THE EXPERI ENCE OF A W OMAN W ORKI NG I N NURSI NG SUFFERI NG FROM DE
QUERVAI N’S DI SEASE
Pat r icia Cam pos Leit e1 Mir iam Apar ecida Bar bosa Mer igh i2 Ar let e Silv a3
Leit e PC, Mer ighi MAB, Silv a A. The ex per ience of a w om an w or k ing in nur sing suffer ing fr om De Quer v ain’s disease. Rev Lat in o- am En fer m agem 2 0 0 7 m ar ço- abr il; 1 5 ( 2 ) : 2 5 3 - 8 .
This is a case st udy w it h a phenom enological appr oach on t he ex per ience of a w om an w ho w or k s in nur sing and suffer s fr om t he de Quer v ain’s disease, an ost eo- m uscular disor der r elat ed t o w or king condit ions. This st udy aim ed t o under st and w hat m eans t o be a w om an w or k ing in nur sing and suffer ing fr om an ost eo-m uscular disor der r elat ed t o w or king condit ions t hr ough a w or ker of t he Mat er ial and St er ilizat ion Cent er of a pr iv at e hospit al. The philosophical r efer ent ial fr om Mar t in Heidegger w as used for t he com pr ehensiv e analy sis of t he st at em ent in quest ion. The analy sis r ev ealed t hat t he phy siopat hological pr ocess of t he de Quer v ain’s disease caused changes in t he w or ker ’s life, char act er ized by painful m anifest at ions and especially by phy sical lim it at ions, w hich gener at e a m ult iplicit y of feelings. Anguish is pr esent in t he pr ocess of accept ing t he disease, w hen t he w or ker per ceiv es t he fr agilit y of her ex ist ence and r ecognizes her self as t he one r esponsible for her ow n car e, r eaching aut hent icit y and t r anscending t he disease.
DESCRI PTORS: cu m u lat iv e t r au m a disor der s; w om en ’s h ealt h ; qu alit at iv e r esear ch
VI VENCI A DE UNA TRABAJADORA DE ENFERMERÍ A PORTADORA DE
LESI ÓN “DE QUERVAI N”
El p r esen t e es u n est u d io d e caso cu alit at iv o f en om en ológ ico sob r e la ex p er ien cia d e u n a m u j er t r abaj ador a por t ador a de la Lesión De Quer v ain, un dist ur bio ost eom uscular r elacionado al t r abaj o. Siendo el obj et iv o com pr en der com o es el ser u n a m u j er t r abaj ador a de en f er m er ía den t r o del Cen t r o de Mat er ial y Est er ilización de u n h ospit al par t icu lar con u n dist u r bio ost eo- m u scu lar r elacion ado al t r abaj o. Se u t ilizó el r efer encial filosófico de Mar t ín Heidegger par a el análisis com pr ensiv o de la ent r ev ist a. El análisis m ost r ó que el p r oceso f isiop at ológ ico or ig in ó cam b ios en su v id a, car act er izad os p or las m an if est acion es d olor osas y especialm ent e por lim it aciones físicas, lo que gener ó una m ult iplicidad de sent im ient os. La angust ia est a pr esent e dent r o del pr oceso de acept ación de la enfer m edad, m om ent o en el cual, la t r abaj ador a per cibe la fr agilidad de su ex ist encia y se r econoce com o r esponsable de su cuidado, alcanzando la aut ent icidad y t r anscendiendo la en f er m ed ad .
DESCRI PTORES: t r ast or nos por t r aum as acum ulados; salud de las m uj er es; inv est igación cualit at iv a
A VI VÊNCI A DE UMA TRABALHADORA DE ENFERMAGEM PORTADORA DE
LESÃO “DE QUERVAI N ”
Tr at a- se de um est udo de caso qualit at iv o de abor dagem fenom enológica sobr e a ex per iência de um a m ulher t r abalhador a de enfer m agem por t ador a de Lesão De Quer v ain, um dist úr bio ost eom uscular r elacionado ao t r abalho. Obj et iv ou- se com pr eender com o é ser m ulher t r abalhador a de enfer m agem , est ando doent e por um dist úr bio ost eom uscular r elacionado ao t r abalho, por m eio de um a t r abalhador a do Cent r o de Mat er ial e Est er ilização de u m h ospit al par t icu lar . Ut ilizou - se o r ef er en cial f ilosóf ico de Mar t in Heidegger par a an álise com pr een siv a do depoim en t o em qu est ão. A an álise r ev elou qu e o pr ocesso f isiopat ológico da Lesão de De Qu er v ain d esen cad eou m u d an ças n a v id a d a t r ab alh ad or a, car act er izad as p elas m an if est ações d olor osas e especialm ent e pelas lim it ações físicas, ger ando, assim , um a m ult iplicidade de sent im ent os. A angúst ia se fez pr esent e no pr ocesso de aceit ação da doença, m om ent o em que a t r abalhador a per cebe a fr agilidade de sua exist ência e se r econhece com o r esponsável pelo seu aut ocuidado, alcançando a aut ent icidade e t r anscendendo a doen ça.
