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Care of the self in the daily living of nurses: an integrative review

El cuidado de sí en el cotidiano del enfermero: una revisión integrativa

ABSTRACT

Objectives:

to identify if nurses care for themselves and describe such practices.

Methods:

this is an integrative review of the literature published between 2006 and 2018 and indexed in the Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medical Literature Analysis and Retrieval System Online and Web of Science databases.

Results:

the sample totaled 20 articles, grouped by content similarity in the thematic categories “limits and possibilities for the care of the self”, “knowledge about practices on the care of the self” and “implications of care of the self in professional practice”.

Final considerations:

the knowledge about techniques on caring for the self allows nurses to develop themselves personally and professionally. We suggest to managers and administrators a redirection of the nursing practice that contemplates the strengthening of the nurse as the manager of care and leader of the team, as well as the inclusion of the concept of care of the self in the curricula of undergraduate and graduate nursing courses.

Descriptors:
Nursing; Care of the Self; Self-Care; Occupational Health; Nursing Human Resources

RESUMEN

Objetivos:

identificar si los enfermeros cuidan de sí mismos y describir dicho cuidado.

Métodos:

revisión integrativa de la literatura publicada entre 2006 y 2018 e indexada en las bases de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Medical Literature Analysis and Retrieval System Online y Web of Science.

Resultados:

la muestra totalizó 20 artículos, agrupados por similitud de contenido en las categorías temáticas “Los límites y posibilidades en el cuidado de sí mismo”, “Conociendo prácticas para cuidar de sí mismo” y “Las implicaciones del cuidado de sí mismo en la práctica profesional”.

Consideraciones finales:

el conocimiento de las técnicas para el cuidado de sí le permite al enfermero el desarrollo personal y profesional. Se sugiere a los gestores una reorientación de la práctica que contemple el fortalecimiento del enfermero como gestor del cuidado y líder del equipo, así como la inclusión del cuidado de sí en los planes de estudios del grado y posgrado.

Descriptores:
Enfermería; Cuidado de Sí; Autocuidado; Salud Laboral; Personal de Enfermería

RESUMO

Objetivos:

identificar se os enfermeiros cuidam de si e descrever esse cuidado.

Métodos:

revisão integrativa da literatura publicada entre 2006 e 2018 e indexada nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medical Literature Analysis and Retrieval System Online e Web of Science.

Resultados:

a amostra totalizou 20 artigos, agrupados por similaridade de conteúdo nas categorias temáticas “limites e possibilidades para o cuidado de si”, “conhecendo práticas para cuidar de si” e “implicações do cuidado de si na prática profissional”.

Considerações finais:

o conhecimento das técnicas para o cuidado de si permite que o enfermeiro se desenvolva pessoal e profissionalmente. Sugere-se aos gestores um redirecionamento da prática que contemple o fortalecimento do enfermeiro como gestor do cuidado e líder da equipe, bem como a inclusão do cuidado de si nos currículos de graduação e pós-graduação.

Descritores:
Enfermagem; Cuidado de Si; Autocuidado; Saúde do Trabalhador; Recursos Humanos de Enfermagem

INTRODUCTION

The care for people has been considered the epistemological object of Nursing over its historical development. The nurse is the professional who cares for people from birth until death. But do nurses take care of themselves? Several studies have pointed stress, work overload and other problems that denote lack of care for the self among nurses(11 Padilha KG, Barbosa RL, Andolhe R, Oliveira EM, Ducci AJ, Bregalda RS, et al. Nursing workload, stress/burnout, satisfaction and incidents in a trauma intensive care units. Texto Contexto Enferm. 2017;26(3):e1720016. doi: 10.1590/0104-07072017001720016
https://doi.org/10.1590/0104-07072017001...

2 Medeiros-Costa ME, Maciel RH, Rêgo DP, Lima LL, Silva MEP, Freitas JG. Occupational Burnout Syndrome in the nursing context: an integrative literature review. Rev Esc Enferm USP. 2017;51:e03235. doi: 10.1590/s1980-220x2016023403235
https://doi.org/10.1590/s1980-220x201602...

3 Martinez MC, Latorre MRDO, Fischer FM. Stressors influence work ability in different age groups of nursing professional: 2-year follow-up. Cienc Saude Colet. 2017;22(5):1589-600. doi: 10.1590/1413-81232017225.09682015
https://doi.org/10.1590/1413-81232017225...
-44 Azevedo BDS, Nery AA, Cardoso JP. Occupational stress and dissatisfaction with quality of work life in nursing. Texto Contexto Enferm. 2017;26(1):e3940015. doi: 10.1590/0104-07072017003940015
https://doi.org/10.1590/0104-07072017003...
). Associated with these factors are the great pressure on the work environment, high ethical responsibility and low pay.

Care of the self cannot be considered something theoretical, dissociated from everyday life. This theme has been studied and reported since Ancient times, for example among ancient Greeks, who were concerned with the aspects that permeate the whole life process, from attention to their diet to performing physical activities and engaging in reflective moments, aiming at the maturing of the mind and the strengthening of the spirit(55 Ramos ED. Care of the self, the contemporary practices of the self and self-help speeches: a foucaultian reading [Internet]. 2016 [cited 2018 May 10];7(12):240-55. Available from: http://periodicos.pucminas.br/index.php/SapereAude/article/view/P.2177-6342.2016v7n13p240/9739
http://periodicos.pucminas.br/index.php/...
).

