SCI ENTI FI C NURSI NG PRODUCTI ON FROM THE PERSPECTI VE OF SOCI AL
REPRESENTATI ON. BRAZI L, 1 9 7 5 -2 0 0 1
Ser gio Cor r êa Mar ques1 Mar ia Ant oniet a Rubio Ty r r ell2 Denize Cr ist ina de Oliv eir a3
Marques SC, Tyrrell MAR, Oliveira DC. Scientific nursing production from the perspective of social representation. Brazil, 1975- 2001. Rev Lat ino- am Enferm agem 2006 set em bro- out ubro; 14( 5) : 762- 9.
This st udy aim ed t o: survey t he num ber of nursing t heses and dissert at ions produced bet ween 1975 and 2001 wit h a social represent at ion approach ( RS) ; charact erize t he product s wit h regard t o t he inst it ut ion of origin, count ry region, st udy subj ect s and represent at ion obj ect s; t o group in t o t hem e cat egories and research lines in nur sing. The dat a w er e collect ed fr om t he Cent er of St udies and Resear ch in Nur sing at t he Br azilian Nur sing Associat ion. The result evidenced 131 st udies wit h RS support , originat ed in 1990, wit h higher product ion in t he year 2000, m ainly in t he Sout h East ( 83.1% ) . I t regist ered 145 subj ect s; t he m ost com m on obj ect s are “ disease” , “ healt h- disease process” , “ nurses’ professional pract ice” and “ care delivery” . I n t he t hem at ic cat egorizat ion, t he care area j oins t he great est quant it y of st udies. I n short , nursing has been seeking t o appropriat e it self of t his t heoret ical- m et hodological fram ework as t he basis and guide for part of it s knowledge product ion.
DESCRI PTORS: nur sing r esear ch ; classificat ion; m et hods
LA PRODUCCI ÓN CI ENTÍ FI CA DE LA ENFERMERÍ A EN LA PERSPECTI VA DE LA
REPRESENTACI ÓN SOCI AL. BRASI L, 1 9 7 5 -2 0 0 1
Est e est u dio obj et iv ó: in v en t ar iar el n ú m er o de t esis y diser t acion es de en f er m er ía del per íodo de 1975 a 2001 con aproxim ación de las represent aciones sociales ( RS) ; caract erizar las producciones con relación a la inst it ución de or igen, a las r egiones del país, a los suj et os de los est udios y obj et os de r epr esent ación; r eunir en las cat egor ías t em át icas y lineas de inv est igación en enfer m er ía. Los dat os fuer on r ecolect ados del cat álogo del Cent r o de Est udios y Pesquisas en Enfer m er ía/ Asociación Br asileña de Enfer m er ía. El r esult ado ev iden ció 1 3 1 est u dios con sopor t e de las RS, pr odu cidos desde 1 9 9 0 , con m ay or pr odu cción en el añ o de 2 0 0 0 , pr in cipalm en t e en la Región Su dest e ( 8 3 , 1 % ) . Se r egist r ar on 1 4 5 su j et os; los obj et os m ás com u n es fu er on “ en fer m edad” , “ pr oceso salu d- en fer m edad” , “ pr áct ica pr ofesion al del en fer m er o” y el “ cu idar ” . En la cat egorización t em át ica, el área de at ención es el que reúne el m ayor núm ero de invest igaciones. En resum en, la Enferm ería busca apropiarse de est e referencial t eórico y m et odológico en el em basam ient o y guía de part e de la pr oducción de su conocim ient o.
DESCRI PTORES: in v est igación en en fer m er ía; clasificación ; m ét odos
A PRODUÇÃO CI ENTÍ FI CA DA ENFERMAGEM NA PERSPECTI VA DA
REPRESENTAÇÃO SOCI AL. BRASI L, 1 9 7 5 - 2 0 0 1
O pr esen t e est u do obj et iv ou : lev an t ar os qu an t it at iv os de t eses e disser t ações de en f er m agem do per íodo ent r e 1 9 7 5 e 2 0 0 1 , com abor dagem das r epr esent ações sociais ( RS) , car act er izar as pr oduções em relação à inst it uição de origem , às regiões do país, aos suj eit os dos est udos e obj et os de represent ação, agrupar nas cat egorias t em át icas e linhas de pesquisa em enferm agem . Os dados foram colet ados do cat álogo do Cent ro de Est udos e Pesquisas em Enfer m agem da Associação Br asileir a de Enfer m agem . O r esult ado evidenciou 131 est udos com supor t e das RS, or iginados em 1 9 9 0 , com m aior pr odução no ano de 2 0 0 0 , pr incipalm ent e na Região Sudest e ( 83, 1% ) . Regist r ou- se 145 suj eit os, os obj et os m ais com uns são “ doença” , “ pr ocesso saúde-doença” , “ prát ica profissional do enferm eiro” e o “ cuidar” . Na cat egorização t em át ica, a área assist encial é a que reúne a m aior quant idade de pesquisas. Em sum a, a enferm agem vem procurando se apropriar desse referencial t eór ico- m et odológico na fundam ent ação e guia de par t e da pr odução do seu conhecim ent o.