DESCRI TORES: t r anst or nos t r aum át icos cum ulat iv os; saúde da m ulher ; pesquisa cualit at iv a
1 Doct or al st udent , Pr ofessor at Univer sit y Cent er Nove de Julho, e- m ail: pat ipavan@uninove.br ; 2 Fr ee Lect ur er at Univer sit y of São Paulo College of Nur sing,
e- m ail: m er ighi@usp.br ; 3 RN, Full Pr ofessor I at Univer sit y of Guar ulhos, e- m ail: ar lsilva@uol.com .br
I NTRODUCTI ON
I
n o u r p r o f e ssi o n a l e x p e r i e n ce , w e h a v e per ceived t hat t he r ealit y of nur sing w or ker s has beenm a r k e d b y d a i l y a ct i v i t i e s l o a d e d w i t h b a d w o r k
condit ions, caused not only by a lack of hum an and
m at erial resources, but also by t he st ress inherent in
hospit al act iv it y.
Mo s t h o s p i t a l i n s t i t u t i o n s h a v e a h i g h l y
com plex and diver se ser v ice st r uct ur e. How ever, t his
does not r educe t he w or k er s’ ex posur e t o count less
pr oblem s( 1 ).
The w or k condit ions offer ed by hospit als and
t he peculiar it ies of nur sing w or k , associat ed w it h t he
difficult ies in t he healt h sect or, cont ex t ualize nur sing
pr ofessionals’ w or k sit uat ion in differ ent count r ies( 2).
D e s p i t e t h e w h o l e b e n e f i c i a l d i m e n s i o n
at t r ibut ed t o w or k, it is know n t hat , in nur sing, var ious
e x p e r t s h a v e l o o k e d a t t h e e x h a u s t i o n ,
discour agem ent , fr ust r at ion and desir e t o give up t he
pr ofession( 3 - 5 ).
As n u r sin g p r of ession als ar e p r ed om in an t ly
w o m en , a d i f f er en t i at ed l o o k o n t h ese w o r k er s i s
needed, w ho m ost ly w or k a double or t r iple j our ney
an d is r espon sible n ot on ly for h ou sew or k , bu t also
f or pr of ession al act iv it ies.
Th is f act cau ses cou n t less h ealt h pr oblem s,
w h en ev en a f f ect o f f i ci a l m o r t a l i t y a n d m o r b i d i t y
st a t i st i cs b e t w e e n t h e t w o g e n d e r s, w i t h h i g h e r
m or bidit y r at es am on g w om en an d h igh er m or t alit y
r at es am ong m en( 6).
I n t h e con t ex t of f em al e n u r si n g w or k er s’
i l l n esses, Wo r k Rel a t ed Mu scu l o sk el et a l D i so r d er s
( WMSD) st an d ou t . Th is n am e in clu d es a g r ou p of
i l l n e s s e s , s u c h a s t e n o s y n o v i t e s , t e n d i n i t e s , D e
Qu er v ain ’s disease, sy n ov it es, an d per iph er al n er v e
com pr ession sy n dr om es, besides m or e dissem in at ed
s y m p t o m s , s u c h a s m y o f a s c i a l s y n d r o m e ,
fibr om y algia an d r eflex sy m pat h et ic dy st r oph y( 7 ).
D e Q u e r v a i n i n j u r y i s a l s o k n o w n a s
t enosy nov it is of t he r adial st y loid, r esult ing fr om t he
const r ict ion of t he com m on sheat h of t he long abduct or
and shor t ex t ensor t endons of t he t hum b. I t m ainly
a f f e c t s w o m e n o v e r 4 0 , a n d i s a s s o c i a t e d w i t h
occupat ional ex posur es t hat r equir e r epet it iv e t hum b
m o v e m e n t s, p i n ch i n g o f t h e t h u m b w i t h f l e x i o n ,
ext ension, r ot at ion or r epeat ed ulnar deviat ion of t he
carpus and use of scissors for long periods. The clinical
pict ure is charact erized by pr oj ect ed pain in t he st yloid
process of t he radial nerve w it h or w it hout irradiat ion
i n r a d i a l p r o j e ct i o n u n t i l t h e sh o u l d e r a n d w h i ch
incr eases t hr ough act ive r adial abduct ion of t he t hum b.
Tum or s m ay appear in t he painful r egions( 8).
I n m ost cases, t he sym pt om s init ially appear
in sid iou sly an d ar e m or e p r ed om in an t t ow ar d s t h e
en d or pr odu ce peak s, w it h r est giv in g som e r elief.
H o w e v e r, o v e r t i m e , t h e sy m p t o m s ca n b e co m e
f r eq u en t d u r in g w or k an d ev en af f ect t h e w or k er ’s
ex t r a- occu pat ion al act iv it ies( 9 ).
