Let it not be that nursing that asks for silence: participation in social movements and sociopolitical-emancipatory knowledge

Que no es esa enfermería la que pide silencio: participación en movimientos sociales y saberes sociopolíticos-emancipadores

ABSTRACT

Objectives:

to analyze the expression of sociopolitical-emancipatory knowledge, based on the participation of women-nurses in social movements, and the implications for nursing care.

Methods:

a research-interference, whose data were obtained from narrative interviews with six women-nurses inserted in social movements and with political representation. Data were submitted to discourse analysis, based on Michel Foucault.

Results:

women-nurses’ social and political involvement is driven by the contexts of life and work, marked by gender inequalities. Ability to criticize oneself, the profession and health policies and practices are presented as expressions of sociopolitical-emancipatory knowledge. Nursing care is conceived as a political practice that, influenced by learning from social movements, must go through a denial of the historically performed form.

Final Considerations:

participation in social movements triggers sociopolitical-emancipatory knowledge, resulting in differentiated care, a way of acting oriented towards reducing inequalities.

Descriptors:
Political Activism; Nursing Care; Nursing; Gender Equity; Feminism

RESUMEN

Objetivos:

analizar la expresión del saber sociopolítico-emancipador, a partir de la participación de las enfermeras en los movimientos sociales, y las implicaciones para el cuidado de enfermería.

Métodos:

investigación-interferencia, cuyos datos fueron obtenidos a partir de entrevistas narrativas con seis mujeres-enfermeras insertas en movimientos sociales y con representación política. Los datos fueron sometidos al análisis del discurso, con base en Michel Foucault.

Resultados:

la participación social y política de las mujeres enfermeras está impulsada por los contextos de vida y de trabajo, marcados por las desigualdades de género. La capacidad de autocrítica, la profesión y las políticas y prácticas de salud se presentan como expresiones de saberes sociopolíticos-emancipadores. El cuidado de enfermería se concibe como una práctica política que, influida por los aprendizajes de los movimientos sociales, debe pasar por una negación de la forma históricamente realizada.

Consideraciones Finales:

la participación en los movimientos sociales desencadena conocimientos sociopolíticos-emancipadores, resultando en una atención diferenciada, una forma de actuar orientada a la reducción de las desigualdades.

Descriptores:
Activismo Político; Atención de Enfermería; Enfermería; Inequidad de Género; Feminismo

RESUMO

Objetivos:

analisar a expressão de saberes sociopolíticos-emancipatórios, a partir da participação de mulheres-enfermeiras em movimentos sociais, e as implicações para o cuidado de enfermagem.

Métodos:

pesquisa-interferência, cujos dados foram obtidos de entrevistas narrativas com seis mulheres-enfermeiras inseridas em movimentos sociais e com representação política. Dados foram submetidos à análise do discurso, baseada em Michel Foucault.

Resultados:

o envolvimento social e político das mulheres-enfermeiras é impulsionado pelos contextos de vida e trabalho, marcados por desigualdades de gênero. Capacidade de crítica sobre si, sobre a profissão e sobre as políticas e práticas de saúde se apresentam como expressões de saberes sociopolíticos-emancipatórios. O cuidado de enfermagem é concebido como uma prática política que, influenciada pelos aprendizados com os movimentos sociais, deve passar por uma negação à forma historicamente realizada.

Considerações Finais:

a participação nos movimentos sociais aciona saberes sociopolíticos-emancipatórios, resultando em um cuidado diferenciado, um modo de agir orientado para redução das desigualdades.

Descritores:
ATIVISMO POLíTICO; CUIDADOS DE ENFERMAGEM; ENFERMAGEM; INIQUIDADE DE GêNERO; FEMINISMO

INTRODUCTION

Nursing is a human science, as its central domain is care. This perspective allows the integration of theoretical and practical knowledge of the profession, highlighting the interdisciplinary relationships with other human and social sciences(¹). For the conformation of nursing practice, a set of knowledge is combined, from scientific sources, in addition to other sources, organized into four dimensions: empirical, ethical, personal and esthetic(²). More recently, other dimensions of knowledge have been incorporated: sociopolitical, emancipatory and spiritual(³-⁵).

Care has been assumed as a central concept in the nursing course and a characterization of professional action(⁶). It is exercised in an act, in an inseparable relationship between being, knowing and doing and, therefore, it can be called know-how-to-care(⁷).

