The re-humanization of the executive nurse's job: a focus on the spiritual dimension

Rehumanización del trabajo de la enfermera ejecutiva: enfoque sobre la dimensión espiritual

A re-humanização do trabalho da enfermeira executiva: um enfoque na dimensão espiritual

Artigo de Revisão

THE RE-HUMANIZATION OF THE EXECUTIVE NURSE'S JOB: A FOCUS ON THE SPIRITUAL DIMENSION

Isabel Amélia Costa Mendes¹

Maria Auxiliadora Trevizan²

Clarice Aparecida Ferraz³

Neide Fávero¹

This work synthesizes the authors' views on the damages to the development of human capital in health services, which are caused by the disregard to the human spiritual dimension. New administration paradigms related to the development of spirituality are pointed out. Considering that the spiritual dimension has a systemic nature and that, by means of ethics and esthetics, it harmonizes all of man's dimensions in his relationships with others, the authors aim at approaching the spiritual value as fundamental for the re-humanization of the managing nurse's job. They recommend the integration of the spiritual dimension to the daily work of such professional as a determinant factor for a new performance as well as an inductor for nurses' better personal and professional life quality.

DESCRIPTORS: personal satisfaction, nurses, nurse administrators, health services, ethics, esthetics

REHUMANIZACIÓN DEL TRABAJO DE LA ENFERMERA EJECUTIVA: ENFOQUE SOBRE LA DIMENSIÓN ESPIRITUAL

Este trabajo sintetiza la visión de las autoras sobre los perjuicios al desarrollo del capital humano de los servicios de salud, causados por la desconsideración de la dimensión espiritual humana. Nuevos paradigmas de la administración ligados a la evolución de la espiritualidad son apuntados. Considerando que la dimensión espiritual es de naturaleza sistémica y que a través de la ética y de la estética se armonizan todas las dimensiones del nombre en sus relaciones con otros, las autoras tienen como objetivo abordar el valor espiritual como fundamental para la rehumanización del trabajo gerencial de la enfermera. Recomiendan la integración de la dimensión espiritual al trabajo diario de este profesional como factor determinante del nuevo desempeño e inductor de mejor calidad de vida personal y profesional de la enfermera.

DESCRIPTORES: satisfacción personal, enfermeras, enfermeras administradoras, servicios de salud, ética, estética

A RE-HUMANIZAÇÃO DO TRABALHO DA ENFERMEIRA EXECUTIVA: UM ENFOQUE NA DIMENSÃO ESPIRITUAL

Este trabalho sintetiza a visão das autoras acerca dos prejuízos ao desenvolvimento do capital humano em serviços de saúde causados pela desconsideração à dimensão espiritual humana. Novos paradigmas de administração relacionados à evolução da espiritualidade são apontados. Considerando que a dimensão espiritual tem uma natureza sistêmica e que, através da ética e estética, harmoniza todas as dimensões do homem em seus relacionamentos com outros, as autoras objetivaram abordar a dimensão espiritual como fundamental para a re-humanização do trabalho da enfermeira executiva. Elas recomendam a integração da dimensão espiritual ao trabalho diário dessa profissional como um fator determinante para sua atuação assim como um indutor para uma melhor qualidade de vida pessoal e profissional da enfermeira.

DESCRITORES: satisfação pessoal, enfermeiras, enfermeiras administradoras, serviços de saúde, ética, estética

With regard to the human zenith and decadence, it is argued that the modern man, supported by scientific and analytical rigor, has transformed the essence of future⁽¹⁾. By disclosing and utilizing matter exhaustively, he prides himself on the knowledge acquired about his habitat and natural phenomena, and, by showing an attitude of near omnipotence, considers that the future belongs to him. He foresees everything and continually elaborates projects for many of his activities. When the risks involved in his processes and products are detected, he tries to find the means to control, minimize or conceal them. By excessively utilizing and manifesting the reason of science, he feels ecstatic by his achievements and by his immediate success. In this way, directed by scientific and technological power, man has not taken into account aspects such as spirituality, ethics or faith. Thus, he does not understand that the inspiration arising from such aspects is the source of harmony for his ventures.

Modern man is so involved with his "gears", which have become more and more complex, that, in order to regulate them, he needs to resort to other more and more complicated mechanisms and resources. With the help from such resources, he conducts himself in the maze of his world, which is somewhat natural, somewhat mechanical; therefore, the fact that all these efforts have not been able to prevent the difficulties presently faced by contemporary society is not surprising⁽¹⁾. The reason for this predicament is that we search for the "ways to progress, welfare and salvation mainly out of ourselves and not as a result of the improvement of what we are or of our ways of thinking and acting. Modern man is capable of transforming everything, but forgets to develop himself"⁽¹⁾.

