ORIGINAL RESEARCH

 

Nurses' training and the (re)construction of their professional identity (1970s)

 

Sheila Saint-Clair da Silva TeodósioI; Maria Itayra Padilha II

I Federal University of Rio Grande do Norte, Natal, RN, Brazil. PhD in Nursing. Study Group on the History of Nursing and Health Knowledge (GEHCES-UFSC) E-mail: saintclairenf@gmail.com
II Federal University of Santa Catarina, Florianópolis, SC, Brazil. PhD in Nursing. Study Group on the History of Nursing and Health Knowledge (GEHCES-UFSC). Email: itayra.padilha@ufsc.br

DOI: http://dx.doi.org/10.12957/reuerj.2018.20054

 

 

ABSTRACT

Objective: to examine the contribution of nursing education to (re)constructing nurses' professional identity and its expression after their admission to the labor market. Method: this qualitative, socio-historical study was conducted between September 2013 and May 2014, using oral history in interviews of sixteen graduates and four professors of the Nursing and Obstetrics course at Rio Grande do Norte Federal University. Results: content analysis showed the importance of training in the construction of nurses' professional identity, but the nurses themselves also contributed to gaining recognition for the profession. It was recognized that, in this dialectic, socialization processes both influence the construction of subjects' identities and are restructured by them. Conclusion: evidence was found of the educational action of teachers, not only as mediators of learning, but also by their fostering social recognition and helping constitute the professional identity of these alumni.

Descriptors: Nursing; formation; identity; history of nursing. profession.

 

 

INTRODUCTION

In contemporary world, socialization is a continuous and dynamic process of building and rebuilding the subjects. In the course of their lives, they assume the sense of belonging to the family, to the school, to the community, among others, thus creating a social identity.

In this context, identity is conceived as the product of successive socializations, which occur throughout the developmental trajectory of the subjects and involve continuities and discontinuities. However, it can not be seen in a single dimension, nor as a mere transmission of values, norms and social norms, but it must also have access to the individual developing a representation of the world. It is in the internal understanding of the perceptive and operational, strategic and identitary representations of cognition and affectivity that lies the mystery of the operational construction of identities1,2.

Among the multiple dimensions of the identity of individuals, the professional dimension has gained particular importance. It is considered that professional training, by following all the changes of work and employment, intervenes in the identitary dynamics throughout long times, and beyond the school period1.

In university education, this contribution to the construction of professional identity becomes more evident because the university is a space of socialization in which theoretical and practical knowledge, methods, values and norms make an interrelationship with professional action. It is therefore considered that "training is essential in the construction of professional identity because it facilitates the incorporation of knowledge that simultaneously structures the relationship with work and professional career"3:51.

The Nursing literature has research works that points to a diversity of elements that contribute to the construction and development of the professional identity of nursing. Among them, the following stand out: studies on the image and self-image of the profession published by the press4; approaches on transformations in students'garments5.

However, with regard to the constitution of the professional identity of nurses, the literature emphasizes the importance of university education for this process. In a study about the analysis of the concept of professional identity of nurses, the contributions of training appear as a primordial antecedent, both in undergraduate and postgraduate courses6. In the same line, a research showed that of the 55 articles published in the Brazilian Journal of Nursing (Revista Brasileira de Enfermagem) from 1983 to 2012, 24 pointed to university education as an element of valorization of nursing, in a symbolic identification with status and authority of higher level of knowledge7.

Likewise, a study developed in 2008 with graduates from the University of the State of Rio de Janeiro - UERJ 8, and another carried out in 2014 with graduates of the Federal University of Rio Grande do Norte - UFRN confirmed training as an attribute in the consolidation of professional identity9,10.

Based on the understanding that the training process has a preponderant role in the construction of professional identities, this study aimed to analyze the contribution of the nursing training process to the (re)construction of the professional identity of nurses and its expression after entering the labor market.

The 1970s are the period of time analyzed in this study and this choice is justified by the fact that it was those years corresponded to creation of the two Undergraduate Courses in Nursing in Rio Grande do Norte: the Nursing and Obstetrics Course of the State University of Rio Grande do Norte - UERN in 1968, recognized in 1972, and the Nursing and Obstetrics Course of the UFRN in 1973. The memories of the graduates of the first class are the object of the present study.

