THE EXPERIENCE OF A WOMAN WORKING IN NURSING SUFFERING FROM DE QUERVAIN’S DISEASE

El presente es un estudio de caso cualitativo fenomenológico sobre la experiencia de una mujer trabajadora portadora de la Lesión De Quervain, un disturbio osteomuscular relacionado al trabajo. Siendo el objetivo comprender como es el ser una mujer trabajadora de enfermería dentro del Centro de Material y Esterilización de un hospital particular con un disturbio osteo-muscular relacionado al trabajo. Se utilizó el referencial filosófico de Martín Heidegger para el análisis comprensivo de la entrevista. El análisis mostró que el proceso fisiopatológico originó cambios en su vida, caracterizados por las manifestaciones dolorosas y especialmente por limitaciones físicas, lo que generó una multiplicidad de sentimientos. La angustia esta presente dentro del proceso de aceptación de la enfermedad, momento en el cual, la trabajadora percibe la fragilidad de su existencia y se reconoce como responsable de su cuidado, alcanzando la autenticidad y transcendiendo la enfermedad.


INTRODUCTION
In our professional experience, we have perceived that the reality of nursing workers has been marked by daily activities loaded with bad work conditions, caused not only by a lack of human and material resources, but also by the stress inherent in hospital activity.
Most hospital institutions have a highly complex and diverse service structure.However, this does not reduce the workers' exposure to countless problems (1) .
The work conditions offered by hospitals and the peculiarities of nursing work, associated with the difficulties in the health sector, contextualize nursing professionals' work situation in different countries (2) .
Despite the whole beneficial dimension attributed to work, it is known that, in nursing, various experts have looked at the exhaustion, discouragement, frustration and desire to give up the profession (3)(4)(5) .
As nursing professionals are predominantly women, a differentiated look on these workers is needed, who mostly work a double or triple journey and is responsible not only for housework, but also for professional activities.
This fact causes countless health problems, when even affect official mortality and morbidity statistics between the two genders, with higher morbidity rates among women and higher mortality rates among men (6) .
In the context of female nursing workers' illnesses, Work Related Musculoskeletal Disorders (WMSD) stand out.This name includes a group of illnesses, such as tenosynovites, tendinites, De Quervain's disease, synovites, and peripheral nerve compression syndromes, besides more disseminated symptoms, such as myofascial syndrome, fibromyalgia and reflex sympathetic dystrophy (7) .
De Quervain injury is also known as Tumors may appear in the painful regions (8)   .
In most cases, the symptoms initially appear insidiously and are more predominant towards the end or produce peaks, with rest giving some relief.
However, over time, the symptoms can become frequent during work and even affect the worker's extra-occupational activities (9) .
Due to the countless symptoms included in WMSD, some diffuse and others well delimited in anatomical and/or physiological terms, diagnosing and proving the disease is not always easy, which turns the process of looking for adequate treatment even slower (10) .

METHODOLOGICAL TRAJECTORY
We carried out a case study from an existential phenomenology approach, about the experience of a 40-year-old nursing worker, who is married and mother of two children, has been phenomenon, considered as anything that shows itself, manifests itself, appears to a conscience that questions it, giving up prejudices and premises (11) .
Heidegger's thinking is about an awakening based on the question of the meaning of being, seeking to unveil its comprehension, considering phenomenology as a way to access the understanding of human existence (12)(13) .
The human being's basic way of existence is "being-in-the-world", in which man is understood based on the world he is in and how he relates to it, to objects and people, opening up to himself and the world (14) .
In this context, the nursing worker who experiences the disease process can, to the extent that she opens up to herself and the world, question herself about her own existence in the world, perceiving the fragility of her existence brought about by the WMSD symptoms.Thus, another ontological characteristic defined by Heidegger is the anguish that emerges when the human being becomes aware of his existential instability.Moreover, according to this philosopher, it is also when acknowledging herself as a being-for-death that this being can find her authenticity, a moment when this woman can transcend the disease (15).
As described above, we used Heidegger's existentialist reference framework, in the belief that the structures the author proposed could serve as a mark in the comprehensive analysis of this nursing worker's testimony, who is experiencing a work related musculoskeletal disorder (WMSD).

