Everyday life in nursing work under the Michel de Certeau's perspectiveRates, Hosana FerreiraI Cavalcante, Ricardo BezerraI Santos, Regina Consolação dosI Alves, MariliaII
- IUniversidade Federal de São João Del Rei, Nursing Course. Divinópolis, Minas Gerais, Brazil.
- IIUniversidade Federal de Minas Gerais, School of Nursing. Belo Horizonte, Minas Gerais, Brazil.
to reflect on the everyday life in nursing work based on Michel de Certeau's theorization.
everyday life in nursing work is permeated by tactics of subjects who practice the place. Their movements escape standards, protocols and rules, re-signifying the cultural system defined beforehand. There is a practice proper to professionals who (re)invent the care based on their intentions and pressures. Patients/users also move, create their own itinerary and, similarly to professionals, use strategies to achieve specific results in the therapeutic process.
to think on the everyday life in nursing work as an object of research requires to consider the care (re)invention in every act in health care. We need to dive into the invisible dimension of the uncontrollable tactics of subjects that re-signify the social system.
Work, Nursing, Nursing Research, Nursing Care, Social Theory
In the nursing context, "everyday life" is often used in several research approaches, as a backdrop to reflections related to the work process, and not as an object of research(1-2). "Everyday life" in such studies is related to routine activities resulting from little theoretical reflection, associated with the daily life and usual activities of the profession(1). Endorsing these claims, the everyday life in nursing work has been approached as practical and common actions of the daily life, which are marked by languages and symbols, in addition to the development of activities directed to patient care(2).
Although nursing practice is widely researched, its everyday life needs to become a research object to enlighten the real care practices that effectively occur in work environments. Thus, care and everyday life merge based on actions that can be constantly (re)invented, besides protocols and standards, which depend on power relationships, as well as circumstances that pressure subjects involved in care. According to Certeau(3), everyday life comprises "circumstantial situations" that arouse in the subjects new ways of doing their jobs, ways to escape the logic of what is imposed. Such situations would be events that pressure individuals to the need of creating and adapting reality itself, which is formed by the dynamicity of life(3).
However, it is worth mentioning that the specificity of practices and their descriptions, as well as the appropriation of knowledge, have created the ways of "doing" in the health care area. To apprehend the "reality" of everyday life, in any spacetime it happens, we need to learn beyond what we already know. To be aware of everything that happens, that is believed, repeated, created and innovated. Based on Certeau's everyday life concept(3), we must understand that the practice of the individual in the nursing context, in any scenario it takes place, will demand the establishment of multiple networks of relationships between subjects, their values and prejudices, with which they build everyday spaces/times.
The search for understanding the everyday life in nursing work as an object of research and the movements silenced in may be supported by Certeau's theories(3), which highlights the everyday life as what is given to us each day, pressures us day after day, but not as a simple routine work scenario. It is the locus where power relationships are manifested and overlapped in practices that are materialized through tactics, trickeries of the practice that re-signify and stimulate the movements proper to every subject there circumscribed. Thus, the everyday life experienced is inherent to the health sector, and depends on movements and actions established in the relation between professionals, institution and users of these services. It is important to capture the everyday life, understand it, to enter in its invisibility and participate in what people have been living through. Therefore, we aimed to reflect on the everyday life in nursing work based on Michel de Certeau's theories.
"EVERYDAY LIFE" IN MICHEL DE CERTEAU: CONCEPTUAL BASES
According to Certeau(3), everyday life can be understood as something beyond a mere routine work scenario, representing a space of production and reproduction of social practices. It is a space where the dominated can seize the symbolic sphere constituted by the dominants, transforming and re-signifying it according to their needs and possibilities. The subject's triumph is in inventing everyday life, to give new meanings to validated and legitimized practices, regarding the norms established by the public administrators.
