Nursing training in the brazilian red cross in the 1940 s : a foucaultian approach

Objectives: To identify and analyze the discursive statements that characterizes the training of human resources in nursing in the 1940s by the Brazilian Red Cross. Method: The approach of the documentary sources was through the assumptions of the Historical Method and they were questioned by using the thought of Michel Foucault. Results: Historically, a peculiar model, the military teaching model, influenced the training of human resources in nursing, especially in the 1940s. The Brazilian Red Cross was linked to the Ministry of War and its nursing education had an emphasis on moral conduct, discipline, and respect for hierarchy, culminating in the production of nurses’ “docile bodies”. The attributes expected of nurses constituted the triad in the professional formation identity at that time: dedication, discipline and obedience. Conclusion: The military model still reverberates practices in training of nurses in the present, as in the management, care and education in nursing.


intrODUctiOn
The field of human resources in health, especially nursing, both in training and professional practice, is a valuable object of study to question the constitution of knowledge, powers and practices of subjectivation of health professionals.Efficacy, efficiency and effectiveness can historically be reflected from perspectives that allow the understanding and, above all, the questioning of truths legitimated throughout the history of the profession.In this sense, the role of education, whether graduation or permanent education, is particularly considered a driving force for constituting the expected traits in the practice and social representation of the nursing professional.
The history of nursing (HN), more than accessing knowledge of the past, has been a way for students, professors and professionals to raise new questions for "truths" given or supposedly "consolidated", particularly in spite of current practices in the management of human resources and constitution of the professional identity of these agents over time (1) .History is useful for professionals, as the events may be linked to the present, and thus allow the feeling of strangeness towards practices that, because they are so "common" and "normal", remain superficial and unquestioned.The history of the profession is one of the disciplines included in the undergraduate curriculum and should be the guiding principle to discuss and foster the critical reflection of the nurse, as advocated by the Diretrizes Curriculares Nacionais dos Cursos de Graduação em Enfermagem [Brazilian National Curriculum Guidelines for Undergraduate Courses in Nursing].In this sense, history becomes a tool for deconstructing myths and untruths constituted by the strife of interests of each age (2) .
The aforementioned aspects corroborate earlier studies in the HN with a focus on human resources, particularly in light of the requirements imposed by the labor market since the beginning of the professionalization of this occupation.In this study, we highlight aspects related to a specific historical context, the 1940s, in which the behavior and moral conduct of the woman/nurse prevailed, and finally some aspects recommended as priorities in nursing human resources in to meet the demand of interests of the socio-political context of that time.
In the case of studies in human resources in nursing, the majority focuses on workforce issues and permanent education.The production in these areas is justified by the quantity of nursing human resources in the health market and people management strategies.This number is stratified into three occupational categories: nursing auxiliaries make up the largest share, followed by practical nurses and registered nurses.However, a reversal of these numbers in the not-too-distant future is predicted, because public policies geared to education are allowing greater access to university education.Because of this, many nursing auxiliaries and practical nurses are pursuing undergraduate courses (3) .
Research in human resources with a historical approach is important for nurses as a way to revisit the past and know which conditions and forces consolidated practices and truths during the trajectory of the profession, whether in health services management, nursing services and/or in direct patient care.In this sense, the people engaged in care are decisive in the production of health care and should be understood, studied, questioned and comprehended regardless of the complexity of the current health care system, whether private or public (3) .
Despite the increasing number of works produced on the HN, this area still receives little value by nurses in Brazil.Most of the studies developed in the HN uses the perspective of individual and interpretative issues of some periods of Brazilian nursing.These studies would reach even greater relevance if they analyzed and discussed its object under the prism of questioning.At all times, we must seek to know the past through the following questions: How do we become what we are?What were the conditions of possibility that allow the reaffirmation of certain attitudes in the formation and consolidation of human resources in nursing?