CONSTRUCTING THE RESULTS
After the interview, we transcribed the collected discourse in full.Next, we read and reread the transcriptions to find units of meaning, that is, significant extracts of discourse, in view of Martin Heidegger's propositions.The following step was to group the units of meaning according to similarities, which gave rise to themes that constituted the Ontological Unifications (16) .
We present the ONTOLOGICAL UNIFICATIONS identified in the discourse of the female nursing workers who suffers from De Quervain's disease, which revealed the being a female nursing worker living with the WMSD: Being-in-the-world living with the WMSD Considering that man is understood based on the world he lives in and how he relates to this world, being a woman in the world, working in the nursing team, living with a WMSD is much more that experiencing pain and professional difficulties.It also includes living a daily reality of impossibilities to perform even simple daily tasks, as presented in the discourse extract below: ...and at my house too I couldn't do anything anymore, I couldn't even manage to pull up the blanket to cover me...

(Marília)
In daily life, the meaning of many things only appears to the human being when something is missing, that is, the experience of a loss or limitation evidences the meanings that had been hidden or ignored until then (14) .
The female nursing worker starts a process of perceiving herself in the world as she is, living with her different impossibilities, considering the many modifications in her physical abilities that disable her not only for work, but also to perform simpler activities related to her own self-care.
The nursing worker's testimony reveals that, despite the pain, the limitation, she continues working and insisting, resisting her intense pain and making efforts not to take leave from her professional activities: ... The nursing worker still performs her professional activities, attempting to prove to herself that she is still able, although this often represents the most relevant factor for the worsening of her injury.Her being-in-the-world is intensely modified through the alterations resulting from the WMSD, as these manifestations unavoidably occur and this woman finds herself obliged to live with the changes because, although she is ill, she still lives with herself and the world, establishing simple relations of existing in the world, suffering from the pain and her limitations.

The nursing worker living the ambiguity of solicitude
The nursing worker living with the WMSD can experience other people's concern about her and her health condition.This concern is based on the ontological constitution of the pre-sence as being-with, guided by consideration and tolerance or patience towards the other, the so-called solicitude (14) .
. The impersonal is present all over, in which the whole world is the other and nobody is himself and this experience totally dissolves the person's own pre-sence in the way of being-with the others, in a way that the others disappear even more in their possibility (14) .
Besides this difficult observation, there is the nursing workers' hidden prejudice: The prejudice and discrimination also extend to her nursing team colleagues, evidencing neglect in daily relations.This situation tends to generate even more suffering in the worker as, although the world is shared, the experience of being a WMSD patient is individual.
The anguish of living with a WMSD In the context of acquiring a WMSD, it should be emphasized that many modifications result from the physiopathological process.Considering that, in most cases, women are responsible for home and professional activities, the new situation, marked by painful manifestations, decreased muscle strength and restrictions to perform many activities, this obliged the nursing worker to become aware of the fact that her life changed, that the transformations caused by the disease already established themselves and that her future is uncertain.
We observe that uncertainties about her physical abilities, commitments and response to treatments made her experience anguish: When she talks about "right hand", it is evidenced that, in her relation with the world and its things, she perceives her disability and starts to question her existence, in which "wanting to die" seems to be the end of everything, the end of getting confronted with such an and personal fragility.This exposes the worker's anguish, who perceives herself as a beingfor-death.
Death is the most personal, most singular of the possibilities of being-there, and that is exactly the source of anguish.In this aspect, when thinking about her limitations, the female nursing worker who lives with the WMSD approaches her finiteness, where she'll be able to live either authentically, opening up to herself, or inauthentically, in function of the fear of getting confronted with herself and with her beingtowards-the-end (14) .
Moreover, the worsening of the disease gives rise to the feeling that she could never practice her profession again, which created an enormous feeling of incapacity.In this phase of the disease, the anguish this worker experienced was so intense that it exerted a decisive influence on her treatment, in which she acknowledged the need to invest in psychotherapy, as revealed by the following statement: ...at some moments, I thought I could not even work any longer, and then I started an intense psychotherapy treatment...I really needed that (crying, silence) (Marília).
It is when acknowledging the possibility of death that the human being finds his authenticity, as death is an unconditional and insurmountable possibility.Therefore, for the author, anguish is a kind of ontological nausea that invades the human being when he is close to understanding the uncertainty of his existence (14) .
In this aspect, when confronted with her reality in view of her finiteness, the woman decides to face her new life situation.At this moment, she starts to live in her authenticity.In this aspect, the phenomenologist describes that it is only through the opening of the pre-sence that the most original phenomenon of truth is reached, and that the pre-sence exists in the truth (14) .
The course the nursing worker followed made Marília's discourse demonstrates that, in transcending the disease, she acknowledges the symptoms and gets to know ways to relieve her pains, allowing her to establish self-care means, instead of waiting for solutions from other people.
In creating awareness of herself, her limitations and fragility, the ontological-existential condition remains of the possibility of being free for the actually existential possibilities (14) .
Thus, her experience of living with the WMSD allowed for the possibility of being-herself, with her limitations and commitments, facing her truth and history, acknowledging her fragility as well as her possibilities in the world.

