NURSING SUPPORT IN THE INCLUSIVE EDUCATION OF CHILDREN AND ADOLESCENTS WITH DISABILITIES: EXPERIENCE REPORT
APOYO DE ENFERMERÍA EN LA EDUCACIÓN INCLUSIVA DE NIÑOS Y ADOLESCENTES CON DISCAPACIDAD: RELATO DE EXPERIENCIA
APOIO DE ENFERMAGEM NA EDUCAÇÃO INCLUSIVA DE CRIANÇAS E ADOLESCENTES COM DEFICIÊNCIA: RELATO DE EXPERIÊNCIA
https://doi.org/10.31011/reaid-2024-v.98-n.1-art.1900
Letícia Viana dos Santos1*
Mateus Ibiapina Vaz de Sousa Cruz2
Nanielle Silva Barbosa3
Amanda Alves de Alencar Ribeiro4
Rosa Jordana Carvalho5
Ítalo Arão Pereira Ribeiro6
Eukália Pereira da Rocha7
Márcia Astrês Fernandes8
1 Federal University of Piaui. Teresina, Brazil. ORCID: https://orcid.org/0000-0003-3923-9994
2 Federal University of Piaui. Teresina, Brazil. ORCID: https://orcid.org/0000-0002-0774-8340
3 Federal University of Piaui. Teresina, Brazil. ORCID: https://orcid.org/0000-0001-5758-2011
4 Federal University of Piaui. Teresina, Brazil. ORCID: https://orcid.org/0000-0002-5729-6063
5 Maurício de Nassau University Center. São Raimundo Nonato, Brazil. ORCID: https://orcid.org/0000-0003-4118-8591
6 Federal University of Piaui. Teresina, Brazil. ORCID: https://orcid.org/0000-0003-0778-1447
7 Federal University of Piaui. Teresina, Brazil. ORCID: https://orcid.org/0000-0003-2588-2639
8 Federal University of Piaui. Teresina, Brazil. ORCID: https://orcid.org/0000-0001-9781-0752
*Corresponding author
Letícia Viana dos Santos
Department of Postgraduate Nursing. Federal University of Piaui. Minister Petrônio Portella University Campus.
Ininga neighborhood. ZIP code: 64049-550. Teresina, Piauí, Brazil. Email: leticiawviana@gmail.com. Telephone: +55 86 3215-5558
Submission: 14-06-2023
Approval: 18-03-2024
ABSTRACT
Objective: to report the experience of nursing students in supporting inclusive education for children and adolescents with disabilities. Method: experience report experienced by nursing students during a non-mandatory internship aimed at supporting the inclusion of children and adolescents with disabilities and developmental disorders in public teaching units in Teresina - PI, from November 2021 to February 2023. Results: during the internship, activities were carried out, such as table games and the use of images for sensory stimulation, aiming at improving students' learning, which resulted in the progress of communication skills, independence, concentration and focus, spatial awareness, development neurological and psychomotor, as well as logical reasoning and memory. Final Considerations: the internship contributed to understanding the role of nursing in a role that it rarely occupies, that of a support professional, enabling debates concerning health in the educational space.
Keywords: Nursing Care; Disabled Persons; Mainstreaming, Education.
RESUMEN
Objetivo: relatar la experiencia de estudiantes de enfermería en el apoyo a la educación inclusiva de niños y adolescentes con discapacidad. Método: relato de experiencia vivido por estudiantes de enfermería durante una pasantía no obligatoria dirigida a apoyar la inclusión de niños y adolescentes con discapacidad y trastornos del desarrollo en las unidades públicas de enseñanza en Teresina - PI, de noviembre de 2021 a febrero de 2023. Resultados: durante la pasantía, Se realizaron actividades, como juegos de mesa y uso de imágenes para la estimulación sensorial, con el objetivo de mejorar el aprendizaje de los estudiantes, lo que resultó en el progreso de las habilidades de comunicación, independencia, concentración y enfoque, conciencia espacial, desarrollo neurológico y psicomotor, así como como el razonamiento lógico y la memoria. Consideraciones finales: la pasantía contribuyó a comprender el papel de la enfermería en un papel que rara vez ocupa, el de profesional de apoyo, posibilitando debates sobre la salud en el espacio educativo.