DESCRI TORES: pesqu isa em en fer m agem ; classificação; m ét odos
1 Doct oral st udent , e- m ail: sergiocm arques@uol.com .br; 2 Full Professor, e- m ail: direcao@eean.ufrj .br, dco@uerj .br. Anna Nery School of Nursing, Rio de
Janeiro Federal University
I NTRODUCTI ON
I
n Brazilian nursing, scientific production is not a special focus of attention by nurses, but has rem ained latent in professional training and practice for several decades. I t was stim ulated from the m id-1970’s onwards, t hrough research originat ed in t he first st r ict o sensu graduate course (m aster’s level) at Anna Nery School of Nursing of Rio de Janeiro Federal University(1-2). Later,o t h er st r i ct o se n su g r ad u at e p r o g r am s w er e im plem ent ed, such as t he I nt erunit Doct oral Program by the Colleges of Nursing at the University of São Paulo, strengthening the construction of nursing knowledge and encouraging regular research developm ent( 3).
I t should be em phasized t hat t he evolut ion of nursing research has been support ed not only by graduat e program s, but also by professional ent it ies, especially t he Br azilian Nur sing Associat ion ( ABEn) , as well as by research ent it ies like t he Coordinat ion for t he I m provem ent of Higher Educat ion Personnel ( CAPES) and t he Nat ional Council for Scient ific and Technological Developm ent ( CNPQ) .
I f, on the one hand, due to historical, political or social reasons, nursing took tim e to get inserted in scient ific research pract ice, on t he ot her, t here have been progressive and constant advances in trials and in the incorporation of m odels and m ethodologies that are m ore adequat e t o it s research obj ect s.
Unt il 1 9 8 4 , nur sing r esear ch in Br azil w as guided by positivism , in line with scientific paradigm s at t hat t im e. This pr iv ileges t he m easur em ent and com par ison bet w een phenom ena, t he obj ect iv it y of o b se r v a t i o n s a n d t h e a b se n ce o r l i m i t a t i o n o f explanat ory analyses( 2), t hat is, t he predom inance of
the quantitative approach, em phasizing fact description and pr ocedur e st andar dizat ion. At t he st ar t of t he 1980’s, there was growing interest in the developm ent o f r e se a r ch t h a t u se s o t h e r p h i l o so p h i ca l a n d p ar ad ig m at ic or ien t at ion s, su ch as d ialect ics an d p h en om en olog y, aim ed at “ ap p r eh en d in g n u r sin g knowledge and pract ice as hist orical and art iculat ed wit h concret e social form at ions”( 2).
Th i s ev i d en ces n u r si n g ’s p er cep t i o n t h at q u est i o n s r el a t ed t o t h e h ea l t h - d i sea se p r o cess i n v o l v e h i st o r i ca l a n d so ci a l a sp ect s, st a r t i n g a t r aj ect or y m ar k ed b y d ist an cin g f r om b iom ed ical p ar ad ig m s an d ap p r ox im at ion of p ar ad ig m s f r om hum an sciences. This st udy ar ea st ar t ed t o t r y out in n ov at iv e t h eor et ical- m et h odological appr oach es, which adj ust ed t o such a vast and diversified obj ect as “ care delivery in t he healt h- disease process”.
These observations point towards the current predom inance of nursing studies guided by theoretical reference fram eworks from hum an and social sciences, su ch as so ci al p sy ch o l o g y an d so ci o l o g y, w h i ch reinforces the hypothesis that the paradigm used in this area changed. This tendency culm inated, in the 1980’s and 1990’s, wit h t he search for and incorporat ion of dif f er en t t h eor ies, su ch as Social Repr esen t at ion s Theory, which found fertile ground in the nursing area(4).
So m e n u r se s h a v e b e e n d e d i ca t i n g t h em sel v es t o t h e a n a l y si s o f sci en t i f i c n u r si n g pr oduct ions acr oss t he y ear s, addr essing differ ent asp ect s: r esear ch d ev el op m en t ar eas; r ef er en ce fr am ew or k and cont r ibut ion t o t he body of nur sing k n ow ledge( 5 ); classificat ion of scien t ific pr odu ct ion
accor din g t o t h e adopt ed m et h od, w it h a v iew t o d e t e r m i n i n g t h e p h a se s a ch i e v e d b y n u r si n g research( 6); and, also, analysis of nursing knowledge
and classificat ion according t o areas of int erest( 7). These and ot her st udies w it h sim ilar goals ar e r elev an t t o t h e ex t en t t h at t h ey ev iden ce, in dif f er en t sen ses, h ow t h e n u r sin g ar ea h as t ak en t heories from ot her knowledge areas, disclosing t his ret ranslat ion process in scient ific product ion and also revealing fut ure t endencies in t his field.