The HN is rich in sources that could be subjected to these issues, and thus affect their agents with discomfort, i.e., a critical eye on forces that hold sway in favor of peculiar interests in which the professionals are inserted during professional practice.
Considering human resources in nursing from a problematizing historical look, the object chosen for this study was the education model of the Escola de Enfermagem da Cruz Vermelha Brasileira, Filial Estado de São Paulo [Nursing School of the Brazilian Red Cross, State of São Paulo Branch] (EECVB-FESP) in the early 1940s, diffused by the institution itself and legitimized by the prevailing wisdom of that time; legislation, medical discourse and media resources.The choice is justified for being a peculiar social and political context in the history of Brazil, whose relevance lies in the manners of thinking about how political interests and issues interfere directly or indirectly in nursing.
The early years of the 1940s were marked by the outbreak of World War II (1939-1945), a conflict between the countries of the Allies bloc against the Axis, with a great belligerent repercussion in Europe.It is worth mentioning that in 1942, Brazil took part in the conflict as a supporter of the Allies, the bloc that included the United States.Although there was no proper war in the Brazilian territory, the government at the time, with President Getúlio Vargas in charge, was spreading the atmosphere of war, in which the entire population should be prepared for the conflict (4) .In this sense, nursing had a key role in leveraging women, and the health context, in demarcating spaces (public and private, male and female) and leveraging nationalistic and dictatorial policies in the Brazilian territory.
The objectives of this study were to identify and analyze the discursive enunciations that characterized the HR training in nursing, in the 1940s, by the Brazilian Red Cross.

TheoreTical-philosophical framework
The study was based on the thought of Michel Foucault, whose philosophizing consists in historiography as a tool for thinking about the present, not in search of truth, but questioning already given knowledge and practices.Foucault is considered the philosopher of visibilities, because his task is not to uncover what is hidden, but to make visible what, because it is so close and so closely linked to the agents, seems invisible.For the author, there is no absolute truth, but different truths about reality at different times, which meet the needs of power at a time, in a context (5) .
In this study, in order to question the discourses legitimized by efficiency, efficacy and effectiveness in the production of knowledge, powers and subjectivities in human resources in nursing, the results were discussed in the light of power as a relationship of forces that continually goes through the agents and produces effects of knowledge and subjectivation.
It is through subtle mechanisms of disciplining, in visible games of power, that subjectivities are produced.Power is treated here as a set of strategies, tactics, pacts, alliances and complicities manifested through complex sets of postures, gestures, words, silences, threats, rewards, peculiar forms of expression, networks and crossings of relationships (6) .

MetHOD
Considering the object and purpose, the study was conducted by the Historical Method, whose heuristic phase stemmed from the selection and organization of the sources, followed by the hermeneutic phase for the questioning and interpretation of documents.The sources were composed of nursing-related text and image publications of the newspaper "A Gazeta", from the period of 1940 to 1945, as well as other historical sources, as the EECVB-FESP Regulation of 1940, and diaries with curriculums from the period.The documents are preserved in the Public Archive of the State of São Paulo and in the collection of the Brazilian Red Cross -São Paulo State Branch.
Collection was performed in the years of the PhD of one of the authors (2010-2013), defended in 2014 in the Graduate Program in Nursing Management (PPGEn) at the School of Nursing of the University of São Paulo.The compilation of the documents was performed using a digital spreadsheet developed according to the enunciations identified in the collection that had a direct or indirect relationship with the discourse of human resource training in the period, which were the publicized aspects of the student/nurse graduated from EECVB-FESP represented through the discourse on being female and being a nurse, and on the issue of clothing , i.e., nurses' uniforms.
Therefore, it is a study of historical-documentary approach.The consulted documents are in the public domain and there was no involvement with human beings.However, all ethical principles in research were observed, such as obtaining an authorization from the Brazilian Red Cross -São Paulo State Branch, where documents were consulted.The other documents belong to Public Archives, such as the one of the State of São Paulo, in Brazil, and their use and reproduction in academic research is authorized, since they are also in the public domain.