Palabras clave: Atención de Enfermería; Personas con Discapacidad; Integración Escolar.
RESUMO
Objetivo: relatar a experiência de acadêmicos de enfermagem no apoio à educação inclusiva de crianças e adolescentes com deficiência. Método: relato de experiência vivenciado por acadêmicos de enfermagem durante estágio não obrigatório direcionado ao apoio à inclusão de crianças e adolescentes com deficiência e transtornos de desenvolvimento em unidades públicas de ensino de Teresina - PI, no período de novembro de 2021 a fevereiro de 2023. Resultados: no decorrer do estágio foram realizadas atividades, como jogos de mesa e uso de imagens para estímulo sensorial, visando a melhoria da aprendizagem dos estudantes, o que resultou no progresso das habilidades de comunicação, independência, concentração e foco, noção espacial, desenvolvimento neurológico e psicomotor, além de raciocínio lógico e memória. Considerações Finais: o estágio contribuiu para compreender a atuação da enfermagem em uma função que raramente ocupa, a de profissional de apoio, viabilizando no espaço educacional debates concernentes à saúde.
Palavras-chave: Cuidados de Enfermagem; Pessoas com Deficiência; Inclusão Escolar.
INTRODUCTION
In Brazil, education is a legal right guaranteed by the 1988 Federal Constitution and must be ensured by the State, family and promoted by the entire society. The right to education aims at the democratization of education and the State has the duty to offer primary and secondary education, compulsory and free, from four to seventeen years of age, also being responsible for specialized care for children and adolescents with disability, preferably in regular education1.
Figures show that, in Brazil, around 6.6 million children and adolescents up to the age of 17 have some type of disability, with approximately 400 thousand children up to the age of 14 having intellectual/mental disabilities2. In this scenario, inclusive education brings with it changes in the values of traditional education. It is a model based on human rights, making an intrinsic association between equality and difference, rebuking prejudiced notions and progressing in discussions of equity and abandonment of exclusionary thinking3.
However, inclusive education still faces some difficulties in its consolidation. While 30.9% of the population without disabilities has no education or only primary education, this percentage reaches 67.6% in the population with disabilities4. Some of the main obstacles to its implementation concern the lack of in-depth discussion on the topic in school Pedagogical Projects (PPs), the difficulty of dialogue between the teacher and the student, the lack of accessibility in schools, the traditional teaching methodologies used in education regularity and the presence of prejudice and indifference on the part of society5.
From the 90s onwards, movements emerged that advanced discussions about the effectiveness and means of implementing inclusive education. It is worth highlighting the World Conference on Education for All (1990), in which Brazil, through the World Declaration on Education for All, committed to establishing the guarantee of the universalization of the right to education, the introduction of the itinerant teacher in the state of Goiás (which was gradually replaced by support professionals) and the institution of an assistant to assist teachers who worked with students with disabilities6.
In 2015, with the Brazilian Law on the Inclusion of Persons with Disabilities, the concept of the support professional was defined as a “person who carries out feeding, hygiene and mobility activities for students with disabilities and works in all school activities in which they are involved.” as necessary, at all levels and types of education”. This professional can join both public and private institutions, as long as they do not carry out technical activities or activities duly regulated by other professions7.
As it is a recent professional occupation, some questions still persist, mainly regarding their performance and level of education, in addition to the real effectiveness of the inclusion promoted through this support. It is also argued that the function has been carried out randomly and without well-defined criteria, which allows the inclusion of groups without specific qualifications, from high school students to family members of people with disabilities. From the above, it is evident the importance of developing more specific and representative regulations that define the practical work issues of this occupation, governing the responsibilities of these professionals, their relationship with teachers and the construction of collaborative work, among other premises8.
In this context, the relevance of this study lies in its ability to recover, based on the experience of academics, a current panorama of the reality of the dimension that the support professional occupies within inclusive education. Through the study, it will be possible to obtain contributions regarding the particularities of inclusive education, notably on the articulation between inclusion and support professionals and on how this educational modality can provide equal conditions for children and adolescents with disabilities.
