Studies on the image of nurses: five decades between imagery and its repercussions

ABSTRACT

Objective

To analyze the image of the nurse in written press in the 1930’s-1950’s and its repercussions in the 1970’s-1980’s.

Method

Historical-documentary study with a qualitative approach, which used as data sources the reports published in a newspaper from Bahia called A Tarde in the 1930’s to the 1980’s, marked by important historical events in the national and international scenario and discussions about image transformation and reconstruction of the nurse’s professional identity.

Results

Three central representations of the nurse were identified in the journalistic press: the religious and military imagery of the profession and the repercussions of the nurses’ images as a product/producer of other imagery that was written in historical time and will be products of continuities, ruptures and discontinuities.

Conclusions and implications for practice

The images of nurses and their repercussions are co-creations determined in the political and economic social field that crosses the times and history being related to government and market interests.

Keywords:
History of Nursing; Gender Identity; Mass Media; Qualitative Research; Occupational Groups

RESUMO

Objetivo

Analisar a imagem da enfermeira na imprensa escrita nas décadas de 1930 a 1950 e suas repercussões nas décadas de 1970 a 1980.

Método

Estudo histórico-documental com abordagem qualitativa, que utilizou como fontes de dados às reportagens publicadas no Jornal baiano A Tarde nas décadas de 1930 a 1980, marcadas por importantes acontecimentos históricos nos cenários nacional e internacional, discussões sobre transformação da imagem e reconstrução da identidade profissional da enfermeira.

Resultados

Foram identificadas três representações centrais da enfermeira na impressa jornalística: a imagética religiosa e militar da profissão e as repercussões das imagens das enfermeiras como produto/produtoras de outras imagéticas que se escreveram no tempo histórico e que serão produtos de continuidades, rupturas e descontinuidades.

Conclusões e implicações para a prática

As imagens da enfermeira e suas repercussões são cocriações determinadas no campo social político e econômico que atravessa os tempos e a história estando relacionada aos interesses governamentais e de mercado.

Palavras-chave:
História da Enfermagem; Identidade de Gênero; Meios de Comunicação de Massa. Pesquisa Qualitativa; Categorias de Trabalhadores

RESUMEN

Objetivo

Analizar la imagen de la enfermera en la prensa escrita en los años 1930-1950 y sus repercusiones en los años 1970-1980.

Método

Estudio histórico-documental con enfoque cualitativo, que utilizó como fuentes de datos los informes publicados en el periódico bahiano A Tarde en las décadas de 1930 a 1980, marcadas por importantes acontecimientos históricos en el escenario nacional e internacional y discusiones sobre la transformación de la imagen y la reconstrucción de la identidad profesional de la enfermera.

Resultados

Se identificaron tres representaciones centrales de la enfermera en la prensa periodística: las imágenes religiosas y militares de la profesión y las repercusiones de las imágenes de las enfermeras como producto/productora de otras imágenes que se escribieron en el tiempo histórico y serán producto de continuidades, rupturas y discontinuidades.

Conclusiones e implicaciones para la práctica

Las imágenes de las enfermeras y sus repercusiones son co-creaciones conjuntas determinadas en los campos sociales político y económico que cruzan los tiempos y la historia en relación con los intereses del gobierno y del mercado.

Palabras-clave:
Historia de la Enfermería; Identidad de Género; Medios de Comunicación de Masas; Investigación Cualitativa; Grupos Profesionales

INTRODUCTION

Image can be described as the idea one has of ​​a person or an object. Its construction is influenced by determining factors such as political, social and historical. In this way, the influences of the information or attitudes that have been acquired, the aspirations and desires credited by a state of opinion, constitute an image.¹

The professional category is a figure represented by the association with power, recognition and status. Its professional spread disclosed to society is as relevant as the meaning of the profession, since the disclosing of the profession interferes with development and its recognition.¹

It is worth noting that we are analyzing the image of the nurse and its repercussions, the determinants of this context linked to the 20^th century and, at that time, this profession was viewed in a disciplined way, exercised by female people, in a society where the concept of intellectual competence and male leadership predominated and the feeling of religiosity or vocation was linked to the exercise of the functions of a nurse.²

The nurse’s imagery in the society’s view pervaded/pervades the construction of stereotypes, signs and symbols that link their representation to selflessness and submission, as well as gender issues and the subjugation of women’s work, whether due to the fragility of professional identity or impaired social recognition in view of the relevance of caring for the life of the individual and the community.³ This implies the social prejudice of the image of this category, interferes in the value of the workforce and in what society expects from these professionals.

