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Texto & Contexto - Enfermagem

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

Texto contexto - enferm. vol.29  Florianópolis  2020  Epub Sep 07, 2020

http://dx.doi.org/10.1590/1980-265x-tce-2020-0132 

Special Section COVID-19

THE PATH OF HOPE IN RELATIONSHIPS INVOLVING OLDER ADULTS: THE PERSPECTIVE FROM THE COMPLEXITY OF THE COVID-19 PANDEMIC

EL CAMINO DE LA ESPERANZA EN LAS RELACIONES QUE IMPLICAN A LOS ADULTOS MAYORES: LA PERSPECTIVA DESDE LA COMPLEJIDAD DE LA PANDEMIA DE COVID-19

Karina Silveira de Almeida Hammerschmidt1  2 
http://orcid.org/0000-0002-7140-3427

Lisiane Capanema Silva Bonatelli2 

Anderson Abreu de Carvalho2 

1 Universidade Federal do Paraná, Departamento de Enfermagem, Curitiba, Paraná, Brasil.

2Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Enfermagem. Florianópolis, Santa Catarina, Brasil.


ABSTRACT

Objective:

to reflect on the relationships involving the older adults during the COVID-19 pandemic from the perspective of complexity, envisioning the path of hope.

Method:

this is a reflection based on the Theory of Complexity, according to Edgar Morin, and on articles addressing the new coronavirus.

Results:

the experiences during the pandemic showed economic, social, health, cultural, ethical, and moral difficulties in relation to the older adults. Facing the uncertainties of COVID-19 teaches about the attitude towards this inevitable involvement in the individual and collective life, as well as in the history of the country and the world - a problem aggravated by the fears of humanity. Therefore, adapting society and remodeling it with regard to relationships with the older adults can translate into success against the pandemic disease. This induces thought reform, reorganizing the understanding of the older adults, which currently involves scattered, disjoint, compartmentalized, and excluding thinking. This reform is broad, deep, paradigmatic, cultural, ethical, and moral, which strengthens the culture of aging, propagating and democratizing the poetry of living, allowing the older adults to know the beauty of emotions, and to discover their own truths through the masterpieces of their lives. However, this intention presupposes a metamorphosis of individualism, oppression, and exclusion, in whose context gerontological nursing is fundamental.

Conclusion:

the transformations experienced during the pandemic may be the prelude to changing relationships with the older adults, through multiple reforming and transforming processes that come together, by the strengthening of gerontological nursing. Perhaps the pandemic moment is the beginning of the path of hope for new times of Humanity's dignity.

DESCRIPTORS Coronavirus; Older adult; Hope; Geriatric nursing; Philosophy in nursing

RESUMEN

Objetivo:

reflexionar sobre las relaciones que implican a los adultos mayores durante la pandemia de COVID-19 desde la perspectiva de la complejidad, vislumbrando el camino de la esperanza.

Método:

reflexión basada en la Teoría de la Complejidad, según Edgar Morin, y en diversos artículos que tratan el tema del nuevo coronavirus.

Resultados:

las experiencias durante la pandemia evidenciaron dificultades económicas, sociales, de salud, culturales, éticas y morales en relación con los adultos mayores. Enfrentar las incertezas del COVID-19 deja enseñanzas sobre la postura frente a este fenómeno inevitable en la vida individual y colectiva, y en la historia del país y del mundo: un problema agravado por los miedos de la humanidad. En consecuencia, adaptar la sociedad y remodelarla en lo que concierne a las relaciones con el adulto mayor puede traducirse en el éxito contra la enfermedad pandémica. Eso induce a remodelar el pensamiento y a reorganizar la comprensión sobre el adulto mayor, que actualmente implica un pensamiento disperso, disociado, compartimentalizado y excluyente. Dicha reforma es amplia, profunda, paradigmática, cultural, ética y moral, y fortalece la cultura del envejecimiento, propagando y democratizando la poesía de vivir, tornando así posible que los adultos mayores conozcan la belleza de las emociones y descubran sus propias verdades por medio de las obras maestras de sus vidas. Sin embargo, esa intención presupone una metamorfosis del individualismo, de la opresión y de la exclusión, en cuyo contexto la enfermería gerontológica es fundamental.

