ORIGINAL ARTICLE
ALVES, Geania Moreira [1]
ALVES, Geania Moreira. A sensitive look at pedagogical practice in hospital spaces: Andragogy. Revista Científica Multidisciplinar Núcleo do Conhecimento. Year 05, Ed. 10, Vol. 22, pp. 05-34. October 2020. ISSN: 2448-0959, Access link: https://www.nucleodoconhecimento.com.br/pedagogy/sensitive-look
ABSTRACT
This article aims to present the benefits of andragogic care within hospital pedagogy to assist in the promotion of the integral health of hospitalized adults and the positive reflexes for both the student-patient and the hospital and for the city economy.It considers the important role of Hospital Pedagogy within the historical context of education and is based on a liberating and humanitarian methodology that acts through projects and dialogues in an enriching way with the curricular components established by the National Common Curriculum Base – BNCC for the development of skills and abilities, critical thinking and the student’s affection. The educational practices of the 21st century call for the immediate inclusion of the hospitalized adult in the care of Hospital Pedagogy.
Keywords: Andragogy, hospital pedagogy, hospitalized adults.
Teaching is not transferring knowledge, but creating the possibilities for your own production or construction. (FREIRE, 2014)
1. INTRODUCTION
This article discusses the performance of the pedagogy professional within the hospital environment, the various contribution bias and awakens to various considerations regarding the importance of education and its reflexes in the prevention and treatment of adult health.
The technology has provided great advances for the discovery, prevention and cure of various diseases in the health area, however, as to human relations, it is still possible to observe in hospital environments a dichotomy in the professional-patient-pathology relationship.
Administrative formalism, the difficulty of access to specialized hospital services, lack of human resources, and the greater demand of a society increasingly dependent on emotional support and support to various pathologies, reflect in overcrowding, causing, in general, the unilaterality in care and the distancing of human aspects for quality hospital care.
In this respect, the patient’s depersonalization is inprogress, where he is often identified by the pathology, analyzed and treated as a number or used as a research tool and not as a biopsychosociospiritual being. This situation leads to the lack of identity and autonomy of the patient, often creating disinterest and apathy that put him in conditions of passivity and generates other mental pathologies in the face of a process in which he should be active to restore his clinical condition.
Actions are needed that promote partnerships aimed at the quality of care in the hospital environment. In view of this scenario, the Hospital Pedagogy emerges that goes beyond the hospital class and embraces the entire hospital institution, and proposes a culture of education to act as a bridge in specialized support to multidisciplinary teams and hospitalized adults, who need continuous care and especially an educator and welcoming look through affective and cognitive stimuli , thus contributing to the dehospitalization process.
Hospital Pedagogy has proven over time that it is a mode of teaching that enables rehabilitation in children and adolescents, as well as adults, through Andragogia, favoring not only the continuity of studies, but also to provide an educational experience based on their interests and thus promote well-being, self-esteem, dignity , mental health and citizenship preservation.
This article is the result of observations made during hospital care. These are experiences that point to the urgency in the expansion of pedagogical care through Andragogia and aims at more attractive proposals for the educational process of hospitalized adults. It is urgent to include this public in this type of education. It is a social issue of great human, sanitary, psychological, economic, political and cultural impact. And it raises some reflections, that is:
- What are the benefits of extending access to Education to hospitalized adults?
- If education is everyone’s right, how can we ensure that this hospitalized adult has access to hospital pedagogical care?
Paulo Freire, Norman Doidge and Malcolm Knowles: lighthouses that illuminate and impact 21st century education.
1.1 BRIEF HISTORY OF THE EVOLUTION OF THE EDUCATIONAL SYSTEM IN BRAZIL
To truly educate is not to teach new facts or to enumerate ready-made formulas, but rather to prepare the mind to think. (EINSTEIN)
Sparta and Athens gave rise to educational conflicts that have fueled for centuries the pedagogical debate in Brazil, with tendencies or one, or to another model. This is more evident when analyzing the Argentine documentary “A Educação Proibida”, produced in 2012, whose educational historical analysis of the last 200 years, through the participation of academic professionals from Latin American countries makes it evident in its history that, in Prussia, in the 18th century, when public education emerged, free and mandatory, enlightened despotism used enlightenment principles (Paidéia) to satisfy the people , however, preserving the absolute regime (Agogé), where children needed to develop their abilities, day after day, having the interests of the adult to conduct their development, always guided by repetitions, competitions and a system of awards and punishments imputed by parents and teachers. This historical approach points to the “Prussian” system of 1819, that is, in the 18th century. XVIII d.C., presents profound reflections of the influence of Spartan education, which, particularly in Brazil, is strongly identified through the traditional methodology applied in the classrooms still today. These findings give rise to profound reflections that refer to Plato (17th century). V, a.C), and dialogues with the Myth of the Caves narrated in his book “A República”, from where, is the present analogy:
If on the one hand, learning is the tool that attracts people closer to the light of knowledge, opening up new possibilities and connections, as occurs to the fugitive who follows out of the cave and finds a new world, unknown and unexplored, full of colors, brightness, life… On the other hand, the myth of caves makes it reflect that the absence of knowledge is the shadow, the fear of the unknown, which prevents the individual from leaving the cave towards the light. Taking into account the economic structure of the current labor market, the misery and hunger spread in the country, this represents the lack of stimulus and preparation of both the student, as well as the denial of employment by companies and the devaluation of the human being through the exploitation of the labor force.
