Heroines in Covid-19 times: visibility of nursing in the pandemic

Heroínas en tiempos de Covid-19: visibilidad de la enfermería en la pandemia

ABSTRACT

Objective

To analyze the visibility of Nursing workers through images, which circulated in the media during the Covid-19 pandemic.

Methods

Cultural analysis that aims to articulate the image and its effects with theories from authors in the field of Cultural Studies.

Results

Six figures were selected in which nurses are portrayed as heroines to fight Covid-19 and are promoted from supporting actor to main character, combining the care strategy with the scientific discourse of defense of social isolation. The images portray them as women who face labor suffering from strenuous work and prolonged use of personal protective equipment.

Final considerations

The pandemic, has highlighted speeches related to health work, where we see images of nurses as heroines who organize the chaos and bring order to the “frontline”, making the idealization of Nursing visible.

Keywords
Coronavirus infections; Pandemics; Nursing; Social media

RESUMEN

Objetivo

Analizar la visibilidad de los trabajadores/as de Enfermería a través de imágenes, que circularon en los medios durante la pandemia del Covid-19.

Métodos

Análisis cultural que tiene como objetivo articular la imagen y sus efectos con teorías de autores en el campo de los Estudios Culturales.

Resultados

Se seleccionaron seis figuras en las que se retrata a las enfermeras como heroínas de la lucha contra el Covid-19 y se promocionan como complemento del protagonista, conjugando la estrategia asistencial con el discurso científico de la defensa del aislamiento social. Las imágenes las retratan como mujeres que enfrentan el sufrimiento laboral por realizar un trabajo arduo y el uso prolongado de equipo de protección personal.

Consideraciones finales

La pandemia ha destacado discursos relacionados con el trabajo en salud, donde vemos imágenes de enfermeras como heroínas que organizan el caos y ponen orden en la “primera línea”, visibilizando la idealización de la Enfermería.

Palabras clave
Infecciones por coronavirus; Pandemias; Enfermería; Medios de comunicación sociales

RESUMO

Objetivo

Analisar a visibilidade de trabalhadores/as de Enfermagem através de imagens, que circularam na mídia durante a pandemia da Covid-19.

Métodos

Análise cultural que visa articular a imagem e seus efeitos com teorizações de autores do campo dos Estudos Culturais.

Resultados

Foram selecionadas seis figuras nas quais enfermeiras são retratadas como heroínas para combater a Covid-19 e são promovidas de coadjuvante à personagem principal, aliando a estratégia de cuidado ao discurso científico da defesa do distanciamento social. As imagens as retratam enquanto mulheres que enfrentam sofrimento laboral por executarem trabalhos extenuantes e uso prolongado de equipamentos de proteção individual.

Considerações finais

A pandemia tem colocado em evidência discursos referentes ao trabalho em saúde, onde vemos imagens de enfermeiras como heroínas que organizam o caos e trazem a ordem à “linha de frente”, ficando visível a idealização da Enfermagem.

Palavras-chave
Infecções por coronavírus; Pandemias; Enfermagem; Mídias sociais

TIMES OF WAR, CORONAVIRUS AND VISIBILITY OF NURSING

The World Health Organization (WHO) announced on March 11, 2020, that a Covid-19 pandemic was occurring, a disease caused by the mutation of a new coronavirus called Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-CoV-2). Since then, all over the world, news, images, interviews, announcements about this event and its effects have been produced, data involving the spread of the disease, news about the latest scientific research, guidelines on ways to prevent contagion, ways to behave on the street and at home, in short, a large volume of information and guidance where we also see images, many images, every day. Among them, draws attention to the war in images that call for nursing professionals “on the frontline” to the “fight” against the coronavirus, as if they were talking about soldiers, creating the expectation that they should be ready to sacrifice their lives for the maintenance of our well-being1.