In this regard, the literature points out³ that it was possible to observe the relationship between the opinion formation power of the media on the visibility of the nurse’s image, since the media is understood as an independent institution, that is, it determines its rules in favor of a hierarchy of values, establishing what it intends to disclose and how the subject will be explained.

This article starts from the articulation of the findings in two master’s dissertations – a first that analyzes the image of the nurse between the years 1936 and 1956, noting that nursing had a visibility in the written press, with calls for candidates to join the Corpos Expedicionários de Saúde (Expeditionary Health Corps, in free translation) of the military services and a second dissertation that also analyzes the image of the nurse between the years 1970 to 1980, which identified the visibility given by the media about the organization of the professional council, restructuring of the Associação Brasileira de Enfermagem – ABEn (Brazilian Nursing Association, in free translation), and review of the curricula of nursing education, associated with reporting beyond the political engagement of nursing workers and, together with the participation of representative entities.

In this context, it is observed that the construction of the professional image is continuous and depends on the historical context in which it is inserted.⁴ In this way, the historical events between the years 1936 and 1956, in which nursing had a visibility among the media, with calls for candidates to join the Corpos Expedicionários de Saúde of the military services, on the other hand, it was a moment of organization of the council and restructuring of the Associação Brasileira de Enfermagem (ABEn) associated with political engagement and, coupled with the participation of representative entities experienced in the 1970s and 1980s, resulted in the construction of two works entitled: “The image of the nurse in the newspaper “A Tarde” from 1936 to 1956” and “Professional militancy of a nurse in print media from Bahia”.

In the first study, the justification for the time frame is centered on the events of that period, both nationally and at the local level, among them: World War II and the Red Cross – when women were summoned to serve the interests of war; Vargas Era, in which the nursing profession contributed to spread the idea of ​​populism through actions in the field of Public Health and the creation of the Escola de Enfermagem (Nursing School, in free translation) of the Universidade Federal da Bahia (EEUFBA).

In the second study, the historical context of the 1970s and 1980s was marked, on the one hand, by the proletarianization of nursing workers, and on the other hand, by the political mobilization in this professional field, specifically, by the revision of the Nursing training model, and for structuring the Council and reviewing changes in the Associação Brasileira de Enfermagem (ABEn), through the “Movimento Participação” (“Participation Movement”, in free translation). In this scenario, we understand that the printed media may have portrayed these movements, influenced by several aspects of the historical-social context, reaching a large sphere of society, bringing peculiarities linked to the view of the editors of the written press.

Given this, the article has the guiding question: How was the image of the nurse represented in the Brazilian written press and what are its repercussions? And as an objective: To analyze the image of the nurse in the Brazilian written press in the 1930s and 1950s and its repercussions in the 1970s and 1980s.

METHOD

The choice of the written press, as a historical document for research, is supported by the proposal of Social History in the dimension of the historical field.⁵ With regard to the domains of this field, the research theme was directed to the study of nurses regarding the individual or collective political performance of this professional group.

The study of history is understood as a science composed of more questions than answers to the researched phenomena, assuming that the researcher has the knowledge of the object that will be necessary to study, narrate or interpret. It emphasizes that the study of history presents the differential, in which the object is volatile because it is not quantifiable. Therefore, the study is composed of individuals in society who react or move about political, social, cultural issues, among others.⁶

Following this same trend, contemporary history considers that the problem can be approached in a diversified way, encompassing broader aspects of society and, thus, it is started to talk about “history seen from beneath”. In contrast to the biographical description of great men, historians turn to the great masses, to ordinary, anonymous individuals, in search of understanding from a new perspective.⁷ Historians stop looking at history from the perspective of dominant power and begin to analyze events and social relations from a new point of view, previously not conceived by the traditional paradigm.

The use of the newspaper as a data source allows the researcher to investigate not only the facts that have occurred, but also makes it possible to analyze how the media represented these movements to society. Furthermore, it is a documentary research that is understood through the historical reconstruction of a given fact or moment lived, through documents, relevant to the verification of data and the access to the relevant sources of the study.⁸

Beforehand, it should be noted that not every historical record is configured as a source of data, as the document is only considered historical due to its importance in a given context and time period, analyzed from the present and establishing communication with past facts.^9,10

To this end, the press has the task of strategically reproducing the ideals of dominant groups, with the aim of achieving their interests and social control. Thus, the newspaper, when publishing events or facts, propagates the production of meanings and factors that will influence society.⁹

In the search for clarification of the objectives of this study, the reports published in the newspaper A Tarde, a printed media published in the state of Bahia at the time, were chosen as data sources, as this presents itself as the most widely read newspaper, most relevant in the Salvador region and of highest circulation in the period of interest.¹¹

It was also opted to work with journalistic material because it is understood that the media is an important instrument in the formation of public opinion, reflecting on changes in behavior and concept. As, due to its persuasive power, the representations it builds in its publications tend to be perceived as truths.¹²

The data were collected via online and analyzed between the months of July 2017 to January 2019, through a survey of news published in the newspaper A Tarde. The entire journalistic collection was digitized and available for access from computers located at the Pedro Calmon Foundation, in the city of Salvador.

