NURSES’ VI SI BI LI TY ACCORDI NG TO THE PERCEPTI ONS OF THE
COMMUNI CATI ON PROFESSI ONALS
Ligia Fahl Kem m er1 Maria Júlia Paes da Silva2
Kem m er LF, Silva MJP. Nur ses’ visibilit y accor ding t o t he per cept ions of t he com m unicat ion pr ofessionals. Rev Lat ino- am Enfer m agem 2007 m ar ço- abr il; 15( 2) : 191- 8.
This st udy aim ed t o fur t her our under st anding of t he social r epr esent at ions of nur ses and t he nur sing profession by com m unicat ion professionals, since t hey are int erm ediat es in t he decoding of im aging and writ t en represent at ions about societ y. Met hod: t his is a qualit at ive st udy, based on t he social represent at ion t heory of Moscovici. Five com m unicat ion pr ofessionals w or king on r adio, t elevision, w r it t en pr ess, adver t ising and event s were int erviewed. Result s suggest 1) ignorance about t he nurse’s field of work, j ob m arket and nursing profession cat egor izat ion. 2) nur ses’ inv isibilit y befor e t he m edia and societ y and 3) nur se’s ow n r esponsibilit y t o obt ain pr ofessional r ecognit ion and v isibilit y . Par t icipant s in t his st udy point ed t w o essent ial pr ocesses for building a m or e coh er en t im age of n u r sin g an d n u r ses: 1 ) ex posin g t h e pr ofession pr im ar ily befor e t h e m edia, w h ich ignores it s pot ent ialit ies, and 2) t hrough t he m edia in order t o reach t he populat ion in general.
DESCRI PTORS: com m unicat ions m edia; nur se’s r ole; com m unicat ion
LA VI SI BI LI DAD DEL ENFERMERO SEGÚN LA PERCEPCI ÓN DE LOS
PROFESI ONALES DE COMUNI CACI ÓN
Est e est udio busca pr ofundizar la com pr ensión con r espect o a las r epr esent aciones sociales acer ca del enfer m er o y la enfer m er ía por pr ofesionales de com unicación, consider ando que est os son los int er m ediar ios en la codificación de represent aciones de im ágenes y t ext os sobre la sociedad. Met odología: est udio cualit at ivo basado en la t eor ía de las r epr esent aciones sociales de Moscov ici. Fuer on ent r ev ist ados 5 pr ofesionales de la com u n icación q u e t r ab aj an en r ad io, t elev isión , p r en sa escr it a, p r op ag an d a y ev en t os. Los r esu lt ad os d el an ál i si s m o st r ar o n 1 ) el d esco n o ci m i en t o d e l o s cam p o s d e act u aci ó n , d el m er cad o d e t r ab aj o y d e l a cat egorización profesional de la enferm ería; 2) la invisibilidad del enferm ero frent e a los m édios de com unicación y la sociedad y 3) la responsabilidad del propio enferm ero para obt ener reconocim ient o profesional y visibilidad. Se indican dos pr ocesos im pr escindibles com o est r at egia par a la const r ucción de una im agen m ás coher ent e del enferm ero y de la enferm ería: 1) la exposición de la profesión frent e a los propios m edios de com unicación, quienes desconoce sus pot encialidades, y 2) alcanzar a t oda la población a t r av és de est os m edios.
DESCRI PTORES: m edios de com unicación; r ol del pr ofesional de enfer m er ía; com unicación
A VI SI BI LI DADE DO ENFERMEI RO SEGUNDO A PERCEPÇÃO DE
PROFI SSI ONAI S DE COMUNI CAÇÃO
Est e est udo pr ocur ou a com pr eensão das r epr esent ações sociais sobr e o enfer m eir o e a enfer m agem por pr ofission ais de com u n icação, u m a v ez qu e est es são in t er m ediár ios n a codificação das r epr esen t ações im ag ét icas e t ex t u ais sob r e a socied ad e. Met od olog ia: est u d o d e cor t e q u alit at iv o, b asead o n a t eor ia d as r ep r esen t ações sociais d e Moscov ici. For am en t r ev ist ad os cin co p r of ission ais d e com u n icação at u an d o n as ár eas de r ádio, t elev isão, im pr en sa escr it a, pr opagan da e ev en t os. Resu lt ados das an álises in dicar am 1 ) o desconhecim ent o dos cam pos de at uação, m er cado de t r abalho e cat egor ização pr ofissional da enfer m agem ; 2) a invisibilidade do enfer m eir o per ant e a m ídia e a sociedade e 3) a r esponsabilidade do pr ópr io enfer m eir o par a haver r econhecim ent o pr ofissional e visibilidade. Apont am dois pr ocessos im pr escindíveis com o est r at égia para a const rução de um a im agem m ais coerent e do enferm eiro e da enferm agem : 1) a exposição da profissão pr im eir am ent e per ant e a pr ópr ia m ídia, que desconhece suas pot encialidades, e 2) at r av és da m ídia, par a o alcan ce da gr an de popu lação.
