FIRST GENERATION OF NURSES TRAINED IN MAGALLANES, CHILE: ELEMENTS OF THEIR PROFESSIONAL IDENTITY

PRIMEIRA GERAÇÃO DE ENFERMEIROS(AS) FORMADOS(AS) EM MAGALLANES, CHILE: ELEMENTOS DE SUA IDENTIDADE PROFISSIONAL

ABSTRACT

Objective:

to know the main elements of the construction of the professional identity in the first generation of graduated students from the Nursing course in Magallanes, from 1972 to 1976.

Method:

a historical research study with a qualitative approach, where the five graduated students from the first generation and a woman professor constitute the main source for reconstructing the past through oral thematic history. Data collection was performed by means of a semi-structured interview. The collected data were organized with the help of the Atlas Ti^® program, then performing thematic content analysis based on Claude Dubar's concepts on identity types.

Results:

there are elements present in Dubar's exposition, such as the identities as an individual nurse and as a social nurse, whose constructions actually start prior to the beginning of the academic training in order to shape a new identity through successive reconstruction processes during the whole curricular process; however, in this group the importance of the faculty of that time stands out as a fundamental element in the construction of identities.

Conclusion:

the importance is evidenced of the identity projected by the professors in charge of the academic, theoretical, practical, and value-related activities, since they will model the identity the students will build when exiting their classrooms, reason why those who direct the training of the future nurses must consider both the historical and social moment of the generation being trained, as well as the competences, values, and own identities of those who train them.

DESCRIPTORS:
History; Nursing; History of Nursing; Profession selection; Nursing education; Professional identity; Social identification

RESUMO

Objetivo:

conhecer os principais elementos da construção da identidade profissional na primeira geração de enfermeiros titulados do Curso de Enfermagem em Magallanes, entre 1972 e1976.

Método:

pesquisa histórica, de abordagem qualitativa, na qual os cinco titulados da primeira geração e uma docente conformam a principal fonte de reconstrução do passado atráves da história temática oral. A coleta de dados foi realizada por meio de entrevista semiestruturada. Os dados obtidos foram organizados com a ajuda do programa Atlas Ti^®, realizando-se, posteriormente, a análise de conteúdo temático, basada nos conceitos de Claude Dubar sobre formas identitárias.

Resultados:

há elementos presentes nas considerações de Dubar, como as identidades como enfermeira individual e como enfermeira social que, de fato, começam a ser construidas antes mesmo do início da formação acadêmica, e través de sucessivos procesos de reconstrução durante o desenvolvimento curricular, formam uma nova identidade. No entanto, neste grupo destaca-se como elemento fundamental de construção de identidade, a importância do corpo docente da época.

Conclusão:

evidencia-se a importância da identidade que projetam os docentes a cargo das atividades acadêmicas, teóricas, práticas e projetoras de valores, pois modelam a identidade que será construída pelos alunos que forem formados em suas aulas. Desta forma, quem dirige a formação de futuros enfermeiros deve considerar o momento histórico e social da geração que está sendo formada, bem como as competências, os valores e a identidade própria dos encarregados de sua formação.

DESCRITORES:
História; Enfermagem; História da enfermagem; Seleção de profissão; Educação em enfermagem; Identidade profissional; Identificação social

RESUMEN

Objetivo:

conocer los principales elementos de la construcción de identidad profesional en la primera generación de titulados de la carrera de Enfermería en Magallanes, en el período de 1972-1976.

Método:

investigación histórica, con abordaje cualitativo, donde los cinco titulados de la primera generación y una docente, constituyen la principal fuente de reconstrucción del pasado a través de la historia oral temática. La recolección de los datos fue a través de una entrevista semiestructurada. Los datos obtenidos fueron organizados con la ayuda del programa Atlas Ti^®, para posteriormente realizar el análisis de contenido temático, basándose en los conceptos de Claude Dubar sobre formas identitarias.

Resultados:

existen elementos presentes en lo expuesto por Dubar, como son las identidades como enfermera individual y como enfermera social, que efectivamente se comienzan a construir previo al inicio de la formación académica, para a través de sucesivos procesos de reconstrucción durante todo el proceso curricular, formar una nueva identidad, sin embargo, en este grupo destaca como elemento fundamental de construcción de identidad, la importancia del cuerpo docente de la época.

Conclusión:

evidencia la importancia de la identidad que proyectan los docentes a cargo de las actividades académicas, teoricas, prácticas y valóricas pues modelarán la identidad que construirán los estudiantes que egresen de sus aulas, es por ello que quienes dirigen la formación de las futuras enfermeras y enfermeros deben considerar tanto el momento histórico y social de la generación que se está formando, cómo las competencias, valores y propia identidad de quienes los forman.

