Educational game: an instrument for the
promotion of a health care of people with hypertension
Jogo educativo: um instrumento para a promoção do cuidado à saúde de pessoas com hipertensão arterial
El juego educativo: un instrumento para la promoción del cuidado de la salud de personas con hipertensión arterial
*Doutoranda em Memória pela Universidade Estadual do Sudoeste da Bahia (UESB)
Mestre em Enfermagem e Saúde pela UESB. Docente do Departamento de Saúde da UESB
**Mestre em Enfermagem e Saúde pela UESB. Docente do Curso de Educação Física da UESB
***PhD em Bioética pela Universidade Católica Portuguesa
Docente do Programa de Pós Graduação em Enfermagem e Saúde da UESB
****Doutora em Educação pela Universidade Federal da Bahia
Docente do Programa de Pós Graduação em Enfermagem e Saúde da UESB
Valeria Alves da Silva Nery*
Ramon Missias Moreira**
Sâmia da Costa Ribeiro Teixeira**
Rita Narriman da Silva Oliveira Boery***
Ana Cristina Santos Duarte****
This paper describes and discusses an educational strategy developed in a school for nursing assistants and technicians, located in the city of Jequie in the state of Bahia, whose goal was to encourage individuals to reflect on their knowledge of hypertension and the importance health education carried out among people with hypertension, characterized as an instrument of education from the perspective of health promotion, prevention and control. For this purpose, a dynamic student-professional interaction, this was based on the use of educational games in groups. The content used to systematize the dynamics was: general guidance on hypertension, concept, diagnosis, risk factors, prevention, treatment, complications and health education and use of educational materials for communication and learning (game). The strategy enabled the construction of knowledge by the participants, the exchange of experiences between them, beyond understanding and a greater understanding of the individual experience of illness by health professionals and students.
Keywords: Hypertension; Health Education; Educational Games.
O presente trabalho descreve e discute uma estratégia educativa desenvolvida em uma escola de formação de Auxiliares e Técnicos de Enfermagem, situada na cidade de Jequié, no estado da Bahia, cujo objetivo foi estimular o indivíduo a refletir sobre seus conhecimentos acerca da hipertensão arterial e a importância da educação em saúde realizada junto a pessoas com Hipertensão, caracterizando-se como um instrumento de educação em saúde sob uma perspectiva de promoção, prevenção e controle. Para tal, foi implementada uma dinâmica de interação profissional-estudante, que teve por base o uso de jogo educativo em grupos. Os conteúdos utilizados para a sistematização da dinâmica foram: orientação geral em hipertensão, conceito, diagnóstico, fatores de risco, prevenção, tratamento, complicações e educação em saúde e uso de material educativo de comunicação e aprendizagem (jogo). A estratégia utilizada possibilitou a construção do conhecimento pelos participantes, a troca de vivências entre os mesmos, além do entendimento e maior compreensão acerca da experiência individual da doença pelo profissional de saúde e estudantes.
Unitermos: Hipertensão. Educação em saúde. Jogos educativos.
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This article presents the experience of an educational activity conducted by an educational game, developed with a group of students in a School of Nursing auxiliaries and technicians, city Jequie, Bahia. The experience is based on a Constructivist Approach Interactions, based on the use of educational games and learning strategy.
The use of educational games in the learning process and the interaction between education and health, requires the development of an active subject when interacting with users of health can help them build a lifestyle related to their disease, contributing thus to improve the quality of life of users.
The concept of health approved the Constitution of 1988 points to a progressive shift of health services, passing a healthcare model focuses on disease-based and service to those who seek for a model of integrated health care, where there is progressive incorporation the promotion and protection, beside those proper recovery (BRASIL, 1988).
It is understood well, for health education in a field of practices that take place on the level of social relationships usually established by health professionals together with the institution, and especially with the user in developing their everyday activities. One can not think health services without reflecting on the relationships between these actors or subjects, since any health care involves at least the interaction between two people.
We understand that the game is a strategy that facilitates the exchange of experiences and the development of health education through playful activities, noting that this strategy should be inserted in the educational practices developed by health professionals in their work process in care users of health services among these patients with Hypertension.
