NURSI NG, NUTRI TI ON AND PHYSI OTHERAPY STUDENTS: CAREER CHOI CE
Beat riz Sebben Oj eda1 Marion Creut zberg2 Ana Maria Pandolfo Feoli3 Denizar da Silva Melo4 Valéria Lam b Corbellini5
Oj eda BS, Cr eu t zber g M, Feoli AMP, Melo DS, Cor bellin i VL. Nu r sin g, n u t r it ion an d phy siot h erap y st u den t s: car eer choice. Rev Lat ino- am Enfer m agem 2009 m aio- j unho; 17( 3) : 396- 402.
I n t he per spect ive of car eer choice, ent er ing univer sit y encom passes m eanings of self- accom plishm ent and social st at us, which are perm eat ed by concept s and ideals people const ruct in t heir lives. This st udy aim ed t o analyze regim es of t rut h t hat perm eat e career choice in nursing, physiot herapy and nut rit ion. This qualit at ive-descript ive st udy w as carried out w it h undergraduat e freshm en. Dat a w ere collect ed t hrough focus groups, ev aluat ed by discour se analy sis fr om a Foucault ian per spect iv e. The follow ing t hem es em er ged fr om t he analy sis: - car eer choice: cr ow ning a pr ocess of social differ ent iat ion, - r eflex es of pr ofessions’ hist or y of acknowledgem ent ; - career choice beyond professional proj ect s. Discourse highlight s t hat scient ific knowledge acquires st at us in relat ions of pow er bet w een different professions and societ y and is essent ial t hat healt h professional educat ion is linked t o public policies t hat expand t he part icipat ion of different professions so as t o m eet dem ands in favor of int egral care.
DESCRI PTORS: career choice; power ( Psychology) ; nursing; physical t herapy ( specialit y) ; nut rit ionist ; healt h per son n el
ESTUDI ANTES DE ENFERMERÍ A, NUTRI CI ÓN Y FI SI OTERAPI A:
LA ELECCI ÓN PROFESI ONAL
Baj o el aspecto de la elección profesional, el ingreso a la Universidad trae em butido significados de autorrealización y de status social, los cuales contienen conceptos e ideales construidos en el vivir cotidiano de las personas. El obj et ivo del est udio fue analizar r egím enes de ver dad cont enidos en la elección pr ofesional de enfer m er ía, nut rición y fisiot erapia. Se t rat a de un est udio descript ivo, de abordaj e cualit at ivo realizado en los est udiant es que ingresan a la Graduación. La recolección de dat os fue realizada en Grupos Focales, evaluados por m edio del Análisis del Discur so, baj o el m ar co t eór ico de Focault . Del análisis em er gier on las t em át icas: Elección profesional; Coronam ient o de un proceso de diferenciación social; Reflej os de la hist oria del reconocim ient o de las profesiones; La elección profesional – m ás allá de proyect os profesionales. Los discursos señalan que el conocim ient o cient ífico adquier e st at us en las r elaciones de poder ent r e las difer ent es pr ofesiones y en la sociedad, siendo fundam ent al que la form ación de los profesionales de la salud est é art iculada a las polít icas públicas que am plían la part icipación de las diferent es profesiones, con la finalidad de at ender las dem andas en pro de una at ención int egral.
DESCRI PTORES: selección de profesión; poder ( Psicología) ; enferm ería; terapia física ( especialidad) ; nutricionista; personal de salud
ACADÊMI COS DE ENFERMAGEM, NUTRI ÇÃO E FI SI OTERAPI A:
A ESCOLHA PROFI SSI ONAL
Sob o aspecto da escolha profissional, o ingresso na universidade traz em butido significados de autorrealização e status social, nos quais perpassam conceitos e ideais construídos no viver da pessoa. O objetivo do estudo foi analisar regim es de verdade que perm eiam a escolha profissional da enferm agem , fisioterapia e nutrição. É um estudo descritivo, de abordagem qualitativa, com ingressantes na graduação. Coleta de dados foi realizada com grupos focais, avaliados pela análise de discurso, sob o olhar de Focault. Da análise em ergiram as tem áticas: -escolha profissional: coroam ento de um processo de diferenciação social, - reflexos da história de reconhecim ento das pr ofissões, - a escolha pr ofissional par a além de pr oj et os pr ofissionais. Os discur sos assinalam que o conhecim ento científico adquire status nas relações de poder entre as diferentes profissões e a sociedade, sendo fundam ent al que a form ação de profissionais de saúde est ej a art iculada às polít icas públicas que am pliam a participação de diferentes profissões, a fim de atender às dem andas em prol da atenção integral.