DESCRI TORES: m eios de com unicação; papel do pr ofissional de enfer m agem ; com unicação
1
Assist ant Professor, St at e Universit y of Londrina Depart m ent of Nursing. Doct oral st udent in Nursing at t he Universit y of São Paulo at Ribeirão Pret o College of Nursing, WHO Collaborat ing Cent re for Nursing Research Developm ent , e- m ail: ligia@fahl.com .br; 2 Full Professor, Universit y of São Paulo College of Nursing, e- m ail: j uliaps@usp.br
I NTRODUCTI ON
T
h e i m a g e o f a p r o f e ssi o n a l g r o u p o r a p r of ession r ep r esen t ed b y t h e m ed ia is f r eq u en t ly under st ood as significant m easur e of t he social and econom ic value of t hat gr oup( 1). I n t he last decades, int ernat ional lit erat ure has shown great int erest in t he im ag e of t h e n u r se an d t h e n u r sin g p r of ession in d i f f e r e n t c o m m u n i c a t i o n m e a n s , r e g a r d i n g t h e hist orical, social and et hical focus and gender- relat ed issues. This im age has a m eaning, expressed by social r ep r esen t at ion s:“ We u n d e r st a n d b y p r o f e ssi o n a l i m a g e a n et w or k of social r epr esen t at ion s of Nu r sin g w h ich , b y m ea n s o f a set o f co n cep t s, a f f i r m a t i o n s a n d e x p l a n a t i o n s , r e p r o d u c e s a n d i s r e p r o d u c e d b y i d eo l o g i es o r i g i n a t ed i n t h e d a i l y so ci a l p r a ct i ces int er nal/ ex t er nal t o it . The pr ofessional im age leads us t o professional ident it y it self, in it s int ricat e net work of m eanings t hat int end t o be exclusive and, t herefore, i n h e r e n t t o t h a t sp e ci f i c p r o f e ssi o n . H e n ce , t h e p r o f essi o n al m ean i n g co n su b st an t i at es i n i t s o w n r epr esent at ion of pr ofessional ident it y ”( 2 ).
Nur sing has m oved t ow ar ds t he const r uct ion of it s body of scient ific k now ledge, seek ing, t hr ough s t u d i e s a n d r e s e a r c h , i t s d e f i n i t i o n a s s c i e n c e . Resear ch and fields of act ion in nur sing hav e gr ow n s u b s t a n t i a l l y i n m o r e r e c e n t y e a r s , o p e n i n g per spect ives of know ledge in m ult iple dir ect ions. The so ci a l r ep r esen t a t i o n s i d en t i f i ed i n sev er a l so ci a l segm ent s and t hose t ransm it t ed by t he m edia reflect , however, a professional wit h neit her power, aut onom y, k now ledge nor v oice( 3 ).
Re s e a r c h t h a t e v a l u a t e s t h e s e s o c i a l r e p r e se n t a t i o n s o f n u r si n g w o r l d w i d e , a n d m o r e specifically in Br azil, also denounce an old fashioned and depr eciat ing r epr esent at ion of t he pr ofession( 3- 5). St u d ies p er f or m ed w it h d if f er en t p op u lat ion st r at a ident ified r epr esent at ions r elat ed t o t he inv isibilit y of t h e n u r si n g p r o f essi o n al , w h o i s ch ar act er i zed b y per for m ing sim ply t echnical t ask s( 4), subor dinat ed t o t he m edical ar ea( 6), ident ified as t he phy sician’s aid, a n d e x e r ci si n g a p r o f e ssi o n t h a t su g g e st s ch e a p labor( 7 ).
Ref lect ion s on t h e r esu lt s of t h ese st u d ies leg it im at e in q u ir ies ab ou t t h e in f lu en ce t h e m ed ia ex er t s on collect iv e ideas abou t t h e n u r se an d t h e n u r sin g p r of ession . Th e im p or t an ce of t r an sm it t in g r ep r esen t at ion s – t h r ou g h t ex t s or im ag es b y t h e m edia – f or t h e per pet u at ion of st er eot y pes or t h e
co n t r i b u t i o n o f n e w r e p r e se n t a t i o n s st e m s i n i t s p er v asi v en ess, m an y t i m es w i t h o u t co n n ect i o n t o r ealit y.
A st udy based on t he analy sis of im ages in new spaper s, nat ional m agazines and TV pr ogr am s in Br azil illu st r at es t h e w ay t h e im age of t h e n u r se is conveyed in t he Brazilian m edia( 3). The st udy reveals t h a t , i n s o a p o p e r a s , m e n ’ s m a g a z i n e s a n d n e w sp a p e r s, t h e t r a n sm i t t e d r e p r e se n t a t i o n s a r e relat ed t o t he m oralit y associat ed wit h t he charact ers em bodied by nurses: t he m ot her, t he saint , t he angel, t h e ph y sician ’s sh adow an d t h e w om an - obj ect . Th e r esear ch also ident ified t he charact er “ doct or- nur se”, isolat ed am on g ot h er r ep r esen t at ion s an d d ecod ed by nurses’ at t em pt t o art iculat e an audible vocabulary. I n q u i r i e s a i m e d a t a n a l y z i n g t h e l i t t l e ex posit ion of nur sing in t he m edia, or it s oft ent im es m i sr e p r e se n t a t i o n , i n cl u d e t h e co n ce r n t o b e t t e r under st and t he v iew of t he pr ofessional r esponsible for m ediat ing bet w een t he sour ce and t he r ecept ion of infor m at ion: t he j our nalist and t he m ar k et ing and adv er t isin g pr of ession al.
