Creative Education
2013. Vol.4, No.12B, 83-88
Published Online December 2013 in SciRes (
Open Access 83
Teaching of Health Care-Related Infections within an
Integrated Nursing Curriculum
Suellen Karina de Oliveira Giroti1, Mara Lúcia Garanhani1,
Maria Helena Dantas de Menezes Guariente1, Elaine Drehmer de Almeida Cruz2
1Department of Nursing of the State University of Londrina (UEL),
State University of Londrina, Londrina , Brazil
2Department of Nursing of Federal Universit y of Paraná, Federal University of Paraná, Curitiba, Brazil
Received October 29th, 2013; revised November 29th, 2013; accepted December 6th, 2013
Copyright © 2013 Suellen Karina de Oliveira Giroti 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 Li-
cense all Copyrights © 2013 are reserved for SCIRP and the owner of the intel lectua l property Suellen Karina de
Oliveira Giroti et al. All Copyright © 2013 a re guarded by law and by SCIRP as a guardian.
Health care-related infections have become an issue of paramount importance in the health care field.
Their rates are high in many parts of the world and the adherence of health care professionals to preven-
tion and control measures still involves a minority of them. This study aims to analyze how the teaching
on the theme health care-related infections takes place within an integrated Nursing curriculum. This is a
qualitative research carried out through documentary analysis of the teaching plans adopted in interdisci-
plinary modules and interviews conducted with professors. Data collection took place in 2012. To deepen
the analysis, we used Edgar Morin’s theoretical framework. We found out that the formal teaching on the
theme was conducted in a theoretical and practical way, and there were some contradictions between what
professors reported and what was recorded in the teaching plans. Given the complexity of health care-re-
lated infections, we hope that this study contributes so that professors dealing with Health Sciences think
through their education practices, seeking to systematize this theme with a view to training professionals
committed to prevention measures and infection control. We advocate for including the theme in a
cross-sectional way into the curriculum to educate nurses and the other health care professionals.
Keywords: Nursing Education; Infection; Curriculum
Many contents are relevant to train the nurse for a profes-
sional practice consistent with the social needs involved health
care; among them, stand out the theme health care-related in-
fections (HCRIs).
In the late 20th century, HCRIs started being regarded as a
public health problem, instead of being just focused on the
hospital environment. The subject began to be publicized, dis-
cussed, and planned, promoting the development of prevention
and control actions in all health care areas in the world (La-
cerda, 2003).
The HCRIs are among the five leading causes of death
worldwide (Nosow & Puschel, 2009), next to cardiovascular
diseases, neoplasms, respiratory diseases, and infectious dis-
eases. According to a study carried out in Brazilian hospitals,
there is a wide variation in the mortality coefficients due to
hospital-related infection, from 9% to 58%, reaching 40%
among bloodstream infections. It is known that the rates related
to these illnesses vary according to topography, primary disease,
etiology, among others (Marra et al., 2011; Ministry of Health,
Given this context, nurse’s training requires systematic dis-
cussions on HCRIs. They must be taught, covering the theo-
retical and practical knowledge field, in order to develop pro-
fessional activities and attitudes aimed at the prevention and
control of infections (Azambuja, Pires, & Vaz, 2004). We em-
phasize that the various diagnostic and therapeutic procedures
taught always comply with infection prevention guidelines and
routines (Pereira, Souza, Tipple, & Prado, 2005; Tipple &
Souza, 2013). Thus, it is believed that, as soon as the theme
HCRI becomes more frequently addressed in Higher Education
courses, there will be an increased adherence to prevention and
control guidelines on the part of these professionals.
Since the nurse is the professional in charge of supervising
the various environments involved in health care, she/he must
be prepared to work there by connecting her/his entire knowl-
edge to the prevention and control of the HCRIs.
Thus, we decided to conduct this study to deepen this issue
regarding nurse’s training. Therefore, the guiding question of
this research is: “How has the teaching on the theme HCRI
been conducted in a Nursing course in southern Brazil?” The
purpose is to analyze this issue within an integrated Nursing
Type of study: this is a research with a qualitative nature,
carried out in 2012.