I n the sam e line, this study analyzes nursing research produced in st rict o sensu graduate program s in Brazil and which used social represent at ions as a t h e o r e t i ca l a n d / o r m e t h o d o l o g i ca l r e f e r e n ce fram ework, bet ween 1975 and 2001. We defined t he follow ing obj ect iv es: quant it at iv e sur v ey of nur sing dissertations and theses, produced between 1975 and 2001, which used t he t heoret ical prem ises of social r e p r e se n t a t i o n s; ch a r a ct e r i za t i o n o f sci e n t i f i c product ions in t erm s of inst it ut ions of origin, count ry r egions, st udy subj ect s and r epr esent at ion obj ect s; an d g r ou p in g in t o t h em e cat eg or ies an d n u r sin g research lines of Graduat e Program s.
Through the Graduate Coordinator Workshops prom ot ed by CAPES/ CNPq, nursing has at t em pt ed t o develop a proposal for a scientific product classification schem e, aim ed at consolidating nursing research lines and priorities. This schem e “ serves as a ‘classification t y p o l o g y ’ f u n d a m e n t a l t o o r d e r t h e p r o d u ce d k now ledge. I n science const r uct ion, it ser v es as a structure to arrange the corpus of Brazilian nursing”(8). Ho w e v e r, t h i s sch e m e sh o u l d b e su b m i t t e d t o experience in order to assess its reliability( 9).
psychology, history and philosophy, presenting nuances in their respective dom ains, particularly in the adopted group and social concept ions, and also in how t hey identify representation objects in a specific social context. I n t h is r espect , ou r in t en t t o iden t if y u n der w h at t h eor et ical per spect iv es n u r sin g pr odu ct ion s w er e dev eloped becam e unv iable as, in t he t ot al set of pr oduct ions w e analy zed, only 18 st udies ex plicit ly registered in the abstract that their study was developed in the context of the psychosocial approach, while the rem ainder did not m ention its theoretical fram ework.
METHODOLOGY
We carried out an exploratory and descriptive st u d y w i t h a q u a n t i t a t i v e a p p r o a ch . D a t a w e r e collected from the I nform ation about Nursing Research and Researchers cat alogues, issued by t he Brazilian Nu r si n g Associ at i on ’s ( ABEn ) Cen t er f or Nu r si n g St udies and Research. We used t he CD- rom edit ion that j oins volum es 1 to 18, for the period from 1979 to 2000, and the print version of volum e 19, issued in 2001. Moreover, we consulted abstracts of dissertations a n d t h e se s d e f e n d e d i n s t r i c t o s e n s u g r a d u a t e program s, for t he period from 1975 t o 2001.
First, we read the 2,642 abstracts included in the above m entioned publications, screening for studies that adopted social representations in their theoretical-m et h o d o l o g i cal r ef er en ce f r atheoretical-m ew o r k . Dat a w er e collected from August to October/ 2004.
Data were analyzed quantitatively. The following categories were presented in tables: production m ode, institution, period, study subjects, representation objects, distribution per them e category and research lines.
RESULT DESCRI PTI ON AND ANALYSI S
The CEPEn/ ABEn published 2,642 abst r act s of dissert at ions and t heses bet ween 1975 and 2001. I n t his collect ion, we ident ified 131 product ions t hat used social represent at ion as t he t heoret ical and/ or m et hodological fr am ew or k , cor r esponding t o 5% of t he t ot al num ber of scient ific nursing product ions.
Table 1 shows that 71.7% of these are theses and 28.3% dissertations, while one study was related t o a free lect ureship research.
Ta b l e 1 - D i st r i b u t i o n o f n u r si n g r e se a r ch p e r product ion t ype. Brazil, 2004
e p y t n o i t c u d o r
P F %
n o it a t r e s s i
D 37 28.3
s i s e h
T 94 71.7
l a t o
T 131 100
Tw e n t y - se v e n s t r i c t o s e n s u g r a d u a t e program s are offered in Brazil, m ore than half of which are Mast er’s courses( 10). These are represent at ive as
t h ey w er e cr eat ed t en y ear s b ef or e t h e Doct or al courses ( Mast er, EEAN, 1972 and Doct oral, EE/ USP, 1982) . Usually, Mast er’s courses have m ore st udent s and t ake less t im e ( about t wo years) t han Doct oral courses ( about 4 years) , leading to a larger scientific research volum e. This confirm s and j ustifies the higher concent rat ion of social represent at ion product ions in Mast er’s courses. Bet ween 1990 and 1993, when t he f ir st st u d ies w it h t h is t h eor et ical ap p r oach w er e con clu d ed , six Mast er ’s t h eses an d on ly on e f r ee lect ureship t hesis were produced. I n 1993, t he first Doct or al t hesis w as concluded at t he Univ er sit y of São Paulo School of Nursing ( USP/ São Paulo) .
