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Texto & Contexto - Enfermagem

Print version ISSN 0104-0707On-line version ISSN 1980-265X

Texto contexto - enferm. vol.26 no.1 Florianópolis  2017  Epub Feb 06, 2017

https://doi.org/10.1590/0104-07072016004370015 

ORIGINAL ARTICLE

THE PROFESSIONAL IDENTITY OF NURSING IN THE PAPERS PUBLISHED BY REBEN

IDENTIDAD PROFESIONAL DE ENFERMERÍA EN LOS TEXTOS PUBLICADOS POR LA REBEN

Adriana de Lima Pimenta1 

Maria de Lourdes de Souza2 

1M.Sc. in Nursing Programa de Pós-Graduação em Enfermagem (PEN), Universidade Federal de Santa Catarina (UFSC). Florianópolis, Santa Catarina, Brazil. E-mail: adricorpoanalise@hotmail.com

2Ph.D. in Public Health. Professor at PEN/UFSC. Florianópolis, Santa Catarina, Brazil. E-mail: repensul@uol.com.br


ABSTRACT

Objective:

to analyze the content of scientific papers published in the Brazilian Journal of Nursing (REBEn) concerning the professional identity of nursing.

Method:

This qualitative study used content analysis. The study’s corpus was composed of scientific papers published in REBEn from 1983 to 2012; 55 papers were selected.

Results:

The analysis considered the theoretical propositions of Eliot Freidson concerning the Sociology of Professions.

Conclusion:

The conclusion is that the papers published in REBEn reveal theoretical inadequacy in the analytical matrix of the nursing profession. Therefore, theoretical studies addressing the nursing profession are needed to support propositions consistent with the complexity of conflicts and how to overcome them.

DESCRIPTORS: Sociology; Occupations; Nursing; Professional autonomy; Nurse´s role.

RESUMEN

Objetivo:

analizar la identidad profesional de enfermería en los textos publicados en la Revista Brasileña de Enfermería.

Método:

Se desarrolló una metodología de naturaleza cualitativo con análisis de contenido. El cuerpo del investigación fue la producción científica publicada en la Revista Brasileña de Enfermería, de 1983 a 2012, com 55 artículos seleccionados.

Resultados:

El análisis se construyó teniendo en cuenta la Sociología de las Profesíones en Eliot Freidson. Llegamos a la conclusión de que hay textos con una inadecuación teórica en el marco analítico de la profesión de enfermería.

Conclusión:

son necesarios estudios teóricos sobre la profesión de enfermería para apoyar propuestas acordes con la complejidad de sus conflictos y su superación.

DESCRIPTORES: Sociología; Ocupaciones; Enfermería; Autonomía profesional; Rol de la enfermera.

RESUMO

Objetivo:

analisar o conteúdo da produção científica publicada na Revista Brasileira de Enfermagem sobre a identidade profissional da enfermagem.

Método:

Adotou-se metodologia de natureza qualitativa, com análise de conteúdo. O corpus da pesquisa foi constituido por textos publicados na Revista Brasileira de Enfermagem, de 1983 e 2012, resultando em 55 artigos selecionados.

Resultados:

A análise foi construída tomando-se em consideração proposições teóricas da Sociologia das Profissões, em Eliot Freidson. Conclui-se que os textos publicados na Revista mostram inadequação teórica da matriz analítica da profissão de enfermagem.

Conclusão:

são necessários estudos teóricos sobre a profissão de enfermagem para subsidiar proposições condizentes com a complexidade de seus conflitos e sua superação.

DESCRITORES: Sociologia; Ocupações; Enfermagem; Autonomia profissional; Papel do profissional de enfermagem.

INTRODUCTION

Labor in post-industrial societies has conditioned the identity of individuals as it has become an essential category in the construction of social relationships.1 Professional labor, understood as an activity performed by occupational groups specific to the world of labor, constructs its identity based on a dialog between elements intrinsic and extrinsic to the profession: its historical constitution, particular occupational culture, specific knowledge, and specific dialect.2 For an occupational group to call itself “professional”, however, the parameters based upon which professionalism is constructed need to be observed.3

One of the goals of a professional project, legal acknowledgment on the part of the State, through the law of professional practice, is affirmed as an instrument of identity, defining who can and who cannot “practice the profession”, ensuring job share protection. In contemporary societies, having a college degree is what enables an individual to obtain educational accreditation and have the autonomy to practice a given profession.2

One of nursing’s pillars in the process of professionalization and the constitution of professional identify is the construction of specific and necessary knowledge regarding care. The profession, however, is a project of prestige and power, in which one seeks social recognition and privileges in the professional domain. Therefore, deepening knowledge regarding professional identity - specifically in this paper, the identity of nursing - contributes to understanding regarding this profession, and can support understanding of its organization and professional project.2

Hence, this discussion is intended to support decision-making concerning public policy formulation intended to guide the organization of labor in the field of health in terms of the qualification of nursing education and its regulation.

