Construction of professional identity in nursing students: qualitative research from the historical-cultural perspective*

Objective: to analyze the process of professional identity construction in undergraduate nursing students during their education. Method: qualitative research, anchored in the Historical-Cultural framework. Twenty-three undergraduate nursing students took part. Data were collected through individual interviews, with a semi-structured script. Thematic Analysis was used to analyze the data. Results: the following four themes were obtained, “The subject in movement to become a nurse: from previous experiences to entering the courses”; “The nursing professor in the construction of the undergraduate’s professional identity: a two-way mirror”; “Pedagogical relationship: instrument for constructing the student’s professional identity” and “Historical-cultural conditions: space for the construction of the student’s professional identity”. Conclusion: the construction of the students’ professional identity is limited to the material conditions of existence, translating appropriation to the intrapsychic scope of elements that occur, first, in the inter-psychological space of interactions. Nursing professors can become a paradoxical mirror, with one face to be imitated and the other, which materializes meanings of a model not to be followed. This construction is also influenced by the conditions of professional practice and university education.


Introduction
The term professional identity in Nursing is not always clearly grounded (1) . Perhaps because this field of study is marked by complexity, in close relationship with the diversity of theoretical frameworks supporting research (2) .
Nevertheless, nursing educators around the world share the concern that it is necessary to provide future nurses with space to construct professional identity (3) , especially in training, in order to provide conditions for the subject to appropriate cultural production aspects of what it means to be and to work as a nurse at a given historical and social moment.
The construction of this identity is related, therefore, to the context of the profession, to the movements and activities of Nursing (4) .
In this sense, the dialectical perspective of human development -as a historical and cultural process, producing qualitative transformations, always in motion, enabling the subject to achieve selfdetermination (5) -can contribute to understanding of the phenomenon.
Based on Historical-Cultural Theory, it is not possible to conceive of man, and therefore his identity, in a bipartite way and to study them in a dissociated way, that is, to seek to understand the psyche without behavior, or vice versa (6) , as studies would be reduced to explanatorycausal or comprehensive-descriptive readings.
Therefore, we seek to understand professional identity going beyond the dualism between the attributes inherent to the subject and the behavior expressed by a professional group. The professional identity of the nurse is conceived as a set of psychological functions integrated with each other, developed based on the multiple relationships of the subjects throughout their history and operated in the working relationships within the scope of work.
As eminently socio-historical functions, this development cannot be decontextualized from the conditions of its production, which raises the question: how are the cultural elements of the profession made available and how are they appropriated by students in the trajectory of constructing their professional nurse identity?
There is a need for research enabling understanding of the processes of constructing professional identity in nursing students so as to, on this basis, expand the possibilities of changing education (7) , sometimes still based on content paradigms, centered on the disease and on hospital practices (8)(9) , in dissonance with what is expected of nurses nowadays.
Furthermore, the importance of such research emerges when one considers the historical moment that the nursing profession is going through, materialized in the worldwide Nursing Now campaign, which seeks to value and empower professionals in the face of health sector challenges (10) . It is understood that discussing the construction of professional identity in nursing students still in training can contribute important elements to achieving the results of this campaign, particularly in relation to the goal of improving education and professional development (11) . Especially because, the scope of the desired macro-political transformations presupposes a critical analysis of the dynamics of micropolitics, in the concrete spaces where the training of future nurses occurs (12) .
In view of these notes, this study aims to analyze the process of constructing professional identity in nurses by undergraduate nursing students during their education.