When nurses do not give due importance to these aspects, there may be direct interference in one’s life and work. Some variables are related to this fact: the first one is the leadership that the nurse must perform, being a link between the nursing team and the whole multiprofessional team(66 Carvalho AGF, Cunha ICKO, Balsanelli AP, Bernardes A. Authentic leadership and the personal and professional profile of nurses. Acta Paul Enferm. 2016;29(6):618-25. doi: 10.1590/1982-0194201600087
https://doi.org/10.1590/1982-01942016000...
). The mastering of self-awareness is critical for the development of leadership skills, because by performing care of the self, nurses will also be capable of knowing and caring for those under their leadership, consolidating professional actions according to the institutional philosophy, aiming at, among other things, patient safety. Moreover, as professionals who manage care, nurses must comprehend how certain emotions and actions can affect their life or the life of others, since empathy must be used to consolidate their caregiving(77 Silva IJ, Oliveira MFV, Silva SED, Polaro SHI, Radünz V, Santos EKA, et al. Care, self-care and caring for yourself: a paradigmatic understanding thought for nursing care. Rev Esc Enferm USP. 2009;43(3):690-5. doi: 10.1590/S0080-62342009000300028
https://doi.org/10.1590/S0080-6234200900...
). If a nurse does not know oneself, his/her values and does not understand what makes him/her happy or uncomfortable, such nurse can hardly be near individuals whose health is impaired.

Lack of care of the self may happen when the professional engages in caring for others while being distant from oneself, as if such care could be neutrally performed. This refers to the speech on health professionals as being free from diseases, compared to “ascetic priests” who use their instinct, their art, their abilities and even a kind of happiness of their own to fulfill all their tasks and to be whole and immune to diseases while performing their professional duties(88 Moraes MA, Monteiro SB. Vida, vivências, vivido na formação da enfermeira. Educ Soc Cult [Internet]. 2013 [cited 2018 May 05];38:185-202. Available from: https://www.fpce.up.pt/ciie/sites/default/files/12.dialogos_vivido.pdf
https://www.fpce.up.pt/ciie/sites/defaul...
).

Some literature reviews on this topic have already been made in Brazil(99 Silva AA, Terra MG, Gonçalves MO, Souto VT. O cuidado de si entre profissionais de enfermagem: revisão das dissertações e teses brasileiras. Rev Bras Ciênc Saúde. 2014;18(4):346-52. doi: 10.4034/RBCS.2014.18.04.10
https://doi.org/10.4034/RBCS.2014.18.04....

10 Oliveira RKM, Maia CAAS, Queiroz JC. Self-care in nursing: an integrative review. Rev Pesqui Cuid Fundam Online. 2015;7(1):2104-12. doi: 10.9789/2175-5361.2015.v7i1.2104-2112
https://doi.org/10.9789/2175-5361.2015.v...
-1111 Tomaschewski-Barlem JG, Piexak DR, Barlem ELD, Lunardi VL, Ramos AM. Scientific production of nursing about self-care: an integrative review. Rev Pesqui Cuid Fundam. 2016;8(3):4629-35. doi: 10.9789/2175-5361.2016.v8i3.4629-4635
https://doi.org/10.9789/2175-5361.2016.v...
); however, these reviews did not include international literature nor action proposals to make care of the self an effective practice. Seeking to fill these gaps, this study searched the literature for studies that answered the following research questions: do nurses take care of themselves? And how does this practice occur?

OBJECTIVEs

To identify if nurses practice care of the self and describe such practices.

METHODs

This is an integrative literature review, a method that contributes to the deepening of the knowledge about the researched object, presenting the conclusions of the literature on a particular phenomenon and enabling the identification of knowledge gaps about a given phenomenon(1212 Crossetti MGO. Integrative review of nursing research: scientific rigor required. Rev Gaúcha Enferm [Internet]. 2012 [cited 2018 May 2];33(2):8-13. Available from: http://seer.ufrgs.br/index.php/RevistaGauchadeEnfermagem/article/view/31430/19566
http://seer.ufrgs.br/index.php/RevistaGa...
). The following steps were employed: definition of the research question, searching the databases, categorizing the studies, evaluating the studies included in the review, interpreting the results and synthesizing the knowledge produced(1313 Paula CC, Padoin SMM, Galvão CM. Revisão integrativa como ferramenta para tomada de decisão na prática de saúde. In: Lacerda MR, Costenaro RGS, (Org.). Metodologias da pesquisa para a enfermagem e saúde: da teoria à prática. Porto Alegre: Moriá; 2016. p. 51-76.).

The guiding question established was: “what has been produced from 2006 to 2018 about nurses’ care of the self?” This period was chosen because it would complement the studies already presented(99 Silva AA, Terra MG, Gonçalves MO, Souto VT. O cuidado de si entre profissionais de enfermagem: revisão das dissertações e teses brasileiras. Rev Bras Ciênc Saúde. 2014;18(4):346-52. doi: 10.4034/RBCS.2014.18.04.10
https://doi.org/10.4034/RBCS.2014.18.04....

10 Oliveira RKM, Maia CAAS, Queiroz JC. Self-care in nursing: an integrative review. Rev Pesqui Cuid Fundam Online. 2015;7(1):2104-12. doi: 10.9789/2175-5361.2015.v7i1.2104-2112
https://doi.org/10.9789/2175-5361.2015.v...
-1111 Tomaschewski-Barlem JG, Piexak DR, Barlem ELD, Lunardi VL, Ramos AM. Scientific production of nursing about self-care: an integrative review. Rev Pesqui Cuid Fundam. 2016;8(3):4629-35. doi: 10.9789/2175-5361.2016.v8i3.4629-4635
https://doi.org/10.9789/2175-5361.2016.v...
) - conducted between 2006 and 2013 -, thus outlining a broader picture.