It is perceived that education in Brazil is influenced by the Spartan educational model, presenting, according to the myth of caves, most schools as a dark, inhuman cave that segregates and forms students with the objective of competitiveness, obedience and passivity, following an educational system focused on political and industrial interests. And when a student comes across a methodology that stimulates critical thinking and affectivity, he finally frees himself from the traditional system to immerse himself in new concepts of learning, discovering the meaning and beauty of learning that respects and values the individual. Thinking of those who remained in the shadow of the cave, he returns. But it finds no room to be heard because the educational system, for the most part, remains a machine that does not stimulate in the student the manifestation of thought.
“It is in this sense that one is able to form is much more than purely training the student in the performance of dexterities, […]”. (FREIRE 2016, p.16).
The history of Brazilian education shows that the model followed for centuries was an influencer of the formation of the Brazilian people, but this historical-cultural process began to weaken, from 1932, with the Manifesto of the Pioneers of New Education, which, according to INEP (1944) presented the necessary organizational proposals in the States and in the area of education. This Manifesto became the political basis that undersuped Brazilian education and society to date, presenting the primacy of school administration established as a fundamental factor for the solution of the educational problems of the time.
“The educational renewal was based on the psychological theories of Lourenço Filho, on the sociological contribution of Fernando de Azevedo and on the philosophical and political thinking of Anísio Teixeira.” (SANDER, 2007, p.28)
This Manifesto functioned as a watershed, bringing guidelines for Brazilian education and, according to Aranha (2012) “reiterated the need for the State to assume responsibility for education, which was lame with the demands of development”.The proposal aimed at renewing the techniques and requiring the single, compulsory and free school. A new educational policy emerged, based on the training of the education professional, with the educator more aware of the administrative capacities that he should perform and, where scientific methods and techniques would serve as a basis for evaluating the situation and results after its application. It was the beginning of the application of scientific thought in the school’s actions.
Thus, new perspectives were unveiled before the hope of democratizing and transforming Brazilian society through school and, in the late 1950s and early 1960s, a new educational model emerged with a liberating pedagogy that stimulated student autonomy for integrated learning, with the participation of the family and has its origins in the popular education movement , but was interrupted by the military coup of 1964, which, within the regime, instituted education programs focused on economic interests, among them, in 1967 the MOBRAL – Brazilian Literacy Movement, whose objective was the functional literacy of young people and adults teaching to read and write to work in industries (ARANHA, 2012), recalling the Spartan model as to a formation devoid of the sense of ensuring the development of adults in its biopsychossoci aspects cultural and moral. MOBRAL was extinguished in 1985.
And with the arrival of democracy, the resumption of development arose in the late 1970s and early 1980s, bringing as a proposal, school activity based on discussions of social and political issues and actions on immediate social reality; in order to analyze the problems, the determining factors to structure a form of action focused on the transformation of social and political reality. A new proposal for an educational model emerged where the teacher is seen as an activity coordinator who organizes and works together with the students.
Educational public policies pointed to progressive trends with proposals for integrative educational projects and flexible curricula for education.
It is in this context that there is the emergence of hospital pedagogy.
2. THE HOSPITAL PEDAGOGO
2.1 HISTORY AND LEGISLATION OF HOSPITAL PEDAGOGY
According to Matos and Mugiatti (2014), since antiquity, through evidence found in Egyptian papyri, there is a concern for health. In which, over time, this concern was taking even greater proportions, in which people began to relate social, educational and environmental factors with health, as can be seen in the medieval age.
Thus, Hospital Pedagogy aims to minimize the suffering of infant patients within hospitals, in order to complement medical treatment, aiming at psychosocial and cognitive care, in addition to ensuring other beneficial factors during treatments of children and adolescents.
According to Esteves (2013), Hospital Pedagogy, emerged in 1935 in France, through the creation of the first institution aimed at unadapted children. Inaugurated by the Minister of Education, Henri Sellier. Being this exemplary model, later implemented throughout France, Europe, Germany and the United States, with the purpose of meeting the school difficulties of tuberculous children.
World War II can be seen as the significant milestone in the introduction of schools in hospitals. Due to the occurrence of many disasters that affected many children and adolescents, being mutilated and unable to go to school, caused there to be an engagement, especially of doctors, in defense of the school’s involvement in its service.
In 1939 the C.N.E.F.E.I. – National Center for Studies and Training for Unadapted Children, located in Suresnes, in order to train and train teachers for work in special institutions and hospitals. Later this year, in France, there was the creation of the Position of Hospital Professor with the Ministry of Education. From its inception to the day to this day, the C.N.E.F.E.I. aims to show people that the school is not a closed place. This offers internships for teachers and school principals; school health physicians and social workers in boarding school.
In Brazil, the legislation verified in conjunction with the statute of the Child and Adolescent Hospitalized, through Resolution No. October 41, 1995, in item 9, the “Right to enjoy some form of recreation, health education programs, monitoring of the school curriculum during their hospital stay”.
In 1969, Decree Law No. 1044/69 was created, which says:
Art. 1º Students of any level of education, with congenital or acquired diseases, infections, trauma or other morbid conditions, determining acute or acute disorders, characterized by: a) relative physical disability, incompatible with the frequency of school work, are considered worthy of exceptional treatment; provided that there is the conservation of the intellectual and emotional conditions necessary for the continuation of school activity in new lines.