Conclusión:

las transformaciones experimentadas durante la pandemia pueden ser el preludio del cambio en las relaciones con los adultos mayores, mediante múltiples procesos reformadores y transformadores que se entrelazan, gracias al fortalecimiento de la enfermería gerontológica. Quizás el momento pandémico sea el comienzo del camino de la esperanza para nuevos tiempos de dignidad de la Humanidad.

DESCRIPTORES Coronavirus; Adulto mayor; Esperanza; Enfermería geriátrica; Filosofía en enfermería

RESUMO

Objetivo:

refletir sobre as relações envolvendo os idosos durante a pandemia da COVID-19 sob o olhar da complexidade, vislumbrando o caminho da esperança.

Método:

trata-se de reflexão alicerçada na Teoria da Complexidade, segundo Edgar Morin, e em artigos abordando o novo coronavírus.

Resultados:

as vivências durante a pandemia evidenciaram dificuldades econômicas, sociais, de saúde, culturais, éticas e morais em relação aos idosos. Enfrentar as incertezas da COVID-19 ensina sobre a postura diante desse acometimento inevitável na vida individual, coletiva e na história do país e do mundo - um problema agravado pelos medos da humanidade. Portanto, adaptar a sociedade e remodelá-la no que concerne às relações com o idoso pode se traduzir no sucesso contra a doença pandêmica. Isso induz a reforma do pensamento, reorganização da compreensão sobre o idoso, que na atualidade envolve pensamento disperso, disjunto, compartimentalizado e excludente. Essa reforma é ampla, profunda, paradigmática, cultural, ética e moral, que fortalece a cultura do envelhecimento, propagando e democratizando a poesia do viver, possibilitando que os idosos conheçam a beleza das emoções, descubram as próprias verdades por meio das obras primas de suas vidas. Porém, essa intenção pressupõe metamorfose do individualismo, da opressão e da exclusão, em cujo contexto a enfermagem gerontológica é fundamental.

Conclusão:

as transformações vividas durante a pandemia podem ser o prelúdio da mudança nas relações com os idosos, mediante processos múltiplos reformadores e transformadores que se coligam, pelo fortalecimento da enfermagem gerontológica. Quiçá o momento pandêmico seja o começo do caminho da esperança para novos tempos de dignidade da Humanidade.

DESCRITORES Coronavírus; Idoso; Esperança; Enfermagem geriátrica; Filosofia em enfermagem

INTRODUCTION

We share the same planetary destiny, humanity suffers equal and deadly threats, as arising from the confrontation with the new coronavirus, designated as Severe Acute Respiratory Syndrome Coronavirus-2 (Sars-Cov-2),1 causing the disease called Coronavirus Disease-19 (COVID-19),2-3which mainly generates acute respiratory infection in human beings. These are natural hosts for Sars-Cov-21 and, between 2 and 4 weeks, the virus is eliminated by the human body.2-5

The most vulnerable population group with the highest lethality in relation to COVID-19 are the older adults, especially those with chronic diseases.2,6 This is due to immunosenescence, which increases the vulnerability to infectious diseases and brings the worst prognosis for those with chronic non-communicable diseases.2,7However, human beings are not only biophysical, but also psychosociocultural.8

Thus, the older adults who, before the pandemic, experienced cruelty, repression, prejudice, stereotypes, and pre-judgments9 felt during the pandemic period the perniciousness of the hydra of ageism, disguised in health protection actions. During the COVID-19 pandemic,10 humanity experiences multiple crises,11 not allowing reaching a state of Humanity with older human beings.

In 1932, with a level of clarity that can be considered extremely current for the times of the pandemic, Paul Valéry asserted, aligned with the theory of complexity, that humanity never gathered so much power to so much disorder, so many concerns to so many manipulations and so much knowledge to so many uncertainties.12 In 2020, amidst the guidance, guidelines, and decrees with recommendations for the older adults to remain socially distant,4,10the heterogeneity of the Brazilian oldest population highlights the difficulties in attending to their demands, exposing weaknesses, mainly linked to the family and to the support network. However, the fate of the planet cannot be decided in isolation; a feeling of citizenship, responsibility and commitment to oneself, with the other, and with the world itself is essential.