DESCRI TORES: escolha da profissão; poder ( Psicologia) ; enferm agem ; fisioterapia ( especialidade) ; nutricionista; pessoal de saúde
Faculdade de Enferm agem , Fisiot erapia e Nut rição, Pont ifícia Universidade Cat ólica do Rio Grande do Sul, Brasil: 1Ph.D. in Psychology, Adj unct Professor,
bsoj eda@pucr s.br ; 2Ph.D. in Biom edical Ger ont ology, Adj unct Pr ofessor, e- m ail: m ar ionc@pucr s.br ; 3Ph.D. in Biochem ical, Adj unct Pr ofessor, e- m ail:
[email protected]; 4Ph.D. in Medical Clinic, Adj unct Professor, e- m ail: dm [email protected]; 5Ph.D. in Educat ion, Adj unct Professor, e- m ail: vlam [email protected]. Disponible en castellano/ Disponível em língua portuguesa
I NTRODUCTI ON
T
h e f r agm en t at ion of h ealt h pr act ices is a m odern realit y, concret ized in m ult iple professions andspecializat ions. I n t his per spect iv e, each pr ofessional
in t h e differ en t scen ar ios of pr act ice, is r espon sible f or a sh ar e of car e in w h ich in v isible k n ow ledge is
used, for ex am ple, t he nat ur alizat ion of fem ale and
m a l e p r a c t i c e s i m m e r s e d i n t h e v a r i o u s h e a l t h pr of ession s( 1 ).
Moder n scient ific dev elopm ent w as essent ial
f o r t h e e m e r g e n ce o f p r o f e ssi o n s l i k e n u t r i t i o n , p h y siot h er ap y an d n u r sin g( 2 - 4 ). Th e con st r u ct ion of
n u t r i t i on sci en ce w as st i m u l at ed b y t h e Eu r op ean
indust rial revolut ion ( 18t h cent ury) , and becam e visible as from World War I , due t o t he need for st udies and
r e se a r ch a n d a l so b e ca u se o f t h e n e e d t o t r a i n
pr of ession al ex per t s, cu lm in at in g in t h e cr eat ion of t he first nut rit ion cont rol and int ervent ion agencies( 3).
The developm ent of t his area in Lat in Am erica becam e
m ore syst em at ized as from t he m id 19t h cent ury and w a s i n t e g r a t e d i n t o m e d i c a l k n o w l e d g e .
Ph y s i o t h e r a p i s t r e s o u r c e s i n t e g r a t e d m e d i c a l
t r eat m en t( 2 ) in Brazil in t h e 1 9t h cen t u r y. I n cr eased p h y s i o t h e r a p i s t d e m a n d s a s f r o m Wo r l d Wa r I I
r e q u i r e d n o n - p h y s i c i a n p r o f e s s i o n a l s t o d e l i v e r
phy siot her apy car e. Nur sing w as bor n in England in
t he m id 19t h cent ury wit h Florence Night ingale, whose
m o d e l w a s i n f l u e n c e d b y B r i t i s h d i s c i p l i n a r y
con cept ion s, w it h r igid r u les based on m ilit ar y an d
m or al cust om s r ecom m ended in m onast er ies. Based
on st at ist ical bases, her knowledge and concerns wit h
sanit ar y, nut r it ional and env ir onm ent al m easur es led
t o t h e r ef or m u lat ion of m ilit ar y h ospit als an d ar m y
healt h adm inist rat ion. Being a reference in sanit arian
issues, she par t icipat ed in t he elabor at ion of int er nal
and ext er nal healt h policies, laying out t he bases for
nur sing as a pr ofession w or ldw ide( 4).
Th ese b r ief h ist or ical f r ag m en t s r ev eal t h e
close r elat ion of t h ese pr ofession s w it h t h e m edical
ar ea. These w er e dev eloped as fr om m edical needs
or dem ands for specialt ies. I n t his social const ruct ion,
t he nat ur alizat ion of occupat ions r ank ed under social
pract ices in healt h( 1) becom es clear.
Ev er y societ y possesses regim es of t rut h( 5 )
,
w hich est ablish ident it ies, det er m ine r ules, legit im at e
or disr egar d pr act ices, det er m ine or im pose differ ent
s o c i a l v a l o r i z a t i o n s . Re g i m e o f t r u t h i s w h a t i s est ab lish ed b y m ean s of k n ow led g e- p ow er d ev ices
ca p a b l e o f r e g i st e r i n g i n r e a l i t y so m e t h i n g t h a t
b e c o m e s t h e t r u t h , w h i c h w i l l b e t h e r e s u l t o f
discour se, pr act ices and k now ledge( 5 ).
Ent er ing univ er sit y r epor t s t o car eer choice, w h i c h e n c o m p a s s e s t h e m e a n i n g o f s e l f
-accom plishm ent and econom ic aut onom y, per m eat ed
b y c o n c e p t s a n d i d e a l s c o n s t r u c t e d a c r o s s t h e p e r so n ’ s l i f e . Reg im es of t r u t h, w h i ch d e t e r m i n e h i e r a r ch y a m o n g h e a l t h p r o f e ssi o n s, se e m t o b e
pr esent in social discour se and academ ic and healt h i n s t i t u t i o n s . I n t h i s p e r s p e c t i v e a n d w i t h t h e
developm ent of m odern m edicine, m edical knowledge
sh ap ed social, p olit ical an d econ om ic r elat ion s an d becam e im per at iv e t o healt h k now ledge( 5).
