Secondary Level Nursing Schools: agreements and disagreements regarding the actions for their creation and implementation

Abstracts

Estudo histórico-documental, interpretado à luz da teoria de Pierre Bourdieu, cujos objetivos são: identificar e descrever as convergências e divergências entre os movimentos que propiciaram a criação e implementação de escolas/cursos de nível médio de enfermagem, em sete hospitais privados modelo-referência da cidade de São Paulo, de 1945 a 1989, e explicar a intencionalidade das instituições estudadas na criação e implementação dessas escolas/cursos. Os resultados evidenciaram convergências e divergências sintetizadas nos itens: abertura e encerramento dos cursos, mantenedoras e vinculação religiosa de sua direção, fontes de financiamento, objetivos e finalidades, número de alunos formados e impacto na força de trabalho. Concluiu-se que os hospitais criaram suas escolas em momentos diferentes, mas com objetivos convergentes, quais sejam: preparar sua mão de obra, usufruir de serviços dos alunos, conquistar isenções fiscais e auxílios e agregar capital cultural, social e econômico e, consequentemente, poder simbólico, na luta travada por prestígio.

Educação em enfermagem; Ensino fundamental e médio; Escolas de Enfermagem; História da enfermagem

ARTIGO ORIGINAL

Secondary Level Nursing Schools: agreements and disagreements regarding the actions for their creation and implementation^*

Escuelas de Nivel Medio de Enfermería: convergencias y divergencias de las acciones para su creación e implementación

Leila Maria Rissi Caverni^I; Maria Cristina Sanna^II

^IRegistered Nurse. PhD in Science from the Federal University of Sao Paulo. Registered Nurse of the São Paulo City Council. Member of the Health Administration and Management in Nursing Study and Research Group. São Paulo, SP, Brazil. [e-mail]

^IIRegistered Nurse. PhD in Nursing. Accredited Supervisor in the Post-graduation Program of the Federal University of Sao Paulo. GEPAG Researcher. São Paulo, SP, Brazil. [e-mail]

Correspondence addressed

ABSTRACT

This historical-documental study, interpreted under the light of Pierre Bourdieu's theory, was performed with the following objectives: to identify and describe the agreements and disagreements between movements that promote the creation and implementation of secondary-level nursing schools/courses in seven private model-reference hospitals located in São Paulo, from 1945 to 1989; and to explain the intentions of the studied institutions in creating and implementing these schools/courses. The results provided evidence of the agreements and disagreements synthetized in the items: opening and closing of courses, maintenance and direction by religious institutions, sources of funding, objectives and purposes, number of graduates and impact on the workforce. It was concluded that the hospitals created their schools at different times, but their objectives were in agreement, which included: preparing their workforce, use of student services, obtaining tax exemption and support and aggregating cultural, social and economical assets, and, consequently, symbolic power in the battle for reputation.

Descriptors: Education, nursing; Education, primary and secondary; Schools, nursing; History of nursing

RESUMEN

Estudio histórico-documental, interpretado según la teoría de Pierre Bourdieu, cuyos objetivos son identificar y describir convergencias y divergencias entre los movimientos que favorecieron la creación e implementación de escuelas/cursos de nivel medio de enfermería en siete hospitales privados modelo-referencia de São Paulo-SP, entre 1945 y 1989, y explicar la intencionalidad de las instituciones estudiadas en la creación e implementación de dichas escuelas/cursos. Los resultados demostraron convergencias y divergencias sintetizadas en los ítems: apertura y cierre de cursos, mantenimiento y vinculación religiosa de su dirección, fuentes de financiamiento, objetivos y finalidades, número de graduados e impacto en el mercado de trabajo. Se concluyó en que los hospitales crearon sus escuelas en momentos diferentes, pero con objetivos convergentes, tales como: capacitar su mano de obra, usufructuar el trabajo de alumnos, beneficiarse con exenciones fiscales y subsidios y sumar capital cultural, social y económico y, consecuentemente, poder simbólico en la conquista de prestigio.