Currently this law, even though it dates back to 1969, is very present, because it guarantees the continuation of the studies of students who are in a convalescent state, in which it determines in its art. 2º the assignment of home exercises with school monitoring, as a way of compensation of absence, in a way compatible with their possibilities of health and establishment.
In 2002, the Ministry of Education was prepared by the Deputy Department of Special Education a document of strategic guidelines aimed at the care of hospital classes, ensuring access to basic education.
In 2006, CNE/CP No. 1 presented another important advance by instituting National Curriculum Guidelines that included the expansion of pedagogical care outside school environments, as stated in article 4, item IV: “working, in school and non-school spaces, in promoting the learning of subjects at different stages of human development, at various levels and modalities of the educational process”. This document recognizes that education goes beyond the walls of the school and invades all the spaces and times of life, whether inside homes, companies, prisons, streets, institutions that house children, young people and the elderly, also extending to hospitals.
Thus, in 2018, the legislation on Hospital Pedagogy was revised and updated through law no. 13,716, with the insertion of Article 4º-A in LDB no. 9394/96, ensuring educational care to the primary education student hospitalized for health treatment, in hospital or home for a prolonged period.
Matos and Mugiatti (2009) presents Hospital Pedagogy as a sublime challenge that differs from traditional teaching because it suggests an educational action that adapts to the needs of each student in different circumstances. In this area the Pedagogue develops a personalized pedagogical assistance, within ethical, bioethical and aesthetic principles, which respects the pathology of the patient and adapts to hospital structures, using a didacticand flexible and playful methodologies so that hospitalized students feel stimulated in the continuity of the teaching process learning, thus ensuring access to education.
The existence of pedagogical-educational care in hospitals ensures that new knowledge and information can be acquired contributing to the biopsychosociocultural and spiritual development of the student. And in this sense Morin (2003, p. 42) reinforces that the
education’s goal is not to transmit ever more numerous knowledge to the student, where knowledge is accumulated, stacked, and does not have a principle of selection and organization that gives him meaning, but the “to create in him a deep and inland state, a kind of polarity of spirit that guides him in a defined sense , not just during childhood, but throughout life.
Thus, Hospital Pedagogy has been expanding in the care of hospitalized students, in which the emphasis of humanistic philosophy stands out in many hospitals in Brazil.
It is worth noting that the development of hospital pedagogical care within humanized premises will benefit the mental health of the hospitalized student, reflecting, still according to (MATOS and MUGIATTI, 2014), in the physical and psychological health aspects of the individual.
It is observed that the continuity of studies, parallel to hospitalization, brings greater vigor to the forces […] as a motivational stimulus, inducing it to become more participant and productive, with a view to an effective recovery. This fact, in addition to generating an integration the active participation that excites the hospitalized school, by the effective continuity of the external reality, contributes, still subconsciously, to the triggering of the pressing desire to need healing, that is, a predisposition is born that facilitates its healing and shortens its return to the environment to which it was integrated. (MATOS and MUGIATTI, 2014, p. 72).
And Matos and Mugiatti (2014, p. 73), complement that “the hospital pedagogue is an evolution and agent of change”, that is, he is the intermediary for “the adaptation of the hospital environment to the school and the school to the hospital environment constitutes a need” that aims at the well-being of the student who would otherwise be harmed in his rights to continue his studies. It is an ethical and citizenship issue.
Thus, Humanization is the word that defines the process of pedagogical-hospital care, since the Pedagogue must know how to recognize the limitation of the student in contributing to an activity. It involves the integral being, meeting their physical, psychic, cultural and social needs.
Therefore, Sales; Lima e Souza (2016) highlight that the pedagogue who works in a hospital environment needs to be bioethical and empathic to emotionally understand the situation of the hospitalized student. In a moment of such emotional fragility and physical and psychic vulnerability, it is up to the pedagogue sensitivity and empathy to know the moment to act, either through pedagogical didactics or support to the student in his frailty using an active listening, an attentive look and welcoming, always considering an environment where feelings as fear , uncertainty, insecurity and longing are as frequent as the hospital.
And in this sense, Freire (2014, p. 70) points out that “joy and hope must permeate the pedagogical space”, and the pedagogue’s total responsibility is the transformation of the hospital environment into a pleasant environment through educational practices that stimulate the participation of the student as an active subject in the teaching-learning process.
When there is a horizontal, dialogical relationship between teacher and student and student and teacher, where there is no content transfer, but rather the understanding of the object studied obtained through the materials offered by the teacher to the student (FREIRE, 2014 p.116).
The pedagogue who works in hospitals lives with different realities of different people who have had their dreams and projects interrupted, even if temporarily, because of the emergence of a disease that prevents them from attending school, work, living with family and friends being able to trigger problems in their psychological development , school, professional and social.
In this way, they conclude Sales; Lima and Souza (2016), it is up to the pedagogue, together with the multidisciplinary hospital team, to provide joyful, playful and multidisciplinary activities, aiming to minimize the patient’s suffering. Thus, when the hospitalized student can resume his/her routine, he/she will be able to continue his/her life and studies. It is known that this work is hard, but also satisfactory, as it will provide the student with the possibility to continue their dreams and interrupted projects throughout the hospitalization period. And “one should not deny the right to dream to those who dream.” (FREIRE, 2014, p. 141).
