ENFERMAGEM ONCOLÓGICA: INTEGRAÇÃO UNIVERSIDADE-COMUNIDADE NO PROCESSO DE ENSINO-APRENDIZAGEM

Objetivo: descrever os aspectos operacionais e as vivências de discentes do curso de Enfermagem em um projeto de extensão universitária em Enfermagem Oncológica. Método: estudo descritivo, tipo relato de experiência relacionado a um projeto de extensão em Enfermagem. Resultados: dividiu-se o projeto em três etapas, incluindo a oferta de curso livre na área de oncologia, atividades extensionistas na comunidade e pesquisa em oncologia. Compôs-se a equipe por oito discentes, cinco docentes e quatro enfermeiras. Revela-se que, nas atividades de ensino e extensão, participaram 103 estudantes e 120 pessoas da comunidade, entre profissionais de saúde e outros residentes do município. Produziram-se 12 trabalhos científicos apresentados em eventos com abrangências local, regional e nacional. Permitiu-se, pela vivência dos discentes no projeto, a aproximação com a prática de Enfermagem Oncológica, consolidando os princípios de integralidade das ações de saúde na formação universitária. Conclusão: demonstrou-se, pelo estudo, a aplicação de um modelo de ensino-aprendizagem na Enfermagem que busca integrar universidade e comunidade, contribuindo para a abordagem de temas ainda pouco trabalhados na formação profissional e suscitando possibilidades de práticas interdisciplinares, com a reflexão crítica do ser “enfermeiro” nesse campo de atuação. 

103 students and 120 people from the community participated in the teaching and extension activities, among health professionals and other residents of the municipality. There were 12 scientific papers presented in events with local, regional and national scope. Through the experience of the students in the project, the approach to the practice of Oncology Nursing was allowed, consolidating the principles of integrality of the health actions in the university education.

Conclusion:
The study demonstrated the application of a teaching-learning model in Nursing that seeks to integrate university and community, contributing to the approach of themes still little worked on in professional training and raising possibilities of interdisciplinary practices, with the critical reflection of being a "nurse" in this field of action.

Descriptores: Enfermería; Enfermería Oncológica; Relaciones Comunidad-Institución; Prácticas
Interdisciplinarias; Aprendizaje; Educación en Enfermería. Cancer represents a set of diseases with clinical and epidemiological importance and is considered a serious public health problem in Brazil, ranking second among the main causes of death in the country. 1 Despite the advances in diagnosis and treatment, numerous physical, emotional and social consequences are produced that require attention and support from the multiprofessional team.
In this way, the nurse manages the patient-centered integral care in all phases of health care, which requires technical-scientific knowledge, clinical practice and human skills. To do so, one must think and build the professional qualification from graduation in such a way that educational institutions can train nurses capable of recognizing and intervening on health problems, which presupposes articulation of theory with practice and social transformations. [2][3] Professional training is positively impacted by teaching with reflective and qualified Nursing practices. This should be the guide for the changes, knowing that the student can become a multiplier of improvements when he/she starts to act as a professional in care, teaching or research. 3 The experience of scholars in extension projects is crucial to this process, since it tends to bring students closer to a significant reality that is relevant to their work in the various scenarios presented. The processes that structure the conception and practice of the Extension Guidelines in Higher Education are established as an integral part of the promotion of initiatives, under the social commitment of higher education institutions, in the areas of communication, culture, human rights, education, environment, health, technology and production and work. 4 Thus, the indissociability between the teaching, research and extension spheres is presented as an interaction responsible for transforming the various social contexts as well. Understanding the relevance of the insertion of the university extension in the integrated professional formation, the proposal of curricularization of the extension in the university context is highlighted. Thus, new challenges for higher education institutions are pointed out, seeking to provide insertion experiences in daily, political, social and economic reality through experiences with the community, with a new approach to practices. 5 In this context, university extension is an important link in the improvement of academic learning and extension projects contribute to the application of the knowledge acquired during INTRODUCTION How to cite this article Dominguez RGS, Barros EPT, Freire ASV, Silva SS, Cardoso LS.
Oncology Nursing: university-community integration in the teaching-learning process. J Nurs UFPE on line. 2021;15:e244374 DOI: https://doi.org/ 10.5205/1981-8963.2021.244374 graduation, also working to improve the self-confidence and learning of the student in the chosen area. 5 To describe the operational aspects and experiences of students in a university extension project in Oncology Nursing.
It is a descriptive study, of experience report type, about a university extension project linked to the Nursing course of the Federal University of Recôncavo da Bahia (UFRB), with focus on teachinglearning and practices of Oncology Nursing. The project was carried out in the municipality of Santo Antônio de Jesus, Bahia, from July to December 2018, in three stages, involving teaching, extension and research activities.
A team composed of seven students from the Interdisciplinary Health Baccalaureate (IHB)/ Nursing Matrix, one student from the Nursing course, five teachers from UFRB and four nurses from other institutions, three of them specialized in Oncology and one inserted in the Family Health Strategy (FHS) was constituted for its operationalization.
It is noteworthy that the educational institution follows the cycle model, being the 1st cycle in IHB and the 2nd cycle in Nursing, which allows the participation of IHB students in projects in their area of professional training, providing critical-reflexive experiences that meet the needs of the community and the health system. Included in the target public of the course were students and health professionals from internal and external communities, totaling 147 participants evaluated according to their attendance in the course and score in post-tests.
For the construction of this experience report, the data from the partial and final project reports with the quantitative and qualitative description of all actions as well as the Revised Standards for Quality Improvement Reporting Excellence guide were analyzed. The teaching activities took place in the university auditorium, while the extensionist actions used the space of Family Health Units and a public square in the city center.
It is explained that the Nursing in Oncology extension project aimed to create a space for study, discussion and production of knowledge in the oncology area, valuing the principles of integrality in health care and interdisciplinarity expressed in face-to-face activities with professionals and students from different areas. The development of educational activities in the community aimed at the prevention of the most prevalent types of cancer in the municipality of Santo Antonio de