The logic of efficiency and efficacy, which is so easily assimilated and incorporated by man, has found its excellent habitat in organizations, where the mechanist paradigm has reached its zenith.

As to the difficulty of work in the context of industrial companies, De severe accusations are made against their present organization⁽²⁾, among which we point out:

A) "productive organizations produce unhappy people because they force those depending on them to be (or at least seem) efficient and competitive at any expense";

B) another difficulty consists in the astonishment and impotence generated by organizations in their collaborators.

Concerning the first accusation, it is also asserted that a violent and harmful war is established in companies and that such war rewards aggressiveness, "devastate the meaning of solidarity, the habit of good manners, the sweetness in human relationships, the esthetics of places and life expectancy"⁽²⁾.

Related to the second accusation is the fact that most workers are placed under the power of strangers who never or rarely consider their welfare and who, instead of encouraging autonomy and creativity, submit their employees to a hard and repetitive penalty⁽²⁾.

Despite the fact that many organizations apply disconcerting procedures, they are essential to human survival and progress. However, it seems certain that the most competent organizations are those that congregate the least unhappy workers in a participation-oriented atmosphere⁽²⁾.

From what has been presented, it can be inferred that administration theories that analyze the dynamics and functioning of organizations, behavioral models preconized by different administration schools and, above all, the values founding management and leadership in health services are becoming obsolete if we consider that, in addition to the physical, mental and psychosocial dimensions, human beings also integrates in themselves the spiritual dimension. Management paradigms present in health organizations, and particularly those in nursing organizations, have not enabled full human development once they have not valued spirituality. The internal structure in present organizations is a combination of position and power; however, in emergent organizations, such combination must be one of mutual understanding and responsibility⁽³⁾. New management paradigms associated with the spiritual dimension lead us to long for understanding. In this way, we can recognize the individualities and the different universes present in a relationship and consequently discern possibilities of integration and complementarity even in diversity.

Understanding that the spiritual dimension has a systemic nature which, by means of ethics and esthetics and without prejudice, harmonizes all the other dimensions in man himself as well as in his relationships with others, the authors aim at approaching the spiritual dimension as fundamental for the re-humanization of the executive nurse's job. They believe that the integration of the spiritual value to her everyday managerial work will determine a new performance in her practice, which will provide the nurse with better standards in her personal and professional lives.

NURSES' MANAGEMENT FOUNDED ON SPIRITUALITY

In the past few years, researchers in general, and particularly those in the Latin culture, have contested the instrumental conception of labor by questioning themselves about the forgotten dimensions, trying to "make human experience comprehensible as well as by trying to capture its complexity and richness" through other theoretical perspectives. Such concern and questioning have shown to be relevant, since the criticism in relation to the qualification of future administrators has increased⁽⁴⁾. Academic programs for the development of such professionals tend to depreciate interiority and value objectivity.

By developing reflection on interiority as an element in the composition of psychic reality, it is emphasized that awareness of this process is necessary for the comprehension of the organizational universe, and that people know more than they think or believe they know with regard to the causes of success or failure related to motivation, vision, imagination and direction⁽⁵⁾. Frequently, it is the case of a subjective knowledge - knowledge that is felt and experienced, intuitive and concealed. Interiority as is defined as "an individual's most secret and mysterious aspect in its cognitive as well as affective components. It is, therefore, the dimension that characterizes the individual in the deepest and most authentic way. Under the view of interiority, direction and leadership are founded on the acceptance of others, on the capacity of compassion, on the capacity of understanding one's inner conditions, that is, on spirituality. "Spirituality means being awake ... never being at the mercy of any event, thing or person... it means having found the mine of diamonds within yourself..."⁽⁶⁾.

Although forgotten and even denied in organizational life, spirituality is an essential part of the management process and as to the importance of re-spiritualization in administration and in life it is pointed out that "the fundamental issues to contemporary managers and leaders are no longer those concerning tasks or structure, but rather those concerning the spirit"⁽⁷⁾. Managers will certainly continue to dedicate themselves intensively to the thought as well as to the rational action and logic that constitute the intellectual foundation of their undertaking, aiming at productivity, efficiency, costs and results. However, the psychosocial behavior, the power of involvement, teamwork, workers' physical health as well as that of the whole staff will be present in the manager's agenda. Innovation is related to spiritual awakening.

Management carried out by the nurse needs a deep transformation. In our view, such change must be founded on spirituality. Therefore, this professional must search for and promote significant changes in her way of being. In order to promote such modifications, the nurse must, above all, know herself, that is, she must be aware of herself.