Discour se is for m ed in st at em ent s, t heor ies
an d in st it u t ion s in t h e w ay pr act ices ar e or gan ized and t ransm it t ed. The accept ance of a discourse com es
from repet it ion and dissem inat ion of st at em ent s. There
ar e m any sour ces of language t hat build st at em ent s and w hich can be v iew ed in differ ent for m s of social
discourse, such as in t he m edia, in t he academ ic and
pr ofessional ar eas. These pr act ices t ell us about t he
t r ut h, r egim es of t r ut h, an d ar e st r on g en ou g h t o becom e unquest ionable in power relat ions, regardless
of w h at is d et er m in ed b y law an d w h at p eop le or gr oups of people w ish. They becom e nat ur alized!( 5)
I nt egrat ed in t his social st ruct ure, t his st udy
analy zes t he discour se of st udent s ent er ing nur sing,
phy siot her apy and nut r it ion pr ogr am s, because t hey
r e p r e s e n t a r e a l i t y w h e r e r e g i m e s o f t r u t h a r e p r o d u c e d o n t h e s e p r o f e s s i o n s , a n d w h i c h a r e
ex pr essed in social policies, h ealt h in st it u t ion s, t h e
m edia and inst it ut ions.
A s t u d y c a r r i e d o u t w i t h u n d e r g r a d u a t e
st u d en t s ab ou t p r of essi on al p r est i g e of 1 3 h i g h er
e d u c a t i o n p r o f e s s i o n s h i n t s t h a t h i e r a r c h y i s
expressed in t he j udgm ent of each profession. I n t his
st u dy, t h e m edical pr of ession w as iden t if ied as t h e
one w it h t he highest pr est ige, phy siot her apy r ank ed
si x t h an d n u r si n g ei g h t h , w h i l e n u t r i t i o n w as n o t
included in t he list of evaluat ed professions( 6). Anot her
r ecen t st u dy appoin t s t h e m edia’s in f lu en ce on t h e
f o r m a t i o n o f st a t em en t s p r esen t i n t h e i m a g e o f
p r o f e s s i o n s l i k e n u r s i n g , w h i c h r e q u i r e t h e s e
p r o f e s s i o n s t o s e e k s t r a t e g i e s t o p r o v i d e m o r e
i n f o r m a t i o n , v i si b i l i t y a n d t o h a v e a v o i ce i n t h e
social scop e( 7 ). Ref lect ion s r eg ar d in g t h e r esu lt s of
t h e se st u d i e s i n d i ca t e t h e n e e d t o b r o a d e n t h e
u n d er st an d in g of t h e scen ar io in w h ich t h e ch oice
o f a c a r e e r a n d t h e e d u c a t i o n o f f u t u r e h e a l t h
I n t he analy sis of fr eshm en’s discour se, w e
seek w h at is n at u r alized, n ot qu est ion ed, disper sed
i n d i f f e r e n t s t a t e m e n t s , t r a n s v e r s a l i z e d a s m at er ialit ies of gam es of t r ut h, w hich influenced t he
car eer ch oice( 5 ). Hen ce, t h is st u dy aim s t o in st ill a
c r i t i c a l p e r s p e c t i v e i n s t u d e n t s , p r o f e s s o r s a n d r esear ch er s r eg ar din g t h e social scen ar io of h ealt h
p r of ession s.
OBJECTI VE
To an aly ze r egim es of t r ut h t h at p er m eat e t h e ch oice f or n u r sin g, ph y siot h er apy an d n u t r it ion
m a n i f e st e d b y st u d e n t s e n t e r i n g t h e r e sp e ct i v e cou r ses.
METHOD
T h i s i s a q u a l i t a t i v e - d e s c r i p t i v e s t u d y. S t u d y p a r t i c i p a n t s w e r e s t u d e n t s e n t e r i n g t h e
n u r sin g, ph y siot h er apy an d n u t r it ion u n der gr adu at e
p r o g r a m s a t t h e Po n t i f i ca l Ca t h o l i c Un i v e r si t y o f Rio Gr ande do Sul ( PUCRS) . St udent s w er e select ed
am on g classes at t h e begin n in g of t h e sch ool y ear
sem est er s ( 2 0 0 6 / 1 an d 2 0 0 6 / 2 ) , t h r ou gh v olu n t ar y
part icipat ion aft er a brief present at ion of t he proj ect .
All st udent s who m et t he inclusion crit eria: availabilit y
t o p ar t i ci p at e i n f o cu s g r o u p s, en t er ed u n i v er si t y
t h r ou gh t h e r equ ir ed w r it t en ex am , w er e at t en din g
t he first course sem est er, w ere invit ed t o part icipat e.