In any case, the study always requires a serious and curious attitude in seeking to understand the things and facts we observe. A text to be read is a text to be studied. A text to be studied is a text to be interpreted. We can’t interpret a text if we read it without attention, without curiosity […]. (FREIRE, 1996, p.59)
In view of the above, it is concluded that pedagogical care is also therapeutic, since it provides numerous benefits to the hospitalized student, since it reconciles education, inclusion, adaptation and socialization promoting critical thinking, joy, self-esteem, appreciation and well-being to all involved; and that it can be extended to the hospitalized adult who, vulnerable and fragile, often “follows from afar the performance of the pedagogue, and even forgets the pain when smiling and manifesting the desire to participate”, according to reports of experiences of nursing teams. These reports awaken to some reflections.
After all, how to ensure that this hospitalized adult has access to hospital pedagogical care?
Hypothetically, imagine the child who played, smiled, weaved dreams yesterday, becoming the figure of the adult who is today in hospital beds: one wonders, how would he react if he could have access to hospital pedagogical care? Or, approaching the situation to the field of empathy: how would the reader react if he was hospitalized for a period, and could not access this care giving rise and/or sequence to the studies accomgone and postponed, sometimes, for so many years?
Without easy access to education, the individual can develop, in some cases, without cultural and moral parameters and without critical thinking, and this may reflect positive or negative concepts and habits “inherited” from the environment. And perhaps because of the reflections of this cultural heritage, it is common to hear them say that education is done for children and young people, and that adults are no longer old enough to learn.
And Knowles (2011, p. 49) undoes this belief by clarifying that:
[…] all the great teachers of ancient times – Confucius and Lao Tsé in China, the Hebrew prophets and Jesus in biblical times; Aristotle, Socrates and Plato in ancient Greece, and Cícero, Evelídio and Quintiliano in ancient Rome – were teachers of adults, not children. And that in these experiences, they developed a very distinct concept of the teaching/learning process than the one that would eventually dominate formal education. These notable teachers believed that learning was a process of mental investigation, not the passive reception of transmitted content, thereby developing techniques to engage students with research […]”. And motivating curiosity and critical thinking is one of the techniques used by Hospital Pedagogy.
On the other hand, it is evident that, being the great masters holding wisdom, they taught adults because they knew that the younger ones needed the good examples of the elders. However, with the advances and setbacks of the history of education over the centuries, one perceives a possible dichotomy that would justify the understanding of some adults about “no longer being old enough to learn”.
21st century education asks for a closer look at the baggage full of experiences, feelings, sensations, stories, mistakes and successes, of lives that deserve to be respected and valued, along with their beliefs, and values. It is a social issue of great human, sanitary, psychological, economic, political and cultural impact.
The Constitution (1988) establishes citizenship, dignity, health and education as the right of all, the Law of Guidelines and Bases of National Education (LDB No. 9394/96) regulates education to all, ensuring in its Article 3, item XIII, the guarantee of the right to education and lifelong learning and in Article 4º-A, the educational care of the student of basic education in hospital treatment in hospital or home. In addition, there is CNE/CEB Resolution No. 1/2000, which regulates and enforces the right to adult education. Thus, considering the differentiated specificities for education in hospital spaces, it is necessary only a complement to the differentiated educational practices for andragogic care in Hospital Pedagogy.
Andragogia is a term created as an integrated model for adult learning to differentiate it from the theory of child and youth learning, as Explains Knowles (2011, p. 78):
If in pedagogy it is up to the teacher full responsibility for decisions about the content of learning, leaving children in a submissive role in educational dynamics, in Andragogia adult education is based on a self-directed education where the pedagogue acts as a facilitator of the learning teaching process. In this model, adults need to know why they need to learn something and take responsibility for their own decisions and for their lives.
And, next, Knowles explains which aspects need to be observed and what differentiates andragogy pedagogy in its practices,
By clarifying the characteristics and abilities of adults, in which they are autonomous subjects, responsible for their decisions and life; have greater capacity to understand educational activities and necessary solutions depending on the challenges and situations of life, due to their variety of experiences when compared to those of a child; they are also focused on life for their guidance and learning, needing to know why they need to learn something; in addition to responding better to internal motivators than to external drivers.
These topics make it clear that Andragogia dialogues with pedagogical care for hospitalized adults, which is why the Pedagogue needs to be attentive and qualified to act in different levels of languages.
2.2 WHAT IS EXPECTED OF THE PEDAGOGUE PROFESSIONAL IN HOSPITAL PRACTICE
Madness is wanting different results doing everything exactly the same. (EINSTEIN)
The individual, when hospitalized,
He is deprived of the freedom he occupied until then in society and begins to participate in a specific social group, of hospitalized patients, where he develops marked dependence starting with limited physical space, his clothes and personal objects removed, loss of privacy, among others. (SILVA, 1996).
In this context, Kamiyama (1984) draws attention to the fact that the motivational state of the hospitalized adult is special, as it is characterized by insecurity, loss of autonomy, loss of identity and self-esteem and can lead to depression, stress, anxiety or other mental pathologies due to the psychological inability to deal with the aspects that accompany both the severe disease and the change of environment. And Silva (1996), points out that the hospitalized patient misses activities, recreation and affective social relations. All these aspects are a threat to your mental health and can create negative reflexes in the evolution of your physical health, often reflecting a longer period of hospitalization.