In this context, in gerontology, ideological currents historically stimulated the autonomy and independence of the older adults,13 aiming at successful aging. This motivated the development of several social and psychological theories, focusing on them as protagonists of the aging process itself. Under this understanding, the world invested in public policies and guidelines to age actively, proactively, and functionally.

Although in the Brazilian reality, the older adults are the main financial providers of the families, being prominent in family management, many times their demands are not fully met. In this sense, actions to control the pandemic have come to highlight their needs: recommendation to stay at home, support network for purchases, and self-preservation of their health as a primary action.

The moments experienced during this sudden pandemic ratified the economic, health, social, cultural, ethical, and moral difficulties involved in the relations with the older adults, addressing the inherent complexity as a fundamental problem and a new paradigm.14 Perhaps, the transformations are the prelude to a real change in relations with the older adults, including the strengthening of gerontological nursing. The planetary system is doomed to this change,15 through multiple reforming and transforming processes that come together.16 We must remember that the future is born from the present; thus, thinking about the present means envisioning the future;14 perhaps the pandemic moment is the beginning of the path of hope for new times, providing an extra-disciplinary look,8,17envisioning in its entirety the way of doing gerontological nursing and of promoting care with empathy, scientific knowledge, and innovation.18

In this understanding, gerontological nursing is highlighted, as these professionals made a difference during the COVID-19 pandemic. In addition, the year 2020 was designated by the 72ndWorld Health Assembly as the International Year of Nursing, converging with the Nursing Now campaign and with the strategy of the 2030 World Nursing Agenda, which endorses investing in nursing education to meet the global needs and the domestic demands, as well as to respond to the technological changes and advanced models of integrated health and social assistance.19 It is considered that this area of action needs to reformulate the thought that isolates and separates by what unites and distinguishes; the disjoint and reducer by the complex.8 Thus, the transformations experienced during COVID-19 may be profound, as they will have rectified in the practice the essentially of gerontological nursing care, strengthened, robust, and prepared for emerging and reemerging needs.

Within this context, this article aims to reflect the relationships involving the older adults during the COVID-19 pandemic under the perspective of the theory of complexity, envisioning the path of hope.

OLDER ADULTS IN THE COVID-19 PANDEMIC, IN THE LIGHT OF COMPLEX THOUGHT

This article reflects on the relationships that involve the older adults during the COVID-19 pandemic in the light of complex thinking, conjecturing the possibility for the path of hope. It is based on two main pillars: the relationships that involve older human beings; and the hope of reforming thinking with the COVID-19 pandemic.

Since the social reality is in constant evolution and transformation20-21and the pandemic has brought changes not only in the experience of the older adults in Brazil and in the world, but also in the whole society, some questions arise: What understanding of human being involves the older adult today? What relationships are established by and with this older human being? What characteristics permeate the socio-cultural understanding of the older human being? What reform does society need in relation to the situation that involves the older human being? What thoughts prompt changes in relations with the older adults during the COVID-19 pandemic period? How to integrate aspects of the crisis generated by the pandemic in complex and multidimensional contexts of gerontological nursing?

Developing learning for the changing world,22 at an unprecedented pace, a priori implies breaking down exclusionary and preconception barriers, so that relationships are systemic and prevail over linear and fragmented living; multidimensionality, on deterministic causalities; horizontality, on vertical relations; and complexity, about simplifying approaches. The metamorphosis may have started in the present, with the transformations imposed by the COVID-19 pandemic.

RETHINKING THE REFORM, TO REFORM THINKING IN RELATION TO OLDER HUMAN BEINGS

Standardized models of human development ignore the solidarity, skills, and knowledge of the older adults; however, it is important to rethink diversity and development in order to safeguard these older human beings. Thus, despite the complexity of living, the simultaneous biological and cultural8 disclosing in aging is pertinent and makes reflection relevant beyond biophysiological and functional aspects, through humanized relationships. In a multi-polar society, which focuses on youth and productivity, the pandemic change forces us to rethink the emerging reform.

Such reform can start with thinking about the information and disclosures that went viral on social networks, massively used in times of social distancing, with the use of audios, videos, figures involving the older adults in various situations, generally negative and charged with judgments and exclusion. The emphasis on the behavioral difficulties and on the inadequacy to distancing prevailed, instilling interpretations of reticent, stubborn, and disobedient older adults. There was also an emphasis on the generational relationship, with mention for the care of the child, reinforced by the limitations imposed during this phase of life, which, in this pandemic moment, are transferred as “revenge” to the older adults. In addition, actions of contempt, insults, offenses, and humiliations were shown, and it is appropriate to point out that some of these attitudes were often practiced or publicized by the family members themselves.