D a t a c o l l e c t i o n w a s c a r r i e d o u t t h r o u g h
f ocu s g r ou p s. Th e f ocu s g r ou p t ech n iq u e h as b een
i n c r e a s i n g l y u s e d i n s e v e r a l a r e a s o f r e s e a r c h ,
e sp e ci a l l y i n r e se a r ch u si n g q u a l i t a t i v e m e t h o d s
a i m i n g a t s o c i a l i n v e s t i g a t i o n . T h i s t e c h n i q u e
p e r m i t s t h e r e s e a r c h e r t o k n o w t h e o p i n i o n ,
t h ou g h t s, f eelin g s an d act ion s of a g iv en g r ou p in
r elat ion t o a social ph en om en on( 8 ). Th e sev en f ocu s
g r o u p s w i t h s e v e n t o 1 2 p a r t i c i p a n t s w e r e
c o n d u c t e d b y r e s e a r c h e r s , w i t h a m a x i m u m
d u r at ion of 9 0 m in u t es. Th e g r ou p d iscu ssion w as
b ased on t h e f ollow in g g u id in g q u est ion s: How d o
y o u se e t h e p r o f e ssi o n a l a r e a y o u h a v e ch o se n ?
How d o y ou see t h e in ser t ion of t h is p r of ession in
t h e h ealt h ar ea an d in societ y ? Wh at do y ou ex pect
f r o m t h e s e a r e a s ? N o n - v e r b a l i n f o r m a t i o n a n d
d iscu ssion w er e r eg ist er ed an d t ap e- r ecor d ed w it h
t h e p ar t icip at ion of an ob ser v er.
Dat a were analyzed t hrough discourse analysis in Foucault ’s per spect iv e( 5). The analy sis pr oposes t o
d escr ib e st at em en t s, w h ich m ig h t b e ex p r essed in
differ ent w ay s: in a phr ase, a figur e or in an act of language. Social concept ions on t he chosen area were
analyzed based on t he part icipant s’ discourse, seeking
t o put in ev idence w hich regim es of t rut h per m eat e concept s and pract ices in t hese areas.
Th e p r o j e ct w a s f u n d e d b y t h e Re se a r ch
Foundat ion of t he St at e of Rio Gr ande do Sul, Br azil and appr ov ed by t he Resear ch Et hics Com m it t ee at
PUCRS and part icipant s signed t he free and inform ed
consent t er m .
RESULTS AND DI SCUSSI ON
Ca r e e r c h o i c e : c r o w n i n g a p r o c e s s o f s o c i a l
dif f er en t iat ion
En t e r i n g u n i v e r s i t y, w h i c h r e f e r s t o t h e
car eer ch oice, seem s t o cr ow n a p r ocess of social dif f er en t iat ion : [ …] Any t hing I w ant ed t o st udy , since I
w as lit t le, had t o do w it h t he healt h ar ea, m edicine, nur sing, I ev en consider psy chology [ …] (G5 )*. Th e car eer ch oice
also su st ain s a social im age abou t a giv en ar ea in
t h e at t em pt t o m at er ialize t h e per son ’s w ish es an d
lif e p lan( 1 ).
The process of choosing a career begins at a
very young age in m odern societ y( 9), but societ y’s and
f a m i l i e s ’ e x p e c t a t i o n s a b o u t c a r e e r c h o i c e a r e
int ensified at t he end of high school wit h t he perspect ive
o f a t t e n d i n g t h e o b l i g a t o r y w r i t t e n e x a m , w h i ch
requires one t o opt for a bachelor’s degree, t hat is, a
profession: [ …] I didn’t have the slightest idea when I was a
3rd year high school student, when I realized it, ‘Gosh, what am I gonna do, I ’ll be out of school, I ’ll go to university’ and I had no idea of what program I was going to choose [ …] ( G5) .
Fam ilies influence adolescent s’ car eer choice
because proj ect s are const ruct ed in t he fam ily t hrough
p a r e n t s’ a n d f a m i l y m e m b e r s’ e x p e ct a t i o n s a n d
wishes:[ …] I didn’t pass in m edicine but t he nursing program called m e, t hey didn’t believe I ’d st udy nursing aft er having tried m edicine and they still don’t see it as a professional at the end of the first sem ester [ …] ( G2) . Thus, t he career choice is also an opport unit y t o show loyalt y t o t he fam ily or
t he concr et izat ion of a collect iv e fam ily pr oj ect : [ …]
when I said to m y dad that I wanted to study nutrition, he said “ you’re going to be a cook?” he wanted m e to study m edicine, to be a doctor [ …] but I ’m enchanting him , when I get hom e I tell him about m y classes, about what I ’ve learned, related to m edicine and he’s encouraging m e m ore [ …] ( G7) . I n anot her st udy( 8), st udent s r epor t ed t he st r ong influence par ent s ex er t
t o t h e ex t en t of gen er at in g dou bt s in t h e decision
-m aking process. Oft ent i-m es, t he fa-m ily wishes t o find, t h r o u g h t h e s t u d e n t ’ s c h o i c e , t h e i r o w n s o c i a l
p r o j ect i o n , w h i ch ca n l ea d t o d em a n d s a n d ev en
gr eat er in decision .