Thus, in view of these conditions, the presence of the hospital pedagogue has an important impact, since pedagogical care helps hospitalized adult patients to transform the hospital environment into a pleasant place through interactive activities that promote curiosity, joy and socialization with multidisciplinary teams favoring harmony, integration and well-being between the student and the various hospital environments. It also contributes to transform the entire local society that transits in these spaces and in the surroundings. It’s education that benefits everyone.
This proves the theory of neuroscientist Doidge (2012, p. 9) who clarifies that “the brain produces neurogenesis all life and this gives it the ability to learn and organize content, regardless of age.” And it presents several scientific experiments that prove that, according to thought, learning or acting can activate or disable genes, shaping brain anatomy and human behavior. It also states that neuroplasticity* allows the brain to modify its own structure and functioning in response to mental activities and experiences. In other words, the human being learns and feels stimulated by what stirs with emotions, with the senses, which generates curiosity, joy, pleasure. You’ll always learn something new. This ability only ceases when the individual dies. Thus, the more cognitive stimuli permeated by affection the hospital pedagogue presents, the greater the capacity of the hospitalized student’s brain to change, contributing to their healing and learning.
And within this perspective, Mora (2017) clarifies that pedagogical-andragogical care presents assumptions that emphasize the importance of “breaking the scheme and getting out of monotony” because “the unknown elements, which surprise us, are those that open the window of care , essential for learning”. That is, it emphasizes the need for hospital pedagogues to create powerful pedagogical practices, permeated with affection and respect so that they act as stimuli to the brain and influence changes in thoughts, which in turn will influence emotions and attitudes, contributing as an aid in the healing process and even de-hospitalization, since, according to the philosopher Hippocrates of Cos, who between the 4th and 5th centuries BC, already presented in-depth studies and some scientific bases on aspects of mood and its influence on the cure or on the complication of the disease in the individual, it complements (FERNANDES, 2020).
And what are the benefits of extending access to Education to hospitalized adults?
Being the right education of all, the hospital pedagogue of the 21st century needs different skills and abilities to work the skills and abilities of the hospitalized student with ethical and bioethical qualities that enable him for clinical and innovative educational practices aimed at andragogic and pedagogical care, since within the hospital environment are children and adults from diverse contexts. Thus, once unable to go to school, the school should go to them, since the disease cannot be seen as a discontinuity factor in the teaching-learning process, whether of the child or adult, and it is in this aspect that hospital pedagogy and andragogy has profound impacts, after all it is not any type of teaching that promotes the interest and development of the sick student : special mediation is needed to raise the desire to participate in the educational process within the hospital context, to which Paulo Freire (2016, p. 12) reinforces the issue of ethics when he says that “Teaching is not transferring knowledge”, is to respect the autonomy and identity of the student. Thus, to obtain different results, the hospital pedagogue develops differentiated pedagogical practices and multidisciplinary projects that involve all hospital employees promoting education and well-being for the student, the companion and the entire multidisciplinary team that accompanies him. The result is the well-being of the patient who, stimulated recovers faster, generating greater turnover. Thus, the Pedagogue becomes an important tool also for the process of growth and hospital approval in the market. It is the professional who arrives to revolutionize the education of the 21st century.
And within this mechanism, according to Matos and Mugiatti (2009) is the reflection of hospital pedagogy in favoring communication and partnership between the various teams and sectors in the most varied environments of the hospital through inter and transdisciplinarity because the pedagogue also brings an attentive look to the environment and takes into account the profile of employees who will support and receive support , contributing to the well-being of all, including considering their differentiated work shifts. Thus, it helps to guarantee, still, greater profitability, because education is promoted to all involved, so, from the patient to the employees, everyone feels more stimulated and engaged, increasing productivity and hospitality, and generating well-being not only in employees but in all internal and external customers.
The role of the pedagogue in the business environment, more specifically in the health area, is developed through pedagogical techniques with the purpose of offering more efficient and effective learning resources, aiming at the continued training of teams. (O QUE É EXPERIÊNCIA DO COLABORADOR? 2020)
The pedagogue professional contributes to the development of skills (knowledge, skills, attitudes, values, surroundings and sustainability) in a world that is increasingly complex (MU-V.UC.A[2]) and makes use of pedagogical methodologies to offer and apply educational projects to hospital employees and even to the surrounding area, that is, local society, promoting partnerships for lectures on men’s health, women’s health, child health, among others (WUNDERLICH, 2020), generating positive effects on the health and economy of the country.
According to Prado (2018), human intellectual capital, that is, people’s knowledge becomes increasingly a precious asset to be preserved in the business world. Pedagogy in the health area can promote considerable changes in the improvement of employees, realize humanization through education and cause positive transformations in the environment for a better performance of teams, bringing, consequently, better results in the experience of hospitalized clients, since, within the hospital environment, the pedagogue works in partnership with the care areas (medical teams , nursing, surgical center) and support center, necessary for the operation of the institution such as nutrition, hospitality, maintenance, quality sector, human resources, among others, which support educational actions for employees, according to the purposes and objectives of the hospital institution assisting in communication between the various sectors to ensure the well-being of the central client: the patient.
Thus, the hospital pedagogue of the 21st century needs to be clothed with sensitivity and humanization to do psychopedagogical, with the most sensitive and strategic ethical, aesthetic and bioethical approach to build bridges between the student’s development and the hospital environment.