Military metaphors gained prominence in the early 20th century, relating war to critical health situations. Whereas before it was the doctor who waged the fight, now society as a whole does it. Susan Sontag points out that “in fact, the use of war as an opportunity for mass ideological mobilization makes the idea of war an adequate metaphor to designate any campaign whose objective is presented as the defeat of an “enemy”2^:68. The case of covid 19 is no different, we have observed that one of the ways to characterize this pandemic is with the use of metaphors related to war. Xi Jinping (China) has pledged to wage a “people’s war” against the virus; Emmanuel Macron (France) repeatedly declared that France was “at war”; Italy’s special commissioner for coronavirus emergency called for a “wartime economy”; Donald Trump (United States of America) introduced himself as a “president of war”; British Prime Minister Boris Johnson told the public that it was “a fight” in which “all of us are directly enlisted”1.

Wars, over the centuries, have always been concerned due to the number of deaths they cause, when they do not decimate entire populations. In the past, as one of the causes of population decline, especially male, wars threatened the mastery and power of kings and emperors. We learned, however, that “wars were never as bloody as they were in the 19th century and never, keeping the proportions, regimes had, until then, practiced such holocausts in their own populations”3^:147. In this sense, “wars are no longer fought in the name of the sovereign to be defended, they are fought in the name of everyone’s existence; entire populations are driven to mutual destruction in the name of the necessity of living”3^:147. Michel Foucault conceptualizes “biopolitics” to “designate what makes life and its mechanisms enter the domain of explicit calculations and makes power-knowledge an agent of transformation of human life” 3^:154. In this direction, we observe that to expose the effects of both wars and pandemics, numbers, measures, indices, and rates are used that acquire great importance when you want to organize the biopolitical management of life, directing and optimizing individual and collective conducts, as well as comparing data with other historical events.

We use the metaphor of war to recall a striking aspect of the history of Modern Nursing, the visibility and importance that the profession acquires in these events. Nursing, as we know it, was invented at a time of crisis by Florence Nightingale (1820-1910) during the Crimean War (1853-1856), where the Russian Empire fought against the Anglo-French Alliance for dominance of the Black Sea in lands of the Ottoman Empire (present-day Turkey)4. Based on knowledge acquired from the Sisters of Charity who worked in institutions to help the poor and sick in Germany, Florence recruited and trained 38 volunteer nurses to care for the wounded in the war and organized the field hospital. Such care saved the lives of wounded soldiers leading Florence to be recognized as a heroine in England, being the only woman decorated by Queen Victoria.

In 2020, the bicentenary year of Florence’s birth is celebrated and, for this reason, the WHO and the International Council of Nurses (ICN), among other entities in the category, decided to launch the Nursing Now Campaign, which has the objective to raise the status and profile of Nursing professionals around the world. With the coronavirus pandemic, this trend expanded and the celebrations and tributes to nurses became more visible, even reaching the Internet, newspapers and magazines5.

Thus, the study has the objective to analyze the visibility of Nursing workers through images that circulated in the media during the Covid-19 pandemic, formulating the following research questions: How Nursing is being made visible in the context of the Covid pandemic-19? What reflections can we elaborate from images published in the media regarding Nursing workers during the Covid-19 pandemic?

METHODOLOGICAL PATH

This is about a cultural analysis that aims to articulate the image and its effects with theorizations of authors in the field of Cultural Studies. The object of analysis are images selected in different media, about the performance of Nursing workers, who circulated during the Covid-19 pandemic, in 2020. In the theoretical field of Cultural Studies, it does not seem appropriate to define a single way of establishing research, as such studies break with the rigid format of developing investigations and it is not possible to make demarcations. This theoretical field is fertile and does not have the characteristic of a unified, fixed theory. The methodology is diverse and broad, a real mass of ideas, methods and themes that depend on the questions elaborated, and may combine different methods6.

Image analysis depends on the modes of expression and understanding of each time and place. An image is not just a set composed by lines, colors, lights, and shadows or just a matter of shape; it exists as a political, historical, and cultural thought, that is, each image tells its own story, incorporates, and presents certain representations in very particular ways. An image is a cultural artifact that can be understood as “a great subjectifier of identities and as an instrument propagator of truths”7^:907. Thus, the critical reading of images implies in learning aesthetic and cultural values through what they show and how they show7.