Th e pr ocess of ch oosin g a car eer does n ot
cease w it h t h e st u d en t ’s in g r ession in t h e ch osen
program . At t he beginning of t heir academ ic t raj ect ory, st u d en t s r eev al u at e t h ei r o p t i o n s i n v i ew o f t h ei r
e x p e r i e n c e s a n d k n o w l e d g e a c q u i r e d o n t h e
profession, which can reaffirm t heir choice or put it in quest ion( 10).
Ca r eer ch o i ce: r ef l ex es o f p r o f essi o n s’ h i st o r y o f ack n ow led g m en t
I n a w ay, t h e car eer ch oice also ev iden ces t he hist orical process of each profession, it s st ruggles,
p r e c o n c e p t i o n s , a n d p e r s p e c t i v e s o f s o c i a l
ack now ledgm ent : [ …] m y first opt ion was m edicine but I started to see that not only m edicine, but also nursing, nutrition or any other related to the health area would give me great pleasure, to be dealing with patients, and present in every m om ent, in each sit uat ion( G4 ) .
Th e h ist or ical pr ocess of h ealt h pr of ession s
cont ains t he st r uggle one has faced t o ent er higher
e d u ca t i o n a s a st r a t e g y i n se a r ch o f l e g i t i m a cy,
au t on om y an d social ack n ow ledgem en t . Nu t r it ion ist
educat ion in Brazil was idealized by t he first generat ion
of n u t r iologist ph y sician s at t h e st ar t of t h e 1 9 4 0 ’s
w it h t h e cr eat ion of n ew t ech n ical cou r ses( 3 ). Th e
st ruggle t o have t he nut rit ion program acknow ledged
as a higher educat ion pr ofession began in t he 1950s
and was only won in 1962. I n t his hist orical process,
a considerable enlargem ent of professional areas was
e v i d e n c e d , a s w e l l a s t h e c r e s c e n t p r o c e s s o f
specializat ion/ div ision of nut r it ionist s’ obj ect of w or k /
st u d y, w i t h t h e d e v e l o p m e n t a n d q u a l i f i ca t i o n o f
t echnical- scient ific sk ills and com pet ences. How ev er,
t his st ruggle seem s t o be current ly ongoing: [ …] I guess nutrition has the sam e value as m edicine [ …] ( G5) .
The acknowledgem ent of nursing as a higher
educat ion degree began in t he 1930s, when wom en’s
work began t o expand in Brazil. However, it was only
c o n c l u d e d i n 1 9 6 8 w i t h t h e Un i v e r s i t y Re f o r m .
Because nur sing educat ion w as v iew ed as a fem ale, dom est ic and auxiliary profession, st udent s wit h a level
of educat ion low er t han t he rem aining st udent s w ere
accept ed in higher educat ion for m any year s( 11). This p ar t icu lar it y w as r ev er t ed in 1 9 6 2 w it h t h e Law of
Basic Ten et s an d Gu id elin es of Nat ion al Ed u cat ion ,
which required t he com plet ion of high school t o ent er u n iv er sit y in t h e sam e w ay ot h er ar eas r equ ir ed it .
Un t il t h e 1 9 6 0 s, n u r sin g sch ools in t h e p r ocess of
n u r sin g edu cat ion w er e at t ach ed t o Medical sch ools at t en d i n g t h e n eed f or sp eci al t i es. Nu r si n g w as a
s u b j e c t i n t h e m e d i c a l a r e a , c a l l e d p a r a m e d i c
profession. Only in 1968, wit h t he Universit y Reform , were nursing schools acknowledged as academ ic unit s
in t h e u n iv er sit y con t ex t . Pr econ cept ion s in r elat ion
t o nursing are present in social concept ions, from t he pr ocess of car eer ch oice u p t o academ ic edu cat ion
an d pr of ession al lif e. Pr of essor s an d st u den t s f r om
o t h e r a r e a s f r e q u e n t l y e x p r e s s p r e c o n c e p t i o n s r egar ding t he qualificat ion of nur sing k now ledge( 10).
Physiot herapy, also in t he st ruggle t o achieve
social ack now ledgem ent as a healt h pr ofession, w as adm it t ed t o higher educat ion in 1964, t hough at t he
t im e it w as seen as an aux iliar y pr ofession, subj ect
t o m edical guidance and responsibilit y( 2), which seem s
t o be present in t he follow ing discourse: [ …] everyone
t hinks t hat physiot herapy is only clinics; there’s a lot of t hings i n p h y si o t h e r a p y , l i k e i n a b a si c h e a l t h u n i t , w h i ch a physiotherapist can do, not only the physician. People don’t know t hat ( G4 ) . The ack now ledgem ent of phy siot her apy as a h i g h e r e d u ca t i o n p r o f e ssi o n i s o n e o f i t s m a i n
a c c o m p l i s h m e n t s b e c a u s e t h e d e v e l o p m e n t o f
m ult iple dem ands is evidenced, ent ailing great er social
v isibilit y( 2).