Du e t o t h e cou n t less sy m pt om s in clu ded in
WMSD , so m e d i f f u se an d o t h er s w el l d el i m i t ed i n
anat om ical and/ or physiological t er m s, diagnosing and
pr ov ing t he disease is not alw ay s easy, w hich t ur ns
t h e pr ocess of look in g for adequ at e t r eat m en t ev en
slow er( 1 0 ).
Th u s , o u r c o n c e r n s w i t h t h e i n c r e a s e d
i n ci d en ce o f m u scu l o sk el et a l p r o b l em s i n n u r si n g
w or k er s, associat ed w it h t h e lack of st u d ies ab ou t
WMSD specifically in t his pr ofessional gr oup, lead us
t o t h e t h e m e o f t h i s st u d y, w h i ch a t t e m p t e d t o
under st and w hat it is like t o be a w om an w ho suffer s
f r om a w or k - r elat ed m u scu losk elet al d isor d er – De
Quer v ain inj ur y , t hr ough t he ex per ience of a nur sing
w o r k er .
METHODOLOGI CAL TRAJECTORY
We c a r r i e d o u t a c a s e s t u d y f r o m a n
e x i s t e n t i a l p h e n o m e n o l o g y a p p r o a c h , a b o u t t h e
ex per ien ce of a 4 0 - y ear - old n u r sin g w or k er, w h o is
m a r r i e d a n d m o t h e r o f t w o c h i l d r e n , h a s b e e n
p r of ession ally act iv e at a Mat er ial an d St er ilizat ion
Cen t er f or 1 2 y ear s an d su f f er s f r om De Qu er v ain
disease, a WMSD.
I n or der t o under st and w hat it is like t o be a
w o m a n w h o s u f f e r s f r o m a w o r k - r e l a t e d
m u s c u l o s k e l e t a l d i s o r d e r – D e Qu e r v a i n i n j u r y ,
t h r o u g h t h e e x p e r i e n ce o f a n u r si n g w o r k e r , w e
co n si d e r e d t h e q u a l i t a t i v e m e t h o d o l o g y a s m o r e
c o h e r e n t w i t h o u r g o a l s . Th u s , w e u s e d t h e
c o m p r e h e n s i v e a p p r o a c h o f M a r t i n H e i d e g g e r ’ s
ex i st en t i al p h en o m en o l o g y t o an al y ze t h e n u r si n g
w or k er ’s discour se, pr esent ed her e as a case st udy,
w h i c h c o n s t i t u t e d t h e g u i d e l i n e t o a n a l y z e t h e
t est im ony under st udy.
A s a s t u d y m e t h o d , p h e n o m e n o l o g i c a l
r esear ch allow s t he r esear cher t o access t he hum an
conscience and go back t o t hings t hem selv es, t o t he
phenom enon, consider ed as anyt hing t hat show s it self,
m anifest s it self, appears t o a conscience t hat quest ions
it , giv ing up pr ej udices and pr em ises( 11).
Heidegger ’s t h in k in g is abou t an aw ak en in g
based on t he quest ion of t he m eaning of being, seeking
t o u n v e i l i t s c o m p r e h e n s i o n , c o n s i d e r i n g
phenom enology as a w ay t o access t he under st anding
of hum an exist ence( 12- 13).
The hum an being’s basic w ay of exist ence is
“ b ei n g - i n - t h e- w o r l d ”, i n w h i ch m a n i s u n d er st o o d
based on t he w orld he is in and how he relat es t o it ,
t o obj ect s and people, opening up t o him self and t he
w or ld( 14).
I n t h i s co n t e x t , t h e n u r si n g w o r k e r w h o
ex per ien ces t h e disease pr ocess can , t o t h e ex t en t
t hat she opens up t o her self and t he w or ld, quest ion
h e r s e l f a b o u t h e r o w n e x i s t e n c e i n t h e w o r l d ,
per ceiving t he fr agilit y of her exist ence br ought about
by t h e WMSD sy m pt om s. Th u s, an ot h er on t ological
charact erist ic defined by Heidegger is t he anguish t hat
em er ges w h en t h e h u m an bein g becom es aw ar e of
his ex ist ent ial inst abilit y. Mor eov er, accor ding t o t his
philosopher, it is also w hen ack now ledging her self as
a b e i n g - f o r - d e a t h t h a t t h i s b e i n g c a n f i n d h e r
a u t h e n t i c i t y, a m o m e n t w h e n t h i s w o m a n c a n
t r anscend t he disease( 1 5 ) .
As d escr i b ed a b o v e, w e u sed Hei d eg g er ’ s
ex ist ent ialist r efer ence fr am ew or k , in t he belief t hat
t he st r uct ur es t he aut hor pr oposed could ser v e as a
m ar k in t h e com pr eh en siv e an aly sis of t h is n u r sin g
w or ker ’s t est im ony, w ho is exper iencing a w or k r elat ed
m u scu losk elet al disor der ( WMSD) .