It is known that inequalities, in their different manifestations, are a reality far from being overcome in Brazil and in the world. The gender focus places the country in the 92^nd position in the gender equality ranking, composed of another 152 countries(⁸). Amidst the COVID-19 pandemic, several conditions of inequality were accentuated. We are experiencing a health and economic crisis that, added to the (mis)governance of public health, neoliberal authoritarianism and science denialism, has been shaped, above all, as a social and political crisis(⁹).

In this context, a critical and feminist approach to social justice is defended that leads women-nurses to face conditions that lead to health inequities, involving not only access to health services, but also to social resources and institutionalized oppressions(¹⁰).

We chose to adopt, in the study, the expression women-nurses, to demarcate the importance of the gender category in the profession conformation. Gender is understood as a sociological category that defends the overcoming of man-woman binarism and maintains connections with other axes of identity and oppressions - inequality of class, race, ethnicity, sexuality, generation, among others. Thus, the analysis of gender relations today includes reconfigurations that range from sexuality to work relationships, the experience of what is perceived as intimate and personal, and the dimensions of participation in the public sphere(¹¹).

Debating gender inequalities in society and in the profession prompts action guided by sociopolitical and emancipatory knowledge. It is considered redundant to distinguish such dimensions of knowledge, since both show the concern with issues related to social injustice and the conditions that create them and require skills to correct them(¹²). Thus, we chose to adopt the expression sociopolitical-emancipatory knowledge in an attempt to bring the two sets of knowledge closer together.

It is accepted that participation in social movements is a condition that strengthens civil society in the construction of paths for social transformation(¹³). Specifically, feminisms encompass social and political movements devoted to overcoming female subordination, dispute over historical narratives and questions about what social justice would be(¹⁴-¹⁵).

An integrative review showed low involvement of nurses in policy making, with the need to defend their rightful place in political forums, encouraging them to work as policy makers rather than implementers (uncritical) and develop qualitative studies that understand the experiences of nursing leaders who make a significant political contribution(¹⁶). The findings of another global-scope review suggest an increase in investigations into nursing policy, at the macro level, and political action, but little evidence that reveals nurses’ sustained interest and commitment to act politically in government spheres for the public good(¹⁷).

Despite the recognition of the feminine character of the profession, there is little and sparse evidence about the approximation between nursing and social movements, especially feminists. Some studies focus on the contributions of the feminist theoretical aspect to nursing(¹⁸-¹⁹), and others deal with the gender perspective to assess the profession social conformation(²⁰-²²). Thus, “[...] a model of asexual, rigid, authoritarian, excessively technical and little politicized professional has been defended”(²¹) (own translation), which reflects on the difficulty of advancing in health care models and in the reconstruction of myths and discourses about the profession(²¹).

In this sense, the question is: how does the participation of women-nurses in social movements, including feminist movements, trigger the development of sociopolitical-emancipatory nursing knowledge? What are the implications for care production?

OBJECTIVES

To analyze the expression of sociopolitical-emancipatory knowledge, based on the participation of women-nurses in social movements, and the implications for nursing care.

METHODS

Ethical aspects

The research was approved by the Research Ethics Committee. All steps are in line with the ethical principles involving research with human beings, established by the Brazilian National Health Council (Conselho Nacional de Saúde), according to Resolutions 466/2012 and 510/2016.

Study design

This is a research-interference, with a qualitative approach, anchored in the post-structuralist perspective with a narrative focus. The article presentation was guided by the Consolidated criteria for Reporting Qualitative research (COREQ).

The research-interference theoretical-methodological design is anchored in the reception of (in)worlds that escape the dominant totalization characteristic of knowledge production. Thus, this type of research has deconstruction as its principle, as it questions traditional approaches and produces radical interventions in the field of micropolitics(²³). When approaching such an outline, it is necessary to consider that the construction of the methodology takes place during the study process, with the researcher in a state of alert body to what the field asks for(²³).

Methodological procedures

The study is part of a doctoral thesis, carried out in two research moments: mapping the participation and involvement of nurses in social movements; and analysis of subjectivation processes involved and the implications for nursing care. In this clipping, results of the second research moment are presented, in which the data production tool was narrative interview, followed by discourse analysis, based on Foucault’s framework(²⁴-²⁵).