Alt hough t he highlight ed hist orical fact s focus
on ly on n u t r it ion , n u r sin g an d p h y siot h er ap y, t h ey
m aint ain a cert ain sim ilarit y wit h t he st ruggle of healt h
pr of ession s in h igh er edu cat ion , lik e t h e sear ch f or
social acknow ledgem ent , aut onom y and em ancipat ion
of pr act ices. I n t his per spect ive, t he physician is st ill
seen as t h e m ain h ealt h ag en t , w h ich im p lies t h e
secondary part icipat ion of t he rem aining professionals
in t he scope of healt h pract ices( 12).
I n t he hist or ical pr ocess of t he healt h ar ea,
m edicine becam e t he k now ledge m at r ix , est ablishing
it self as what Foucault calls biopower. This knowledge
b r o ad en s an d co m p r i ses t h e d i f f er en t n u an ces o f
c o n s t i t u t i n g s o c i a l p r a c t i c e s . W h e n m e d i c i n e
a c q u i r e s s u c h a s o c i a l d i m e n s i o n , i t g r a n t s
p r of ession als a . d if f er en t iat ed st at u s in r elat ion t o o t h e r h e a l t h p r o f e s s i o n a l s . T h e s o c i a l s t a t u s
con f er r ed by m edicin e is pr obably on e of t h e m ain
r eason s t h is ar ea is st ill t h e m ost ch osen in pu blic a n d p r i v a t e u n i v e r s i t i e s( 1 ). S u c h d i f f e r e n t i a t i o n
m o b i l i zes r el a t i o n s o f k n o w l ed g e/ p o w er i n ca r eer
ch o i ce .
En t e r i n g a m e d i c a l p r o g r a m g i v e s t h e
st u den t t h e st at u s of ph y sician , t h at is, t h e select ion
it self b ecom es a st r at eg y in t h e k n ow led g e/ p ow er r e l a t i o n t h a t d i s t i n g u i s h e s f u t u r e m e d i c a l
p r o f e ssi o n a l s f r o m t h e r e m a i n i n g p r o f e ssi o n a l s,
w h ich in t egr at e t o t h is st at u s ( pr e) con cept ion s t h at r u l e a s r e g i m e s o f t r u t h : m o r e i n t e l l i g e n t a n d
i n st r u ct e d st u d e n t s, w h o r e ce i v e d d i f f e r e n t i a t e d
e d u c a t i o n , a r e a b l e t o e n t e r t h e m o s t d e s i r e d pr ogr am s an d ar e t h er ef or e t h e best pr of ession als,
w h i ch m a i n t a i n t h e d i f f e r e n t i a t e d st a t u s o f t h i s
p r of ession , t u r n in g it in t o au t h or it y of k n ow led g e.
[ …] t h e p h y sician t h in k s t h at j u st b ecau se h e’s st u d ied
m edicine and is t r eat ing t he hum an body and m edicat ing, he t hink s he’s t he best and w hat happens is t hat he r ules t hings
[ …] ( G6 ) . Th e r egim e of t r u t h t h at gr an t s a dif f er en t ial
t o t h e s t u d e n t e n t e r i n g t h e p r o g r a m r a n k s t h e
en t r an ce of st u d en t s in h ealt h p r og r am s, w h ich is
p e r m e a t e d b y s o c i o e c o n o m i c a n d c u l t u r a l
dif f er en ces t h at also per m eat e t h ese pr of ession s( 1 ).
T h e h i g h d e m a n d f o r t h e m e d i c a l a r e a
m a k e s m a n y c a n d i d a t e s c h o o s e o t h e r h e a l t h
p r o f e ssi o n s a s a se co n d o p t i o n . I n a st u d y w i t h
st u d e n t s r e g i st e r e d i n a n u r si n g p r o g r a m , 7 0 %
c h o s e t h i s a r e a b e c a u s e t h e y w e r e n o t a b l e t o
cl assi f y i n an o t h er ; m ed i ci n e w as t h e f i r st o p t i o n
f o r m o s t o f t h e m( 1 1 ). We o b s e r v e t h a t t h i s
p h e n o m e n o n i s a l s o p r e s e n t i n o t h e r h e a l t h
p r o f essi o n s a cco r d i n g t o t h e f o l l o w i n g d i sco u r se:
[ …] p h y si o t h e r a p y , b e ca u se e v e r y o n e w a n t s t o st u d y m ed icin e, b ecau se t h e d em an d is h ig h an d it ’s d if f icu lt [ …] ( G4) . [ …] y ou’r e st udy ing nut r it ion because y ou w ant ed t o st udy m edicine but didn’t m anage t o be accept ed [ . . . ] ( G5 ) .