The responses and actions of the older adults to the facts experienced during the pandemic were intertwined with physical, emotional, and cultural conditions of passivity and revolt, including harmful reactions in the home and public environments. Unfortunately, society is not prepared for the “culture of aging”, which begins with being oneself in one's context of life. On the other hand, the cultural, sociological, and civic challenge23 incites metamorphosis, which could not happen except through the multiform development of society, perhaps with the creation of planetary decision circumstances for vital problems, such as living in the aged world.

Faced with this pandemic challenge, aware of the needs that involve the Brazilian older adults, many feel powerless, resign themselves, fall into fatalism, and lose hope or become angry. It is opportune that there is awareness of how dramatic the events that occurred during the pandemic are for the human species: the current moment raises not only awareness of ambivalence, risks and dangers, but also of their chances of promoting Human evolution.16

Through this process it is possible to raise awareness of the possibilities of new policies aimed at the older adults, which simultaneously allow for the involvement of planetary solidarity, carrying out a profound transformative reform of society. For that, it is necessary to reform minds;8the start point can be the national gerontological diagnosis, in which the multiplicity and aggravation of the problems involving the older adults had a symbiosis with the evils of society and civilization, expanding selfish, perverse, and reductionist actions.16,24

Added to this, we experience unrestrained appetites for individualism; degradation of concrete solidarities; technological exacerbation, and pressure;25 quantitative domination of doing and productivity, mainly in the work environment; illusory obligations of financial support and intergenerational care relationships; older adults as conditioned and atomized citizens; lack of affection and separation that compartmentalizes; in addition to fragmented and limited knowledge. All of this prohibits the possibility of covering the fundamental problems of gerontology and the lives of the older human beings, in the midst of the crisis of blind thinking, in which there is an inability to formulate reflections on reality.16

Social evils involving the older adults are also evoked, such as uncontrolled consumption of medications, lack of economic and moral sharing, hyper specialization of work, with a prevalence of young people, and demotivation in living. Still, lack of empathy, sympathy, compassion, translated by indifference, exclusion, and lack of courtesy towards the older adults, in addition to lack of recognition of the older adults as a dignified human being. It is about humanism revisited with the anthropocentric justification of man,14 deficient in the awareness that young people will be older adults in the future.

The degradation of the ties that reconnect the social and family solidarity of the older adult can be added to the myriads of small evils that oppress, disturb, and obscure the context of life.24 However, it is not appropriate to base acts on the actions of others; the planet needs individual and collective changes, which primarily begin with each being that inhabits the terrestrial globe. In this sense, it is relevant to contextualize and situate these older adults in the Universe, not separating them from the planetary ensemble, with their rooting and uprooting in the physical cosmos and in the sphere of life.8

In the midst of these contradictions, misunderstandings and problems involving the older adults, experienced mainly in the first quarter of 2020, there is no space to allow for a regression in relation to the achievements of the older human being. On the other hand, reflection is necessary as a means of reforming thought and the planet, both through the understanding of the older adult involved in the supreme form of recognition and by means of acts of love and protection, highlighted during the actions experienced in the pandemic.

THE PATH OF HOPE FOR THE OLDER ADULTS

Evolution obeys a multi-causal principle, in which inter-retro-actions not only combine and fight each other, but also produce their own causality, with external determinations that support a complex self-nexus-causality.14 At the same time that the closed and devitalized culture does not tolerate autonomous and active older adults, it disintegrates them from society and isolates them, social fissures turn into cracks, and exclusion widens.16 In contrast, the active and open culture proposes integration into society with recognition and respect regarding its condition. Thus, it is time to revitalize gerontological thinking, fostering the “culture of aging” in Brazil.

Society needs to heal itself, mainly due to the worsening situation of crises during the pandemic, which on the one hand showed facets of anguish, frustration, and displacement. On the other hand, they catalyzed certain actions of solidarity, empathy, understanding, and individual and collective love, involving broadened affective and friendly relationships,26-27enabling emotional, psychological, and moral well-being in the community.

