.
Open Access 68
ing autonomy and depth of specific kinds of knowledge, aiming
at a multidimensional understanding of phenomena. Brazilian
theorists advocate for the interdisciplinary integration aimed at
the problems of health care, considering that the contents of
disciplines which help understanding this reality interact in
dynamic way, establishing connections and mediations between
themselves (Merhy, 2002; Morin, 2007; Romano, 2000).
The principle of relationship between theory and practice
claims that these poles must be simultaneously worked on,
constituting an indissoluble unity, where the practice is not
simply the application of theory and the theory is not designed
without practice.
The fourth principle highlights the curriculum as a process.
This must remain open to discussion, criticism, and transforma-
tion, since it is continuously constructed and reconstructed with
a succession of changes. Edgar Morin (2010) argues that the
reductionism that traditional knowledge has undergone led us to
lose the notions of multiplicity and diversity. So, it is cautious
and useful to have openness and flexibility in the curricular
structures designed. There is a need to be receptive to emergen-
cies, bifurcations, and changes taking place in learning envi-
ronments, because non-linearity and indeterminism may require
a route change, causing an initially unplanned and insignificant
action to turn into something important and meaningful at an-
other moment of the process (Moraes, 2010).
In addition to the 4 principles mentioned above, the profes-
sors of the course have elected a fifth one: integration between
teaching, service, and community. This choice was based on the
appreciation of space shared by professors, students, health care
professionals, and users. Article 14 of the Brazilian Health
Organic Law provides for the creation of Permanent Commis-
sions for integration between health care services and High
School and Higher Education institutions. Article 27 of this
Law states that the public services included into the Unified
Health System (SUS) constitute practice fields for teaching and
research, by means of specific standards, designed along with
the education system (Lei no 8080, 1990).
Curricular Structure
When preparing the pedagogical proposal of the integrated
curriculum, there was a structural break with the current model,
which was focused on traditional disciplines. The aim was
making the academic knowledge interdisciplinary, by means of
actual teamwork experiences, in a relationship involving recip-
rocity and shared property, allowing the dialogue between the
various disciplines in the pursuit of integration. It was intended
to overcome failures derived from a too compartmentalized
science which has no communication (Santomé, 1998). With
this purpose, the disciplines were replaced by the interdiscipli-
nary modules.
Interdisciplinary modules are didactic/pedagogical organiza-
tions structured in all learning grades of the course. They are
characterized as interdisciplinary activities which seek to de-
velop competences through the inter-relation of concepts and
organization of activities, encouraging meaningful learning by
using active methodological strategies. Each module must en-
sure the improvement of cognitive (knowledge), psychomotor
(know-how), and attitudinal (know how to be and know how to
live along) skills, needed to achieve the skills and competences
that make up the nurse’s profile intended. They are organized
into teaching units that guide and lead the student to gradually
acquire a greater breadth and depth with regard to her/his
knowledge improvement and construction.
The teaching plans used in the modules of the Nursing course
were named planning and development notebooks for the inter-
disciplinary modules. These notebooks are structured this way:
general purpose; number of hours; professors and departments
in charge; knowledge areas involved; thematic tree and/or con-
ceptual map; competences; specific skills and abilities; teaching
units and activity sequences; assessment criteria; schedule;
references; and appendices.
For integrating the basic and clinical cycle, the concepts of
basic sciences were incorporated throughout the modules, try-
ing to relate them to their application to professional practice.
Thus, professors from the basic sciences and professional de-
partments involved in nurse’s training started working together,
something which led to the reorganization and restructuring of
the work process in the course.
Currently, the curricular matrix has 18 modules and it is set
as shown in Table 1.
The operationalization of interdisciplinary modules takes
place according to the activities which are going to be devel-
oped. Thus, students are gathered in small groups (from 15 to
20 people), large groups (30 people), and plenary meetings (60
people), all of them mediated by a professor. The activities of
classes and internships, at different scenarios of nurse’s work,
are also organized into modules from the first grade of the
course. Early insertion of the student in the service practice
favors the understanding of the relationship between theory and
practice.