Media analysis allows us to explain relationships between images and social trends in a certain culture, in addition to providing skills to read current trends in society and/or observe changes7. The media, understood as television, radio, press and the internet, makes use of cultural artifacts, here understood as social and cultural inventions, which circulate and are present in everyday activities, producing senses and meanings that challenge subjects in advertising pieces, advertisements, music, movies, internet social networks, videos, images, cartoons, magazines, booklets, books, newspapers and television programs, among others8. Media texts, therefore, are a form of language that constitutes as social practice and challenge social and cultural relations, producing meanings and transforming subjects8.

From this, it is possible to affirm that the discourses and images, produced and conveyed by the media, make it possible to think about discursive networks that subject their readers, producing effects that intend to conduct behaviors and determine ways of life9.

Among the countless images that circulated in the media about Nursing work, we selected six that we consider representative of what we want to show: the visibility of Nursing workers. After selecting the images, carried out between March and May 2020, we performed the analysis. To do so, we met as an analysis group (manuscript authors) and together we “dissected” what we saw: which aspects caught our attention? Which ones did not pay off the theoretical-analytical investment? What theoretical questions did the images raise for us? From an image-analytical conversation wheel, we decided on what we would invest to produce the collectively agreed analysis and who would be dedicated to writing the analytical text. Afterwards, all authors read the text and revised it, including new comments and authors.

We emphasize that the ethical aspects related to the use of images in this work are in accordance with Law No. 9,610/1998, which deals with copyright10. The use of such images in the public domain is ensured, especially in the statements of article 46, chapter IV, items I and III, in which the importance of citing the author and the origin of the work is highlighted.

ABOUT THE PAIN AND THE DELIGHT OF BEING A NURSE IN TIMES OF PANDEMIC

In the Covid-19 pandemic, Nursing is characterized by a work in the frontline of combating what threatens the lives of the population, as in the beginning of modern Nursing, when it stood out in the Crimean War. In Brazil, warning messages about the importance of social distancing were circulated shortly after the occurrence of the first cases of Covid-19 and the professionals have prepared for battle: duly uniformed, like soldiers heading to war, dressed and prepared to fight the invisible enemy.

Figure 1 -
Health professionals publish photos on the internet carrying posters that encourage people to stay at home

Image like the one in Figure 1 circulated on the internet in March 2020, showing health professionals in a campaign that was characterized by the phrase “we are here for you! Stay home for us!” The initiative, which emerged abroad from posts by doctors and nurses holding signs with the words “we stay here for you, please stay home for us”, was replicated in several health services with workers holding signs with similar phrases. In it we see anonymous subjects with faces covered by protective masks. Here it does not matter who they are, but the position and place they occupy in the face of the pandemic, that is, the production of discourse in the field of science based on the affirmation of social distancing as the most effective resource to prevent the contamination and proliferation of the disease.

The act of “staying at home”, encouraged by the Covid-19 pandemic, translates into isolation and social distancing, and can also be understood as an unfolding of historically known quarantines. Quarantine constituted a period of confinement, counted in days and imposed on individuals who were sick or suspected of carrying infectious diseases. They gained prominence during the Middle Ages to distance diseased from leprosy and bubonic plague11. However, in the case of Covid-19, the “stay at home for us” was a discourse aimed at the entire population, to prevent them from getting sick, as there were no diagnostic and treatment resources available. Thus, in this situation, care for the sick and control of the population seems to be one of the only resources for a disease that, until that moment, did not have medicines or vaccines. Here, we see biopolitics3, that is, the policy of control of lives, in the administration of bodies and in calculating management, acting directly on the entire population, supported by the knowledge and powers of science, by scientific discourses, transforming human life, from the reinforcement of these actions through the discourse of health workers.

Figure 2 -
Banksy’s new work shows nurse as heroine

Figure 2 is an illustration by the English artist Banksy who gained visibility in the world via social networks. The work was left at the University Hospital of Southampton, England, with a note that read: “Thank you for all you are doing. I hope this brightens up the place a little, despite being in black and white”12. In the boy’s hands there is a doll dressed as a nurse that flies as if it were a heroine, while other dolls, men, represented by Batman and Spider-Man, are left to one side, in a basket. The figure of the woman, almost always linked to that of wife and mother, is a powerful discursive construction that crosses the times and that downgrades the female sex. When referring to the figure of the “Wonder Woman” we can see that for a long time she gained the role of assistant to the male superhero13. What we see in Figure 2is a deconstruction of this invention making the nurse no longer a supporting role in other professions/heroes, but the main character. It is important to highlight here that the way the media dispose elements helps to shape the communication environment and often encourages greater respect for cultural actors14.