The feelings of com m unicat ion pr ofessionals – int er m ediar ies in t he com m unicat ion of new s and t h e c o n s t r u c t i o n o f r e p r e s e n t a t i o n s – c a n b e im pr egn at ed w it h pr econ cept ion s r elat ed t o n u r sin g a s a n u n d e s i r a b l e p r o f e s s i o n , b e c a u s e i t i s p r ed om in an t ly f em in in e an d su b alt er n . Th u s, it is suggest ed t hat t he percept ions of j ournalist s and m edia pr oducer s r egar ding nur sing and nur ses( 8) should be f u r t h er ex plor ed.
An analysis of art icles published in t he m aj or São Paulo St at e press in 1994 was t he base of a st udy about j ournalist s’ percept ion about t he im age of nurses and t heir profession( 5). I t was revealed t hat , from t heir point of v iew , nur ses and t he nur sing pr ofession ar e c o n c e n t r a t e d i n s i x c a t e g o r i e s : e d u c a t i o n a n d p r o f e ssi o n a l e x e r ci se , w h a t t h e n u r se d o e s, t h e t r ansgr essor nur se, t he v ict im nur se, t he nur se as a person and cit izen and t he profession as an adj ect ive. Th e st u d y au t h o r s d i scu ss t h at t h e p er cep t i o n o f j ournalist s influences t he const ruct ions of t he nurse’s im age in societ y and t hat , alt hough t hey ident ified care in a very solid way in t he discourse t hey analyzed, t he f u n ct i o n s r e l a t e d t o m a n a g e m e n t , t e a ch i n g a n d research were not explicit ly m ent ioned at any t im e.
r e p r e s e n t a t i o n s o f n u r s e s a n d n u r s i n g o f s o m e com m u n icat ion p r of ession als w h o w or k in a cit y in t he Nor t h of Par aná.
Ther efor e, t his r esear ch aim s t o analy ze t he social represent at ions about t he nurse and t he nursing profession am ong five professionals act ive in different com m unicat ion areas, in a cit y in t he nort h of Paraná.
JUSTI FI CATI ON
Th e m ed i a h av e p o r t r ay ed t h e n u r se i n a pej orat iv e and subser v ient w ay. As t hey est ablish a dy n am ic of con v er gen ce t h at con t r ibu t es t o ex plain s e v e r a l c o d e s t h a t a r e s h a r e d , r e c o g n i z e d a n d inst it ut ionalized by m odern societ y, it can be inferred t hat t he sym bolic const ruct ions found in t he cont ent s t h e y t r a n sm i t a r e n o t d i st a n t f r o m o t h e r so ci a l elem ent s’ const r uct ions. Com m unicat ion pr ofessionals ar e in t er m ed iat es in t h e cod in g of im ag e an d t ex t r e p r e s e n t a t i o n s o f s o c i e t y. B y g i v i n g s o m e com m unicat ion pr ofessionals t he oppor t unit y t o voice t heir int erpret at ions, w e int end t o furt her underst and w h at r ep r esen t at ion s on n u r ses an d n u r sin g t h ese p r o f e s s i o n a l s ( w o r k i n g i n d i f f e r e n t a r e a s o f com m u n icat ion in t h e sam e cit y ) sh ar e, sin ce t h ey a r e c o d e i n t e r m e d i a r i e s o f i m a g i n g a n d t e x t r epr esen t at ion s on societ y.
METHODOLOGI CAL PROCESS
We d e c i d e d t o u s e a c r o s s - s e c t i o n a l d escr ip t iv e st u d y w it h a q u alit at iv e ap p r oach . Th e q u alit at iv e ap p r oach is j u st if ied b ecau se it p er m it s “ in cor p or at in g t h e issu e of m ean in g an d in t en t as inher ent t o act s, r elat ions and social st r uct ur es. The lat t er ar e consider ed bot h in t heir m anifest at ion and t r ansfor m at ion as significant hum an const r uct ions”( 9).
St u dy Par t icipan t s
A con v en ien ce sam ple of f iv e pr of ession als fr om dist in ct ar eas of com m u n icat ion w as select ed. Th ese p r o f essi o n a l s a r e co n si d er ed r ef er en ces i n Londrina, PA, Brazil, and have had som e cont act wit h t h e h ea l t h a r ea a n d h ea l t h p r o f essi o n a l s i n t h ei r act iv it ies.