 

THEORETICAL FRAMEWORK

This study was anchored in the sociological field as a basis for understanding the constitution of professional identity, with the theoretical conceptions of Claude Dubar1,3,11 and the contributions of Maurice Halbwachs12 on the dialectic between memory and identity as starting point.

The first step was the understanding that professional identity is not only an identity of work but also a perspective of what the individual wants for himself, as a projection of the future, the anticipation of a trajectory in the world of work during the training process. However, this non-linear identity is constructed, deconstructed and reconstructed throughout the professional trajectory, in the interactions and training experiences, as the product of successive socializations1.

In addition, the theoretical contributions of Claude Dubar 6 have been fundamental for the understanding about the dialectic between memory and identity. Memory is responsible for the strengthening of identity, both at the individual and collective levels6. They hold an indissoluble bond that explains the dialectic of memory and identity.

 

METHODOLOGY

Research of a qualitative nature with a socio-historical approach based on the philosophical bases of new history. This historical perspective promoted transformations in this field, offering other possibilities of historical studies, valuing qualitative analysis and the importance of individual experiences, as well as stimulated the use of oral sources 13-15.

The context of the study was the Nursing and Obstetrics Course of the UFRN, and the participants were graduates and teachers of the first class of this course. Data were collected through interviews conducted using the oral history technique, because this technique values oral testimonies obtained through the interaction between researcher and interviewee, actor/witness of facts relevant to the understanding of the object under study 12,14-17.

Sixteen graduates participated in the study, of which 15 were female and one was male. In addition, five teachers were mentioned by most of the interviewees as fundamental in the constitution of their identity. However, as one of these teachers lived abroad and, although numerous attempts were made to contact her, she was not located. Thus, only four teachers were interviewed. In the statements, the graduates were identified with the letter G, and the teachers with the letter T, both followed by numbers that corresponded to the order of the interviews. The interviews took place from September 2013 to May 2014. The inclusion criteria were: voluntary acceptance to participate and physical and psychological conditions to participate in the research.

The Thematic Content Analysis technique was used to analyze the data16 because this method includes the uniqueness and subjectivity of the participants that emerge in the course of the interview.

The study was guided by the principles of Resolution 466/2012 and submitted to the Ethics Committee on Research with Human Beings (CEPSH) of the Federal University of Santa Catarina, where it was appraised and approved under Opinion 388.018, of September 09, 2013. All participants signed the Informed Consent Form.

 

RESULTS AND DISCUSSION

Identitary configurations are closely related to the training logics and, therefore, are inseparable. Thus, the fact that nursing education has a preponderant role in the construction of identity of nurses can not be disregarded because such training develops a learning process that seeks to bring the subjects closer to learning the concrete reality of the profession, both from the ethical, technical, and social point of view 1.

The importance of training in the construction of professional identity is revealed by the graduates when some of them affirm that the course helped to deconstruct an initial image of the role of nurses and to (re)construct a new identity, as evidenced by the following speeches:

The course influenced the construction of my professional identity because I began to see the nurse differently, as a health professional who participated in a team that developed a work with some important characteristics (G1).

[...] my professional identity was drawn during the undergraduate course. The time of the course causes us to become impregnated with a new identity [...] during the course, the identity is constantly rebuilt. This identity that I carry with me until today, the way I see the profession, how I deal with the students, [...] brought from my training process (G10).

In the previous speeches it is observed that the training process made possible the resignification of the sense of being a nurse. This fact corroborates with the conception that the training process, when intervening in the educational situation of the subjects can influence the (re)construction of the identity processes, both in the individual and professional dimension.

A study about graduates and job satisfaction ratified these findings, stating that, through the curricular proposals, training helps consolidating the professional identity by contributing to the approximation with the world of work and sharpen the critical and reflexive sense of the students8. In line with this conception, a research carried out with 358 graduates from six professions of the health area concluded that "the reflection on training and interprofessional practice contributed to the evaluation of the path experienced and teamwork as a potentiator of the construction of the professional identity"18:12.

In the dialectic training and professional identity, the role of the teacher as a mediator of the educational process is fundamental because, beyond the teaching-learning process, the teacher enhances the acquisition of ethical values and citizenship13.