Method
Qualitative research based on the Historical-Cultural framework, which guides the investigative effort in order to uncover the bases that are the genesis of a phenomenon, as the appearance and the way in which the phenomenon manifests depends on the conditions enabling its production (6,13) . Thus, an analysis is proposed that goes beyond the phenotypic surface, going beyond appearance. and were not included. A pilot study was previously carried out with four students to assess the relevance of the interview script. As it was not necessary to change the semi-structured script, the resulting data was included in the analysis. Therefore, 23 students participated in the research, selected by convenience.
No one refused to participate.
The data were obtained by the main researcher through individual interviews, guided by a semistructured script (Figure 1), the audio of which were recorded.
It is noteworthy that the interviewer researcher, although he did not share subjects with the participating students during the period, had already taught subjects throughout the undergraduate course, which encouraged approaching the students and the personal invitation to participate in the study. The interviews were conducted in a room at the university itself, with scheduling as requested by the respondents.
The researcher and the interviewee remained alone in the environment in order to provide a welcoming atmosphere, without external interference.
To record the audio, a digital recorder was used.
The total duration of the interviews was approximately six hours, varying between eight and 30 minutes each.
The variation in time was related to the uniqueness of each participant in the way they expressed ideas, which did not represent a significant difference in the content of the interviews.
The interviews were transcribed in full in a text editor by the first author. The transcribed data totaled 101 pages.
Thematic analysis was used to analyze the data (14)(15) , following six steps: familiarization with the data; generating initial codes, which was done inductively, based on the entire data set; elaboration of themes, that is, grouping a set of meanings related to ontological and epistemological assumptions that support the research construction; review of themes regarding external heterogeneity and internal homogeneity; defining and naming the themes; producing the research report.
The analysis was collaborative, carried out by the main researcher together with the research supervisor, with the critical contribution of the other authors (15) .
To ensure the rigor of the investigation, the procedures for collecting and analyzing data and the theoretical perspective that underpinned the research were explained, and the results were analyzed with interpretations in the light of the related literature (16) .
The research was conducted and the report produced in line with the criteria of the Consolidated criteria for reporting qualitative research (17) . The close relationship between professional identity under construction and the material conditions of working as a nurse.
7 -Are there any questions you would ask yourself on this topic which were not ask during the interview? How would you respond?
Relevant aspects of the experiences from the students' perspective which were not accessed by the previous questions Rev. Latino-Am. Enfermagem 2020;28:e3284.

Results
Thematic analysis of the data led to four themes, three of which had two subthemes ( Figure 2).

Themes Subthemes
1 -The subject in movement to become a nurse: from previous experiences to entering the course 2 -The nursing professor in the construction of the undergraduate's professional identity: a two-way mirror Professor: mirror of the nurse the student wishes to be Professor: mirror of the nurse the student does not wish to be  The influence of the family was noted as a factor that awakens the choice of nursing as a career option, however, it was observed that it can also be a coercive The second theme, named "The nursing professor in the construction of the undergraduate's professional identity: a two-way mirror", shows the way teachers are perceived by students. Sometimes, the teacher is a model from which nursing takes shape for students, an aspect organized in the sub-theme "Professor: mirror of the nurse the student wishes to be". [ On the other hand, the paradox that in the same work as nursing professor, particularly in the context of teaching professional practice in health services, students seem to delimit what they do not want to be. These meanings were organized in the sub-theme "Teacher: mirror of the nurse who does not want to be". Regarding the fourth and last theme, called "Historical-cultural conditions: space for the construction of the student's professional identity", it was found that the socially constituted conditions of professional practice, as well as the conditions in which training takes place, translated into conformation of the curricular structure, playing a role in the configuration of professional identity.
In the subtheme "Nursing working conditions", the way in which socially elaborated meanings about the profession accompany students in their trajectory is presented: [