Eligible articles on the topic were considered as those available in English, Spanish or Portuguese and published between January 2006 to May 2018 in journals indexed in the Web of Science, Medical Literature Analysis and Retrieval System Online (Medline) - through the PubMed search engine - and Literatura Latino-Americana e do Caribe em Ciências da Sáude (Lilacs), accessed via the Brazilian version of Virtual Health Library (VHL). For the searches, the Boolean operators AND and OR were combined with the descriptors self care, nurses and nursing - according to Medical Subject Heading (MeSH) terms -, and their corresponding words in Portuguese language: “cuidado de si”, “autocuidado”, “enfermeiro”, “enfermeira” and “enfermagem”, established by Health Sciences Descriptors (DeCS). In the Web of Science database the descriptor care of the self was also used. Searches were conducted in May 2018, excluding theses, dissertations, monographs, books and reviews of any kind.

In total, 1,164 articles were found, 860 in Lilacs, 299 in Medline and 5 in the Web of Science. These articles were selected according to the flowchart shown in Figure 1. To ensure the rigor of the selection of publications, all authors participated in this process. The abstracts of all 1,164 articles were read and of these, 1,113 were excluded due to not fitting the guiding question, 10 due to being duplicates (found in more than one consulted database), 8 due to not being fully accessible via Medline and 13 due to being meta-analyzes or reviews.

Figure 1
Flowchart representing the search in the Lilacs, Medline and Web of Science databases

Articles were classified according to the level of evidence, following the classification of Melnik and Fineout-Overholt(1414 Melnyk BM, Fineout-Overholt E. Evidence-based practice in nursing and health: a guide to best practice. Philadelphia: Wolters Kluwer; Lippincott Williams & Wilkins Health; 2011.), which establishes that:

  • Level 1: evidence from systematic review or meta-analysis.

  • Level 2: evidence from at least one well-delineated, randomized controlled trial.

  • Level 3: evidence from non-randomized well-delineated trials.

  • Level 4: evidence from well-delineated cohort and case-control studies.

  • Level 5: evidence from a systematic review of descriptive and qualitative studies.

  • Level 6: evidence from a single descriptive or qualitative study.

  • Level 7: evidence from an expert opinion.

Twenty articles were selected for evaluation in their entirety(1515 Baggio MA. Relações humanas no ambiente de trabalho: o (des)cuidado de si do profissional de enfermagem. Rev Gaúcha Enferm [Internet]. 2007 [cited 2018 May 8];33(2):409-15. Available from: http://seer.ufrgs.br/index.php/RevistaGauchadeEnfermagem/article/view/4695/2599
http://seer.ufrgs.br/index.php/RevistaGa...

16 Targino THSJ, Silva PMC, Azevedo EB, Saraiva AM, Cordeiro RC, Ferreira Filha MO. Taking care of yourself to take care of the other: reflections of nursing professionals about self care. Rev Pesqui Cuid Fundam. 2013;5(4):440-8. doi: 10.9789/2175-5361.2013.v5i4.440-448
https://doi.org/10.9789/2175-5361.2013.v...

17 Elias EA, Souza IEO, Vieira LB. Meanings of themselves-care of nursing professional women in a emergency unit. Esc Anna Nery. 2014;18(3):415-20. doi: 10.5935/1414-8145.20140059
https://doi.org/10.5935/1414-8145.201400...

18 Salimena AMO, Elias EA, Souza IEO, Vieira LB. Falatório e ocupação no cotidiano das profissionais de enfermagem no cuidado de si e do outro. Rev Baiana Enferm. 2016;30(1):316-24. doi: 10.18471/rbe.v1i1.14393
https://doi.org/10.18471/rbe.v1i1.14393...

19 Silva AA, Terra MG, Leite MT, Freitas FF, Xavier MS, Ely GZ. Nursing and self-care in the world of psychiatric care. Rev Pesqui Cuid Fundam. 2015;7(1):2011-20. doi: 10.9789/2175-5361.2015.v7i1.2011-2020
https://doi.org/10.9789/2175-5361.2015.v...

20 Baggio MA, Formaggio FM. Profissional de enfermagem: compreendendo o autocuidado. Rev Gaúcha Enferm [Internet]. 2007 [cited 2018 May 10];28(2):233-41. Available from: http://seer.ufrgs.br/index.php/RevistaGauchadeEnfermagem/article/view/3168/1739
http://seer.ufrgs.br/index.php/RevistaGa...

21 Baggio MA, Formaggio FM. Automedicação: desvelando o descuidado de si dos profissionais de enfermagem. Rev Enferm UERJ [Internet]. 2009 [cited 2018 May 10];17(2):224-8. Available from: http://www.facenf.uerj.br/v17n2/v17n2a15.pdf
http://www.facenf.uerj.br/v17n2/v17n2a15...

22 Soares RJO, Zeitoune RCG. O cuidado e suas dimensões: subsídios para o cuidar de si de docentes de enfermagem. Rev Pesqui Cuid Fundam. 2012;(Supl):41-44. doi: 10.9789/2175-5361.2012.v0i0.41-44
https://doi.org/10.9789/2175-5361.2012.v...

23 Silva AA, Terra MG, Motta MGC, Leite MT, Padoin SMM. Nursing and self care: perception of itself as a existential body in the world. Rev Enferm UERJ [Internet]. 2013 [cited 2018 May 10];21(3):366-70. Available from: http://www.e-publicacoes.uerj.br/index.php/enfermagemuerj/article/view/7525
http://www.e-publicacoes.uerj.br/index.p...

24 Dezorti LW, Crossetti MGO. Spirituality in self-care for intensive care nursing professionals. Rev Latino-Am Enfermagem. 2008;16(2):212-7. doi: 10.1590/S0104-11692008000200007
https://doi.org/10.1590/S0104-1169200800...

25 Baggio MA, Monticelli M, Erdmann AL. Cuidando de si, do outro e "do nós" na perspectiva da complexidade. Rev Bras Enferm. 2009;62(4):627-31. doi: 10.1590/S0034-71672009000400023
https://doi.org/10.1590/S0034-7167200900...

