NURSING CONSULTATION TEACHING IN NURSES’ TRAINING: A BIBLIOMETRIC STUDY

Objective: to identify the Brazilian scientific production about Nursing consultation teaching in nurses’ training. Method: a descriptive study of a bibliometric nature conducted in the portal of Biblioteca Virtual em Saúde and in PubMed from April to May 2021, with the following inclusion criteria: full articles, in Portuguese or English, published from 2009 to 2020. Results: a total of 13 studies were identified, of which four were published in a B2 journal from the Northeast region, although with predominance of papers from the South region (38.46%), with the experience report type standing out. The most frequently observed themes were related to the teaching methodologies, especially the active ones with use of technological tools. “Nursing consultation” was not found to be one of the most frequent keywords. Conclusion: by verifying the incipience of the production on the theme, this study provides subsidies for expanding this knowledge area, reverberating in improvements in Nursing consultation teaching and in nurses’ training.


INTRODUCTION
The essence of Nursing is based on care and interpersonal relationships and is materialized in different environments from multiple interactions permeating uncertainty, variability, the unexpected and the unpredictable 1 .Thus, the Nursing practice involves action, reaction, interaction and transaction between groups and individuals in a given social system that aims at achieving health goals and, in order to be efficient, a work methodology based on a scientific method is necessary 2 .However, although scientific knowledge in Nursing has a different origin, clinical action is where it takes place and is structured, as it is characterized by practical-reflective rationality, not in a linear way but in dynamically and continuously, like a spiral, since it is from prior knowledge that understanding is elaborated leading to interpretation and, consequently, to a new understanding/action, reverberating in a knowledge specific to the field of Nursing that differs from other disciplinary types of knowledge 1 .
In this context, the Nursing Process (NP) stands out, characterized by the dynamics of systematized and interrelated actions aiming at assistance and care for human beings 2 .From this perspective, the NP is a methodological instrument that guides care and the documentation of the professional practice 3 .According to Resolution No. 358 of the Federal Nursing Council (Conselho Federal de Enfermagem, COFEN), the Nursing Process must be carried out systematically and deliberately in all environments where professional Nursing care exists and when performed in institutions that provide outpatient health services, in homes and in schools, corresponding to the Nursing Consultation (NC) 4 .In turn, this should be guided by the principle of integrality and by evidence-based practice, enabling a systematized performance capable of contributing to improving the quality of the assistance provided 5 .In this vein, the Nursing consultation represents a resolute technological care strategy, supported by law, exclusive for nurses, and which results in benefits in the assistance provided, favoring health promotion, early diagnosis and treatment, in addition to the prevention of avoidable situations [6][7] .
Historically, the interviews conducted by nurses in 1920 are considered the precursors of the Nursing consultation, which was named as such in 1968 8 .It is noted that regulation of the NC in Brazil was through Law No. 7.498/86 7 and Decree No. 94,406/87 9 .However, in 1993, COFEN Resolution No. 159 recommended the compulsory character of the NC while developing Nursing care at all health care levels 10 .Such normative was revoked in 2017 by COFEN Resolution No. 544 11 .However, the Nursing consultation is dealt with in COFEN Resolution No. 358, still in force, which provides for the Systematization of Nursing Care and the implementation of the Nursing Process 4 .
It is noted that Nursing consultations favor nurses' work, contemplating the Nursing Process stages 2,4 .COFEN recognized these stages in 2009, which consist in data collection or Nursing history, diagnosis, planning, implementation and evaluation 4 .Thus, the NC must be guided by the Systematization of Nursing Care (SNC), which organizes professional work in terms of method, personnel and instruments, making it possible to operationalize the Nursing Process, resulting in adequate, individualized and effective Nursing care 12 .Therefore, the NC represents an effective strategy for achieving the nurses' responsibility to facilitate, enhance and restore human beings' ability to take care of themselves, envisioning independence from other systems, thus leading individuals to an ecological understanding necessary for the care to be provided 1 .However, for this to happen, NCs require theoretical-practical articulation, emerging as one of the specific and systematic pillars of nurses' training.
Given the importance of Nursing consultations, and for considering the prevailing