Table 1.
Curricular matrix of a nur s ing c ourse in southern Br azi l.
University an d t he
Nursing Course at UEL Health-Illnes s P rocess Vacation Morphophysiologic al and Psych ic Aspects of the Human Being
1st grade
Interdisciplinary Practices and the Interaction between Teaching, Service, and Community I
Caring Practices Vacation Organizat io n of Health Services
and Nursing Adult Health IMaterial and Biosafety C enter
2nd grade Interdisciplinary Practices and the Interaction between Teaching, Service, and Community II
Adult Health II Vacation Children and Adol escents’ Health Women’s He alth and Gender
3rd grade Course Conclusion Mon ograph I
Communicable Diseases Mental Health
Critical Pa t ient Care Supervised In ternship (Nursing Internship) Supervised In ternship (Nursing Internship)
4th grade Course Conclusion Mon ograph II

M. L. GARANHANI ET AL.
Thus, the academic activities undertaken by students com-
prise theoretical groups; laboratory practices; practices at dif-
ferent health care services, schools, nursery schools, and along
with the community; interdisciplinary and multiprofessional
practices; course conclusion monograph; and supervised in-
ternship, named nursing internship. Supplementary academic
activities are also proposals, including outreach, teaching, and
research projects, participation in scientific events, tutorships,
extracurricular internships, among others.
The pedagogical project also allows us to approach cross-
sectional themes. They are teaching guidelines which aim to
contribute to the individual’s overall training, in order to enable
her/his qualified participation in society. Cross-sectionality
promotes a comprehensive understanding of knowledge objects
and perception of the subject as an agent in the production of
her/his knowledge, overcoming the dichotomy between them
(Ministério da Educação, 1998).
In the integrated curriculum, the term cross-sectional themes
was replaced by the designation saps, keeping the same mean-
ing, i.e. what goes through curricular disciplines. The saps must
be included in the interdisciplinary modules, with a greater or
lesser close approach degree, so that students incorporate them
throughout the grades until graduating from the course.
The saps are driving forces of academic activities, increas-
ingly connected to the specific contents and crucial skills from
the va r ious modules.
1) Social-historical-cultural human being: the human being is
understood as a whole, with biological, psychological, spiritual,
and social interconnected and interdependent characteristics.
She/he is determined by her/his personal life history, being
included into a social group. Her/his insertion in the productive
process determines her/his health-illness process.
2) Social determination of the health-illness process: com-
prises the comprehensive view of the human being in the social
and historical determination of her/his sickening process.
3) Unified Health System: it is the current health care system
in Brazil since 1988, with the promulgation of the Federal Con-
stitution and the federal Law 8080/90. Its constitutional prince-
ples are universality; and equality and comprehensiveness. Its
guidelines are decentralization; regionalization; hierarchy;
solvability; and popular participation. These principles and
guidelines drive the public policies aimed at health care.
4) Care management: it is an administrative tool that the
nurse must use to coordinate and systematize the provision of
care. It must be planned, analyzed, and assessed, considering its
inter-relation nature (Christovam & Santos, 2004).
5) Care methodology: operationalized by means of the nurs-
ing process, aiming to systematize care through the following
steps: history; diagnosis; care plan; prescription; and nursing
evolution. These steps constitute the nursing care systematize-
tion, a nurse’s exclusive work tool established by the Profes-
sional Practice Law (Lei no 7,498/86), which provides nursing
care with autonomy and independence.
6) Integration teaching-service-community: connection of the
undergraduate and graduate centers to the health care services
and the community. It allows searching for solutions to health
problems, enabling the transformation of teaching and profess-
sional practices. It aims to make the student aware of the need
to improve intra and interpersonal relationships, acknowledging
popular kinds of knowledge.
7) Health education: it regards education and health as con-
cepts connected to the historicity of human beings, their culture,
social scenario, and worldview, leading to changes in health
care actions. A role played by the nurse is that of educator.