Study site: this study was carried out in a Nursing school in
southern Brazil, which has been applying an integrated cur-
riculum for thirteen years.
The integrated curriculum is defined as that providing a
knowledge organization which integrates contents holding a
relation to each other. For this, there is subordination of each
previously acquired piece of knowledge to a c en tral idea.
The integrated curriculum enables the inclusion of themes in
a gradual, comprehensive, and continuous way, over the four
years student training, by means of interdisciplinarity. Knowl-
edge construction takes place by putting social reality and the
health care field into question, encouraging student’s active
participation in the learning process, appreciating her/his pre-
vious knowledge, and establishing a relationship between the-
ory and practice (Garanhani & Do Valle, 2010).
The curriculum matrix of this proposal is established in 18
interdisciplinary modules. They are characterized as activities
seeking to develop competences through the inter-relation of
concepts and organization of activities, which encourage
meaningful learning by means of active methodological strate-
gies. The modules are organized into teaching units which
guide and lead the student to a gradual acquisition, with greater
breadth and depth in the development and construction of
knowledge (Garanhani, Alves, Nunes, & Araújo, 2012).
The teaching plans used in modules of the Nursing course
were named planning and development notebooks of the inter-
disciplinary modules. These notebooks are designed by profes-
sors from the knowledge areas related to the teaching units
involved, and they are intended to make clear the learning path
that the student should follow. The notebooks are structured in:
general purpose, workload, competences, specific performances
and skills, teaching units, and activity sequences to be devel-
oped by the student in different learning environments, assess-
ment criteria, and references.
Study participants: 19 professors of the undergraduate
Nursing course participated in the study, whose inclusion crite-
ria was being coordinator of a module and teaching according
to the integrated curriculum for at least two years. Other sources
of data were the planning and development notebooks of the
interdiscip l i n a ry modules.
Data collection procedures: data were collected by means
of semi-structured interviews with 19 professors of the Nursing
course and documentary analysis of the planning and develop-
ment notebooks of the interdisciplinary modules of the year
The semi-structured interview consisted of the following
questions: In the module you coordinate, is any approach for-
mally or informally made to health care-related infections?
How are these activities conducted?; Is this theme considered in
student’s learning assessment? How? How do you assess the
teaching of this subject in the integrated curriculum? After
transcribing the interviews, professors’ testimonies were identi-
fied using a number. When the modules had more than one
coordinator, we added a letter to the number, in order to iden-
tify the different coordinators involved in the same module, e.g.
11A, 11B, and 11C. The planning and development notebooks
for the teaching and learning activities of the interdisciplinary
modules were randomly numbered, corresponding to the coor-
dinators concerned.
Data analysis procedures: for analyzing the interviews, we
used the content analysis technique (Bardin, 2011), applied in 3
phases: pre-analysis, material exploration, and processing of
Pre-analy sis: it is the time for organizi ng materials, syste ma-
tizing ideas, choosing documents, reviewing the hypotheses and
objectives proposed. At this time, the interviews were tran-
scribed, read, and organized, providing an overview of the col-
lected data.
Material exploration: this phase consists in encoding data to
reach the text’s core understanding, a representation of the
content. At this phase, the transcribed interviews were inter-
preted and separated into register units. Then, these units were
brought closer with regard to their similarities and differences,
i.e. they were organized into categories.
Processing of results: the results already categorized are in-
terpreted so that they become meaningful. The results of this
study were interpreted and analyzed from the researcher’s per-
spective, as well as by means of the theoretical framework on
HCRI and the theoretical framework proposed by Edgar Morin
(2000, 2010, 2011).
For documentary analysis of the teaching plans of interdisci-
plinary modules, then there was a reading which consisted of
four phases, as suggested by Gil (2010): exploratory, selective,
analytical, and interpretive reading.
The exploratory reading: it aims to identify information and
data in the documents studied, analyzing consistency and estab-
lishing the relation of information contained in the documents
to the proposed problem. At this phase, all the teaching plans,
represented by the planning and development notebooks of the
interdisciplinary modules were fully read.