In view of the tables presented, it is inferable that the Pedagogue, besides being humble and humanized, needs to have a reflexive posture, open to new conceptions in the act of planning, applying and self-evaluating himself, maintaining the bioethical view for a structured and flexible planning to pedagogical practices that cover all sectors, since it becomes the central axis, connecting all departments and bringing multidisciplinary teams closer to the patient and this to all teams to all teams , providing integration and learning and transforming the hospital into a “welcoming environment, a cheerful and cozy pedagogical space, contributing to the sick student improving emotionally, mentally and physically, thus ensuring the learning process and cognitive, psychological and affective development, guide (CECCIM and FONSECA 1999).
Moreover, it is worth mentioning that it also requires a special sensitivity to work with diversity, since within a hospital environment you can find students with different cultural baggage, acting even, many times, as a scribe, since there will be students unable to write.
It is concluded by all aspects observed, that the hospital pedagogue will act as a facilitator in learning, needing to develop a good personal relationship with the student, based, according to Knowles (2011) in three acitive qualities: sincerity, esteem, trust and respect; have empathic understanding, be sensitive and a good listener.
2.3 PEDAGOGICAL PRACTICES IN HOSPITAL DAILY LIFE
It’s the humble ones who become good adult teachers. In an adult class, the student’s experience counts as much as the teacher’s knowledge. (KNOWLES, 2011, p.52)
Considering the innovative aspects necessary for the education of the 21st century, which asks the professional of education to humanization in methodologies for a more significant and contextualized learning, aiming at the formation of the integral being, the hospital pedagogue, needs to dialogue with the needs of this new time through research and continuing education seeking the acquisition of new knowledge that contributes to coherent pedagogical practices , powerful and innovative capable of promoting reflections and positive changes in the life of the hospitalized student and the environment in which he is.
Thus, before thinking about which resources and pedagogical practices are the most indicated, it is up to the hospital pedagogue to observe some fundamental stages to the good progress of his work:
It is important to emphasize, as presented in the previous item, that in the first place is the well-being of the student, and, therefore, it is up to the hospital pedagogue a careful and empathetic look to perceive the needs and emotional state of it, where often the pedagogue becomes the shoulder friend and confidant of this fragile human being and vulnerable to the pain and the environment in which he is.
In this sense, pedagogical practices should be based on ethical, aesthetic and humanistic principles, recommended by Freire and Knowles for pedagogical care to adults in general, aiming at this article, special attention, according to Knowles (2011) to the hospitalized student, for the organization and planning of humanistic educational projects, taking into account that every human being carries in himself a historical baggage , cultural and social, and that new knowledge is built from the previous knowledge of the student, which requires the hospital pedagogue a sensitive, humble and open posture, reinforces Freire (2016), where respect for the individualities that meet there with their cultural, ethnic and social diversities are preserved.
And Knowles (2011), clarifies that practices should be directed to an entrepreneurial and autonomous education, with personalized contents where the hospitalized adult feels valued, welcomed and stimulated in curiosity, interest, independence, creativity and autonomy sharing their experiences and providing a more emotional, creative and transformative education.
“Respect for the autonomy and dignity of each one is an ethical imperative and not a favor that we can or cannot grant each other.” (FREIRE, 2014, p. 58).
And in this aspect, andragogic care within Hospital Pedagogy presents a proposal of integrated education of the being based on a methodology that reconciles different pedagogical practices as strategies in education and motivation of the hospitalized student. It is necessary to reinforce that, because it is a hospital environment, the student lives in different and painful realities, and it is the pedagogue who, in partnership with multidisciplinary teams, uses methodological resources that allow the familiarization and acceptance of treatment, helping the student in understanding the procedures. And, in this communication bridge, multidisciplinary teams are very important because they provide relevant information regarding the clinical and emotional state of the patient in favor of a pedagogical care that has salutary effects. Due to overcrowding in hospitals, this partnership with multidisciplinary teams is fundamental to the pedagogical and humanitarian practices that the pedagogue promotes, because it establishes calm and trust to the student who begins to cooperate for his clinical improvement.
It is common, for example, for the hospitalized adult to wake up sad, anxious, tired or afraid of the environment in which he/she finds himself, refusing to accompany one of the employees to another sector for procedures. Once the bond of empathy, trust and friendship between the student and the hospital pedagogue is established, the condition changes after his arrival, a moment when the student often asks the pedagogue to follow up to the place of the procedures. On the path and even waiting for the exam or surgery, the pedagogue works the cognitive and socio-emotional skills of this student with inclusive and interactive practices providing a light, quiet and at the same time educational and playful intermodal environment, using present elements such as stethoscope, nebulizers and others to make jograis, rhymes and other productions of verbal or non-verbal intermodal texts that , at the same time that it becomes familiar, and involves not only the hospitalized student but also all those present who are in that environment, in an experience that transforms this moment into a collective activity. It is the pedagogical care of the 21st century occurring in various sectors of the hospital and promoting the student integration with the environment, with people directly or indirectly associated with its treatment, in addition to the knowledge and purpose of the procedures and instruments that surround it and that connects it not only with all the situations experienced but also with the curricular components BNCC providing at the same time, cooperation with its treatment that flows smoothly and the promotion of the learning teaching process.
Another important aspect for pedagogical practice is active listening, thus, from the facts narrated by the student, the pedagogue establishes with him a project where he shares responsibility and places himself as a facilitator of the process. From there a bond is established, because the student feels motivated and valued in his autonomy.