Discussion
The trajectory of constructing the nursing student's professional identity is related to their life history and circumscribed to the material conditions of existence from which it is constituted, through the appropriation of the cultural elements available to them.
Students go into nursing due to the historical possibilities that circumscribe them. For example, for some participants, access to university was through the nursing course -in view of lower competition, compared to other courses in the health care field (18) . Although the first course option for some students was medicine, they were unable to access it, restricted, in most cases, to a group of students due to the competition (19) .
For the nursing workforce, this is particularly important. If, historically, medicine tends to be the first choice of students who aspire to careers in the health care field (20) , nursing can bring together students who do not wish to become nurses and choosing to enter the profession without awareness of its duties (21) , which can impact how it is valued by the student him/herself and the future professional of the area.
Thus, incentivizing policies must be put in place to recover the historical and cultural value of the nurse's profession, strengthening social and political positioning as central aspects to the health and development of society (10) .
Nevertheless, the students' statements enable us to infer that the subjects can reframe the profession.
Although it cannot be guaranteed that completion of the course will result in effective professional practice, the fact that a student enters the course without consciously wanting it and concludes it by reconfiguring thinking, highlights the importance of the training process. This is related to the assumption that the learning process leads to the continuous development of higher psychological functions and education not only influences the development processes in isolation, but can restructure the subject's functions in all its breadth (13) .
Based on new needs, human beings create a different appropriation of the meanings of the objects around them. Consequently, they dialectically transform it, to the same extent that they modify their own surroundings (6) . Thus, the learning that occurs during the degree may modify the student's development in other fields of life, with consequent new formations of personal purposes and world view.
In continuous interaction with social actors throughout their education, students can develop resources and functions to adapt to the requirements of the prospective career (22) or even rethink their choices.
In this process, the role of teachers, as nurses, seems important for students to materialize what it means to be and work as a nurse. The professors' role in this construction is not limited to the classroom (23) and their contextualized performance in the fields of practice occupied a prominent place in this study.
The path to constructing professional identity as nurses, by students, may be similar to the trajectory formulated in the Cultural Development Law, which assumes that every higher psychological function is rather a socio-cultural formation, beyond the biological field (6) . Thus, at first, being a nurse happens in the interpsychological sphere, among peers. The professor, as a nurse, demonstrates conduct, skills, materializes attributes and indicates meanings, and based on this relationship, the students appropriates what, in itself, it means to be a nurse, presenting himself as a nurse to the other, professor and peers, and, at the same time, becoming a nurse for themselves.
Based on what they demonstrate by the way in which they operate the different characteristics of being a nurse, professors are a model for the student (3,24) .
Professional models are perceived as those who influence others, exemplifying ways of acting, professional and/or personal characteristics expected in nursing, and which can be imitated by others (25) .
Imitation, in turn, is a highly important mechanism in the transformations which occur in personality functions, because it is a process that allows learning to happen in collaboration with the other, leading to development and transitions (13) .
This aspect is noted in the interviews, mainly regarding interactions between professors and students in clinical practice environments. There is a consensus in the literature that clinical practice is an essential part of nursing education (26) , it gives meaning to theory (3) and doing linked to practice is central for the student to develop professional identity as a future nurse (27)(28) .
In line with this finding, studies have observed that the manifestation of values by professional models, in the practical field, is a great incentive for students to develop these characteristics (29) . Students can take teachers as examples and seek to appropriate professional attributes at the beginning of training, during the internship, and in the future career (23) .
On the other hand, it was observed that models perceived by students as inadequate also play a role in the process of developing professional identity.
There are authors who infer that students can even learn from professional models whose attitudes are not consistent with their practice (25) and that professors' perceived lack of empathy pushes nursing students to work towards developing a better standard than that perceived in their professors (30) .