The selective reading: it is a critical and objective reading
aimed to determine which material actually matters, consider-
ing the research objectives. At this time, we sought to identify
which notebooks of the interdisciplinary modules could provide
references to the theme HCRI. At this time, two modules were
excluded, because they consist in preparing the course conclu-
sion monograph.
The analytical reading: it aims to organize and summarize
information contained in the documents, seeking answers to the
research problem. Reading at this phase must be objective,
impartial, and respectful, without researcher’s bias or unwell-
ingness. At this phase, we selected in the planning and devel-
opment notebooks of the interdisciplinary modules the follow-
ing topics: module identification; competences, performances,
skills and references specific to HCRI.
The interpretive reading: it is the last phase of this process
and the most complex one, seeking to compare the meaning
obtained through analytical reading without compromising the
scientific validity of documents. At this phase, we sought to
relate citations of the theme under study to concepts and con-
structs defined by the theoretical grounding of the subject and
the theoretical framework proposed by Edgar Morin (2000,
2010, 2011).
In this study, we use the term “formal” to deal with teaching
situations, where it is intended to promote education so that
there is a pedagogical interaction with overt definition of objec-
tives, criteria for selecting contents, identification of methodo-
logical guidelines, and indication of assessment criteria. In turn,
the term “informal” refers to activities taking place without
overt definition of purpose and strictly educational interaction,
when situations occur with no prediction or formalization of
procedures (Ministry of Health, 2003).
Theoretical framework: in order to study teaching on
Open Access
HCRIs within an integrated Nursing curriculum, we chose to
adopt as theoretical framework the Complex Thought proposed
by Edgar Morin. This thought has enabled us to think through
the theme of HCRI within the integrated curriculum, including
the complexity of interdisciplinary education pursuing entirety.
When making the Complex Thought closer teaching on HCRI
and the integrated curriculum, we believe that it is possible to
address this theme as a complex content.
Ethical aspects: this study was approved by the Research
Ethics Committee of the State University of Londrina (UEL),
Paraná, Brazil, under the Protocol 173/2011, according to the
CAAE 0162.0.268.000-11.
Results and Discussion
Out of the 19 interviewed professors, 12 have a Ph.D aca-
demic title and 7 are Masters, only 1 is a man, the time since
graduation ranged from 10 to 34 years and 17 are graduated
from the university under study. The time working as a profes-
sor ranged from 6 to 34 years, and the time working as module
coordinator ranged from 1 to 10 years.
Out of the 16 planning and development notebooks of the
interdisciplinary modules, used in the Nursing course in 2011,
we identified 44 references to the theme HCRI from the 2nd to
the 4th grades of the course. In the first year of the course, this
theme was not introduced to the students
In the second year, 2 modules addressed the contents: hand
hygiene and antisepsis, use of gloves for prevention and self-
protection, disinfection of the patient’s unit, sterilization proc-
esses and quality control, microbial death mechanisms, bio-
safety, and issues related to the Regulating Standard (RS) 32,
which deals with the safety and health status of health care pro-
fessionals. The following definitions were worked on: hospital-
related infections; infection in health care services; usual, resi-
dent, and transient microbiota; asepsis; anti-asepsis; contamina-
tion; disinfection; cleaning; sterilization, and chemical agents.
In the third year, all modules adopt some sort of approach to
the theme. They were related to the prevention and control of
hospital-related infections regarding newborn infant’s health,
children and adolescents’ health, women’s health, and adult
The last year of the course brought relevant issues regarding
critical patients, transmission mechanisms of infectious agents,
major agents found in patients from the intensive care unit,
prevention of hospital-related pneumonia in patients using me-
chanical ventilation, tracheostomy tube care, biosafety, RS 32,
unit disinfection processes, and isolation/caution standards
regarding communicable diseases.
Combining the analysis of the notebooks of the interdiscipli-
nary modules to the interviews conducted with professors en-
abled the construction of three thematic categories which cover
teaching, extracurricular activities, and the theme HCRI.
