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Reflections on the working process in nurse participation in political activities

Reflexiones sobre la participación política del proceso de trabajo del enfermero

ABSTRACT

Objectives:

To reflect on the scope of the working process in nurse participation political activities as a possibility for expanding its performance.

Methods:

this is a reflective study, supported by the discursive elaboration on the nursing participation political activities and work process, structured through concepts, theoretical perspectives and practices based on the experiences described in references.

Results:

studies on this process demonstrate that nurses need sensitivity to understand the complexity of their social practice.

Final Considerations:

in their professional actions, nurses must mobilize political resources, making their knowledge, skills and attitudes available to their practices, aiming at power and improvement of conditions for the work of Nursing.

Descriptors:
Nursing; Education; Power; Policy; Stakeholder Participation

RESUMEN

Objetivos:

reflexionar sobre el alcance de la participación política del proceso de trabajo en el escenario profesional de la Enfermería como una posibilidad para la expansión de su actuación.

Métodos:

se trata de un estudio reflexivo, basado en la elaboración discursiva de la participación política del proceso de trabajo, estructurado mediante conceptos, perspectivas teóricas y prácticas fundamentadas en las experiencias descritas en las referencias.

Resultados:

los estudios sobre este proceso muestran que es necesario que el enfermero tenga sensibilidad para vislumbrar la complejidad de la realidad de su práctica social.

Consideraciones finales:

el enfermero en su acción profesional debe movilizar los recursos políticos, poniendo sus conocimientos, habilidades y actitudes a disposición de sus prácticas, apuntando hacia el poder y hacia el florecimiento de las condiciones del trabajo de la Enfermería.

Descriptores:
Enfermería; Educación; Poder; Políticas; Participación de los Interesados

RESUMO

Objetivos:

refletir sobre a abrangência do processo de trabalho participar politicamente no cenário profissional da Enfermagem como possibilidade para a ampliação de sua atuação.

Métodos:

trata-se de um estudo reflexivo, amparado na elaboração discursiva sobre o processo de trabalho participar politicamente, estruturado por meio de conceitos, perspectivas teóricas e práticas pautadas nas experiências descritas em referências.

Resultados:

os estudos sobre esse processo demonstram que requer do enfermeiro sensibilidade para compreender a complexidade da realidade da sua prática social.

Considerações Finais:

o enfermeiro no seu agir profissional deve mobilizar os recursos políticos, colocando o seu conhecimento, as suas habilidades e as suas atitudes à disposição das suas práticas, objetivando poder e melhoria das condições para o trabalho da Enfermagem.

Descritores:
Enfermagem; Educação; Poder; Políticas; Participação dos Interessados

INTRODUCTION

Present and future changes in the health sector require competent professionals in the organization and planning, as well as qualified to participate and make decisions that strengthen management. Admittedly, the training of nurses prepares them for this, and this expectation reflects what is required in the job market.

Currently, the recommendations of national and international health and Nursing organizations, the World Health Organization (WHO) and the International Council of Nurses (ICN) stand out for the empowerment and insertion of nurses in the elaboration and strengthening of public policies(11 Organização Pan-Americana da Saúde (OPAS). Diretriz estratégica para a enfermagem na Região das Américas. Washington, D. C: OPAS; 2019.). WHO and ICN propose the expansion of care and management work, encouraging the production of innovative practices in Nursing. Thus, they point to the strengthening of professional education, preparing for these challenges, as well as new ones that may arise, with teaching based on the best available evidence and motivating pedagogical projects for innovation in care practices(11 Organização Pan-Americana da Saúde (OPAS). Diretriz estratégica para a enfermagem na Região das Américas. Washington, D. C: OPAS; 2019.-22 Ministério da Educação (BR). Resolução CNE/CES nº. 3, de 7/11/2001. Institui Diretrizes curriculares nacionais do curso de graduação em enfermagem. Diário Oficial da União, 09 nov 2001; Seção 1.).