Certeau(3) also understands that everyday life is formed based on the changeable relationship between dominants and dominated: sometimes a subject, norm, social structure or system is the issuer of domination elements and can transmit them, sometimes this relationship is reversed. There is a culture established in the sphere between dominant and dominated, differing only by the possibility that one and other must transmit it. It is argued that the dominant culture belongs to those who own the means of control, production and dissemination, which shape spaces of power and create their own autonomous worldviews. On the other hand, the dominated culture belongs to those who do not have the means to employ their culture and make it official. However, the dominated can take the symbolic sphere constituted by the dominants and transform it(3).
In this sense, as the everyday life is constructed based on the dynamic relationships between dominants and dominated, subjects such as ordinary men (common hero) are valuated, those who can use trickery in these places to the benefit of their interests and use the occasions and naps of an watchful eye(4). Therefore, there is an invisibility in the everyday life that influences the practice of each subject and compositions established in interpersonal networks and with the system to be consumed.
In the construction of everyday life, Certeau(3) defines two types of subject's behaviors: the strategic and the tactical. The author constructs these terms based on observation of the military context and assigns them new meanings.
He describes institutions, in general, as "strategic", organized by an authority's postulate. A strategy can have the dominant order status or be sanctioned by the dominant forces and engages in systematizing, imposing order.
The strategy delimits a place that is an instant configuration of positions and implies a stability indication. Those that use strategies dominate time to conquer and prepare expansions, in order to have independence regarding the other, which dominate places based on observation and measurement to better control, predict and anticipate readings and space and, finally, that define the power through knowledge, due to the ability of transforming uncertainties into readable spaces(4-5).
On the other hand, the tactics constitute a calculated action and operate coup by coup, fact by fact. They take advantage of "occasions" and flaws that situations enable in power surveillance. A tactic infiltrates, does not try to dominate or win. Aware of its "weak" status, the tactic makes no attempt to confront the strategy, but tries to fill its needs by hiding behind an appearance of conformity. In the the difficulty in identifying the tactic is a significant part of its power(3).
In the space of tactics, Certeau(3) highlights "ordinary" subjects, who can, even if momentarily, divert from encounters with "the power", escape from a totalizing view, disciplinary framework, fixed and predetermined places. Hence, ordinary man (common hero) is the one that can with trickery and tactically use those places and frameworks in the benefit of other interests. When looking for living in the best possible way with anonymous trickery of the arts of practice, the ordinary man creates, (re)invents the everyday life based on his tactics(3).
The place as invention of the practice is the practiced place, in opposition to the place determined by the order. The street, airport, square or health service are transformed into space by people: pedestrians, travelers, patients, health professionals who circulate and give life to these places. It is the actions of the subjects that define the spaces; the places already exist, static, on inertia(3).
Thus, in place-space as invention of the tactics, the common hero creates inventive ways of escape and confrontation in each situation, breaking not only with the normative character of everyday social action, but also enhancing the power relationships that focus on social construction of life. At last, the tactic is the movement within the field of action of the other and in the space controlled by such; it takes advantage of the occasions and captures the possibilities offered in a moment.
The concept of tactic is used to explain how individuals, categorized as consumers by the dominant system, subvert "closed" products incessantly abounding in peripheral social spaces to influence and dominate them(4-5). Certeau exemplifies(3) that, in Colonial America, as the Portuguese domination did not reach the desired intent – although the natives showed that they were being completely dominated, in fact they subverted the imposed action, not rejecting them, but modifying them according to their practices, resisting to be dominated by power. They carried out "bricolages" with the products determined by settlers, according to their interests and rules. Bricolage is how the unsubmissive subjects flees the order, "escape" and then form a new knowledge, a new culture by synthesizing the several fragments of the culture imposed.