For the students/graduates, some teachers were recognized as fundamental and role models in the construction of professional identity. The teacher Raimunda Medeiros Germano was especially mentioned by all the graduates as excelling in her competence, dedication, and kidness in the act of teaching. In the area of public health, the teacher Mary Anne Small was distinguished by her knowledge and experience in primary care. In the clinical area, the graduates emphasized the performance of the teachers Nadir Soares Vila Nova and Francisca de Assis Teixeira Duarte. In the area of obstetrics, the teacher Normélia Maria Freire Diniz was recognized as a model with which some students identified.

The performance of these teachers as mediators of the teaching-learning relationship and in the relationships with each other was significant3 and not only promoted the mediation of the process of knowledge construction, but also social recognition, and contributed greatly to the constitution of the professional identity of these students. In this respect, the narratives that follow are very elucidative:

Teacher Raimunda, who until today is my reference as a dedicated and loving teacher, was my inspiration to start teaching. [...], our qualification was in Collective Health, so Mary Anne had experience in this area with a wonderful performance, we left prepared [...] to assume collective health (G3).

One teacher who caused an impression on me was Normelia, because she was competent and mastered everything in the maternity ward. She was the one who encouraged me to do the contest for a teaching position. Teacher Nadir of the surgical center use to teach very well. Raimunda Medeiros Germano was very kind (G8).

The contribution of teachers to the construction of the identity of the students is reflected in the actions of the graduates when they took on the nursing work process and in the choices in the field of work. This recognition of the graduates towards teachers was reciprocal, because when the teacher refer to the class this is very noticeable.

[...] we saw, in this first group, a group very interested in changing many things (T1).

[...] you would come and criticize what you did not agree with, so that we were convinced, [...] that we were training people who wanted to be nurses capable of transforming things, capable of becoming professionals in the area of health (T1).

All my students in the first class worked in surgeries knowing what they were doing. They knew what kind of pathology it was, they knew the surgery plans. [...] And I had a great satisfaction when I was part of the evaluating committees, when we were about to insert the new graduates of the first group in the Nursing Department as teachers (P2).

It can be seen in the discourses of the graduates and teachers that there was a commitment with training mediated by the educational action, clothed in a relationship with many meanings and senses, woven individually by each of these subjects and collectively by the feeling of belonging to the profession. Thus, it is reaffirmed that the construction of the identity of nurses occurs "in the relationship of being with oneself and with the other, in which the other says and reaffirms who the nurse is, serving as his mirror, and this has a double meaning" 19:53.

It is noteworthy that, because this was a new course in the UFRN and because of the lack of nurses in the region, the training of nurses in the 1970s was very challenging. However, to ensure the completion of the course, some foreign nurses working for the Hope Project were associated with the teachers hired by the UFRN.

The Health Opportunity for People Everywhere (HOPE) Project, launched in 1958, was started in Natal via the HOPE hospital ship in February 1972. Its objective was to share training and research programs as well as services to the population of developing countries. The ship spent 18 months in Natal, but some nurses remained as collaborators of the UFRN and contributed to the undergraduate nursing course20-22.

Although students who graduated from the first UFRN class did not have the opportunity to practice in the HOPE hospital ship, they emphatically mentioned the possibility of having foreign teachers in their training, and local teachers also considered it important to insert the American ones in the course, due to their experience.

Nurse Mary Anne from the HOPE project was very important to our training. She was developing a project of community organization [...] with preventive measures aimed at improving life. So, we explored Cidade Nova [...], house by house, doing the mapping of the needs and thanks to our work, a mini station was later built (G5).

The Americans were fundamental because Sheron was a person with a lot of competence in pediatrics, and Mary Anne had the competence of collective health. [...]. They were important, especially Mrs. Margarete [...] who worked in the administration with great competence and helped in the organization of the Department (T4).

The importance of the North American teachers to the training of the nurses in RN, since the organization of the course until its consolidation, was evident in the previous narratives. When the HOPE ship arrived in Natal in 1972 brought with it not only the purpose of contributing to the training of health professionals and to the health of the population, but above all, brought a new model of nursing based on American ideals. HOPE nurses had more freedom in their actions and were not dependent on physicians, as it was still the case seen in Brazil in the 1970s20-22.

