RESEARCH ARTICLES

Nurse professors’ perception of the environment in the care of human being

Diéssica Roggia Piexak^I; Dirce Stein Backes^II; Marli Terezinha Stein Backes^III; Silvana Sidney Costa Santos^IV; Daiane Porto Gautério^V; Jamila Geri Tomaschewski Barlem^VI

ABSTRACT: The objective was to identify nurse professor’ perception of the environment in the care of human beings. This is a qualitative research, carried out with seven nurse professors from a Undergraduate Program in Nursing of private higher education institution, located in central State of Rio Grande do Sul, Brazil. Data were collected in October 2011, through focus group. Discursive text analysis was used. Results: the professors recognize the importance of the environment as well as the relationships established in it for the care of human beings. For them, it is vital to consider human beings as inserted in their personal environment and in their environment as a whole, and understand that both have influence over their health/disease process. In conclusion, nurses should consider the environment as something that fosters care and supports life.

Keywords: Nurse professor; nursing care; research in nursing; environment.

INTRODUCTION

Nursing as a science in construction1 needs to search for knowledge, not isolated and disconnected from all, but from the complex relationships with the environment to which it belongs. The nurse needs to recognize the human being and the environment in an extended and complementary way, since all knowledge is only relevant when contextualized with the object².

The complexity is at the core of the thought of Edgar Morin. However, the term complexity, as definition, appears in his work only from the end of 1960, derived from cybernetics, systems theory and the concept of self-organization³. The author argues the non-fragmentation of the world and science. Thus, the complexity has the task of linking everything that is disjoint, focuses on the construction of a multidimensional knowledge that values the complex thinking of relink to the detriment of the simplistic and reductionist thinking. It is a thought able to consider internal and external influences.

It started from the assumption that a more appropriate knowledge on how the environment is perceived in the care to human beings by the professor of nursing, may contribute to rethink the future nurses training and continuing education for professors, improving training and, consequently, the development of skilled nursing care and consistent with the needs of the population.

From these reflections, the guiding question was: how do teachers perceive the environment in nursing care to human beings? Thus, the objective was: to identify the perception of professors of nursing about the environment on the human being.

LITERATURE REVIEW

The nurses have concerns with environmental issues since Florence Nightingale, which was the first nurse to identify the role and influence of the environment on human health. Nightingale emphasized that the issues of the environment interfere directly about the vital power of human beings, whether concerning the external environment – context in which human beings live, or for the internal environment related to organic function⁴.

However, it seems that these conceptions of environment are not yet perceived as complementary and interdependent nursing care development, since the environment is often understood as an element – part – of everyday life of the people and not as a space – all – which constitutes the human being, the family and the community⁵.

In this sense, the nursing care needs to find new ways of being and relating to the complex reality. To do this, the nurse must understand the relationships, interactions and associations established between human beings and the environment.

It is important to emphasize that the environment can be one of the most important determinants of health⁶, which highlights the need for the professors in nursing, as well as the nurses, assistance in understanding and bring together the issues related to environment in nursing care, justifying this study.

METHODOLOGY

This is a qualitative and descriptive research, held in a higher education private institution (HEI), located in the central region of the State of Rio Grande do Sul, Brazil. Seven professor nurses of undergraduate program in nursing participants in the study, which were selected by lot, through the institutional registration number and then made the formal invitation for all selected, who replied affirmatively.

For data collection, held in the month of October 2011, the focal group technique was used, with the aim of encouraging moments of reflection and discussion. The lead researcher acted as Coordinator (moderator) and a nurse as an observer. The speeches of the participants were recorded on digital Sony IC Recorder and transcribed with the greatest possible trust. The notes taken in writing by the observer during the realisation of the groups were also analyzed. Three meetings were developed with the focal group with a maximum time of 1 hour and 30 minutes in each one.