The facilitator is based on each student’s desire to implement the purposes that have meaning for him as the motivational force behind meaningful learning. Thus, the facilitator seeks to “organize and make available as many resources for learning as possible, whether written materials, psychological support materials, people, equipment, audiovisual resources – all possible resources that their students wish to use for their own improvement and to meet their purposes”. In this process, “the facilitator sees itself as a flexible resource to be used” by the hospitalized student, since it is the bridge between the hospital environment and the external environment. “He is available as a counselor, speaker, advisor, a person with experience in the field. When responding to the student’s manifestations, the facilitator accepts intellectual content and emotional attitudes, seeking to give each aspect the approximate degree of emphasis he has for the individual or for the group. (KNOWLES, 2011, p. 89)
It is known that all areas of knowledge communicate naturally, as well as the various sectors within a hospital institution and, in this sense, in Brasil (2017) is the Common National Curriculum Base – BNCC with the guidelines for the competencies and skills aimed at the student’s socio-emotional development, and it is up to the Hospital Pedagogue to be the “connection”, that is, , be attentive and present to mediate these learning bridges that connect the student with the curricular components.
Through Resolution CNE/CEB No. 4/2010, it clarifies that hospital pedagogues bring in their training the differential that enables them to exercise these enriching educational practices, since the professional develops projects where the student is the protagonist, he is the facilitator of knowledge and the various areas that constitute the hospital environment become the learning laboratory and, within this process, the educator is the axis that promotes the interaction between the student, the multidisciplinary teams responsible for their treatment and other hospital staff , in addition to the interactive experiences that expand knowledge and generate well-being to all the environments involved, thus assisting in the faster de-hospitalization of the hospitalized student.
Thus, when thinking about educational practices, the hospital pedagogue uses simple but permeated resources of love and based on the four pillars of education: learning to know, learning to do, learning to live together and learning to be, with methods guided by Paulo Freire and Knowles (previously presented in this article) to know how the adult student, including , the hospitalized student thinks about his reality and what reading he makes of the world and his experiences, to propose a project with a theme that generates several questions that foster curiosity, debates and experiences to map new possibilities and expand knowledge. In the course of this knowledge, the activities are self-directed and focused on the interest of the student, so, while the student receives stimuli to develop critical thinking and create proposals for solutions that make sense to himself and his reality, the hospital pedagogue, using dialogical methodology, follows the provisions of the BNCC and connects elements of languages, logical reasoning , arts, geography and history, technology and others) to practical, cognitive and socio-emotional skills, organizing these elements in the learning practices of interactive projects.
“No one educates anyone, no one educates himself, men educate themselves, mediated by the world.” (FREIRE, 1968, p.44).
The pedagogical practices of 21st century education aim at the development of the integral being and, to achieve the objectives, the resources most used in hospital pedagogical care are the tools of the arts such as Storytelling, manual skills, theatricalization, games, music, poetry, in addition to case studies, gamification, technological resources, and others, where the pedagogue becomes a facilitator of learning and the student the active subject in the construction of pedagogical practice innovative and transformative.
It is also noteable that the use of modern technologies has great prominence in planning for a coherent pedagogical practice through multidisciplinary projects and curricula being the most accessible and fast means of communication, accessible to almost all patients, whether tv, mobile, tablet, notebook, among others. And in this sense, Aranha (2012) warns that the educational problem is not only in using technology as an advanced instrument in teaching, or to follow its evolution in the world of work, but to question how it should be from now on a pedagogy that really guides the citizen to understand the world transformed by technology and act on it critically.
In 21st century education it is not enough to know, it is necessary to know “how” to use technology within education and thus contribute to the learning of students in an integrated way for their training.
By way of example, there is a routine situation in hospital environments: when entering the ward and finding the student making use of one of the suggested technologies, this is an excellent opportunity for the hospital pedagogue to start pedagogical practices and “enter” the student’s reality to establish a cordial dialogue and a pedagogical methodology consistent with the student’s need , customizing the service from the first meeting. For this, it uses the characters that this hospitalized student is moving (game, film, novel, etc.), where any element of interest is the agent for the promotion of learning. Using this technique one can approach the history, geography, habits, characteristics and customs related to the time that the event occurs while stimulating the student to make associations with the reality in which he is. Thus, the hospital pedagogue skillfully maps and inserts the BNCC components (e.g., phonetics, verbal or nonverbal writing, production of intermodal texts, argumentation, logical reasoning), and socio-emotional competencies, aiming at critical thinking and skills. Through anamnesis and mapping, at the next meeting, the hospital pedagogue will be able to present the generating theme for a project where he will act as a facilitator of learning. This pedagogical practice takes into account the social, human and cultural aspects of each student.
It is 21st century education integrating all areas of knowledge available in the BNCC to promote an integral education to the hospitalized student.
The technique of pedagogical approach with the child follows the same practice, however, differentiates in the language and in the pedagogical resources, since it takes into account the degree of development, as recommended Piaget (1999). Thus, one can use the same approach and the same project, as long as it is attentive to respect the difference in application: hospital pedagogy requires differentiated resources adapted to the level of understanding of the child or the hospitalized adult.
And in conclusion, it is worth noting that the hospital pedagogue should keep in mind that the focus is the quality of learning and not the amount of information that the brain stores. Thus, pedagogical practices for hospital care begin with empathy and focus on the participation and cooperation of the student for the integrated development of the being, and it is important to create methodologies that stimulate and dialogue with these practices in an active, playful, spontaneous, creative way. The motivation to logical reasoning should be present in all reflective themes, in order, according to Doidge (2012) to stimulate the student’s curiosity.
