NURSI NG CARE ACCORDI NG TO W OMEN I N ABORTI ON SI TUATI ONS
Mar iana Gondim Mar iut t i1 Ana Mar ia de Alm eida2 Mar islei San ch es Pan obian co2
Mar iut t i MG, Alm eida AM, Panobianco MS. Nur sing car e accor ding t o w om en in abor t ion sit uat ions. Rev Lat
ino-am En f er m agem 2 0 0 7 j an eir o- f ev er eio; 1 5 ( 1 ) : 2 0 - 6 .
This qualit at ive st udy aim ed t o underst and how wom en having an abort ion experience t he nursing care t hey r eceiv e. The st at em ent s of 1 3 hospit alized w om en w er e analy zed t hr ough cont ent analy sis. The cent r al cat egory “ Nursing care experienced in sit uat ions of abort ion” was const it ut ed from 4 subcat egories: care cent ered in physical needs; fear of j udgm ent in abor t ion sit uat ions; legal aspect s defining car e; t he need for suppor t in abor t ion sit uat ions. These w om en ident ified nur sing car e as based on phy sical aspect s, w it hout cont em plat ing t heir individualit y and specificit ies. Result s indicat ed t he need t o creat e an environm ent t hat st im ulat es list ening, helping t hese w om en t o elabor at e t heir feelings and allow ing pr ofessionals t o behav e closer t o t hese w om en’s realit y, in order t o reduce t heir own desires and conflict s and cont em plat e t he int egralit y of care.
DESCRI PTORS: abor t ion; w om en’s healt h; nur sing; nur sing car e
EL CUI DADO DE ENFERMERÍ A SEGÚN LA MUJER EN SI TUACI ÓN DE ABORTO
Est udio cualit at iv o con obj et o de com pr ender com o m uj er es en sit uación de abor t am ient o vivencian el cuidado de enfer m er ía que r eciben. El análisis de los t est im onios de 13 m uj er es hospit alizadas ocur r ió m ediant e la t écnica de análisis de cont enido. Se com puso la cat egor ía cent r al “ El cuidado de enfer m er ía vivenciado en la sit uación de abor t am ient o” a par t ir de cuat r o subcat egor ías: el cuidado cent r ado en las necesidades físicas; el r ecelo del j uicio en la sit uación de abor t am ient o; aspect os legales definiendo el cuidado; la necesidad de apoyo en la sit uación de abor t am ient o. Las m uj er es ident ificar on el cuidado de enfer m er ía com o basado en aspect os físicos, no cont em plando su indiv idualidad y especificidades. Los r esult ados indicar on la necesidad de cr ear un am bient e que pr opicie la escucha, les ayudando a esas m uj er es a elabor ar sus sent im ient os, per m it iendo a los pr ofesionales una conduct a m ás pr óx im a de su r ealidad, de for m a que sus pr opios deseos y conflict os sean m enor es, y que sea cont em plada la int egr alidad de la at ención.
DESCRI PTORES: abor t o; salud de las m uj er es; enfer m er ía; at ención de enfer m er ía
O CUI DADO DE ENFERMAGEM NA VI SÃO DE MULHERES EM SI TUAÇÃO DE ABORTAMENTO
Est udo qualit at iv o que buscou com pr eender com o m ulher es em sit uação de abor t am ent o v iv enciam o cuidado de enfer m agem que r ecebem . A análise dos depoim ent os de 13 m ulher es hospit alizadas ocor r eu por m eio da t écnica de análise de cont eúdo. Foi com post a a cat egor ia cent r al “ O cuidado de enfer m agem vivenciado na sit uação de abor t am ent o” , a par t ir de quat r o subcat egor ias: o cuidado cent r ado nas necessidades físicas; o r eceio d o j u lg am en t o n a sit u ação d e ab or t am en t o; asp ect os leg ais d ef in in d o o cu id ad o; a n ecessid ad e d e apoio na sit uação de abor t am ent o. As m ulher es ident ificar am o cuidado de enfer m agem fundado em aspect os físicos, não cont em plando a indiv idualidade e as especificidades delas. Os r esult ados apont ar am a necessidade de cr iar um am bient e que pr opicie a escut a, aj udando essas m ulher es a elabor ar seus sent im ent os, per m it indo aos pr of ission ais con du t a m ais pr óx im a da r ealidade delas, de f or m a qu e seu s pr ópr ios desej os e con f lit os sej am m enor es, e que sej a cont em plada a int egr alidade da assist ência.
DESCRI TORES: abor t o; saú de da m u lh er ; en fer m agem ; cu idados de en fer m agem
1 RN, M.Sc.in Public Healt h Nur sing, e- m ail: m gm ar iut t i@yahoo.com .br ; 2 PhD, Pr ofessor at t he Univer sit y of São Paulo at Ribeir ão Pr et o College of Nur sing,
WHO Collaborat ing Cent r e for Nur sing Resear ch Developm ent , e- m ail: am alm eid@eer p.usp.br, m ar islei@eer p.usp.br
I NTRODUCTI ON
T
h e illeg alit y of ab or t ion in Br azil h as n ot im peded it s pr act ice in dif f er en t con dit ion s, r an gin gf r om clin ics w it h car e q u alit y con t r ol t o p r ecar iou s
and clandest ine ones. Per year, 1. 4 m illion abor t ions
ar e p er f or m ed in t h e cou n t r y, cor r esp on d in g t o 2 3
abor t ions per 100 pr egnancies and 50 m illion per year
all over t he w orld, im posing sever e r isks on w om en’s
h e a l t h a n d l i v e s( 1 - 3 ). I n t h e co n t e x t o f m a t e r n a l m or t alit y, 1 2 . 5 % of t h e t ot al n u m b er of d eat h s is
caused by abor t ion com plicat ions, occupying t he t hir d
place am ong it s causes.