RESULTS
Jesus was also sought. Scientific production in oncology was also encouraged, contributing to the visibility of the topic and offering subsidies to strengthen the transforming potential of the university in the local context. Three different stages have been designed for this, but they are interconnected by the thematic axis of Oncology, namely: a) offering a free course in oncology; b) intervention activities in the community and c) research activities.

Teaching: Oncology Nursing Extension Course
The course was conceived and built in ten thematic modules in Oncology, starting from the discussion of more general aspects to specific knowledge involving the practice of the The modules were taught by professionals with experience in teaching and in the thematic areas of the course. Priority was given to didactic methods that encouraged the active participation of those enrolled, using audiovisual resources such as videos, expository and dialogue classes, case studies and practical demonstrations. At the end of each module, post-tests of applied knowledge were carried out in which participants had to obtain at least 80% of the grade in order to receive approval and certification in the module. Another evaluation criterion was the general attendance in the course, which should also be equal or superior to 80%, the participant being subject to elimination for absence.
Initially, through online registration for the Oncology course, an estimated audience of 148 participants was revealed. It was noticed, however, that in the first module of the course, whose absence of the inscription had an eliminatory character, the total number of presents corresponded to 67 participants, despite the confirmation of anticipated presence; Of these, 20 (29.9%) were students of IHB-Nursing; 16 (23.9%) of Nursing; ten (14.9%) of IHB-Nutrition; eight (11.9%) of IHB-Medicine; eight (11.9%) of IHB; one (1.5%) of IHB-Psychology and four (6%) are health professionals.
At the end of the course, 32 (47.8%) participants were approved, considering the criteria of attendance and evaluation in the post-test, with a majority of Nursing students, being six (19%) students from other Higher Education Institutions and 14 (43.8%) from UFRB's IHB-Nursing, which highlights one of the great challenges of maintaining the regularity of the public in face-to-face extension courses promoted over a long period of time.
Thematic modules were carried out every fifteen days, with a four-hour workload, in the afternoon shift. The meetings took place in the auditorium of the Health Sciences Center of UFRB, being chosen due to the sufficient space for the number of enrolled in the course.
In addition, a technical visit was made to an outpatient service specialized in Oncology, with the presentation of the flow of care, welfare protocols, consultation with Nursing and other team members (doctor, nutritionist, pharmacist), home monitoring and palliative care. The nurses of the service also conducted training on the technique of totally implanted catheter puncture aimed at the participants.
At the end of the course, the application of forms containing objective evaluation of the following criteria was chosen: programmatic content; performance of the facilitators; location; methods and general satisfaction. It was presented positive feedback by the aspects evaluated, highlighting the diversity of speakers as something quite acceptable by the audience, as well as the programmatic content and methods used, which was reinforced as a point facilitator and energizer in the presentation of the proposed topics.
Only one question was negatively evaluated by the participants, regarding the location of the course, due to the lack of comfort due to the high temperature in the room and non-padded chairs, revealing the need to review the choice of space. However, despite the lack of infrastructure, the general satisfaction of the participants was considered as optimal.
The experience in monitoring the extension course was particularly challenging, given the circumstances experienced during the period. The contact with students from different courses encouraged the maturation of the students in the development of negotiation and interpersonal relationship skills, with fundamental importance both for the execution of the course and for the improvement of professional practice.
The course also allowed the integration between teaching and extension, since the establishment of these relations bases the plurality of health care, making use of humanization as a propeller for the provision of a quality service that values the individual through its particularities, as well as the respect for his/her autonomy. It has also provided students with a space to share and acquire experiences that are intrinsic to the formation of a health professional based on the practice of integral care.
In this way, the participation in the course became essential for the construction of all the project activities carried out throughout the period, providing theoretical support both for the application of the themes addressed in the communities and in the exercise of knowing how to listen to the demands related to oncology coming from the external and internal communities and, thus, think and do health together. The activity took place at FHU in the waiting room with the parents waiting for the child care consultation with their children, totaling nine people. The action culminated at the university with the Oncopediatrics module of the extension course in Oncology Nursing, with 28 people present. It is described that there was active participation in the workshops, mainly from the children's parents, who showed curiosity and interest in the topics discussed, removing doubts and identifying the signs and symptoms of alert for child cancer.