Between Greek tales and epics, medieval and Renaissance heroes, passing through the modern pop culture of comics and movies, it is not new that the image of the hero appears in our societies. However, draws our attention the appearance of the nurse in the place of a heroine, wearing a cape and able to fly, to whom we must thank.

Figure 3 -
Super heroes bow in respect to Nursing professionals

Figure 4 -
Nurse as a member of the masked heroes team

Figures 3 and 4 are among the most publicized on Nurses’ Day, on May 12 this year, according to a report by the internet channel G115. When we recall the beginnings of Nursing in Brazil, we return to the year of 1923 when the first School of Nursing was founded in Rio de Janeiro1. At the time, it was up to the nurse to be devoted, honest, disciplined, selfless and sometimes religious or spiritualized. In addition, the nurse should also be subordinate, a support element, assisting especially the physician and never a principal agent16. Films recurrently portray scenes of nurses who value rules, norms and discipline. Historical heritage, based on values that were part of the trajectory of nurses who assisted patients in war4.

In the aforementioned Figures (especially 2, 3 and 4), however, a “new” professional character appears, who assumes the leading role in assistance. Such images dialogue with feelings, affections, and desire for recognition, allowing reflection on the visibility of Nursing workers in the pandemic. We observed that there is a tendency to romanticize the effort, pointed out as heroic and suffering, possibly to inspire other professionals so that they continue to act under risks, both for themselves and their families. After all, the social inequalities present in our country, the inclusion of different levels of care in the same universal health system and the neglect of the working conditions of those who are working can contribute to an emotional collapse in those who would be responsible for maintaining the structures available in times of pandemic17.

We are certainly attracted to heroes and superheroes because they elevate the human condition - and they do so precisely because they operate on a “superhuman” plan. Heroes are like us, but empowered: stronger, smarter, faster. They suffer from the same human frailties that we do however, because of their superpowers, these inner conflicts become apparent in an arena more dramatic than ours. Superheroes impose order on a chaotic world, which always seems to be gripped by nefarious forces (from natural disasters to supervillains) that we, mere mortals, cannot identify - let alone fight. Apparently, we seem to prefer a world of superheroes above the law to a world without any super-heroism.

The superhero condition linked to Nursing imposes on professionals’ characteristics similar to the fearless characters constructed by the media. Identities are anonymous, faces are covered up, disposition is constant, there is no day or hour to go away. Despite the tribute or appreciation represented in the images of superheroes, what professionals experience are crowded health services, especially hospitals, bodies marked by uncomfortable and worn masks, overloaded professionals and on the brink of collapse due to high rates of transmissibility and lethality caused by Covid-19.

Figure 5 -
Women of health become the cover of a Mexican magazine: ‘true influencers’

During the pandemic, media images show Nursing professionals with marks on their bodies. Figure 5was the cover for May of the Latin American edition of Marie Clare magazine, printed in Mexico. It shows the face of nurse Olivia Giorgi at the end of her work shift, an image captured by photographer Alberto Giuliani in a hospital in Italy. The edition aimed to highlight the efforts of professionals to assist victims of Covid-19. The image caused great national repercussion, and, after the publication of the magazine’s edition, other Nursing professionals began to expose on social media the marks left by the constant use of personal protective equipment (PPE). We observed visible marks on the nurse’s face, indicating adversities faced given the long and strenuous workdays, with the use of PPE, when available, which squeeze, hurt, and heat the “supposed” heroine’s exhausted body. We see that the pandemic has also isolated the body itself of Nursing professionals, who sometimes spend six to eight hours without being able to remove their “armor” to go to the bathroom or eat. Being with the body marked by the mask demonstrates the sacrifice of the nurse and reveals the effects of the worker's suffering when taking care of patients sick with Covid-19.