An ear lier phenom enological st udy obser v ed
t h at w om en in ab or t ion sit u at ion s sh ou ld h av e t h e
possibilit y t o express t heir physiological and exist ent ial
p a i n , i n d e p e n d e n t l y o f t h e c a u s e o f a b o r t i o n ,
r em inding t hat t he decision t o get an abor t ion is not
i n d i v i d u a l , a s i t i n v o l v e s ci r cu m st a n ce s a n d l i f e
hist or ies. Abor t ion r ev ealed t o be an ex per ience t hat
leads t o a discom for t ing hospit alizat ion as, alt hough
hospit alizat ion t im e t ends t o be shor t , t he w om en w er e
v er y anx ious t o go hom e, out of fear t hat significant
people w ould discov er w hat had occur r ed. This st udy
also ident ified feelings of guilt or fear, due t o societ y’s
v a l u e p a r a m e t e r s. Th e a b o r t i o n e x p e r i e n ce a l so
inv olves concer n about t he body and it s int egr it y, in
v iew of t he possibilit y of com plicat ions and t he fear
of no longer being able t o have children. Hence, t hese
w om en revealed abort ion as an experience t hat ent ails
t he desir e t o r econsider t heir life pr oj ect s( 4).
As h ealt h p r of ession als, w e ar e con cer n ed
about nur sing car e fr om t hese w om en’s per spect iv e.
Th i s r e s e a r c h a i m e d t o u n d e r s t a n d h o w w o m e n
hospit alized at a public hospit al in abor t ion sit uat ions
ack n ow ledge t h e n u r sin g car e t h ey r eceiv ed.
METHODOLOGI CAL PROCEDURES
This is a qualit at iv e r esear ch, as it at t em pt s
t o focus on t he individual w it h a view t o underst anding
t h e st u dy ph en om en a.
Th is appr oach is ch ar act er ized as a m et h od
t o under st and and r eflect about a t hem e and at t em pt
t o r e f l e ct o n q u e st i o n s o f co n ce r n , b a se d o n t h e
discourse of t he subj ect s subm it t ed t o analysis, w hich
p r e s e n t s m e a n i n g s t h a t h e l p t o u n d e r s t a n d t h e
r esear ch pr oblem( 5 ).
Th is ex plor at or y an d descr ipt iv e st u dy u sed
cont ent analy sis, w hich is defined as: “ ... a r esear ch
t ech n i q u e ai m ed at t h e o b j ect i v e, sy st em at i c an d
q u an t it at iv e d escr ip t ion of t h e m an if est con t en t of
com m u n icat ion ”( 6 ).
We st udied nur sing car e t o w om en in abor t ion
sit uat ions, based on t he discour se of 13 w om en w ho
w er e h osp it alized at a p u b lic h osp it al in São Pau lo
St at e bet w een May and July 2003, aft er at least 20
hour s of hospit alizat ion.
Ou r c o n c e r n f o c u s e d o n t h e c o n t e n t s o f
discourse, so as t o guarant ee t hat t hese r eflect ed t he
w om en ’s ex per ien ces w h en r eceiv in g abor t ion car e.
D a t a sa t u r a t i o n o ccu r r e d w h e n co n t e n t s b e ca m e
r e p e a t e d , w i t h o u t t h e p r e se n ce o f n e w f a ct s f o r
in t er pr et at ion .
Al l et h i ca l p r o ced u r es f o r h ea l t h r esea r ch
w e r e t a k e n i n t o c o n s i d e r a t i o n . Th e p r o j e c t w a s
su bm it t ed t o appr ov al by t h e r esear ch h ospit al an d
lat er appr ov ed by t he Resear ch Et hics Com m it t ee at
t he sam e inst it ut ion.
I m p o r t a n t a sp e ct s f o r t h e su b j e ct s w e r e
c o n s i d e r e d , s u c h a s t h e i n t e r v i e w e r s ’ f o r m a l
pr esent at ion, t he subj ect ’s int er est in t he int er v iew ,
t he st udy obj ect ive and t he guar ant ee of anony m it y.
At t he end of each int erview , t he w om en could clarify
doubt s about aspect s r elat ed t o t he t hem e.
The m eet ings occur r ed as follow s: fir st , t he
int er view er pr esent ed her self and asked t he par t icipant
t o sign t he Fr ee and I nfor m ed Consent Ter m and t o
aut horize t he recording of t he int erview , clarifying t he
possibilit y t o t urn off t he recorder during t he int erview
if t his affect ed t he w om an’s w illingness t o t alk .