DESCRIPTORES:
Historia; Enfermería; Historia de la enfermería; Selección de profesión; Educación en enfermería; Identidad profesional; Identificación socia

INTRODUCTION

The Region of Magallanes, Chile, is located in the Southern end of the American continent, constituting part of the Patagonia, a harsh and isolated region which can only be accessed by sea or by air from the rest of the country. Undoubtedly, it is much quicker now to move to the center of the country to attend higher studies, but 45 years ago it represented individual and, definitely, family sacrifices which not everyone was willing to make.

In the 1970s there was an unmet need: undergoing university studies in a health area like Nursing in Magallanes, which, although having a house of the State Technical University (Universidad Técnica del Estado, UTE), its academic offer was only related to the fields of Engineering. It was then that a group headed by the University rector sets out to create the Nursing course in the South house, after determining that there existed conditions both in terms of infrastructure and of human resources^*.

In the years 1970-1971, experts in Human Resources training of the UTE, female Professor-Nurses of the Medical School at the University of Chile and the Ministry of Health, among whom was Lidia Vidal^**, perform market studies, as well as of students, curricular environment, clinical fields, and health professionals in the region, in order to determine if the efficiency conditions to create the Nursing undergraduate program were met.

Nursing was in a professional historical moment marked by the status it had acquired due to its participation in the Public Health campaigns that managed to eradicate big health evils like child mortality and malnutrition, themes already described in a study on the identity of the Chilean nurses in times prior to the 1970s.1^-2

At that time, many young women had to leave their homes and travel to the center of the country when they decided to attend the Nursing undergraduate program, and had to consider their own expenses related to such move, something that not all could afford, or whose families were not willing to allow, besides the separation from their families.

The Nursing program is officially created on May 4^th, 1972, with 35 men and women admitted to an eight-month curriculum which granted them the graduate degree of Nurses^***.

Shortly after the start of this new project, the 1973 Coup d’état stroke Chile. In general, this meant a violent and drastic rupture to the ongoing democratic process in our country until then. This rupture affected all the areas of development of the country, and education was not the exception since it moved from an education inspired in democratic socialism to a process where the State is a subsidiary participant, public education co-existing with subsidized private institutions.3

In view of the above, it is extremely relevant in the Magallanes Nursing history to know how the course was born, as well as the identity attained by this group when they finished their pre-graduate training.

History is part of the reality where we live because, if we know who we were, we can better understand who we are and, in that way, shape a better future for our profession.4

The study of the socio-identity processes is directly related in this case to the study of the history of Nursing, separating the essence of Nursing from what Nursing does. Identity is built in society; for this reason, it does occur only once: it is constructed and reconstructed in successive socializations and it can be modified by life experiences during academic or professional training.5

When thinking about the Nursing profession and assimilating it into Dubar's postulates5 which set forth that the socialization of identity must go through two stages where the first stage is the attribution of identity given by the agents and the institutions with a direct relationship with the individual; in the case of Nursing, we might think that the health institutions and the very professionals who work in them would provide this first stage to the students. The second stage would correspond to the internalization of the identity by the very individuals by means of their self-construction and of the legitimization of those who identify them as nurses. When both stages are fulfilled, the result is called identity types.5

Thus, the objective of this study was to know the main elements of the construction of the professional identity in the first generation of graduated students from the Nursing program in Magallanes, from 1972 to 1976.

METHOD

This is a socio-historical research study with a qualitative approach, where the graduated students from the first generation constitute the main source for reconstruction of the past through oral thematic history.6 “Nursing gains strength from historical studies because they disclose all the historicity instilling new dimensions of knowledge and practices, with various views of the world and of science”.6^:9 As its main source for the reconstruction of the past, oral thematic history uses verbal testimonies related to the interest in a specific topic, professional identity in this case, and it generally starts from previously documented assumptions.7

The main source for data acquisition was constituted by the experience reports of the graduate students from the first generation trained in Magallanes in 1976.

Although 21 students graduated in that first generation, it was not possible to locate them all through the current communication means: social networks, e-mail or mobile telephones. We managed to reach ten of them, apart from the fact that one of the graduates had died. Mrs. Lidia Vidal, who, together with her husband, Roberto Bravo, directed the creation of the Nursing course in Magallanes, was also incorporated to the interview. This decision was based for considering her as live history at her 100 years of age, in a current health condition which allowed her to share her memories from that time.