Descriptores: Educación en enfermería; Educación primaria y secundaria; Escuelas de Enfermería; Historia de la enfermería

INTRODUCTION

The study has as its aim the creation and development of mid-level schools of nursing in private reference-model hospitals of the city of Sao Paulo. The reference-model terminology was used, which confers a series of attributes to the object of study in order for it to be considered as such. Thus, to be a reference is to serve as a basis for comparisons and evaluations of species, situations, and similar or equivalent attributes⁽¹⁾. Thus, when referring to reference-model hospitals, those that possess determined attributes that qualify them to be reproduced by imitation are cited, they are opinion formers among the population, they exert leadership in professional associations and in education, they have in their ideas the formation of human resources, they participate in the construction of scientific knowledge, they are in the forefront of healthcare technology, have a philanthropic social role and/or are teaching hospitals. It is assumed that, most probably, a high number of professionals are formed in them, since the implementation of the first mid-level nursing course in Sao Paulo, in 1945, by the Sisters of the Congregação de São José⁽²⁾, supporting and legitimizing the hierarchical stratification model of Nursing, and also that they have served as a model for other courses. The scope of the object for private hospitals is based on the fact that their decision-making process takes place in a more autonomous way than in public hospitals, exempting them from the variability caused by the continuous process of political succession, as well as the social stratum that they serve and the financial resource support they receive, providing care with cutting edge technology and requiring qualified human resources for its operation.

Hospitals had been practicing the training of service personnel before they decided on the creation of the schools, minimizing the valorization of this to some extent, because the option of officially linking to the education system represented an essential attribute in the qualification of the hospital, given that when creating a school, it was automatically subjected to external monitoring. At the same time, the establishment of the school and its operation, or condition of legality, allowed the expedition of documentation - certification, which demonstrated the competence of the hospital to the society in which it was inserted, a reason that also justifies the study of these schools. One of the factors that complicates the comprehension of the object of study is the low number of studies regarding it. Results of studies^(3-5) on the theme indicate that little has been reported regarding the history of the formation of mid-level nursing professionals and that the literature is scarce in relation to the peculiarities of the work of the agents of mid-level nursing, even though they represent a significant contingent of professionals and courses/formation programs. This information lead to the realization that it is relevant to study the history of the mid-level teaching of Nursing, particularly in the city of São Paulo, since it has been and remains the first metropolis of the country, and it has long been creating beds, employment positions and, consequently, forming mid-level nursing professionals to fill these positions. Moreover, the schools or technical courses created in this city were among the first created in Brazil, in the twentieth century, and the fact that they were pioneers and have remained in operation for a long time suggests that they possibly served as models, justifying their study.

In this context, this study aims to identify and describe the convergences and divergences between the movements that have propitiated the creation and implementation of mid-level schools/courses for formation of the auxiliary nurse and/or nursing technicians in private reference-model hospitals of the city of São Paulo, in the period 1945 to 1989; and to explain the intentionality of the hospital institutions studied, in the creation and implementation of the schools/courses for the formation of mid-level nursing professionals.

METHOD

This is a study of a social-historical nature, with a time frame that has its first milestone in the date of the founding of the first school of auxiliary nurses in a private reference-model hospital, in the city of São Paulo, in 1945, and ending in 1989, the year in which the creation and implementation of the last school studied took place, before the creation of the Grupo de Interesse do Ensino Médio de Enfermagem - GIEMEn⁽⁶⁾, of the Brazilian Nursing Association (ABEn), in 1991, when the schools began to unite in the social space of the group, seeking to resolve their problems, with a different strategy from that adopted previously, when they struggled in isolation for their needs.

The courses studied are or have been linked to the following institutions: Irmandade da Santa Casa de Misericórdia de Sao Paulo, Matarazzo Hospital, Santa Catarina Hospital, Santa Marcelina Hospital, Samaritan Hospital, Hospital Beneficência Portuguesa de São Paulo and the Albert Einstein Israelite Hospital, all concentrated in the geographical area of the municipality of São Paulo. The primary sources were the documentation of the courses and the legislation on the theme, enacted in the period, collected through a search of the documentation, in the schools surveyed, and in collections regarding nursing legislation. The first was composed of the legal acts of the creation of the schools, the school regulations, the registration books, the minutes of meetings, the supervision reports, books of certificates or diplomas, annual reports and other teaching records of the school or the course, that relate to the object of study, a total of 191 different documents. The legislation included education laws and the professional practice of nursing and its complementary acts. As secondary sources, publications about the courses and authorized histories in relation to the reference-model hospitals and their sponsors were employed. The law can be defined as the right consciously prepared by an authority, through an act of will, which is called legislation, i.e. the act of making laws, and consists of a legal declaration covered in written form and incorporated into a document⁽⁷⁾. The pioneers of Nursing realized the importance and scope of the legislation and struggled to participate in the development and approval of laws favorable to the profession, because the law is the most important source of rights in the Western civilization⁽⁷⁾.