METHOD
This is a descriptive research study with a quantitative approach and of a bibliometric nature, aiming to help identify trends in the expansion of knowledge in a given discipline, dispersion and obsolescence of scientific fields, authors and more productive institutions, in addition to highlighting the journals most used in the dissemination of research studies in a given knowledge area 13 .This study followed five stages: definition of the research objective, design of the protocol, data collection, analysis, and synthesis with presentation of the results.The topic was defined in the first stage, in addition to elaborating the research objective and guiding question, already presented in the Introduction.
In the second stage (Figure 1), called "research protocol", an exploratory search for articles on the theme was initially carried out to identify possible descriptors, with selection of the most frequent which were subsequently verified in DeCS/MeSH, with the purpose of determining if the definition was adequate to the study proposed.
In view of the need to use the most reliable and robust definition, the alternative terms "Formação Profissional em Saúde" and "Consulta de Enfermagem" were used for "Capacitação de Recursos Humanos em Saúde" and "Enfermagem no Consultório", respectively.Subsequently, the descriptors in English were validated through a search in DeCS/MeSH and in the body of articles already published; subsequently, the search strategies were defined, as well as the data sources, using the BVS (Biblioteca Virtual em Saúde) portal, which integrates multiple information sources and comprises several databases, such as LILACS, MEDLINE and BDENF, among others.In addition to that, the PubMed database was also used, which enables access to the MEDLINE biomedical literature, to Life Sciences journals and to online books.
The search strategy was outlined based on the combination of the descriptors with the OR and AND Boolean operators, resulting in a restricted strategy, as presented in Figure 1.
training process for their critical, reflective and assertive performance, the following research question is formulated: Which is the Brazilian scientific production on Nursing consultation teaching in nurses' training since 2009?Given the above, the objective of this study is to identify the Brazilian scientific production about Nursing consultation teaching in nurses' training.
This research is justified due to the lack of studies on the theme and it is expected, based on its findings, to contribute to strengthening NC teaching in undergraduate Nursing courses, as well as to expand dissemination of the theme and raise reflections on the Nursing Consultation teaching process in Brazil.In the third stage (Figure 2), called "data collection", a search was carried out in BVS and PubMed from April to May 2021, having the following as inclusion criteria: full articles, in Portuguese or English, and published from 2009 to 2020.The time frame took into account the year in which COFEN Resolution No. 358/2009 4 was published.The database was also built in this stage, by resorting to Microsoft Excel ® (2016 version), including title of the article, objective, conclusion and year of publication.After reading the abstracts, the articles that were not related to the study object were excluded, as well as those that were duplicates and of non-Brazilian origin.During the fourth stage, called "data analysis", the analysis matrix was prepared in Microsoft Excel® (2016 version), including the following data: database, title of the article, authors, institution/affiliation, state, region, language, year, title of the journal and keywords.The frequency of the keywords found in the articles was obtained through SoftwareAntconc (AntConc corpus analysis toolkit), version 3.5.8.0.Subsequently, the .CSV file with the selected words, along with the frequency with which they appeared, was posted on the WordClouds.comfree-use website, resulting in the creation of the word cloud.In addition to that, the data were also analyzed by calculating the absolute and relative frequencies.In the last stage of the study, it was decided to use charts and figures to present the results.
It is noted that, as this study only uses documentary data available in the databases, submission to a Research Ethics Committee (Comitê de Ética em Pesquisa, CEP) was unnecessary, according to Resolution No. 510/2016 14 ; however, all ethical and authorial aspects were respected.
Nursing consultation teaching in nurses' training: a bibliometric study Jesus LA de, Costa LEL, Oliveira MG, Souza VR dos S, Silva GTR da, Cordeiro ALAO, et al As for the main journals that published articles on the theme, the following stand out: Revista de Enfermagem UFPE online, with four articles, Revista Brasileira de Enfermagem, with three, and Revista de Pesquisa (Universidade Federal do Estado do Rio de Janeiro Online) with two publications.Regarding the year of publication, there is no difference between 2020 and 2018, both with three articles, followed by 2011  All the articles found had a version in the Portuguese language.No author was present in more than one article.The prevailing study type among the publications was the experience report (five), followed by descriptive studies (three).
Regarding the most incident themes, the approach to the teaching methodology or strategy stood out, corresponding to seven (53.84%) of the publications.In relation to the terms most frequently cited as keywords in the articles, the absence of "Nursing Consultation" was noticed, as can be seen in Figure 4.