Stefanini (2004) cites that health education is understood as a
transformation process which promotes the individuals’ critical
awareness with regard to their own health problems, encourage-
ing them to seek collective solutions.
8) Communication: it comprises the verbal, non-verbal, and
written communication process in health care, crucial for
nurse’s work. A communication process, at any level, may
facilitate or pose barriers to the establishment of a therapeutic
and interpersonal relationship between work teams.
9) Scientific research: research helps the students to improve
scientific reasoning, critical thought, and actions aimed at im-
proving nursing care and the population’s quality of life.
10) Teamwork: in Brazil, nursing is a profession practiced by
a multidisciplinary team, involving professionals trained at a
High School or Higher Education level. Teamwork is a vital
requirement to obtain satisfactory results in the provision of
health care.
11) Bioethics: it addresses theoretical contents related to pro-
fessional ethics; citizenship; human rights; patient’s rights;
social inequality; human vulnerability; allocation of health care
resources; social justice; autonomy; informed consent; human
dignity; assisted fertilization; euthanasia; dysthanasia, palliative
care; research involving human beings; organ donation; among
others.
12) Biosafety: nursing is a profession included in a society
which exposes it to unhealthy settings and risks arising from
the work process. Biosafety gathers measures aimed at avoiding
physical, ergonomic, chemical, biological, psychological, and
safety risks. It involves thinking through and deploying actions
which favor health promotion, maintenance, and protection, as
well as human life.
In order to combine the principles adopted in the integrated
curriculum, it was decided to structure it as a spiral-like cur-
riculum, which proposes a course organization coming from the
general towards the specific knowledge, at increasing levels of
complexity and involving successive close approaches (Dowd-
ing, 1993). This curriculum organization way supports the con-
struction of knowledge sequences defined according to knowl-
edge the competences intended for the profile of prospective
nurses. Thus, new kinds of knowledge and skills (cognitive,
affective, and psychomotor) are introduced at subsequent mo-
ments, resuming what is already known and sustaining the in-
terconnections to previously acquired information (Dessunti,
2012).
Figure 1 displays the integrated Nursing curriculum as a
cone, illustrating the spiral-like movement.
This movement explains the intention of gradually exposing
cross-sectional themes, which must be addressed from the 1st to
the 4th grades, comprising increasingly complex levels and
successive close approaches. Externally, there are activities
highlighted in the figure which, together, enable us to consoli-
date the development of knowledge, skills, and competences
intended to be included in nurse’s profile. Within the cone we
observe the kinds of knowledge, skills, and attitudes distributed
into the four domains proposed by Delors et al. (1999), learning,
learning to do, learning to be, and learning to live together,
realizing that these 4 learning ways constitute only one, i.e.
there are many points of contact, relationship, and exchange. At
the bottom of the figure, the human being is highlighted, the
nursing care actions are aimed at her/him, who is regarde d as a
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M. L. GARANHANI ET AL.
Figure 1.
Pedagogical project of the spiral integreated curriculum of the Nursing course of UEL
historical being in her/his own life cycle, from birth to death,
with dignity, enjoying her/his citizenship.
Role of the Professor and Student
This topic addresses the principles of meaningful learning,
the choice for active methodologies and the role of the profes-
sor and student. We assume that learning is a complex action
and that teaching does not always mean learning. We believe
that the ultimate goal of education is learning, making it neces-
sary to be aware that not all human beings learn the same way
and knowing that adults learn differently from children.
In this context, the integrated curriculum is based on the the-
ory of meaningful learning, aimed at adults. This learning takes
place when new information are related to pre-existing knowl-
edge in the student’s cognitive structure, at the time when new
concepts anchor each other, fostering a learning chain (Ausubel,
Novak, & Hanesian, 1980). The adult person also can learn by
means of different strategies: meaning; initial understanding;
rhythm; expectations; participation; adequacy; and interdisci-
plinarity (Piconez, 2007).
Having these principles as a basis, the pedagogical proposal
must take into account the life history of each student, her/his
cultural pattern and thinking ways, thus achieving a more natu-
ral knowledge construction.