Thereafter, Certeau(3) deepens the user/consumer issue considering that they make bricolage with and in the dominant order using several metamorphoses of the law. The consumer establishes popular procedures (also "tiny" and daily) that play with discipline mechanisms and do not conform to it except to change them. In short, there are "ways of doing" that form the counterpart, the consumer side of the silent processes that organize the sociopolitical life. They weave in real action networks, whose tessitura is not a mere repetition of a pre-established social order, but takes place through social practices of those who insert creativity and plurality into the social structure, modifiers of rules and relations between the supposed power of structures and dominants and the lives that are supposedly submitted to it.
EVERYDAY LIFE IN NURSING WORK SUBJECTIVITIES, CREATIVITY AND (RE)INVENTION OF CARE
When health professionals are at work, in relation to the user, the care is defined based on encounters marked by their subjectivities and trajectories(6). Thus, there is a subjective health care production that makes subjectivity one of the dimensions of the means of production in health(6-7). Regarding the nursing context, such subjectivities are present and move the work, define the acts of care, nursing practices, as well as assumed or non-assumed self-care by patients/users(8-9). The construction of subjectivities in the nursing work is manifested through the perceptions and behaviors in health professionals' practices, related to their productivity, referring to the need of reinventing the everyday life, transforming the work environment to provide care to the individual(8-9).
We must consider the several circumstantial situations that also influence such subjectivities at health and nursing work. In this context, nursing professionals and users are recognized as subjects inside a health system in deficit with several issues (standards of management model, norms and routines of institutions, precarious and wrecked infrastructure)(9). Thus, the improvisation and the recreation of the nursing staff in their everyday life can be correlated as legitimate resignification of care, strengthening its importance and representing its freedom of action.
In the nursing worker's everyday life, there is a difference between the work practiced, which is prescribed by standardization, and the real work, re-signified by individuals in their work environment. What is practiced not always follows the prescribed and standardized; health care goes beyond standardization, it empowers and confers autonomy to the professional, even in the invisibility of their actions(8).
Regarding the nursing work, one expects the involvement of patients/families/communities as coparticipants of care, paying attention to the need of recognizing their tactics and their (re)inventions of their proper care. Users and workers in health services undertake "tactical actions", based on their suffering and disease confrontation, creating ways of inhabiting the system interconnected by health services and equipment. The ways of inhabiting refer to the confrontation style of situations within operating norms issued by the institutions(7).
Therefore, we perceive the everyday life in nursing work there is a logic given by the instrumentalized reason of the strategy; on the other hand, it operates the subjectivities that feed tactical actions. If the reason is easily organizable using protocols/guidelines, the care in act is given by the tactics, loaded of intentionalities, which celebrate the encounter between workers and users. This scenario is determined by several singularities, different subjects and marked by the complexity that produces the care. Thus, new practices and creativity proper to the workers are opened for agency among themselves, characterizing the creative work of these subjects(7).
Freedom is stated as expecting a creative work, being a propelling force of the wills of working individuals, being carried out based on the idea of care that each one has(7-8). Therefore, achievement of a state of freedom by worker depends on his action in "break away from market, moral and scientific signals as agencies of his subjectivity and, therefore, as lines of capture that act to shape his practice"(7). The reach of freedom presupposes new escapes and deviations, the re-signification of working, with a care conducted based on the relationship with the user, on the subjectivities of encounters in the health work. Thus, the intuitive knowledge, i.e., the knowledge that recognizes the affective body as a source of knowledge, may be an alternative care model(7).
Everyday life, according to Certeau(3), is operated by creativity, generating escape lines in the health area. Therefore, we can state that the creative work of the nursing professional is an uncontrollable reality of the everyday life. The nurse's action can significantly change care, with escape lines able to modify the therapeutic processes and to give new directions to care and defense of life.
The creative work, in this perspective, reorders spaces (place lived) by assigning new senses and meanings, which allows the subject to reappropriate and re-signify his/her everyday practices aiming at a cohesive practice with its way of acting, (re)inventing the care(7,9). Thus, (re)invention of care is a practice of each subject; the practices are based on a care that starts from the relational work, which values the sensitivity, peculiarity and the subjective production of care.