Teaching o f Health Car e-Related Infections
The professors reported conducting formal, theoretical, and
practical activities, in 9 interdisciplinary modules. The docu-
mentary analysis revealed that 7 interdisciplinary modules
showed agreement between the formal record of the activity
and the interview with professors.
Regarding the theoretical contents addressed, themes associ-
ated to HCRI were cited, such as: nursing history, microorgan-
isms, surgical site infection, infectious diseases during preg-
nancy, puerperal complications, respiratory infections, vaccine-
tion, basic sanitation, disinfection, sterilization, and processing
of dental/medical hospital devices. Reports by professors illus-
trate these findings:
We mainly address the reason why she [Florence Nightin-
gale] had a health education view, we talk about it [...] they
approach this issue of hospital-related infection, which is very
important, caring procedures, and everything else, so, by
studying Florence, they see that she decreased the hospi-
tal-related inf ection rate, the number of deaths. (5)
In fact, infection is systematized, in the module where it is
addressed, we check signs of surgical site infection, indicate
factors [...] we mainly address surgical site infection, not only
that related to the patient, but also that related to the profes-
sional. (14B)
In this study, the RS 32 and biosafety were included because
we believe that these themes have a direct relation to HCRI.
The coordinators have described formal activities on these 2
themes in 5 modules. Documentary analysis showed that, for-
mally, the RS 32 and biosafety are addressed in 3 notebooks of
the interdis c i p l i nary modules.
According to professors, practical classes enable the acquisi-
tion of specific techniques, such as hand hygiene, surgical in-
strumentation, and conduction of invasive procedures, espe-
cially at units with surgical patients, material and sterilization
center, and surgical center, as well as guidelines for hospital
discharge. The speech of a professor expresses an example of
practical act ivity:
[...] nevertheless, they have a practical class on handwashing.
This handwashing class is a practice using paint on the hands.
Respondents also reported that there is no formal education
on HCRI in 5 modules, and 1 of these had some activities de-
signed as formal in the notebook of the module. This leads us to
reflect on the lack of knowledge about the module itself. Some
coordinators justified the absence of the theme based on the
relevance of the contents specific to their modules.
Documentary analysis also showed that 4 interdisciplinary
modules had specific bibliographic references on HCRI. They
were cited by respondents with regard to formal activities and
had records in the planning and implementation notebooks; 3
interdisciplinary modules, which also mentioned formal active-
ties and records in documentary analysis, showed no specific
references to the theme.
Many professors reported that in the interdisciplinary module
they work in they adopt an informal approach to the theme,
totaling 13 modules. The informal approaches were reported as
those occurring by means of reflection on the theme both in
theoretical and practical classes. For instance, reflections on
HCRIs related to care for polytrauma patients, as well as for
children and elderly people, different types of infection, mate-
rial and sterilization center and surgical center, emergence of
multidrug-resistant microorganisms, among others. The speech
below illustrates this finding:
[...] but we have worked this way. We care for the child with
multidrug-resistant organism, then, we discuss which microor-
ganism we are fighting, why [the patient] is isolated. So, we
always discuss with them, explain the reason why we use the
protective equipment, we analyze whether it is needed. (15)
The results revealed both agreement and disagreement be-
tween what is recorded in the notebooks of the interdisciplinary
Open Access 85
modules and the testimonies of professors. This fact shows both
a clear and structured dimension of the curriculum and a hidden
curriculum which is progress.
Contradiction between what was recorded and what was re-
ported is not an unusual fact in education, as professors often
address themes which were not planned. However, this reality,
although showing that the issue has been addressed, does not
guarantee that it will be made available for all students. Any-
way, both situations express a reality experienced between
teaching planning and execution.
It is possible to observe that the hidden curriculum practice
takes place in the reality under study. The hidden curriculum is
that where standards, teachings, and values are transmitted in
an implicit, but effective, way to students, and usually they are
not described in the course plannings prepared by professors
(Magalhães & Ruiz, 2011).
Thus, in this curriculum, overt and covert teaching practices
interact, there is no absolute reason, but a teaching practice
which is conducted by means of ongoing construction.