26 Baggio MA, Erdmann AL. Multiple relationships of nursing care: the emergence of care "of the us". Rev Latino-Am Enfermagem. 2010;18(5):895-902. doi: 10.1590/S0104-11692010000500009
https://doi.org/10.1590/S0104-1169201000...

27 Oliniski SR, Lacerda MR. Cuidando do cuidador no ambiente de trabalho: uma proposta de ação. Rev Bras Enferm. 2006;59(1):100-4. doi: 10.1590/S0034-71672006000100019
https://doi.org/10.1590/S0034-7167200600...

28 Lubinska-Welch IL, Pearson T, Comer L, Metcalfe SE. Nurses as instruments of healing: self-care practices of nurses in a rural hospital setting. J Holist Nurs. 2016;34(3):221-8. doi: 10.1177/0898010115602994
https://doi.org/10.1177/0898010115602994...

29 Lamke D, Catlin A, Mason-Chadd M. "Not just a theory": the relationship between Jin Shin Jyutsu® self-care training for nurses and stress, physical health, emotional health, and caring efficacy. J Holist Nurs. 2014;32(4):278-89. doi: 10.1177/0898010114531906
https://doi.org/10.1177/0898010114531906...

30 Vitale A. Nurses' lived experience of Reiki for self-care. Holist Nurs Pract. 2009;23(3):129-47. doi: 10.1097/01.HNP.0000351369.99166.75
https://doi.org/10.1097/01.HNP.000035136...

31 Ferreira ES, Souza MB, Souza NVDO, Pires AS. The importance of self-care for nursing professionals. Ciênc Cuid Saúde. 2015;14(1):978-85. doi: 10.4025/cienccuidsaude.v14i1.23360
https://doi.org/10.4025/cienccuidsaude.v...

32 Becker SG, Crossetti MGO. Ampliando a consciência do eu: o cuidador olhando-se no espelho. Rev Gaúcha Enferm [Internet]. 2007 [cited 2018 May 06];28(1):27-34. Available from: http://seer.ufrgs.br/index.php/RevistaGauchadeEnfermagem/article/view/4694/2615
http://seer.ufrgs.br/index.php/RevistaGa...

33 Speroni KG, Williams DA, Seibert DJ, Gibbons MG, Earley C. Helping nurses care for self, family and patients through the nurses living fit intervention. Nurs Adm Q. 2013;37(4):286-94. doi: 10.1097/NAQ.0b013e3182a2f97f
https://doi.org/10.1097/NAQ.0b013e3182a2...
-3434 Dunaway LL, Running A. Job satisfaction as self-care within a restrictive regulatory environment: Nevada's study. J Am Acad Nurse Pract. 2009;21(10):557-64. doi: 10.1111/j.1745-7599.2009.00446.x
https://doi.org/10.1111/j.1745-7599.2009...
). After characterization, which considered the variables title, objective and outcome of the articles, three categories were established, by content similarity: “limits and possibilities for the care of the self”, “knowledge about practices on the care of the self” and “implications of care of the self in professional practice”.

RESULTS

Characterization of articles

From the included studies, a chart was drawn up containing the characteristics of these publications and the categories they created.

Chart 1
Characteristics and categorization of the selected articles

DISCUSSION

Limits and possibilities for the care of the self

Articles in this category(1515 Baggio MA. Relações humanas no ambiente de trabalho: o (des)cuidado de si do profissional de enfermagem. Rev Gaúcha Enferm [Internet]. 2007 [cited 2018 May 8];33(2):409-15. Available from: http://seer.ufrgs.br/index.php/RevistaGauchadeEnfermagem/article/view/4695/2599
http://seer.ufrgs.br/index.php/RevistaGa...

16 Targino THSJ, Silva PMC, Azevedo EB, Saraiva AM, Cordeiro RC, Ferreira Filha MO. Taking care of yourself to take care of the other: reflections of nursing professionals about self care. Rev Pesqui Cuid Fundam. 2013;5(4):440-8. doi: 10.9789/2175-5361.2013.v5i4.440-448
https://doi.org/10.9789/2175-5361.2013.v...

17 Elias EA, Souza IEO, Vieira LB. Meanings of themselves-care of nursing professional women in a emergency unit. Esc Anna Nery. 2014;18(3):415-20. doi: 10.5935/1414-8145.20140059
https://doi.org/10.5935/1414-8145.201400...

18 Salimena AMO, Elias EA, Souza IEO, Vieira LB. Falatório e ocupação no cotidiano das profissionais de enfermagem no cuidado de si e do outro. Rev Baiana Enferm. 2016;30(1):316-24. doi: 10.18471/rbe.v1i1.14393
https://doi.org/10.18471/rbe.v1i1.14393...

19 Silva AA, Terra MG, Leite MT, Freitas FF, Xavier MS, Ely GZ. Nursing and self-care in the world of psychiatric care. Rev Pesqui Cuid Fundam. 2015;7(1):2011-20. doi: 10.9789/2175-5361.2015.v7i1.2011-2020
https://doi.org/10.9789/2175-5361.2015.v...

20 Baggio MA, Formaggio FM. Profissional de enfermagem: compreendendo o autocuidado. Rev Gaúcha Enferm [Internet]. 2007 [cited 2018 May 10];28(2):233-41. Available from: http://seer.ufrgs.br/index.php/RevistaGauchadeEnfermagem/article/view/3168/1739
http://seer.ufrgs.br/index.php/RevistaGa...

21 Baggio MA, Formaggio FM. Automedicação: desvelando o descuidado de si dos profissionais de enfermagem. Rev Enferm UERJ [Internet]. 2009 [cited 2018 May 10];17(2):224-8. Available from: http://www.facenf.uerj.br/v17n2/v17n2a15.pdf
http://www.facenf.uerj.br/v17n2/v17n2a15...