The int er v iew w as held in July 2004 at t he
w or ker ’s hom e, in São Paulo Cit y and t ook 42 m inut es.
I t w as t ape- r ecor ded w it h t he w om an’s aut hor izat ion,
t h r o u g h t h e Fr ee an d I n f o r m ed Co n sen t Ter m . To
conduct t he int er v iew , w e used t he follow ing guiding
quest ion: What is it like for you t o be a fem ale nursing
w orker and live w it h a WMSD? The aim of t his quest ion
w as t o guide us t o t his w om an’s w or ld- life, based on
h e r o w n e x p e r i e n c e s , c o n s i d e r i n g t h a t t h e
phenom enon of being- a- fem ale- nur sing- w or k er liv ing
w it h a WMSD can only be unveiled w hen st ar t ing fr om
t h e su b j ect w h o ex p er ien ces t h e d isease, t h e p ain
and t he suffer ing caused by t he WMSD.
I t should be em phasized t hat , befor e holding
t he int er v iew , t his st udy w as assessed and appr ov ed
by t he Resear ch Et hics Com m it t ee at t he Univ er sit y
of São Paulo College of Nur sing ( EEUSP) .
CONSTRUCTI NG THE RESULTS
A f t e r t h e i n t e r v i e w , w e t r a n s c r i b e d t h e
collect ed discour se in full. Nex t , w e r ead and r er ead
t h e t r an scr ipt ion s t o f in d u n it s of m ean in g, t h at is,
sig n if ican t ex t r act s of d iscou r se, in v iew of Mar t in
Heidegger ’s pr oposit ion s. Th e f ollow in g st ep w as t o
gr oup t he unit s of m eaning accor ding t o sim ilar it ies,
w h i c h g a v e r i s e t o t h e m e s t h a t c o n s t i t u t e d t h e
Ont ological Unificat ions( 16).
We p r e s e n t t h e O N TO LO GI CA L
UNI FI CATI ONS ident ified in t he discour se of t he
f e m a l e n u r s i n g w o r k e r s w h o s u f f e r s f r o m D e
Quervain’s disease, w hich revealed t he being a fem ale
nur sing w or k er liv ing w it h t he WMSD:
Being- in- t he- w or ld liv ing w it h t he WMSD
Con sid er in g t h at m an is u n d er st ood b ased
on t h e w or ld h e liv es in an d h ow h e r elat es t o t h is
w or ld, bein g a w om an in t h e w or ld, w or k in g in t h e
nur sing t eam , living w it h a WMSD is m uch m or e t hat
ex per iencing pain and pr ofessional difficult ies. I t also
i n cl u d es l i v i n g a d ai l y r eal i t y o f i m p o ssi b i l i t i es t o
per for m ev en sim ple daily t ask s, as pr esent ed in t he
discou r se ex t r act below :
...and at m y house t oo I couldn’t do anyt hing anym ore,
I couldn’t even m anage t o pull up t he blanket t o cover m e...
( Marília)
I n daily life, t he m eaning of m any t hings only
a p p e a r s t o t h e h u m a n b e i n g w h e n so m e t h i n g i s
m issing, t hat is, t he experience of a loss or lim it at ion
ev i d en ces t h e m ea n i n g s t h a t h a d b een h i d d en o r
ignored unt il t hen( 14).
Th e fem ale n u r sin g w or k er st ar t s a pr ocess
of perceiving herself in t he w orld as she is, living w it h
h er d if f er en t im p ossib ilit ies, con sid er in g t h e m an y
m odificat ions in her physical abilit ies t hat disable her
not only for w or k, but also t o per for m sim pler act ivit ies
r elat ed t o her ow n self- car e.