s n o i t u t i t s n i g n i h c a e
T Years f %
0
9 91 92 93 94 95 96 97 98 99 00 01
J R F U / N A E
E - - 01 - 01 05 09 07 06 04 05 - 38 29.0
o t e r P o ã r i e b i R / P S
U 01 - - - - 02 03 05 07 03 04 01 26 19.8
o l u a P o ã S / P S
U - - 01 01 01 - 01 02 04 07 06 01 24 18.3
O I R I N
U 01 - - - 01 - 02 01 01 02 07 - 15 11.4
C S F U / . t p e D . s r u
N - 02 - - 01 - - - 03 01 - - 07 5.3
á r a e C . U . d e
F - - - 02 - - 01 01 02 06 4.6
a b í a r a P . U . d e
F - - - 01 - - - 02 01 04 3.1
a i h a B . U . d e
F - - - 02 02 04 3.1
o l u a P o ã S . U . d e
F - - - 02 - - 02 1.5
s i a r e G s a n i M . U . d e
F - - - 01 01 02 1.5
o l u a P o ã S / C U
P - - - 01 - - - 01 0.8
a s o ç i V . U . d e
F - - 01 - - - 01 0.8
a il í s a r B . v i n
U - - - 01 - 01 0.8
l a t o
T 02 02 03 01 04 08 18 15 21 20 29 08 131 100
Tab le 2 sh ow s t h at social r ep r esen t at ion research regist ered in t he CEPEn cat alogues st art ed i n 1 9 9 0 , w i t h a p r og r essi v e i n cr ease ov er t i m e, m ainly from 1995 onwards; a slight decrease in 1997, and t he highest concent rat ion in 2000 ( 29 st udies) . The year 2001 shows a considerable decrease, which m ay result from delays t o send abst ract t o t he CEPEn, w h en v olu m e 1 9 w as con clu ded. Th is asser t ion is r e i n f o r ce d b y t h e f a ct t h a t 3 6 0 a b st r a ct s w e r e cat alogued in 2000, against only 89 in 2001, which cert ainly does not reflect t he t ot al num ber of st udies produced in t hat year.
Th e h i g h e s t f r e q u e n c i e s o f t h e s e s a n d dissert at ions using social represent at ions t heory were f o u n d i n t h e f o l l o w i n g s t r i c t o s e n s u g r a d u a t e p r og r am s: An n a Ner y Sch ool of Nu r sin g - ( EEAN/ UFRJ) , responsible for 29% of product ions, Universit y of São Pau lo at Ribeir ão Pr et o College of Nu r sin g ( 19.8% ) , Universit y of São Paulo School of Nursing ( 18.3% ) and Universit y of Rio de Janeiro UNI RI O -( 11.4% ) . The low est frequencies w ere found at t he Pont ifícia Universidade Cat ólica de São Paulo, Viçosa Federal Universit y and t he Universit y of Brasília, wit h 0.8% each.
At t he lat t er t hree inst it ut ions, t he graduat e p r o g r a m s a r e n o t o f f e r e d i n t h e n u r si n g a r e a . However, as the nurses’ productions are registered in t he CEPEn cat alogue, our dat a sour ce, w e believed t hey should not be excluded.
This result also evidences that program s with t h e h i g h est p r od u ct i on l ev el s ar e l ocat ed i n t h e Sou t h east of Br azil, w h ich of f er s m or e g r ad u at e program s and, consequently, concentrates the highest percent age of st udies ( 83.1% ) .
Alt hough eight of t he 13 inst it ut ions included i n t h i s s t u d y c o m e f r o m t h e So u t h e a s t , t h i s in f or m at ion in it self does n ot j u st if y t h is r egion ’s par am ou n t posit ion . As descr ibed abov e, t h e f ou r inst it ut ions wit h t he highest product ion percent ages w er e n ot on ly p ion eer s, b u t also con t in u ed t h eir regular product ion of social represent at ions research acr oss t h e st u dy per iod. Th is m ov em en t occu r r ed on a sm aller scale at ot her inst it ut ions in t he sam e regions, but is not found in ot her Brazilian regions. The Nort h has no st r ict o sen su graduat e program s, w h ich ex plain s t h e absen ce of pr odu ct ion s in t h is r eg ion .
I t is in t er est in g t o obser v e t h at t h e en t r y d o o r f o r so ci a l r ep r esen t a t i o n s i n Br a zi l f r o m a
s o c i a l p s y c h o l o g y p e r s p e c t i v e , w h i c h w a s t h e Nor t h east , m or e sp ecif ically t o St at e of Par aíb a, w a s n o t w e r e s t r i c t o s e n s u g r a d u a t e n u r s i n g p r o g r a m s g o t a c q u a i n t e d w i t h t h i s t h e o r e t i c a l appr oach , as t h e f ir st st u dies in t h at r egion on ly a p p e a r e d i n 1 9 9 6 , o n e a t Pa r a íb a Fe d e r a l U n i v e r s i t y ( U FPA ) a n d t w o a t Ce a r á Fe d e r a l Un iv er sit y ( UFCE) . How ev er, af t er t h e Sou t h east , t h e h i g h e st p r o d u ct i o n l e v e l s a r e f o u n d i n t h e Nor t h east ( 1 0 . 8 % ) .
Th e Th eor y of Social Repr esen t at ion s w as int roduced in Brazil by Prof. Denise Jodelet ( School for Higher Studies in Social Science/ France) , in 1982, interm ediated by Prof. Ângela Arruda, who invited her t o pr esen t a cou r se in Cam pin a Gr an de/ PA abou t social represent at ions m et hodology, and t o serve as an advisor for a proj ect on m ental health and som atics b y t h e Scien ce an d Tech n olog y Gr ou p at Par aíb a Federal Universit y( 11).