Based on the above, the objective of the present study is to report the experience of nursing students in supporting the inclusive education of children and adolescents with disabilities enrolled in basic and fundamental education in public units in the city of Teresina, Piauí.
METHODS
This is a descriptive study with a qualitative approach, of the experience report type, experienced by students of the nursing course at the Federal University of Piauí, in the period between November 2021 and February 2023, during the practical activities of students in the internship. -mandatory linked to the Municipal Department of Education (SEMEC) of Teresina/PI and aimed at supporting the inclusion of children and adolescents with disabilities and developmental disorders, aged between 2 and 14 years, in public schools and daycare centers in the municipality.
This experience report was constructed in accordance with the guidelines of Resolutions 466/2012 and 510/2016, of the National Health Council, and developed without any type of procedure or intervention for scientific research purposes, therefore dispensing with the assessment ethics through the CEP/CONEP system.
RESULTS E DISCUSSION
The support professional is an occupation considered recent and only better elucidated through the publication of the Brazilian Law for the Inclusion of Persons with Disabilities, of 20157. Even more recent, the appropriation of this function by the nursing area has been built from the implementation of assistance following the essential principles of care, contributing to achieving social inclusion and maximum development of the potential of people with disabilities. The main responsibility refers to assistance to students with regard to mobility, hygiene and food9.
Although it is not yet a completely clear role, the support professional has an important role in the school life of students with disabilities. Its implementation is generally made possible through demand raised in educational units and, in the case of public schools, through a request from the assistant to the education department. It was through this procedure that the academics were selected to hold positions in two schools in Teresina10.
As part of the initial stages of initial recognition and formalization of the contractual relationship, academics were encouraged to go to the internship location and meet the children and adolescents for whom support had been designated. Thus, the students experienced their first contact with the practical reality of inclusion in basic public education.
In a short time, it was possible to realize that, for the support area, there is a high demand that cannot be completely met. In part, due to the perception of the teachers at the teaching units themselves, who consider that there is a growing number of children with disabilities enrolled in early childhood education, which tends to require greater numbers of support professionals. On the other hand, regarding school inclusion, the discussion about disabilities and/or disorders diagnosed in childhood is still notoriously recent and, as a consequence, the guidelines that establish the functions to be performed by this professional are also incipient.
During training offered by the municipality's SEMEC, important aspects related to inclusive education were discussed, such as the historicity and stigma that people with developmental disorders and/or disabilities inevitably carry with them. The responsibilities of the support professional and the guidelines that ensure them were also explained, and it was made clear to all present that the fundamental principle is to facilitate accessibility for students with disabilities, aiming for their inclusion in the classroom in the best possible way, without the primary exercise of any other pedagogical activities.
From this discussion, it was possible to verify, through reports from other interns, that the limited amount of information about the support professional associated with still recent legislation causes some disorganization in the delimitation of tasks and responsibilities, which can occur from the request to academics for the development of pedagogical activities – which is far from the responsibilities of the support professional position – to reports on classes taught in elementary school classes. Thus, inclusion activities become the backdrop for carrying out the pedagogical agenda.
The educational institutions where this study was carried out had professionals willing to work as a team to promote a conducive environment, in which inclusion actually took place. Therefore, in consensus with the teachers and the schools' administrative staff, the academics chose to research in advance what would best fit the situation of the students assigned to them. The research focused on scientific articles on children and adolescents with disabilities, neuroatypical children and, more specifically, on visual impairment, Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD), as the three The latter stood out in the school scenario11.
Given the characteristics that accompany ASD and ADHD, the importance of including people with these disorders in common education requires strategies that prioritize psychomotor, sensorimotor, cognitive and affective education, starting in early childhood education. It is necessary to be aware of these characteristics so that plans and actions to aid school inclusion can be developed. The needs required by these disorders differ from the demands correlated to visual impairment, as this concerns individuals with mild loss up to blindness, according to visual acuity and/or campimetry measurements12.