The nur sing w or k er ’s t est im ony r ev eals t hat ,
despit e t he pain, t he lim it at ion, she cont inues w orking
and insist ing, r esist ing her int ense pain and m ak ing
e f f o r t s n o t t o t a k e l e a v e f r o m h e r p r o f e s s i o n a l
act iv it ies:
...and aft er t he inj ur y est ablished her e, you know , I
couldn’t do har dly anyt hing anym or e, I couldn’t t ake a box, t ake
dow n boxes fr om t he shelf...I couldn’t do alm ost anyt hing at t he
Mat erial Cent ral...So I arrived, I choose t he shift t hat was possible
for t hat day, but som et im es I couldn’t w or k unt il t he end of t he
We can per ceiv e t h at t h e w or sen in g of t h e
disease t ends t o cause a series of physical and m ent al
a l t e r a t i o n s a n d t h a t t h e w o r k e r i s a w a r e o f h e r
lim it at ion s f or w or k . How ev er, f or h er, t ak in g leav e
f r om w or k m ean s m u ch m or e t h an ack n ow led g in g
h e r d i se a se , i t m e a n s a cce p t i n g a n d t u r n i n g h e r
d i s a b i l i t y p u b l i c , a s e v i d e n c e d b y t h e f o l l o w i n g
d iscou r se:
...I ’m not going back hom e, I w ant t o see unt il w hat
point I m anage t o w or k, you know .... ( Mar ília)
Th e n u r s i n g w o r k e r s t i l l p e r f o r m s h e r
pr ofessional act iv it ies, at t em pt ing t o pr ov e t o her self
t h at sh e is st ill able, alt h ou gh t h is oft en r epr esen t s
t h e m ost r elev an t f act or f or t h e w or sen in g of h er
in j u r y. Her b ein g - in - t h e- w or ld is in t en sely m od if ied
t hr ough t he alt er at ions r esult ing fr om t he WMSD, as
t h e se m a n i f e st a t i o n s u n a v o i d a b l y o ccu r a n d t h i s
w om an finds her self obliged t o liv e w it h t he changes
because, alt hough she is ill, she st ill lives w it h herself
and t he w orld, est ablishing sim ple relat ions of exist ing
i n t h e w o r l d , s u f f e r i n g f r o m t h e p a i n a n d h e r
lim it at ion s.
The nur sing w or k er liv ing t he am biguit y of solicit ude
The nur sing w or ker living w it h t he WMSD can
ex per ience ot her people’s concer n about her and her
h e a l t h c o n d i t i o n . Th i s c o n c e r n i s b a s e d o n t h e
ont ological const it ut ion of t he pre- sence as being- w it h,
g u id ed b y con sid er at ion an d t oler an ce or p at ien ce
t owar ds t he ot her, t he so- called solicit ude( 14).
...in t his int er val, I found a doct or w ho t ook car e of m e
and said you have t o t ake leave, you know , t his arm has t o rest ...
( Marília)
W h e n r e p o r t i n g o n t h i s p r o f e s s i o n a l ’ s
solicit ude, she r ev eals her gr at it ude for t he fact t hat
he w ar ned her about her act ual sit uat ion and t he need
t o grant im port ance t o her ow n illness, w hich allow ed
her t o open up t o being- able- t o- be her self, living w it h
t he t rut h.
Unfor t unat ely, t he w or ker r epor t s t hat it was
difficult for pr ofessionals t o give t his suppor t , neit her
pr ofessionals involved in occupat ional healt h car e nor
h er n u r sin g t eam colleagu es. Th e f eelin g of disdain
o r l a c k o f c a r e , g r e a t l y p r e s e n t i n t h e w o r k
e n v i r o n m e n t , co n f i g u r e d t h e d i st a n ci n g f r o m t h e
b e i n g - w i t h a s , a c c o r d i n g t o H e i d e g g e r, w e a r e
essent ially relat ion and, in t his relat ion, concern about
t he ot her, t hat is, “ solicit ude” becom es t he essence of
our ex ist ence( 14).
. . . in f act , I d id n ’t f eel t h at t h ey w er e t ak in g m e
seriously... I felt t hat he didn’t believe in m y pain, you know , t hat
it w as t hat int ense...a kind of disdain... ( Mar ília)
Mar ília’s st at em ent dem onst r at es t hat she felt
t h at t h e occu p at ion al h ealt h car e p r of ession als d id
n ot accor d d u e im p or t an ce t o h er com p lain t s. Th is
i m p er so n al i t y i n t h e co n t ex t o f t h e d o ct o r - p at i en t
relat ion accuses t his w om an’s need for solicit ude since,
at t hat m om ent , w hat she m ost needed w as t o feel
hear d about her pain, about her suffer ing.
The im per sonal is pr esent all ov er, in w hich
t h e w h ole w or ld is t h e ot h er an d n obody is h im self
and t his exper ience t ot ally dissolves t he per son’s ow n
pr e- sen ce in t h e w ay of bein g- w it h t h e ot h er s, in a
w ay t h at t h e ot h er s d isap p ear ev en m or e in t h eir
possibilit y( 14).
Besides t his difficult observat ion, t here is t he
n u r sin g w or k er s’ h idden pr ej u dice:
I ended up being negat ively consider ed, you know , by
m y colleagues, I ended up w it h a bad im age in t he sect or , t oday,
I say t o m y psychot her apist like t his, I … I feel w hat black people
feel ( cr ying) ... ( Mar ília)
The pr ej udice and discr im inat ion also ex t end
t o her nursing t eam colleagues, evidencing neglect in
daily r elat ions. This sit uat ion t ends t o gener at e ev en
m or e suffer ing in t he w or k er as, alt hough t he w or ld
is shared, t he experience of being a WMSD pat ient is
in d iv id u al.