It should be noted that this is the category with the largest contingent of health professionals, working directly or indirectly in the Unified Health System – Sistema Único de Saúde (SUS). It has approximately 59.3% professionals, among them nurses, nursing technicians and assistants, who occupy spaces of care, management and system management(33 Machado MH (Coord.). Perfil da enfermagem no Brasil: relatório final: Brasil / coordenado por Maria Helena Machado. Rio de Janeiro: NERHUS - DAPS - ENSP/Fiocruz; 2017.), which, properly mobilized, can establish new partnerships to ensure more health services to the population.

In 2011, recommendations in the National Curriculum Guidelines for Nursing (NCGN) guided towards the differentiated teaching of nurses, mainly in the basic skills for health care, which are: decision making, communication, leadership, continuing education and management(22 Ministério da Educação (BR). Resolução CNE/CES nº. 3, de 7/11/2001. Institui Diretrizes curriculares nacionais do curso de graduação em enfermagem. Diário Oficial da União, 09 nov 2001; Seção 1.). They must be present and guide the pedagogical projects, which are essential in the professionals’ training, as they allow influencing, conducting and leading policies that can generate changing processes, with implications for research, education and professional practice(44 Waddell A, Adams JM, Fawcett J. Exploring nurse leaders’ policy participation within the context of a nursing conceptual framework. Policy Polit Nurs Pract. 2017;18(4):195-205. doi: 10.1177/1527154418762578
https://doi.org/10.1177/1527154418762578...
).

Thus, the teaching of nurses cannot be separated from the changes that occur in health services, evolving to offer new professional practices based on the working processes in Nursing: caring, managing, teaching, researching and political participation(55 Sanna MC. Work processes in Nursing. Rev Bras Enferm. 2007;60(2):221-4. doi: 10.1590/S0034-71672007000200018
https://doi.org/10.1590/S0034-7167200700...
). This last process is very important since it is the articulator of the other ones, negotiating conditions that allow professionals to develop their activities with quality and measurable results.

OBJECTIVES

To reflect on the scope of the working process in nurse participation in political activities in the professional setting as a possibility for expanding its performance.

METHODS

This is a reflective study supported by the discursive elaboration on the working process political participation, structured through concepts, theoretical and practical perspectives, based on the experiences described in references.

Working process in nurse participation in political activities

Nursing work processes are interrelated and have elements that characterize them. Caring seeks to promote, maintain and recover the health of people and social groups through systematization and professional procedures. Managing, through the use of tools such as planning, decision making, among others, coordinates the care, teaching and research activities, with the last two ones aimed at qualifying the category, through the production of knowledge and training of human resources(22 Ministério da Educação (BR). Resolução CNE/CES nº. 3, de 7/11/2001. Institui Diretrizes curriculares nacionais do curso de graduação em enfermagem. Diário Oficial da União, 09 nov 2001; Seção 1.,55 Sanna MC. Work processes in Nursing. Rev Bras Enferm. 2007;60(2):221-4. doi: 10.1590/S0034-71672007000200018
https://doi.org/10.1590/S0034-7167200700...
). All processes mobilize and require skills to lead, negotiate and decide on the nurses’ actions, being considered essential for political positioning.

The political participation process has the characteristic of linking the other ones, negotiating conditions that allow professionals to develop tasks with quality and measurable results. Thus, nurses who act politically can bring greater social recognition and an increase in the visibility of Nursing for themselves and their work group, reaching power spaces(55 Sanna MC. Work processes in Nursing. Rev Bras Enferm. 2007;60(2):221-4. doi: 10.1590/S0034-71672007000200018
https://doi.org/10.1590/S0034-7167200700...
). In addition to party involvement in the representative entities of Nursing, presence in decision-making places should be expanded in services, providing opportunities and expanding the practices of the category, whether already known or new and innovative ones.

Therefore, participating politically enables nurses to position themselves in different professional settings, inside and outside their work structure, notably in civil organizations and class representatives, making the potentialities visible and expanding their performance. Care must be taken to ensure that the values and precepts of Nursing are present and are the guidelines in conducting the negotiations that are necessary in these achievements, for the category or population(11 Organização Pan-Americana da Saúde (OPAS). Diretriz estratégica para a enfermagem na Região das Américas. Washington, D. C: OPAS; 2019.,55 Sanna MC. Work processes in Nursing. Rev Bras Enferm. 2007;60(2):221-4. doi: 10.1590/S0034-71672007000200018
https://doi.org/10.1590/S0034-7167200700...
).