22 Soares RJO, Zeitoune RCG. O cuidado e suas dimensões: subsídios para o cuidar de si de docentes de enfermagem. Rev Pesqui Cuid Fundam. 2012;(Supl):41-44. doi: 10.9789/2175-5361.2012.v0i0.41-44
https://doi.org/10.9789/2175-5361.2012.v...

23 Silva AA, Terra MG, Motta MGC, Leite MT, Padoin SMM. Nursing and self care: perception of itself as a existential body in the world. Rev Enferm UERJ [Internet]. 2013 [cited 2018 May 10];21(3):366-70. Available from: http://www.e-publicacoes.uerj.br/index.php/enfermagemuerj/article/view/7525
http://www.e-publicacoes.uerj.br/index.p...

24 Dezorti LW, Crossetti MGO. Spirituality in self-care for intensive care nursing professionals. Rev Latino-Am Enfermagem. 2008;16(2):212-7. doi: 10.1590/S0104-11692008000200007
https://doi.org/10.1590/S0104-1169200800...

25 Baggio MA, Monticelli M, Erdmann AL. Cuidando de si, do outro e "do nós" na perspectiva da complexidade. Rev Bras Enferm. 2009;62(4):627-31. doi: 10.1590/S0034-71672009000400023
https://doi.org/10.1590/S0034-7167200900...
-2626 Baggio MA, Erdmann AL. Multiple relationships of nursing care: the emergence of care "of the us". Rev Latino-Am Enfermagem. 2010;18(5):895-902. doi: 10.1590/S0104-11692010000500009
https://doi.org/10.1590/S0104-1169201000...
) showed that care of the self is fundamental and includes individual habits, customs, beliefs, and individual values. Self-neglect, observed as the main limitation for such care, can occur because the nurse’s training focuses on the care for the other, not assigning enough importance to care for the self(3535 Shimizu HE, Couto DT, Merchan-Hamann E. Pleasure and suffering in intensive care unit nursing staff. Rev Latino-Am Enfermagem. 2011;19(3):565-72. doi: 10.1590/S0104-11692011000300016
https://doi.org/10.1590/S0104-1169201100...
).

Associated with these factors, fragmentation, inadequate communication between team members, and lack of attribution of meaning to work are crucial to the disqualification of the care of the self(1515 Baggio MA. Relações humanas no ambiente de trabalho: o (des)cuidado de si do profissional de enfermagem. Rev Gaúcha Enferm [Internet]. 2007 [cited 2018 May 8];33(2):409-15. Available from: http://seer.ufrgs.br/index.php/RevistaGauchadeEnfermagem/article/view/4695/2599
http://seer.ufrgs.br/index.php/RevistaGa...
-1616 Targino THSJ, Silva PMC, Azevedo EB, Saraiva AM, Cordeiro RC, Ferreira Filha MO. Taking care of yourself to take care of the other: reflections of nursing professionals about self care. Rev Pesqui Cuid Fundam. 2013;5(4):440-8. doi: 10.9789/2175-5361.2013.v5i4.440-448
https://doi.org/10.9789/2175-5361.2013.v...
). When labor is fragmented and performed in an automatic manner, lacking associated reflexive practice, it shows a tendency of alienating(3636 Keshet Y, Popper-Giveon A. Work experiences of ethnic minority nurses: a qualitative study. Isr J Health Policy Res. 2016;5:18. doi: 10.1186/s13584-016-0076-5
https://doi.org/10.1186/s13584-016-0076-...
) professionals and compromising the perception on the need for care of the self.

Although professionals often realize the need for taking care of themselves, they cannot put it into practice. Day-to-day occupations drain the time that nurses could dedicate to themselves, so taking care of oneself takes second place and is even forgotten at times(1717 Elias EA, Souza IEO, Vieira LB. Meanings of themselves-care of nursing professional women in a emergency unit. Esc Anna Nery. 2014;18(3):415-20. doi: 10.5935/1414-8145.20140059
https://doi.org/10.5935/1414-8145.201400...

18 Salimena AMO, Elias EA, Souza IEO, Vieira LB. Falatório e ocupação no cotidiano das profissionais de enfermagem no cuidado de si e do outro. Rev Baiana Enferm. 2016;30(1):316-24. doi: 10.18471/rbe.v1i1.14393
https://doi.org/10.18471/rbe.v1i1.14393...
-1919 Silva AA, Terra MG, Leite MT, Freitas FF, Xavier MS, Ely GZ. Nursing and self-care in the world of psychiatric care. Rev Pesqui Cuid Fundam. 2015;7(1):2011-20. doi: 10.9789/2175-5361.2015.v7i1.2011-2020
https://doi.org/10.9789/2175-5361.2015.v...
).

The neglect of care of the self seems to stem from the lack of time to feed properly and to care of physical and aesthetic aspects, and from the need to give up time for oneself in favor of work(2020 Baggio MA, Formaggio FM. Profissional de enfermagem: compreendendo o autocuidado. Rev Gaúcha Enferm [Internet]. 2007 [cited 2018 May 10];28(2):233-41. Available from: http://seer.ufrgs.br/index.php/RevistaGauchadeEnfermagem/article/view/3168/1739
http://seer.ufrgs.br/index.php/RevistaGa...
). Many professionals have more than one employment relationship, which reduces free time and impairs the care of the self. The lack of time, which can be interpreted as the lack of priority for the self, has a great possibility of causing stress and other psychic disorders. Moreover, the lack of adequate rest, coupled with the professional’s exposure to adverse labor market conditions can lead to chronic pain, agitation, insomnia, anxiety and, consequently, self-medication(2020 Baggio MA, Formaggio FM. Profissional de enfermagem: compreendendo o autocuidado. Rev Gaúcha Enferm [Internet]. 2007 [cited 2018 May 10];28(2):233-41. Available from: http://seer.ufrgs.br/index.php/RevistaGauchadeEnfermagem/article/view/3168/1739
http://seer.ufrgs.br/index.php/RevistaGa...
).