Aft er t hese pr ocedur es, t he int er view st ar t ed
w it h t he follow ing quest ions: How do you acknow ledge
t he nur sing car e you ar e r eceiving? Can you descr ibe
i t ? Al l i n t er v i ew s w er e ca r r i ed o u t b y o n e o f t h e
r esea r ch er s.
Due t o t heir char act er ist ics and subj ect iv it y,
t he collect ed dat a w er e subm it t ed t o qualit at ive analysis
an d sy st em i zed acco r d i n g t o t h e co n t en t an al y si s
t ech n i q u e. D at a w er e o r g an i zed t h r o u g h t h em at i c
an aly sis, w it h a v iew t o an aly zin g t h e m ean in gs of
t h e w om en ’s discou r se abou t t h e n u r sin g car e t h ey
r eceiv ed dur ing hospit alizat ion in abor t ion sit uat ions.
I n t his analysis, we at t em pt ed t o ident ify t he
m eaning of t his care in t heir discourse, by looking at
t he care wit hout prej udices about t he t hem e, in order
t o underst and it at t hat m om ent , from t he perspect ive
of t h e per son ex per ien cin g t h e pr ocess of r eceiv in g
car e in an abor t ion sit uat ion. Thus, aft er r eading t he
n u r sin g ca r e e x pe r ie n ce d in a bor t ion sit u a t ion s,
pr esent ed t hr ough four sub- cat egor ies, nam ely : car e
ce n t e r e d o n p h y si ca l n e e d s; f e a r o f j u d g m e n t i n
abor t ion sit u at ion s; legal aspect s def in in g car e; t h e
need for support in abort ion sit uat ions. At t his m om ent ,
w e h i g h l i g h t ed si g n i f i can t ex t r act s com p osi n g t h i s
cat egory, in t he form t he w om en expressed t hem . To
gu ar an t ee an d pr eser v e an on y m it y, all w om en w er e
ident ified t hr ough fict it ious nam es.
RESULTS AND DI SCUSSI ON
Ch ar act er izat ion of w om en
Th e w om en w er e bet w een 2 0 an d 4 5 y ear s
old. On t he occasion of t he abort ion, t heir gest at ional
age r an ged bet w een 9 an d 2 2 w eek s. Fiv e of t h em
r epor t ed t hey w er e single, t hr ee m ar r ied and five had
a fixed part ner. Educat ion levels ranged from illit eracy
t o f in ish ed secon d ar y ed u cat ion . As t o occu p at ion ,
o n e w a s a st u d e n t , t h r e e w e r e h o u se w i v e s, t w o
u n e m p l o y e d , f o u r d o m e s t i c s e r v a n t s , t w o s h o p
assist ant s and one public ser v ant . Thr ee par t icipant s
m ent ioned t his w as t heir fir st pr egnancy and, for t he
ot h er s, t h e n u m ber of ch ildr en r an ged f r om on e t o
four. Thr ee w om en r evealed t hey had had an abor t ion
befor e. Only t w o w om en had planned t he pr egnancy.
What t he use of cont r acept ive m et hods is concer ned,
eight par t icipant s indicat ed t hey did not use any; t hr ee
t ook t he pill but had int errupt ed it s use.
Nur sing car e ex per ienced in abor t ion sit uat ions
Car e should never r em ain r est r ict ed t o healt h
a c t i o n s a n d i n t e r v e n t i o n s b u t , i n s t e a d , s h o u l d
com pr ise t h e dev eloped of at t it u des an d spaces f or
t r u e i n t er su b j ect i v e m eet i n g s, f o r t h e ex er ci se o f
p r act i cal k n o w l ed g e f o r h eal t h , su p p o r t ed b u t n o t
l i m i t e d t o t e c h n o l o g y ; a n e n c o u n t e r b e t w e e n
car egiv er s an d pat ien t s sh ou ld be pr om ot ed w it h a
v iew t o a m or e sy m m et r ical r elat ion bet w een bot h( 7). I n t h i s st u d y, ca r e ca n n o t b e ex p er i en ced i n t h i s
dim ension, in accordance w it h t he follow ing descript ion
of su bcat egor ies.
Car e cen t er ed on ph y sical n eeds
I n t heir discour se, t he w om en per ceiv ed t he
m ean in g of n u r sin g car e as t h at car e in w h ich , on
m o s t o c c a s i o n s , t h e “ b a s i c ” i s p e r f o r m e d . Th i s
m ea n i n g p o i n t s t o w a r d s co m p l i a n ce w i t h p h y si ca l
n eeds an d t h e per f or m an ce of t ech n ical pr ocedu r es
and was r evealed as “ nor m al”, highlight ing at t endance
t o needs r elat ed t o t he phy sical body.