Documental analysis and the historical method were used to perform the study. Repeated reading was conducted for the comprehension of the documents and analysis categories were constructed for the presentation and discussion of the findings, which were compared with the available literature on the theme, in the light of the theoretical framework. The choice of the theoretical framework of Pierre Bourdieu was due to its suitability for studies in the area of the History of Nursing, as well as the conclusion of the investigation⁽⁸⁾ that found a prevalence of this in related studies, conducted with documentary written and iconographic sources. This framework provided the foundation for the analysis of the agents, the institutions and the structures of the areas involved - the Nursing Corporations, the Education System, the Reference-Model Hospitals and their Elements or Agents.

RESULTS AND DISCUSSION

To analyze individually each school gives an idea of the circumstances of creation and implementation of each of them; the deeper analysis, however, requires looking at the set, searching for shared contingencies and equivalent positions, with regard to the time of the creation of the schools, guidance and characteristics of the sponsors, among others. Presented below are 5 of the 16 convergences and divergences identified in the strategic actions of creation and installation of the schools in the study that led to this research.

Opening and closure of the courses

Regarding the time of the creation of the schools investigated in this study, it is interesting to note that only one - the São José School of Nursing, was created in the 1940s and one other - attached to the Albert Einstein Hospital, in the 1980s. Three of the seven schools were created in the 1950s, attached to the Samaritan, Santa Catarina, and Matarazzo hospitals, and two in the 1960s, which may mean that the combination of the areas of Nursing, Health and Education was more favorable for the creation of new schools for the formation of mid-level nursing professionals at some times rather than others. It is noteworthy that, with the exception of São José, all the other schools were created after the enactment of Law No. 775/49⁽⁹⁾, which made the nursing auxiliary course official. Moreover, in the 1940s the hospitalcentric healthcare model was implemented and prospered, with its peak in the 1960s and 1970s, justifying the greater number of schools created during this period, to expand the formation of professionals to work in hospitals.

It was identified that the schools did not always perform their inaugural lecture or inauguration ceremony after obtaining the operating authorization or recognition by the official education authority. This inauguration can be interpreted as the intention of the sponsor to show, to the outside community, that the hospital had a school attached, as this gives them, and the hospital, importance. Five schools did not perform this ceremony, because it was more important and urgent to have the school functioning. This can be explained as due to the concern over forming auxiliary nurses and the deficiency of human resources for the hospitals, as opposing to what, in the case of the initiative to meet their own needs, did not justify investing in demonstrations to the external public. Two schools studied were closed, in the period of coverage of the study - those of the Samaritan Hospital and of the Matarazzo Hospital.

In August 1971, there was the closure of the activities of the nursing auxiliary course of the school attached to the Samaritan Hospital. The possible causes and the time of closing the operation of the school were noted in the minutes of board meetings of the sponsor, which indicate that the onus shifted from the school to the hospital, five years after its initiation, because after graduation there was insufficient adherence of the professionals to remain working in the institution. Considering these and other records that reveal that the school often relied on public subsidies and private donations, from companies and individuals linked to the hospital, for its operation, it can be inferred that the school in focus was closed due to financial problems and for not meeting the human resources needs of the hospital, even after having tried to change the maintenance from the Samaritan Hospital Society, in 1966, to the Job Lane Nursing School Foundation.

With the closure of the technical course of the Pia Matarazzo Nursing School, in 1973, the nursing auxiliary course continued to function there, possibly until 1981. However, the reason for its closure appears to be linked to the fact that the Sisters of the Congregação das Apóstolas do Sagrado Coração de Jesus stopped working in the school and hospital, as well as to the closure of the hospital, due to financial problems, some time later. Given the above, it can be interpreted that these schools were closed when, as enterprises, they were no longer able to raise capital, whether cultural, economic or social, and consequently symbolic power, to the sponsor or to the hospital.

Sponsors of schools and religious affiliation of their management

The sponsors of the schools under study were or are institutions of a civil, private and philanthropic nature. In this latter quality, they rendered services to the society without making a profit and the positive financial results obtained were reinvested in the institutions that they maintain. Three of the sponsors of the schools studied were characterized as Catholic confessionals: São José, Santa Catarina and Santa Marcelina Nursing Schools. Among the remaining four, two - Matarazzo and São Joaquim, were not confessional, but were directed and organized by the initiative of the Sisters of the Catholic Church, during a significant space of the time, coming under, therefore, the direct influence of the Catholic Church. Furthermore it should be noted that the Catholic congregations that created or directed the schools were all from the European continent. The other two schools - Samaritan and Albert Einstein were also created by sponsors linked to religious orientations, however, not Catholic: the first linked to Protestantism and second to Judaism.