The indiscriminate use of medications to minimize physical or psychic symptoms reveals carelessness for the self and increases health risks(2121 Baggio MA, Formaggio FM. Automedicação: desvelando o descuidado de si dos profissionais de enfermagem. Rev Enferm UERJ [Internet]. 2009 [cited 2018 May 10];17(2):224-8. Available from: http://www.facenf.uerj.br/v17n2/v17n2a15.pdf
http://www.facenf.uerj.br/v17n2/v17n2a15...
). Many professionals already suffer from psychological distress, but mainly use anxiolytic and analgesic drugs to mask the symptomatology and continue to perform their daily activities(3737 Pereira IF, Faria LC, Vianna RSM, Corrêa PDS, Freitas DA, Soares WD. Depression and use of medicines in nursing personnel. Arq Ciênc Saúde. 2017;24(1):70-4. doi: 10.17696/2318-3691.24.1.2017.544
https://doi.org/10.17696/2318-3691.24.1....
).

Furthermore, other limiting factors to the care of the self were described by nurses: inadequate working hours, excessive bureaucracy, low pay, submission, impotence, competitiveness and incompatibility between work, family and leisure(2222 Soares RJO, Zeitoune RCG. O cuidado e suas dimensões: subsídios para o cuidar de si de docentes de enfermagem. Rev Pesqui Cuid Fundam. 2012;(Supl):41-44. doi: 10.9789/2175-5361.2012.v0i0.41-44
https://doi.org/10.9789/2175-5361.2012.v...
).

The attribution of importance to the care of the self occurs as the individual values himself/herself, facing the world as his/her own existential body, engaging in dialogical relationships with others(2323 Silva AA, Terra MG, Motta MGC, Leite MT, Padoin SMM. Nursing and self care: perception of itself as a existential body in the world. Rev Enferm UERJ [Internet]. 2013 [cited 2018 May 10];21(3):366-70. Available from: http://www.e-publicacoes.uerj.br/index.php/enfermagemuerj/article/view/7525
http://www.e-publicacoes.uerj.br/index.p...
). The establishment of a support network among professionals was presented as a possibility for taking care of the self, contemplating and favoring communication and supportive care, including sensitivity, empathy and cooperation in situations of suffering, stress and helplessness in the work environment(2424 Dezorti LW, Crossetti MGO. Spirituality in self-care for intensive care nursing professionals. Rev Latino-Am Enfermagem. 2008;16(2):212-7. doi: 10.1590/S0104-11692008000200007
https://doi.org/10.1590/S0104-1169200800...

25 Baggio MA, Monticelli M, Erdmann AL. Cuidando de si, do outro e "do nós" na perspectiva da complexidade. Rev Bras Enferm. 2009;62(4):627-31. doi: 10.1590/S0034-71672009000400023
https://doi.org/10.1590/S0034-7167200900...
-2626 Baggio MA, Erdmann AL. Multiple relationships of nursing care: the emergence of care "of the us". Rev Latino-Am Enfermagem. 2010;18(5):895-902. doi: 10.1590/S0104-11692010000500009
https://doi.org/10.1590/S0104-1169201000...
).

Spirituality, self-knowledge and self-esteem are considered facilitating factors for the care of the self among nurses(2323 Silva AA, Terra MG, Motta MGC, Leite MT, Padoin SMM. Nursing and self care: perception of itself as a existential body in the world. Rev Enferm UERJ [Internet]. 2013 [cited 2018 May 10];21(3):366-70. Available from: http://www.e-publicacoes.uerj.br/index.php/enfermagemuerj/article/view/7525
http://www.e-publicacoes.uerj.br/index.p...
-2424 Dezorti LW, Crossetti MGO. Spirituality in self-care for intensive care nursing professionals. Rev Latino-Am Enfermagem. 2008;16(2):212-7. doi: 10.1590/S0104-11692008000200007
https://doi.org/10.1590/S0104-1169200800...
). The search for inner development requires the desire to evolve and improve as a human being to achieve personal, professional, economic and social fulfillment(3838 Ponte PR, Koppel P. Cultivating mindfulness to enhance nursing practice. Am J Nurs. 2015;115(6):48-55. doi: 10.1097/01.NAJ.0000466321.46439.17
https://doi.org/10.1097/01.NAJ.000046632...
).

Knowledge about practices on the care of the self

Knowledge about care of the self is still incipient in the speech of professionals who care for other peoples’ health. This may occur because health practices are still strongly anchored in the biomedical model and by organizational interferences in the work environment, so that nurses do not identify the need to take care of themselves so they can effectively take care of other people(3939 Campos LF, Melo MRAC. Assistência em enfermagem na perspectiva da clínica ampliada em unidade de terapia intensiva. Rev Gaúcha Enferm. 2011;32(1):189-93. doi: 10.1590/S1983-14472011000100025
https://doi.org/10.1590/S1983-1447201100...
).

Awareness about care of the self can be fostered in the nursing team within the work environment by encouraging professionals and the flexibility of managers. An action proposal developed in the South region of Brazil sought raise awareness about care of the self on the nursing team of an intensive care unit by proposing different activities such as stretching, group activities and relaxation activities. The proposal had a positive return, since professionals reported feeling cared for and valued, getting to know each other better and practicing caring actions for themselves(2727 Oliniski SR, Lacerda MR. Cuidando do cuidador no ambiente de trabalho: uma proposta de ação. Rev Bras Enferm. 2006;59(1):100-4. doi: 10.1590/S0034-71672006000100019
https://doi.org/10.1590/S0034-7167200600...
). From this analysis we can argue that practices on care of the self can and must be incorporated into nurses’ daily work(4040 Haley B, Heo S, Wright P, Barone C, Rettiganti MR, Anders M. Relationships among active listening, self-awareness, empathy, and patient-centered care in associate and baccalaureate degree nursing students. NursingPlus Open. 2017;3:11-6. doi: 10.1016/j.npls.2017.05.001
https://doi.org/10.1016/j.npls.2017.05.0...
). Such awareness will lead to excellent care practices with improved patient safety.