Study setting

In the first moment of the research, 17 events were observed, conducted by or with the participation of social movements and women’s collectives in the Metropolitan Region of Belo Horizonte, MG, Brazil. The first movement to include participants was to recognize, in the events observed, the presence of formal nursing organizations. With that, the attitude adopted was to go to the field to know the social collectives, to enter the places where the social movements occur and “Assuming women, or women, as their own field of research, insofar as their bodies were a privileged territory of domination, dispute over knowledge, normalization practices, and discourse of truth” (own translation)(¹⁵).

Data source

Participant selection started from the identification, in the observed events, of women-nurses with involvement in social movements, in a non-probabilistic and intentional sampling. This type of sampling is guided by the deliberate inclusion by the researcher of participants considered strategically rich in information and who present extraordinary manifestations to the phenomenon of interest(²⁶). The judgment regarding inclusion was made by the researchers considering the aspects of adequacy and appropriation to define a sample capable of generating sufficient and quality data and producing a full understanding of the phenomenon of interest.

Initially, two nurses were identified who were interviewed and indicated another four, of which two were also included. We also intentionally added a nurse, with a political-party connection and legislative mandate, and another, with a connection with the student movement, totaling six participants. There were no refusals or withdrawals from participating in the research. Throughout the article, participants will be mentioned with an alphanumeric code, formed by N (nurse) plus a sequential number.

Data collection and organization

The narrative interviews were conducted by the lead researcher, who had been observing social movements for at least six months and had experience in conducting in-depth open-ended interviews. Prior to the interview, telephone contacts, e-mail correspondence or even one-to-one contact were made, explaining the purpose of the research and establishing dialogues with participants. In these moments of negotiation, for the interviews to take place, participants mentioned various information of interest so that the field texts were important materials for such records. Such field notes were recorded shortly after the end of the interviews.

The interviews were carried out from May 2019 to April 2021, with an average duration of one hour and 23 minutes, in person or remotely (due to the COVID-19 pandemic period), always with the presence only of the researcher and woman-nurse interviewed. The previously prepared script was about participation in social movements and the relationship with nursing life and practice. After being audio-recorded, each interview was transcribed in full, in a detailed recording process and analyzed before the next interview. Subsequently, the transcripts were shared with participants for validation.

The option to interrupt data collection was made when observing recurrence and complementarity of information that indicated that the research objectives were achieved. It is important, however, to highlight the possibility of always having element(s) of unrepeatability when opting for narrative interviews.

Data analysis

By bringing the analysis to Foucault’s definitions, it is understood that, more than a linguistic function of joining utterances, discourse is a socio-historical practice, a dimension of production of social reality(²⁷).

In the analysis procedure, immersion was carried out in each transcribed interview and its field notes, with at least four full readings of the material, seeking to extract answers to the research questions. The individual analysis of each interview lasted about 30 hours with the following procedures: thematic reading, demarcating important passages about the mentioned social movements, their agendas and forms of social participation; structural reading(²⁸), identifying the summary, the complicating actions and the narrative turn; performative reading(²⁸), with attention to direct speeches, use of refrains, verbal inflections and construction of preferred versions of oneself to indicate the speaker’s stand and, finally, the focus on discursive formation, looking for statements, rules of discourse, regularities, rarities, interdiscursivities, effects on bodies, subjective positions and possibilities of resistance. This process is recorded in the supplementary material attached to this article.

Analytical devices were adopted that articulate two logics to constitute the empirical corpus: one singular (of each character) and another transversal, simultaneously and circularly. Regarding the singular logic, information about the participant’s profile, conditions of production of the meetings, coherence and internal tensions of each report were recorded. Regarding the transversal logic, a process of analysis of the set of interviews was carried out, reconstructing thematic perspectives of the singular phase and resuming emerging analytical perspectives(²⁹).

RESULTS

The research participants have clear recognition in the political action of nursing. They have an average age of 44 years (three are between 30-40 years old, one is between 40-50 years old and two are over 50 years old), graduating from Brazilian public universities. Four of them have a stricto sensu graduate degree and one has a postgraduate degree in the lato sensu modality. They work in teaching, health care or in the legislature in the Southeast, Midwest and North regions. Chart 1 presents a synthesis of other aspects of the unique analysis of each narrative.