Another characteristic of the institutions is that they were linked to the colonies of immigrants, also mainly of European origin: English, Italian, Portuguese and German, as well as Israeli, of Asian origin, but with strong European linkages, given the dispersion characteristics of the people of Israel. Given the above, it is important to make some considerations on issues related to the binomial Nursing and Church, that is, the link between nursing practice and the influence of the religious orders or associations. It must be taken into consideration that one of the many forms of charity that the various Christian Churches adopted was the care of the sick and, in the history of nursing, charity was one of the moral values present in the teaching and exercise of care, marking, ideologically, the practice of care for the other and modeling behavior to meet these teachings⁽¹⁰⁾.

It should be remembered that the scientific and educational basis proposed by Florence Nightingale, the founder of Modern Nursing, led to the construction of professional nursing in the world and was directly influenced by its introduction in places where lay nursing care was performed, based on Christian religious concepts of charity, love for others, giving and humility, and the precepts of valorization of an adequate environment for the care, social division of labor and authority regarding the care to be provided⁽¹⁰⁾. In Brazil, a country essentially Christian, it was no different. There were several disputes over specific capital in the fields of education and nursing practice, involving its leaders and the Catholic Church, which can be examined in two studies^(10-11) on these struggles, fought for better positions, by the Catholic nurses, who were politically organized and created the Union of Religious Nurses of Brazil - UREB.

Importantly, until the proclamation of the Republic, the Catholic Church was an institution very close to the State in various fields of power, including that of Health, because it was responsible for the administration and the care of the sick in the majority of Brazilian hospitals, especially in the Santas Casas de Misericórdia. The close union between Church and State was officially broken in the Constitution of 1891 and also, from the end of the monarchy, the medical profession assumed the management positions in the hospital institutions, causing the Church to lose space in the health field^(10-11). To reverse this condition, the Church turned to internal reforms, in order to improve their position in the social space and to free themselves from the relationship of domination by the State, which resulted in the strategy to strengthen its participation in the activities of formal education, which further resulted in the expansion and consolidation of the Catholic presence in the field of Education, including Nursing.

Even in the secular nursing schools, this influence was present, although there were movements to break with this position, which also faced resistance. In fact, from the promulgation of Decree No. 20.109/31⁽¹²⁾, the Nursing School of the National Department of Public Health, currently the Anna Nery School of Nursing, became considered the standard-school - a reference, for the purpose of the creation and equalization of other nursing schools. This provoked the reaction of the Catholic Church, who sought legal protection for the Sisters working in nursing in the hospitals that they maintained, gaining specific legislation that assured them of these rights.

Another result of this movement was the increase in the number of nursing schools of a religious nature, among which was the School of Nurses of the São Paulo Hospital, founded and led by Mother Marie Domeneuc, in 1939. In 1944, former students of this school, also under the leadership of the Sisters, came together and founded the Union of Religious Nurses of Brazil (UREB), in order to provide the church, responsible for 65% of the work of hospital care, with a technical body essential to the Catholic apostolate. This called attention to the fact that, in 1946, its headquarters was moved to São Paulo, starting to function in the São José School of Nursing⁽¹³⁾.

Shortly thereafter, in 1948, with the aim of obtaining greater proximity and better understanding between the nurses and lay Catholics in order to exist in the national context, the UREB founded, in Sao Paulo, the Catholic Union of Nurses of Brazil - UCEB, an integral part of the World Union of Catholic Nurses. During the eight years of existence of the UCEB, 17 mid and/or higher-level nursing schools were created, 13 of them linked to the Catholic Church (76.47%), a very significant number⁽¹⁴⁾. It should be noted that, from 1944, the year of creation of UREB four of the schools in this study were created: São José, Santa Catarina, Matarazzo and São Joaquim. Thus, it is considered that the UREB contributed significantly to the increase in the number of nursing schools, both mid and higher-level, and had the commitment of inculcating the religious habitus in the future nurses and auxiliary nurses, instituting a new model of the Catholic nurse/nursing⁽¹⁵⁾.

It highlights the fact that the religious were given priority in the places of the courses of auxiliary nurses, indicating the intention of acquisition and accumulation of cultural capital for the Sisters, especially in the target state, to achieve the diploma, accumulating symbolic power and commanding dominant arrangements for these.