Data analysis was based on methodological mechanisms created from the interpretation of the writings of Michel Foucault, who believes that in the archaeological work there are two possibilities to consider in the analysis of discourse: the first one regards the constitutive nature of discursive elements and the second regards interdiscursivity and intertextuality in discursive practices.In this perspective, the analysis of the empirical material was performed according to the following steps: pre-analysis (reading and pre-categorization), re-reading and highlighting themes, questioning, theoretical support, composition/re-composition.

reSUltS
The discourses of the Brazilian Red Cross, as the political locus of human resources training in nursing in the 1940s, depict the production of "docile bodies" in this area.In addition, the following results revealed that the mechanism of the pedagogical model of the Escola de Enfermagem da Cruz Vermelha Brasileira has not only fostered the building of a supposed professional identity, but also designed it from the military model, creating possibilities for women's emancipation.
The selection and interpretation of the documents allowed the compilation, in this study, of the following enunciations: EECVB-FESP as an institution that produces a specific model of human resources in nursing, the woman in the political discourse, the production of docile bodies, the pedagogical model and professional identity arising from the military model as the leashing strategy of this school.From the enunciations that emerged during the handling of documents, it is possible to understand that nursing was a key part of the Vargas dictatorship strategies.The appeal of care to women and comparing the nurse to the caregiver and nation guardian were tools in the search for the population's sympathy towards the model of Vargas's "New State".
Although it has arisen in a teaching model in which the disciplinary rules and moral conduct prevailed, guided by the servile role and docility of subservience to the male figure, the nursing profession was one of the ways found by women to rise and conquest the public space, whether in school, at work or in the political sphere.
Such enunciations have provided clues and intellectual framework for a historical look in which it is possible to question present practices in the training, management and caregiving action of human resources in nursing.In this sense, one must not ask the whys of such behaviors, phenomena or certain events, but what are the conditions of possibility with which certain practices are produced, legitimized and taken as truths when it comes to understanding the context of human resources within institutions.
Nursing Training in the Brazilian Red Cross in the 1940s: a Foucaultian approach www.ee.usp.br/reeusp

The Brazilian red cross: producTion of human resources for care
The Red Cross is an internationally recognized institution since it was created in 1863 by Henry Dunant during the Battle of Solferino in Italy.It has always been based on the principle of neutrality and performed humanitarian activities freely in armed conflicts or situations of public calamity.The Brazilian headquarters were built in 1908 and informally offered courses for human resources training in nursing from 1910 to 1914, when it officially opened its first course for training professional and Samaritan or volunteer nurses (7) .
HN studies skillfully broach the participation and representation of nursing between the First and Second World Wars, especially Brazilian Red Cross (CVB) nurses.However, in the 1920s and 1930s, that school decreased its activities as a training center, resuming them with dedication in 1940.The representation of nursing in 1914 and 1940 is explained by the coincidence of those periods and the beginning of the World Wars, because that school is based on training nursing professionals to meet an specific demand of a certain historical context (2,8) .
Within the framework of what was to be a woman, to be a nurse in the context of that time, it is noteworthy that the press captures and disseminates events, producing narratives that, instead of describing them, forge what is presented through a shift of the immaterial part of the event to an identity fixed within a discourse that defines both the speakable and what no one is allowed to say (9) .
The journalistic discourse reaffirms itself all the time as a valuable resource for the "governmentalization" of the attitudes and values shared by the population with regard to the nature and sphere of activities of the work of the nurse, especially in the case of CVB (10).
From the findings, some questions guide the issue of subjectivities.How has the political context influenced the HR training in nursing by the mentioned institution?What was the professional identity of these students/alumni?How were the discourses delivered at the time characterized?
The discourse about women/nurses legitimized notorious disciplinary and regulatory provisions both in media articles and in the Regulations of EECVB-FESP, especially when they disseminated a certain knowledge and behavior that were inherent and expected from the woman of that time, how they were supposed to be and act in the social sphere.