For the treatment of the data discursive textual analysis was used⁷, organized around the focus: disassembly of the texts or unitarization; establishment of relations – categorization process; taking the new emerging; a self-organized process. The discursive textual analysis is characterized as a cycle composed of the focus described, showed as a movement that allows the emergence of new understandings based on self-organization metaphorically called as light storm, since emerging from the chaotic and cluttered mean, become fleeting flashes of light rays, illuminating the phenomena investigated, allowing through an intense communication effort, expressing new understandings along the analysis. This kind of analysis presents an approximation with the complexity. From the discursive textual analysis, two categories emerged: the care environment: the entire space and the Environment and nursing care: dimensions of a complex field.

Ethical considerations were followed as the Resolution nº 196/96 of the National Council of Health⁸. The participants were informed about the purpose of the research, form of participation and invited to sign an informed consent. The project was approved by the Ethic Committee in Research in the health area of the Federal University of Rio Grande (CEPAS/FURG), by Opinion 173/2011. provided to the participants the anonymity, identifying them by the initial letter of the word Professor followed by a digit: (P1), and so on.

RESULTS AND DISCUSSION

The environment of care: the whole space

This environment involves multiple dimensions of care and covers a set of elements integrating it⁹. In this sense, it is necessary to recognize the whole involving the parts, as well as the parts that involve the whole, as the systemic or organizational principle of complexity, linking the knowledge of the parts to the knowledge of the whole². This all is a complex unit and cannot be reduced to the sum of the elements that constitute the parts; in fact, the sum of the parts is greater than and less than the whole, because each part presents its particularity and in touch with each other, change the parts and also the whole¹⁰. It is emphasized that the knowledge of the whole depends on the knowledge of the parts, as the part depends on the knowledge of the whole, in a dialogical relationship and complementarity^2.10.

Professors of nursing recognize the care environment as a whole and the relations established in this environment that pervade the actions and interrelationships of nurses with the other human beings:

 [The nurses] have to act also in this environment in the family [...] nursing has to have that understanding.(P1)

The care starts when I understand the other and understand their needs in various contexts [...].(P5)

In addition, the care is a moment of encounter between my world and the world of this subject [...]. (P4)

Thus, the professors showed that care involves the encounter between the subject, between the caregiver and the cared, and that we must realize and pay attention when is taking care of the cared, his needs and his environment, in the various spaces and contexts of practice of nursing.

The environment of care requires that developed favorable conditions to health, in order to promote a healthy, constructive environment and with healthy interpersonal relationships¹¹. Thus, the environment of care need to involve an interactive, associative and favourable ethical process, in different social, institutional and environmental spaces⁹.

Essential nursing activities are related to promotion of dynamic relations of patients, interacting within the environments. In this study, it is defined as the space environment, conditions, circumstances, factors or variables that affect the individual, the family and the social context. These conditions may include physical factors such as climatic effects on citizens of a community and other non-physical influences, such as economic and political forces, which are also considered environmental aspects of influence¹².

In this understanding, it can be highlighted that some theoretical nursing has included the concept of interaction or relationship with the environment. However, these concepts related to nursing theories present a linear model and anthropocentric, in which the environment affects the customer. The relationship and interaction of humans with the environment, are not usually referred to within the nursing theories¹². This may be explained by the fact that the nursing theories have emerged in late 1970, time that it had a different understanding of the environment, which was usually designated as environment, seen as a way to use to serve human beings, from the anthropocentric vision.

The professors nurses of this study realize that the environment can affect the human being, recognizing also the interactions established of that human being with the environment. However, it seems this professors are lack of a greater understanding about the influences that human beings have on the environment, affecting him in a negative way and destroying him, generating an environment undergoing degradation.

Environment and nursing care: dimensions of a complex field

Nursing professors understand that it is vital to show the human being articulated to the environment, seeking to contextualize it, because they understand that the environment influences on health/disease of human beings, which shows indissociable in this relationship:

 [...]the issue of the environment, to connect the patient and the environment [...] many times, I realize that it doesn't help realize just the patient, because the problems also come from that environment.(P1)

Health and disease are environmental phenomenon in relations with nature, through a demonstration of creativity, activity, diversity and interrelation of all beings, which are opposite to the Cartesian concept, which perceives nature as inert, passive and fragmented, i.e. separated from the human being and ready to be explored¹³.