Understanding the essential aspects of these conditions, academics carried out research into interventionist aspects, including the way children and adolescents organized themselves in the classroom, as the environment itself could become a stressful factor for them. In addition, educational strategies and materials to enhance focus could be easily found on blogs managed by specialists in child behavior, such as the blogs Espaço do Professor and Daniela Freitas13-14, and also on the Telegram platform, using terms of interest, such as “ teaching contents” and “school development”, through the “search” function, serving as a research source.
After reading and discussing the content raised, it was understood that, in addition to the focus, it would also be necessary to work on basic issues already inherent to the context of childhood and adolescence, such as encouraging autonomy and independence, within the limits that the condition of each student would allow. Although the professional's principle is to always assist the student, it is important that the student is able to complete their tasks alone.
To avoid overlapping of functions, such activities were organized by the teachers and put into practice with the collaboration of academics, which contributed to the democratization of teaching, since the attention directed only to that particular child or adolescent could not be done without the help from an exclusive support professional.
Furthermore, within the school routine there are many obstacles, which force the support professional to go beyond their basic functions, starting to provide assistance in tasks that the student is not able to perform without help in the classroom, such as: help to hold the pencil correctly or more precise guidance on what needed to be done in pedagogical activities. Outside the classroom, it was often necessary to participate in activities together.
The perception of students' low interactivity in long-term activities was extremely important. Taking into account that children, especially, soon lost focus on what had been proposed and were no longer interested in continuing, as they could easily become bored. Small tasks or larger tasks subdivided into smaller ones were proposed, in order to encourage interaction with other colleagues in simple activities such as, for example, distributing teaching material in the class. It was necessary to value them, through praise, simplified instructions, moments of responsibility and encouragement, as well as objective language, avoiding connotations.
In the case of students with visual impairments, adapted table games were used, such as checkers and dominoes, in addition to encouraging writing in Braille, a tactile writing and reading system, in high relief. This system uses its own code that requires the use of instruments such as the reglete, a special ruler with code spaces that correspond to letters; and the punch, a material similar to a stylus, which allows marking the points of writing on the paper15. Other materials, such as paints, brushes, modeling clay and puzzles were also useful in this process.
Among the other activities, we can highlight board games and adapted puzzles. In the latter, an image of the child himself was printed in the shape of the pieces so that he could put them together and organize/assemble himself. The strategy therefore contributed to the child's integral development, as it stimulated cognitive skills, such as the ability to concentrate and focus, spatial awareness, neurological and psychomotor development, as well as logical reasoning and memory.
In moments of crisis, which occurred mainly at the beginning of the academics' contact with the school, one of the means used to manage the situation was to reduce external stimulus, removing the child from the place that caused the crisis and taking them to another with less stimulus. visual, auditory or noise. For some children, receiving massages on the back and back of the head proved equally calming; for others, active listening was most effective. However, it was not always effective, as finding out what really helped was a different process for each child.
At the end of the internship period, the students were able to evaluate the changes caused by the strategies that were developed while working as support professionals. Children who previously were unable to perform basic activities such as going to the bathroom without a companion or holding a pencil correctly, for example, were now able to do them; and children who were unable to stay in the classroom for a long time began to stay as long as necessary to participate in activities without this triggering stressful situations. Among the most notable changes is the evolution of communication and socialization skills with other children, increasing self-confidence and independence.
Among the limitations of the study, conflicts over the support professional's responsibilities stand out, which, even though they are established by law, are not completely widespread and common sense, so that the educational institutions themselves tended to disagree about them. Due to limited resources, some activities were made unfeasible due to the unavailability of materials for use in the units and immediate acquisition. Although it was not the academics' first contact with elementary education, it was their first contact with early childhood education, which, combined with a restricted literature on the contribution of nursing to school inclusion and the occasional lack of resources, became an obstacle .
It is also possible to list the break in the continuity of implemented strategies due to student absences for health reasons or other issues not specified by those responsible, and also due to school dropout. The abrupt breaking of the bond with the educational institution, in addition to the delay in learning, also hampered the development of social skills, especially for children with ASD, as they are linked to predictability and do not react well to changes in routine.