In the Brazilian reality, a large part of students who enter the
university comes from a traditional kind of education, which
does not favor the critical and active profile in learning. Thus,
the integrated curriculum must enable the student to develop
skills and competences throughout the course, as she/he is ex-
posed to various situations promoting meaningful learning,
getting her/him involved in the action of solving daily life and
scientific problems, relating theory to practice.
The integrated curriculum seeking a critical and thoughtful
education process uses teaching methodologies consistent with
the reality aimed at nurse’s training, in case, active methodolo-
gies. It is understood that teaching methodologies are theoretic-
cal and technical means used to fulfill an educational proposal,
but, for this, there is a need to be aware of the intention and the
way how it is going to be addressed (Luckesi, 2005).
The active methodology arises from the need for changes in
the teaching and learning process, seeking an education more
adequate to contemporary times. It takes place by means of
interactive knowledge processes; analysis; studies; surveys; and
individual or collective decisions, whose purpose is finding
solutions to problems. In this approach, the professor guides the
student’s reflection and decision making process (Bastos,
2006).
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M. L. GARANHANI ET AL.
The active methodology breaks with the traditional model
and it proposes to promote a student-driven teaching, turning
the student into an active and participatory agent with regard to
her/his learning process, leading her/him to learn how to learn.
This process takes place in a dynamic way, using the student’s
prior knowledge and connecting it to the newly acquired con-
tents, establishing the construction of new kinds of knowledge
and techniques.
A study carried out by Tacla (2002) used problematization,
an active methodology similar to Problem Based Learning
(PBL), with undergraduate students in Nursing. It was found
out that this methodology led participants to increase their con-
fidence and discover abilities poorly explored by traditional
teaching methods. For the author, it is not enough to teach con-
tents, there is also a need to trigger attitudes that lead students
to investigate, discuss, respect divergent positions, organize
themselves, and make collective decisions.
Active methodologies led to changes in professors’ role,
mainly because many of them were trained through traditional
methodologies. Thus, the professor takes the role of tutor, i.e.
learning facilitator and mediator, and she/he must work in a
conscious and continued way, seeking to awaken in the student
her/his potential to intervene in reality. There is a need to be
available to monitor this student, who is in an environment
where unforeseen and unknown situations emerge.
Professor’s role is triggering a cognitive conflict involving
the student and promoting an action which requires search for
information in order to understand and explain the theme under
study. For this, it is possible to use questions, movies, plays,
interviews, visits, dialogued lectures, case studies, experience
reports, debates with guests from the external community,
problem situations, spoken newspaper, portfolio, among others.
Thus, it is a must that the professor leads the student to feel
challenged and that she/he thinks of the problem as an obstacle
that she/he is able to overcome (Garanhani, Takahashi, & Ki-
kuchi, 2000; Garanhani, Alves, de Almeida, & de Araújo,
2012).
In short, it is expected that professors: have technical com-
petence regarding the contents to be worked on; use the prob-
lem as a bridge to learning and improving the professional
competence to solve daily life and scientific problems; create
conditions so that the student asks about her/his knowledge and
experience or about her/his intuitive ideas; mediating attitude in
the teaching and learning process and appreciation of students’
prior knowledge, regarding them as a point of entry into their
cognitive system and as a bridge to the incorporation of new
information and t h e newly learn ed contents.
The student is expected to: be critical, creative, and active,
playing a leading role as someone aware of the process of
changes; identify and relate her/his prior knowledge to the
whole knowledge construction process; construct her/his know-
ledge about a problem extracted from reality, through direct
and/or indirect observation with a critical look, using such in-
formation and scientific knowledge already constructed to de-
sign and share an explanation which, even existing, starts being
her/his own explanation for the phenomenon; understand not
only the answer to the problems under study, but also be able to
explain the process by means of which the solution was
achieved; apply the knowledge constructed to various teaching
and learning situations experienced.