Thinking of education according to the reflections provided
by Morin’s complex thought implies put it under a totalizing
view, under a comprehensive understanding of life with regard
to all of its possibilities and constraints. Morin believes that
something complex requires a thought which captures relations,
inter-relations, mutual implications, multidimensional phe-
nomena, realities which are both sympathetic and conflictive,
besides respecting diversity and, at the same time, unity. This is
an organizing thought that designs the reciprocal relationship
between all parties (Morin, Almeida, & Carvalho, 2009).
According to Morin, the fragmentation and compartmentali-
zation of disciplines leads to hyper-specialization, something
which prevents us from looking at the global, making it impos-
sible to learn what is woven together. The knowledge separate-
ing the complex from the world divides problems into portions,
but the key issues are not divisible, they must be thought
through within their context, which needs to be related to
world’s context (Morin, 2010). The author claims that life
brings possibilities and constraints through contradictory con-
cepts, in a dialogical way. It becomes dialogic by combining
two principles which should exclude each other, but, at the
same time, they are inseparable within the same reality, assum-
ing that contradictory notions come together in order to devise a
single complex phenomenon (Morin, E., Almeida, M., & Car-
valho, E. A. (Org.). (2009).
One principle of the integrated curriculum assumes that the
whole and the parts are simultaneously worked on, connecting
concepts and relating them to knowledge from various disci-
plines. This is the principle of entirety, which must be imple-
mented in all modules of the curriculum (Garanhani, Alves, De
Almeida, & Araújo, 2012). We may relate this principle to Ed-
gar Morin’s holographic principle, which claims that not only
the part is into the whole, but the whole is inscribed on the parts;
thus, we may not reduce the whole to the parts, or the parts to
the whole (Morin, Almeida, & Carvalho, 2009; Morin, 2011;
Ministery of Health, 2003).
We emphasize the importance of the relationship between
theory and practice for constructing knowledge and the adop-
tion of strategies for active teaching and learning. The student,
by conducting activities in this context, has the possibility to
gather values and responsibilities, establishing relationships
between social facts and the various realities observed in prac-
tice. The experience in multiple and varied practical spaces
enables the student to exercise perception, observation, and
analysis, contributing to change concepts and meanings (Co-
berllini et al., 2010). Theoretical and practical spaces must be
together in the teaching and learning process, thus, the student
may establish a meaningful relationship during the acquisition
of knowledge.
Thus, we emphasize the need for professors to think through
teaching on the theme HCRI, so that it is part and is connected
to the other contents addressed in nurse’s training. It is note-
worthy that the absence of the theme is not justified by the
contents specific to each module. Thinking of entirety, we be-
lieve that the HCRIs are observed in the everyday work of all
health care services. Education must be a training process
which does not reject specific knowledge, indeed, it has to deal
with the specificity of events, processes, natural phenomena,
and history, as a provisional synthesis of multiple determina-
tions (Silva & Camillo, 2007).
Morin (2011) emphasizes that the professor must not simply
communicate the contents which students should study, but
participate in the construction of knowledge, contextualizing
and inter-relating students’ doubts and findings, contributing to
improve individual discretion and responsibility.
We think that the HCRIs must be among the cross-sectional
themes within the curriculum, regarded as those permeating the
curricular disciplines, aiming to contribute to provide the nurse
with a comprehensive training, making her/him able to face
reality and live in a globally connected world. Cross-sectional-
ity promotes to a systematic approach of themes along with
contents specific to each module, every year and in an increas-
ing way, and it is related to specific abilities that students must
acquire (Guariente et al., 2012). Thus, the information and data
are addressed in context, allowing students to make sense of
them, since knowledge on isolated information or data is not
enough for learning (Silva & Camillo, 2007).
Morin, E., Almeida, M., & Carvalho, E. A. (Org.). (2009)
indicates that the pertinent knowledge must recognize this mul-
tidimensional nature and introduce relevant data to it. Complex
thinking is useful to interconnect these kinds of knowledge, in
order to deal with the relationship between the disciplines.