This sam ple w as used t o obt ain t he v iew of p r o f e s s i o n a l s f r o m d i f f e r e n t s e g m e n t s o f t h e
com m u n icat ion ar ea, bu t w or k in g in t h e sam e cit y, wit h t heir life experiences, t heir encount ers wit h healt h an d illn ess an d w it h t h e p ossib le d iv er sit y of t h eir r ep r esen t at ion s ab ou t n u r sin g an d t h e n u r se. Fiv e p r o f e ssi o n a l s w e r e i n t e r v i e w e d , w h o w o r k o n 1 ) Telev ision, 2) Radio, 3) Wr it t en pr ess, 4) Adv er t ising a n d 5 ) Ev e n t s . A l l p a r t i c i p a n t s w o r k e d i n com m u n icat ion , w it h an ed u cat ion al b ack g r ou n d in j our nalism or m ar k et ing, and t heir act iv it ies included pr oduct ion, edit ing or pr esent at ion of pr ogr am s t hat , a t s o m e p o i n t , i n v o l v e d o r a p p r o a c h e d h e a l t h pr ofession als an d sect or s.
Et hical Aspect s
We ob t ain ed t h e ap p r ov al of t h e Resear ch Et hics Com m it t ee at t he Hospit al Universit ário Regional
in Nort hern Paraná and, next , t he part icipant s’ writ t en i n f o r m e d co n se n t , w h i ch d e scr i b e d t h e r e se a r ch obj ect iv es, t he v olunt ar y nat ur e of t he par t icipat ion, t he possibilit y t o w it hdr aw fr om t he r esear ch at any t i m e , w i t h o u t a n y l o s s o r d a m a g e , a n d t h e r esear cher ’s com m it m ent t o pr eser ve confident ialit y.
I n st r u m en t
We used a script wit h ident ificat ion dat a, such a s a g e , g e n d e r, p r o f e s s i o n a l b a c k g r o u n d a n d occu p at ion , an d g u id in g sem ist r u ct u r ed q u est ion s: What is your im age of nursing? What is your im age of t he nur se? Wher e does t his im age com e fr om ? How do y ou per ceiv e t he im age of t he nur se and nur sing t hr ough t he m edia?
Access t o Par t icipant s
Dat a w er e collect ed t hr ough sem ist r uct ur ed in t er v iew s, in sit es ch osen by t h e par t icipan t s. Th e r esear cher int r oduced her self, ex plained t he r esear ch obj ect iv es, gu ar an t eed t h e et h ical aspect s in v olv ed i n t h e r e s e a r c h a n d a s k e d p e r m i s s i o n t o u s e a r ecor d er.
Discou r se An aly sis
ex pr ession of w h at a det er m in at e popu lat ion t h in k s or believ es about a cer t ain t hem e. This t hink ing, in t urn, can be m anifest ed, am ong ot her w ays, t hrough t h e set of v er bal discou r ses issu ed by people f r om t his populat ion” ( 9).
Th e st at em en t s w er e f ir st t r an scr ib ed an d su b m i t t ed t o d escr i p t i v e an al y si s. Th er ef o r e, f o u r m et hodological figures w ere used: anchorage, cent ral i d e a , k e y e x p r e ssi o n s a n d t h e co l l e ct i v e su b j e ct discour se( 10). Dat a w er e int er pr et ed by select ing t he m ain anchorages and/ or cent ral ideas present in each o f t h e i n d i v i d u a l st a t e m e n t s a n d i n a l l o f t h e m t oget h er, fin ish in g in a sy n t h et ic for m , in w h ich w e sought t o obt ain t he discur siv e r econst it ut ion of t he social r ep r esen t at ion of t h e n u r se’s an d n u r sin g ’s i m ag e.
PRESENTATI ON AND DI SCUSSI ON OF THE
RESULTS
The int erviewees’ age varied bet ween 26 and 44 years, two were wom en and three m en; two had a bachelor’s degree in Social Com m unication, three had a graduate degree in Marketing and Propaganda, with eight to 23 years of experience in their respective areas.
Collect iv e discou r ses w er e r econ st it u t ed by analyzing t he individual percept ions of com m unicat ion p r o f e ssi o n a l s a b o u t t h e i m a g e o f t h e n u r se a n d n u r si n g . Th e i r co n st r u ct i o n r e v e a l e d so m e so ci a l represent at ions t hat st and out . These represent at ions cov er im ages abou t n u r sin g, r eflect ed as: car e an d serenit y, ident ifying, at t he sam e t im e, t hat t he m edia t r a n s m i t s a d i s t o r t e d i m a g e o f t h e n u r s e ; t h e p e r ce p t i o n o f a h a r d a n d e x h a u st i n g p r o f e ssi o n , st r u g g lin g f or in ser t ion in t h e j ob m ar k et an d t h e a d v e r s e c o n d i t i o n s o f t h i s r e a l i t y ; t h e l a c k o f k n ow ledge abou t t h e n u r se’s act iv it y ar eas; lack of k now ledge by m edia pr ofessionals about pr ofessional cat egories ( reflect ing t hat t he populat ion, as a whole, does not r ecognize t he nur se in an independent w ay eit her ) ; t he inv isibilit y of t he pr ofession in t er m s of t ask s an d ach iev em en t s/ t h e n u r ses’ r esp on sib ilit y for t heir inv isibilit y befor e t he m edia and societ y.
