SEXUALIDADE NA GRADE CURRICULAR ACADÊMICA DE ENFERMAGEM: AVALIAÇÃO EM UNIVERSIDADES SEXUALITY IN THE NURSING ACADEMIC CURRICULAR GRID: EVALUATION IN UNIVER- SITIES

Objective: to identify, with regard to sexuality, the composition of the curricular grids of undergraduate nursing courses at universities. Method: it is a qualitative, descriptive, exploratory, field study. The curricula of the three universities offering undergraduate nursing courses were analyzed, which were found on the institutions' websites, and literature on the subject was used, present in LILACS, MEDLINE and Science Direct databases, and the SCIELO Virtual Library. Compulsory and J Nurs UFPE on line. 2021;15:e246549 DOI: 10.5205/1981-8963.2021.246549 https://periodicos.ufpe.br/ revistas/revistaenfermagem elective courses and their corresponding menus were analyzed. These data was correlated with the thematic literature found in the researched sources. Results: in the curricula of universities in Recife, the absence of sexuality content was identified. This contributes to the lack of information inherent to the theme, which can limit student knowledge to the demand of the LGBTQIA + population and compromise the assistance provided by future professionals. Conclusion: it is concluded that the inclusion of the debate on sexuality in the pedagogical program of universities is a challenge in strengthening a comprehensive health care policy for this population and implies the necessary breadth of knowledge of future nursing professionals to promote equity and universality of the access to nursing services. Descriptors: Sexuality; Nursing; Universities; Education; Health; Gender Diversity. RESUMEN Objetivo: identificar, en materia de sexualidad, la composición de los planes de estudio de los cursos de pregrado en Enfermería en las universidades. Método: se trata de un estudio de campo cualitativo, descriptivo, exploratorio. Se analizaron los currículos de las tres universidades que ofrecen cursos de pregrado en Enfermería, los cuales se encontraron en los sitios web de las instituciones, y se utilizó la literatura sobre el tema, presente en las bases de datos LILACS, MEDLINE y Science Direct, y la Biblioteca Virtual SCIELO. Se analizaron los cursos obligatorios y optativos y sus correspondientes menús. Estos datos se correlacionaron con la literatura temática encontrada en las fuentes investigadas. Resultados: se identificó la ausencia de contenido de sexualidad en los planes de estudio de las universidades de Recife. Esto contribuye a la falta de información inherente a la temática, que puede limitar el conocimiento del estudiante a la demanda de la población LGBTQIA + y comprometer la asistencia brindada por los futuros profesionales. Conclusión: se concluye que la inclusión del debate sobre la sexualidad en el programa pedagógico de las universidades es un desafío en el fortalecimiento de una política de atención integral en salud para esta población e implica la necesaria amplitud de conocimientos de los futuros profesionales de Enfermería para promover la equidad y universalidad del acceso a los servicios de Enfermería. Descriptores: Sexualidad; Enfermería; Universidad; Educación; Salud; Diversidad de Género. 1,2,3,4,5,6,7Pernambuco Catholic University/UNICAP. Recife (PE), Brazil. 1 https://orcid.org/0000-0001-5192-2695 2 https://orcid.org/0000-0001-7518-2361 3 https://orcid.org/0000-0002-1412-363X 4 https://orcid.org/0000-0002-8481-8736 5 https://orcid.org/0000-0001-9260-1994 6 https://orcid.org/0000-0001-5587-8054 7 https://orcid.org/0000-0003-3200-1131 8Federal University of Pernambuco/UFPE. Recife (PE), Brazil. 8 https://orcid.org/ 0000-0001-5547-5298 ! The structuring of the curriculum of undergraduate schools is organized according to different disciplinary areas, persuading academics to find, accumulate and manage information from knowledge disciplines. In this way, the school world begins and ends with the disciplines of knowledge and the high academic culture that produces, maintains and sanctions them. Thus, the curricular composition is part of the planning and structuring of health courses, in addition to contributing to the academic development of future professionals..1 It is explained that it is through the body that the individual makes himself/herself present, relates to the world and organizes his being; it is also through the body that nursing professionals become aware of their historicity, of their