In this sense, the objective established for this study was to analyze the content of scientific production published in the Brazilian Journal of Nursing (REBEn) regarding the professional identity of nursing, from the framework of Eliot Freidson regarding the Sociology of Professions.

METHOD

This qualitative study included a bibliographic search and is based on Eliot Freidson’s propositions regarding the Sociology of Professions. The study’s corpus is composed of papers published in REBEn, the periodical that creates and disseminates the professional ideology of nursing, between 1983 and 2012. The year 1983 was chosen because it was when the journal standardized its publications and abstracts became mandatory. This time period and the presence of abstracts showed to be appropriate strategies to lead to deeper analysis.

The following inclusion criteria were used: full texts of scientific papers addressing the topic published in REBEn between 1983 and 2012. The following were excluded from the study: editorials and sections titled Student Page, Readers’ letters, Abstracts of Theses and Dissertations, Book Reviews, and the publication of documents.

The papers were selected according to the relevance of content presented in the abstracts in regard to the study question. This criterion was established while skimming the texts and after verifying what had resulted from merely searching for terms of legislation, professional regulation, professional practice, identity, professional identity, professional role and professionalization, in the titles, abstracts, and key words was insufficient because material relevant to the theme ended up being discarded.

In the period between May and September 2013, a total of 89 papers were selected. After reading, 34 papers were excluded for not presenting relevant content, so that 55 papers were selected to compose the study’s corpus (Table 1).

Table 1 List of papers published in the Brazilian Journal of Nursing from 1983 to 2012 selected for the study 

n Paper n Paper
1 Barros e Araujo, 1983.4 29 Vieira, 1998.32
2 Angerami and Almeida, 1983.5 30 Lacerda, 1998.33
3 Coradini and Barbiani, 1983.6 31 Ide and Schneck, 1998.34
4 Barros, 1985.7 32 Dias, Monticelli and Nazário, 1998.35
5 Mendes, 1985.8 33 Monticelli, 2000.36
6 Winck and Brüggemann.9 34 Araujo Netto and Ramos, 2000.37
n Paper n Paper
7 Vieira and Oliva, 1985.10 35 Pires, 2000.38
8 Carvalho, 1986.11 36 Albuquerque and Pires, 2001.39
9 Oliveira, 1986.12 37 Oguisso, 2001.40
10 Feijo and Gigante, 1986.13 38 Costa and Gomes, 2001.41
11 Barros et al., 1986.14 39 Barreira and Baptista, 2002.42
12 Bueno et al., 1986.15 40 Araujo Netto and Ramos, 2002.43
13 Lorenzetti et al., 1986.16 41 Nascimento et al., 2003.44
14 Santos et al., 1986.17 42 Vale and Silva, 2004.45
15 Capella e Gelbecke, 1988.18 43 Guimaraes and Carvalho, 2005.46
16 Capella et al., 1988.19 44 Trevizan et al., 2005.47
17 Subsídios para elaboração ..., 1988.20 45 Gomes and Oliveira, 2005.48
18 Castro, 1988.21 46 Hahn et al., 2006.49
19 Carvalho and Oliveira, 1988.22 47 Bueno and Queiroz, 2006.50
20 Nascimento, 1991.23 48 Gomes and Oliveira, 2008.51
21 Angerami and Mazzo, 1991.24 49 Campos and Oguisso, 2008.52
22 Vieira, 1992.25 50 Erdmann et al., 2009.53
23 Barreto et al., 1992.26 51 Pereira et al., 2009.54
24 Projeto político da enfermagem brasileira, 1992.27 52 Kletemberg et al., 2010.55
25 O papel do enfermeiro hoje, 1997.28 53 Borges e Silva, 2010.56
26 Padilha, Nazario and Moreira, 1997.29 54 Almeida et al., 2009.57
27 Rodrigues et al., 1997.30 55 Albuquerque and Pires, 2006.58
28 Bezerra et al., 1998.31

The texts were organized and systematized using content analysis, while thematic analysis was used for discussing the results.59

The thematic analysis was conducted in three phases. The first phase was pre-analysis, which included skimming the texts, composing the corpus, and establishing objectives. The second phase included exploring the material, which was characterized according to “core meanings”. The third phase was composed of treating and analyzing results according to the concepts proposed by Eliot Freidson regarding Professional Identity, with five sub concepts, called here thematic axes. Two main themes guided this analysis: Higher education: accreditation through a college degree; and Professional regulation: recognition on the part of the State of professional jurisdictions.

RESULTS AND DISCUSSION

Professional Identity with axes established by Eliot Freidson presents a relationship of inter-influence, even though some axes have more influence than others in the composition of the identity of professional groups.2 Hence, data collected from the texts are presented and discussed separately, even if portions of each of them necessarily lead to others.