The analysis of that period allows the understanding of EECVB-FESP as a field of power and knowledge fostered and incited by several institutions that emanated discourses and practices at the time: family, religion, arts (especially cinema), school and mainly the hospital, besides discursive and non-discursive practices in the political field that regulated the aforementioned ones.All of them were legitimated in the light of the journalistic discourse.

women in The poliTical discourse and The producTion of docile Bodies
The foundations of the 1940s in Brazil were a dictatorial government that resonated in the social division of labor, the alliance between the Church and the State in the dictates about male and female spaces as well as female submission and the reclusion of women in the private space.In this sense, women represented most of the nursing HR and the CVB, an organization institutionalized by the government and the church, knew assertively how to use female qualities to reproduce and legitimate the occupations that were appropriate for women.
EECVB was depicted daily in the media as an opportunity for women to act in favor of the nation.Women's features as femininity, sweetness and subservience were requisites valued by the State and legitimated by the Church.Both were considered by Foucault as disciplinary institutions, i.e., they take individuals away from family and society in order to shape conducts, discipline behaviors and format thinking, for that is how they control time, space and the knowledge of subjects (11) .Those were convenient strategies in the production of docile bodies useful for the political interests at the time.
Foucault considers every educational system a political way to maintain or modify discourses through its power and knowledge (5) .In this way, the philosopher invites us to think language beyond what it means, as truth, whether temporary or permanent, but truth.He also highlights the several ways in which it may be told, the manners and creative diversity to tell this or that truth (6) .
"Truth" may take the form of science, scientif model or enunaciations produced in the institutions and control practices.In this case, the knowledge of EECVB-FESP produced processes of subjectivity with specific characteristics as a part of ethical discernment, to do or not to do something, to serve the motherland or not (2) .
In 1942, when Brazil declared its participation in the war, the CVB magazine published several issues in simulating Brazilian women's voice towards President Getúlio Vargas.In these notes, women declare unconditional support and being ready to fulfill their "women's duty".
In the Foucaultian perspective, it may be inferred that EECVB-FESP worked in a certain way as a "disciplinary institution" that aimed at controlling not the students' time, but their bodies, duties and actions, shaping behaviors.
It was an institution specialized in education, and that implied total discipline of the student's existence, rules that exceeded its apparently precise purposes.
In the context of human resources management in nursing, or people management, the development premises of nurses are the imperatives dictated by the job market, interests that are presented most of the time in a subtle and imperceptible manner, but have the purpose of leashing agents to serve the interests of the established power.The highlights of this line of reasoning are: discipline, control, demarcation of time and space, and legitimation of consolidated knowledge in the health field.In the knowledge field, nursing has always been recognized for the doing, moral conduct and behavior rather than intellectual knowledge, which another area of health is recognized for (12) .
In analytical reflection, the historical-social context must be considered when the analysis is based on the production of human resources in nursing, i.e., the possibilities that enabled us to become what we are is always mandatory in the Foucaultian analysis.The strategies for producing docile bodies in human resources are aimed at the relations of forces of a certain strife of interests.Just like Vargas' dictatorship had its strategies, the present has its own, leaving the professionals with the passive displacement to become critical agents of their time, of their know-how-to-do, know-how-to-know, and, above all, know-how-to-be.

The pedagogical model and professional idenTiTy from The miliTary model
In nursing training, the model of EECVB fostered the identity construction from the perspective of the education marked by military prerrogatives spread by school.Professional identity refers to the feeling of being part of a certain professional unit, with its common symbolic body of intellectual and moral qualities (13) .It is formed in different moments, starting in the classroom, followed by the first contacts with the object of care (in the case of nursing), interacting with other agents as the experiences happen in daily practice, in constant professional development (14) .