One study sought to understand self-care and health promotion practices among nurses at hospital in the United States to determine if there was a need to develop a holistic self-care program with these professionals(2828 Lubinska-Welch IL, Pearson T, Comer L, Metcalfe SE. Nurses as instruments of healing: self-care practices of nurses in a rural hospital setting. J Holist Nurs. 2016;34(3):221-8. doi: 10.1177/0898010115602994
https://doi.org/10.1177/0898010115602994...
). The study showed that most nurses know the importance of caring of the self and prefer to participate in physical activity and nutritional education programs to achieve this goal. Thus, we can conclude that developing intervention proposals to improve the quality of life of this population is feasible.

Innovative practices were identified in hospitals in the United States to promote the care of the self among nurses, such as the use of complementary therapies(2929 Lamke D, Catlin A, Mason-Chadd M. "Not just a theory": the relationship between Jin Shin Jyutsu® self-care training for nurses and stress, physical health, emotional health, and caring efficacy. J Holist Nurs. 2014;32(4):278-89. doi: 10.1177/0898010114531906
https://doi.org/10.1177/0898010114531906...
-3030 Vitale A. Nurses' lived experience of Reiki for self-care. Holist Nurs Pract. 2009;23(3):129-47. doi: 10.1097/01.HNP.0000351369.99166.75
https://doi.org/10.1097/01.HNP.000035136...
). Evaluating the effectiveness of training professionals in Jin Shin Jyutsu (an ancient healing art that uses hand contact on specific parts of the body to harmonize each person’s life energy) and correlating training with the perception of personal and organizational stress and patient care, a study showed an increase in positive attitudes, gratitude, motivation, calmness, effective communication and significant reduction of anger, resentment, depression, stress symptoms and moral problems(2929 Lamke D, Catlin A, Mason-Chadd M. "Not just a theory": the relationship between Jin Shin Jyutsu® self-care training for nurses and stress, physical health, emotional health, and caring efficacy. J Holist Nurs. 2014;32(4):278-89. doi: 10.1177/0898010114531906
https://doi.org/10.1177/0898010114531906...
). Nurses reported reduced muscle pain, insomnia, and headache. An increase in the effectiveness of care was also observed, occurring due to empathy, serenity, respect for differences, individualization, ability to minimize stress situations, planning for multiple needs and creativity in care.

Another study presented similar results by exploring the experience of nurses who practiced Reiki (a therapy that uses the touch to balance the body’s energy centers) for self-care. This practice helped in the management of daily stress, in the strengthening of self-esteem and spirituality and in the connection with oneself, with others and with the whole(3030 Vitale A. Nurses' lived experience of Reiki for self-care. Holist Nurs Pract. 2009;23(3):129-47. doi: 10.1097/01.HNP.0000351369.99166.75
https://doi.org/10.1097/01.HNP.000035136...
).

Studies of this category have shown that evidence-based intervention programs are needed to train nurses on the adoption of better lifestyles, and that managers must promote healthier work environments, which could improve the quality of care provided(4141 Dyess SM, Prestia AS, Smith MC. Support for caring and resiliency among successful nurse leaders. Nurs Adm Q. 2015;39(2):104-16. doi: 10.1097/NAQ.0000000000000101
https://doi.org/10.1097/NAQ.000000000000...
-4242 Phiri LP, Draper CE, Lambert EV, Kolbe-Alexander TL. Nurses' lifestyle behaviours, health priorities and barriers to living a healthy lifestyle: a qualitative descriptive study. BMC Nurs. 2014;13(1):38. doi: 10.1186/s12912-014-0038-6
https://doi.org/10.1186/s12912-014-0038-...
).

Implications of care of the self in professional practice

This category grouped the articles that evaluated the effects of caring of the self in the care of other people. Four studies were identified, two with a qualitative approach(3131 Ferreira ES, Souza MB, Souza NVDO, Pires AS. The importance of self-care for nursing professionals. Ciênc Cuid Saúde. 2015;14(1):978-85. doi: 10.4025/cienccuidsaude.v14i1.23360
https://doi.org/10.4025/cienccuidsaude.v...
-3232 Becker SG, Crossetti MGO. Ampliando a consciência do eu: o cuidador olhando-se no espelho. Rev Gaúcha Enferm [Internet]. 2007 [cited 2018 May 06];28(1):27-34. Available from: http://seer.ufrgs.br/index.php/RevistaGauchadeEnfermagem/article/view/4694/2615
http://seer.ufrgs.br/index.php/RevistaGa...
) and two with a quantitative approach(3333 Speroni KG, Williams DA, Seibert DJ, Gibbons MG, Earley C. Helping nurses care for self, family and patients through the nurses living fit intervention. Nurs Adm Q. 2013;37(4):286-94. doi: 10.1097/NAQ.0b013e3182a2f97f
https://doi.org/10.1097/NAQ.0b013e3182a2...
-3434 Dunaway LL, Running A. Job satisfaction as self-care within a restrictive regulatory environment: Nevada's study. J Am Acad Nurse Pract. 2009;21(10):557-64. doi: 10.1111/j.1745-7599.2009.00446.x
https://doi.org/10.1111/j.1745-7599.2009...
).