Within this teaching and learning context, there is a need to
have an assessment able to cover all particularities of the train-
ing process. Assessment from a critical pedagogical perspective
may be thought through as a mediating space between teaching
and learning, where student and professor seek an open and
overt dialogue, allowing to set ways to overcome the difficul-
ties found throughout the teaching and learning process (Álva-
rez Méndez, 2002). It must have an ongoing nature, i.e. it must
be continuous, democratic, procedural, diversified, comprehen-
sive, systematic, intentional, inclusive, participatory, and sym-
pathetic, contributing to the progress, development, or im-
provement of the learning concerned (Silva, 2004; Brasil, 2003),
and its function is collecting information, systematize, interpret,
and intervene in order to promote meaningful learning.
In 2005, as a result of maturation and collective construction
by the group of professors and students, the course adopted an
assessment system with a two-dimensional concept, involving
the formative assessment, seeking to appreciate qualitative
aspects to the detriment of quantitative ones, taking subjectivity
as inherent to any assessment process.
Demo (1999) claims that, in order to assess, we need a con-
trastive scale, which may be quantitative (grade) or qualitative
(concept), however, strictly speaking, there is no difference
between grade and concept, since both of them refer to a scale.
So, what has led the course to abolish the grade and adopt the
concept (two-dimensional instead of multidimensional) was the
strengthening of formative assessment. That is, it was clear for
many professors that, either grade, concept, or any other term,
what really matters is the professor’s commitment to learning
and her/his decisions with regard to the assessment results,
understanding that, at that time, working with a two-dimen-
sional concept may strengthen the formative nature of assess-
ment by means of the emphasis on feedback. Furthermore, this
system does not operate using an average, i.e. an essential
competence cannot be compensated by another one, something
which allows the professor to clearly identify satisfactory and
unsatisfactory performance.
The assessment by means of a two-dimensional concept in
the integrated curriculum requires the construction of crucial
competences and skills, without which the student cannot move
forward in the course, and it avoids classifying students as bet-
ter or worse ones, something which constitutes a major conflict,
both for students and professors.
For conducting an assessment from this perspective, what is
written within the classroom would not be enough; there is
need for a qualitative approach taking into account complex
everyday work situations, and that is the reason why the Nurs-
ing course adopted an assessment based on performance, in
order to achieve the competences defined for the nurse’s pro-
file.
Competences consist in the individual’s ability to connect
and resort to her/his knowledge, skills, and values, with auto-
nomy and critical attitude, in order to deal with her/his profes-
sional tasks (Ramos, 2001).
For this, each interdisciplinary module has a set of crucial
skills, i.e. those regarded as key to acquire the competences
defined in the teaching planning.
Currently, the professors are aware that the learning of di-
mensions (involving learning, learning to be, learning to live
along, and learning to do) does not take place in a separated,
static, and isolated way. Thus, the activities planned for con-
ducting the modules seek to address these dimensions in a con-
nected manner wi th regard to assessment.
Different strategies and instruments are used for gathering
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M. L. GARANHANI ET AL.
information on student’s performance, such as: oral and written
tests; seminars; practical tests; summaries; clinical case reports;
reviews; portfolio; record of field observations; internship;
among others.
In the dimension named learning to do, the professors seek
to combine, mainly, theory to practice and knowledge on the
basic and clinical areas to findings from the classroom, labora-
tory, practical field, and internship. Instruments such as a check
list of performance have been useful to assess activities, pre-
venting the skills required to a certain activity to be neglected.
In the dimensions named learning to be and learning to live
along, student’s assessment by the professor, self-assessment,
and peer review have been used to help developing skills con-
sistent with the professional profile required.
We believe to be moving towards an integrated assessment,
i.e. continued and procedural, appreciating the professor-stu-
dent relationship, in order to fill in the remaining gaps between
intentions expressed in the political and pedagogical project and
the reality constituted by the context where the education prac-
tice takes place and our individual actions.
Collegiate Management
We emphasize that, for developing the integrated curriculum,
collective work, cooperation between the course collegiate, the
department managers, the managers of the Center for Health
Sciences of the university and those of other centers involved in
the nursing course have been crucial, as well as the support
provided by many supporting agencies, such as its library, the
interdisciplinary laboratories of nursing and informatics, among
others.