Higher education

Universities are socially recognized as the place where knowledge is produced in modern society. They are established to provide training based on epistemological processes, enabling individuals to understand, reflect, analyze data, and understand social facts. These are elements that ground decision-making, problem-solving, creativity, and initiatives that characterize a distinctive quality, professional expertise.60 This understanding is in agreement with Eliot Freidson’s proposition regarding professions, that professions are a special type of occupation to the extent which, among other qualifiers, they contribute to solving problems in society based on competence grounded on the “authority of knowledge” acquired with higher education.3

With this in mind, 55 papers were analyzed. None mentioned that college education is a basic requirement for the professional establishment of the occupation group of nursing. There are ambiguous approximations to this statement, such as those identified in 24 papers that present college education as an element that adds value to nursing, in a symbolic identification with status and the authority of knowledge acquired with higher education, established as scientific discourse, and autonomy that one can achieve with it based on the construction of knowledge. “[...] the combination of theoretical study grounded on a scientific basis is indispensable for the education of nurses because ‘without solid instruction, there is no power of initiative, spirit of observation, or sense of responsibility’”.44:448

There is an approximation to Freidson’s thinking,61 given the affirmation of characteristics inherent to professional expertise; expertise grounded on college education, with a basis that enables decision-making and problem-solving based on scientific judgment and mastery of fundamentals. The texts present the need for college education to construct the profession without, however, mentioning that it only enables one to become part of the group but that it is not a reality for the whole group, as if the professional identity of nurses based on college education was sufficient to ensure the professional project of the nursing field as a whole. Nursing is treated, or mentioned in the texts’ content, as being a unity: “nursing”, “the nursing professional”, “the nursing staff”, and “the nursing program”. There is no differentiation between “nursing practiced by nurses” from the “nursing practiced by the other workers making up the team”.

In the scope of the occupational organization of contemporary societies, professional autonomy is established in the first instance through academic or educational accreditation. This is not an arbitrary demarcation established by sociologists or a merely legal requirement. It is important to ask whether the university has played this role, though no one questions whether this is, in fact, its social role.61

There is a contradictory discourse concerning the essentiality of higher education in the constitution of the professional project and, consequently, of the professional identity of nursing. In agreement with Freidson’s propositions, we understand that status, autonomy and authority are privileges of professionals.62 Hence, they are exclusive to nurses only, not for nursing workers.

Professional regulation

Freidson stresses the importance of the role played by the State in the constitution of professions, which ensure job share protection in legal terms, that is, in the scope of State’s policies. It is the State that lends professions its support, ensuring the right of exclusivity over certain jobs, in addition to legitimacy, so the professionals themselves enforce and organize the production and reproduction of the knowledge related to the practice.3 Professional regulation is the maximum expression of the State’s support for the authority of the institutionalized expertise of the professional system to the extent which access to the practice of regulated acts is exclusive to those who have accreditation, establishing “property rights,” as it were, for professionals.62

In Brazil, the professional identity of “Nursing” is legally attributed to a heterogeneous occupational group, internally divided among types of workers with different competencies, spheres of action, and educational backgrounds.55 The first legal contribution of the Brazilian State to regulating this professional practice, Decree No. 20.109 from June 15th 1931, does not mention this internal division; rather, it only stipulates the title “registered nurse”, which would be exclusive to those with a degree acquired and registered in official schools.63 Only in the 1950s was the organization of nursing made explicit in the Law of Professional Practice, No. 2,604, from September 17th 1955, in regard to the division of occupational categories.64 The new law replaced the one from 1931, denominating nursing “PR actioners”: nurses, nursing auxiliaries, midwives with and without a college degree*, practical nurses or nursing practitioners and practical midwives. Nursing, with its history in the Brazilian context, achieved Law No. 7,498 on June 25th 1986, which replaced the one from 1955,65 and this new law establishes that nursing be performed exclusively by nurses, nursing technicians, nursing auxiliaries and midwives.

It is relevant to note that, according to the terms of the Sociology of Professions, only nurses are entitled to the professional denomination because nurses are members of an occupational group organized around an expertise, accredited by a college degree. Law No. 7,498/86 provides the right of nurses to prescribe and give consultations due to knowledge acquired during higher education.65

Note that less than ten years after, Law No. 8,967 from December 28th 199466 established in a single paragraph that nursing aids, workers without specific qualification, hired before the enactment of this law, were under this same umbrella, legally allowed to practice nursing.67 In this way, when we refer to nursing as a profession, we have a heterogeneous group composed of occupational categories that, even though they include professional and non-professional workers, are all legally allowed to perform the work of the nursing profession.