Hypertension is a major health problem that usually occurs in adulthood and is accentuating the cases of death from cardiovascular disease (BRASIL, 2006). Educational activities undertaken by the Primary care in people with high blood pressure is, therefore, of great importance, since their carriers require full attention aimed at quality of life through health promotion, disease control and prevention complications.
Thus, in this study we used a strategy of using educational games, as we believe that the development of health education activities through educational games becomes more enjoyable, since the play activity inhibits, encouraging people to propose justify and defend something they believe, thus facilitating the teaching - learning process that aims to raise awareness of prevention and care before a grievance health.
Thus we have the general objective: To assess the understanding of nursing students about hypertension and educational activities in the care of people with hypertension, using an educational game as a means of health education. And, as specific objectives: check the knowledge of nursing students as hypertension (concept, factors, preventive care, treatment, complications); assess the implementation of educational games in teaching-learning process in health education.
This study is important to know and to promote understanding of students about the importance of carrying out health education to the quality of life of patients with Hypertension. Besides the possibility of similar contribution to the understanding of educational activities for hypertension present in relationships that are in the process of job aids and nursing technicians in the construction of knowledge and practices to develop joint projects for social transformation, and also the ability to contribute to the training in healthcare.
Also, seek prompt a new look from students, future health workers, about understanding how is education in the context of human rights to health, thus becoming fertile ground for reflections of the process of health education, the from hypertension and its contribution to a possible modification of the behavior of the community, which can provide them a better quality of life, benefiting their health situation and allowing the promotion, prevention and reduction of morbidity and complications of hypertension.
Arterial Hypertension (HBP) is a serious public health problem in Brazil and worldwide. She is one of the most important risk factors for the development of cardiovascular, cerebrovascular and renal, accounting for at least 40% of deaths from stroke by 25% of deaths from coronary heart disease and, in combination with diabetes 50% of cases of ESRD. With the current diagnostic criteria of hypertension (BP 140/90 mmHg), the prevalence in the urban adult population ranges from 22.3% to 43.9%, depending on the city where the study was conducted. The main relevance of the identification and control of hypertension is the reduction of its complications, such as cerebrovascular disease, coronary artery disease, heart failure, chronic kidney disease, peripheral arterial disease (BRASIL, 2006).
Epidemiological studies in Brazil have shown that hypertension affects 11-20% of the adult population over 20 years (BRASIL, 2001). The number of people with this disease is increasingly rising early and taking in Brazil about 17 million people with hypertension, of which 35% of the population are over 40 years old (BRASIL, 2006).
It is characterized as one of the biggest causes of reduced quality and life expectancy of individuals since it has set an important risk factor for diseases resulting from atherosclerosis and thrombosis, which are externalized by cardiac involvement, brain, kidney and peripheral vascular (ASSIS; BARRETO; PASSOS, 2006).
There are several factors that complicate the treatment and control of hypertension among these, non-adherence to treatment, a fact that is much observed by health professionals. Although not an exclusive problem of hypertension, being frequent in other therapeutic regimens prolonged lack of adherence to antihypertensive treatment deepens in complexity (REINERS, 2004).
One factor that complicates the membership is the absence of symptoms in hypertension because only half the people who suffer from high blood pressure know they have the disease because no symptoms and often have the impression of being in good health. These people may have changes in blood pressure (BP) and together, habits and health behaviors that favor the persistence of this high. Most noted the diagnosis of this condition when they are victims of some complication, such as stroke, aneurysm and renal failure.
Health professionals have basic network prime importance in strategies to control hypertension, but also in defining the clinical diagnosis and the therapeutic or the efforts required to inform and educate the hypertensive patient as to do so following the treatment.
Within the universe of chronic diseases, hypertension stands out for the high medical and social costs as it has implications for cardiovascular disease, renal and neurological, being one of the most important risk factors for morbidity and mortality worldwide, as well as the cause of early retirements. It is a syndrome characterized by increased blood pressure, both systolic and diastolic, and direct or indirect cause of the high number of deaths caused by stroke, myocardial infarction, heart failure and kidney (PORTO; RASSI, 1997).