The experiences during the COVID-19 pandemic also highlighted the imperative to valuing quality of life, relationships, air, food, water, health, climate, and living. They incited the detoxification of incessant productivity, continuous and prevalent activities of individualism and the devaluation of the other, resulting in a compromising pathology that involves the older adult and society. For the evolution emerging from the revolution sparked by the COVID-19 pandemic, innovations, creations, cultures, and ideas14 can be seen in possible currents for future scenarios, which include the following: rehumanization of relations with the older adults, revitalization of solidarity, and inclusion of older human beings in the planetary sphere.

The rehumanization of relationships includes the family and society. In the meantime, respect and zeal for the older adult stands out, including understanding about the changes in senescence and senility. In this context, the care policy for the older adult is included, which excludes rejection, demotivation of residentialization and exacerbated video protection, allowing freedom for spaces of understanding and affection of the older adult in the social environment. It is about involve young people (children, adolescents, and adults) as collective links with the older adults; although those are generally stronger physically, the latter have wisdom of life, so that this union is capable of promoting a symbiotic relationship, which can emancipate everyone and lead to human dignity.

It is of utmost importance to reflect and understand humanism, embracing the meaning of human beings in their triple nature (biological, individual, and social), as well as awareness of the human condition, including its history, intricacies, contradictions, tragedies, and victories. The human dimension makes it possible to maintain solidarity and fraternity, allowing conceiving the identity of the older human being, as well as the differences and complexity of the other.16

The revitalization of solidarity is intertwined with the valorization of the older adult as a multifaceted human being, and this involves understanding beyond the numerical aspect of years lived; it presupposes the strengthening of the support network, especially for those who live alone or have physical or cognitive limitations, a group that presents a relevant quantitative growth.28

It should be remembered that social behavior is influenced by personal (health, gender, income, education), and contextual (social support, physical barriers, and opportunities) aspects, and by common events of old age that characterize socially transitory moments.13 Thus, it is time to establish public policies that promote activities shared among the older adults themselves, as well as intergenerational ones, especially strategies for the inclusion of the older adults in teaching and work activities, as the daily interaction between them and young people enable an integrated social life, opening up new horizons.

Another important item involves the safety of the older adults, especially those who are frail. Any action of violence or the creation of an environment of insecurity involving them must be rejected by society. Unfortunately, acts of violence against the older adults are common nowadays, countless times being practiced by the family members or caregivers themselves, showing disrespect, devaluation, and contempt.

Let us remember that we are in a universe permeated by the principle of agitation, dispersion, and disorder, in which there is permanent reorganization,14including the struggle to face uncertainties, such as the COVID-19 pandemic. This teaches us about the attitude towards this inevitable involvement in individual and collective life, as well as in the history of the country and the world - a problem aggravated by the fears of humanity. The crisis can incite a multidimensional revolution, encompassing simultaneous changes;21,23therefore, it has the possibility to reshape society with regard to the relations with the older adult and to translate into success against the pandemic disease. This can occur even without a quantitative change in the epidemiological statistics, as some changes are not numerical, but qualitative and relational of human evolution.

Such a scenario induces thought reform8 and reorganization of understandings about the older human being, which today are combined with dispersed, disjointed, compartmentalized, and excluding thinking. This reform is broad and profound, paradigmatic, cultural, ethical, and moral;8 it presupposes emphasis on the “aging culture”, which propagates and democratizes the poetry of living, allowing each older adult to know the beauty of emotions, discovering their own truths through the masterpieces of life. For that, it is necessary to reflect on individualism, oppression, and exclusion.

Thus, the ideas put forward in this article are not conclusive, but are intended to instigate reflection and thinking, so that criticism builds new ways of being and living. It is believed that the central defense aligned with the experiences of the older adults up to the moment in the COVID-19 pandemic incite the need to remodel relationships, with a new policy for aging, in which the “culture of aging” promotes the possibility of living with dignity and healthy, pulling out apathy, resignation, and ageism.