The survey of the initial data allowed a stratified cut of the study during the researched period, according to the year and months of major publications that contained the search terms, being tabulated in a Microsoft Excel spreadsheet.

It started with a broad search, collecting all the reports published in the period and, then, those that would compose the documentary corpus for this research were selected. Thus, the collection included three moments: 1) collection of all the news reports that dealt with the category during the entire period of interest, using the search terms “nurses”; “nurse”, totaling 2206 publications; 2) grouping of news reports by thematic; 3) selection of news reports that showed the military and religious image of nurses in the 1940s and 1950s, and of news reports that showed the precariousness of nursing work in the 1970s and 1980s, totaling 100 publications.

Finally, the following categories emerged: the nurse’s religious imagery: charity, benevolence and vocation; the nurse’s military imagery and; repercussions of the nurse’s imagery and the precariousness of Nursing work. This broad categorization enabled the construction of an overview of publications about nurses in the period of interest. The categories that emerged from the years selected for the analysis were consistent with the total findings. Thus, the categorization described covers the years 1936 to 1989, comprising the 53 years researched.

In accordance with the rules and guidelines established by the Ethics Committee on Research with Human Beings and defined in Resolution 466/12 of the National Health Council, there was a prior waiver of submission of the research project to the Research Ethics Committee, as it is a matter of a documentary study that uses only public and freely accessible documents. In addition, Resolution No. 510/16 establishes that surveys that use publicly available information under the terms of Law No. 12,527/2011 and/or surveys that adopt information in the public domain will not be registered or evaluated by the CEP/CONEP system.

RESULTS

The results are presented in two stages, in the first we present the imagery and, in the second, its repercussions. In this sense, we understand that job insecurity is determined, among others, by sexist aspects and a relationship with the professional image found in evidence in the first three decades of this study. Thus, the findings of the last two decades will be presented as a repercussion of that first period.

In highlight, two central representations of the nurse were identified in the journalistic press, the religious and military imagery of the profession. As follows:

However, in the second analytical cut, the repercussions of the nurses’ images were identified as a product/producer of other imageries that were written in historical time and that will be products of continuities, ruptures and discontinuities.

DISCUSSION

The results were summarized in two analytical sections: one with the identification of the image and the second with the identification of the repercussions. We identified that the nurse’s imagery is situated, in a more representative way, in the organizations that took care of the patients before their professionalization, the religious and the military organization. In specific:

The Nurse’s Religious Imagery: charity, benevolence and vocation

In Chart 1, we can identify the image of the nurse being constituted by the attributes of religiosity. The health care practices were carried out by the religious, so the constitution of the nurse’s image is associated with some meanings such as charity, vocational gift and benevolence. In such a way, that these attributes are personified in women, that is, permeated by gender issues.

Chart 1
The Nurse’s Religious Imagery: charity, benevolence and vocation

Newspaper clipping
[refers to the nurse] [...] They are young women who prepared [...] a divine lesson in health, teaching her the healthy way of leading her child, elementary dietetics and the many necessary precautions for those who, in this world, have the happiness of being a mother. 5/20/37
Dressed in white, prepared [...] they receive their diploma and in the oath [...]: “We promise, under our word of honor, before God and our Father: In every home we enter, as messengers of Health that we are [...] 5/20/37
[speech about the nurse’s work] [...] Noble and humanitarian priesthood, concretized in merciful examples of tenderness and fraternal love, the profession of nurse is one of the most beautiful destinations that a woman can hope for. [...] “Escola Ana Neri” is a beautiful and productive nucleus of theoretical and practical nurse training, hundreds of competent and dedicated professionals leave from there each year. [...] young women who are candidates for the said priesthood. [...] 2/10/40

In this perspective, the literature explains that the priesthood takes over the functions of care, seen as a tradition and manifested by healing power.¹³ Religion corresponds to the individual survival needs of the people that aim at contemplating material success, the health of the body and the immortality of the soul.

