Nursing entrepreneur care in social inequity contexts

Rev Bras Enferm. 2020;73(4): e20190014 http://dx.doi.org/10.1590/0034-7167-2019-0014 6 of ABSTRACT Objectives: to identify emancipatory strategies to strengthen the social protagonism of recyclable materials collectors in the light of entrepreneurial Nursing care. Methods: qualitative study carried out in two stages: field approach from healthcare interventions in a Recycling Materials Association, and individual interviews conducted between October and December 2018. Results: the analysis resulted in three thematic categories: Social contribution of recyclable materials collectors; From the assistentialist perception to entrepreneurial Nursing care; Emancipatory strategies of recycling work. Final Considerations: the emancipatory strategies to strengthen the social protagonism of recyclable materials collectors in the light of entrepreneurial Nursing care are related to the appreciation, recognition and enhancement of social work that has been already performed by these professionals, and to the creation of spaces for the socialization of experiences, expectations and perspectives. Descriptors: Social Inequity; Solid Waste Use; Health Education; Nursing care; Nursing Research.


INTRODUCTION
According to Agenda 2030 priorities, ensuring a healthy life and promoting wellbeing for everyone requires a collaborative impulse for the integration of economic, social and environmental dimensions, as well as a systemic and interdependent understanding between the different segments of society that invigorate the process of healthy living. Despite economic progress and improved health indicators, chronic diseases and those resulting from social determinants and conditions are still among the main challenges for the Nursing/ Health science, especially in contexts of social inequities. Studies show that economic losses resulting from these diseases in middleand low-income countries will exceed USD 7 trillion by year 2025 (1)(2) .
The most important workers among the socially vulnerable groups are those from Recycling Materials Associations. Most of the time, these professionals operate in unhealthy conditions, are exposed to risks of all kinds, such as chemical, biological, environmental and others, and live with iniquities and social devaluation. These factors have directly influenced their healthy living, which is understood as a singular, circular and interactive process, dynamized through life experiences of order and disorder in search of a continuous individual, family and social self-organization (3) .
From this perspective, social entrepreneurship can be understood as an inductive tool for new knowledge and solidary and collaborative practices. For scholars in the area, entrepreneurship induces processes that interconnect different agents and social segments, since innovations and transformations at the local level result from interactive and associative networks in which the needs of individuals and communities are addressed collaboratively (4)(5) .
In the nursing area, the entrepreneurial vision assumed commercial and social characteristics associated with the (re)creation of something for generating market benefits. It is also associated with the capacity to generate creative processes and associations with the aim of emancipating individuals, families and communities. In this direction, entrepreneurial nursing care can/should be considered a complex phenomenon systematized through multiple relationships, interactions and systemic associations with a view to promote healthy living in an integral and coordinated way with other sectors of society (3,6) .
In the perspective of social entrepreneurship, the (re)significance of Nursing care is a recurrent theme in debates that guide the Brazilian Unified Health System (Portuguese acronym: SUS), the curricular guidelines of Nurses' professional training and institutional policies, where is reinforced the stimulus to protagonism and social co-responsibility. The perception that through entrepreneurial care, nurses can contribute to sustainable social development related to expanded opportunities and real possibilities of individuals, families and communities, is no longer a challenge, but a prospective appeal for the advance of nursing science. Nurses assume a proactive role in identifying the care needs of the population, and in promoting and protecting individuals' health in their different dimensions (7)(8) .
There is still much to be investigated in the field of social entrepreneurship, especially by associating it with the eradication of poverty, reduction of social inequities and promotion of a healthy life. These challenges transcend the health area and deserve priority in research agendas of the different areas of knowledge. Thus, the question is: How to promote the protagonism and social emancipation of members of a Recycling Materials Association in the light of entrepreneurial Nursing care?

OBJECTIVES
To identify emancipatory strategies to strengthen the social protagonism of recyclable materials collectors in the light of entrepreneurial Nursing care.

Ethical aspects
The recommendations of Resolution number 466/2012 of the National Health Council were followed and the project was approved by the Research Ethics Committee under number 1.641.967. In order to maintain participants' anonymity, their speeches were identified with the letter "P" (Participant) followed by an Arabic numeral corresponding to the order of the speech: P1, P2... (22).

Type of study
Descriptive, exploratory, qualitative study. Social entrepreneurship was used as a theoretical reference, and the thematic content analysis was the technique used for data analysis.

Methodological procedure
The study included two steps. Initially, a field approach was carried out in a Recycling Materials Association based on care interventions, such as health education workshops with topics suggested by workers, conversation wheels, confraternization in special dates, volunteer days at the Association, and other dynamic teaching and research interventions performed creatively with active participation of workers. At this stage, researchers sought to recognize the context and working conditions, relationships and interactions between members and their social environment.
In the second stage, researchers were already familiar with the scenario and conducted individual interviews with the 22 employees of the Recycling Materials Association on days and times previously agreed upon with participants.