Figure 6 -
Nurse photographs the impact of the coronavirus on hospitals in Italy

Figure 6 is a record of the nurse Paulo Miranda, a nursing worker at the Hospital de Cremona in Italy, the epicenter of the pandemic in March 2020. Such image was published in a report produced by BBC News about the context and routine of health professionals in care to those affected by Covid 19. The selected figure shows a health professional being supported by another in a demonstration of suffering at work. Exposure to danger is constant and can be experienced as the possibility of death due to contamination by the virus, aggravated by the frequent lack of personal protective equipment and associated with long and exhausting working hours. The reinvented place for nurses in the pandemic reminds us that the care she provides goes beyond hospital boundaries. After all, it is they - the nurses - who continue to be responsible, exclusively or mostly, for the care of their families, they “cannot defend themselves with a quarantine in order to guarantee the quarantine of others”18^:16.

Among the discourses that cross nurses, there are also those who place them as women of science, who need to study constantly, always dedicated to patient care, usually seen in a disciplinary activity, especially in the hospital, an environment where technology dominates, and which proposes to care and cure, even severe cases. Furthermore, nurses have been portrayed by the media, particularly at this time of the pandemic, as saviors, as those who give themselves to others, to their pain, to their disease condition. Living in such situations, Nursing workers are exhorted and crossed by discourses that define them as heroines, praised in and by the media, which puts them in a difficult position. Even in a risky situation, there is no room to go back, give up, stay at home, so that such discourses constitute another source of stress.

Women, considered caregivers in Western patriarchal societies, are the majority among Nursing professionals and are working on the frontline of care inside and outside institutions19. Health care has almost always been a woman's assignment. Even so, nurses have in their history and in their daily lives the most diverse challenges and aspects that accompany them and have remained in force over the years, “because the impeccably ‘white’ uniform gives the nurse an asexual character, without social class, without aggressiveness or without their own desires, this aspect having more value than their own knowledge”20^:10.

We live in a period with repercussions in the endemic economic and social crises, a scenario that has highlighted discourses related to health work. Through different images of nurses or in reference to them, (re)produced by media and social networks, Nursing, as a professional category, and in the “frontline” of the pandemic, was reinvented and dressed as a heroine on a world scale, role which was dignified, until then, to a single nurse, Florence Nightingale.

Through the analysis of six chosen images, it is possible to see the attempt to reinforce this professional recognition. In some, nurses are the heroines who actively take the “frontline”, who organize chaos and bring order, setting an example for the children. In others, heroines sacrifice their bodies to protect others. If, on the one hand, the images presented are inscribed in a discursive order that idealizes the profession, on the other, they show the problems of having to work in such adverse conditions.

FINAL CONSIDERATIONS

The analyses presented here point out to a necessary reflection-inquiry: who are the true health protagonists? We do not want to glorify, insinuate, or try to answer this question here. We chose to bring, throughout the text, just some reflections on the roles, places of speech and strategies to govern bodies, in the midst of the current pandemic.

Although our intention was not to exhaustively demonstrate the numerous images that circulated - and will certainly continue to circulate - in the media, regarding the work of nurses, we believe that works like this will enable the realization of other forms of analysis on the construction and reproduction of discourses, articulated with other issues, such as structural racism and gender differences, for example, so naturalized among us.

This article, produced in the context of Cultural Studies and Foucaultian Studies, seeks to contribute to the expansion of analyses around the media production and identity of the profession. Other researches, carried out over the last decade, by researchers in the area and in this field of studies, demonstrate how much we still have to study and analyze, based on historical and contemporary cultural productions, in an interdisciplinary way, so that we continue to question/under scrutiny some of the truths (and, in the case of this article, of the images) that constitute us. Finally, we believe that the study can contribute to the dissemination and a better understanding of the Nursing Now campaign in the sense of thinking, questioning, and reflecting on these and other issues related to the visibility of Nursing, in the year 2020 and beyond.

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• Funding

  This study received financial support with postgraduate scholarships from the Coordination for the Improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES).

Publication Dates

• Publication in this collection
  22 Sept 2021
• Date of issue
  2021

History

• Received
  02 Oct 2020
• Accepted
  17 May 2021