Nursing is influenced by the origins of health practices, associated with both gender and religion issues, being characterized as maternal, selfless and submissive.¹⁴ This brings a disturbance of the image between the professional being and the religious aspect that implies the professional status and social recognition.

Nursing training was carried out in institutions that spread Christian ideals, such as hospitals and schools. So, nursing was structured based on Christian thoughts, where the act of caring, provided by women, was present in the religious identity of the profession.¹⁴

Another point addressed refers to religious congregations, which were composed, in most cases, by women who helped the Catholic Church to care for convalescent individuals. Women dedicated to Christian works, for being female, were seen as fit for the exercise of care, in addition to domestic activities.¹⁵ In view of this, humanitarian activity related to the Christian is observed, due to the exercise of health practices to the needy, emerging in the profession, by the way of caring, through religious thought.

Finally, religiosity influenced the training of nursing professionals, adding the precepts that the trajectory shows us as female attributes. This had repercussions on the formation of a disciplinary and subordinate profession in view of the power relations between health professionals.

The Nurse’s Military Imagery

When analyzing Chart 2, specifically, when seeking to understand the insertion of women in the armed forces, we identified that it is linked to the value of the soldier’s body, as well as the technical ability to care. This ability was built socially through the culture of patriarchy. Thus, there was the appropriation of the nurse’s work for the benefit of the State’s developmental policy, constituting military values to the profession.¹⁶

Chart 2
The Nurse’s Military Imagery

Newspaper clipping
[speech about nurse admission criteria in the army] [...] being a native Brazilian; being single or widowed without children; be at least 20 years old and at the most 40 years old; hold a nurse’s diploma or a Samaritan or volunteer rescuer course certificate, issued by a reputable school, or hold a certificate provided by the establishment where she serves; have proven moral integrity; recognize, by written commitment, the obligation to provide military service [...] 01/11/44
[speech about the trajectory of a nurse] [...] one of the many nurses of the F. E. B who are showing the world the moral value and the firm spirit of our young women. The arduous mysteries of war nursing did not break the strength of spirit of these girls [...] and they are not concerned only with the physical suffering of soldiers. They also contribute, with their joviality, to alleviate the spiritual shocks of the combatants. [...] the value of Brazilian women in war who are comforting with their magnificent work our soldiers who fight valiantly on the front of Italy. 11/11/44
[in a speech by the Red Cross professor] he appealed for the kindness of women in order to save thousands of wounded by war who died without treatment. [speech about Ana Neri] the manly figure of Ana Neri, prototype nurse, who went to the battlefields of Paraguay where the Bahian charitable spirit was most prominent. 02/12/40

On the other hand, training courses for volunteers to provide care to the wounded during war conflicts, published in the media, were important to promote the visibility of the nurse professional and enhance the demand for the search for the profession.

In this sense, the insertion of Brazil in the war caused the government to adopt protective measures for possible attacks in the national territory, which motivated the awareness of volunteers, through the media, to ally themselves in favor of the country. Thus, nursing served as a cause emblem for women and nurses to join the Força Expedicionária Brasileira – FEB (Brazilian Expeditionary Force, in free translation), since they would be serving the homeland and assisting the wounded in war.¹⁷

Despite the participation of women in wars of smaller scale, the outbreak of World War II was a milestone for the female insertion in places previously occupied by men in the military. The incorporation of the nurse’s image, under the female figure, demonstrated that they would be able to care for the wounded, due to their skills and techniques, inherent to women.¹⁸

In view of what was categorized in Chart 2, the signs that were disseminated about the nurse’s work in the military area were related to morality and fighting spirit, associating the nurse in war as a heroic.

In this way, nurses, when published in newspapers of the time, had heroism and humanitarian activity as symbols, as well as sensual representations of voluptuous models. This demonstrates the deterministic axis of the genre, as well as a conflicting military imagery between the heroic and the objectification of the woman’s body.¹⁹

It is emphasized that military nurses were linked to the heroic image and love of the country. These women would have the adjectives of defenders of the homeland that was in danger, in addition to providing care for wounded soldiers.

Corroborating this idea, the journalistic speeches disseminated about the insertion of women in war had as a reference the character of Anna Nery, who was associated with the image of the Motherland. In this way, served as an example to the FEB nurses who needed to mirror themselves during the process of military activities during the war conflict. This reflects FEB’s symbolic intention that nurses have appropriated the heroin model, which legitimized in society.¹⁸

Repercussions of the nurse’s imagery and the precariousness of Nursing work

The precariousness of work is a political and social process, based on macroeconomic issues and neoliberal capitalism, which aims to cheapen the workforce and its production.²⁰ For these authors, this social phenomenon is based on the permanent insecurity of the worker, subjecting them even further to exploration.