Although this term is widely discussed nowadays, it is a challenge to analyze and discuss the pedagogical model at a time when knowledge was not built from the development of competences, which means that teaching, regardless of the area of knowledge, was reproduced from the holder of knowledge -the teacher -to the learner, characterizing passive leaning.
The normalization of conducts is clearly identified in the biomedical approach of elementary nature of the curriculum in the EECVB-FESP Regulation of 1940.The term "notions" that precedes the names of the subjects emphasizes the superficiality with which the theoretical content was delivered, for intellectuality and depth of knowledge were limited to the physician (8) .The other subjects, such as Work Ethic, were based on moral conduct, religiousness and obedience, highlighting the docile profile expected in the actions of nurse towards the patient and the other members of the healthcare team (15) .
It is relevant to remember that, in Brazil, the connection of nursing with women, due to innate qualities and skills considered innate to them, is quite evident in the early 20 th century (16) .The cause of female subordination would be related to the symbolic association of women with nature, while men would be symbolically connected to the public sphere.Women would be linked to the symbol of nature for being the provider of life and the caregiver in the house, and their bodies put them in social roles that are considered inferior to those of men in the cultural pro-cess and in relations of power, causing the depreciation of women in fields of power.
Within a family context, the woman is given the culturally built social role of taking care of the children and of the house, a classification scheme linked to the subjectivity.When women "invade" the public environment, they may suffer discriminatory processes, because the same positions of men in the public space may lead to unequal distribution of resources, which are understood as power, prestige and status (13) .
In this sense, this study aimed at reflecting on the crossings of networks of power that existed within the school field, and still exist, especially in the fields of practice of nursing professionals.Passivity and resilience still are competencies expected and developed in human resources within institutions.It is noteworthy that subjects are immersed in institutions from the moment they are born until their death; whether they be family, school, religion, etc. "Institutions" come from the etymological sense, "to institute" (to establish, to decide) meanings literally connected to educational and religious precepts.
It may be stated that the choice for nursing represented a possibility of reconciliation between the religious morality and professional emancipation, which is why so many young women chose the nursing career as a possibility of exploring the public space (14) .
According to Foucault (5), "the important point is to know in what forms, through what channels, flowing through what discourses power reaches the most tenuous and individual conducts.Which paths allow it to attain the rare or almost imperceptible forms of desire, in what way the power penetrates and controls everyday pleasure -all with effects such as refusal, blocking, disqualification, but also incitement, dissatisfaction; in short, polymorphous techniques of power." In the discriminatory context of role segregation according to sex, other institutions -school among them -kept reproducing and producing spaces for such inequalities.
Foucault, studying the articulations between power and knowledge, reports that different knowledges intertwine and organize themselves to become a will to power.In his understanding, power, in its positivity, is related to the production of knowledge, whether for the purposes of transformation or leashing.However, power acts on free subjects, in which there is always the virtual possibility of resistance (12) .
In this light, school can be understood as a privileged field of power and production of subjectivity.It is a space that allows a network of crossing of several powers, with the emergence of areas of tension, of correlation of forces, of the exercise of power, institutional strives of power/knowledge/truth which delimit and constitute the different levels of subjectivation of the training process; in the case of EECVB-FESP, a markedly militarized nursing (17) .
Examples of knowledge of this school can be identified from documents legitimated as a source of knowledge that is inherent to the "good mother", the "good nurse" and exemplary woman produced by CVB.
nursing as condiTions of possiBiliTy for female emancipaTion Femininity, in recent centuries, has been a ground on which discourses from various institutions proliferate, in addition to influencing subjects themselves.The present study is contextualized in a period marked by great mobilization in favor of female emancipation, and nursing also had an active participation in movements driven by leading nurses during that period (14) .
There are no clear signs of the participation of EECVB-FESP in the articulation of the issues that fostered the feminist movement at the time.However, one of the most prominent leaders in nursing in the period, Edith de Magalhães Fraenkel, who graduated from this school, was a friend and fought with Bertha Lutz for the feminist cause in Brazil (18) .Bertha, since the early 20 th century, became known to the general public by advocating the expansion of civil and political women's rights (19) .