The support provided by the Undergraduate Studies Dean’s
Office and all other bodies of the institution has also been a
must, helping in the academic management of the course.
We also notice that the Nursing course has, over the last 20
years, developed training sections with the entire course faculty.
The early ones took place between 1992 and 2000; professors
from other institutions who worked on themes related to Educa-
tion and Health par ticipated in them.
Between 2000 and 2010, the training sections were also pro-
vided, however, there was a decrease in their frequency and in
the participation of professors. It is worth noticing that, within
this period, a high percentage of professors sought to improve
their knowledge, especially by attending Ph.D courses.
Since the beginning of the school year in 2010, the course
collegiate has provided pedagogical training for newly hired
professors, addressing the proposal of an integrated curriculum
and organizing workshops with the coordinators and professors
of the modules on pedagogical techniques and tools adopted in
the course.
The pedagogical training of professors from other health
education institutions has been conducted by means of many
workshops requested by Nursing schools in various Brazilian
states, over the years following the deployment of the inte-
grated curriculum.
This responsibility has been taken by the collegiate coordina-
tion and there are professors who volunteer to carry out active-
ties aimed at describing the curriculum change, sharing the
pathway and explaining the strategies adopted, as well as the
weaknesses and difficulties faced in the academic and peda-
gogical route.
For evaluating the curriculum, the Nursing course held, from
2001 to 2008, 7 Assessment Forums on an annual basis, with
the participation of professors, students, and nurses working in
the services of the practice fields and the course internship, as
well as representatives of the organized civil society. After
2008, this event has taken place every two years. In order to
promote knowledge, support, and planning, the results of this
forum are shared with department managers involved in the
course, the managers of the Center for Health Sciences, the
Planning Dean’s Office, and the Undergraduate Studies Dean’s
Office.
The report of the results of these Assessment Forums, as well
as the description of the processes which generated data, has
contributed by providing important elements for the institu-
tional assessment of the university and other scenarios that
stand out due to their high quality hea lth care education.
In addition to the Assessment Forums, much has been made
about the experience involved in the integrated curriculum,
ranging from course conclusion monographs, MS dissertations,
Ph.D theses, and participation in national and international
scientific events to the publication of articles, books, in short,
there are many records of the education practice conducted in
the institution.
These experiences have allowed those involved to learn on a
continuous basis about health care education in an innovative,
participatory, and shared way, and it is possible to state that, in
recent years, the proposal of the integrated curriculum has be-
come consolidated among all professors involved in the Nurs-
ing course.
Final Remarks
After more than a decade since the deployment of the inte-
grated Nursing curriculum, we have conducted several evalua-
tions and reflections about the pathway taken. We have shared
situations which favor and hinder the walk. We believe that
ensuring the achievement of the goals of this curriculum re-
quires monitoring the progress made and the difficulties ex-
perienced, as well as designing future actions.
The development of a curricular project must be regarded as
something dynamic, valid, useful, and effective, with an aggre-
gating structure which ensures its continuity, consistency, and
flexibility to take part in the contributions arising from this
curricular project viewing the incorporation of news pedagogi-
cal perspective in order to incorporate the new pedagogical
perspectives.
We may mention that the search for training a critical and
thoughtful nurse concerned with facing the population’s health
care needs is an ongoing challenge. The pursuit of integration
and interdisciplinarity also constitutes a goal to be improved
every day. This is so mainly due to the influx of new professors,
who are not experienced with regard to the integrated curricu-
lum, reinforcing the need for ongoing training of professors.
Integration with health care services and the community is an-
other current challenge for the university, since it depends on
the commitment of many actors.
The selection of contents, skills, and key competences which
make up the interdisciplinary modules also constitutes a con-
tinuous process for refining the curriculum. We have already
advanced a lot with regard to the integration with professors
from the basic areas, but this integration needs to be cared for
every year, in a continuous movement. Mastering active meth-
odologies and the two-dimensional assessment represents an
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M. L. GARANHANI ET AL.
existential challenge for professors and students, who have lived
along, sharing knowledge, practices and feelings, and estab-
lishing new teaching and learning ways.