Of the 11 individuals contacted when coordinating the interview, only six accepted: five women and one man. The others had health problems or were on vacation abroad. Data collection was performed by means of a semi-structured interview lasting approximately 45 minutes, in the place agreed upon by the interviewees, be it workplace, home, or via Skype^®, in the case of those who were away.8 The interview had questions directed to the description of the participants and open questions on the construction of their identities. The interview questions were built in such a way so as to allow knowing the participants' experiences in relation to the personal identity they built as nurses, as well as those related to their identity in society, namely: ¿What did you think about nurses before entering the course?, ¿What motivated you to study Nursing?, ¿What changed from your initial opinion during your academic training?, and ¿What do you think were the elements that shaped your current identity as a nurse?, among others. The interviews were conducted between September and December 2018.

The inclusion criteria were the following: having graduated as a nurse in the first generation of graduates (1976), o having been a professor of that first generation, being available for the interview, being in physical and psychological conditions that allow their participation in the research, and accepting being interviewed and recorded.

The exclusion criteria were the following: not graduating in that first 1976 generation despite having entered with the rest in 1972, and having any health condition which prevented them to access to a recorded interview, due to mental or physical pathologies either expressed by the graduate or by their family.

Subsequently, the interviews were transcribed in Word^®, and the data obtained were organized with the help of the Atlas Ti^® program, to then perform thematic content analysis,⁶ which includes three stages: pre-analysis; exploration of the material; and treatment and interpretation of the results, with the theoretical base of Claude Dubar's concepts on identity types.5

The study was approved by the Scientific Ethics Committee of the University of Magallanes, Chile, fully complying with its guidance and rules.

RESULTS

It could be concluded that there elements present in Dubar's exposition, such as the identities as an individual nurse and as a social nurse, but that the fundamental element of identity construction was the professional identity projected by the faculty of that time.

The results obtained were grouped into three categories: Personal identity as a nurse, Social identity as a nurse, and The importance of the professional identity of training professors.

Personal identity as a nurse

The first category is related to what the respondents considered “being a nurse” and to what they longed to be, that is, “what type of nurse I want to be”. The respondents had a concept of what it meant to be a nurse before entering their pre-graduate training:

When I was 5 or 6 years old, I travelled to Río Gallegos and, as it was in Argentina, I had to get a vaccine against Smallpox, Chile had already won over it, but not Argentina, so they took me to the regional vaccination center, a nurse with a white apron took care of me, she was very tall, very imposing, in a vaccination center where everything was chastity white and there was a smell of alcohol or disinfectant, this nurse was really sweet and explained everything to me, in time I remembered that, when I got out, I told my mum I wanted to be like her (M. N1).

I didn't know any nurses back then, but we had a very good vocational orientation there in the Punta Arenas high school for girls, and professionals from different areas and among them nurses, went there many times to give us lectures, they impressed me with their excellence and knowledge, I was fascinated by the idea of embracing that profession (L. N2).

I liked nurses back then, you entered the hospital and the nurses were Lady nurses, they had that self-confidence with their cloaks. [...] That image was associated with dignity, with the gift of command, with good treatment, with authority (N. N4).

About the nurses, due to the experience of my mother's disease, I knew they helped people to recover their health, it was a noble act (E. N5).

From the analysis of these answers, the previous image that the respondents had of the Nursing professional stands out, which was rather related to what they did or to the functions of the nurse, which, at the time, was more related to technical tasks, and the association with immaculateness and with a position of respect, reasons that motivated them to study Nursing.

Additionally, and complementing this identity, they modeled through their training a broader identity associated to the various dimensions of professional development:

Before I entered the course, I identified nurses with the assistance area and, when I entered first year I became aware of the four areas, which potentiated the role of the Nursing professionals in society and not only in their work environment (M. N1).

The truth is that I could realize all that a nurse could do, but that image of a respected and knowledgeable professional that fascinated me in high school remained unchanged (L. N2).

Of course, as we progressed I realized what the true function of the nurse is and how important and transcendental it was, in the whole process of the person itself, as a professional and, on the other hand, from the social point of view and, on the other hand, also from the work performance perspective (I. N3).

The elements which contributed to shaping the professional identity were related to the desire to care for others, through a professional career in the health area, in this case Nursing, but the personal history processes, the families, and their social origins were also influential.

Social identity as a nurse

Another category evidenced in the analysis was that of the identity as a nurse, but from the social point of view, that is, how society perceives them or says what they are, especially in the Magallanes region at that time.