Chart 1
Unique aspects of each narrative, Belo Horizonte, Minas Gerais, Brazil, 2021

	Spaces/movements to which it is linked	Setting of production of meetings and form of identification of the participant*	Internal consistency†	Internal voltages‡
N1	Trade union movement	In a formal university environment, indicated by people found in the field.	Social participation and academia, social representation of nursing.	Party involvement and formal spaces for organizing the profession.
N2	Political party and movements related to land and peoples	In an informal environment during a scientific event in which she was identified, interrupted by the participant’s commitment.	Political care in nursing, positions situated in professional practice, clashes with different people.	Icons and representative entities of nursing.
N3	World March of Women (WMW) and political party	Remote, identified in events and indicated by other participants, more exploratory than narrative.	Conflicts at work, ties linked to the link with the church, sexual division of labor.	Movements/guidelines of the professional category.
N4	WMW, musical, virtual and professional collectives.	In the workplace, indicated by another interviewee, interrupted by the closing of the service.	Working conditions and gender relations.	Formal spaces for organizing the profession.
N5	Space for the defense of democracy, social rights and health, front against outsourcing, decolonial study group, political party	Remote, included by the interest in the younger generation, conducted in two moments and sometimes with connection problems.	Nuances of participation in student movements, common tone of irony/sarcasm in the reports.	Internal conflicts in social movements, accusation of oppressive attitude, nursing and feminism.
N6	Women, health, labor, transport and human rights committees in the legislature	Remote, indicated by another interviewee, included because of her interest in political-party affiliation.	Nursing is inert, fragmented, does not realize the importance and is not organized as a category, medicine has a differentiated organization, with a debating and provocative tone.	The pressure suffered by politically representing nursing, but that alone cannot move forward with some guidelines.

• ^*
  place/means of the researcher-participant meeting, way of identifying the participant, aspects related to the interview; †aspects portrayed fluidly in the narratives, to which a greater number of episodes and details are dedicated, including main narrated characters; ‡Aspects related to impasse or difficulty in narration (rarity or interdiction in speech).

In order to present the results of the narratives’ transversal analysis, it was decided to organize them in two axes: Participation in social movements and socio-political-emancipatory knowledge; Implications of social participation on women-nurses’ know-how-to-care.

Participation in social movements and socio-political-emancipatory knowledge

As shown in Chart 1, the participants are involved in several social movements, some known as the World March of Women, others local and specific. Not all are linked to women’s or feminist movements themselves. However, in all narratives, engagement in agendas considered feminist was identified, as they aim to overcome female subordination and oppression.

The aforementioned social participation guidelines are linked to the following major areas: environmental education, land rights, sexual and reproductive rights, public policies (especially the defense of the Unified Health System (Sistema Único de Saúde), social inequality and vulnerable populations, violence against women, training and labor/union issues in nursing.

Regarding the forms of expression and modes of social engagement, several strategies were narrated in which they are involved, such as: marches; public acts; event organization; activation of the public power by strikes; assemblies; political articulation; fundraising actions for collectives; financial and emotional support to people in need; foundation of spaces for social participation; elaboration of collective debates; workshops on gender and nursing; therapeutic poetry workshop; conjunctural analysis of lived moments; academic readings; participation in scientific events; student youth training; dissemination of union role; candidacy for spaces of social participation; and publicity on social networks.

In the narratives, women-nurses express that social and political involvement is driven and addressed to change contexts of life and work, reflecting knowledge about the profession and social practice. At the same time, they inform an ability to reveal the gender inequalities manifested by oppression and submission:

[...] there were the conditions that nursing goes through, all the oppressions experienced by nursing and then came feminism, the issue of women, the record of the violence suffered by my mother for many years came to light [...] these things were integrated [...] I managed to combine there the oppressions experienced with the politics that was being put in place, the studies and the movement of women, the self-organization of women, so I joined the women’s movement [...]. (N4)

[...] we always [...] made a point of even discussing, because feminism, you know, like that [...] because we understand that [...] anyway, that there was a machismo that was structuring and that we, the perspective of changing this reality is what made us feminists [...]. (N1)

Recognizing the social conditions that affect women, patriarchy issues, gender, class, racial, regional inequalities, in addition to the effects of beauty standards on women’s health and bodies, it is a capacity that indicates the expression of sociopolitical-emancipatory knowledge. The recognition of inequalities is so much a dominant discourse that failure to comply with its principles is considered a “boner”:

[...] we invited them to a coffee, to talk about body standardization, beauty standards and women’s health and we said that we thought that this type of event was not good for women’s health, for all this context, that he only reiterated a series of issues that were very difficult for most women and such. (N1)

[...] and we did the pre-event and we said “I don’t want anyone talking, and, by the way, it wasn’t even talking, I don’t want anyone committing gaffes of oppression with other regions”, so we did an anti-racist training, no one would be ashamed, anti-racist, feminist [...] it’s about the issue of sexuality, about the issue of nursing struggles, so we did almost a month of training with the people who went to the event [...]. (N5)

It is important to note that the social context mentioned by participants does not only refer to the women they care for, but also to what the participants themselves experience in childhood situations, work circumstances, challenges to study, among others. The discourse is self-reflective, expressing the ability to be conscious, inherent to sociopolitical-emancipatory knowledge:

[...] I saw cracked earth, I saw drought, I saw people getting water from the well, water that cattle drink, I [...] I don’t forget that I went to take a cardboard box to the girl who ironed clothes at home, who her baby had died, so she could bury the baby [...]. (N4)

[...] when I entered university, I worked [...] I started working very early, because my mother died when I was 14 years old, and then I came to live with my grandparents, so, since I was 14, I had been working outside from home, because we were already working at home [...]. (N3)

[...] we understand our role as women more deeply, why did we fight so hard for nursing? [...] then you begin to understand why you take this fight so willingly, because it is our fight of oppressed women [...]. (N6)

Still on the contextual aspects of inequalities, notes are made in relation to the population’s difficulties in accessing services and guaranteeing rights. N3 relates the population’s lack of assistance to poor management and the existence of political conflicts, noting that the problem is not the lack of funding. In this aspect, the mobilization of socio-political-emancipatory knowledge is also expressed, through the capacity for critical reflection and visualization of the context of health policies:

[...] we raised the problems within the community and you would see that many of the problems with women were a matter of discharge, right? The issue that was not accessible/the service did not work from the Pap smear [...]. (N2)

[...] for me, it was very scandalous, so, some things, this preventive thing was something scandalous [...] discovering that there was a region that had leprosy and that 23 cases were identified, being part with grade three, you know? No septum and no ear. What is it? In a rich municipality equal to X, understand? [...]. (N3)

When reflecting on the profession, the participants recognize the existence of an ideal stereotype of a nurse and a practice crossed by disciplinary discourses, military and religious systems permeated by norms and standards. Some participants perceive themselves as deviant from this pattern, with a conflicting relationship with nursing. In this regard, the ability to criticize oneself and the profession is an exercise that informs sociopolitical-emancipatory knowledge:

[...] first, that I walked with my hair the way I wanted to, my hair was always curly and I always loved walking with it loose, fluttering the way it was and I walked with my clothes, it didn’t have that little pattern, huh? [...]. (N2)

In the context of health services, some oppressive, silencing practices that blame, judge and victimize, especially other women, and family care, romanticized, dedicated to hygiene, control and medicalization of bodies, focused on restoring pathological expressions and in verbal counseling. Due to these characteristics, the care offered is understood as inadequate and harmful:

[...] let it not be that nursing staff who asks for silence, let us tear down any poster that you see someone from our connection asking someone to shut up, right? [...]. (N2)

[...] this junction of religiosity with militarism is not a good mix, in my view, I think they have very legal processes, but I see nursing today very medicalized, always valuing a dimension of the procedures, right? It’s not today, it’s always been like this [...]. (N1)

According to N3, N4 and N6, there is recognition of the approximations between the oppressions experienced by nursing and gender issues. Devaluation is associated with the fact that it is a female job, permeated by the sexual division of labor, associated with the private and charitable environment. Often, this perception of the relationship between gender and profession happens, belatedly, as a discovery. There is also a statement that the oppressions experienced by nursing are related to the intersectionality of gender, class and race:

[...] understand that society was organized based on a sexual division of labor, where this care work was said to be women’s work and was private [...] and it didn’t even need training, because it was seen as something natural of women [...]. (N3)

[...] it was only at the end of the course that it dawned on me [...] that nursing was experiencing all those oppressions, because we were women [...] and I swear it was an insight, it wasn’t no one told me, no [...]. (N4)