Ca r e e r ch o i ce b e y o n d p r o f e ssi o n a l p r o j e ct s
I t seem s t h at en t er in g cer t ain ar eas g oes
bey on d pr of ession al pr oj ect s, t h at is, t h ese ch oices
h a p p e n a s o c c a s i o n a l c h o i c e s o f s o m e o n e w h o
k n o w s l i t t l e a b o u t t h e a r e a , b u t b r i n g s co n ce p t s
an d v alu es t h at cir cu lat e in societ y: [ …] I w as k ind of
t aken aback because it w asn’t ex act ly w hat I w ant ed but t hen I changed m y m ind, because I w as going t o st udy dent ist r y , but I passed in m y second opt ion, nut r it ion, ‘I ’ll do it and see if I lik e it ’, and I ’m lov ing it now , don’t w ant t o change it any m or e, I w ant t o st udy nut r it ion ( G5 ) .
A s t u d y w i t h s t u d e n t s f r o m t h e h e a l t h scien ces ar ea( 1 2 ) r ev ealed t h at , am on g m ot iv at ion s
t h at l ed st u d en t s t o ch o o se a cer t ai n ar ea, t h er e
w as t h e “ im possibilit y of st u dy in g t h eir f ir st ch oice”, e s p e c i a l l y m e d i c i n e a n d d e n t i s t r y , w h i c h a l s o
appear s in t h e f ollow in g r epor t : [ …] phy siot her apy w as m y second opt ion because I w ant ed dent ist r y but I lik e t he healt h ar ea v er y m uch and, since I couldn’t do dent ist r y , I chose phy siot her apy [ …] ( G4 ).Th e st u dy in dicat es som e d eg r ee of f r u st r at ion in t h ese st u d en t s w h o, ev en af t er at t en d in g a lar g e par t of t h e pr ogr am , r eg r et
n ot h av in g accom p lish ed t h eir lif e p lan . Reg ar d in g
p r o f e s s i o n a l e x p e c t a t i o n s , s t u d e n t s r e p o r t p r o f e s s i o n a l a c k n o w l e d g e m e n t , w h i c h i n c l u d e s
p r o f e s s i o n a l a n d p e r s o n a l r e a l i z a t i o n , “ w i n
p r o f e s s i o n a l l y , o v e r c o m e o b s t a c l e s , g a i n r e co g n i t i o n f r o m p a t i e n t s a n d p r o f e ssi o n a l s a n d
p r act ice t h eir p r of ession w it h d ig n it y, ap p ly in g t h e
acq u i r ed k n o w l ed g e”( 1 2 ).
So m e a sp ect s t h a t f a ci l i t a t e en t er i n g t h e
m e d i c a l p r o f e s s i o n a l( 1 3 ), s u c h a s h i g h f a m i l y
i n co m e, p ar en t s w i t h h i g h er ed u cat i o n , at t en d i n g
g o o d h i g h sch o o l s, at t en d i n g p r ep ar at o r y co u r ses
f or t h e w r it t en ex am r eq u ir ed t o en t er u n iv er sit y,
h av in g f am ily m em b er s w h o ar e p h y sician s, sh ow
t h e r el ev an ce o f sev er al so ci o eco n o m i c f act o r s i n
d et er m i n i n g car eer ch o i ce: [ …] m y f am ily p r essu r ed m e ‘ah , g o st u d y m ed icin e’ [ …] I ’ll st u d y p h y siot h er ap y because I ’d been a pat ient , I ’v e lik ed it a lot . My uncles w ho ar e phy sicians w er e lik e ‘but phy siot her apy is so m uch alik e m edicine’ ( G7 ) . Th is r ealit y does n ot seem t o be t h e s a m e i n p r o f e s s i o n s l i k e n u r s i n g , n u t r i t i o n a n d
p h y s i o t h e r a p y , i n w h i c h t h e n u m b e r o f
u n d e r g r a d u a t e p r o g r a m s i n t h e r e g i o n a l a n d
n a t i o n a l s c o p e i s e n o r m o u s . T h e r e w e r e 4 1 5
u n d e r g r a d u a t e n u r s i n g( 1 4 ) p r o g r a m s i n Br a z i l i n
2 0 0 4 , 2 0 1 i n n u t r i t i o n( 1 5 ), a n d 3 3 9 i n
ph y siot h er apy( 1 6 ). Th e n u m ber of slot s is lar ger t h an
t h e n u m b er of st u d en t s en t er in g t h ese p r og r am s,
a s t h e s e a r e a s a r e a l s o m a r k e d b y s i g n i f i c a n t
a b a n d o n m e n t r a t e s, m a ssi f y i n g t h e e d u ca t i o n o f
t h ese p r o f essi o n al s an d t h ei r en t r an ce i n t h e j o b
m ar k et . An ot h er im por t an t aspect t o be con sider ed
i s t h e so ci o e co n o m i c co n d i t i o n o f st u d e n t s w h o
co l l e g e . We o b se r v e d i n p r i v a t e i n st i t u t i o n s t h a t
5 4 . 4 % o f t h e s t u d e n t s e n t e r i n g t h e n u r s i n g
p r o g r a m , 3 5 . 1 % i n n u t r i t i o n a n d 3 1 . 6 % i n t h e
p h y s i o t h e r a p y p r o g r a m w o r k . D a t a r e g a r d i n g
f am ily in com e r ein f or ce t h e dif f icu lt y st u den t s h av e
t o f ace: 7 7 . 3 % in n u r sin g , 7 0 . 9 % in n u t r it ion an d 6 9 . 2 % in ph y siot h er apy h av e an in com e low er t h an
1 0 m in im u m w ag es( 1 4 - 1 6 ). Th is is also a r ealit y f or
t h e st u d y p ar t icip an t s.
