HISTORY OF NURSING AND HEALTH KNOWLEDGE STUDY GROUP: PRODUCTION OF KNOWLEDGE IN THE GRADUATE PROGRAM

The History of Nursing and Health Knowledge Study Group linked to the Graduate Nursing Program at the Federal University of Santa Catarina, has been producing knowledge on this subject over the past 15 years. This documentary study presents an assessment of the group’s master’s theses and doctoral dissertations conducted between 1995 and 2010. A total of 23 master’s theses and 12 doctoral dissertations were developed. The group has contributed on many fronts, whether with scientific production that embodies innovative content taught to students, or with the dissemination of its studies’ results, which gives greater visibility to its members translates into invitations for them to participate in scientific events and on editorial boards. There is a need to move toward greater integration with other research groups in the field of history and sensitize the academic community to the importance of nursing history. DESCRIPTORS: Nursing. History. Research. Knowledge. GRUPO DE ESTUDOS DE HISTÓRIA DO CONHECIMENTO DA ENFERMAGEM E SAÚDE (GEHCES): PRODUÇÃO DE CONHECIMENTO NA PÓS-GRADUAÇÃO STRICTO SENSU RESUMO: O Grupo de Estudos de História do Conhecimento da Enfermagem e Saúde, vinculado ao Programa de Pós-Graduação em Enfermagem da Universidade Federal de Santa Catarina, vem produzindo conhecimento sobre este tema nos últimos quinze anos. Trata-se de uma pesquisa documental com o objetivo de analisar as dissertações de mestrado e teses de doutorado deste grupo, no período de 1995 a 2010. Foram produzidas 23 dissertações de mestrado e 12 teses de doutorado. O grupo contribui em inúmeras frentes, seja com a produção científica que se materializa através dos conteúdos inovadores ministrados aos estudantes, seja através da disponibilização dos resultados de suas pesquisas, proporcionado aos seus integrantes maior visibilidade que se traduz através dos convites para participação de eventos científicos e integração de comitês editoriais. Há necessidade de avançar no sentido de ampliar a integração com outros grupos de história e a conscientização da comunidade acadêmica acerca da história da enfermagem. DESCRITORES: Enfermagem. História. Pesquisa. Conhecimento. EL GRUPO DE ESTUDIOS DE HISTORIA DEL CONOCIMIENTO DE LA ENFERMERÍA Y SALUD (GEHCES): PRODUCCIÓN DE CONOCIMIENTO EN POST-GRADO RESUMEN: El Grupo de Estudios de Historia del Conocimiento de la Enfermería y Salud, vinculado al Programa de Postgrado en Enfermería de la Universidad Federal de Santa Catarina, produce conocimiento sobre este tema nos últimos quince años. Se trata de una investigación documental con el objetivo de analizar las disertaciones de maestría y tesis de doctorado de este grupo, en el período de 1995 a 2010. Fueron producidas 23 disertaciones de maestría y 12 tesis de doctorado. El grupo contribuye con la producción científica a través de contenidos innovadores enseña a los estudiantes, ya sea poniendo a su disposición los resultados de su investigación, proporciona una mayor visibilidad a sus miembros que se traduce a través de invitaciones a participar en eventos científicos. Hay necesidad de avanzar en el sentido de mayor integración con otros grupos de historia y la conscientización de la comunidad académica acerca da historia de la enfermería. DESCRIPTORES: Enfermería. Historia. Investigación. Conocimiento. 71