Norm al, people, t he nurse, everyone’s nice. Everyt hing
nat ur al, excellent t r eat m ent . Ever yt hing you need, t hey com e
int o your r oom all t he t im e, you know ? They give you ever yt hing
you need, t hat ’s how it is, you know ? They’r e not im polit e or
anyt hing, ever yone’s nice ( Gilda)
... t heir car e, t he nur ses’, nor m al, r eally nor m al, t hey
w ash us, m easur e blood pr essur e, fever , give m edicat ion...t ake
care... t heir j ob... ( Lúcia)
The healt h area st ill operat es w it h an essent ial
an d biological con cept ion of t h e h u m an con dit ion( 8 ). Ther e is a need for a change in t he car e focus, m aking
t h e n u r sin g t eam r ef lect on t h eir act ion s, as car e
should go bey ond t he solut ion of phy sical pr oblem s,
t h a t i s, i n co r p o r a t e i t s so ci a l , p sy ch o l o g i ca l a n d
spir it u al dim en sion .
N u r s i n g a c t i v i t i e s w e r e p e r c e i v e d a s
m ean in g less act ion , or w h ose m ean in g w or k er s d o
n o t k n o w . Th i s m a k e s t h e m r e p r o d u c e a
b u r eau cr at ized k n ow led g e an d p r act ice. Hen ce, n o
nat ur al gift can r esist t o t he aut om at ic r epet it ion of
act s and w orking in services st ruct ured like t his usually
becom es unbear able( 9). Thus, nur sing com pet ency is associat ed w it h t h e t ech n ical an d bu r eau cr at ic side.
The w om en’s discour se r evealed and defined t his w ay
of b ei n g as “ n or m al ” an d con si d er ed t h e w or l d of
nur sing w or k as:
... would t hat be... t he role of nurses? Advising, passing
by t o check if ever yt hing’s OK, if you need anyt hing or w hat ever ,
checking fever , giving m edicat ion, m easur ing pr essur e. These
nor m al t hings... ( Vânia)
Th i s st a t e m e n t r e v e a l s t h a t , i n a b o r t i o n
si t u a t i o n s, n u r si n g co n t e m p l a t e s t h e p r o ce d u r e s
at t en d in g t o p h y sical n eed s, w h ich is t h e m ean in g
t hese w om en per ceiv e w it h r espect t o nur sing car e.
I n t his sense, t here is no difference bet w een different
p r o f e s s i o n a l n u r s i n g c a t e g o r i e s ’ t a s k s ( n u r s e ,
t echnician, auxiliary) , as part icipant s did not dist inguish
am ong t hese differ ent cat egor ies’ w ay s of act ing.
Accor d in g t o t h ese w om en ’s r ep or t s, d aily
nur sing w or k w as m ar k ed by t echnical act ions. Their
discour se ex pr essed t he im per sonal w ay of being in
t h is t eam ’s w or k an d poin t ed t ow ar ds t h e n eed f or
n ew car e pr oposals.
Par t icipant s r ev ealed t he need for car e t hat
st at em en t s, t h e n eeds t h ey pr esen t ed t r an sgr essed
ph y sical car e an d abor t ion appear ed as a ph y sically
an d ex i st en t i al l y d i f f i cu l t , co m p l i cat ed an d p ai n f u l
sit u at ion .
And people going t o hospit al independent ly of anyt hing,
t hey go because t hey need help... t hings happen in our life and
befor e w e know it has alr eady happened... and it can happen t o
an y on e. Th er e’ alw ay s t h e side of pain , ev en ph y sical, an d
suffer ing, alt hough it ’s hum an... ( Ver a) .
...now , like...physically I ’m OK ... ( cr ies, cr ies a lot )
( Dulce) .
I t should be highlight ed t hat t he pr iv ilege of
p h y si cal car e asp ect s d o es n o t seem t o t ak e i n t o
account t he needs t hese w om en ex per ience, as t heir
discou r se r ev ealed t h at t h is m odel is in su f f icien t t o
p r o v i d e i n t e g r a l c a r e . Th e r e l a t i o n s b e t w e e n
p r o f e ssi o n a l n u r si n g ca t e g o r i e s a n d cl i e n t s w e r e
influenced by each person’s subj ect ive condit ions and
by m at er ial w or k con dit ion s. Realit ies sh ow ed t o be
co m p l e x , d i f f i cu l t t o a p p r e h e n d a s a w h o l e a n d
per m eat ed by dist inct and som et im es diver ging beliefs
and int er est s( 9).
These w om en, in t heir life cont ext s, hist ories,
ex pect at ions and par t icular it ies, som et im es r ev eal t o
b e d iscon n ect ed f r om t h eir ow n id en t it y an d of t en
s a f e g u a r d t h e m s e l v e s b y n o t e s t a b l i s h i n g a
r e l a t i o n s h i p o f c o n f i d e n c e w i t h p r o f e s s i o n a l s .
Som et im es, t his is j ust ified by t heir difficult y t o deal
w it h t he consequences of w hat is consider ed a sinful
and illegal act .
Fear of j udgm ent in abor t ion sit uat ions
Out of fear of j udgm ent about t he act t hey
have pr act ised, som e w om en in self- induced abor t ion
si t u a t i o n s se e k ca r e b e ca u se o f t h e p r e se n ce o f
em br yo r em nant s. Fear of fam ily and social censor ship
m akes t hey face hospit alizat ion alone, t urning it even
m or e painful( 10).