Let us consider, together with nurses, some orientation⁽⁸⁾:

- "the mind always conceals the Being";

- "man must constantly meditate about the Being, perform the Being, firmly establish on the Being and experience the blessing of the Being";

- "it is important to recognize that man is essentially divine, and that such divinity can only be experienced by knowing oneself";

-"in order to experience his own reality ... man performs various spiritual practices. All such practices directed to searching for the Being are activities performed by man only when he is in a state of ignorance";

- "if man performs certain spiritual practices, he only does it in order to satisfy his mind";

- "man does not need to carry out spiritual practices in order to recognize himself";

- "greatly talented people ... in the different sectors of life, have not acquired their knowledge from some place ... Such knowledge is a manifestation of their innate potentialities. Thinking that a person can be perfected by another is a demonstration of ignorance. All knowledge is already within yourself; what you do by means of your efforts is to manifest or externalize that which is inherent in you";

- "if you understand the true meaning of your heart, you will realize that it is far beyond all limits. The same heart that is within you is also within all others, including those that you hate and those that hate you";

- "all differences found in the world are reflexes from your minds".

In face of such considerations, the nurse must use introspective methods in order to achieve self-knowledge and in order to search for vitality in her essence and in her being.

It is asserted that the gentle and tranquilizing silence that follows mind relaxation is, in itself, the true knowledge. Such knowledge is our own nature and not a new thing that must be acquired. It is concealed by the mind and its aberrations⁽⁸⁾.

As a result of this proximity and of this intimacy with her essence, inspiration, enthusiasm, vigor and energy emanate from the nurse's interiority. Through this process, this professional acquires strength from her being in order to face the challenges of her personal and organizational lives. In this way, the nurse's new management - founded on spirituality - will be based on the commitment to the essential, on confidence and on intention, which requires courage, wisdom and compassion. This new attitude demands that the executive nurse control her own reality, and then begin to inspire and encourage her collaborators to do their best.

In this context, management is associated with art and its processes are more intuitive, spontaneous and innovative. As a consequence, there will be changes in the established organizational culture: people being and connecting their being, experiences, emotions and feelings among themselves

A question is asked whether the contemporary culture of health care - dressed in technology and entrepreneurial control - can re-incorporate spirituality in its view of cure and health recovery. It is then pointed out that nursing advocates a holistic view - body-mind-spirit - of people. By understanding this, nurses know that the people under their care react in their totality and that, hence, they are dealing with the spiritual manifestation of others⁽⁹⁾. We agree that an ethical response to such awareness presupposes an appreciation of spiritual aspects in caregiving as an integral part of nursing interactions. In this way, nurses must include behaviors that care for spiritual as well physical and mental issues.

Spirituality is the animating force, the principle of life or the essence of the being that permeates life and which is expressed and experienced in multifaceted connections with the self, others, nature and God, or the Vital Force^(10-11). Thus, the meaning and the purpose of life as well as those of the events of life flow from the spirit and are manifested in a free and private way. Whether they have a religious orientation or not, whether they deny the existence of the divine or not, all people are spiritual; however, beliefs and values are shaped by each individual's spirituality as well as by social and cultural conditioning.

We recognize that this is a dimension of difficult approach by the nurse due to the fact that, although spirituality is a universal need, it constitutes a person's extremely private question. But it is fundamental that nurses develop competence to work with the spiritual needs of clients under their care.

FINAL CONSIDERATIONS

It is recommended that every once in a while, a manager should examine the formal chart of requirements for the position he holds and that he compare it with the one in his heart. If the "two charts are not rather similar, it is time to change the formal chart"⁽¹²⁾. This recommendation can be related to the question concerning management and leadership by a female, since according to literature, there has been an agreement among researchers that women have presented a different way to command: they support themselves on their interpersonal abilities, listen more, are more cooperative, more welcoming towards people and more intuitive, that is, they more frequently act in accordance with what their hearts tell them to do.

Although Brazilian nursing by far congregates more female than male nurses, the characteristics of management by a woman - pointed out above - have not been reflected in their practice, which has based its action much more on the formal and impersonal models of bureaucracy in detriment of a culture of greater human appreciation^(13-14).

The conduct of the managing nurse has suffered exhaustive analyses and the causes given for such behavior have been attributed to external factors, that is, to medical expectation. It seems that the Brazilian nurse, with some exceptions, still allows her manipulation by almost exclusively external forces. And they are unhappy^(15-18).

It is urgent that a position be taken in order to change this scenario. It is urgent that nurses understand the concern and interest in relation to their work as demonstrated in this study. It is urgent that they also understand that the fundamental force for the necessary transformation is within themselves, within their interiority, in the spiritual dimension.

Recebido em: 23.1.2001

Aprovado em: 25.2.2002

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Publication Dates

• Publication in this collection
  15 Jan 2003
• Date of issue
  June 2002

History

• Received
  23 Jan 2001
• Accepted
  25 Feb 2002