Another major challenge involves considering the profile of
entering students in the Nursing course, since most of them are
young women, and they often express contradictions with re-
gard to their feelings about the course and career. Another
relevant factor concerns the need for special strategies for the
integration of students coming from Brazilian policies for in-
clusion in Higher Education, such as Indian and black people,
students with special needs, and the students coming from pub-
lic education.
Since 2012, we have also dealt with the early experiences of
approving students to participate in international exchange and
mobility programs, due to the Science without Borders Program.
This is a challenge for the course collegiate to determine the
equivalence between disciplines of courses attended within
different contexts, as well as to allocate students coming from
other countries. There is a great interest in encouraging such
exchange programs, since they are opportunities to share ex-
periences and foster professional and personal improvement. In
addition to individual learning, we believe that all people in-
volved benefit from living along with people from other cul-
tures and realities. This practice brings concreteness to the con-
text of a globalized world without geographical boundaries.
Many advances have been consolidated with regard to infra-
structure. The creation of new physical spaces, such as class-
rooms, libraries, and laboratories, has supported the needs for
developing active methodologies.
Thus, we stress that we regard as an advance the experience
itself, without denoting it is positive or negative. Some ad-
vances are visible and measurable, others are not. Some are
collective, others are individual. The advances are not the same
for all actors involved, but, surely, each actor is no longer the
same since the deployment of this curriculum.
Therefore, we conclude this article highlighting some major
points, however, being aware that they do not cover all ad-
vances made in the construction of this curriculum. They are:
collective construction; democratic and participatory process;
relationship between theory and practice; diversification of
teaching strategies, including complementary activities of dis-
tance education; successive close approaches between the con-
tents of the modules; two-dimensional assessment, comprising
cognitive and attitudinal skills; pursuit of new kinds of knowl-
edge or deepening of other ones in order to expand the view of
the social context and its relations to the health care and educa-
tion fields; use of different scenarios of professional practice as
internship fields, with early introduction of the student; use of
local and national reality as a reference for conducting the
teaching and learning activities; and researches aimed at the
pedagogical practice.
Walking in the pathway of this integrated curriculum has
enabled us to understand that, since it is the human being who
discovers the world by means of her/his eyes, her/his interpre-
tation, she/he always has the possibility of appropriating the
history and constructing, sharing responsibilities and results. It
is by experiencing the world of education and health care that
the teaching and learning pathway is redrawn throughout pro-
fessional training. We are aware that the route to follow to-
wards the changes which are still needed is long and continuous.
We record our experience, overtly described in this report,
hoping to contribute to other Higher Education institutions
trying to develop an innovative methodology.
REFERENCES
Almeida, M. J. (2003). National curricular guidelines for university
courses in the health field. Londrina: Rede Unida.
Álvarez Méndez, J. M. (2002). Evaluate to know, assess to exclude.
Porto Alegre: Artmed.
Ausubel, D. P., Novak, J. D., & Hanesian, H. (1980). Educational
psychology. Rio de J aneiro: Interamericana.
Bastos, C. C. (2006). Active methodologies.
http://educacaoemedicina.blogspot.com.br/2006/02/metodologias-ati
vas.html
Ministry of Education (1998). National Curricular Parameters. 3rd and
4th cycles of Primary Education. Transversal Themes. Brasília: Min-
istry of Education.
Ministry of Health (2003). Pedagogical proposal: Evaluating the ac-
tion. Brasília: Ministry of Health.
Christovam, B. P., & Santos, A, I. (2004). The challenges of nurse’s
management at the central health level. UERJ Journal of Nursing, 1,
66-70.
Dellaroza M. S. G., & Vannuchi M. T. O. (2005). The integrated cur-
riculum of the nursing course of the State University of Londrina:
From dream to reality. Londrina: Hucitec.