Study scenario
The study was conducted in a Recycling Materials Association located in the central region of the state of Rio Grande do Sul. This Association started in 2009 and provides work and income to approximately 30 families who depend on this source of income, even though only 22 people work there. The average number of children per family ranges from four to eight. The daily workload is of eight hours and the monthly income of each collector varies between R$ 400 and R$ 600 plus voluntary donations.

Collection and organization of data
Data were collected between October and December 2018 through interviews conducted after the scenario recognition and care interventions. The inclusion criteria of participants were: to be of Nursing entrepreneur care in social inequity contexts Backes DS, Forgiarini AR, Silva LD, Souza MHT, Backes MTS, Büscher A. active at work during the data collection period and participate in at least 80% of the previously performed intervention activities. Exclusion criteria were individuals aged under 18 years and those who did not wish to participate in the study. Interviews were conducted with the 22 collectors based on the following guiding questions: What is the contribution of your work to society? If you could do anything differently in your job, what would it be? What Nursing/ Health care activities do you consider important to qualify your work in the Association?

Data analysis
The interviews were complemented by observations made during the care interventions, transcribed, organized, and then was performed the thematic content analysis. The objective was to discover the nuclei of meaning in the communication, whose presence or frequency added significant perspectives to the object of study. Subsequently, followed the three steps of this technique: pre-analysis with exhaustive reading of data, followed by organization of the material and formulation of hypotheses; exploitation of the material with the coding of crude data; interpretation and delimitation of data in thematic categories according to the understanding of meanings (9) .

RESULTS
Three thematic categories resulted from the organization and analysis of data, as follows: Social contribution of recyclable materials collectors; From the assistentialist perception to entrepreneurial Nursing care; Emancipatory strategies of the recycling work.

Social contribution of recyclable materials collectors
Each statement, expression, look or gesture from workers of the Recycling Association demonstrates their social contribution. The expression "I am proud of what I do. I recognize the value of my work" was heard often with emotion and gleaming eyes. In general, all workers are aware of the relevance of their work for the sustainable development, although their rights are not always understood, as expressed: Another contribution present in participants' speeches concerns the rescue of citizenship and the promotion of the dignity of other close people. While recognizing their work as 'humble' , members of the Recycling Association equate it with the work of any other profession. In some cases, they consider it even more relevant because it contributes to sustainable development and, above all, to the support of their families, as expressed in the speech: In general, participants showed concern for the family and children in their testimonials. In addition to daily subsistence, they reckon their work is an example of life and dignity for their children, as expressed: "so they won't be proud and indifferent people". With this expression, they portray their indignation with provocative attitudes and the indifference of many people of society, who consider themselves superior to others.

From the assistentialist perception to the entrepreneurial Nursing care
In participants' speeches, the social dimension of nursing care was strongly emphasized. At first, nursing care was aimed at the Association's workers and, in a second moment, at the community in general. In the testimonial of one of the leaderships, the form of Nursing recognizing people's needs and dealing with them has the potential to emancipate the different social groups, particularly the collectors, so that they take on new spaces in society, as some workers feel diminished and devalued in their daily life.
Here, everyone needs to understand that we are doing a decent, honest job and assuming this condition. We are not robbing or prostituting ourselves. It's a decent job ... everyone needs to think this way and not feel diminished ... Nursing helps us think and realize the greatness of this work ... shows we are fundamental to society. (P4) One of participants specifically referred to the basic care discussed by Nursing, such as hand washing, physical activities and preventive care, and highlighted how the issues were addressed with workers. This same participant recognized the effectiveness of interventions performed, including perceptible changes in the attitudes and behaviors of her work colleagues: In a different moment, another leadership reinforced the need to instrumentalize the community in general about the meaning and social relevance of recycling by considering that many people cannot distinguish recycling from trash, that is, they consider "everything as garbage". Participants of this study recognize the fundamental educative role of nursing, because these professionals induce the exercise of citizenship and new forms of thinking and acting in society. From the testimonies expressed, Nursing already glimpses new theoretical-practical approaches in which users are the subjects and protagonists of their history. The care and punctual nature of nursing care has gradually assumed entrepreneurial characteristics and is committed to environmental sustainability and social development.