Assistance to your users involves focused approach to the changing lifestyles and the process of treatment compliance in order to avoid conditions such as morbidity and contribute to the reduction of social and physical damage, it is paramount to establish link users to treatment, enabling them to systematically monitor.
Thus, health professionals should potentiate the actions of early diagnosis, control, monitoring and treatment for users, with an emphasis on educational about the risk factors, change of lifestyle and the co-responsibility of the users about their treatment there quality of life. Changing lifestyle is a difficult task, and is almost always accompanied by a lot of resistance, so most people can not make changes, and especially keep them for long. However, health education is a fundamental alternative to drive people to these changes, for the prevention and / or control of risk factors of hypertension through healthy habits and attitudes (SANTOS, 2003).
The experience of health education through groups favoring participation as a way of ensuring the individual and the community the opportunity to decide their own destiny, and capacity of these subjects to work on improving their health (BUSS 2003).
Promoting health care through educational games
Alves (2005) defines health education "as a set of knowledge and practices aimed at disease prevention and health promotion." As authors, we believe that this knowledge, mediated by health professionals through educational, may mean re-designing health of people mainly from the understanding of the determinants of health-disease process that should be made explicit in these actions.
Therefore, health promotion is done through education, adoption of healthy lifestyles, the development of individual and collective capacities and the production of a healthy environment. Is therefore linked to the implementation of public policies for the quality of life and developing the ability to critically analyze reality and promote the transformation of the determinants of health.
Education permeates people's lives from an early age. Whether through formal or informal all teach and learn in their relationship with each other. Lima (2005) conceives education as a dialogical process between actors; it favors the development of their human qualities, the acquisition of knowledge, skills, interests, attitudes and power for action providing your personal and social growth and development of consciousness critical.
Health education carried out through the use of educational games has shown a facilitating strategy in increasing knowledge, of autonomy and linking the subject with the service and the health professional. Our practice showed increased user participation in the meetings of the Programme of the Ministry of Health This strategy aims at the understanding of hypertensive about their disease process, stimulating changes in habits and change the way of life (TORRES; HORTALE; SCHALL, 2003 ) and has contributed significantly to prevention and control of diseases.
The games are educational action based on dialogue, enabling learning and interaction, stimulating concentration and thought, and at the same time provide fun. Act as instruments of communication, expression and learning, further knowledge and enhance the various exchanges of knowledge, which are the basis of learning (TORRES; HORTALE; SCHALL, 2003).
Valla (2000) considers that the health professional should use simple and understandable language, suitable to reality and which has as a key point the individual seeking for your needs regarding the disease. This language allows the traders pursues an educational practice and carry out appropriate diagnosis. Complementarily Stotz and Valla (1994) suggest that professionals should act as a facilitator and mobilizing to improve the living conditions of the people and prevent the onset of disease.
For Torres, Hortale and Schall (2003), the educational practices that promote an interactive system between individual and health professionals, mediated and structured by the concept of disease, provide the development of personal attitudes that associate the concept of lifestyle.
Strategies of health education as active methodologies, properly structured enable sharing of information in the search for improved quality of life and promoting health. The health professional who has training and governance to work in the health-illness, it is the construction of educational practices supported in dialogic processes with horizontality of power and ways to share knowledge appropriate to the target population and to meet the health needs, in order to develop proposals for emancipation and not coercive. The discussion of educational methodologies integrates the process of health education as a pedagogical strategy, inseparable to the professions who work in health care (ANDEDRADE 2004).
Understanding, the individual, the interactive system in educational practice, the interfaces established between it and the healthcare professional, mediated and structured by the concept of disease, favor the development of personal attitudes that associate the concept of lifestyle.
The lifestyles do not match only some behaviors, such as exercise, diet or no consumption of harmful substances, but also to other attitudes and practices, such as tolerance, solidarity, respect for differences and human rights and participation, which occur in the collective life. Restrepo (2001) affirms the need to know more about the individual experience of diabetes, the physical and social environment, the influence of culture in defining the disease and attitudes towards it.
When referring to the educational process for the control of diabetes, talk about the importance of adopting strategies whose actions should be participatory nature of both the individual and his family. It is known that education influence the lifestyle, improve the professional-individual and the social and physical environments. In addition, health education, as a social practice, based on dialogue, ie, exchange of knowledge, fosters the understanding of this relationship in the disease process and, respectively, the exchange between the scientific and popular knowledge (BRICEÑO-LEON, 1996).