How Social Repr esent at ions Theor y st ar t ed t o be dissem inat ed in Brazil, as well as t he int erest ar o u sed i n d i f f er en t k n o w l ed g e ar eas, i n cl u d i n g nursing, and t he consolidat ion of t his st udy field, were a n a l y ze d i n a r e se a r ch a i m e d a t ch a r a ct e r i zi n g n at i on al p r od u ct i on ab ou t soci al r ep r esen t at i on s b e t w e e n 1 9 8 8 a n d 1 9 9 7 , u s i n g d o c u m e n t a r y sources( 11). I n t his st udy, t he aut hor s obser ved t he
cont inuous gr ow t h of healt h r esear ch, especially in n u r sin g an d collect iv e h ealt h , m ain ly f r om 1 9 9 2 onwards. Specifically wit hin t he healt h area, nursing pr esent ed t he lar gest cont r ibut ion ( 4 8 . 1 % ) , w hich evidences t he level of im port ance at t ribut ed t o t his r ef er en ce f r am ew or k .
Con sider in g t h at t h e social r epr esen t at ion c o n c e p t c a n b e u n d e r s t o o d a s t h e m e n t a l r epr oduct ion of som et hing, as t he act ion of giv ing for m or m eaning t o som et hing m ent ally elabor at ed or, also, as “ an act of t hinking t hrough which a subj ect relat es t o an obj ect ”( 12), and is t herefore t he fruit of
Table 3 - Study subj ects of nursing productions based on social represent at ions. Brazil, 2004
These aspect s are essent ial when at t em pt ing t o use so ci a l r e p r e se n t a t i o n a s a t h e o r e t i ca l a n d / o r m et hodological suppor t fr am ew or k .
So ci a l r e p r e se n t a t i o n i s d e f i n e d a s t h e r epr esent at ion of som et hing ( obj ect ) and som eone ( su b j ect ) , w h o se ch ar act er i st i cs m an i f est i n t h e obj ect( 12). All represent at ions are charact erized by a
global and unit ar y v iew of an obj ect , indiv idual or gr oup, w hich gr ant s t hem t heir social char act er( 13).
Thus, because t hey do w it hout t his subj ect / obj ect i n d i sso l u b i l i t y, w e a t t e m p t e d t o i d e n t i f y w h a t r ep r esen t at ion ob j ect s h av e ar ou sed in t er est an d concern in nursing st udies.
Table 4 - Representation objects of nursing productions based on social represent at ion. Brazil, 2004
s t c e j b u
S f %
s e s r u
N 37 25.5
n e m o
W 25 17.3
s t n e it a
P 19 13.1
y tl u c a f g n i s r u
N 11 7.6
s l a n o i s s e f o r p g n i s r u
N 10 6.9
s t n e c s e l o d a d n a n e r d li h
C 10 6.9
s r e v i g e r a c d n a s e v it a l e
R 09 6.2
s t n e d u t
S 06 4.1
s l a n o i s s e f o r p h tl a e
H 06 4.1
s p u o r g y t i n u m m o
C 05 3.4
s r e k r o
W 03 2.1
) s r e s u s g u r d , y l r e d l e , n e m ( s r e h t
O 04 2.8
l a t o
T 145 100.0
Dat a f r o m Tab l e 3 sh o w t h at 1 2 su b j ect ca t e g o r i e s w e r e i d e n t i f i e d i n t h e 1 3 1 st u d i e s, corresponding to a total frequency of 145. This reveals t h at som e st u dies look at m or e t h an on e t y pe of subj ect . Nurses appear m ost frequent ly, bot h as an isolat ed cat eg or y ( 2 5 . 5 % ) an d in ser t ed in ot h er ca t e g o r i e s, su ch a s “ n u r si n g f a cu l t y ”, “ n u r si n g pr of ession als” an d “ h ealt h pr of ession als”. An ot h er aspect disclosed by t hese cat egor ies is t hat healt h an d p ar t icu lar ly n u r sin g p r of ession als h av e b een privileged in nursing research, corresponding to 44.1% of subj ect s.
Nu r si n g f a cu l t y, w i t h t h e f o u r t h h i g h e st frequency, are a focus of attention in these productions a n d , t h er ef o r e, m a i n t a i n ed sep a r a t el y f r o m t h e nur sing cat egor y. This dem onst rat es t he int er est in analyzing professional nursing t raining on t he basis of t hese subj ect s’ psychosocial incorporat ion, as well as t heir pract ices.
I n the frequency ranking, nurses are followed b y w om en ( 1 7 . 3 % ) an d p at ien t s ( 1 3 . 1 % ) . Th ese percent ages dist inguish t hem from t he ot her subj ect groups. I n the “ patient” group, m ost studies ( 14) refer t o individuals subm it t ed t o surgical procedures, while the rem ainder is related to individuals with psychiatric pr oblem s.
I n t h e su b j e ct a n a l y si s, t h e “ r e l a t i v e s” cat egory deserves special observat ion. I t s frequency ( 9) shows a rising t rend in researchers’ int erest in a m icr o- social analysis of t he healt h- disease pr ocess, based on t his group.