Research and extension: knowledge to transform reality
The third stage of the project was focused on the scientific production in oncology by the scholarship students and volunteers for the approximation of the themes under study. Twelve abstracts were produced that were accepted for poster presentations and oral communication in events with national, regional and local scope, being six epidemiological studies, five integrative reviews of the literature and one experience report.
The following topics were addressed: hospital mortality and morbidity due to cancer; secondary prevention of cervical cancer; screening for breast cancer; challenges of Primary Health Care in controlling colorectal cancer; complementary therapies in Nursing; palliative -perinatal care in rural populations, in terminology, in medical and nursing training and in scientific production in Brazil, contributing to the visibility of the topic and strengthening the transforming potential of the university in the context of the municipality of Santo Antônio de Jesus. Figure 1 presents the synthesis of the productions published in annals. There was a growing trend in cancer mortality among the residents of Santo  It contributes, through extension activities in the formative process of the nurse, to the construction of a fruitful space for the production of knowledge based on scientific evidence and technological innovations, besides allowing the integration between teaching, local services and the community in favor of change, without disregarding the indissociability between research and university extension. 6 However, it is warned that studies that seek to understand these different knowledges in order to deepen the discussions of this tripod in higher education, whether in public or private education, are still scarce. 7 Thus, the importance of knowledge of the transformative processes that govern today's society is highlighted as the basis for a formation based on individuals who are committed to social intervention. In this experience report, the stages of operationalization of an extension project interconnected by the thematic axis of Oncology were described and analyzed, understanding its importance to public health, 8 which requires a qualified professional training in the different levels of health care.
In the context of the extension project developed, it was sought to contribute to the consolidation of knowledge relevant to the practice of the health professional who works or will work in public health services, as well as to the development of skills that go beyond the theoretical framework, such as learning to deal with the fears, sufferings, psychobiological and spiritual needs of individuals and their families.
Great interest in the participants was awakened by the approach of current themes such as palliative care in oncology. In the training of nurses, the teaching of palliative care is still incipient

DISCUSSION
in the undergraduate curricula, despite its importance today to qualify comprehensive care to individuals affected by life-threatening diseases, 9 which reveals the innovative character of the project.
The university extension establishes the relationship between the university and the community in various ways and methods, promoting the improvement in the quality of life of individuals through health education and offering a gain of experience by breaking down barriers in the classroom. 10 This tool can be used through health promotion, disease prevention and rehabilitation actions, also presenting itself as a tool for the training of multipliers and caregivers by putting into practice the acquired learning. 5 The insertion of academics in the local reality, considering their daily, political and socioeconomic aspects, makes it possible for them to participate and live with the community, enabling a cycle of social transformation.5 Other experiences have shown that these actions can be considered a promising approach to reduce health disparities as they contribute to the empowerment of individuals and communities, enabling them to become the main actors in the prevention and solution of their own health problems. 11 Another study showed that the implementation of these changes becomes feasible through partnerships with a variety of organizations, including non-profit organizations, government agencies and health services in which the research nurse approaches the target audience in order to understand their needs. 12 The project's extensionist activities have encouraged learning from local experience, subsidizing community interventions and producing scientific knowledge about the clinical, epidemiological and cancer screening profile that can guide local services and managers in decision-making. In this way, the extension in the health area can facilitate the alignment of community health priorities with the university's educational, research and clinical activities, allowing them to be more effective. 13 The teaching-service-community articulation is presented as a strategy that contributes to the critical-reflexive formation of the nurse, in accordance with the profile required by the current National Curricular Guidelines of Brazil. It is known, however, that there are challenges in its implementation in an institutionalized manner that refer to the prevailing hospital-centric model in some curricula, fragmentation of content in disciplines, resistance of the teaching staff itself, low valorization and incentive to extramural practices. 14 To overcome so many challenges, it becomes evident the importance of institutionalizing these practices in the curricula, as well as of valuing initiatives that promote teaching in multiprofessional and interdisciplinary activities, with the involvement of teachers, students, health professionals, community and managers. Thus, the University's commitment to the modification of health training and transformation of health care processes is reaffirmed. 14 This study demonstrated the application of a teaching-learning model in the Nursing course that seeks to integrate university and community, from the development of extension projects, in addition to contributing to the approach of topics still little worked on in professional training, but of great epidemiological and social importance. In this sense, this work raises possibilities of interdisciplinary practices in the area of oncology Nursing, leading the students to a critical reflection of being a "nurse" in this field of action.
The activities developed in the extension project "Oncology Nursing" revealed the potentiality of the university extension by providing experiences of consolidation of theoretical knowledge through its application in practice, study of local reality and scientific production. The experience of the academics in this extension project has produced knowledge about nursing education, the training of professionals in the services, as well as an approach to reality in the activities with the participation of the community.
It is hoped that this study will foster reflection on Oncology Nursing and palliative care,