It could be said that all the schools studied, at the time of their creation, were of a confessional character or had once been of a confessional/religious association, especially to the Catholic Church. Therefore, the inculcation⁽¹⁶⁾ was used with the intention of contributing to the perpetuation and reproduction of its social order or to consecrate, sanctify and sanction the structure of the systems of religious representations and practices inherent to Catholicism. In addition, there was an intention to attend to the charisma of each religious order involved, with regard to Catholicism. In the case of Judaism, the issue of indoctrination is also applicable, however, to a lesser extent, in view of some determinations, mainly contained in the regulations of the school, such as the offering, even if voluntary, of religious orientation, or the question of obedience of the holy days of this religion.

Sources of funding

The schools were created at different times, but they all used the strategy of obtaining benefits and fiscal aid, due to the condition of philanthropy/public service of the sponsor/hospital/school. In 1955, discussion regarding the poor accommodation of the school was registered in the minutes of the board meeting of the Samaritan Hospital Society, as well as studying the construction of a new building, which would have been costly, with delays in its implementation, which can be interpreted as a certain disinterest in the physical conditions of the school or even a way to delay the resolution of this structural problem, reinforcing the hypothesis that the school lent itself to the interests that, although relevant, were not a priority.

The school of the Matarazzo Hospital reported that it possessed the structure and material barely adequate for its operation, although operating in this same building. The school had no laboratory and used the hospital facilities or an adapted classroom for the training in the majority of the techniques, which leads to the inference that this was permitted by the teaching authority that supervised the ideal conditions offered for the course and convenient for the sponsor, because it did not require an additional investment of economic capital.

The analysis of the documents of the schools showed that some sought public funding; however, it is not possible to affirm whether there were schools that did not seek this because it was not possible to examine the complete documentation of all the schools studied, principally those that were closed, where the documents were lost and/or transferred to the custody of the education authority, that did not make them available in full. The other schools, in which no data regarding the search for public funds or donations were found, were those of the hospitals Matarazzo, Santa Marcelina and Einstein. However, it was considered that all the sponsors of the schools studied were entities declared to be public services or certified as philanthropic, which can be translated into receiving subsidies in the form of exemption from payment of taxes and fees, in addition to receiving direct aid and grants. It was found that the São José School began to receive financial assistance from the Santa Casa from 1949 and, in 1959, requested funding from the public institution - Caixa Econômica Estadual de São Paulo, to purchase the building and expand its facilities.

Several papers reveal requests for public funding and donations, from companies and private collaborators, for the Samaritan Hospital School, from 1955 to 1972. The amounts involved in these records ranged from 3.75 to 105.3 times the minimum wage, according to the equivalence of values corresponding to the minimum wage at the time⁽¹⁷⁾. The Santa Catarina School requested funds to renovate the school building and grants from Ministry of Education and Culture, in the year 1966. Regarding the São Joaquin School of Nursing, in 1960, its sponsor requested Cr$2,000.00 (equivalent to 208.3 MW in 1960)⁽¹⁷⁾ from the MEC. From the above, it can be concluded that some schools were used as a means of ensuring economic capital for their sponsors, either by obtaining donations or public and private funding, or with fiscal exemptions.

In the São José School of Auxiliary Nurses, by the year 1967, students enjoyed free and full-time education. There is a record that there was a group of recent graduates who assumed the commitment to working in the Santa Casa, for a period of 6 months, with guidance provided by the school, probably as contracted workers. With respect to the Samaritan Hospital, records were found in the minutes, of the years 1958 and 1959, regarding a monthly allowance granted to the students in order to ensure their services at the hospital after their graduation, through a contract, as well as from reports of a survey concerning working hours performed by the students of the Auxiliary Nursing Course, conducted by the school director. The value of the allowance paid to students can be considered low because it does not even correspond to a quarter of the minimum wage of the time.

In the Auxiliary Nursing School of Santa Catarina, there is proof that the course was free, from its creation until at least 1978, becoming paid by the students after that, with it not being possible to verify exactly when this started. According to the Rules of the Course of the school attached to the Hospital Matarazzo, of 1975, the students paid for the course, however it can not be affirmed that this was the case with the first classes, due to the lack of contemporary records regarding the issue. However, the students who stood out, due to their academic achievement, dedication to the patients, to study and to the nursing profession, would be exempted, by the sponsor, in part or in full, from the payment of the school fees. The course was and is free in the Nursing School of São Joaquim. In an application, sent to the City of São Paulo, containing information about the school, in the years 1961 to 1963, it was announced that the students enrolled for the entrance examination have the right to proper accommodation, a full medical inspection with laboratory tests and X-ray, uniforms, books, notebooks and school material in general, without any payment, and students recognized as poor received a grant for their personal expenses during the course, with an average value of Cr$ 3,000.00 per month, equivalent to 4.5 MW in 1961, and 7 MW, in 1963⁽¹⁷⁾. In the schools attached to the Santa Marcelina and Albert Einstein Israelite hospitals, the students paid for the course. The analysis shows that the creation of a school could result in advantages for the hospital or sponsor, with the course free to the students or not, because the school permitted various capital to be obtained, which could be transmuted into symbolic capital.