INTRODUCTION
Graduate nursing programs were implemented in Brazil in the 1970s. The first programs were introduced at the Federal University of Rio de Janeiro, Anna Nery Nursing School (UFRJ) in 1972 and then at the University of São Paulo, School of Nursing (EEUSP) in 1973. 1 Afterwards, other programs were implemented and the increase in scientific production is undeniable (i.e. theses, dissertations, papers, books, and books chapters, among others) observed from the 1980s on. This production has been gradually consolidated, both in Brazil and internationally, in the health and nursing fields, and has contributed to the qualification of human resources and Brazilian scientific-technological development. 2 Scientific production, which, in the beginning, was individually accomplished by Brazilian researchers, gradually became a task conducted by teams of researchers organized in research groups. [3][4][5][6][7] A research group is composed of researchers, students and technical support staff, who organize the group's studies around lines of research according to a hierarchical rule based on experience and technical-scientific competence. This group of people uses the same facilities and physical installations. 8 Generally, these people are linked to institutions of higher education and other scientific research institutes and are enrolled in the National Council for Scientific and Technological Development (CNPq) -Directory of Research Groups. Nursing research groups emerged in Brazil in the 1970s and there are, according to the 2010 Census, 448 groups registered in the directory. 8 Following institutional and educational development, research groups have expanded and directly contributed to the qualification of professionals, as well as contributing to nursing practice based on the search for new knowledge. Coupled with this professional maturity, the interest for thematic fields and lines of research in the nursing field have advanced and follow the movement of the profession itself over the course of time. 9 From the 1990s on, there has been an expansion in publications in the field of Nursing History, which was recognized as line of research by CAPES* in 2000. According to the 2010 Census, there are 34 Research Groups in the field of Nursing History, which is one of these groups' lines of research. 9 The consolidation of Research Groups in Nursing History, as well as the development of its technical-scientific production, connected to the teaching of nursing history in both graduate and undergraduate programs, promotes a secure and strengthened awareness of nursing as a science and profession. [10][11][12][13] The Study  In 2008, the group made an essential change in its name to "History of Nursing and Health Knowledge Study Group" (GEHCES). This change originated from an internal evaluation and also due to the perception that the group's composition actually met the recommendations of the Graduate Nursing Program at UFSC, that is, welcoming students from other disciplines to attend the Master's or doctoral nursing programs.
Currently, GEHCES is composed of seven researchers, 15 students and two technicians. It is developing studies within five lines of research: The history of nursing in Brazil -a prospective study; The history of health and nursing specialties; The history of nursing teaching and practices in Brazil; Professional identity in health and nursing; and History of nursing in health.
The group's objective is to conduct studies addressing the retrospective and prospective views of nursing both in the Brazilian and international political, cultural, educational, and social contexts in order to recover written documentation, iconographic sources and cultural material concerning the institutions that guided Brazilian and international nursing practices; to identify and analyze the process of knowledge production in the nursing field; to identify the actors and their experiences in constructing the history of nursing; to preserve the memory of Brazilian nursing, seeking to provide tools for other researchers and also host the memory of the health field; to consolidate the line of research in Nursing and Health History in PEN/UFSC; and also to support the development of research projects in nursing history and related fields.
After 15 years of existence and work developed by its members, GEHCES presents significant scientific production. It is therefore, important and necessary to give visibility to what has been produced so far. This study's objective is to analyze the master's theses and doctoral dissertations defended by students, members of GEHCES, between 1995 and 2010. This initiative is due to the celebration of the group's 15-year anniversary and also to the fact that it is extremely important to detect gaps in knowledge and enable greater visibility of the themes addressed. Hence, this study will enable other researchers and individuals interested in nursing history to stay abreast of what has been produced so far and the use of this bibliographical material. This paper will give greater visibility to the publications addressing nursing history and will also assist the group in directing its own investigations, straightening, broadening and also redesigning its lines of research.

METHOD
This is a descriptive and exploratory documentary study with a quantitative and qualitative approach. 14 To achieve the proposed objective, this study was developed in three stages. The first stage comprised the identification of all dissertations and theses, conducted under the advice of the professors, members of GEHCES, and which were reported in the professors' curricula available on the CNPq Lattes Platform and also listed in the PEN-UFSC's theses and dissertations. A total of 23 dissertations and 12 theses were found. In the second stage, all the abstracts from all the studies concluded up to September 2010 were carefully read; the chapters concerning the objects, theoretical-methodological frameworks, and final considerations of some studies were also read.
In the third stage, the researchers analyzed data in the following the phases: ordination, classification, and grouping of studies according to GEHCES' lines of research. Data were initially organized in forms containing the studies' titles, objectives, authors, authors' affiliations and professions, theoretical framework, methodological framework, and main findings. This process enabled us to make an overall assessment of the group's scientific production, defining its achievements and devising new perspectives for research in nursing and health history. After analyzing the material obtained, information was grouped into tables and graphs in order to discuss its content in qualitative terms.
The study project was not submitted to the Institutional Review Board given its documentary nature. Nonetheless, it does comply with all ethical principles in accordance with Resolution 196/96, Brazilian Council of Health.

RESULTS AND DISCUSSION
During its 15 years of existence, GEHCES produced 12 doctoral dissertations and 23 master's theses, which gave origin to various indexed papers, abstracts and works presented at both Brazilian and international events. At present, we opted to focus on the production of knowledge in stricto sensu graduate programs. Even though the group's focus was Nursing History, some unspecific studies were conducted at the beginning because PEN/UFSC had courses that encouraged the production of studies in other fields in its mandatory curriculum. The first thesis conducted within the group was that of Professor Elizabeta Roseli Eckert, Nursing Department, UFSC, titled: "Educational practice implemented with families of hospitalized children", defended in 1999.
The group's scientific production, presented in figure 1, shows it maintains a constant number of master's theses over time: one to three master's theses are developed a year. An expressive increase in the number of theses, though, is observed from 2000 on due to the entrance of a second professor into the research group.
In regard to the doctoral dissertations, we verified that the first defense took place in 2001. The author, Mauro Leonardo dos Santos, was originally from the Universidade Federal Fluminense and his dissertation was "Compassion and vicissitudes in the practice of nursing". Thereafter, other dissertations were defended, one to two a year on average, due to the small number of professors advising within the group and also due to the 48 months required to complete the doctoral program. It is worth noting that at this writing we have five doctotal students working on their dissertations.
Almost all the dissertations and theses produced between 1995 and 2010 were produced by nurses (32), although students from other fields came to be members of GEHCES: two physical therapists and two psychologists. The reason, as previously mentioned, is due to the fact that the graduate nursing program changed its curriculum in 2000, under a new identity called "Care in the human living process", with a single area of concentration and started to welcome professionals from other fields within health and education.