We can differentiate two moments: one when they enter the course and the other when they are already professionals; thus, when starting the process, we find:

The community saw with very good eyes that they were trained here because the profession was valued, since nurses were very distinguished and really identified as such, they used circlets and cloaks. They were bosses, they were authority. They were also very few, that's why they stood out (M. N1).

There were few nurses at that time, but they were respected and valued in the public system, there was only the public system back then. [...] Nurses were very well-ranked professionals, very respected, then studying Nursing undoubtedly gave you certain status in the society of the time (L. N2).

The nurse was seen almost as a doctor, the nurse was by the patient, she was important (I. N3).

It was perceived as something positive, Nursing was a distinguished profession, seeing the nurses with their uniforms and their cloaks gave them an image which inspired respect and authority (E. N5).

Their image was very high, and it was always like that, the first class was excellent, a lot of vocation, that helped raise the course, it was born with a lot of prestige (L. N6).

In view of the above, we can assert that the respondents perceived that, for the Magallanes community of the time, being a nurse was related to prestige, status, and social value; such social identity was related to the very construction of being a nurse.

This did not change when they were inserted into the working world; rather, that relationship was reasserted which confers high social value to the nurse:

As I was born in Magallanes and studied here, people knew me; I used to work in health brigades, so they already identified me with helping others, the work environment did impose challenges on you, I had just graduated, the environment imposed challenges, I took them on, and I came out victorious, community valued that (M. N1).

They saw you as someone respectable, willing to take on challenges, despite being young (E. N5).

As I was telling you before, nurses were respected and, as a university professor myself, I was of course respected, even more at that time when the course was starting, all that which I loved at the beginning or even before entering, I lived it personally (L. N2).

They saw me as someone who was self-confident, knowledgeable and capable of reaching the patient and the staff, they respected me, nobody ever disrespected me, despite being young (I. N3).

The importance of the professional identity of training professors

The third category identified was mentioned by all the respondents and is related with the importance of the identity of the training professors of the time, who constituted fundamental cornerstones, clearly identifying some of their conducts in themselves when performing their work, still maintained in some up to the present day:

It's very important to consider the modeling offered by the professors, both at the university and those who perform in the clinical practice. [...] the women professors of that time were diverse, some were warm, others were not, they helped from their perspectives. [...] I remember the course Director, she was a great woman nurse, Ms. Sonia Orloff, she was a nurse, a first-grade woman, a feminist, she helped and was concerned about the students from the human point of view, not only from the academic perspective (M. N1).

All the memories are really pleasant, I do have to highlight the professors' concern with conveying the knowledge, their vocation towards the students, giving their best so that we could incorporate it and I believe they were successful. [...] I specifically remember Sonia Orloff, she was our course Director, a very intelligent woman, very active, very strict in her actions though, in her requirements as regards the students' uniforms and behavior, she was concerned about each and every detail, I believe she influenced a lot on our professional identity (L. N2).

The women professors had the direction of how we were trained, with rigor, with dignity, with vocation, a lot of importance was given to studying. We devoted ourselves to studying, even today I read and research as much as I can. [...] That Sonia was really strict beginning with the uniform, with everything, our profession was born and raised like that (L. N6).

DISCUSSION

In the respondents' answers it is observed that, when choosing the Nursing profession, they had a preconception of what these professionals were, motivated by personal experiences and by family situations, where they had to care for other individuals, others in which they were cared for or during their high school studies; their construction occurred based on what the nurses did, rather than on the varied dimensions of development of these professionals, results similar to those obtained in studies on professional identity in Brazil.9^-10

Likewise, another element worth highlighting which built the individual identity was the desire to care for others through a professional career in the health area which is in direct contact with individuals in a state of vulnerability.

We consequently agree with Dubar's concepts in that identity is constructed in close relationship with others, and that it occurs throughout the professional life, always in relation to the people around us5 because, in the course of their academic training, they gradually reconstructed their identity with new elements, related to a position as agents for social change, represented by the professional nurse in the community.

Another element which stands out in the construction of their social identity is the image and status reflected by the nurses, apart from the authority they imposed and which was acknowledged by society. On the other hand, it is evidenced in the answers that the Nursing profession back in those years was perceived as linked to ethical and value-related principles.

An element worth highlighting was the importance of the behavior of certain women professors, whom they considered as their models because they were responsible for directly contributing to shaping their professional identity, both in the training of their theoretical knowledge and in that of the practical skills.