Aims and purposes

The aims or purposes of the schools or of their nursing auxiliary courses, stated in the regulations, repeated the text of the specific legislation, such as that of the Santa Marcelina and Einstein, and informed that the aim of the school consisted of the general purposes contemplated by the Laws of Guidelines and Bases of the National Education, in force at the time. They also indicated or revealed the intention of creating the school, as in the case of São José, which was intended for the formation of auxiliary nurses, training the students in all activities of curative care, according to the laws of Catholic morality, explaining the intention of indoctrination and of reproduction of the systems of representation and of the Catholic religious practices.

The school of the Santa Catarina Hospital was proposed to prepare personnel to assist the nurse in their curative care, as was the school of São Joaquim, however, in the latter, the terms training of the personnel, assist the registered nurse and preventive and curative care appeared. In the Matarazzo Hospital School the aim was expanded, proposing to provide the qualification of personnel to provide, under the guidance of the nurse and physician, nursing care to hospitalized patients or outpatients and to assist in the curative care and in the care of patients in the Emergency Unit, Outpatient Unit, Dispensaries and Health Centers, as well as to collaborate in the community health programs. In the Samaritan Hospital School no documents were found which clarified this issue. Considering the aims and purposes mentioned, it appears that the creation of the schools was conditional on the need to address the lack of nursing human resources of the hospitals to which the schools were attached, however, also aimed to meet the charisma of the Catholic congregations involved and to acquire social, economic and cultural capital, and, consequently, symbolic power for the institutions involved.

Number of students formed in schools and their impact on the work force

The Final Report of the Survey of Resources and Needs of Nursing in Brazil⁽¹⁸⁾ informed that the annual average of auxiliary nurses formed in schools had been increasing rapidly, especially since 1949. It also informed that, in a period of 16 years – from 1941 to 1956, the 28 existing private schools bestowed 1,475 nursing certificates, resulting in an average of 82 per school (2.93 students formed in each school) and 92.2 (3.29 students formed in each school), annually, for the group of schools. In addition, it informed that private schools in the country formed 1,163 auxiliary nurses , in the period from 1952 to 1956. Thus, 232.6 students were formed each year and an mean of 8.3 formed students/school/year. The total number of auxiliary nurses formed in the studied schools was 12,938 and that of nursing technicians was 3,030. The final sum of both professional categories, from all the schools studied, was 15,968 professionals. According to the older statistical data⁽¹⁹⁾ published on the number of nursing professionals registered in the COREN-SP (Regional Council of Nursing of the State of São Paulo), dated December 1993, the sum of auxiliary nurses and technicians comprised, at the time, a total of 21,938. In December 2007, this totaled 82,823⁽²⁰⁾.

Given the above, it may be considered that there was a positive impact regarding the training of mid-level human resources, in the seven schools investigated in this study. This impact becomes visible when compared to the health policies implemented since the 1960's and the expansion of the quantity of health professional, as well as the number of jobs associated with the healthcare sector during the 1970's.

CONCLUSION

The investigation of the movements of creation and implementation of the schools/courses studied comprised seven institutions and their respective schools, noting that several actions and decisions were common among some of them, a strong indication that they were motivated by a greater conjuncture, which involved them. Some sponsors of these schools highlighted their creation, performing inaugural classes in the presence of authorities in the areas of Education and Health, in a clear demonstration of how the formation of this new professional was necessary for the hospitals that wanted to stand out from the others, be it for the training of their own staff or for the adherence to the new model of professional nursing. In other schools, however, the creation was not as welcomed and there were those which were established in temporary spaces, denoting their not being long-term projects. Nevertheless, some of the studied schools that started their activities in this condition are still in existence, only two of them have closed their activities, in the period studied, and one more afterwards.

