Expressions of violence in the university environment the view of nursing students
The aim of this qualitative descriptive exploratory study was to investigate the perception of nursing undergraduate students on the forms of expression of violence in the college environment. Data were collected using semi structured interviews. The collected data were submitted to the thematic content analysis, and led to the construction of three categories: "interpersonal violence in the relationships established in the course" "participation as a victim or perpetrator" and "reasons for the incidence of violence" The findings highlight inequalities in the relationships of power, the incidence of different types of violence and the tendency to naturalize them. Results point to the need to create a system to make it easier to report cases of abuse and offer support to the victims; to invest in intervention programs to raise awareness on the subject, improve academic relationships and prevent mistreatment; and to include the violence subject in the course program. Descriptors: Violence; Education, Higher; Education, Nursing; Students, Nursing; Mental Health. RESUMO Estudo qualitativo, descritivo, exploratorio que investigou a percepcao de estudantes de enfermagem sobre as formas de manifestacao de violencia no ambiente universitario. Para a coleta de dados, utilizou se entrevista semiestruturada. Os dados submetidos a analise de conteudo, modalidade tematica, permitiram construir tres categorias: "violencia interpessoal nos relacionamentos estabelecidos no curso" "participacao como vitima ou perpetradora" e "razoes para a ocorrencia da violencia" Os achados destacam desigualdades nas relacoes de poder e ocorrencia de diferentes tipos de violencia e tendencia na naturalizacao desses. Os resultados apontam necessidade de criacao de sistema que facilite a denuncia de abusos e ofereca apoio as vitimas; investimento em programas de intervencao que conscientizem sobre o tema, melhorem as relacoes academicas e previnam maus tratos; inclusao do tema violencia nos curriculos. Descritores: Violencia; Educacao Superior; Educacao em Enfermagem; Estudantes de Enfermagem; Saude Mental. Scherer ZAP, Scherer EA, Rossi PT, Vedana KGG, Cavalin LA. Rev. Eletr. Enf. [Internet] 2015 jan/mar;17(1) Available from: http:/dx.doi.org/10.5216/ree.v17i1.22983. 2 INTRODUCTION In recent decades, violence has become object of study of scientific research and ongoing discussions by society. Violence in the workplace is one of the situations that have been receiving increasing attention. It may affect any professional category in virtually any sector. Due to the characteristics of the service provided and the work environment, professionals in the health sector are subject to pressures for reform, the necessity of overtime and extended work shifts, and demoralization. In addition, the results of increased domestic and street violence are reaching health facilities. As a consequence of this widespread violence, deterioration in the quality of patient care occurs, and professionals end up quitting their jobs; this may lead to reduced services and increased healthcare costs. Given this reality, in 2002 the International Labour Office, the International Council of Nurses, the World Health Organization and Public Services International jointly developed the "Framework Guidelines for Addressing Workplace Violence in the Health Sector," which provides important strategies for dealing with violence. Educational institutions, in turn, play an important role in society; they constitute a place for education, socialization and professional formation of individuals. The adjustment of students to the academic environment is a complex, multidimensional, multifaceted process based on the daily relations established between students and institutions; it can be enhanced or impaired. Higher education institutions in particular constitute an educational system that is linked to the enhancement of self assertion expressed in relations of power, control and domination (prevalent standards in our society) based on competitive and coercive behavior rather than cooperation. The reproduction of social inequalities between students, professors and other professionals in the university environment facilitates the occurrence of violence, which is often seen as a natural behavior and often underestimated or ignored. Among healthcare professionals, nurses are often exposed to violent situations in their workplace, negatively affecting their performance. They occupy the first position in the ranking of victims of such violence in comparison to other professions in the healthcare area. Some professionals even quit their careers. The literature shows that from the beginning of their formation, while they are still nursing students, they are victims of various acts of aggression. At the university, affection in the professor student relationship and practicing skills in controlled situations may contribute to preparing students to deal with professional requirements and responsibilities. On the other hand, coercive actions perceived as violent may result in damage to the development of learners, expressed by lack of interest, reduced willingness to learn and work, absenteeism, delays, dropouts and symptoms of anxiety and depression. Therefore our question is: How do professor student, professional student and student student relationships occur? Are students able to identify the types of violence that occur in the academic environment? What is the impact on their learning, professional performance and health condition (physical and mental) In this sense, knowledge about what nursing undergraduate students know or experience in terms of violence in different environments within the university may provide material to facilitate understanding of how it happens. Likewise, clarifying the objectives behind it will enable future professionals to develop the competencies and skills necessary to manage the social reality that they will face, that is, the operation in healthcare services of recognition, assistance and care for victims of violence. Given the above, in this study we investigated the perception of nursing students about different expressions of violence in the university environment. METHOD Qualitative descriptive exploratory study with the participation of 13 unmarried female students between Scherer ZAP, Scherer EA, Rossi PT, Vedana KGG, Cavalin LA. Rev. Eletr. Enf. [Internet] 2015 jan/mar;17(1) Available from: http:/dx.doi.org/10.5216/ree.v17i1.22983. 3 20 and 31 years old who are attending the third year of the nursing bachelor course of a public higher education institution in the state of Sao Paulo, Brazil. The selection of the participants was random. From the attendance list for the third year class (total of 76 students) we used the criterion of arithmetic progression of ratio 5 counted from the first name of the list. When any of the selected students declined to participate in the study, we selected the following or previous name on the list, respectively. The definition of this purposive sampling was based on closure by the theoretical saturation technique, that is, the inclusion of new participants was suspended when the obtained data became redundant or repetitive, adding no relevant information to the understanding of the phenomenon under study. Third year students of the course were chosen because they presented greater experience in the academic environment and contact with the profession. There were no exclusion criteria. A semi structured interview, previously developed and submitted to appraisal by three judges, was used to collect the data. The questions included identification data for the participants and their knowledge about violence and its occurrence in the university context. The individuals were interviewed from June to September 2010 in private rooms and on previously set schedules, without any loss in participation of the students in their academic activities. The duration of each interview ranged from 20 to 45 minutes. The interviews were recorded and subsequently transcribed and submitted to thematic content analysis. We read the transcripts and tried to identify the meaning units, sorting them into conceptual categories according to analog reunification. Subsequently, we articulated the empirical material with the literature. In order to provide a representative view of the studied contents and support the discussion, we introduced excerpts from the interviews, identified with the letter "E" followed by the number corresponding to the order in which they were conducted. This procedure aimed to ensure the anonymity of the individuals. The project that originated the research was approved by the Research Ethics Committee of the studied institution (Protocol 1033/2009) and all the participants signed the Free and Informed Consent Form. RESULTS AND DISCUSSION All 13 students interviewed identified the occurrence of interpersonal psychological violence in their course. Four of them also mentioned episodes of physical violence, and one mentioned a situation of self inflicted negligence. The content analysis of the transcribed material allowed the identification of empirical categories that were configured as major themes of analysis. Thus, the three categories were: "interpersonal violence in relationships established in the course" "participation as victim or perpetrator" and "reasons for the occurrence of violence." These were described and exemplified with excerpts from the speech of the interviewed students. Interpersonal violence in relationships established in the course Of the total of participants, 7 reported having witnessed situations of violence involving colleagues, and 6 mentioned having just heard such reports. They mentioned professors, professionals in internship fields and colleagues as perpetrators. The university environment is different from the environment that the students had contact with in their previo