DISCUSSION
Recognition of Nursing as a science demands using the Nursing consultations since, as they resort to systematized and inter-related actions, they represent the essence of the profession 15 .However, this study evidenced a reduced number of publications on the Nursing Consultation teaching, revealing low visibility of the theme, and corroborating the idea of NC underutilization by Brazilian Nursing as a care technology 15 .Also in this perspective, the imbalance found in the distribution of the productions is outstanding, with the most significant concentration in the South region, reinforcing the South-Southeast axis as a knowledge production hub.In this sense, this finding can be the result of the centralization of graduate courses in the Southeast and South regions [16][17] .
There was no recurrence of authors in the articles, which provides indications of the scarcity of research groups focused on this knowledge area.However, the institutional partnerships established stand out, including two foreign institutions, showing an attempt for articulation among the authors and revealing an incipient concern about the NC teaching process.
Nursing consultation teaching in nurses' training: a bibliometric study Jesus LA de, Costa LEL, Oliveira MG, Souza VR dos S, Silva GTR da, Cordeiro ALAO, et al Although production is predominant in the South region, it is noted that the journal with the most publications on NC teaching was Revista de Enfermagem UFPE online, with qualis B2 according to the 2013-2016 quadriennium classification of the Coordination for the Improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, CAPES).This journal was founded in 2006 and is currently published by the Graduate Program in Nursing of the Health Sciences Center belonging to Universidade Federal de Pernambuco.Based on this finding, it is inferred that aspects related to the Nursing Process, especially NCs, represent an outstanding line within the scope of this journal.In addition, when evaluating the qualis corresponding to the journals of the highlighted publications, it can be seen that the existing productions were published in journals with qualis strata A and B. In this way, it is considered that, despite the reduced number of studies, they present methodological and scientific robustness, in view of the journal's qualis, therefore, reverberating in important contributions to the Nursing work.It should be noted that qualis assesses the quality of a journal and, in this study, the latest classification published on the CAPES platform was used, which is divided into eight strata in decreasing value order: A1, A2, B1, B2, B3, B4, B5 and C.However, it is worth noting that there is already a new classification which has not yet been legitimized or published in the CAPES platform.
The main study method observed was the experience report, which is related to and favors knowledge construction in the area from real and contextualized descriptions.Thus, it is inferred that the preponderance of this method is supported by the practical nature of NC teaching, enhanced for being a still little explored research area; consequently, sharing of experiences makes possible and contributes to knowledge development.Given the above, experience reports are relevant for the professional practice and provide subsidies for reflections and applications in the NC teaching praxis.Also from this perspective, it is understood that the notoriety of teaching strategies permeated by theoretical-practical articulation is intended to strengthen the learning process, as well as skills development through participation, engagement and experience of the profession.
Regarding the most frequent keywords, the absence of "Nursing Consultation" was noticed, reiterating its invisibility.However, it is to be noted that the DeCS/MeSH present "Nursing practice limited to an office" as concept for this descriptor, thus restricting its definition and application.Thus, from its non-use as a descriptor in the articles, it is inferred that this is a strategy by the authors for using NC as a broad term and not restricted only to clinics, as the NC is present in all environments where Nursing assistance is present.It is noted that in addition to supporting nurses' decision-making, positively interfering in the health/disease process, the NC evidences the scientificity of the work performed by this profession and, therefore, cannot be reduced to a minimalist concept 15 .
Regarding the most frequent themes, there was predominance of the approach in relation to the teaching methodology and strategy, with emphasis on the active methodology and on using technology as a learning tool.It is noted that it is fundamental that the teaching strategies accompany the theoretical-scientific and technological advances of the profession, through innovating interdisciplinary practices and active methodologies.The main strategies found were simulation, clinical case and use of virtual tools 18 .
NCs are a technological care strategy based on scientific principles, through the use of their own method, constituting the Nursing Process, which systematizes Nursing care 19- 20 .Thus, NC teaching should not happen in a technical and automated way, above all, given its core of providing opportunities for the provision of comprehensive care.This article presents the lack of depth regarding the qualitative issues of the productions as a limitation; however, it raises reflections on NC teaching in nurses' training, requiring further research studies on the theme.The incipient production on Nursing Consultation teaching found in the literature and evidenced in this study, due to the reduced number of scientific publications, reflects the invisibility of NCs in the services, often taking place in a complementary way to the medical consultations or seen as expendable.This is because they are not seen as spaces for dialog, education in health or a guide for nurses' decision-making, which takes place through systematic phases based on scientific grounds.
It is worth noting the role of Higher Education Institutions in changing this scenario, which must strive to teach NC through methodologies that integrate theory and practice and favor the students' critical reflective ability, minimizing technicist and automated trends.And for this to occur, it is to be added that it is essential to encourage the conduction of new studies on the theme, especially in places where the scientific production about NC teaching is still incipient or absent.Thus, by revealing the scientific production related to NC teaching, this article provides subsidies for reflections that may drive new research on the theme, with the aim of transforming the evidenced scenario; therefore contributing to visibility and expansion of this knowledge area and, consequently, to advances in Nursing Consultation teaching, which, in turn, will exert a positive impact on nurses' training and on their professional practice.