Figure 1 -Distribution of studies per year of publication and type of study. Florianópolis, SC, Brazil 2010
In regard to the origin of the master's and doctoral students, they were mainly nurses working in health services in the states of Santa Catarina and Rio Grande do Sul. There were also two students from Minas Gerais, one from Argentina, who had been living in Brazil for some time already, and one from Aveiro, Portugal. This last student was enrolled in the program through a cooperation agreement established in 2005 between UFSC and the University of Aveiro, Portugal. Under this agreement, three other nurses attended the master's program in PEN/UFSC according to the program's internationalization policy. This was a particularly important experience for the members of GEHCES since they had, for the first time, direct and prolonged contact with a student from the European continent, a reality very diverse form the Brazilian and Latin-American context. Consequently, there was an exchange of experiences, both from the professional and cultural point of view, which shows the need to constantly seek greater integration with different countries and cultures.
The line of research that most frequently appeared among master's theses (Figure 2) was "The history of nursing teaching and practices," with 15 works. We believe this is due to the fact there was a requirement in a mandatory discipline called "Clinical Practice" in which students had to plan and implement a clinical practice project in one environment of professional practice. Most frequently, students decided to continue the project as part of their master's thesis through the method of Convergent-Care Research (PCA). 15 This modality of research was developed by Professors Mercedes Trentini and Lygia Paim at the end of the 1990s and can be seen as a connection between thinking and doing; between actions developed by researchers and people who experience certain situations, in general health problems, in a relationship of mutual cooperation. 15 PCA is characterized as an investigative work, the purpose of which is to reflect upon and analyze clinical practice, based on phenomena experienced in its context, as innovative conceptual constructions. The act of assisting and caring is part of the research process. The professional emphasizes "thinking" and "doing", that is, the professional performs his/her work thinking, in a reflective manner, and thinks while performing his/her work, aiming to systematize his/her work. 15 In the midst this interaction, the definition of the research problem would emerge and a search for empirical data would occur. As a consequence, many of the theses focused on care practices.
Because of the focus given to the clinical practice course, which required an intervention in professional practice, the theses initially departed somewhat from the perspective of GEHCES' lines of research in history. The development of historical research was not feasible during the period of two years, which is the period master's students had available from the time of their entrance into the program up to the completion of the program. Despite all the difficulties and limitations, some important works of a historical nature were developed within and outside health institutions, such as the thesis developed by Lúcia Helena Rodrigues da Costa: 16 "Memories of midwives: intertwining gender and history of a care practice" and the thesis by Neli Sílvia Andreazzi Canassa 17 addressing the "know-how of midwives in the Carmela Dutra Maternity Hospital (1977)(1978)(1979)(1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)", a facility built in 1950 in Florianópolis, SC that was of vital importance in Santa Catarina's society. Other historical studies addressed AIDS in Santa Catarina (Nereu Ramos Hospital) 18 and retired workers from the Colônia Sant'Ana Hospital. 19 There were also two other studies addressing AIDS focusing on the experiences of people affected by the HIV virus, based on their histories of life, 20-21 which fit within the history of heath and nursing specialties. The development of clinical practice remained a mandatory requirement in the program up to 2008. For this reason, there was a strong tendency among students to develop their studies toward a solution or minimization of problems faced in practice or propose changes and/or the introduction of innovations in health practices. These studies could lead to consistent theoretical constructions; the PCA method was being used. 15 However, from 2008 on, a new curricular structure was implemented in the Nursing Master's Program and the clinical practice course was removed from the program. PCA was then assumed as a method, together with the remaining qualitative and quantitative methods, which eased a greater implementation of historical studies.
The doctoral dissertations, in turn, mainly focused on the research line "History of health and nursing specialties" (eight) followed by "Professional identity in health and nursing" (two) and "History of nursing teaching and practices" (two) (Figure 3), confirming the impact of publications in the field of Nursing History at the national and international levels, which causes GEHCES to be effectively known and recognized in its field.
The doctoral process of education in nursing enables the qualification of professionals to develop research, teaching, and the health care provided to the population. In this process, the construction of new knowledge in the field is an essential element for scientific and technological development in nursing and health, while the lines of research work as a guiding axis in this process. 12,22 In this context, the doctoral students of GEHCES began to develop historical studies seeking the historical elements that would respond to the contemporary challenge of understanding the professional construction, as well as nursing care practice. 2