The sponsors of the majority of the schools, their management and a large portion of their teaching staff had strong religious links of Christian orientation, predominantly Catholic, apart from one of Protestant and another of Jewish orientation. Even lay schools held relationships with representatives of religious orders, which were also present in the hospital sites, thus resulting in a strong moral orientation, based on the ideology they professed, in the formation of the mid-level professionals. The intentionality of inculcation of Jewish-Christian religious precepts, in view of their propagation through the students, included the acceptance of dedication/donation without personal gain, which reinforced the moral and work discipline, and the obedience to the hierarchy. These moral values also served the interest of the hospitals where these schools where created, insofar as the use of students as members of the working staff became acceptable and they were obligated, when professionals, to remain working in that hospital institution.

The funding of the schools was primarily through aids, grants and the waiver of taxes, given the philanthropic character of their sponsors, demonstrating, even in those schools which required monthly payment from the students, the intention of maintaining the operation of the school without imposing this condition. Only in one of the schools studied – the Samaritan Hospital, closure took place due to financial difficulties. Initially, there was attribution of vacancies, in the studied schools, to religious students, due to the need of regulating their legal-professional situation, in accordance with the succession of legislations which controlled education and the practice of the nursing profession. However, the presence of lay students having always been foreseen, since the aim was to qualify the worker for the same nosocomial institution which held the school, was determinant in their creation.

At the time the São José Nursing School was created, there was a need to incorporate the auxiliary element, who were formed more rapidly than the nurse, providing a space for struggle, especially for the elaboration of legal actions that regulated the teaching and the practice of Nursing. This battle was fought, by the nurses, through the ABEn (Brazilian Nursing Association), and the Sisters of the São Jose Nursing School, for the approval of legislation making the courses for the formation of auxiliary nurses official, some of which were already in progress, such as the aforementioned school and Anna Nery School.

This process aimed to secure the development achieved by Nursing and to maintain possession of the symbolic capital by the nurses and, therefore, by the ABEn, thus allowing them to prevail, by means of controlling the auxiliary nurses who would be formed. In this sense, the creation of mid-level schools in reference-model hospitals, in the city of São Paulo, fully attended to these purposes. Another symbolic battle was fought by the religious nurses as a result of the reforms taking place in the context of the Catholic Church and in Nursing, which resulted in the creation of the UREB (1944) and UCEB (1948). These associations motivated the creation of nursing schools of a religious nature, both for the formation of nurses and auxiliary nurses, in order to ensure their permanence in the fields of Education, Health and Nursing. In the same way, for the hospitals, the creation of the schools allowed for a gain of symbolic power, since it was the strategy that resulted in the input of cultural, economic and social capital. Thus, having a school attached to the hospital brought financial advantages with the possibility of the work of students, even under the condition of a free course for them, since there was greater availability of low-cost workers for the hospital. Furthermore, it was prestigious to have their own school, because, apart from enabling the hospital or the sponsors to gain from taxes wavers and donations from the private or governmental sectors, it was considered an advantage in the competition for clients – symbolic and economic power. Finally, by contemplating the expressive number of professionals formed in the studied schools, it can be affirmed that their creation and later consolidation had great influence in constituting the work force in Nursing in the capital of the State of São Paulo, the reason why studying the movements that propitiated their activity and explaining the intentionality of the hospital institutions involved in this project was relevant.