Emancipatory strategies of the recycling work
The first strategy evident in participants' speeches is related to the ability to recognize and enhance the work performed by members of the Recycling Materials Association in favor of environmental sustainability. The second strategy that was clearly perceived and recommended by members, is that the community does not feel 'sorry' for recyclable collectors, but rather values them as 'human beings' who deserve respect and dignity like any other professional worker, as shown in the following statement: We do not want them to feel sorry for us or for our work. We are not worthy of pity, because we work with dignity. We do want them to value our work and collaborate with us by separating recyclable material in their homes. (P5) In all speeches, the strong appeal was for people in general beginning the separation of solid materials in their homes and sending it in minimally acceptable conditions to the Association. In this direction, collectors do not ask for anything extraordinary, only for greater consideration and appreciation for the work they do.
I wish people of the community had more consideration for our work, for us ... that they became aware of the need to recycle their materials at home and not humiliate us and treat us as if our work was inferior and less important. (P13) Another strategy is related to the creation of opportunities and spaces for the exchange of experiences and socialization of future perspectives and expectations. In other words, the provision of environments for workers, so they can verbalize their feelings, concerns and insecurities regarding their daily life, and demonstrate the importance of their work for social development. Some members of the Association show a desire to learn to read and write, that is, to prepare themselves for new and different life and market perspectives. Others also mentioned the need to think about strategies related to self-medication, since drugs are often discarded incorrectly by the general community and handled by collectors.

I'm really scared of people's self-medication. I am afraid of what gets here and the destination that workers give for this type of medication.
We need to think of some strategy. (P22) In the interviewees' conception, a strong educational increase is related to environmental education and health prevention and promotion as priority investment areas. They emphasize that recycling should not be reduced to a specific space and/or limited to a group of people, but the process should be conducted in a responsible and collaborative way by the community in general.

DISCUSSION
Entrepreneurial Nursing/health care empowered by the active and responsible participation of different social actors is an important strategy for the exercise of citizenship, social development and the achievement of a more dignified and healthy life for all. The more we advance in the construction of knowledge and practices in the perspective of social entrepreneurship, the better we can contribute to the advancement of nursing science and the development of public policies consistent with real needs, especially in contexts of greater social vulnerability (7,10) .
However, little is known about how social entrepreneurs develop innovative and transformative solutions in specific social contexts. In a study, is recognized that social entrepreneurship can develop collaborative processes and expand networks and partnerships, but remains the question: how to promote the social protagonism of citizens subjugated by society, but who perform a highly relevant social work, such as recyclable materials collectors? (5) .
The speech of participants demonstrated that social and health policies and/or successful assistance interventions are not enough. More than ever, there is a need for collaborative and intersectoral processes to combat social inequities, since each part reacts/interacts directly with the whole -society and vice versa. For global social development, it is critical to hear, understand and welcome the needs of the different social segments. Furthermore, their initiatives and expectations of life and work should be strengthened individually and collectively.
Recyclable materials collectors consecutively emphasize that people in general should not feel "sorry" for their living and working conditions. They plead for recognition, valorization, respect and dignity, which are considered basic human needs. This thinking requires a paradigm shift by various professionals and segments of society, especially in the way of conceiving and dealing with vulnerable classes. Traditionally, social interventions were motivated by assistentialism, that is, conducted based on punctual and linear actions in which the main participants were understood as objects and/or in a pretentious and utilitarian way.
However, in the logic of social entrepreneurship, roles/functions complement and potentiate themselves. A study shows that social entrepreneurship is one of the main inducing factors of economic and social development, and its operationalization is effective from the identification of opportunities and development of collaborative and associative processes in which the different actors participate and recognize themselves as social subjects (11) . Among its purposes, social entrepreneurship aims to exchange ideas and solutions for solving social problems by creatively combining knowledge and practices and creating new possibilities for self-sustainability through strategic associations (12) .
In Nursing, social entrepreneurship translates into sensitive, interactive and associative care that expands life possibilities and promotes the healthy living of individuals, families and communities with a view to emancipating them as protagonists of their own history (6,13) . The social relevance of Nursing care and its contributions to the advancement of science lie in nurses' ability of being active and proactive agents in the decision-making process and in their relation to the exercise of citizenship of different social groups (14) . In this direction, entrepreneurial nursing care is distinguished by the ability to identify the real needs of individuals and communities and, above all, by the ability to intervene in an aggregating and integrative way in the different movements related to the healthy living process (3) .

Limitations of the study
The few references on Nursing social entrepreneurship, especially at the national level, are considered as a limitation of this study.

Contributions to the nursing area
The main contribution of this study is related to the induction of an entrepreneurial culture in the Nursing area, and the promotion of new theoretical and methodological approaches of social intervention with a view to advancement of the Nursing science. It also demonstrates the need to train nurses for social entrepreneurship, which, according to this vision, implies training critical, flexible and proactive professionals for what is new and different. These professionals should be able to identify opportunities amid contradictions, thereby enabling a new local and global organization.

FINAL CONSIDERATIONS
The emancipatory strategies to strengthen the social protagonism of recyclable materials collectors in the light of entrepreneurial Nursing care are related to the appreciation, recognition and enhancement of the social work performed by these professionals, and the creation of spaces for the socialization of experiences, expectations and future perspectives.
Recyclable materials collectors aspire for social recognition. They plead to be understood as human beings who deserve respect and dignity for the work they do in favor of the environment and social development. In this context, the entrepreneurial dimension of Nursing care has the function of aggregating, potentializing and inducing new forms of thinking, living together and relating in community.