In our approach, care is not merely a practice of scientific nature, but it is the art of practice, a consequence of the creative work of every professional who reinvent himself/herself every day, based on circumstantial situations that pressure him/her. The context impels the subject to a care that exceeds the culture of books, which is validated and legitimized. To provide care, in this view, has to do with the creative life inside human beings, because it is part of the human nature to be interested in others and in their suffering, and to be interested in taking care of them.
The care provided by ordinary subjects does not happen exclusively through formal mechanisms, but also by their own methods, sometimes invisible for their conduction. We not only mention the care (re)invented by professionals, but also the care that patients experiment when deciding, choosing and creating their own manners of self-care, assuming a certain role in the health/disease/treatment(11). Self-care, the care assumed by the own patient, is the production of liberty practices, which aim to establish individuals as rulers of their own life, instead of living in constant processes that imply anti-personification. This implies to individuals to understand the relationships that construct and influence them. It is not the case of dividing and making themselves as a separated object that would require description and study, but to remain completely present and aware of their own capabilities(11). We perceive this issue especially when the use of creativity by the workers is identified in several circumstances of their professional work, for users also manifest their creativity and sensibility for self-care based on these aspects.
Therefore, the everyday life in nursing work is full of life, conflicted, and their voices are from ordinary men – those who shape an order proper to the place. Professionals and users, in this place, will construct their movements, conform their characteristics, (re)invent the everyday life, and (re)create the manners to operate the care production.
It is impossible to reduce everyday life in nursing work to an automatic protocol, to a hegemonic and instrumentalized knowledge of strategies. The cultural system, in such place, is consumed based on conception and desires of which every subject is impregnated. The conflict is set: on one hand, the norm that attempts to standardize and to provide a depersonalized service; on the other hand, subjects who seek to be heard, welcomed and helped. The way out for this conflict might be on the potentiation of the creative practice, (re)invention of everyday life of each subject. However, for that, the label of the "standard" cannot suppress the voices that echo in everyday life, their lives and uproars. The practice, in such everyday life, must not be condemned to the forbidden that violates the rule represented by the protocol, because this is the practice proper to the place, a care characteristic of subjects there inserted, and who practice it in a way to handle the complex reality. The care with creativity evokes, in this sense, the appreciation of knowledge, interaction, multiplicities, user's participation and accountability for the others in their difficult moments, becoming a space of relationships. The standard establishes the guideline, but it is not the absolute truth and relies on the know-how of creative individuals.
As limitations of our study we recognize that the conformist dynamic of the everyday life of nurse's work opens space for the need of new research on the everyday life of health services, in a broader sense. New places and spaces are to be revealed, as well as strategies and tactics in (re)invention of a complex and full of intentions everyday life.
Contributions to the nursing field
We highlight as contributions of our study the recognition of the practice proper to each subject, emphasizing the everyday life not only as a backdrop, but as an object of research to be considered. In addition, our study brings up the subjectivities that permeate the nursing work and that extrapolate the bureaucratic standard of health services. Thus, the everyday life in nursing work, as an object of research, gains the status of the new order of (re)invention of the care based on circumstantial situations.
When reflecting on the everyday life in nursing work, we perceive it as singular (re)inventions of care, in relation to the usual/non-routine, a practice loaded of knowledge proper to the subject. The work, in everyday life, intends to escape the circumstantial situations and power relationships of a previously established cultural system.
In this sense, the work is innovated to circumvent the problems of a health system, but also aims to create its own escapes in relation to it's a re-signification process of the cultural system. They are adaptations of the hegemonic health system articulated to provide care to the user with what is offered to them day after day. In this perspective, the standard reproduction created is rejected, and both health care system and model are re-signified in every practice intended and in every care promoted. At last, the everyday life of subjects, nursing professionals, anonymous heroes, little by little, occupies the center of the scientific scenes. Its invisible practices become phenomena of great interest and admiration.