[...] the issue of race itself, a category of blacks, niggers, periphery, lower middle class [...] people who arrive at a university, sometimes, it is only they who arrive from an entire family, as I was also [...]. (N6)

Implications of social participation on women-nurses’ know-how-to-care

In the statements, one of the aspects highlighted is the ability to understand the structures that shape the world, to analyze the context and work situation, a perception of the effects of patriarchy, reading about being a woman in society and about the factors that influence access to health. This ability to read the world implies a nursing ethically and politically positioned in an emancipatory practice:

[...] I think I could only have this look now, in this place, because of these experiences [...] because of the student movement [...] these are things I wouldn’t be able to see [...] if I didn’t have going through that, I wouldn’t be able to see myself, I don’t know, a health advocate for these people [...] if I didn’t understand that my female patients’ vulnerabilities exist [...]. (N5)

Differentiated care is pointed out as the result of elaboration, reflection, a voluntary process, a political practice. N3 highlights that the lines of flight found in professional practice involve simple actions, of organizing work processes, and that combine knowledge of nursing training with the experience acquired in social participation:

Care was something very expensive, so we, in fact/it wasn’t something that happened and now I’m here working it out, of course I’m working it out from the outside, but, well, it’s not something we used to do tacitly [...]. (N1)

[...] to say that health care practice is also a political practice and can be a transforming practice is something that has remained for me [...] I think it has the mark of this view of popular movements too, in the sense of putting into practice some of the lessons learned from our training, you know? (N3)

In the day-to-day of social participation and in the implementation of health practices, clashes with other people were reported. From the statements, we understand that they are discursive clashes, in the sense of positioned attitudes, and that they are, above all, necessary, worthy and provide learning:

So, you had a clash with the nurse, but it wasn’t a clash of you saying “you’re ugly, you’re beautiful” it wasn’t, you know? It was a clash of positioning, of understanding, of understanding what those roles were there. (N2)

[...] we were beaten a lot, well, it was a lot [laughs], it was a process of a lot of learning, because I was just realizing it, right [...]. (N3)

In the narratives, in relation to activities linked to social movements, the dimension of concrete practice was highlighted. The possibility of exercising care in spaces of social participation is mentioned, in contrast to the “abstract care”, often taught during training. This mode practiced in socialization is linked to an expanded dimension of health, which considers the diversity of people and is supported by loyalty, respect and support:

It is different from the care that is learned in socialization, especially in the socialization of women, and it is also different from the perception of social movements about care [...] another on the issue of support, more subjective, like, “I’m with you”. (N1)

Collectivity is a mark of social spaces. Therefore, the relationship with social movements leads to a different way of coordinating teams, a way of reducing power asymmetries, opting for dialogue and producing collective decisions. An effort to create networks to offer care in line with needs is also mentioned:

[...] guided by this place of recognizing people as subjects of construction, subjects of knowledge and trying to collectively build these processes [...]. (N3)

[...] I got this thing from the network. There is a woman here in the neighborhood who provides delicious food [...] I managed to get this donation money, pass it on to X, X lives near this house, and X is taking lunch boxes [...]. (N4)

Also encompassing aspects of being a nurse in care, the speeches regularly report the difficulty of advancing the profession linked to the inertia of nursing, for not realizing the importance of getting politically involved and not organizing as a category. N2 mentions that, historically, nursing icons generated obstacles to the profession collective organization. It is also important to note that, according to Chart 1, representative entities and unions were treated with interdiction and rarity in an important part of the interviews:

[...] in our case of the category [...] it is far below [...] the category is very difficult because it cannot understand the need for this participation in these forums of debate, in these spaces of power [...] right? (N6)

[...] the nurses who organized themselves to demand salaries were rejected by Florence Nightingale [...] the icon of nursing [...] was contrary [...] the organization of women within nursing [...] did not understand nursing as workers, understood the work of nursing as an action of charity, right? (N2)

Otherwise, as can be seen from the coherence and spaces that the participants make up, presented in Chart 1, there is a discursive rule that nursing needs to be in the places of decision, carry out a political reading of society and the profession history. There is, therefore, a discursive update on nursing submission expressed as a need for changes in the way of dealing with other workers. Furthermore, specifically in N6’s narrative, characteristics of provocation and mobilization of political engagement in nursing are found. A work fundamentally mobilized by sociopolitical-emancipatory knowledge is put into action:

[...] it was important to understand these roots, even, of this process of valorization [...] to also understand how I sometimes related, including with other colleagues in the profession, often with very different dynamics [...]. (N3)

[...] then, you pass an electoral process with the hope of becoming a councilor in the cities, you have a poor response from a category that is immense [...] which is the largest category in terms of quantity in the health area [...] so, how do you want/how does the category want to have a salary floor and working hours if it is not involved with that? [...]. (N6)

DISCUSSION

The socio-political dimension of knowledge is fundamental for understanding the others, due to the effort to visualize nursing in the social, political and economic world, in planning and decisions about health and the power relations that affect health-disease outcomes. Two levels of knowledge are involved: one related to the sociopolitical context of people (patients and nurses); and another, related to the sociopolitical context of nursing as a professional practice, including society’s understanding of it and nursing’s understanding of society and policies(³).

In relation to the socio-political context in which health and nursing actions conform, the results demonstrate recognition of inequalities and systems of oppression in a reflexive exercise of personal experiences and situations that women-nurses experience in health and training spaces. Statements that point to a critical analysis of aspects of the population’s right and access to health were also identified.

It is considered that nursing is often driven to activism, because of its values, and that the values commonly involved include the existence of a duty to act and the understanding that action to improve the health of people and populations is necessary. Thus, becoming a witness to injustice is seen as a precursor act to drive nurses from a position of witness to action(³⁰).

The recognition of living and working conditions is an expression of socio-political-emancipatory knowledge and can be an important means of overcoming existing inequalities, since this dimension of knowledge is linked to the production of equity-oriented social interventions(³¹). Furthermore, the recognition of factors related to the right to health reflects a political understanding(¹⁰).

The findings demonstrate that the life and work context of women and nurses is a driver for social involvement with numerous guidelines and forms of expression that transit through the various markers of difference, such as gender, race and social class that, at the intersection, produce deep iniquities(¹⁰). Overcoming these inequities is a complex task that involves “[...] political struggle, organizational capacity, knowledge, economic autonomy and elaborate levels of social participation” (own translation)(²⁰).

Regarding the level of knowledge about the social context of nursing as a professional practice, the discourse analysis showed: statements of existence of an ideal nursing stereotype; discursive regularity about profession devaluation and distance from decision-making spaces; and recognition of the relationship between the oppressions experienced in the profession and gender issues.

Modern nursing is born as a supporting practice of medical practice and instituted in hospital contexts. Even today, the profession’s feminine character is linked to the maintenance of inadequate working conditions and low professional appreciation(³²).

Professional nursing organizations provide a powerful opportunity for nursing activists to speak collectively(³⁰). However, as shown in Chart 1 and in the second section of results, discursive tensions were found about the formal spaces of profession organization. Although there are obstacles from the point of view of advances for the profession, the discourses found in relation to professional practice, its social, historical and political influence show expressions of socio-political-emancipatory knowledge. Emerging discourses are considered important, since, through repetition, they may multiply(²⁷).

Furthermore, the narratives express questions and provocations that can mobilize for political engagement, overcoming the fragmentation and inertia felt with the profusion. It must be considered that the gender condition associated with nursing translates into challenges for political participation and, therefore, the narratives express power/knowledge effects, as well as constructing realities and subjects(³³).

The reports of bodily impacts of disciplining, standardization, medicalization and control devices express the experience of inequalities and oppression by women-nurses themselves. These conditions are presented as common in nursing, either as an agent of care, which courses, or as an object of a society, which discriminates against and undervalues the profession. This process of self-reflection, of reading impacts on one’s own body and the perception of power devices has a potency of resistance, since, by understanding the ways in which devices are manufactured and how subjectivized we are by them, it may be possible to rethink performances, lines of flight and rupture(³⁴).

From the point of view of implications of social participation for nursing care, in the narratives, complaints were found of common ways of offering it, considered a (lack of) care. Also, in the literature, we find notes of health practices marked by objectification of the other, fragmentation of the human body, specialization of knowledge, distancing and non-recognition of singularities and technological intermediation of relationships(⁷).