The caring work process is the foundation of Nursing, which gives the essence and visibility to the profession, requiring theoretical evidence-based sustainability from others in order to develop itself. The manager is the one who appropriates the knowledge of the Science of Management and mobilizes the political resources that individuals have to technically and politically manage their work spaces(55 Sanna MC. Work processes in Nursing. Rev Bras Enferm. 2007;60(2):221-4. doi: 10.1590/S0034-71672007000200018
https://doi.org/10.1590/S0034-7167200700...
).

Political participation permeates interconnected, overlapping and significant concepts, such as: participation, power and policy. Participation comes from the Latin particeps, “someone who is a part of, who shares something”, which means the ability to influence others and/or the presence in steps in the decision-making process in an organization. Power also comes from classical Latin posse, being capable, having authority, expressing strength, persuasion, control, and it is the “right to determine something” to others or, even, the “ability to mobilize forces” to obtain results deliberately. Politics, originating from the Greek politiká, derivation of polis, means what is public, and the way in which social groups act regarding certain themes of common interest can be understood as a set of rules or norms of a particular organization to achieve its goals(66 Bobbio N. Dicionário de Política. 13ª ed. Volume 2. Brasília: Editora UnB; 2007.).

In common, participation, power and politics are in social and professional, public or private spaces, places that are built by collective, individual or group interests, with disputes or negotiations to occupy them, influencing and conquering those involved, aiming at sharing and getting the best results(77 Abreu JCA, Oliveira VCS, Kraemer CFB. Uma análise de construtos teóricos sobre e participação e gestão social. I Encontro Nacional de ensino e pesquisa do Campo de Públicas; 2015.).

Another present and common meaning is to contribute and share results, which are apprehended throughout social and professional life. Nogueira(88 Nogueira MA. Um Estado para a sociedade civil: temas éticos e políticos da gestão democrática. São Paulo (SP): Cortez; 2011. 268 p 3 ed) highlights that participation has three dimensions: care aiming at mutual assistance, which deals with the interests of social groups or professional classes; political, which seeks to expand power and collective representation by sharing decisions; and managerial, which, articulating with the political, aims at solving problems. The political dimension provides dialogue for better negotiations, highlighting those involved and pluralizing decision-making spaces, while managerial legitimizes group involvement, making decisions public and valuing collective achievements.

The understanding of being in decision-making spaces and moments in the world of work that are in constant tension are areas of disputes that sometimes are difficult to handle, with common and different meanings, motives and interests, as they allow the individual to be a social subject, with intentionality of influence, lead and change the conditions to exercise their practice(77 Abreu JCA, Oliveira VCS, Kraemer CFB. Uma análise de construtos teóricos sobre e participação e gestão social. I Encontro Nacional de ensino e pesquisa do Campo de Públicas; 2015.). So, individuals must recognize and understand situations in the real context, as they are complex meanings, as well as, when reflecting on the breadth of the situation, plan actions based on Knowledge and professional values(99 Meira MDD, Kurcgant P. Nursing education: training evaluation by graduates, employers and teachers. Rev Bras Enferm. 2016;69(1):10-5. doi: 10.1590/0034-7167.2016690102i
https://doi.org/10.1590/0034-7167.201669...
).

Teaching the in the working process of political participation

Having critical and reflective thinking is one of the objectives of the teaching work process. The training of Nursing professionals needs to be careful so that, in the teaching and learning procedure, the lecturer uses knowledge and methods that mean it, enabling an understanding of the scope of the category work(55 Sanna MC. Work processes in Nursing. Rev Bras Enferm. 2007;60(2):221-4. doi: 10.1590/S0034-71672007000200018
https://doi.org/10.1590/S0034-7167200700...
). Critical and reflective education requires intentional pedagogical experiences that are meaningful, mobilizing, with communicational, social and political actions that will develop the skills and attitudes necessary for the future professional commitment of political participation.