The r esult s r ev eal t hat nur sing r esear cher s focus on a r ange of subj ect s in t heir st udies and, m oreover, that they consider the groups of individuals t h e y p r e se n t i n r e l a t i o n t o p a r t i cu l a r a sp e ct s, characteristics that identify them as groups concerned w it h r epr esent at ion obj ect s fr om t heir daily r ealit y.
s t c e j b O n o i t a t n e s e r p e R f e s a e s i
D 26
e c it c a r p l a n o i s s e f o r
P 23
y r e v il e d e r a
C 19
s s e c o r p e s a e s i d -h tl a e
H 17
y t it n e d i l a n o i s s e f o r p ' s e s r u
N 09
s d i a / v i
H 07
g n i d e e f t s a e r B / y c n a n g e r
P 07
e r a c y li m a
F 05
y t il a u x e
S 04
e g a d l
O 04
s r e h t
O 07
l a t o
T 112
One hundr ed t w elv e r epr esent at ion obj ect s were ident ified in t he 131 product ions. This indicat es a disper sed r ange of st udy obj ect s, w hich r equir ed t hat we group t hem int o cat egories.
Th e h ier ar chy sh ow n in Table 4 r ev eals a con cen t r at ion of st u d ies ab ou t ob j ect s r elat ed t o “ d i sea se” ( 2 6 ) , p r o f essi o n a l p r a ct i ce ( 2 3 ) , ca r e deliver y ( 19) , t he healt h- disease pr ocess ( 17) and, to a lesser extent, about nurses’ professional identity ( 09) .
A represent at ion obj ect can be defined as a per son; m at er ial, m ent al or social ev ent ; a nat ur al phenom enon; an idea or theory, and can be im aginary or m yt hical( 12). This range of possibilit ies t o define a
representation obj ect probably turns into a facilitating e l e m e n t f o r n u r se s w h e n u si n g t h i s t h e o r e t i ca l approach, as nurses’ activity areas confront them with m ult iple sit uat ions or phenom ena.
som e studies reveal difficulties to specify the obj ects, due to considering social representations as an isolated concept , rest rict ed t o it s dim ension as an im age or non- specified subj ect iv e cont ent s, as ident ified by ot h er r esear ch er s( 1 3 ). Not all st u dies w e an aly zed
adequat ely defined t he obj ect ’s social relevance and specificit y.
Table 4 also show s t hat t he cat egor ies ar e part of nursing professionals’ daily realit y, howev er, with a strong tendency to adopt obj ects related to the represent at ion of t he disease. I n t his group, insanit y an d can cer w er e t h e m ost f r equ en t ly r epr esen t ed obj ect s. Various st udies have looked at care by or in nursing, a category that also stands out here. I t is a representation obj ect from different perspectives, that is, as the essence of nursing know- how, or as care in specific sit uat ions or, also, in differ ent pr ofessional nursing act ivit y areas.
Pract ice and professional ident it y also st ood o u t am o n g t h e cat eg o r i es, j o i n i n g t h e f o l l o w i n g o b j e ct s: “ b e i n g a n u r se ”, ( t h e n u r se ’s) “ b o d y ”, “ professional pract ice” and “ m anagem ent m odels and pr act ices”, in t er m s of h ow t h ey ar e per ceiv ed or r epr esent ed eit her by t he pr ofessionals t hem selv es or by t he client s. St udies also show concer n about how t hese aspect s influence nursing’s ways of doing and t hinking, as well as about t heir im provem ent .
Seventeen studies focused on identifying how cer t ain social gr ou ps r epr esen t t h e h ealt h - disease pr ocess in it self or based on it s social or polit ical d et er m in an t s. Th is w as t h e f ou r t h t y p e of social r epr esen t at ion obj ect , gr an t in g it a n on - n egligible status which nursing has attem pted to understand with a view t o adapt ing it s professional pract ice.
Ot her cat egories were less expressive, such as “ p r eg n an cy / b r east f eed i n g ”, “ sex u al i t y ”, “ HI V/ AI DS”, am ong ot her s. HI V/ AI DS, for ex am ple, has been t he focus of different st udies, due t o it s ext ent as a public healt h pr oblem and it s im pact in social life, turning it into an im portant representation obj ect nowadays, but explored in only seven product ions.
Som e representation objects did not fit into any category and were included under others, such as the Single Health System , social structure and street life.
I n gener al, t hese r esult s dem onst r at e t hat m o st ca t e g o r i e s f o cu s o n t h e sa m e o b j e ct o f pr ofessional nur sing pr act ice - healt h, disease and the health- disease process; as well as strong em phasis on professional practices - care, professional practice, nurses’ professional identity - revealing the applicative nat ure of nursing research.
In order to analyze these results in terms of the research line classification schem e in Brazil (as defined in the Graduate Workshops CAPES/ CNPq(9)), we highlight
that the latter is structured in three them e categories, which are: professional, care and organizational, each of which includes a set of research lines.