REFERENCES

• 1. Sanna MC. Histórias de enfermeiras gerentes: subsídios para a compreensão de um modelo-referência de organização de serviços de enfermagem no período de 1950 a 1980. Rio de Janeiro: Escola Anna Nery/UFRJ; 2002.
• 2. Carneiro G. O poder da misericórdia: a Santa Casa na história de São Paulo. São Paulo: Press Grafic; 1986. 2 v.
• 3. Caverni LMR, Sanna MC. A história da formação de profissionais de enfermagem de nível médio relatada na literatura científica brasileira. In: Anais do 58ş Congresso Brasileiro de Enfermagem; 2006 nov. 5-9; Salvador, BR [CD-ROM]. Salvador: ABEn-Seção-BA; 2006. p. 2543-44.
• 4. Gonçalez AASS, Sanna MC. Dissertações e teses no Brasil sobre a formação do profissional de enfermagem de nível médio no Brasil: um estudo bibliométrico. In: Anais do 2ş Colóquio Latino-Americano de História de Enfermagem; 2005 set. 12-15; Rio de Janeiro, BR. Rio de Janeiro: Escola de Enfermagem Anna Nery; 2005. p. 535-40.
• 5. Peduzzi M, Anselmi LA. O auxiliar e o técnico de enfermagem: categorias profissionais diferentes e trabalhos equivalentes. Rev Bras Enferm. 2004;57(4):425-9.
• 6. Caverni LMR, Sanna MC. Dez anos do GIEMEn - Grupo de Interesse no Ensino Médio de Enfermagem. Rev Paul Enferm. 2002;21(3):262-8.
• 7. Oguisso T. Sobre a elaboração das normas jurídicas. Rev Esc Enferm USP. 1999;33(2):175-85.
• 8. Caverni LMR, Contim D, Sanna MC. Métodos de pesquisa empregados no estudo da história das escolas de enfermagem. In: Anais do 1ş Simpósio Ibero-Americano de História de Enfermagem: Memória e Identidade Profissional; 2007 out. 29-31; São Paulo, BR [CD-ROM]. São Paulo: Escola de Enfermagem da Universidade de São Paulo; 2007.
• 9. Brasil. Lei n. 775, de 6 de agosto de 1949. Dispõe sobre o ensino de enfermagem no país e dá outras providências. In: Brasil. Ministério da Saúde. Fundação Serviços de Saúde Pública. Enfermagem, legislação e assuntos correlatos. 3Ş ed. Rio de Janeiro; 1974. v. 1, p. 154-7.
• 10. Padilha MICS, Mancia JR. Florence Nightingale e as irmãs de caridade: revisitando a história. Rev Bras Enferm. 2005;58(6):723-6.
• 11. Gomes TO, Silva BR, Baptista SS, Almeida Filho AJ. Enfermeiras católicas em busca de melhores posições no campo da educação e da prática em enfermagem nos anos 40 e 50 no Brasil, no século XX. Texto Contexto Enferm. 2005;14(4):506-12.
• 12. Brasil. Decreto n. 20.109/31, de 15 de junho de 1931. Regula o exercício da Enfermagem no Brasil e fixa as condições para equiparação das escolas de enfermagem e instituições relativas ao processo de exame para revalidação de diplomas. In: Brasil. Ministério da Saúde. Fundação Serviços de Saúde Pública. Enfermagem, legislação e assuntos correlatos. 3Ş ed. Rio de Janeiro; 1974. v. 1, p. 68-72.
• 13. Carvalho AC. Associação Brasileira de Enfermagem 1926/1976: documentário. Brasília: ABEn; 1976.
• 14. Baptista SS, Barreira IA. Condições de surgimento das Escolas de Enfermagem brasileiras (1890-1960). Rev Altern Enferm. 1997;1(2):4-17.
• 15. Bourdieu P. A distinção: crítica social do julgamento. São Paulo: EDUSP; 2008.
• 16. Bourdieu P. A economia das trocas simbólicas. São Paulo: Perspectiva; 2003.
• ¹⁷
  Brasil. Ministério do Trabalho e Emprego. Salário mínimo: evolução do salário mínimo – legislação [Internet]. Brasília; 2009 [citado 2009 jul. 14]. Disponível em: http://www.mte.gov.br/sal_min/default.asp
• 18. Freire MAM, Morais FT, Amorim WM, Silva Júnior OC. As diretrizes do Relatório Goldmark para a organização de um grupo subsidiário de enfermagem (1919 - 1923). Cultura Cuidados. 2007;22(1):40-9.
• 19. Conselho Regional de Enfermagem de São Paulo (COREN-SP). Estatísticas: dez/1993 [Internet]. São Paulo; 1993. [citado 2009 nov. 12]. Disponível em: http://www.coren-sp.gov.br/internet/072005/consulta/estatistica/pdf_estatistica.php?TIPO=cidades&MESANO=121993
• 20. Conselho Regional de Enfermagem de São Paulo (COREN-SP). Estatísticas: dez/2007 [Internet]. São Paulo; 2007. [citado 2009 nov. 12]. Disponível em: http://www.coren-sp.gov.br/internet/072005/consulta/estatistica/pdf_estatistica.php?TIPO=cidades&MESANO=122007

Correspondência:

Leila Maria Rissi Caverni

Rua Afonso Vaz, 559 - Vila Pirajussara

CEP 05580-001 - São Paulo, SP, Brasil

*

Extraído da tese "Escolas de nível médio de enfermagem: criação e desenvolvimento em hospitais privados modelo-referência da cidade de São Paulo (1945-1989)", Universidade Federal de São Paulo, 2009.

Publication Dates

• Publication in this collection
  07 May 2012
• Date of issue
  Apr 2012

History

• Received
  30 June 2010
• Accepted
  18 Aug 2011