Use of the game as educational process. Methodology
This is a descriptive study and intervention with students of Technical Education in Nursing, through an educational game applied to a School of Nursing and Technicians assist in Jequie-BA. For the development of the activity we designed a game with 24 questions about Hypertension, aiming to analyze the understanding of nursing students about hypertension and educational care. The contents were discussed concept, diagnosis, risk factors, signs and symptoms, prevention, complications, treatment and educational activities.
The experience is based on a Constructivist Approach Interactionist, based on the use of educational games, which was used as a pedagogical strategy for enhancing learning dynamically interactionist and more significant.
We use therefore the "Game Data Allocated", developed and adapted to Health Education for Hypertension, from the set Given Colorful, used by Heloisa Torres, Department of Applied Nursing, Federal University of Minas Gerais and Virginia Schall, researcher in Health Education at the Oswaldo Cruz Foundation in its work with groups operating health education for people with diabetes.
This game had a poster and material satisfaction questions about the concept, diagnosis, risk factors, signs and symptoms, prevention, complications, treatment and educational activities organized in columns that followed the numbering of data consisting of six sides, each given number has a specific meaning: number one (01 - concept and diagnosis), 02 (two - risk factors), three (03 - signs and symptoms), four (04 - treatment), five (05 - complications) and 06 (six-prevention and health education).
For the realization of the game divided the students into three groups, each group member was playing dice and according to the number that came out, the group answered a question about the theme of the game, as described above. All members of the group could assist / complement response. If the group hit him the answer won a prize and if he missed the turn going to another group.
Play as educational process and its impact. Results and discussion
The educational process, developed with a group of students of the Course for Practical Nursing, was effectively among professionals and students, leading everyone to participate in the construction of knowledge and avoiding monopoly. Students participated in an active teaching strategy, in constructing knowledge.
The experience of the development of the educational process by Games identified that this educational strategy has the potential to stimulate the student to reflect on the adoption of a practice of care that should be held by the individual with hypertension, aimed at promoting health and prevention of illness and complications, aiding the understanding of disease and practice a healthy lifestyle, as well as the construction of knowledge through a dialogical pedagogy, whether the activities of the individual, or in the collective.
The weather always went well, which prompted a positive meeting and indicated that the health education a training process in which students and professionals realize and take responsibility in the prevention, disease control and health promotion.
Also, a few questions from the students during the course of the educational process, and requested explanations regarding the issues raised in respect of hypertension, which were performed by professionals. However, most students demonstrated knowledge on the issues addressed.
Promote educational for hypertensive individual is the fundamental premise for the treatment of disease. These offer you the opportunity to prevent the onset of chronic complications and improve quality of life. To be effective, require a set of conditions, such as good professional training, which boils down to a good knowledge of pedagogical attitudes, good communication skills and the ability to listen, understand and negotiate (DOTA, 2001).
Group dynamics stimulated the interpersonal relationship between students and health professionals, facilitated discussion between people with the same goals, enabling the exchange of information. The members shared common experiences, which helped in understanding the disease, allowing them to express doubts and expectations and providing mutual support.
The game is a learning strategy that contributes to a time of teaching and learning in order to enhance creativity and encourage the search for new alternatives in the educational process. The professionals who prepared the teaching materials and worked with educational games identified advantages in its use. One is to have created a pleasant environment for learning, necessary to maximize potential to facilitate the promotion of knowledge.
The game used in educational activities conducted among students is an important instrument for the development of knowledge about a certain topic, favoring a learning experience built using a method that enables playful interaction and exchange of knowledge that will guide the actions of health will be developed by students, future health professionals.
However, it is necessary to plan educational activities considering contexts that not only clinicians, as well as meet specific needs for the development of new games or other educational activities. The described experiment showed, albeit approximate, that such resources increased participation and commitment of students and health professionals in clinical and environmental transformation of the educational process itself. We can say that, taking into account the comments made by the students involved in the end of the activity, ie, at the time of evaluation of educational game.
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