The anguish of living w it h a WMSD
I n t he cont ext of acquir ing a WMSD, it should
be em ph asized t h at m an y m odif icat ion s r esu lt f r om
t h e ph y siopat h ological pr ocess. Con sider in g t h at , in
m ost cases, w om en ar e r esp on sib le f or h om e an d
pr ofessional act iv it ies, t he new sit uat ion, m ar k ed by
painful m anifest at ions, decr eased m uscle st r engt h and
r est r ict ion s t o per f or m m an y act iv it ies, t h is obliged
t he nur sing w or ker t o becom e aw ar e of t he fact t hat
her life changed, t hat t he t r ansfor m at ions caused by
t he disease alr eady est ablished t hem selv es and t hat
her fut ur e is uncer t ain.
We o b se r v e t h a t u n ce r t a i n t i e s a b o u t h e r
p h y si ca l a b i l i t i e s, co m m i t m e n t s a n d r e sp o n se t o
t r eat m en t s m ade h er ex per ien ce an gu ish :
...you st art like t hat , w hen you have t his kind of inj ury,
in y our hand, r ight hand, w hen m y hand w as im m obilized I
couldn’t do anyt hing wit h m y left hand, I want ed t o die...( Marília)
Mar ília’s st at em en t r ev eals t h at h er w or ld
Wh en sh e t alk s ab ou t “ r ig h t h an d ”, it is ev id en ced
t hat , in her relat ion w it h t he w orld and it s t hings, she
p er ceiv es h er d isab ilit y an d st ar t s t o q u est ion h er
exist ence, in w hich “ w ant ing t o die” seem s t o be t he
end of ever yt hing, t he end of get t ing confr ont ed w it h
su ch a n a n d p e r so n a l f r a g i l i t y. Th i s e x p o se s t h e
w or k er ’s anguish, w ho per ceiv es her self as a
being-f or - d eat h .
Deat h is t he m ost per sonal, m ost singular of
t h e p ossib ilit ies of b ein g - t h er e, an d t h at is ex act ly
t he sour ce of anguish. I n t his aspect , w hen t hink ing
about her lim it at ions, t he fem ale nur sing w or ker w ho
lives w it h t he WMSD approaches her finit eness, w here
she’ll be able t o liv e eit her aut hent ically, opening up
t o herself, or inaut hent ically, in funct ion of t he fear of
get t in g con f r on t ed w it h h er self an d w it h h er bein
g-t ow ar ds- g-t h e- en d( 1 4 ).
Mor eov er, t he w or sening of t he disease gives
r ise t o t he feeling t hat she could nev er pr act ice her
pr ofession again, w hich cr eat ed an enor m ous feeling
of incapacit y. I n t his phase of t he disease, t he anguish
t his w or ker exper ienced w as so int ense t hat it exer t ed
a decisiv e in flu en ce on h er t r eat m en t , in w h ich sh e
ack n ow ledged t h e n eed t o inv est in psy ch ot h er ap y,
as r ev ealed by t he follow ing st at em ent :
...at som e m om ent s, I t hought I could not even w or k
an y lon g er , an d t h en I st ar t ed an in t en se p sy ch ot h er ap y
t r eat m ent ... I r eally needed t hat ( cr ying, silence) ( Mar ília) .
I t is w h en ack n ow led g in g t h e p ossib ilit y of
deat h t hat t he hum an being finds his aut hent icit y, as
d e a t h i s a n u n c o n d i t i o n a l a n d i n s u r m o u n t a b l e
possibilit y. Therefore, for t he aut hor, anguish is a kind
of ont ological nausea t hat inv ades t he hum an being
w hen he is close t o under st anding t he uncer t aint y of
his ex ist ence( 14).
I n t h i s a sp e ct , w h e n co n f r o n t e d w i t h h e r
r ealit y in v iew of her finit eness, t he w om an decides
t o f ace h er n ew lif e sit u at ion . At t h is m om en t , sh e
st ar t s t o live in her aut hent icit y.
The t r anscendence of t he nur sing w or k er liv ing w it h
t he WMSD
I n experiencing t he difficult ies inherent in t he
p r o ce ss o f ca t ch i n g t h e W MSD , t h e w o m a n l i v e d
feelings of loss, r ev olt , sadness. How ever, w hen she
ack n ow led g ed h er d isease an d h er n ew con d it ion s,
she em br aced new obj ect ives, gr ant ing a new m eaning
t o her ex ist ence.
...t hen I w ent back t her e and I did w ell, like, I r eally
m anaged t o do very w ell...like, t oday I m anage, not for t hem , for
m yself I m anaged t o achieve, ar r ive w her e I w ant ed...in t his one
year she saw m y w or k, you know , she has com plim ent ed m e...
( Marília)
Her t est i m o n y ev i d en ces t h at , i n h er n ew
sit u at ion , sh e h as g on e b ack t o w or k an d b eliev es
t h a t sh e h a s b e e n su cce ssf u l , b e ca u se h e r b o ss
com plim en t s h er an d, in fact , sh e est ablish ed som e
goals for her self, w hich she r eached, allow ing her t o
t r an scen d h er disease an d feelin g accom plish ed.