The unifying thought23 for and with the older adults characterizes them as citizens and protagonists of their lives. It inserts the relationship with young people aligned with support, zeal, respect, and protection, opening up to the planetary context. In the meantime, together (older adults and young individuals), they form links to promote the path of hope for the re-signified future, especially in the face of the experiences of the pandemic. The role of the older adults promotes the development of contextualized, critical, and reflective knowledge about their context, aiming to overcome stigmas and to incorporate an attitude of commitment to leading a full life.29

In Complex Thinking, human beings develop the ability to jointly think about local and global problems, making it possible to make considerations about the parts in their relationship with the whole and about the whole in its relations with the parts. Thus, one does not share fragmented, reductionist or simplified thinking, unable to glimpse globality, which generates the separation of different aspects of the context of life, the isolation of objects or phenomena from their environment, leading to the inability to integrate into the global system.30

It is emphasized that the problems are complex and, consequently, there is no place for simplified knowledge.20,23Behold, every older human being can live the complex identity involved in the depths of his life,14,26aligned with the infinite horizon that goes back to what was known and it was done before the pandemic period. The experiences of the COVID-19 pandemic can awaken rethinking and thinking for new times, in which gerontological nursing reinforces and strengthens its practice aligned with conscience, ethics, morals, and science, guiding care in favor of a dignified, supportive, and fraternal human being.

The recognition of the older human being proposes a conceptual reorganization that breaks the classic determinism, involving reconstruction, with notions of autonomy, individuality, and self-production; encompassing a current link, at the same time product and producer of the context of life. In this context, unity and invariance, plurality of contexts and potentialities of living are favored; respecting ambivalence, contradictions, and the complexity of being.8,24

CONCLUSION

The reflections made in this article encourage alertness to some important points that involve older human beings: involvement of family ties and interactions and the support network for the older adult; narrowing of the treatments given to the older adults in society, mainly with the occurrence of the COVID-19 pandemic; characteristics that permeate sociocultural understandings about the older human being; importance of reforming thinking and transforming society in relation to the conjuncture that involves the older adults; thoughts of change and pandemic experiences; and integration of learning and reflection with the crisis generated in the complex and multidimensional contexts of gerontological nursing practice.

It is opportune to see the older human beings, with their subjectivity, heterogeneity, autonomy, and humanity, integrating themselves in the planetary sphere with respect, consideration, and appreciation. Thus, practices of judgment, ageism, and exclusion are discredited, especially those experienced during the COVID-19 pandemic period. In this context, the older adults need to be surrounded by practices of respect, love, and security.

Despite the pandemic period showing bad aspects, the path of hope for metamorphosis in relation to the older human being implies and inspires the mapping, understanding, and reconstruction of the relationships lived. It is not intended to rival or instigate competition between young and old individuals, but to integrate efforts for new understandings, which embrace both as strengthened links in the journey towards the more dignified future of Humanity.

In this complex context, gerontological nursing, with the pandemic experience of COVID-19, is strengthened in its entirety, making it possible to become a reference and help to intertwine society with the older human being enriched in its contradictions. In this relationship, the dialogical being flows, which complements and combats the confrontations experienced.

The pandemic experience under the complex eye involves reflections, rethinking and thoughts that are not separated from the planetary context, but that place the older adult in it, with recognition of the human condition, strengthened by dignity, solidarity, citizenship, and fraternity. This is the possibility of the path of hope in relation to the older adults, possibilities of giving new meaning to new times!

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Received: April 27, 2020; Accepted: June 15, 2020

CORRESPONDING AUTHOR Karina Silveira de Almeida Hammerschmidt ksalmeidah@ufpr.br

CONTRIBUTION OF AUTHORITY

Study desing: Hammerschmidt KSA, Bonatelli LCS, Carvalho AA. Data collection: Hammerschmidt KSA. Data analysis and interpretation: Hammerschmidt KSA, Bonatelli LCS, Carvalho AA. Writing and/or critical review of content: Hammerschmidt KSA. Review and final approval of the final version: Hammerschmidt KSA, Bonatelli LCS, Carvalho AA.

CONFLICT OF INTERESTS

There is no conflict of interest

EDITORS

Associated Editors: Gisele Cristina Manfrini Fernandes, Mara Ambrosina de Oliveira Vargas, Ana Izabel Jatobá de Souza Editor-in-chief: Roberta Costa

Creative Commons License This is an open-access article distributed under the terms of the Creative Commons Attribution License