It was understood, therefore, that the role of Nursing within the school context to improve the inclusion of children with some type of disability is of notable importance, as it has the technical-scientific knowledge to provide the necessary care to meet demands. This relevance is evidenced by encouraging self-care, without excluding the patient's difficulties, but increasing their degree of autonomy, independence and the development of their skills and potential. This field of action is rich for the development of the profession as it allows contact with a client who is different in terms of their needs and, thus, encourages these professionals to seek greater qualifications to serve them with humanized, individualized and inclusive assistance.
Considering these issues, the study has the potential to contribute to future discussions about the impact of support professionals in the school environment on the development and strengthening of the autonomy of children and adolescents with disabilities. It also allows a better understanding of how nursing can fit into this space and improve the quality of health care provided to these historically marginalized groups, through the qualification and humanization of care.
FINAL CONSIDERATIONS
The experience contributed to the maturity of academics in an integral way, enabling the association between theoretical knowledge studied during graduation and its practical applications in the exercise of support professional activities, a role rarely occupied by nursing. This action facilitates debates concerning health in the educational space, contributing to monitoring, stimulating autonomy, in addition to encouraging dialogue with families about safe development and social relationships.
Furthermore, the activities carried out strengthened the understanding of the adversities that people with developmental disorders and disabilities face, raising awareness about the role of other people in society and how they can contribute to the academic and social training of this part of the population. Since, for the effective exercise of the right and guaranteeing education for all, it is extremely important to expand discussions on inclusive education, which are still limited in many educational institutions, including higher education ones.
Given the material found in the literature, the need for new studies in the area is highlighted, which seek to investigate in more depth the role of the support professional, how nursing can be inserted in these scenarios, the perception of educators about the insertion of these professionals , as well as the difficulties faced.
REFERENCES
1. Brasil. [Constituição (1988)]. Constituição da República Federativa do Brasil [Internet]. Brasília, DF: Senado Federal; 2016 [acesso em: 26 set. 2022]. 454 p. Disponível em: https://www2.senado.gov.br/bdsf/handle/id/603955
2. Instituto Brasileiro de Geografia e Estatística [homepage na internet]. Censo Demográfico 2010. Características gerais da população, religião e pessoas com deficiência [acesso em 18 mar 2023]. Disponível em: https://biblioteca.ibge.gov.br/visualizacao/periodicos/94/cd_2010_religiao_deficiencia.pdf
3. Ministério da Educação (BR). Política Nacional da Educação Especial na Perspectiva da Inclusão [Internet]. Brasília: MEC/Seesp; 2008 [acesso em: 26 set 2022]. Disponível em: http://portal.mec.gov.br/arquivos/pdf/politicaeducespecial.pdf
4. Instituto Brasileiro de Geografia e Estatística [homepage na internet]. Pesquisa Nacional de Saúde 2019 [acesso em: 18 mar 2023]. Disponível em: https://www.pns.icict.fiocruz.br/wp-content/uploads/2021/12/liv101846.pdf
5. Barros AB, Silva SMM da, Costa M da PR da. Dificuldades no processo de inclusão escolar: percepções de professores e de alunos com deficiência visual em escolas públicas. Boletim - Academia Paulista de Psicologia [Internet]. 2015 Jan 1 [acesso em: 27 set 2023];35(88):145–63. Disponível em: http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S1415-711X2015000100010
6. Picolini BRA, Lopes Flores MM. Professor de apoio, professor regente e práticas pedagógicas inclusivas. RPPoi [Internet]. 2021 [acesso em: 25 set 2022];19(Edição contínua). Disponível em: https://periodicos.ufcat.edu.br/poiesis/article/view/63715