The results evidenced the importance for those responsible for the pre-graduate professional training to consider the analysis of the socio-historical period in which they are, since it is evidenced that each period will train groups with distinctive characteristics which, if positive, will favor those who are objects of their care but, on the contrary, if the construction lacks referents and solid foundations which allow identifying with “being a nurse” in society, it could turn out to be detrimental for the community that will receive them as professionals, so as to include theoretical-practical contents where the students can visualize how the curriculum aims to provide them with tools that contribute to shaping an identity of their own and, at the same time, a collective identity of the Nursing professional, given its importance as an agent for change in society.

Likewise, considering the historical moment (the beginning of the military dictatorship), the social position or place they occupied within that society was of vital importance, it was an ideal, either hidden or visible, where status symbols like the cloak, immaculateness, and their upright and imposing posture were valued, in a time where power was in a few people's hands: power and authority resided in the Armed Forces.11

There is a similitude with another study conducted in Brazil with students who graduated in that same time, the 1970s, where, just like in this study group, the importance was verified of the positive experiences with Nursing professionals and how their previous ideas of what they considered to be nurse later became an element of the construction of their professional identity.10

The importance of performing the role of the nurse in society, and the validation received for that, is a contributing factor in this particular group, which is related to a study in which the importance was investigated of the printed media in the construction of identities in 1980s Brazil, where it is concluded that what is published in the media can revalue or devalue the profession before the community.12

Although it is true that, during the construction and reconstruction of the professional identity, they were influenced by most immediate factors like family, social origin, and training place, the most important factor in the professional training of the graduate of that period13 was the socio-historical setting where they shaped such identity, as well as a vital element for the construction of their professional identity, the faculty who served as knowledge mediator in its values, knowledge, and ethical behavior alike, since it constituted an ideal to replicate for those in the process of shaping their own identity.

Before finishing, I must mention the limitations in the development of this research, mainly when considering that Magallanes is the southernmost Chilean region, and many of the graduates live in the central area of the country, reason why it was not possible to reach them. Additionally, those who came from other regions to study in Magallanes returned to their cities of origin when they graduated, thus losing contact with their peers.

CONCLUSION

The objective of the study was to know the elements which contributed to shaping the professional identity in this group of nurses through their memories, coinciding with Claude Dubar's theoretical reference framework in that it was constructed through various processes of socialization, which was a personal and collective historical process where the importance stands out of image and social status.

According to the analysis performed, three categories can be distinguished which contribute to the construction of identities. Regarding this professional and personal identity, there was a preconception determined by the care and by the image projected by the professional active nurses; in that historical moment, nurses stood out as immaculate individuals, with a commanding voice, and full of values, where the traits acquired towards the end of the 1960s in the Public Health campaigns were attached to the role in that period.

An important element is the fact of receiving academic training in the University setting, where they acquire the knowledge and skills they will later use in their professional development.

The women professor-nurses were part of this group that had attained social recognition, positively impacting on society; consequently, they evidenced the traits identified with authority, leadership, immaculateness, and vocation. The group of professors were certain about their own professional identity, about the role they played in society, and about the status they deserved, and that was what they projected.

There was agreement between the respondents' expectations when entering the course of what being a nurse represented and what they saw in the professors.

On the other hand, it is of utmost importance that those who are selected as mediators of the professional training, that is, the professors, are certain about their own identity as nurses, since it is evident that what they built will become part of the elements from the construct of their students.

REFERENCES

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NOTES

• ORIGIN OF THE ARTICLE:

  Article extracted from the dissertation - Professional identity of the first generation of nurses in Magallanes, Chile (1972-1986), presented at the Post-Graduate Program in Nursing of the Universidade Federal de Santa Catarina, in 2019.

• APPROVAL OF ETHICS COMMITTEE IN RESEARCH:

  Approved by the Ethics Committee in Research with Human Beings of the University of Magallanes, Certificate No. 031/cec/2018.

• *
  University of Magallanes. Nursing Department. Nursing Course, Self-Assessment Report, 2016.
• **
  Lidia Vidal, born in Magallanes on June 3^rd, 1918, and who graduated in 1940 in Santiago de Chile, returns in 1942 to perform as Nurse in Chief at the Punta Arenas Hospital, position she held until she retired. Together with her husband, Roberto Bravo, rector of the UTE, Punta Arenas, and with nurse Silvia Muñoz, they designed and executed the project to create the Nursing course in Magallanes.
• ***
  State Technical University. Decree No. 1831, which officializes the Nursing course Curriculum for 1972.

Publication Dates

• Publication in this collection
  16 Nov 2020
• Date of issue
  2020

History

• Received
  18 Sept 2019
• Accepted
  11 Feb 2020