Delors, J., et al. (1999). Education: A treasure to be discovered. Report
to UNESCO by the International Commission on Education for the
Twenty-First Century (3rd ed.). São Paulo: Cortez .
Demo, P. (1999). Mythologies of evaluation: Or how to ignore, rather
than face problems. Campinas: Autores Associados.
Dessunti, E. M. (2012). Contextualization of the integrated curriculum
of the nursing course of the State University of Londrina. In E. M.
Kikuchi, & M. H. D. M. Guariente (Eds.), Integrated curriculum:
The experience of the nursing course of the State University of Lon-
drina (pp. 17-32). Londrina: UEL.
Dowding, T. J. (1993). The application of a spiral curriculum model to
technical training curricula. Education Technology, 33, 21-30.
Garanhani, M. L., Takahashi, O. C., & Kikushi, E. M. (2000). Meth-
odological means for implementing the integrated curriculum of the
undergraduate Nursin g c ou rse of UEL. Magic Eye, 9, 30-34.
Garanhani, M. L., et al. (2012) Guiding principles of the pedagogical
project of the integrated curriculum of the nursing course. In E. M.
Kikuchi, & M. H. D. M. Guariente (Eds.), Integrated curriculum:
The experience of the nursing course of the State University of Lon-
drina. Londrina: UEL.
Kikuchi, E. M., & G uariente, M . H. D. M. (2012 ). Integrated curriculum:
the experience of the nursing course of the State University of Lon-
drina. Londrina: UEL.
Law nr. 7,498, enacted on June 25, 1986. Provides for the regulation on
the nursing practice in Brazil and gives other provisions (1986).
http:// jusbrasil.com.br/legislacao/128195/lei-7498-86
Official Newspaper of the Union (1990). Organic Health Law nr. 8,080,
enacted on September 19, 1990.
Luckesi, C. C. (2005). Philosophy of education (21st ed.). São Paulo:
Cortez.
Martinelli, D. D., et al. (2011). Assessment of the curriculum of the un-
dergraduate course in nursing by graduated students. Cogitare Nurs-
ing, 16, 524-529.
Merhy, E. E. (2002). Health: The cartography of living labor. São
Paulo: Hucitec.
Moraes, M. C. (2010). Complexity and curriculum: For a new relation-
ship. Polis, Journal of the Bolivarian University, 9, 289-311.
Morin, E. (2001) The well-made mind: Rethinking reform, reforming
thought (3rd ed. ). Rio de Janeiro: Bert rand Brasil.
Morin, E. (2007). Introduction to complex thinking. Porto Alegre: Su-
lina.
Morin, E. (2010). Reconnection of knowledge: The challenge of the 21st
century (9th ed.). Rio de Janeiro: Bertrand Brasil.
Piconez, S. C. B. (2007). Young and adult’s learning and its key chal-
Open Access 73

M. L. GARANHANI ET AL.
Open Access 74
lenges. www.nea.fe.usp.br
Ramos, M. N. (2001). Qualification, skills, and certification: Educa-
tional view. Train in g J ou rnal, 1, 17-26.
Romano, R. A. T. (2000). From curriculum reform to the construction
of a new pedagogical praxis: The experience of the collective con-
struction of an integrated curriculum. UERJ Journal of Nursing, 8,
78-83.
Sacristán J. G. (1998). Curriculum: A reflection on practice (3rd ed.).
Porto Alegre: Artes Médicas.
Santomé, J. T. (1998). Globalization and interdisciplinarity: The inte-
grated curriculum. Po rto Aleg re: Artes Médicas.
Silva, J. F. (2004). Introduction: Evaluation of teaching and learning
from a regulatory formative perspective. In J. F. Silva, J. Hoffmann,
& M. T. Esteban (Eds.), Evaluative practices and meaningful learn-
ing: In different areas of the curriculum (2nd ed.). Porto Alegre: Me -
diação.
Stefanini, M. L. R. (2004) . Editorial. Health Information Bulletin, 34.
Tacla, M. T. G. M. (2002). Developing critical thinking in nursing
education. Goiânia: AB Ed.