FINAL CONSIDERATIONS
In understanding the phenomenon of beinga-female-nursing worker living with De Quervain's disease, we could understand that, in getting confronted with the disease process, this woman experiences a multiplicity of feelings.
The worker revealed that living with the WMSD, or being-in-the-world living with the WMSD tenosynovitis of the radial styloid, resulting from the constriction of the common sheath of the long abductor and short extensor tendons of the thumb.It mainly affects women over 40, and is associated with occupational exposures that require repetitive thumb movements, pinching of the thumb with flexion, extension, rotation or repeated ulnar deviation of the carpus and use of scissors for long periods.The clinical picture is characterized by projected pain in the styloid process of the radial nerve with or without irradiation in radial projection until the shoulder and which increases through active radial abduction of the thumb.
July 2004 at the worker's home, in São Paulo City and took 42 minutes.It was tape-recorded with the woman's authorization, through the Free and Informed Consent Term.To conduct the interview, we used the following guiding question: What is it like for you to be a female nursing worker and live with a WMSD?The aim of this question was to guide us to this woman's world-life, based on her own experiences, considering that the phenomenon of being-a-female-nursing-worker living with a WMSD can only be unveiled when starting from the subject who experiences the disease, the pain and the suffering caused by the WMSD.It should be emphasized that, before holding the interview, this study was assessed and approved by the Research Ethics Committee at the University of São Paulo College of Nursing (EEUSP).
managed to achieve, arrive where I wanted...in this one year she saw my work, you know, she has complimented me...
...then I went back there and I did well, like, I really managed to do very well...like, today I manage, not for them, for myself I The experience of a woman... Leite PC, Merighi MAB, Silva A.Rev Latino-am Enfermagem 2007 março-abril; 15(2):253-8 www.eerp.usp.br/rlaeinsertsherinto a daily reality that is characterized by pain and many limitations, which causes physical and mental suffering.The fact that she is often obliged to take leave from work arouses the feeling of incapacity and unproductivity in this woman, as it is through work that she becomes a relation, exercises her knowledge and feels valued.She has experienced the solicitude of a health professional who, as her discourse evidenced, seems to have been responsible for warning her about her real situation.However, unfortunately, the neglect stands out which she mentioned about occupational health professionals as well as her own colleagues, groups that are so close to daily life and, at a fragile moment, revealed such an impersonal attitude towards her suffering.Anguish is part of the feelings the nursing worker in this study experienced, especially because she perceived herself in a new life context, being aware of her fragility as a being in the world.However, despite experiencing all of the difficulties deriving from the physiopathological process, it was evidenced in her discourse that this woman faced the new reality, discovered her role as a caregiver for herself, to the extent that she accepts herself with the disease, gets back to work, re-elaborating her functions, transcending the disease, finding herself in the new life context and attributing a real meaning to her existence.