This ar t icle, giv en t he lit t le space av ailable, w i l l f o cu s o n t h e d i scu ssi o n a b o u t 1 ) t h e l a ck o f k n o w l e d g e o f a c t i v i t y a r e a s , j o b m a r k e t a n d
p r o f e ssi o n a l ca t e g o r i za t i o n; 2 ) t h e i n v i si b i l i t y o f n u r s i n g b e f o r e t h e m e d i a a n d s o c i e t y a n d 3) r e s p o n s i b i l i t y o f t h e n u r s e s t h e m s e l v e s t o g e t
professional recognit ion and visibilit y – bearing in m ind t hat t he ot her r epr esent at ions w e found suppor t and int er connect t he discussion pr esent ed below :
Llack of k now ledge about act iv it y ar eas, j ob m ar k et an d pr ofession al cat egor izat ion
Th e st a t em en t s r ev ea l l a ck o f k n o w l ed g e about t he nur se’s act iv it y ar eas in Br azil now aday s, but point out t he act ual need for nursing professional act iv it ies, giv en t he populat ion’s healt h condit ions:
[ about act ivit y areas] I cannot affirm , I cannot say… I t would be a guess, right ? I figure, t hat , in a m acro way, as t he econom ist s say, a quest ion: is t he populat ion well at t ended t oday in healt h care? I can say, as a cit izen, t hat no! So, in t hat sense, t he nurse’s act ivit y area is very good! ( …) I f you ask m e, I ’ll say, I believe that there is a good activity area, with very great potential, but it m ust be very difficult for t he nurse t o work t oday… like in any ot her profession… ( I C1 DSC1)
Th e com m u n i cat i on p r of essi on al s p er cei v e t he j ob m arket difficult ies for t he nurse as insert ed in a nat ional cont ext , in which t he healt h care st ruct ure is st ill inadequat e – a difficult y shar ed also by ot her not so ack now ledged and v alued pr ofessions.
I d on ’t k n ow , I d on ’t h av e cr it er ia t o sp eak , b u t som et hing t ells m e t hat t he j ob m arket m ust be difficult t o get int o. I believe t hat you have t o be very good t o st and out in t his area. Because t oday t here are m any t echnical nursing courses, right ? I guess t hat t hese courses put a lot of people in t he j ob m arket and som et im es, I don’t know about t he qualit y st andard, if t hey are really prepared for pract ice, and due t o t he Brazilian healt h syst em it self, which is broke… lack of beds, m at erials, m edicat ion, physicians and probably nurses… and vacancies for t hese people t o work. I see t hat , in all professions, t here is great difficult y t o ascend and occupy one’s place in t he j ob m arket . Many people go t hrough t his difficult y, I believe t hat a large part of newly graduat ed people and even senior nurses go t hrough t h i s si t u at i o n . I g u ess t h at , f o r t h e co m m o n n u r se, i t i s com plicat ed, hospit al nurse, I CU… ( I C6 DSC2)
This percept ion about difficult ies t o ascend in t he pr ofession r eflect s im pr essions of a cer t ain lack of pr est ige, shar ed by ot her par t s of t he populat ion. As t o social p r est ig e, n u r sin g occu p ied t h e eig h t h posit ion in a st udy t hat assessed t his concept am ong 13 univ er sit y lev el pr ofessions ( 11).
Why do I t hink everybody who at t ends in hospit al is a nurse? Just supposing [ laugh] . Are t here people who at t end at t he hospit al who are not nurses? [ surprise] Really I don’t know, if t hey had graduat ed or were in t raining or som et hing like t hat … I ’m only supposing [ t hat everybody w as a nurse] . We have a rough idea of t he nurse and ot her professionals, we m ix up a lit t le, t he nurse wit h t he aid, wit h som eone else… ( I C12 DSC1)
The com m unicat ion professionals appoint t he l a c k o f k n o w l e d g e r e l a t e d t o p r o f e s s i o n a l cat egor izat ion as a gr eat difficult y in t he r ecognit ion of t he pr ofession b y ot her elem ent s in societ y.