Therefore, the teacher has to elaborate and develop innovative pedagogical practices, creating and managing formative, transformative and engaging experiences that mobilize students and colleagues to assume co-responsibility in training. Thus, they recognize and make it possible to act as social and political participation subjects who, when negotiating and mediating conflicts, understand their professional political action with the organizations of education, health and those representing the category(55 Sanna MC. Work processes in Nursing. Rev Bras Enferm. 2007;60(2):221-4. doi: 10.1590/S0034-71672007000200018
https://doi.org/10.1590/S0034-7167200700...
,99 Meira MDD, Kurcgant P. Nursing education: training evaluation by graduates, employers and teachers. Rev Bras Enferm. 2016;69(1):10-5. doi: 10.1590/0034-7167.2016690102i
https://doi.org/10.1590/0034-7167.201669...
), which can be a model for students.

The lecturer nurse must understand that the construction of knowledge is what underlies its field(1010 Carper BA. Fundamental patterns of knowing in nursing. Adv. Nurs. Sci. 1978;1(1):13-23.). It has standards, shapes and structure, which act as a referential horizon and exemplify characteristic ways of thinking about phenomena. The standards lead to critical reflection to apprehend the meaning and types of knowledge considered most important for the profession. The standards are: empirical, nursing science and art; aesthetic, the personal component of knowledge and the ethical as a moral component(1010 Carper BA. Fundamental patterns of knowing in nursing. Adv. Nurs. Sci. 1978;1(1):13-23.).

White, a nursing theorist, included a fifth standard: the socio-political. The author proposes to conceptualize understanding at two levels: the socio-political of people, which is related to the cultural identity where they are inserted, such as the language used in health and work relationships; and the socio-political with the profession, which deals with the acquisition of knowledge by nurses for the critical domain of economic, social and political structures that influence the health of people and communities(1111 White J. Patterns of knowing: review, critique, and update. Adv. Nurs. Sci. 1995;17(4):73-86.). As a result of this involvement, there is the nurses’ critical reflection on the social, political, economic and cultural context of people and, consequently, there is greater visibility and care on the part of them in matters of life, health and illness of the population(1212 da Nóbrega MML, de Barros ALBL. Clinical models for nursing practice. Rev. bras. enferm. [Internet]. 2001 [2019 Aug 12];54(1):74-80. Available from: http://www.scielo.br/pdf/reben/v54n1/v54n1a09.pdf.
http://www.scielo.br/pdf/reben/v54n1/v54...
).

Considering White’s socio-political standard with the profession and bringing it to the current setting, there are two aspects to consider in the political dimension: one of them refers to the structures of power relationships that affect the results of everyday health, and the other one in planning and decisions in this area. Both require a critical attitude, as health is not a neutral field, requiring knowledge that nurses need to develop and appropriate in order to achieve the dignified appreciation of their actions(1212 da Nóbrega MML, de Barros ALBL. Clinical models for nursing practice. Rev. bras. enferm. [Internet]. 2001 [2019 Aug 12];54(1):74-80. Available from: http://www.scielo.br/pdf/reben/v54n1/v54n1a09.pdf.
http://www.scielo.br/pdf/reben/v54n1/v54...
).

Thus, the socio-political standard is a dimension of knowledge construction, which implies the necessary skills for the training of nurses. The model, as a representation of the context of this competence in being and living, would be built on parts of theories that exist in the abstract world, but which use words to express themselves, such as actions in an evolutionary and dynamic process, interaction of multiple factors involved in nursing education and performance(1212 da Nóbrega MML, de Barros ALBL. Clinical models for nursing practice. Rev. bras. enferm. [Internet]. 2001 [2019 Aug 12];54(1):74-80. Available from: http://www.scielo.br/pdf/reben/v54n1/v54n1a09.pdf.
http://www.scielo.br/pdf/reben/v54n1/v54...
).