Aft er ent ering universit y, fut ure professionals
st ar t t o ex p er ien ce p ow er r elat ion s ex ist en t in t h e
healt h area: [ …] t here’s a hierarchy, t he physician com es first , then the physiotherapist, then the physical educator, so this is what is created. So I felt little in relation to these things, you know, and seeking m ore knowledge, of course I could do it, I ’d get m ore knowledge in physical education, seeking knowledge in this area, I would get it, it’s not about being superior, but let’s say, show m yself m ore [ …] ( G6) . Ex plicit or silent fight s ar e present so as t o aut horize or legit im at e unconvent ional sp aces an d p r act i ces. En t er i n g p r o f essi o n s i n t h e
h ealt h ar ea m ob ilizes r egim es of t r u t h, w h ich ar e p r e s e n t i n t h e i m a g e o f e a c h p r o f e s s i o n a n d
t r a n sv er sa l i zed i n p r o f essi o n a l ed u ca t i o n a n d t h e
p r o f e ssi o n a l co n t e x t . Th e a ca d e m i c t r a j e ct o r y i s
ex pect ed t o per m it t he const r uct ion of a hist or ically
con st r u ct ed p r of ession al id en t it y t h at at t en d s an d a d a p t s t o ce r t a i n p o l i t i ca l , e co n o m i c a n d so ci a l
p r e scr i p t i o n s. I n co n t r a st , t h e t r a n sf o r m a t i o n o f
k n o w l e d g e a n d p r a c t i c e s s h o w s t h a t t h e s e
p r e scr i p t i o n s a r e t h e f o cu s o f st r u g g l e s b e t w e e n
dif f er en t ar eas.
FI NAL CONSI DERATI ONS
T h e a n a l y s i s d e v e l o p e d i n t h i s s t u d y
r ev ealed t h at st u d en t s’ car eer ch oice w as st r on g ly
link ed t o t he ar ea’s social im age and fam ily influence.
Du r in g edu cat ion , w h en n u r sin g, ph y siot h er apy an d
n u t r it ion st u den t s f ace k n ow ledge in t h e r espect iv e ar eas, t h ey r eaf f i r m t h ei r o p t i o n o r ch o o se o t h er
pr ofessions. Ther efor e, it is im por t ant t hat pr ogr am s
pr om ot e dir ect con t act of st u den t s w it h k n ow ledge an d p r act ices in each ch osen p r of ession sin ce t h e
st ar t .
Pa r t i ci p a n t s’ ca r e e r ch o i ce a n d a ca d e m i c experiences occur in t he cont ext of healt h professions’
p o w e r c o n f l i c t s . S t u d e n t s ’ d i s c o u r s e r e v e a l e d
k n o w l e d g e sh a p e d a cco r d i n g t o m e d i ci n e , w h i ch a cq u i r e s st a t u s i n r e l a t i o n s o f p o w e r. Th u s, t h e
educat ion of healt h pr ofessionals needs t o be link ed
t o public policies t hat enlarge different professions so a s t o m e e t d e m a n d s , w h i c h a l s o i m p l i e s t h e
( r e) or ganizat ion of policies. These m ov em ent s gr ant
v isib ilit y t o p r of ession s an d t h eir p r act ices, w h ich , link ed t o scient ific k now ledge, inst it ut e new regim es of truth.
The sear ch for pr ofessional ack now ledgm ent
an d p er son al accom p lish m en t p er m eat ed t h e en t r y
o f p ar t i ci p an t s i n t o h i g h er ed u cat i o n . Fo r b ey o n d
pr of ession al an d per son al pr oj ect s, t h e pr of ession al
ident it y of nur ses, phy siot her apist s and nut r it ionist s
dem ands t he const it ut ion of a new act , focused on an enlar ged under st anding of healt h t hat giv es v oice t o
t he differ ent pr ofessions in fav or of int egr al car e.
ACKNOW LEDGEMENTS
Sp ecial ack n ow led g em en t s t o t h e st u d en t s who helped in t he dat a t ranscript ion process: Caroline
A b u d , B i a n c a B o s e n b e c k e r Wa l k e r, Je a n i n e
Sau er essi g .
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