The p r of ession al cat egor y and it s r esear ch lines are related to the sphere of the epistem ic subj ect / knowing conscience, j oining: “ theoretical disciplines/ cont ent s and experiences t hat adj ust t o or const it ut e the m ost substantial part of ( professional) knowledge or t he nursing know ledge area”. The car e ar ea and t he t opics invest igat ed in it s research lines refer t o t he k nowable obj ect / obj ect ive r ealit y, t hat is, “ t o w h at is con sider ed ( t h in k in g/ k n ow in g) , or can be co n si d er ed , ab o u t w h i ch p r o f essi o n al aw ar en ess occur s, t owar ds it self, as an obj ect ified r ealit y, and also as ev er y t h in g t h at can be claim ed abou t t h e professional’s ‘know- how’, obviously provided that the possible dim ensions of t he phenom enon of knowing are underst ood in relat ion t o t he care cont ext ”. The third and final category, called organizat ional, and its r espect iv e r esear ch lines, ar e par t of t he im age or “ instrum ental” sphere and are related “ to the subj ects/ t h eo r e t i ca l co n t ex t s a n d ex p e r i en ce s o f r el a t e d sciences/ connect ed dom ains and serve t o approach r ealit y in t he field of k now ledge act iv it ies, as is of int erest t o nursing”( 9).
We f o u n d t h e f o l l o w i n g r e su l t s f o r t h e distribution of the studies analyzed according to these t hem e cat egories and research lines:
Table 5 - Gr oups of nur sing pr oduct ions based on so ci a l r e p r e se n t a t i o n , p e r t h e m e ca t e g o r y a n d research line. Brazil, 2004
s e i r o g e t a
C ResearchLines f %
l a n o i s s e f o r
P 1-theoreitcal-phliosophicalfoundaitonsof y r e v il e d e r a c h tl a e
h 14 10.7
g n i s r u n d n a h tl a e h n i y g o l o n h c e t
-2 05 3.8
g n i s r u n d n a h tl a e h n i s c i h t e
-3 02 1.5
y r o t s i h g n i s r u n
-4 01 0.8
l a t o T -b u
S 22 16.8
e r a
C 1-careprocessinheatlhandnursing 51 38.9
e f il f o y t il a u q d n a h tl a e h
-2 34 25.9
l a t o T -b u
S 85 64.8
l a n o it a z i n a g r
O 1-poilciesandpracitcesinheatlhand g n i s r u
n 04 3.1
d n a s e i c il o p g n i s r u n d n a n o it a c u d e -2 s e c it c a r
p 06 4.6
d n a h tl a e h n i k r o w d n a n o it c u d o r p l a i c o s -3 g n i s r u
n 11 8.4
t n e m e g a n a m e c i v r e s g n i s r u n d n a h tl a e h
-4 03 2.3
d n a h tl a e h n i n o it a c i n u m m o c / n o it a m r o f n i -5 g n i s r u
n Ñ Ñ
l a t o T -b u
S 24 18.4
l a t o
Tab le 5 d isp lay s t h e scien t if ic p r od u ct ion gr oups and show s t hat m ost r esear ch fit s int o t he care t hem e cat egory ( 64.8% ) , against 18.4% for t he
o r g a n i z a t i o n a l a n d 1 6 . 8 % f o r t h e p r o f e s s i o n a l category, reaffirm ing the results of our earlier analysis about t he applied nat ure of nursing research.
Within the research lines for the care category, t he “ car e pr ocess in healt h and nur sing”, involv ing t he syst em ized care process for healt hy or ill hum an beings, in t he individual or collect ive sphere and in t he subj ect ive and obj ect ive dim ensions of care and receiving care, is m ore frequent ( 38.9% ) than “ health an d q u alit y of lif e” ( 2 5 . 9 % ) . Th e lat t er r ef er s t o det er m inant s, indicat or s and ex pr essions of healt h and quality of life and how they relate to the health-d i sease p r ocess, i n t h e i n health-d i v i health-d u al an health-d col l ect i v e sph er e.
These results show that “ care”, acknowledged a s t h e essen ce o f n u r si n g k n o w - h o w , h a s b een pr iv ileged in t hese st udies fr om t he per spect iv e of t he social represent at ions approach. Anot her aspect to be taken into account is that Social Representations Theory is art iculat ed w it h t he paradigm s of nursing care and health prom otion, evidenced in the assertion that health requires the planning of technically viable actions that are adequate to reality. This statem ent is presented, however, without forgetting about the role of act iv e beings assum ed by collect iv e subj ect s. I n t h is p er sp ect iv e, social su b j ect iv it y ap p ear s as a par t icipant in daily nur sing act ions, cont r ibut ing t o ex plan at ion s of t h e h ealt h - disease pr ocess on t h e b a si s o f co m m o n se n se k n o w l e d g e , a s w e l l a s p a r t i cu l a r m e a n i n g s t h a t p a r t i ci p a t e i n t h e det erm inat ion of group processes, for prom ot ion as w ell as cur e( 13). The
or gan izat ion al cat egor y, w hich was the second m ost frequent group ( 18.4% ) , consists of five research lines that cover the following contents in healt h and nur sing: healt h policies; pedagogical, p olit ical an d ed u cat ion al t ech n olog y con cep t ion s, p r o d u ct i o n o f t h e h e a l t h w o r k p r o ce ss, se r v i ce m a n a g e m e n t a n d co m m u n i ca t i o n i n h e a l t h a n d nur sing.