Cases of w om en ex p er ien cin g sp on t an eou s
a b o r t i o n sh o u l d a l so b e t a k e n a cco u n t . Th e y a r e
f r u st r at ed abou t t h is ev en t an d ar e of t en n eglect ed
an d d iscr im in at ed ag ain st , u n t il t h e t eam b ecom es
aw ar e t h at t h e f et al loss w as sp on t an eou s. On e of
t he m ost difficult t asks is t o infor m t his m ot her about
t he baby ’s loss, and har dly any t hing has been done
t o g i v e h e r p sy ch o l o g i ca l su p p o r t . Th e se w o m e n
f r eq u en t ly ex p r ess f eelin g s of r ev olt an d r ej ect ion ,
s o m e t i m e s t u r n i n g t o o t h e r s e r v i c e s t o g e t
confir m at ion, and ex pr ess guilt because t hey did not
avoid t he loss, as w ell as t he need t o know t he m ot ive
of t he abort ion( 10- 11).
Th u s, t h e abor t ion ex per ien ce is con f igu r ed
as a crisis and professional act ivit ies should be guided
b y t h e u n d er st an d in g of t h e f eelin g s t h ese w om en
ex p r ess, seek in g t o d iscer n som e am b iv alen t f ear s
liv ed b y t hese w om en and, m ainly, av oiding legalist
and m or alist posit ions t ow ar ds abor t ion( 8, 11).
The sit uat ion is painful and com plex in bot h
s p o n t a n e o u s a b o r t i o n s a n d c a s e s s u g g e s t i n g
i n d u c t i o n , a n d w o m e n n e e d s u p p o r t a n d
under st anding, independent ly of it s et iology.
How ev er, in ex p er ien cin g n u r sin g car e, t h e
w om en m anaged t o give m eaning t o t he differ ent iat ion
in t he car e t hey r eceiv e.
Also because w e suffer a lot , you know , it is ver y sad
and we need support , I even conform ed t o it and it was som et hing
t hat happened like... nat ur ally, but t hese w om en like t hat ( she
m eant when it is provoked) , I t hink t hey need even m ore support ,
it m ust be com plicat ed ( Gilda) .
...if t hat per son is going t hr ough t hat , it ’s for som e
r eason, do you t hink she’d w ant t o go t hr ough t hat , suffer t hat
m uch and even be r ej ect ed, scor ned by people, pur sued... t hey
t r eat ed m e w it h gr eat hum iliat ion, despise and punishm ent ...
ever ybody know s t hat t r eat m ent is differ ent ... t he few people I
could count on, I could t ell t he t r ut h and t hey r eached out t o m e,
one of t hem w as t hat nur se I t old you about ... ( Adelaide) .
Un iv er sal access t o h ealt h an d r esp ect f or
each in d iv id u al’s sin g u lar it ies, w it h ou t an y t y p e of
d i s c r i m i n a t i o n , a r e c o n s t i t u t i o n a l r i g h t s . Th e
hum anizat ion of healt h act ions depends on t he act ual
a ck n o w l e d g e m e n t o f t h e su b j e ct ’ s co n d i t i o n a s a
cit izen w it h right s, of all persons seeking any kind of
healt h care, at public or privat e services. Care delivery
is a polit ical act an d car e is com plex . Aw ar en ess of
t his com plexit y favors a crit ical dist ancing w it h a view
t o r eflect ion, assessm ent and im plem ent at ion of t he
healt h pr act ices m ost per t inent t o t he sit uat ion. The
h u m a n i za t i o n o f h ea l t h a n d n u r si n g ser v i ces i s a
cont inuous pr ocess and depends on t he nur sing t eam ’s
daily r eflect ions about car e( 12).
Legal aspect s defining car e
The w om en’s discour se r evealed t hat suppor t
is essen t ial at t h is m om en t an d d em on st r at ed t h at
t h ey v isu alize t h e d if f er en ce in su p p or t in cases of
sp o n t an eo u s an d “ su p p o sed l y ” p r o v o k ed ab o r t i o n .
On e p a r t i c i p a n t t r i e d t o s h o w h e r c o n d i t i o n b y
...as I ’ve st ar t ed t o t alk I ’ll say it all, you know ? The
law for exam ple, t he law pr ohibit s abor t ion, but it happens, and
t h e n ? I t a ct u a l l y h a p p e n s. . . . a n d w e h a v e t o g o t o t h e
hospit al...w hat t hen? I know t his should not happen...like w hat
happened t o m e, never m or e...you know ? I t hink it ’s so good
w hen you can t alk about w hat you feel, w hat you should...you
know ? Enough... look, I did it , m y life is like, like, like... I know I
should have prevent ed it , but it happened, you know? ( Adelaide) .
We n e e d t o e x e r c i s e o u r p r o f e s s i o n ,
u n d er st an d in g t h e d if f er en t t r an sf or m at ion s societ y
is going t hr ough, r eflect ing about t he phenom ena t hat
giv e r ise t o car e dem an ds. An y law f acilit at in g t h is
should r eceiv e our suppor t . The illegalit y of abor t ion
in Br azil h as n ot m an aged t o con t r ol it s occu r r en ce
and t hese w om en ar e aw ar e of t his. Hence, t hey need
t o be guar ant eed access t o qualit y car e in public and
pr iv at e h ealt h n et w or k s.