First , t he m ain issue is t hat everybody get s confused and doesn’t know who’s a nurse, because we t hink t hat everybody is a nurse, and t hey act ually are not . There is t he t echnician, t he aid and t he nurse. Because t here is t his m ix- up… Com m on sense is t hat t he person who goes int o t he hospit al room is always t he nurse, t hat t here is no subdivision in t he professional cat egory. Now I separat e t hem . I know t hat t here are professionals of t echnical level and t here are professionals of universit y level, whom I t hink are called st andard nurses; I cannot say t hat for sure. My fam ily, for inst ance, m y closest friends and even t he com m unit y, people do not say: Look, she is a nurse t echnician… No, [ t hey say] it w as t he nurse w ho t ook care or it w as t he nurse w h o did n ot t ak e car e of m e. As an opin ion m ak er in t h e com m unicat ion area I can t ell you, wit hout any doubt , I believe t his confusion t hat I used t o m ake is kind of com m on. ( I C15 DSC2)
We agr ee w it h t he r eflect ion t hat , t o occupy spaces and be ack now ledged as one of t he essent ial h ealt h p r of ession s, a p olit ical ag en d a of t h e class should include t he sev er al aspect s t hat const it ut e a pr ofession, t hat is, specific k now ledge, ex clusiv e j ob m ar k et , for m of or ganizat ion and clar ificat ion about t he nursing t eam hierarchy ( 12).
The invisibilit y of nursing before t he m edia and societ y
Re g a r d i n g h o w t h e y p e r c e i v e t h e r e p r e s e n t a t i o n o f n u r s e s b y t h e m e d i a , t h e per cept ions ar e in line w it h st udies t hat , am ong t he r e p r e se n t a t i o n s, i d e n t i f i e d t h e n u r se f i g u r e a s a professional described as “ t he doct or’s shadow”( 3),and oft en in a st er eot y ped w ay :
[ t h e m ed ia p or t r ay t h e n u r se] As a d oct or ’s aid . Com m unicat ion m eans approach t he nurse and nursing in general, m aking t he sam e m ist ake as com m on sense does… Because I don’t know exact ly w hat a nurse does…I don’t know unt il now . I guess t hat t he press and com m unicat ion m edia in general also m ake t his confusion, because you don’t need higher educat ion t o be a t echnician or an aid. So t he guy [ com m unicat ion professional]
want s t hat nurse, wit h t hat lit t le t hing st uffing one’s head wit h a t hing t hat nobody w ears… but t he guy suddenly w ant s t hat [ t o use in advert ising] . ( I C15 DSC1)
A m i d s t p e r c e p t i o n s o f a s u f f e r e d a n d depr eciat ed pr ofession an d t h e n on - iden t ificat ion of t h e c l a s s h i e r a r c h y, t h e s u r p r i s e , i n p e r s o n a l encount ers wit h nurses, of finding out t hat ( s) he can b e a r e f e r r a l p r o f e ssi o n a l o f r e f e r e n ce i n h e a l t h k n ow led g e ar eas:
I am going t o t ell you about a specific sit uat ion of one occasion when I went t o do an art icle and t hen I found out t hat t he m ain aut horit y in breast feeding here in t he cit y was a nurse, not a doct or. I t was really funny because, on t hat occasion, I w or k ed for t he paper and t he ar t icle w as specifically about b r e a s t f e e d i n g a n d , o b v i o u s l y , I w e n t t o p e d i a t r i c i a n s , gy necologist s fir st . Then t hey said: no, her e in t his cit y t he person who knows m ore about breast feeding is a nurse, she was a consult ant for t hat det erm inat e hospit al at t hat t im e. I worked t h er e a f ew y ear s w i t h cam p ai g n s su g g est ed b y n u r si n g professionals who adm inist er, or coordinat e a hum an m ilk bank at t he universit y. I t was very rem arkable for m e, an im port ant m om ent . We had professionals [ nurses] wit h a lot of experience, people wit h a doct oral degree in t his area, who worked t o recover t hat old cult ure t hat m at ernal m ilk m eans healt h for t he child and t hat t his m eans healt h! ! …I t was exact ly because of t hat [ t hat I have t his im age of com pet ence about t he nurse] .
A t t h e s a m e t i m e , t h e c o m m u n i c a t i o n p r o f e s s i o n a l s i n t h i s s t u d y a p p o i n t t h a t t h i s com pet ence is not socialized wit h t he rest of populat ion a n d w a r n t h a t t h e n u r si n g p r o f e ssi o n i s a l m o st anonym ous and invisible t o t he com m unicat ion m edia i n r e l a t i o n t o a n y h i g h l i g h t s i n t h e i r t a s k s a n d ach iev em en t s.
som e out door propaganda of som e professions, but I don’t recall of any of nurse. I t is a pit y because we don’t read anyt hing about it ( I C15 DSC2)
Re s p o n s i b i l i t y o f t h e n u r s e ( h i m ) h e r s e l f f o r pr ofessional r ecognit ion and v isibilit y
I n view of t his anonym it y, t hey consider it is r e l e v a n t t o st r e ss t h e r o l e n u r si n g p r o f e ssi o n a l s t h e m se l v e s h a v e i n a cl e a r d i sse m i n a t i o n a b o u t nur sing, it s pot ent ialit ies and t ask s.