The findings showed the relevance of care of the self, seeking to identify the nurses’ perception of such care and to describe the actions taken to put it into effect, discussing its repercussions on health(3131 Ferreira ES, Souza MB, Souza NVDO, Pires AS. The importance of self-care for nursing professionals. Ciênc Cuid Saúde. 2015;14(1):978-85. doi: 10.4025/cienccuidsaude.v14i1.23360
https://doi.org/10.4025/cienccuidsaude.v...
). Care of the self was related to the actions undertaken by individual to improve and transform themselves by reflecting on their way of being and acting(4343 Clinton ME, Springler RA. Foucault's legacy for nursing: are we beneficiaries or intestate heirs? Nurs Philos. 2016;17(2):119-31. doi: 10.1111/nup.12113
https://doi.org/10.1111/nup.12113...
) and it was found that care of the self is relevant for physical and mental health, and for work because the actions developed to maintain such care improve the quality of nurses’ personal and professional lives.

Another critical issue regards the way nurses perceive themselves when expanding their self-awareness, taking care of the other(3232 Becker SG, Crossetti MGO. Ampliando a consciência do eu: o cuidador olhando-se no espelho. Rev Gaúcha Enferm [Internet]. 2007 [cited 2018 May 06];28(1):27-34. Available from: http://seer.ufrgs.br/index.php/RevistaGauchadeEnfermagem/article/view/4694/2615
http://seer.ufrgs.br/index.php/RevistaGa...
). The studies show that the self-perception of the professional as a being of sensitivity, aesthetic, possibilities, beliefs and values is an integral part of the expansion of self-awareness. The deepening of the relation of an individual with oneself can also improve the way one engages in relationships with others, since the correct conduct in relationships requires the full and effective care of the self. Such relationships must forgo the perspective of selfish individual interest, but search for individual improvement, overcoming limits and establishing goals.

The importance of ethics with regard to the patient is a crucial guiding axis of these studies, being understood as a product of effective practices on the care of the self. Criticism is fundamental but not only of others, especially of oneself, since the appropriate management of an individual’s own life shall enable him/her to conduct and take good care of other people.

An intervention to help American nurses to improve their quality of life has been shown in another study that focused on the Nurses Living Fit (NLF) program, designed to reduce participants’ body mass index (BMI) and to help, in addition to the nurses, their patients and family(3333 Speroni KG, Williams DA, Seibert DJ, Gibbons MG, Earley C. Helping nurses care for self, family and patients through the nurses living fit intervention. Nurs Adm Q. 2013;37(4):286-94. doi: 10.1097/NAQ.0b013e3182a2f97f
https://doi.org/10.1097/NAQ.0b013e3182a2...
). Given the multidimensional way human beings are constituted, discussing the care with the body as a guiding axis for the care of the self is crucial. The study results showed that the participants had a significant reduction in BMI and waist circumference, as well as improvements in exercise frequency and their diet.

Another study addressed the demographic transition in the United States, specifically in the state of Nevada(3434 Dunaway LL, Running A. Job satisfaction as self-care within a restrictive regulatory environment: Nevada's study. J Am Acad Nurse Pract. 2009;21(10):557-64. doi: 10.1111/j.1745-7599.2009.00446.x
https://doi.org/10.1111/j.1745-7599.2009...
). The large population growth associated with the lack of health care providers can generate an overload on the professionals available to take care of other people. Thus, the same individual may be subjected to having more than one job, being more subject to negative effects on health, such as illnesses and decreased satisfaction and productivity, which indicates the need to understand the importance of care of the self.

Practices on care of the self are thus understood as beneficial not only to the professional, but also to their patients and their families(4444 Billington T. Promoting self-awareness through reflective practice. Br J Nurs. 2013;22(1):45. doi: 10.12968/bjon.2013.22.1.45
https://doi.org/10.12968/bjon.2013.22.1....
).

Study limitations

The possible limitations of this study refer to the sample - since the articles included were those available online and free of charge, which may have led to the non-inclusion of some studies related to the theme - and the low level of evidence of the studies used according to the chosen classification(1414 Melnyk BM, Fineout-Overholt E. Evidence-based practice in nursing and health: a guide to best practice. Philadelphia: Wolters Kluwer; Lippincott Williams & Wilkins Health; 2011.).

Contributions to the field of nursing

From the results found, managers and administrators are advised to change practices and anchor them in self-knowledge, considering the strengthening of nurses as care managers and immediate leaders of the care team. We also suggest the inclusion of the concept of care of the self in the curricula of undergraduate and graduate nursing programs.

FINAL CONSIDERATIONS

The knowledge of care of the self techniques involves the effective perception of the meaning of work and life, allowing nurses to develop personally and professionally. Caring of the self is caring for one’s own soul, learning to live and having the possibility and duty of caring for oneself.

As limiting factors for the effective care of the self among nurses the demand for work, inadequate staffing, exhaustive working hours, unhealthy conditions were found, as well as bureaucracy, lack of autonomy and incompatibility between tasks, family and leisure.

The main differential of this literature review from others of the same theme was the inclusion of non-Brazilian studies. After the analysis, we found that, in Brazil, studies on the consolidation of practices on the care of the self, mainly in the work environment, are still incipient.

From the results found, managers and administrators are advised to change practices and anchor them in self-knowledge, considering the strengthening of nurses as care managers and immediate leaders of the care team. We also suggest the inclusion of the concept of care of the self in the curricula of undergraduate and graduate nursing programs.

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Edited by

EDITOR IN CHIEF: Antonio José de Almeida Filho
ASSOCIATE EDITOR: Italo Rodolfo Silva

Publication Dates

  • Publication in this collection
    30 Mar 2020
  • Date of issue
    2020

History

  • Received
    18 Mar 2018
  • Accepted
    19 Feb 2019
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