Ho w ev er, car e i s j eo p ar d i zed w h en h eal t h
p r o f e ssi o n a l s a p p e a r e d b e f o r e t h e se w o m e n w i t h
v alu e j u dgm en t s an d pr ej u dices.
...it ’s m uch bet t er w hen you’r e able t o t ell t he t r ut h,
but t her e’s fear ...I , as I never hid anyt hing fr om anybody, I
r eally didn’t , . . . t hey t hough I should lie, hide, t hey ’r e ev en
ast onished, because t hey’r e used t o lies, t hey w ant t o hear t he
t r ut h, but t her e’s no w ay of doing t hat in t his sit uat ion. Many
t im es, I ’ve left t he hospit al w it hout r eceiving car e, because I
ar r ived and said w hat m y pr oblem w as and t hey w ouldn’t at t end
m e...t hey left m e t here... ( Adelaide) .
Th is st at em en t poin t s t ow ar ds t h e fact t h at
pr ofessionals seem t o pr efer t o hear lies, r efusing t o
cope with conflicting and polem ic situation like abortion.
I t i s i m p o r t an t f o r h eal t h an d sp eci f i cal l y n u r si n g
professionals to apprehend that universal access to health
and respect for each person’s singularit ies, wit hout any
kind of discrim ination, are constitutional rights(12). I t is underst andable t hat healt h pr ofessionals
pr efer t o at t end successful pr egnancies, but even w ho
is against abor t ion can help w om en at t hese m om ent s
and, if t hey do t his, t hey w ill neit her be com m it t ing a
cr im e n or pr ov ok in g abor t ion . Nu r sin g pr of ession als
have m aint ained an at t it ude against t his pr ecept , oft en
ignor ing t he w om an’s indiv idualit y and dignit y in t his
condit ion( 12).
Need for suppor t in abor t ion sit uat ions
Cr e a t i n g a n e n v i r o n m e n t t h a t b e n e f i t s
l i s t e n i n g c a n h e l p t h e s e w o m e n e l a b o r a t e t h e i r
feelings, allow ing t hese pr ofessionals t o behav e in a
w a y cl o se r t o t h e i r r e a l i t y, so a s t o r e d u ce t h e
p r o j ect i o n s o f t h ei r o w n f eel i n g s an d co n f l i ct s( 1 3 ). Nu r si n g se r v i ce h u m a n i za t i o n i m p l i e s o r g a n i zi n g
s e r v i c e s w h o s e e n v i r o n m e n t i s w e l c o m i n g a n d
c o m f o r t a b l e , b u t m a i n l y o f f e r i n g q u a l i f i e d
pr ofessionals w ho ar e com m it t ed t o car e qualit y.
Th ese w om en ’s discou r se ev iden ces a m or e
hum anized at t it ude, in w hich professionals can be w it h
t hese w om en and help t hem , w hen t hey m ent ion t he
im por t ance of t alk and suppor t at t his m om ent .
... t his is car e, I t hink t hey hav e t o t alk, calm t he
per son... no m at t er w ho t he pat ient is ( Mar ia Apar ecida) .
They t alk t o us, yes, t hey do ever yt hing r ight , but I
w ent t hr ough a lot and I feel t his lack of suppor t . They t alk like,
you know ? What happens? They ask if ever yt hing is ok? I f you
feel pain, but I m iss infor m at ion... and r eally t alking about m y
pr oblem s...it ’s all ver y super ficial, aut om at ic ( Vânia) .
Th e s e w o m e n ’ s d i s c o u r s e s h o w s t h e i r
c o n f o r m i s m a b o u t c a r e , b u t t h e s u p e r f i c i a l a n d
aut om at ic w ay nur sing pr ofessionals appear t o t hem
also st ands out .
New r elat ions bet w een t he car egiver and t he
per son r eceiv in g car e ar e n eeded, t r eat in g t h em as
subj ect s in t his pr ocess and including a com m it m ent
t o t he art iculat ion of new care st rat egies for suffering
p eop l e.
The desir e t o have a child, t he fact of having
pr ov ok ed an abor t ion or n ot , t h e f am ily ’s econ om ic
si t u a t i o n a n d g est a t i o n a l a g e d o n o t i n t er f er e b y
m it igat ing or int ensifying t he pain of t his loss( 14). The w ay t his m our ning is expr essed is ext r em ely per sonal.
Thus, w hen appr oaching w om en w ho ar e exper iencing
an abort ion sit uat ion and are part icipat ing in t his w orld,
t h e f r ee m an i f est at i on of t h ei r m ou r n i n g , t h r ou g h
g est u r es, w or d s an d silen ces, sh ou ld b e p er m it t ed
and facilit at ed( 4).
Th er ef o r e, ca r e i m p l i es t h a t p r o f essi o n a l s
develop r elat ions w it h t hese w om en, r espect ing t hem
a s s u b j e c t s w i t h f r u s t r a t i o n s , e x p e c t a t i o n s a n d
dr eam s. Th ese pr of ession als sh ou ld also be able t o
i d e n t i f y t h e m o m e n t s o f i n t r o sp e ct i o n n e e d e d t o
elabor at e t h e ex per ien ced sit u at ion .