In Chart 3, we observe that low wages, work overload, unemployment and the lack of appreciation of nurses’ work are registered in the 1970s and 1980s.

Chart 3
Repercussions of the Nurse’s Imagery and the Precariousness of Nursing Work

Newspaper clipping
After four years of study [...] the trainee [...] gets an average salary of two thousand cruzeiros for eight hours of work. In hospitals and private clinics the situation is even worse, because they pay less than that [...] what exists is a policy [...] of low remuneration and the preference of hospitals for nursing attendants, paying negligible wages. (8.1975) 2/13/75
About 70% of the staff who practice nursing today in Brazil do not have any course as required by law, and most nurses in the private sector earn little more than the minimum wage. (40.1984) 05/11/84
Maria Ivete denounced the insensitivity of organizations that explore health in the private sector, for not considering the risk that the patient runs in being assisted by a layman. [...] (41.1984) 08/01/84
According to [...] the president of COREN-BA, the problem found for the performance of the function is limited to the deficiency of the staff, both in quality and quantity. [...] (16.1978) 03/28/78
The time when the class could choose a job is long gone, mainly in the capital [...] about five years ago, unemployment started to reach the class [...] the health institutions, which do not admit professionals in sufficient numbers to guarantee the quality of care [...]. (31.1982) 05/12/82

The predominance of women in the profession, the social and technical division of labor, the absence of legislation on the minimum wage and working hours, the existence of an army reserve and the incipient political organization of nurses contribute to reducing the value of the workforce and, consequently, favor professional devaluation.²¹

The nurse’s work originates from domestic work, historically attributed to the control and subordination of women and social and economic devaluation, as demonstrated in the categories above. In this sense, although the professionalization of nursing has granted nurses a professional status and has brought about changes in their practice, society has maintained a labor market apparatus with a domination structure based on the gender relationship, preserving the conditions of subordination and discredit of the profession.²²

With the expansion and modernization of the health service network in Brazil, there was a demand for nursing professionals to compose the new jobs, however the growth in the offer of higher education professionals in contrast to the offer of professionals in the high school level led numerous institutions to meet the economic requirements of the health model, opting for hiring lower-cost labor, replacing nurses with attendants and nursing assistants.²³

These findings confirm the object of this study, when we correlate the nurse’s religious and military imagery and its repercussions which imprint a devalued and invisible care that imply unfavorable contexts in the worker’s health and that perpetuates the logic of exploitation and subjugation of the female nurse.

Finally, it is worth noting that the data in Charts 100 and 200 deal with the decades from 1930 to 1940 and the data in Chart 3 refer to the decades from 1970 to 1980. The first block of results pointed to the image of the nurse and the second block to the results, although it also presents the images found in the following decades, indicated the repercussions in Nursing. This association is possible, as we understand historical research as a continuum. Furthermore, the literature points out as credible this referred articulation.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Thus, the objective was to analyze the image of the nurse in the Brazilian written press in the 1930s and 1950s and its repercussions in the 1970s and 1980s. It is clear that the images and their repercussions are co-created in the social, political and economic fields, which cross time and history, being related to government and market interests.

The profession of nurse was born to meet a demand from the labor market and the government field, limited by values of exploitation of the labor force, and cheapening of the workforce and of production, with the mission of serving the hospital in its formatting of center for healing and rehabilitation, and to sanitize cities by reducing epidemics and mortality rates, in particular, infant mortality.

The religious and military imagery, in this bulge, anchors essential values to the exploitation of workers and their subjection, to submission, to the acceptance of the most perverse and inhuman working conditions, to benevolence, to charity. Nurse’s heroic sense of serving their country anchors values that, later on, made possible and maintained the precariousness of work, low income and lack of social recognition.

However, the main possibility of nurses’ liberation, or of history discontinuity, lies in the recognition and defense of the dimensions of work, in the breadth and centrality of its doing, of the essential knowledge and practices to care and/or manage care, and this has significant repercussions on the other portions of work of other professionals.

Finally, it is essential that nurses understand what they do and know, value the selling of their workforce, and organizes themselves politically and collectively, preserving their profession, to the maximum, from the surplus-value.

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Edited by

ASSOCIATED EDITOR

Antonio José Almeida Filho

Publication Dates

• Publication in this collection
  20 July 2020
• Date of issue
  2020

History

• Received
  23 Mar 2020
• Accepted
  19 May 2020