However, interacting with examples with inconsistent
attitudes can cause loss of interest in learning, feeling that you will not be able to be a successful nurse (30) , difficulties in developing personal strategies to avoid becoming the same as the models you criticize (31) and appropriation of inappropriate conduct that may be replicated in professional practice (32) .
These points, combined with the conception of learning as a process, dependent on the collaboration of others, which aims to provide the individual with mastery over what cannot be done alone (13) , highlight the role of the nursing professor in the students' process of constructing identity.
Relationships established during the degree play a role in this dynamic, given that the student's education is not restricted to the formal curriculum, but takes into account subjective aspects (32) that also impact learning and professional development (33)(34) .
From this angle, an empathic relationship can lead to a constructive learning experience, and thus, students feel interested, motivated to learn more, continue their studies and achieve better results (30) . Establishing such a relationship is facilitated by mutual trust, understanding, care and clear guidelines (33) .
However, verticalized relationships may result in distancing students from spending time with possibly significant models for constituting identity. Some professors' attitudes, such as criticism unaccompanied by encouragement and reproving errors, can distance students and generate feelings such as fear of asking questions (33)(34) , looking stupid, not knowing anything (30) , in addition to anxiety about attitude to evaluation and inappropriate communication from the instructor (35) .
Another important aspect in the findings of this study concerns the influences of sociocultural constructs on nurses' professional practice.
Despite changes in the last decade, perceptions that undervalue nursing and careers in the field sometimes persist in the social imagery (36) . Stereotypes expressed in the media and low financial remuneration given to significant nursing segments in Brazil, raise doubts about nursing as a choice of profession (4) . Such perceptions influence some of the aspirants to the profession (36) .
This devaluation is also expressed in precarious work relationships, with an unstable labor market, characterized by fixed-term employment contracts (37) , double shifts and elevated weekly workload (38) .
It is recognized that students need to support their decisions to overcome the difficulties they encounter throughout their training when faced with these objectives and subjective elements. Therefore, we need to recognize the contradictions permeating the professional practice of nurses these days. If clinical experience in health care services is essential for students to build their professional identity (28) , if there is only a short time in these spaces, learning may be disadvantaged and not provide appropriation of the founding elements of the profession (26) .
Likewise, depending on how student supervision takes place, they will not always be systematically accompanied by a professor linked to the course and, in theory, with training to articulate pedagogical and specific knowledge.
Although national curricular guidelines prescribe that nurses in health care services where internships take place must effectively participate in preparing and supervising students (40) , multiple socioeconomic and political factors stand in the way of achieving this objective.
Furthermore, health care services in which clinical practice occurs during the training period may have limited governance (41) and hierarchical relationships (26) delimiting the teaching possibilities materialized in the curricular proposals.
Thus, what is desired to be operationalized in training is not always possible, given the material conditions circumscribing educational proposals, such as the hegemony of the disciplinary and traditional teaching model, the difficulties in the partnership between teaching and service and the way of hiring nursing professors (42) .
Moreover, it is necessary to recognize that working nurses do not always have the preparation necessary to support students' learning (26,43) . Thus, it is understood that the way training is structured and learning is provided, which professors and students may not pay attention to (44) , is an important element in the trajectory of constructing identity.
The results of this research are corroborated by national and international literature, which highlights the global concern with the training processes in nursing, the role of professors, the curriculum and its consequences in producing the nurses of the future and in the way the profession is valued.
This research has some limitations, such as the fact that it was conducted in only one educational institution, which translates specific socio-cultural conditions, and the data were produced from interviews alone. However, when privileging the interviews, it was considered that it is mainly through language that the system of Rev. Latino-Am. Enfermagem 2020;28:e3284.
historically constructed meanings and the meanings singularly attributed by the students are accessed (13) , elements essential to understanding the complex learning processes related to professional identity.
From this understanding, the analysis presented, based on a theoretical framework (6,13) not commonly used to approach the topic, have enabled advances in this field of studies to the extent that we can have a different view of interaction as a psychological tool that may or may not favor the appropriation of the meanings in the nurse's identity.
This study can contribute to curricular changes by reinforcing the importance of providing appropriate spaces, quantitatively and qualitatively, for establishing interactions that enhance the development of professional identity, which implies establishing strategies to improve teaching-service partnerships and adopting positioning contrary to distance-learning nursing courses.

Conclusion
The construction of the students' professional identity is influenced by their life trajectory and limited to the material conditions of each subject's existence.
It follows a path that translates appropriation to the intrapsychic scope of elements that take place, primarily, in the interpsychological space, and are apparent from interactions, especially those made possible by training, with emphasis on those between nursing professors and students.
For students, the nursing professor can become a paradoxical mirror, with one face imitation, and the other materializing meanings indicating a model not to be followed. This process of constructing professional identity is not detached from the conditions that recursively result in the configuration of the nurse's professional practice and the professional training itself.