...it ’s good w hen t hey t alk t o us...it ’s good, w e feel
bet t er...., but som et im es we don’t even want t o t alk. For exam ple,
I would like t o t alk now, I like t his part , t he t alking, you can let off
st eam and suffer a bit less, I t hink it ’s good, like, but som et im es
it isn’t . You w ant t o st ay quiet , t hink, r elax ( Renat a) .
Th is d iscou r se p oin t s t ow ar d s t h e n eed f or
p r o f e ssi o n a l s t o a ck n o w l e d g e t h e m o m e n t t h e se
w om en ar e going t hr ough and suppor t im plies know ing
Th ese w o m en ’ s d i sco u r se m ak e u s r ef l ect
about t he fact t hat t he obj ect of nur sing w or k should
not focus on t he biological body but look at t his w om an
i n a l l o f h e r p a r t i c u l a r i t i e s , b e n e f i t i n g h e r s e l f
-k n ow ledge an d aw ar en ess of t h e r is-k s t h e abor t ion
sit u at ion ex p oses h er t o; p r ev en t in g r eoccu r r en ce;
el ab o r at i n g t h i s si t u at i o n , p r eser v i n g h er so ci al l y,
af f ect i v el y an d em o t i o n al l y, av o i d i n g p h y si cal an d
p sy ch o l o g i cal seq u el ae, av o i d i n g t h e r ep et i t i o n o f
o t h e r u n w a n t e d p r e g n a n c i e s a n d c o n s e q u e n t l y,
an ot h er abor t ion .
Th e p at i en t s i d en t i f i ed t h i s ch an g e i n t h e
nur sing pract ice paradigm , w hich w as r evealed in t he
w om en ’s discou r se abou t h ow t h ey per ceiv ed t r u t h
-based pr act ice.
We can perceive it by the way they deliver care... (Fernanda).
...it ’s good w hen t hey t alk t o us, but even bet t er w hen
w e now t hat t hey ar e r eally int er est ed... The per son r eally t akes
int er est ...you m ay or m ay not be int er est ed in t he per son, in t he
suffer ing and you can suppor t by t alking or not , one can per ceive
if it ’s t r ue or not ... if it ’s aut om at ic or j ust t alk... you see...it ’s not
t hat t r ue, I ’m not saying t hat it happened like t hat her e, but it
m ay be, one can per ceive it by t heir w ay of t alking, of looking
ever yt hing... looks r eveal ever yt hing... it ’s like t hat in love as
well ( Vera) .
Th ese st at em en t s sh ow ed t h at t h e w om en
p er ceiv e t h e car e t h ey ar e r eceiv in g an d n ot on ly
t h is, bu t also t h e w ay it is pu t in pr act ice, w h et h er
au t om at ically, as a p ar t of r ou t in e, or w h et h er t h e
int er est in helping and shar ing t hat m om ent w it h t hem
is r eal, m ov in g bey on d t h e ph y sical aspect of car e.
Hence, list ening, som et hing apparent ly sim ple, reveals
t o be an ext r em ely com plex phenom enon in pr act ice,
d em an d in g an ar t icu lat ion am on g t h e p ossib le an d
m u lt iple sen ses of each st at em en t , an d also am on g
k n ow ledge f r om dif f er en t ar eas. Th u s, list en in g can
con t r ibu t e t o decr ease t h e occu r r en ce of pr ej u diced
beh av ior s an d t h e j u dgm en t s gen er ally m ade abou t
t hese w om en( 12).
Nur sing pr ofessionals at t he st udy inst it ut ion
have not r eached t his dim ension of car e yet , and t he
w om en seek explanat ions, such as t he nur sing t eam ’s
lack of r espect , lack of consider at ion for t heir needs,
l a ck o f i n f o r m a t i o n , j u st i f y i n g t h e se d e f i ci e n ci e s
t hrough t heir percept ion about an insufficient num ber
of pr ofessionals t o at t end t o t heir dem ands and, hence,
lack of t im e.
Som e st at em en t s descr ibed t h ese pr oblem s
r elat ed t o t he nur sing t eam as insufficient st aff and
lack of t im e.
... som e give m or e car e, besides doing t hese t hings...
check fever , help t o w ash, t alk, and t her e ar e ot her s w ho don’t ,
m aybe because of t im e...( Gilda) .
Ahh..t im e...for exam ple, som et im es t her e ar e m any
pat ient s and few of t hem , so it ’s r eally difficult , t her e’s less
t im e... ( Fernanda) .
As t he w om en feel w eakened by t he abor t ion
sit uat ion, t hey at t em pt t o j ust ify t he car e m er ely based
o n p h y s i c a l n e e d s , a s t h e y h o l d m i n i m a l c a r e
ex p ect at ion s.
So m e o f t h e se w o m e n ’ s st a t e m e n t s a l so
i n d i ca t e d m o m e n t s t h e y co n si d e r e d a s a l a ck o f
r e s p e c t f o r t h e i r n e e d s a n d m o m e n t s o f
t hought lessness by t he t eam .