Th er ef or e, t r an scen d en ce occu r s w h en t h e
w o r k e r a c k n o w l e d g e s h e r a c t u a l s i t u a t i o n , a n d
n ev er t h eless set s goals an d f in ds a m ean in g in h er
ex ist en ce.
I n t his aspect , t he phenom enologist descr ibes
t hat it is only t hr ough t he opening of t he pr e- sence
t hat t he m ost or iginal phenom enon of t r ut h is r eached,
and t hat t he pr e- sence exist s in t he t r ut h( 14).
The cour se t he nur sing w or ker follow ed m ade
h er p er ceiv e h er ow n p ar t icip at ion in t h e r ecov er y
pr ocess because, w hile she r equest s suppor t at fir st
and shar es her com plaint s, expect ing a lot fr om ot her
p eop le, ov er t im e, sh e st ar t s t o act in d ef en se of
her self, inv est ing in her t r eat m ent s and self- car e:
...I t ook t im e t o perceive, if you’re sick, you’re going t o
handle it , you’r e going t o apply a com pr ess... ( Mar ília)
Ma r íl i a ’ s d i sco u r se d e m o n st r a t e s t h a t , i n
t r a n sce n d i n g t h e d i se a se , sh e a ck n o w l e d g e s t h e
sym pt om s and get s t o know w ays t o r elieve her pains,
allow ing her t o est ablish self- car e m eans, inst ead of
w ait ing for solut ions fr om ot her people.
I n c r e a t i n g a w a r e n e s s o f h e r s e l f , h e r
lim it at ion s an d f r ag ilit y, t h e on t olog ical- ex ist en t ial
condit ion r em ains of t he possibilit y of being fr ee for
t he act ually ex ist ent ial possibilit ies( 14).
Thus, her experience of living w it h t he WMSD
allow ed for t h e possibilit y of bein g- h er self, w it h h er
lim it at ion s an d com m it m en t s, f acin g h er t r u t h an d
h ist or y, ack n ow led g in g h er f r ag ilit y as w ell as h er
possibilit ies in t he w or ld.
FI NAL CONSI DERATI ONS
I n under st anding t he phenom enon of
being-a- f em ale- n u r sin g w or k er liv in g w it h De Qu er v ain ’s
d i s e a s e , w e c o u l d u n d e r s t a n d t h a t , i n g e t t i n g
co n f r o n t ed w i t h t h e d i sea se p r o cess, t h i s w o m a n
ex per iences a m ult iplicit y of feelings.
Th e w o r k e r r e v e a l e d t h a t l i v i n g w i t h t h e
insert s her int o a daily realit y t hat is charact erized by
pain and m any lim it at ions, w hich causes physical and
m ent al suffering. The fact t hat she is oft en obliged t o
t ake leave fr om w or k ar ouses t he feeling of incapacit y
and unpr oduct ivit y in t his w om an, as it is t hr ough w or k
t hat she becom es a relat ion, exer cises her know ledge
an d feels v alu ed.
She has experienced t he solicit ude of a healt h
pr ofessional w ho, as her discour se ev idenced, seem s
t o hav e been r esponsible for w ar ning her about her
r eal sit u at ion . How ev er, u n f or t u n at ely, t h e n eg lect
st an ds ou t w h ich sh e m en t ion ed abou t occu pat ion al
h ealt h pr of ession als as w ell as h er ow n colleagu es,
groups t hat are so close t o daily life and, at a fragile
m o m e n t , r e v e a l e d s u c h a n i m p e r s o n a l a t t i t u d e
t ow ar ds h er su ffer in g.
An g u ish is p ar t of t h e f eelin g s t h e n u r sin g
w or k er in t his st udy ex per ienced, especially because
she perceived herself in a new life cont ext , being aware
of her fragilit y as a being in t he world. However, despit e
ex per ien cin g all of t h e dif f icu lt ies der iv in g f r om t h e
ph y siopat h ological pr ocess, it w as ev iden ced in h er
d i sco u r se t h a t t h i s w o m a n f a ced t h e n ew r ea l i t y,
discov er ed her r ole as a car egiv er for her self, t o t he
ext ent t hat she accept s herself wit h t he disease, get s
back t o work, re- elaborat ing her funct ions, t ranscending
t he disease, finding herself in t he new life cont ext and
at t ribut ing a real m eaning t o her exist ence.
REFERENCES
1. Gur gueira GP, Alexandr e NM, Cor r ea HR Filho. Pr evalência d e si n t o m a s m ú scu l o - e sq u e l é t i co s e m t r a b a l h a d o r a s d e en f er m agem . Rev Lat in o am En f er m agem 2 0 0 5 ; 1 1 ( 5 ) : 6 0 8 -1 3 .