relationships with others and with the world. This makes it possible to perceive and understand that the meaning of one's own existence cannot be apprehended or unraveled without mediation and that it offers itself to understanding and interpretation through the body.2 Through the act of caring in Nursing, a very close and intimate relationship is established, which, at different times, is constituted with intense physical contact, permeated by various sensations and feelings. This direct action on the other's body is made with which the nursing professional or student comes into contact with the patient's pain and feelings. Thus, nursing practice is permeated through contact with the different; however, many times, the professional is not prepared to exercise such care.2-4 Article 196 of the Constitution establishes health as a right for all and a duty of the State. This constitutional requirement appears in the Organic Health Law No. 8080/90 in the form of three guiding principles of the UHS: universality, which establishes broad access to health actions and services, without restrictions of origin, race, gender, class , religion or any other form of discrimination; integrality, which implies the obligation to offer quality health care, ranging from protection and prevention to all levels of care complexity, and equity, which seeks to correct injustices with historically vulnerable populations, through policies and specific actions, trying to reduce health inequalities.5 Prejudice and discrimination against sexual behaviors that diverge from the heteronormative pattern (sociocultural norm that hierarchizes heterosexuality to the detriment of other forms of INTRODUCTION How to cite this article Silva PHA, Silva AG, Vasconcelos GMA, Silva JRS, Souza JDS, Thorpe LIF, et al. Sexuality in the academic nursing curriculum: evaluation in universities. J Nurs UFPE online. 2021;15:e246549 DOI: https://doi.org/10.5205/1981-8963.2021.246549 sexuality) are recognized in the literature as health determinants, since they cause specific vulnerabilities, they constitute symbolic barriers access, influence the quality of care and carry a strong potential to trigger processes of suffering, illness and premature death of this population.6 In this way, the symbolic barriers to access imposed by prejudice and stigma comply with the principle of universality. Comprehensive care is prevented due to ignorance and / or negligence on the part of managers and health professionals in relation to the psychosocial aspects and specific needs of the LGBT population, and the heteronormative pattern of health practices, the process of pathologization of behavioral variants, prejudice embodied in the subjectivities of users and professionals, in addition to institutional sexism, hinder compliance with the actions provided for by equity policies.5,7 The relevance of this study to the academy resides in the recent character of phenomena that occurred and analyzed in society. In addition, it proposes a perspective of insertion of professors and students of the Nursing course as mediators on topics related to human sexuality of the LGBTQIA + public.4 ! To identify, with regard to sexuality, the composition of the curricular grids of undergraduate nursing courses at universities. ! It is a qualitative, descriptive, exploratory, field study. For this purpose, the curricula of the three universities offering undergraduate nursing courses in Recife were identified and analyzed, which are found on the institutions' websites, as well as the literature on the subject present in LILACS, MEDLINE and databases. Science Direct, and SCIELO Virtual Library. A qualitative approach was used, which deals with a universe of meanings, beliefs, values and attitudes, thus presenting a better understanding of the relationships analyzed here. It is formulated, by the researcher, above his/her interest in knowing the “qualities” of his/her object of investigation, a knowledge about the properties that are inherent to it, intending to present them in their essence.8 The study was carried out at three universities in Recife-PE, offering undergraduate nursing courses, with the following code names: “University A; University B; University C ”. The concept 4 (CPC) at MEC was obtained through the three courses, of which, from the three institutions surveyed, two were public and one private. The empirical approach was defined by the very criterion OBJECTIVE