I st ar t ed t o get ner vous... And he kept close t o m e, I
asked him t o m ove back, he didn’t , he st ar t ed t o yell at m e and I
st ar t ed t o yell at him , t hen he t ook m y vein, t hen I t hink he
perforat ed m y vein, look here, t hen he cam e t o t alk t o m e, yelling,
I t alked t o him t oo... it ’s not because we’re in t his kind of sit uat ion
t h at w e h av e t o h u m iliat e ou r selv es b ef or e ot h er s ( Mar ia
Aparecida) .
Th i s st a t e m e n t sh o w s t h e t e a m ’ s l a ck o f
r e sp e ct f o r t h e w o m e n ’ s n e e d s a n d m o m e n t s o f
t hought lessness t hat m ay be used, in a hidden way,
as a punishm ent for t he abor t ion, r ev ealing t he fact
t hat pr ofessionals ar e not fr ee fr om v alue j udgm ent s
a n d , s o m e t i m e s , p r i o r i t i z e s c a r e i n o t h e r
h ospit alizat ion sit u at ion s.
I n t heir r epor t s, som e w om en descr ibed t he
car e as t ak in g a lon g t im e an d v er y slow in t h eir
op in ion .
Ahhh...it t akes t im e, you know ...w hen w e call, at least
it t ook t im e ...( Maria Aparecida) .
Ahh...t he car e is good, but I t hink it ’s ver y slow , ver y
slow ( Vera) .
Wo m e n i n a b o r t i o n s i t u a t i o n s w i t h o u t a
com panion per ceive t hat car e t akes a long t im e even
m or e int ensely. I n t heir st at em ent s, t hey r evealed a
delayed care, in w hich t hey have t o w ait silent ly w hile
feeling pain, besides a lack of inform at ion about t heir
condit ion, about t he pr ocedur es t hat w ill be per for m ed,
t r eat m ent s and conduct s.
…m aybe t hey could have been m or e t hought ful, given
m or e infor m at ion, w e don’t know w hat ’s happening, w e didn’t
st udy t hat ...we don’t know what can happen, we’re not inform ed...
I ’m concer ned...I w ant ed m or e infor m at ion, explanat ion about
w hat ’s going on, about w hat w ill happen.... ( Vânia) .
...there’s just som e inform ation that’s m issing... (Eduarda).
Th e w om en r ep or t ed a lack of in f or m at ion
and anx iet ies. Thus, t he sit uat ion is oft en t r aum at ic,
as it is per m eat ed by solit ude and fear of t he unknow n.
A n t i c i p a t i n g o r i n f o r m i n g m e a n s b r e a k i n g t h e
unknow n, saving t hese w om en fr om t he shock of new
t h in gs an d sh ar in g t h e f eelin g of solit u de, t r y in g t o
m in im ize psy ch ological pr oblem s( 1 3 ).
FI NAL CONSI DERATI ONS
Abor t ion is char act er ized as a polem ic issue
an d a p u b lic h ealt h p r ob lem , w h ose m or b id it y an d
m or t alit y sh ou ld b e t ak en in t o accou n t , an d w h ose
illegal nat ur e does not im pede it s occur r ence.
Healt h pract ice based on t he biological m odel
h as r ev eal ed t o b e i n su f f i ci en t t o at t en d t o t h ese
w om en’s needs. I n act ing, it is im por t ant t o under st and
t h e i r s p e c i f i c i t i e s i n t e g r a l l y a n d r e s p e c t t h e i r
aut onom y. The aim is t o pr ovide qualit y car e t o t hese
w om en, r aising t heir aw ar eness, infor m ing t hem and
helping t hem in a sit uat ion t hat has no ret urn.
We underst and t hat professionals should reflect
on t heir pract ice and get genuinely involved. Physical
n eed s m u st b e at t en d ed t o , w i t h o u t f o r g et t i n g t o
co n t e m p l a t e w o m e n a s a w h o l e . Th i s i m p l i e s
u n d er st an d in g ab or t ion in t h e w om en ’s ex ist en t ial
cont ext , det ached from it s illegal or crim inal charact er.
No sit uat ion is isolat ed in it self. Hum an beings live in a
cont ext , have habit s, values, socioeconom ic condit ions,
ways of being t hat int erfere in t heir life, in t heir exist ence.
Besid es h av in g p r of ession als r ef lect in t h e
s e a r c h t o t r a n s f o r m c u r r e n t c a r e m o d e l s , i t i s
fundam ent al for t hese w om en t o change in t he sear ch
for gr eat er aut onom y, k now ledge of t heir ow n body,
dev elopm ent of em pow er m ent , pr ev ent ion w hen t hey
do not w ant t o hav e childr en and a sear ch for t heir
r ight s as healt h ser v ice user s.
H e a l t h a n d m a i n l y n u r si n g p r o f e ssi o n a l s
w or k ing in t his field should be aw ar e of t heir r ole in
ex er cisin g social con t r ol an d in g u ar an t eein g t h eir
client s’ right s, independent ly of t he sit uat ion, as it are
t he subj ect s w ho put in pr act ice, gr ant m eaning, body
and qualit y t o healt h policies. They need t o under st and
t hat univ er sal access t o healt h and r espect for each
p e r s o n ’ s s i n g u l a r i t i e s , w i t h o u t a n y k i n d o f
discr im inat ion, ar e const it ut ional r ight s.
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