Figure 3 -Distribution of doctoral dissertations by line of research. Florianópolis, SC, Brazil 2010
The analysis showed that all studies had a qualitative approach, following the tendency of the PEN/UFSC in recent years. Qualitative research enables understanding human experience as a whole, considering it in a holistic manner and enables health professionals to see from new perspectives, discovering contexts related to the individual's health both in institutional and in community environments, in a flexible manner. 23 In regard to the method of investigation, the abstracts of the dissertations and theses indicate that the research method chosen was historical-social research with a descriptive qualitative nature. Some focused on oral history as their methodology and technique and others on documentary research. PCA was also used as a method, but only in Master's theses.
When we identified the theoretical framework guiding the studies, we perceived that Michel Foucault's framework was used in most of dissertations. The ones that stood out among theses were the theoretical-methodological framework of Paulo Freire's Pedagogy of Liberation Theory and the Humanistic Theory of Paterson and Zderad. The authors also used other theoretical frameworks such as, in dissertations, the subjectivist perspective of symbolic/interpretative/ hermeneutic anthropology defended by Geertz, Nietzsche's and Schopenhauer's ideas, Jurgen Habermas's Theory of Communicative Action, and patterns of knowledge developed by Carper, Munhall and White. The following frameworks were used in the theses: the theoretical framework of Rosemarie Rizzo Parse, Dorothea Orem's Self-Care Theory, and principles of Florence Nightingale, due to studies initially conducted, as already mentioned, under the influence of PEN/UFSC.
The diverse research methods adopted, with a deepening of theoretical and philosophical foundations, shows an appropriation of knowledge on these bases, instilling the application of perspectives of other courses for the study of nursing phenomena. 24 In regard to the fields of study, most of this production is concentrated on adult health (11), followed by the field of psychiatry (seven), children's health (four), women's health (three), collective health (five) and nursing organizational entities (two). Fewer studies concentrated on the field of teaching nursing (two) and the history of specialties (one). It is worth noting that some authors sought to integrate their specialty with historical knowledge, which enriched their theses and dissertations even further.
We also want to note that GEHCES frequently welcomes undergraduate students initiating scientific research and that they make progress within the program heading into the master's and doctoral programs. Many master's students were encouraged to pursue academic careers and applied to the doctoral program (eight), while the theme of their theses was maintained, which made their studies more consistent with the doctoral program. Moreover, some dissertations have become projects financially supported by the CNPq, particularly tied to the projects of the advisor/professors.
The results of the theses and dissertations were disseminated in the form of papers, book chapters, books, and abstracts presented at various scientific events-a very positive aspect that has led GEHCES to be acknowledged at the local, regional, national and international levels. Such acknowledgemnt has been translated into invitations to publish papers, books, book chapters, participate on editorial boards, events, round tables, and committees, among other venues.

F I N A L C O N S I D E R A T I O N S A N D PERSPECTIVES
The assessment of the GEHCES' scientific production revealed the group's contribution to knowledge in the Brazilian nursing field, and even at an international level, is undeniable. GEHCES has contributed on many fronts. Its contribution to the Graduate Program and Nursing Department at UFSC has translated into scientific production that embodies innovative content taught to undergraduate and graduate students and the dissemination of their studies' results. It also provides theoretical and methodological support in the Nursing History field and other content to the faculty members of 30 undergraduate nursing schools in the state of Santa Catarina, Brazil. The group's historical knowledge has given visibility to its members both in Brazil and internationally, especially in Latin America. Such visibility is apparent by the invitations made to its members to participate in scientific events, on editorial boards, and in the abundant production of academic literature.
As a limitation of this study we mention that we did not verify the publication of these dissertations and theses or assess their impact, though we are already addressing such issues in a study that will be published soon. We do recognize, however, that the scientific production in the form of dissertations and theses is still limited because there were only two professors advising master's and doctoral students in the period studied (1995-2000).
We attribute this lack of PhDs in the field of Nursing and Health History to a certain reluctance of health professionals, since in Brazil and even in the globalized world, greater emphasis is given to technical content, with immediate applications, and to seeking to solve problems related to the health-disease continuum.
Concluding, there is still much room for improvement, seeking greater integration with other research groups in the field, with the entry of new PhDs and, finally, sensitizing the nursing community and other health fields to the relevance of Nursing History.