The analysis of the papers integrating the study’s corpus revealed that 14 papers presented content addressing the topic. The papers from the 1980s and 1990s showed a lack of boundaries established among the roles of different nursing workers. This lack of definition is also observed in the Law of Professional Practice current up to 1986.

As seen in the following, there is a conflict inherent to this lack of definition in the practice of nursing workers, who despite different technical/professional backgrounds, perform the same functions in care practice: “Nursing is performed by professionals with a college degree, nurses, by those with high school or middle school education, that is, nursing technicians and auxiliaries, and the largest portion of care that is provided by aids who have no formal education. These different occupational categories performing the profession develop different actions, have different salaries and also have different social connections”.19:165

The Law of Professional Practice that was current up to 1986, Law No. 2,604/55, provided in its Article 5 that all the profession’s activities are responsibilities of nursing auxiliaries and practical nurses, except those in the items included in Article 3, always under the supervision of a physician or nurse.64 The nurses’ exclusive responsibilities, according to the Article, are those concerning administration and teaching, and these responsibilities, according to Freidson, are strategic arrangements in the constitution of professionalism for all professions. The texts under analysis, though, show that the object of administration and teaching are shared by all nursing workers in the practice of care, as exemplified in the following: it is “also established that all categories that could legally practice the profession, including and midwives with and without a college degree. The establishment of nursing functions, however, was not well-defined among all the existing categories. Nurses were differentiated from the remaining categories by four functions that were not exactly inherent to nursing”.40:200

Therefore, the acknowledgment of nurses as professionals is not fully effective in that law (Law N. 2,604/55), as there are no exclusive legal privileges regarding the object of nurses’ knowledge or expertise - care - but only in regard to the teaching and direction of nursing services.64

Another relevant aspect, still considering Article 5 of Law No. 2,604/55, refers to the fact that physicians are potential supervisors of nursing’s “professional practices”, which reveals a tacit understanding of the subordination of knowledge and nursing itself, based on the thesis that nursing actions would only be determined by the context of medicine itself.64 As for this approach, there are excerpts of texts in which nurses themselves, even though knowledge mastery is mentioned as a characteristic of professional work, affirm the alleged actions of nursing as actions delegated by physicians: “[...] physicians, at the same time they master the health work process, delegate fields of activities to other health workers such as nursing, nutrition, physical therapy, etc. These professionals perform delegated tasks but keep certain decision autonomy and domain of knowledge, typical of professional work”.38:256

A hegemonic discourse is repeated, in which superiority of medical knowledge and competence is assumed to justify the authority of physicians in the division of health-related work. The fact is that, historically, similar to what occurs for other professions in the health field, nursing emerged subordinated to medicine. However, even though nursing emerged as a practice subordinated to medicine, it constructed its own technical/technological body, constituting specific knowledge with scientific, technological and philosophical foundations.

The conflict identified in the texts still refers to a lack of definition of roles among workers. Even though definitions are described in Law N. 7,498/86, in practice these definition are not always explicit.65 The problem of the qualification (lack of or poor qualification) of the remaining workers remains a concern, but the texts focus on the “need for professionalization”, seen as technical training. Some of these aspects are observed in the following excerpt: “[...] even though the practice of the nursing profession is regulated with varied and different attributions provided in legislation - which actually confirms the profession’s internal division -a consensus has not yet been achieved nor is there imprinted on it a clear purpose or a clear determination of what is the object of its work and, as a consequence, the relations between this object and nursing workers have not yet been determined”.36:51

Underlying these discussions, we verify that the division of nursing that is explicit in Law No. 7,98/86, is considered in the papers as a confirmation of a particularity of the “nature of the nursing work,” contributing to crystalize a heterogeneous and fragmented organization, assumed to be necessary. We also identified that the approval of the law is considered an advancement in terms of professional autonomy and this autonomy is celebrated as an achievement of nursing, not of nurses, as previously discussed.66,68

FINAL CONSIDERATIONS

The professional identify of nursing, identified in the content of texts published in the Brazilian Journal of Nursing, expressed conflicts and contradictions. There is no proper analysis of the organizational matrix of professions, referred to in the body of knowledge and professional values and ensured by higher education.

While the professional identity of nursing is decomposed by the division of the organization of work between professional and non-professional workers, its power - care - will be compromised and its political force, as a profession with intangible value, will be depleted.

Greater theoretical depth is essential in the study of professions to support an analysis of the nursing profession, the complexity of its conflicts and how to overcome them.

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* At the time this law was implemented, “midwives” included those who did not have a college degree. Midwives without formal education still perform in underdeveloped countries.

Received: October 21, 2015; Accepted: May 05, 2016

Correspondence: Maria de Lourdes de Souza Universidade Federal de Santa Catarina, Centro de Ciências da Saúde Instituto Repensul - Campus Universitário, Bairro Trindade 88040-900 - Florianópolis/SC, Brasil E-mail: repensul@uol.com.br

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