We highlight the importance of specific bibliographic refer-
ences to support students when studying the theme. Currently,
the provision of technical-scientific content (Ministry of Health,
2009; Center for Disease Control and Prevention [CDC], 2011;
Silva, Carvalho, Canini, Cruz, Simões & Gir, 2010), by means
of open access to scientific journals, organizations, and gov-
ernment agencies, enables updating and favors the teaching and
learning process.
Knowledge integration between professors must benefit both
of them, in order to establish a recursive relationship, where
products and effects are producers and causers of each other
(Morin, 2005). A society is produced through interactions be-
tween individuals, generating an organized whole which retro-
acts on individuals, in order to coproduce them as human sub-
jects, something which they would not be if they had no educa-
tion, language, and culture (Estrada, 2009).
It is considered that, with regard to the education processes,
there are always less systematized and more spontaneous spaces
which interact with what is actually found. Often, these spaces
are those allowing interactive processes with education outco mes
as favorable as the formal spaces (Ministry of Health, 2003).
However, the non-systematized education practice, informal,
depends on the opportunities of each reality, leading the theme
Open Access
to be addressed only if a correlated situation occurs during the
practical class. This informality does not ensure the intentional-
ity required so that the theme is worked on with all students, a
fact observed in this study in the approach to the content mul-
tidrug-resistant microorganisms. Respondents indicated that
this approach is not systematized, they believe that there is no
way for the student to go through the practical fields without
experiencing this subject. However, in case they do not care for
patients with multidrug-resistant microorganisms, the system-
atic approach to the theme would be absent in the curriculum
under analysis.
Edgar Morin’s complex thought proposes interaction be-
tween the various thinking modes, by focusing on a thinking
way which does not separate, but rather connects and seeks
needed and interdependent relationships between all aspects of
human life (Silva, Carvalho, Canini, Cruz, Simõe s, & Gir, 2010).
The author argues that we must seek a knowledge way able to
grasp objects within their context, complexity, and set (Garan-
hani, Alves, De Almeida, & Araújo, 2012). It is believed that
the theme HCRI, when addressed in formal and informal ways,
allows students to take contact with its complexity, gathering
knowledge to achieve a professional training with critical and
reflective abil it ies.
Extracurricular Activities Aimed at the Teaching of
Health Care-Related Infections
During the interviews, some professors mentioned as a con-
tribution to student learning the optional extracurricular intern-
ship offered by the Commission for Hospital-Related Infection
Prevention and Control (CCIH) of the University Hospital. The
internship, according to the coordinators, provides opportunity
to supplementary activities and it is regarded as a factor which
has significantly contributed to student learning, according to
the testimony b elow:
What a mind change when they [students] go through this
environment, when they start understanding more clearly the
activities of CCIH. [...] They bring more information, a better
mastery of concepts. When we discuss concepts on infection,
sterilization, they already have this knowledge; when we dis-
cuss biosafety, care for patients with multidrug-resistant bacte-
ria [...] they already know the way how to care for them, they
know the way how to act. The issues of contact prevention,
epidemiological surveillance, students know them all. (11B)
Other professors reported that the students participating in
the internship at CCIH, often, bring updates on HCRI, even
contributing to professors’ learning. In this interaction between
professors and students, we resume the idea of recursion, where
knowledge exchange between individuals generates an organ-
ized whole (Estrada, 2009; Morin, 2011).
The National Curriculum Guidelines for the Undergraduate
Course in Nursing provide for the development of extracur-
ricular activities, which should be supplementary and con-
ducted on a continuous way throughout the professional train-
ing (Resolução CNE/CES n. 3/2001, 2001). We noticed that the
internship at CCIH brings the student into the hospital envi-
ronment, allowing students to establish a relationship between
theory and practice and, thus, contributing to professional
We may say, anchored in Morin’s complex thought, that it
becomes of paramount importance to learn to contextualize,
know how to situate knowledge in an organized set, i.e. global-
ize. Students must gather knowledge in their own life to better
clarify their behavior and self-knowledge, favoring the ability
to reflect, meditate on knowledge (Morin, Almeida, Carvalho &
organizadores, 2009). Knowledge acquired during the extracur-
ricular internship, increasing the information on HCRI within
the integrated nursing curriculum, leads the student to contex-
tualize the theme under study with regard to the global reality
in which we live.