Therefore, the construction of knowledge for the participating politically process goes beyond the domain of content, technique and intervention strategy in Nursing, aspects valued in professional performance and which require skills and attitudes, enabling the professionals and making them competent in articulating being, knowing, doing and living(99 Meira MDD, Kurcgant P. Nursing education: training evaluation by graduates, employers and teachers. Rev Bras Enferm. 2016;69(1):10-5. doi: 10.1590/0034-7167.2016690102i
https://doi.org/10.1590/0034-7167.201669...
,1212 da Nóbrega MML, de Barros ALBL. Clinical models for nursing practice. Rev. bras. enferm. [Internet]. 2001 [2019 Aug 12];54(1):74-80. Available from: http://www.scielo.br/pdf/reben/v54n1/v54n1a09.pdf.
http://www.scielo.br/pdf/reben/v54n1/v54...
). It allows inferring about the importance of the sociocultural standard to be in pedagogical projects, as it is the guide to teachers in the elaboration of their teaching activities.

The lecturer’s challenge comes from this: to build pedagogical practices that correspond to the socio-political standard, which will influence the participating politically work process. Initially, the lecturer must recognize the knowledge, skills and attitudes of this standard, as well as introduce it into a critical, reflective training process, in which the professional future acquires skills for a changing action.

However, it also requires attention to insert the socio-political standard in educational practices related to all nurses’ work processes. These are collaborative training activities that involve the recognition of the situation context, the planning of interventions, the exercise of decision-making and negotiation, the resources that contribute to the understanding of power relations in the health area(99 Meira MDD, Kurcgant P. Nursing education: training evaluation by graduates, employers and teachers. Rev Bras Enferm. 2016;69(1):10-5. doi: 10.1590/0034-7167.2016690102i
https://doi.org/10.1590/0034-7167.201669...
).

It is noteworthy that in the SUS structure, due to its scope, there are other possibilities for political learning. It should be noted that participation and social control, health councils or conferences are spaces for negotiation, mediation of conflicts and collective decisions. In addition, there is participation in commissions that aim to develop action proposals that are closer to users, in an exercise of planning, negotiation and decision making that intervene in social reality with the individuals involved.

By recognizing that academic decision-making spaces also make these exercises possible, a democratic scenario can be a facilitator for political pedagogical practices, as well as engaged teachers who envision new opportunities for their profession(1313 Mckeown M, Dix J, Jones F, Carter B, Malihi-Shoja L, Mallen E, et al. Service user involvement in practitioner education: Movement politics and transformative change. Nurse Education Today. 2014;34(8):1175-8.).

These spaces also allow the student to experience communication, an essential competence to operate the political participation process. When proposing political training practices, the lecturer must be aware that listening, expressing themselves, relating, expressing opinion and deciding are necessary steps for the formation of participation.

So, in the training of nurses, the articulation of power, political and participation knowledge will favor the construction of the necessary knowledge for the socio-cultural standard, unveiling actions that strengthen Nursing education for political participation.

It is understood that training with a focus on this standard will also provide reflective and collaborative subjects who can, in addition to understanding the complexity and need to change health work, expand professional actions, with profit possibilities for all involved.

When understanding that political participation is part of the nursing work process, it is also important to insert characteristics that strengthen this process in the pedagogical practices. One of them is knowing how to influence others and how to use communication resources to be effective in this action.

Limitations

The purpose of this study is not to exhaust concepts and opportunities in the political participation in the working process, but to raise reflections on the theme in professional settings, especially in Nursing education in Brazil.

FINAL CONSIDERATIONS

Professional scenarios and possibilities are dynamic and constantly changing, which require nurses’ participation and political positioning. This view on how to participate politically can favor and collaborate to be a protagonist in health services and class entities, continuously contributing to the improvement of living conditions for the population, with the development of safe and quality work.

When acting politically, professionals must enable others to occupy public and private decision-making spaces, as preparing new leaders for new times is part of being political. Due to the presence of nurses in different settings and hierarchical levels in health institutions, these professionals demonstrate the potential that the category has to guarantee the expansion of their actions.

However, it is essential that lecturers get involved, not losing their professional action and the expansions required by social changes, which must be in pedagogical projects and in the daily practice of teaching.