2 . Ro y a s AD V, Ma r zi a l e MHP. A si t u a çã o d e t r a b a l h o d o pessoal de enfer m agem no cont ext o de um hospit al ar gent ino: u m e s t u d o s o b a ó t i c a d a e r g o n o m i a . Re v La t i n o - a m En f er m ag em 2 0 0 1 ; 9 ( 1 ) : 1 0 2 - 8 .
3 . San t os SR, Rod r ig u es J Filh o. En f er m ag em : f at or es d e sat isf ação. Rev Br as En f er m ag em 1 9 9 5 ; 4 8 ( 3 ) : 2 4 2 - 5 0 . 4 . Lau t er t L. O desgast e pr of ission al: est u do em pír ico com e n f e r m e i r a s q u e t r a b a l h a m e m h o s p i t a i s . Re v Ga ú c h En f er m ag em 1 9 9 7 ; 1 8 ( 2 ) : 1 3 3 - 4 4 .
5. Beck CL, Budó MD, Gonzales RMB. A qualidade de vida na con cep ção d e p r of essor as d e en f er m ag em - elem en t os p ar a r ef lex ão. Rev Esc En f er m ag em USP 1 9 9 9 ; 3 3 : 3 4 8 - 5 4 . 6 . Gom es KRO. Mor bidade r ef er ida por m u lh er es em idade fér t il, uso dos ser viços e qualidade da assist ência: est udo da r eg i ão su l d o m u n i cíp i o d e São Pau l o. [ Tese] São Pau l o : Fa c u l d a d e d e S a ú d e Pu b l i c a d a U n i v e r s i d a d e d e S ã o Pa u l o ; 1 9 9 8 .
7. Minist ér io da Saúde ( BR) . Secr et ar ia de Polít icas de Saúde. Depar t am en t o de Ações Pr ogr am át icas e Est r at égicas. Ár ea Té cn i ca d e Sa ú d e d o Tr a b a l h a d o r. Le sõ e s p o r Esf o r ço s Repet it iv os ( LER) e Dist úr bios Ost eom uscular es Relacionados a o Tr a b a l h o ( D ORT) . Br a síl i a ( D F) : MS; 2 0 0 1 . ( Sé r i e A. Nor m as e Man u ais Técn icos, 1 0 3 ) .
8 . Mi n i s t é r i o d a s a ú d e ( B R) . D o e n ç a s r e l a c i o n a d a s a o t r abalho: m anual de pr ocedim ent os par a os ser viços de saúde B r a s íl i a ( D F) : MS ; 2 0 0 1 . ( S é r i e A . N o r m a s e Ma n u a i s Técn i co s, 1 1 4 ) .
9 . Ol i v e i r a RMR A a b o r d a g e m d a s l e s õ e s p o r e s f o r ç o s r e p e t i t i v o s/ D i st ú r b i o s o st e o m u scu l a r e s r e l a ci o n a d o s a o t r abalh o - LER/ DORT n o cen t r o de r ef er ên cia em saú de do t r abalhador do Espír it o Sant o. [ Disser t ação] . Rio de Janeir o: Escola Nacion al d e Saú d e Pú b lica; 2 0 0 1 .
1 0 . S a n t o s S B , B a r r e t o S M . A l g u m a s c o n s i d e r a ç õ e s m et odológicas sobr e os est u dos epidem iológicos das lesões p o r esf o r ço s r ep et i t i v o s ( LER) . Cad Saú d e Pú b l i ca 1 9 9 8 ; 1 4 ( 3 ) : 5 5 5 - 6 3 .
1 1 . Mer ig h i, MAB. Fen om en olog ia I n : Mer ig h i MAB, Pr aça N S. Ab o r d a g e n s t e ó r i co - m e t o d o l ó g i ca s q u a l i t a t i v a s : a vivência da m ulher no per íodo r epr odut ivo Rio de Janeir o ( RJ) : Gu an abar a Koogan ; 2 0 0 3 . p. 3 1 - 8 .
12. Rée J. Heidegger. Hist ór ia e ver dade em Ser e Tem po. São Pau l o ( SP) : UNESP; 2 0 0 0 .
1 3 . S i l v a A RB . Co n v i v e n d o c o m o c â n c e r g i n e c o l ó g i c o av ançado: em foco a m ulher e seus fam iliar es [ Dout or ado] . São Pau lo: Escola de En f er m agem da Un iv er sidade de São Pau l o; 2 0 0 2 .
14. Heidegger M. Ser e Tem po. 13. ed. Pet r ópolis ( RJ) : Vozes; 2 0 0 4 .
15. Josgr ilber g RS. O m ét odo fenom enológico e as Ciências Hum anas I n: Cast r o DSP Fenom enologia e análise do ex ist ir. São Paulo: Univer sidade Met odist a de São Paulo; 2000. p.44-6 8 .