Thus, the arrival of the HOPE ship in Natal was very important for the training of the first classes of the course, as well as for the creation of the professional identity of nursing in the state of RN, because the presence of experienced nurses from international contexts, working with competence on a high-tech teaching ship leveraged the prestige of nursing in the states where it docked20-22.

With regard to the insertion of graduates in the health/nursing work process, there were plenty of moments of anxiety and fulfillment of a dream to enter the professional life and to obtain financial autonomy, as it happens among many young people in this phase of transition from student to the labor market. However, the interviewed graduates stated that they were privileged due to great availability of jobs/works in both public and private sectors associated to low number of nurses in the region, according to the following reports.

[...] I think our class was privileged, we had no difficulties; those who did not stay at the university at that time did not do so because it wasn't their choice (G9).

When I finished, I went to Caicó by the Secretary of Health of the State. I identified myself a lot with this work. And, I was very respected (G14).

The narratives show that the graduates of the first nursing class of the UFRN found a fertile field to enter the labor market after graduation. This is in line with the reality of the 1970s, when nursing education experienced an expansion of courses and schools with the development of private medical care sectors, with the objective of compensate the low number of nursing professionals in the country and meet the demands of the nursing market, according to the demands of the capitalist model prevailing at the time.

The reports also showed that the students who graduated sought not only to associate job opportunities with their potentialities and aspirations, but were also moved by the identity built up during the training, which extended beyond the academic training process. Thus, the confrontation with the labor market becomes effective as a fundamental moment for the (re/de)construction of identity1,3,23.

Although it is recognized that the training process contributes to the construction of professional identity of nurses after graduation, this identity is not immutable and, therefore, it is (re/de)constructed in the course of the professional trajectory in the interactions and training experiences, by personal decisions, or driven by new forms of identity acquired as the product of successive socializations9.

Moreover, the identitary processes impose (de/re)constructions of the subjects which, on the one hand, feel compelled to face the new in everyday life and rewrite their life trajectory and identity, and on the other hand, also interfere in this process of historical reconstruction of themselves and others. This dialectic of construction and (re)construction of professional identity of nurses was something perceived by some of the graduates.

[...] we had to make a difference in the history of nursing in the state of RN, and show that we were the Ana Nery standard, and I tell you that we did it (G13) .

It is very good when we see that the training contributed to the construction of our identity [...] But, we really helped to write the history of nursing in Rio Grande Norte, we used to participate and we were attentive to the movements, wanting the growth and recognition of our profession. Many of us participated in entities [...] (G3)

The recognition of training in the constitution of the identity, as well as the need to value the profession through the actions of its professionals was evident in the speeches. This is the portrait of the process of identitary (re)construction, which articulates training and work experienced in the institutions that organize the processes of socialization and ensure the recognition of its members as professionals. "The value of the nursing profession, its responsibility, importance and credibility flow from the core of the profession based on the attributes of professional and peer members"24.

The importance of the process of training nurses stands out. This process takes place beyond the learning of scientific knowledge and acquisition of skills necessary for professional practice, in the construction of professional identity. It is also responsible for the appropriation of relevant ethical and political norms and values, and for socialization processes made feasible in classrooms or in practical scenarios where students recognize themselves as future nurses and are recognized as future professionals9,10,13.

 

CONCLUSION

The study focused on the analysis of the contribution of the training process to the (re)construction of the professional identity of nurses based on the memory of graduates. The theoretical reference of the field of sociology about professional identity, in the light of the relational perspective of Claude Dubar, associated with the understanding of the social context of the training process were fundamental to achieve the objectives.

Therefore, it is proposed that the bodies responsible for training nurses promote debates on the construction of professional identity, since it is in the formative process that the identification of students with the profession and the (re/de)construction of the way of being a nurse originates, accompanying them beyond the world of work. Furthermore, it is hoped that this study stimulates other similar researches that may contribute to the process of construction of professional identity of nurses.

The study had as a limitation the fact of enrolling only graduates of the first class of the course. It is expected that similar studies be carried out to address these shortcomings.

 

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