The nurses teachers understand that for care they need show the parts and the whole that pervade the human being and the environment, seeking to develop a nursing care according to their needs and their environment, in addition to encompass the dimensions of a complex field:

 [...] If you can see the socioeconomic condition [...] what are these parts, you will be able to see better the individual and that is also part of our care, considering these determinants of health. (P2)

[...] I can't take care of a patient who lives in a better economic context in the same way the other who lives in the slum, that's what we have to start thinking.(P3)

The term complex is the union between unity and multiplicity, of what was woven together, i.e. when different elements are inseparable and integral part of the whole, and there is an interdependent woven, between the knowledge object and its context, the parts and the whole, and vice-versa¹⁴.

The nurse realizing the human being as singular and searching to contextualize him into his environment, extends their knowledge, providing a unique and multidimensional care. Thus, the relevant knowledge is able to locate any information in its context and, if possible, in the set in which is entered. It can be said that knowledge progresses by ability to contextualize and to encompass².

The environment is integrated by processes, physical and social order, permeated by different problems such as environmental degradation, loss of biological and cultural diversity, poverty associated with the destruction of peoples´ resources and their identities and the deteriorating quality of life. In this sense, the environment is kind of surrounding species and biological populations and also translates into a sociological category related to a rationality that is configured for behaviors, values, knowledge and new productive potential¹⁵.

One of the participants in the study emphasized that:

 [...] for a while, the environmental demands were not a concern so pressing in our doing, today, we're already getting it as a necessity.(P7)

In this perspective, it is displayed that the nurse is transformed from the needs of the environment in which the human being is inserted. This, besides searching for knowledge related to environmental issues, it seeks to develop actions that contribute to communities, empowering the nursing care. That is because nursing care cannot be reduced to a one pointed action, but as something that is broad and engaging, considering the environment as an essential element for care.

The nurses recognizing this expanded and circular environment, may act in matters involving environmental health. It is emphasized, in this regard, that the enlarged nursing performance in environmental health is proactive (primary prevention) and re-enables/interventionist (after existence of the problem), seeking to involve the community in the definitions of environmental issues and contributing to an increase in awareness about environmental risks⁶.

The role of the nurse in environmental health includes seven strategies: evaluate and detect risks when exist; provide information to individuals about the effects of toxins on environmental health and global risks; report serious environmental threats to appropriate agencies; develop and implement wellness programs in schools and the workplace; assist in the formulation of public policies involving the environment; help prevent excessive exposure related to human health. It becomes essential when working with these strategies, to involve the residents of the community, specialists (environmental sanitarians) and politicians⁶.

Although this performance of nursing in environmental health, which includes the relationship with the environment, come to evolve, in practice this action is still partial. It is highlighted that nurses can focus on such performance in the creation of an ecological conscience, a change of attitude and behavior of the clients^6.16.17. What may be good for human beings, to the profession and to the Earth, that is, for environmental sustainability and for life¹².

CONCLUSION

In this research it was possible to identify the perception of professors of nursing about the environment on the human beings. It was evidenced that they recognize the care environment and the relationships established in this environment as a whole and that it is essential to understand and visualize the human beings articulated to their environment, because they understand that the environment influences on health/disease of human beings.

This research presents the limitations of a qualitative research, which is not generalizations. As contributions to nursing, nurses are expected to (re)consider their conceptions of environment and, consequently, their actions/strategies for the promotion of environmental health, developing a nursing care in line with the needs of human beings and the environment in which they are inserted (the caregivers and the cared).

The environment cannot be conceived as something separate or isolated that has nothing to do with the role of the nurse in front of the care of the human beings, but as something that provides and promotes the care and supports life. However, when the environment is not favorable, it can also harm the life and lead to illness and death.

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