Therefore, pedagogical practices for 21st century education are excellent tools inside and outside the hospital environment, since they adapt to the learning process at different levels and stages of learning, providing the development of critical, ethical, aesthetic, affective and creative thinking in a light, pleasant and playful way.
3. REPORTS OF EXPERIENCE WITHIN HOSPITAL PEDAGOGY
It follows some reports of pedagogical experiences as a small sample of the healthy impacts that pedagogical care promotes to hospitalized adults.
Report nº 1:
Professor R.G., tells us a little about his vast experience in hospital pedagogical care and the need to officially expand this care to hospitalized adults.
In a hospital of chronic disease, we have patients of all possible ages. However, the Hospital Class only acts in a chronological section that goes from Early Childhood Education to approximately 21 years.
However, many of the adolescents undergoing treatment end up escaping from regular school processes. And the option to organize EJA groups is a way to access them, again to the school.
In addition, we have parents who come from different regions of the country often arrive in the City of SP, without having had access to studies and benefit from the Groups of EJA, organized in the Hospital Class.
Our EJA classes have always had adolescents and parents of patients hospitalized for treatment of chronicdiseases.
The benefits were enormous, many were literate, elementary school I and II concluded; went to high school and arrived at the University.
Thinking about the EJA in these educational spaces is very important, as a rescue of learning possibilities for students and their families.
Report nº 2:
It is the beautiful story of Lucas, a patient living in Santa Casa who celebrates the achievement of his diploma in elementary school
SÃO PAULO – It was June 2001. Lucas Gabriel Barbosa Santos was 2 years and 8 months old and with symptoms of pneumonia. The family took him to the Santa Casa de Misericórdia in São Paulo, in the central region of São Paulo, certain that he would recover. But the condition worsened and, with it, came the diagnosis: Lucas had Pompe’s disease, a rare genetic anomaly that paralyzes the muscles. The difficulty in breathing was just one of the symptoms of the illness that affected the boy. Lucas was never discharged. He celebrates every birthday at the hospital, where he learned to read, do head accounts and science and history. At the age of 20, Lucas keeps getting over himself. At the end of 2018, he won the diploma of elementary school, after having achieved, with the help of students and volunteers, a score of 7.75 in the National Exam for Certification of Skills of Youth and Adults (Encceja). (ESTADÃO, online)
Report 3: Presents the moving story of Dona Maria, who, although a victim of the compulsory isolation caused by Leprosy in 1940, never gave up studying and is considered the oldest student in a hospital class:
Rio — Maria Trindade was skirting her 87th birthday when she risked the first letters of her name on a piece of paper. Illiterate, the former maid cultivated the dream of learning to write her signature when the Abrigo João Paulo II, where she lives in Marituba, Pará, decided to implement classes on site. Enrolled since then in the literacy class of the unit, today, about to turn 92, Maria is the oldest student in Brazil to take classes in a hospital class, according to the 2017 School Census.
— All I wanted was to have gone to college, unfortunately it didn’t work out. But today after all these years, I’m a student. It’s never too late to learn, just want to – he told GLOBO in an interview
If the chances of studying were already restricted to their social class, with forced isolation, it became even more difficult. And for a long time, Maria left the urge to learn asleep. (O GLOBO, online)
These reports collected in different hospitals, within different contexts, reflect how much 21st century education positively impacts the life of hospitalized adults contributing to citizenship and dignity because it is made up of innovative practices that transform society.
4. FINAL CONSIDERATIONS
If in the History of Education, there are, on the one hand, the ruptures of values that sometimes are for a model of education and sometimes for another; on the other hand, they make it clear that only an integral education is capable of promoting and freeing consciences at any time and place. The education of this new century offers powerful pedagogical practices to meet this objective and recognizes that the assimilation of knowledge involves the senses and perceptions, which means that it is not related to the age of the individual and, yes, to the stimuli he receives, and that by receiving these stimuli, this individual opens up to new knowledge that leads him to new concepts and , from this movement new connections are forming in a continuous, reflective and renewing movement.
Paulo Freire, Norman Doidge and Malcolm Knowles represent some of the modern forerunners with proposals for the development of an integral education and have produced a deep legacy untout of new perspectives for the sublime art of learning to learn in which the hospitalized adult can and should be included.
The education of the 21st century calls for the expansion of the sensitive and humanized look at pedagogical care in all modalities of education, and especially to the adult who is hospitalized.
Within this perspective, the hospital pedagogue of this new century assumes the role of facilitator of learning and is face with a new challenge: to include the andragogic student in hospital pedagogical care.
It is known that there is much to be done in terms of education and continuing education, but for these transformations to take place, it is enough for now to take the first step towards a liberating and quality education.
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APPENDIX – FOOTNOTE REFERENCE
2. MU-V.UC. A: the term VUCA arose in the 1990s, being introduced into the American military vocabulary, in order to explain the occurrence of the events of today’s world, characterized by an unstable, aggressive and challenging space. Given the following question, how can we move in this world? VUCA has also been used in many organizations, due to overlapping requirements when dealing with complex and dynamic change scenarios.
[1] Graduated in Pedagogy.
Submitted: September, 2020.
Approved: October, 2020.