elective courses and their corresponding menus were analyzed. These data was correlated with the thematic literature found in the researched sources. Results: in the curricula of universities in Recife, the absence of sexuality content was identified. This contributes to the lack of information inherent to the theme, which can limit student knowledge to the demand of the LGBTQIA + population and compromise the assistance provided by future professionals. Conclusion: it is concluded that the inclusion of the debate on sexuality in the pedagogical program of universities is a challenge in strengthening a comprehensive health care policy for this population and implies the necessary breadth of knowledge of future nursing professionals to promote equity and universality of the access to nursing services.

RESUMEN
Objetivo: identificar, en materia de sexualidad, la composición de los planes de estudio de los cursos de pregrado en Enfermería en las universidades. Método: se trata de un estudio de campo cualitativo, descriptivo, exploratorio. Se analizaron los currículos de las tres universidades que ofrecen cursos de pregrado en Enfermería, los cuales se encontraron en los sitios web de las instituciones, y se utilizó la literatura sobre el tema, presente en las bases de datos LILACS, MEDLINE y Science Direct, y la Biblioteca Virtual SCIELO. Se analizaron los cursos obligatorios y optativos y sus correspondientes menús. Estos datos se correlacionaron con la literatura temática encontrada en las fuentes investigadas. Resultados: se identificó la ausencia de contenido de sexualidad en los planes de estudio de las universidades de Recife. Esto contribuye a la falta de información inherente a la temática, que puede limitar el conocimiento del estudiante a la demanda de la población LGBT-QIA + y comprometer la asistencia brindada por los futuros profesionales. Conclusión: se concluye que la inclusión del debate sobre la sexualidad en el programa pedagógico de las universidades es un desafío en el fortalecimiento de una política de atención integral en salud para esta población e implica la necesaria amplitud de conocimientos de los futuros profesionales de Enfermería para promover la equidad y universalidad del acceso a los servicios de Enfermería. The structuring of the curriculum of undergraduate schools is organized according to different disciplinary areas, persuading academics to find, accumulate and manage information from knowledge disciplines. In this way, the school world begins and ends with the disciplines of knowledge and the high academic culture that produces, maintains and sanctions them. Thus, the curricular composition is part of the planning and structuring of health courses, in addition to contributing to the academic development of future professionals..¹ It is explained that it is through the body that the individual makes himself/herself present, relates to the world and organizes his being; it is also through the body that nursing professionals become aware of their historicity, of their relationships with others and with the world. This makes it possible to perceive and understand that the meaning of one's own existence cannot be apprehended or unraveled without mediation and that it offers itself to understanding and interpretation through the body.² Through the act of caring in Nursing, a very close and intimate relationship is established, which, at different times, is constituted with intense physical contact, permeated by various sensations and feelings. This direct action on the other's body is made with which the nursing professional or student comes into contact with the patient's pain and feelings. Thus, nursing practice is permeated through contact with the different; however, many times, the professional is not prepared to exercise such care. [2][3][4] Article 196 of the Constitution establishes health as a right for all and a duty of the State. This constitutional requirement appears in the Organic Health Law No. 8080/90 in the form of three guiding principles of the UHS: universality, which establishes broad access to health actions and services, without restrictions of origin, race, gender, class , religion or any other form of discrimination; integrality, which implies the obligation to offer quality health care, ranging from protection and prevention to all levels of care complexity, and equity, which seeks to correct injustices with historically vulnerable populations, through policies and specific actions, trying to reduce health inequalities. 5 Prejudice and discrimination against sexual behaviors that diverge from the heteronormative pattern (sociocultural norm that hierarchizes heterosexuality to the detriment of other forms of sexuality) are recognized in the literature as health determinants, since they cause specific vulnerabilities, they constitute symbolic barriers access, influence the quality of care and carry a strong potential to trigger processes of suffering, illness and premature death of this population. 6 In this way, the symbolic barriers to access -imposed by prejudice and stigma -comply with the principle of universality. Comprehensive care is prevented due to ignorance and / or negligence on the part of managers and health professionals in relation to the psychosocial aspects and specific needs of the LGBT population, and the heteronormative pattern of health practices, the process of pathologization of behavioral variants, prejudice embodied in the subjectivities of users and professionals, in addition to institutional sexism, hinder compliance with the actions provided for by equity policies. 5,7 The relevance of this study to the academy resides in the recent character of phenomena that occurred and analyzed in society. In addition, it proposes a perspective of insertion of professors and students of the Nursing course as mediators on topics related to human sexuality of the

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To identify, with regard to sexuality, the composition of the curricular grids of undergraduate nursing courses at universities.

!
It is a qualitative, descriptive, exploratory, field study. For this purpose, the curricula of the three universities offering undergraduate nursing courses in Recife were identified and analyzed, which are found on the institutions' websites, as well as the literature on the subject present in LI-LACS, MEDLINE and databases. Science Direct, and SCIELO Virtual Library.
A qualitative approach was used, which deals with a universe of meanings, beliefs, values and attitudes, thus presenting a better understanding of the relationships analyzed here. It is formulated, by the researcher, above his/her interest in knowing the "qualities" of his/her object of investigation, a knowledge about the properties that are inherent to it, intending to present them in their essence. 8 The study was carried out at three universities in Recife-PE, offering undergraduate nursing courses, with the following code names: "University A; University B; University C ". The concept 4 (CPC) at MEC was obtained through the three courses, of which, from the three institutions surveyed, two were public and one private. The empirical approach was defined by the very criterion OBJECTIVE METHOD of the concept of university, which differs from that of college, the first corresponding to Higher Education, which covers all areas of knowledge.
Data was collected in December 2017 through the curricular grids available on the website of educational institutions. Compulsory, elective courses and their respective menus were analyzed in order to observe whether there was a cut in the discussion on the theme of health and sexuality, involving LGBT health, in the different areas of nursing professional performance. These data were subsequently correlated with the thematic literature found in the aforementioned databases.