Who is guilt y for us not having clear inform at ion about nursing, what nursing is, t hat it is specialized work? I , who am from t he m edia? Or you who are from nursing? [ pause and sm ile] . Who is wrong? The inst it ut ions t hat do not inform correct ly how t hings work? There is a lacks of com m unicat ion. The professional needs t o be a lit t le creat ive t oo, because if he keeps on wait ing for ot hers t o organize, who will organize it ? Will t he hospit als’ owners or gan ize t h in gs? Bu t I also t h in k t h at t h e f au lt lies in t h e pr ofessional or ganizat ion, because som et hing m ust be done t hrough an associat ion, som et hing t o lapidat e t his im age. There m ust be a direct m echanism and t alk direct ly wit h t hese people and explain t o t hem , you know… like… a direct ed com m unicat ion, a folder, or a sit e, for exam ple… ( I C16 DSC1)
A j ournalist who has been dedicat ed t o writ ing about nur sing and nur ses, w ar ns about t he fact t hat n u r s i n g p r o f e s s i o n a l s h a v e c o n t r i b u t e d t o t h e i r invisibilit y before t he m edia because t hey do not t ake a st and, ev en w hen t her e is som et hing im por t ant t o be com m unicat ed( 13).
For t h e n u r sin g pr of ession t o be iden t if ied, t he need is discussed t o const r uct a hist or y t hr ough relevant and serious work, including t he ident ificat ion of t he professional based on his/ her act ivit y in pract ice:
The newer professions [ such as nursing] will have t o m ake t heir hist ory. How is t his hist ory const ruct ed? Wit h serious work, wit h originalit y, wit h discoveries relevant t o societ y, wit h t hat . I t hink t hat t he cat egory it self or healt hcare professionals are responsible [ for correct ing t he im age] . When you arrive at a healt hcare unit , t he recept ionist does not say: You are going t o be at t ended by a nursing t echnician… ( s) he says: The nurse will m easure your blood pressure… and it is not t he nurse… we know it is not … So, on one hand, I guess t his im age is cr eat ed and cryst allized because of t he professionals t hem selves. ( I C16 DSC3)
Th e p r o f essi o n al i m ag e o f n u r si n g t h at i s t r an sm it t ed by t h e m edia h as been r espon sible f or per pet uat e out dat ed st er eot ypes, but w it hout valuing t he m edia’s role in our const ruct ion of som et hing t hat is not hing m or e t han a r eflex of r ealit y( 1). Thus, t he discussion includes inquiries about t he ext ent t o which
t he nur ses t hem selv es ar e r esponsible w hen t hey do n ot t ak e a st an d , n eit h er t o cor r ect t h e d ist or t ed im ages n or f or t h e v isibilit y of t h e r oles t h ey h av e per for m ed in healt h car e.
This positioning definitely begins in professional practice, in the way we think about ourselves, developing professional com pet ence, and also t hrough a posit ion towards the clients, the fam ily and towards other health professionals; t hrough collaborat ive developm ent wit h com m u n icat ion an d p u b lic r elat ion s p r of ession als; com prehension of the m edia’s role and active exposition
in com m unication m eans( 14).
As a st r at egy t o const r uct a m or e coher ent im ag e, t h e r esear ch p ar t icip an t s ack n ow led g e t h at t he profession is prim arily exposed t owards t he m edia t hem selves, which do not know about it s pot ent ialit ies:
Maybe what is m issing is cont act wit h a leadership, inside t he cat egory, t o est ablish t his com m unicat ion wit h us, becau se w e can dissem in at e t h is. All h ospit als h av e pr ess assist ant s, public relat ions t hat send m at erial t o us [ t he m edia] and t here is no release t alking about t he nursing sect or. What t hey do send are releases about t he inst allm ent of m achines, t hat som e doct or concluded his doct oral program , has put I don’t know w hat , don’t know w here, w it h honor, but t here is not hing specific [ from nursing] . I guess t hat not even t he int ernal press, w hich could collabor at e a lot in t his sense, has t his concept est ablished. This int ernal dissem inat ion t hat sends m at erial t o m ass com m unicat ion m eans, does not say anyt hing about it [ nursing] ( I C16 DSC4)
I n t h e secon d place, an ex posit ion t h r ou gh t he m edia t o reach t he whole populat ion as essent ial pr ocesses t o t r ansm it a m or e coher ent im age of t he nur se and nur sing:
Going t o t he press, I don’t see any ot her w ay, I don’t see any ot her way. I f a nurse m akes a wonderful discovery, and keeps it t o him self/ herself? Nobody finds out about it . How m any volunt ary services are done, how m any hist ories does t he nurse part icipat e in? Then, if you only dissem inat e what went wrong, m aybe t here are a lot of t hings t hat went right , m aybe one t hing depended on t he professional, but it will pass unnot iced. I guess t hat som et hing could be done in t his sense, but I t hink t hat it norm ally is not com m unicat ed, I m ay be wrong, I haven’t seen it at least . So, as a com m unicat or, I see t hat , if t here exist ed a concern, I guess t here would have t o be a press service in t his sen se. I t h in k t h at t h e [ n u r sin g ] associat ion s sh ou ld also collabor at e w it h t he dissem inat ion… I f w e don’t dissem inat e, nobody w ill find out …! ! ( I C16 DSC2)
Nursing and Media: the invisible partner in health care”. The authors analyzed twenty thousand articles published in m agazines and new spaper s select ed in t he Unit ed St at es, ident ifying t hat nurses were m ent ioned in only 4% of the articles related to heath, while physicians were pr esen t in 4 3 %( 1 5 ). Recom m en dat ion s t o giv e m or e v i si b i l i t y t o t h e n u r si n g r o l e i n cl u d e t h e n eed f o r professionals to position them selves strategically towards t h e com m u n icat ion m ean s an d also t o edu cat e t h e journalists them selves about nursing(13-15).