Teaching how to political participations acts in the working process is a challenge, because it requires the construction of significant, critical and reflexive pedagogical practices in which the training settings are not the usual ones in the educational field. Therefore, the lecturer must be a social subject, with an accurate preparation for political training, collaborating in the possibilities of proposals for the professional category, as well as for society.

In addition, it is also important to have the sensitivity to recognize the profession’s interests and potential for interdisciplinary work, as it is a demand from SUS and Nursing education. The work with the multidisciplinary health team must be permeated by decisions on behalf of those involved, guaranteeing the professional space of each category and lending visibility and recognition to all.

Thus, it is important for the strengthening of Nursing to value, recognize and respect the professionals who participate politically. In addition, it is also necessary to open, expand and teach the path for new nurses to work in these conquered spaces.

REFERENCES

  • 1
    Organização Pan-Americana da Saúde (OPAS). Diretriz estratégica para a enfermagem na Região das Américas. Washington, D. C: OPAS; 2019.
  • 2
    Ministério da Educação (BR). Resolução CNE/CES nº. 3, de 7/11/2001. Institui Diretrizes curriculares nacionais do curso de graduação em enfermagem. Diário Oficial da União, 09 nov 2001; Seção 1.
  • 3
    Machado MH (Coord.). Perfil da enfermagem no Brasil: relatório final: Brasil / coordenado por Maria Helena Machado. Rio de Janeiro: NERHUS - DAPS - ENSP/Fiocruz; 2017.
  • 4
    Waddell A, Adams JM, Fawcett J. Exploring nurse leaders’ policy participation within the context of a nursing conceptual framework. Policy Polit Nurs Pract. 2017;18(4):195-205. doi: 10.1177/1527154418762578
    » https://doi.org/10.1177/1527154418762578
  • 5
    Sanna MC. Work processes in Nursing. Rev Bras Enferm. 2007;60(2):221-4. doi: 10.1590/S0034-71672007000200018
    » https://doi.org/10.1590/S0034-71672007000200018
  • 6
    Bobbio N. Dicionário de Política. 13ª ed. Volume 2. Brasília: Editora UnB; 2007.
  • 7
    Abreu JCA, Oliveira VCS, Kraemer CFB. Uma análise de construtos teóricos sobre e participação e gestão social. I Encontro Nacional de ensino e pesquisa do Campo de Públicas; 2015.
  • 8
    Nogueira MA. Um Estado para a sociedade civil: temas éticos e políticos da gestão democrática. São Paulo (SP): Cortez; 2011. 268 p 3 ed
  • 9
    Meira MDD, Kurcgant P. Nursing education: training evaluation by graduates, employers and teachers. Rev Bras Enferm. 2016;69(1):10-5. doi: 10.1590/0034-7167.2016690102i
    » https://doi.org/10.1590/0034-7167.2016690102i
  • 10
    Carper BA. Fundamental patterns of knowing in nursing. Adv. Nurs. Sci. 1978;1(1):13-23.
  • 11
    White J. Patterns of knowing: review, critique, and update. Adv. Nurs. Sci. 1995;17(4):73-86.
  • 12
    da Nóbrega MML, de Barros ALBL. Clinical models for nursing practice. Rev. bras. enferm. [Internet]. 2001 [2019 Aug 12];54(1):74-80. Available from: http://www.scielo.br/pdf/reben/v54n1/v54n1a09.pdf.
    » http://www.scielo.br/pdf/reben/v54n1/v54n1a09.pdf.
  • 13
    Mckeown M, Dix J, Jones F, Carter B, Malihi-Shoja L, Mallen E, et al. Service user involvement in practitioner education: Movement politics and transformative change. Nurse Education Today. 2014;34(8):1175-8.

Edited by

EDITOR IN CHIEF: Antonio José de Almeida Filho
ASSOCIATE EDITOR: Fátima Helena Espírito Santo

Publication Dates

  • Publication in this collection
    21 Dec 2020
  • Date of issue
    2020

History

  • Received
    25 Aug 2019
  • Accepted
    15 June 2020
Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br