CONCLUSION
Nursing consultation teaching in nurses' training: a bibliometric study Jesus LA de, Costa LEL, Oliveira MG, Souza VR dos S, Silva GTR da, Cordeiro ALAO, et al

Figure 2 -
Figure 2 -Data collection -Search for articles according to the study criteria and interests.Salvador, Bahia, Brazil, 2021 Source: The authors (2021).

Figure 3
Figure 3 illustrates the distribution of the publications across the Brazilian territory.Of all 13 articles, four were conducted through partnerships established by national institutions between the states of Amazonas and Pará, Rio Grande do Norte and Paraíba, Rio Grande do Norte and Mato Grosso do Sul, and between Rio Grande do Sul and Santa Catarina.In relation to the distribution across the regions, the South stands out with five (38.46%) of the available publications, prevailing over the other regions.

Figure 4 -
Figure 4 -Frequency of the terms most frequently cited in the keywords from the articles.Salvador, Bahia, Brazil, 2021 Source: The authors (2021).
Nursing consultation teaching in nurses' training: a bibliometric study Jesus LA de, Costa LEL, Oliveira MG, Souza VR dos S, Silva GTR da, Cordeiro ALAO, et al To the Coordination for the Improvement of higher Education Personnel (CAPES) -Brazil for their support, with reference to Funding Code 001 and Process No. 88887.643413/2021-00.To the National Council for Scientific and Technological Development (CNPq) with reference to the Research Productivity (Produtividade em Pesquisa, PQ) Grant under Process No. 205736/2018-1.To the Federal Institute of Education, Science and Technology from Bahia (Process No. 23806.250710.2021-41).
and 2010, with two articles each.Chart 1 presents the Brazilian production on Nursing Consultation teaching in nurses' training in Brazil from 2009 to 2020.
Nursing consultation teaching in nurses' training: a bibliometric study Jesus LA de, Costa LEL, Oliveira MG, Souza VR dos S, Silva GTR da, Cordeiro ALAO, et al Nursing consultation teaching in nurses' training: a bibliometric study Jesus LA de, Costa LEL, Oliveira MG, Souza VR dos S, Silva GTR da, Cordeiro ALAO, et al