I f it does not appears in t he press... [ t he fact does not ex ist ] …t he pr ess is so st r ong t hat it changes opinions! ! The new s serves t o const ruct and t o deconst ruct also, bot h t hings. Because you cannot m ake t he public opinion if don’t use m ass com m unicat ion m eans… As soon as you go t o t he TV, t o a net work and t alk t o m illions of people sim ult aneously, you build an im age and t his im age can som et im es be deconst ruct ed, alt hough t his requires t im e. You have t o provoke, including t he im age. The w rit t en press has it s value, but t he visual press has a m uch bigger value ( I C16 DSC5)
The em phasis on t he role of t he visual im age m ay lead t o im por t an t r ef lect ion s t o n u r sin g, sin ce pej or at iv e v isual im ages about nur ses ar e r elat iv ely com m on in TV program s and m agazines. The quest ion is t hat visual im ages oft en go beyond t he crit ical sense of who sees t hem , even if t hey have no reference in realit y, as a cont em porary philosopher put s it( 16): “One can also t hink t hat im ages do not possess ident it y t o cir cu lat e in t h e sph er e of com m u n icat ion n et w or k s.
They do not pass t hr ough cust om s and do not need t o present a passport t o ent er t errit ories, like people.
Phy sical bar r ier s do not ex ist for im ages; once t hey
hav e r eached a cent r ifugal speed, t hey do not hav e any r efer ence in r ealit y”.
Th e y e m p h a si ze t h e i m p o r t a n ce o f u si n g m u lt iple com m u n icat ion m edia: in t er n et , t elev ision , i n t e r n a l n e w s, w r i t t e n p r e ss, t o a ch i e v e g r e a t e r v isibilit y of nur sing:
I think that, anyway, the m edia add up, so, if you explore t he int ernet , and could m ake t his available wit h cont inuous input and also use press services t o inform t he rest of t he press, and
one t hing leads t o t he ot her. Have you im agined, a really well done sit e, wit h several kinds of inform at ion, it would help a lot , so som e m or e n ot es t h at w ou ld slow ly be issu ed, ev en v er y sm all, everyt hing form s opinion, everyt hing, everyt hing, social colum n… I t is very im port ant t o say t hat universit y professor x defended a dissert at ion about I don’t know what … t his has t hat m eaning. We see it in t he newspaper! Things t hat happen. Today we have seen ot her professionals being exposed by t he m edia and t hen you [ can be seen] as well. ( I C16 DSC6)
CONCLUSI ONS
Th e s e c o m m u n i c a t i o n p r o f e s s i o n a l s ’ st at em en t s poin t t o r elev an t issu es in t h e ex er cise and t eaching of a nursing t hat aim s t o break wit h old paradigm s of subor dinat ion and inv isibilit y. Alt hough t hey recognize us as im port ant pieces in a healt h care p r ocess, t h e com m u n icat ion p r of ession als seem t o ask f or m or e in f or m at ion , m or e v isibilit y an d m or e v oice r egar ding our r ole in healt h car e.
Th e i m p o r t a n c e o f t h i s p o s i t i o n i n g a n d ex posit ion is not r est r ict ed t o t he ack now ledgem ent o f t h e p r o f essi o n an d i t s p r o f essi o n al s. Th e m o st i m p o r t a n t i n q u i r y a b o u t o u r i n v i si b i l i t y i s t h a t i s d i m i n i sh es o u r ab i l i t y t o ch an g e t h e d i r ect i o n s o f healt h care( 17).This reflect ion is necessary at a m om ent w hen nur ses hav e per for m ed such r elev ant act iv it ies in side t h e Sin gle Healt h Sy st em , in Br azil, r an gin g f r o m p l a n n i n g p r o ce sse s t o t h e i r e x e cu t i o n a n d ev alu at ion .
I n t h i s s t u d y, t h e c o m m u n i c a t i o n p r o f e s s i o n a l s a p p o i n t s t r a t e g i e s a n d f o r m u l a t e im port ant considerat ions for a posit ioning of voice and
v isibilit y based on pr act ical sit uat ions, t hr ough j oint work in t he m edia and t hrough t he m edia, aim ing t o r each t he public in gener al.
I t seem s urgent and challenging at t he sam e t im e for t hese reflect ions t o find echo in our act ions, so t h a t w e n o l o n g er a r e t h e “ et er n a l l y i n v i si b l e par t ner s” in healt h car e.
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