Assessment of Learning on Health Care-Related
Professors mentioned that, when assessing students, the
HCRIs are included, at least, into 1 of the education units of 4
interdisciplinary modules. These 4 modules also showed formal
and informal education activities and only 1 of them did not
address this content in the notebook. Below, we have the ac-
count of a professor on the way how he assesses students with
regard to the theme under study.
We have a written assessment, risk factors for infection,
signs of surgical site infection, the issue of hospital discharge,
which advice would you give to a patient at the time of hospital
discharge after surgery. (14B)
However, in 11 interdisciplinary modules the respondents
reported that the theme was not included when assessing, either
theoretically or practically. We stress that, out of these 11 mod-
ules, 5 reported formal and informal activities and other 4 re-
ported informal activities. Out of the 11 modules, 5 showed ac-
tivities described in the planning and development notebook of
the interdisciplinary modules observed in documentary analysis.
Ensuring continued reflection and assessment of education
practice, checking the needs to change or rearrange them, in-
volves an attitude of commitment and responsibility in the
teaching and learning relationships, always taking into account
the complexity and comprehensiveness of this practice (Bedin
& Scarparo, 2011). In this sense, the situation presented above
deserves attention, since, if on the one hand we have the posi-
tive fact that the theme concerned is addressed at various times
throughout the course, on the other hand this theme is discon-
nected from the abilities aimed by the students, because it is not
addressed during the formal assessment process. Assessment is
not intended only to formally register learning, indeed, it has a
diagnostic, procedural, descriptive, and qualitative function. It
is a strategy for intervening, needed in order to achieve future
advances from the level reached by the student in the teach-
ing-learning process (Ministery of Education, 2007). Thus, we
highlight the importance of also including the HCRIs in the
assessment process of student learning, something which con-
tributes to the assessment on the way how this theme is ad-
dressed by professors.
A key principle of Complex Thought related to the assess-
ment process is recursion, a process in which products and
effects are, simultaneously, both causes and producers of what
has been produced, thus breaking with the linear idea of
cause/effect and product/producer (Menossi, Zorzo & De Lima,
2012; Morin, 2011). This process favors a self-constitutive,
self-organizing and self-productive cycle.
Final Remarks
This study showed that not all interdisciplinary modules of
th e integrated curriculu m unde r st udy addresse d th e th eme H CRI .
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Formal education is conducted in a theoretical and practical
way, and there are contradictions between what professors re-
ported they do and what is recorded in the teaching planning
notebooks. Informal and extracurricular activities take place in
the education practice within the reality under analysis.
Considering the results and the relevance of the HCRIs for
nurse’s training, we advocate for their inclusion in nursing cur-
ricula as a cross-sectional theme, i.e. which permeates all mod-
ules and/or disciplines every year. There is a need for formally
including HCRIs in teaching planning. We suggest that this
proposal also be discussed in the assessment forums of Nursing
curricula, providing professors with opportunities to think
through teaching on HCRI and share experiences. We also re-
gard as relevant updating professors’ knowledge on contents,
abilities, and skills aimed at the HCRIs, enabling an integrated
approach to the specific contents of each interdisciplinary mod-
ule, aiming at nurse’s training.
We hope that the analysis of this experience in a Nursing
course which has adopted an integrated curriculum can also be
experienced in other Nursing schools. The curriculum, in its
pedagogical project, focuses on the use of active methodologies
under a teaching and learning idea which is critical and
thoughtful, with interdisciplinary and inseparability between
theory and practice. This curriculum also promotes the training
of professionals by means of the knowledge required to im-
prove the critical and reflective ability to analyze their profes-
sional actions.
Given the complexity of HCRI, we hope that this study can
contribute so that the professors working within the Health
Sciences field pay attention to their education practices on
HCRI; it must be systematized in the curricula in order to have
effects on student’s learning, on the training of committed pro-
fessionals who are aware of prevention and control measures
aimed at the HCRIs.
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