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In the regular curricular grids of the three universities in Recife, the absence of content on sexuality was identified (Figures 1, 2 and 3). This contributes to the lack of information inherent to the theme, which limits student knowledge to the demand of the LGBT population and compromises the assistance provided by future professionals.. 9

Semester
Code Name of course    Only one of the institutions has available, in what concerns the elective contents offered for the course, a discipline that contemplates the theme -named "Gender and Health" and, although it is included in the curriculum of the course, such chair was never effectively taught ( Figure 4). It was also noted, although not the objective of this research, in the teaching plans of the institutions in question, as traditionally happens in health courses in Brazil, the absence of a thematic approach on sexuality in the basic disciplines of the course -Human Anatomy, Physiology and Semiology. It is therefore important, considering that these disciplines form, respectively, the knowledge of human body parts, their functionalities and care techniques for the professional practice of egress in the course, that they contemplate other narratives and care practices that do not exclusively consider the construction of the cisgender body (people who identify with the socio-cultural form of their gender at birth) and heteronormative. 1,4,6

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The basic subjects for the training of nurses, such as Anatomy, Physiology and Human Semiology, are found in the Nursing curricula of the universities analyzed, but discussions, such as the changes suffered by transsexuals, for example, avoid the contents of the syllabus. [3][4][5] The nurse, in the practice of caring, finds himself with different procedures attributed to his function, such as bladder probe, oncotic cytology and breast exams, which are invasive procedures, technically taught and performed only for cisgender bodies. 7 It can be analyzed, in view of the results, that the lack of a restructuring of the basic disciplines of the Nursing courses, observed in this research, allied to the absence of debates, in room, about sexuality, very probably will make the egress, in this course, not trained for the care of all the possibilities of human body, fall in the usual mistake of exposing transgender patients and not binary when there is the need for them to go through these procedures. This situation results in the re-

DISCUSSION
verse of the practice of integral care to the patient, since these procedures are not designed for bodies other than cisgender and heterosexuals. 4,6,9 It is understood that the lack of inclusion, in the training of health professionals, of thinking about the care of bodies that escape heteronormativity, 4 as traditionally thought the disciplines of Human Anatomy, Physiology and Semiology, is a discrepancy, because many are those that have distinct characteristics of the standard body. Professionals capable of caring for the patient and providing integral care are graduated in Nursing, so mastering different anatomical compositions is part of the nurse's service. 7,10 It can be said, regarding the verification of the existence of the only elective discipline -"Gender and Health" -available at the university "A" (Figure 04), that, in the light of the existing literature, although it is an advance compared to the other researched universities, the discipline is not sufficient for the integral formation of the professional nurse, since it has never been taught and, moreover, it is not on the mandatory grid, which weakens the relevance of the theme. 2 Therefore, the need to include the content approach on sexuality in the basic disciplines and in the mandatory schedule of the Nursing course, with a focus on the healthy development of sexuality in the various presentations and orientations, is perceived. This vision is essential, since the absence of these discussions reinforces prejudices, besides depowering the nursing professional's performance in a comprehensive and relational perspective. 2,6 ! This research concludes that the Nursing curricula in question do not present, in their structure, topics on sexuality, which will probably reflect negatively on future professional practices. It is important, in this sense, to restructure the basic disciplines that work with the human body, present in the Nursing graduations in Pernambuco, as well as to include debates on gender and sexuality in the compulsory curriculum of the courses, since trans and non-binary bodies need to be supported by the guidelines of care of the professional in Nursing.
More research is needed regarding the care of the trans body and that it be discussed in the basic disciplines of nurse training, such as Human Anatomy, Physiology and Semiology. The lack of debate on the subject of trans (sexuality) in relation to the discussions and contents experienced by those who have graduated from Nursing courses contributes to the practice of caring for the LGBTQIA+ population, and sexually diverse, who suffer from prejudices and barriers in access to health.
It is believed that the need to include the themes of sexuality and sexual health of the LGBTQIA+ population in the academy and training courses is the strengthening of an integral health CONCLUSION care policy for this population and implies the necessary breadth of knowledge to prepare Nursing professionals to effectively promote equity and universality of access to qualified Nursing services.
It is informed that all authors also contributed in the conception of the article, collection, analysis and discussion of the data, as well as in the writing and critical review of the content with intellectual contribution and in the approval of the final version of the study.