7. Brasil. Lei nº 13.146, de 6 de julho de 2015. Institui a Lei Brasileira de Inclusão da Pessoa com Deficiência (Estatuto da Pessoa com Deficiência). Diário Oficial da União 7 jul 2015; (127 seção 1). Disponível em: https://www.planalto.gov.br/ccivil_03/_ato2015-2018/2015/lei/l13146.htm
8. Lima JR de M, Carvalho LC de O, Tizzo VS. Sobre potencialidades da inclusão: a atuação do profissional de apoio frente ao bullying. Cadernos da FUCAMP [Internet]. 2022 [acesso em: 28 set 2022];21(50). Disponível em: https://revistas.fucamp.edu.br/index.php/cadernos/article/view/2621
9. Da Silva Pereira RS, Martins MM, Alves Machado WC, Pereira AI, da Silva Pereira AM, Chesani FH. Cuidados de Enfermagem para a inclusão social da pessoa com deficiência física adquirida: revisão integrativa. Revista Portuguesa de Enfermagem de Reabilitação. 2020 Dec 15;3(2):86–95. Disponivel em: https://doi.org/10.33194/rper.2020.v3.n2.13.5827
10. Secretaria Municipal de Ensino (Teresina). Edital nº 008/2021. Processo seletivo simplificado para seleção e admissão de estagiários de nível médio/técnico e superior. 2021 [acesso em: 25 set 2022]. Disponível em: https://semec.pmt.pi.gov.br/wp-content/uploads/sites/46/2021/07/Edital_para_Estagia%CC%81rio_vers%C3%A3o-final-1.pdf
11. Sousa DAD. A inclusão de alunos com transtorno de déficit de atenção e hiperatividade no ensino fundamental I: contestações envolvendo os diagnósticos. 2023. Disponível em: http://192.100.247.84/bitstream/prefix/2560/1/Amanda%20Regina%20Bernardes.pdf
12. Brasil. Diretrizes de Atenção à Saúde Ocular na Infância: detecção e intervenção precoce para prevenção de deficiências visuais. Ministério da Saúde; 2016; 1-46. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_atencao_saude_ocular_infancia.pdf
13. Freitas D. Daniela Freitas. Autismo e qualidade de vida da família [Internet]. Blog | Daniela Freitas. Disponível em: https://daniacf.com/category/blog/. Disponível em: https://openrit.grupotiradentes.com/xmlui/bitstream/handle/set/3299/QUALIDADE%20DE%20VIDA%20DAS%20FAM%C3%8DLIAS%20DE%20CRIAN%C3%87AS%20NO%20ESPECTRO%20DO%20AUTISMO.pdf?sequence=1&isAllowed=y
14. Teixeira K. Espaço do Professor [Internet]. Espaço do Professor. Disponível em: https://www.espacoprofessor.com/
15. Sonza AP, Salton BP, Carniel E. Tecnologia assistiva como agenda de inclusão de pessoas com deficiência visual. Benjamin Constant [Internet]. 2016; (Especial). Disponível em: http://revista.ibc.gov.br/index.php/BC/article/view/338
Promotion and Thanks:
Federal University of Piauí (UFPI). Teresina Municipal Department of Education.
Authorship criteria (author contributions)
Letícia Viana dos Santos: contributed substantially to the conception and/or planning of the study; obtaining, analyzing and/or interpreting data; writing and/or critical review and final approval of the published version. Mateus Ibiapina Vaz de Sousa Cruz: contributed substantially to the conception and/or planning of the study; obtaining, analyzing and/or interpreting data; writing and/or critical review and final approval of the published version. Nanielle Silva Barbosa: obtaining, analyzing and/or interpreting data; writing and/or critical review and final approval of the published version. Amanda Alves de Alencar Ribeiro: obtaining, analyzing and/or interpreting data; writing and/or critical review and final approval of the published version. Rosa Jordana Carvalho: obtaining, analyzing and/or interpreting data; writing and/or critical review and final approval of the published version. Ítalo Arão Pereira Ribeiro: writing and/or critical review and final approval of the published version. Eukália Pereira da Rocha: writing and/or critical review and final approval of the published version. contributed substantially to the conception and/or planning of the study; Márcia Astrês Fernandes: writing and/or critical review and final approval of the published version.
Declaration of conflict of interest
Nothing to declare.
Scientífic Editor: Francisco Mayron Morais Soares. Orcid: https://orcid.org/0000-0001-7316-2519
Associate Editor: Edirlei Machado dos-Santos. Orcid: https://orcid.org/0000-0002-1221-0377
Rev
Enferm Atual In Derme 2024;98(1): e024281