I n this them e category, “social production and work in health and nursing” stands out, corresponding to 8.4% . During the study period, not one study was added in the research line “inform ation/ com m unication in healt h and nursing”. This inform at ion refers t o t he hypothesis about the incipient nature of this study area in nursing, or also that the study objects related to this line have not adapted to this theoretical fram ework.
Alt h ou g h on a sm aller scale ( 3 . 1 % ) , t h is t heoret ical approach in nursing is also applied in it s int er face w it h t he field of public policies in healt h, involving the understanding of these policies and their operationalization in articulation with nursing practices. Th e r esu lt s of t h e or g an izat ion al cat eg or y r e v e a l a p a r t i cu l a r w a y o f a r t i cu l a t i n g So ci a l Represent at ions Theory wit h t he healt h area, placed on an inst it ut ional level here, or in com binat ion wit h pr of ession al pr act ice( 1 3 ). Th e an aly sis of abst r act s
sh o w s t h a t n u r ses a t t em p t ed t o a p p r eh en d t h e knowledge const it ut ed by nursing professionals about daily obj ect s, m ain ly in t er m s of t h e h ealt h w or k process and educat ion pract ices at work.
The professional category, which included the sm allest num ber of scient ific pr oduct ions ( 16. 8% ) , consist s of four research lines, relat ed t o t heoret ical-ph ilosoical-ph ical cu r r en t s, t h eor ies an d con cept s t h at guide knowledge and act ions in healt h and nursing, t he product ion and incorporat ion processes of goods and services, et hical aspect s and t he hist orical- social developm ent of t he nursing profession, pract ices and or ganizat ions.
I n the context of this category, m ost ( 10.7% ) nur sing pr oduct ions w er e classified as “ t heor et ical-philosophical foundat ions of car e deliv er y in healt h and nursing”. I n t he ot her research lines, we find a very t im id approxim at ion wit h social represent at ions, especially in research on ethical and historical aspects relat ed t o t he profession.
I t is noticeable in these results that the m ost frequent research lines are also related to care aspects in health and nursing, which strengthens the idea that t his t hem e found fer t ile gr ound in t he pr em ises of social r epr esent at ion.
FI NAL CONSI DERATI ONS
if we look at ot her aspect s, such as t he sm all num ber of r esear cher s involved in t his t heor et ical appr oach i n Br a z i l i a n n u r s i n g , t h e f a c t t h a t t h e s o c i a l r epr esen t at ion s ar ea cov er s v ar iou s con cept s an d t heoret ical dim ensions, and t hat m ult i- m et hodological a p p r o a ch e s a r e p a r t i cu l a r l y i n d i ca t e d i n t h e se st udies, so t hat it s assim ilat ion and applicat ion is not always an easy t ask, it can be inferred t hat t his is an im port ant t heoret ical branch for nursing research in Br azil.
Th e i n cr e a si n g i n t e r e st t h i s t h e o r e t i ca l appr oach has ar oused in differ ent Br azilian r egions discloses a m ov em ent t o consolidat e new r esear ch par adigm s in n u r sin g. Th is im plies t h e sear ch f or t heor et ical ex planat ion m odels t hat ar e capable of pr odu cin g diagn oses or r esu lt s t h at at t en d t o t h e dem ands nursing is faced wit h.
Another relevant aspect refers to the fact that t his st udy used CEPEN cat alogues as a dat a source, as different academ ic nursing st udies were defended out side graduat e nursing program s, especially in t he 1980’s and 1990’s, when access to Doctoral program s in nur sing w as st ill r est r ict ed. These st udies w er e responsible for a group of product ions not calculat ed in our st udy.
As a result of our analysis, we can affirm that r esear ch using t he t heor et ical r efer ence fr am ew or k of social r epr esen t at ion s is dev elopin g in n u r sin g, r eaffir m ing it s applied r esear ch nat ur e, dir ect ed at problem s and obj ects deriving from daily professional nursing pract ice. On t he ot her hand, work it self and t he developm ent of new care t echnologies in nursing have also guided t hese st udies.
Moreover, t his st udy confirm ed t he part icular characteristics of using Social Representations Theory in the health area, highlighted in literature, especially t h e n e e d t o a r t i cu l a t e t h i s t h e o r y w i t h n u r si n g paradigm s; its appropriation to study obj ects that are char act er ist ic of an inst it ut ional lev el or associat ed wit h professional pract ice; and also t he adopt ion of t h eor y as a specific for m of st u dy in g pr ofession al knowledge, an int erm ediary m ode bet ween com m on sense and scient ific knowledge( 13).
Finally, we believe this study m ade visible the evolut ion of scient ific nursing product ions in t he field o f so ci al r ep r esen t at i o n s, co n si d er i n g t h e st u d y aspect s. Ther efor e, w e hope t hat t his init iat iv e w ill st im ulat e fur t her r esear ch, w it h a v iew t o a m or e t horough analysis of new nuances, which t he use of abst ract s only did not perm it .
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