This context is an invitation to change the know-how-to-care of nursing, and the discourses found seem to be an exercise of (lack of) care, a denial of the historically performed form of care. Here, the expression of emancipatory knowledge stands out so that, in addition to the ability to be conscious, critical reflection on the paths and purposes that led to the social, cultural and political scenario, and action to reduce or eliminate inequalities and injustices are also included(⁴).

These findings are important from the point of view of the concept of nursing activism, in which action is highlighted, so that being an activist is acting on behalf of the solution of social and political issues at the forefront of a movement, often compromising its own energy to seek justice and evoke change(³⁰).

Differentiated care, which consists of a political practice implied by learning from social and feminist movements, is pointed out as linked to the expanded dimension of health, with a willingness to face discursive clashes. It results from voluntary elaboration and reflection, from the exercise of awareness of the environment and social structures, open to the community, promoting the reduction of power asymmetries and the creation of networks. Such characteristics are opposed to aspects that commonly maintain/produce inequalities, such as silencing, submission, alienation, oppression, individualism and maintenance of hierarchies.

It is noted that know-how-to-care is inserted in tense spaces, inhabited by different discursive formations, power relations and knowledge(⁷). Thus, in addition to the formal and technical dimension of care, the political face is necessary, which systematically questions and deconstructs the asymmetries of power, making them more democratic and inclusive, collectively expanding citizens’ chances and opportunities(²¹). Therefore, care is endowed with a political potential to encourage critical subjects, in a practice that allows new possibilities for the existence of the person being cared for and the caregiver(²²).

Study limitations

We recognize as a limitation carrying out three interviews remotely, which may have affected the interaction between researcher and participant. However, some attitudes adopted minimized the effects of such limitation, in particular: conducting field negotiations prior to the interview; the opening to carry out the interview in several meetings, if necessary; and the return of the transcript for contributions from the participants.

Furthermore, the fact that all participants graduated from public institutions may influence the study’s findings, suggesting the need to carry out further investigations with a public with other backgrounds.

Contributions to nursing, health, and public policies

Despite the emerging discourses identified, coming from women-nurses with involvement in social movements, it is noted that the idea that sociopolitical participation does not consist of health practice or the profession itself is still dominant. Therefore, the study contributes to the incorporation of strategies that encourage the activation of socio-political-emancipatory knowledge in nursing, especially those linked to spaces and means of social participation. Moreover, it contributes to thinking about ways of offering care with a commitment to reducing inequalities.

FINAL CONSIDERATIONS

It is concluded that the social context of life and work of women-nurses and the participation in social and feminist movements trigger sociopolitical-emancipatory knowledge, through exercises that inform the capacity for criticism about themselves, about the profession and about health policies. The development and expression of sociopolitical-emancipatory knowledge was also highlighted in findings around the body involvement of women-nurses and in statements that inform discursive updating and discourse as a possibility. As a result of actions fundamentally mobilized by sociopolitical-emancipatory knowledge, indications of differentiated offers of care were found in a way of acting aimed at reducing inequalities.

However, it is necessary to promote changes in the form of care commonly offered. The narrated (lack of) care exercises consist of a political practice implied by learning from social and feminist movements, linked to an expanded dimension of health, with a willingness to face clashes. This practice results from voluntary elaboration and reflection, from the exercise of awareness of the environment and social structures, open to the community, promoting the reduction of power asymmetries and the creation of networks.

There is recognition of the need for professional valorization and the relationship between the oppressions experienced and gender issues. However, the formal spaces of profession organization were treated with interdiction and rarity in the narratives, and, with regularity, notes were made about the distancing of nursing from decision-making spaces.

Considering the indications of the potential for transforming realities and producing life in social movements, we suggest carrying out studies with other objects in the middle between nursing and feminism, in order to identify rules of discourse and possibilities of escape related to nursing practice and inequality field.

SUPPLEMENTARY MATERIAL

https://doi.org/10.48331/scielodata.QTAFUH

ACKNOWLEDGMENT

We did not obtain financial support, technical assistance or other assistance from public or private institutions. We are grateful for the acceptance of the study participants, which made it possible to produce the data presented.

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Edited by

EDITOR IN CHIEF: Álvaro Sousa

ASSOCIATE EDITOR: Rafael Silva

Publication Dates

• Publication in this collection
  15 Apr 2022
• Date of issue
  2022

History

• Received
  21 Aug 2021
• Accepted
  28 Dec 2021