Although contradictory, the assertion of feminist movements articulated by nursing date from Florence Nightingale.In this sense, there are authors who consider her "feminist", especially for her family's displeasure when she decided to become a nurse and for Nightingale's rejection of the social expectations for a woman in the Victorian Era.However, other authors disagree with this idea when reflecting on some attitudes from Nightingale that were contrary to the feminist view at the time, such as not agreeing with the admission of women in the medical profession and not agreeing to participate in the Women's Suffrage Movement Society, for women's vote and expanding their rights in the English society (20) .
The reason why there seem to be no records of the involvement of EECVB-FESP can be answered through publications of the time.The authors of daily newspaper chronicles signed with pseudonyms, and their texts made clear that any movements with feminist or emancipative traits were not desired in the Vargas dictatorship.However, female nurses with distinguished achievements emerged during this period of war and knew how to identify escape routes in the profession -make themselves noticed and take advantage of these benefits, especially in favor of female emancipation.
It was during the "New State" that President Getúlio Vargas regulated, among other issues, female work -which, in addition to strengthening the emancipation of women, contributed to their reconfiguration in Brazilian society (21) .
The expansion of the media, through newspapers, magazines, radio, cinema and telephone, favored the breaking of the traditional female image and the structuring of a new social order.Contrary to what is said, one should pay attention to the forged image of nursing during war."Even though labeled by stereotypes created by male domination, the professionalization of nursing was predominant in the emancipation of women, highlighted and valued by its noble mission" (16) .
The press, during World War II, offered prominence to the subject of women, especially when relating them to military aspects.The "A Gazeta" newspaper had a section named "Página Feminina" ["Women's Page"], and between the various subjects "suitable for women" in society, gave distinction to Brazilian or American nurses, depending on the alliances between Brazil and the United States that were made in that period.This prominence directed at the nurse also conferred the effect of appeal and consolidation of a expected profile of women in society, which is explained by Foucault as lines of forces from a discourse that institutionalizes it, legitimizes it as a device, a historic urgency (22) .In the daily newspapers of the time it is possible to observe the exaltation of nursing, also represented by the film industry, in addition to the aspects of military uniforms tailored for nurses and published in the local press.It is worth saying that they were always inspired by the American model as a legitimation of the discourse.
Nursing was not out of one of the most successful endeavors of the Good Neighbor Policy in the media, especially in movies and newsreels about the United States.The artifices employed in this conquest orchestrated the production of reciprocal empathy in the communication area (4) .
It is important to realize that, even when it comes to film characters, the print media published a heroic and humanitarian image of nurses, although they have also been represented by sensual pin-ups a during both world wars.Thus, the appeal and the interests of various media and fields of practice of the profession in favor of recognition and identification of social agents should be noted.

Final cOnSiDeratiOnS
This study deals with three historical perspectives: the CVB training of nurses, the expected social role of women and the ways that nursing provided for the rise of women in that context.Those are lines of thought that enable us to reflect on the reproduction and production of human resources in nursing in a given period of Brazilian historiography, and also that some strategies are repeated almost imperceptibly in the present day.
The study allows us to observe that, like the history of life, the history of institutions, the history of managerial practices, particularly of the human resources management in nursing, should receive a questioning historical look, thus fostering a critical reflection by both the professionals of this area, and nursing students in all levels of their education.
The analysis of the media documents and regulation of the school at the time are tools that can demonstrate the techniques of docility, discipline and leashing to which nursing was subjected in order to produce worka Pin-up is a kind of art that was very diffused in both world wars and whose sensual images were produced on a large scale and had a strong appeal in pop culture.Intended for informal display, pin-ups constitute a mild type of eroticism.Women considered to be pin-ups are usually models and actresses; however, it is possible to find other types of pin-ups that are the more "well-behaved", but also use the pin-up erotic connotation.