ABSTRACT

Objective:

to analyze the processes of meaning production, based on the speeches of nursing professionals, about how they feel about the titles of “angels and heroes” given by society during the pandemic of COVID-19.

Methods:

a qualitative, documentary research. Data was collected in October and November 2020 and analyzed from the perspective of the Discourse Analysis proposed by Michel Foucault.

Results:

they were organized into two thematic categories: “Angels and heroes? The (not) heroic reality of nursing during the pandemic” and “The search for recognition of the professional work of nursing: between what is said and what is not said”.

Final considerations:

the nurses’ speeches enunciate the search for decent conditions for the execution of care, fair wages, and recognition of the professional work by society.

Descriptors:
Nursing; Nurse Practitioners; Speech; Pandemics; Coronavirus

RESUMEN

Objetivo:

analizar los procesos de producción de sentidos, con base en los discursos de los profesionales de enfermería, acerca de cómo se sienten en relación a los títulos de “ángeles y héroes” dados por la sociedad durante la pandemia de COVID-19.

Métodos:

investigación cualitativa, del tipo documental. Los datos fueron recolectados en octubre y noviembre de 2020 y analizados en la perspectiva del Análisis del Discurso propuesta por Michel Foucault.

Resultados:

fueron organizados en dos categorías temáticas: “Ángeles y héroes? La realidad (nada) heroica de la enfermería durante la pandemia” y “La búsqueda por el reconocimiento del trabajo profesional de la enfermería: entre lo dicho y lo no dicho”.

Consideraciones finales:

los discursos de la enfermería enuncian la búsqueda por condiciones dignas para ejecución del cuidado, salarios justos y reconocimiento del trabajo profesional por la sociedad.

Descriptores:
Enfermería; Enfermeras Practicantes; Discurso; Pandemias; Coronavirus

RESUMO

Objetivo:

analisar os processos de produção de sentidos, com base nos discursos dos profissionais de enfermagem, acerca de como se sentem em relação aos títulos de “anjos e heróis” dados pela sociedade durante a pandemia da COVID-19.

Métodos:

pesquisa qualitativa, do tipo documental. Os dados foram coletados em outubro e novembro de 2020 e analisados na perspectiva da Análise do Discurso proposta por Michel Foucault.

Resultados:

foram organizados em duas categorias temáticas: “Anjos e heróis? A realidade (nada) heroica da enfermagem durante a pandemia” e “A busca pelo reconhecimento do trabalho profissional da enfermagem: entre o dito e o não dito”.

Considerações finais:

os discursos da enfermagem enunciam a busca por condições dignas para execução do cuidado, salários justos e reconhecimento do trabalho profissional pela sociedade.

Descritores:
Enfermagem; Profissionais de Enfermagem; Discurso; Pandemias; Coronavírus

INTRODUCTION

Since mid-2018, from the publication Expanding the Role of Nurses in Primary Health Care, released by the Pan American Health Organization and World Health Organization (PAHO/WHO), Nursing has achieved greater visibility for being considered an essential profession in expanding access to health care, especially in health promotion and disease prevention⁽¹⁾. Meanwhile in 2019, the “Nursing Now” campaign was created, an initiative of WHO with the International Council of Nurses (ICN) that aims to recognize the contribution of nursing to the health challenges of the 21st century; and such support is given through investments in education and working conditions and the dissemination of successful practices⁽²⁾.

Still in this perspective, the year 2020 is the bicentennial of Florence Nightingale’s birth, pioneer and founder of modern nursing. Florence brought countless contributions to health care, especially regarding sanitation. Among the precepts he used in his practice were the isolation of the sick, the use of statistical methods of analysis and health planning, as well as the therapeutic representation of nutrition, hygiene, sanitation, hand washing and ventilation in the prevention of disease dissemination⁽³⁾.

Coincidentally, the year 2020 is also marked by the biggest global health crisis of our time. Infection with the new coronavirus, causing the disease COVID-19, was first detected in Wuhan, China, in December 2019⁽⁴⁾. In late January 2020, the World Health Organization (WHO) declared the outbreak of COVID-19 a Public Health Emergency of International Concern (PHEIC)⁽⁵⁾ and, in mid-March 2020, recognized it as a pandemic. Since then, it has rapidly spread across the planet and collapsed health systems even in developed countries⁽⁶⁾.

In Brazil, the confirmation of the first case of COVID-19 was registered on February 25, 2020 by the Brazilian Ministry of Health⁽⁷⁾. With its rapid advance throughout the national territory, the pandemic exposes the structural fragilities and bottlenecks of the UHS, highlighting the lack of health professionals and infrastructure in medium and high complexity care⁽⁸⁾.

In the midst of the pandemic scenario, nursing professionals became the focus of constant homage from the population due to their commitment to act in the front line of the fight against the coronavirus. There were countless types of manifestations, such as the famous “panelaços” (banging of pots and pans) and applauses that took place in the windows of houses and apartments, reported by the media as an incentive to those who, now, were seen as superheroes.

Nursing has used this moment of visibility to reinforce secular struggles, such as the regulation of the 30-hour work day and the salary floor. In addition, the appeals aim at valuing the work done by the professionals of the category, demanding adequate working conditions, personal protective equipment (PPE) in sufficient quality and quantity to provide safe care to patients, the awareness of the population about the protective measures for the virus, as well as the importance of social isolation⁽⁹⁾.

If, on the one hand, the pandemic served to unveil the importance of nursing in human care and for professionals to vibrate for feeling seen and recognized by society, on the other, a certain discomfort emerges due to the media stamp that has been attributed to the work done by the category in relation to the speeches of angels and heroes to designate nurses, technicians, and nursing assistants. The crossings that permeate these relationships also correspond to the meanings produced over decades about the (de)legitimization of the professional work of nursing in the face of collective ideology.

Thus, we chose to analyze the speeches of nursing from a Foucauldian perspective, considering that, for Foucault, the discourse is constituted by a historical plot that represents a place, a time, and the various relations produced⁽¹⁰⁾, allowing an analysis of what is said or silenced, who and why it is said or silenced, within the relationships between nursing and society.

In this context, the following questions emerge: How do nursing professionals feel about being titled angels and heroes by society during the pandemic? Do they recognize themselves as angels and heroes? What is enunciated, or not, in the speeches of these professionals during this period?

OBJECTIVE

To analyze the processes of meaning production, based on the speeches of nursing professionals, about how they feel about the titles of “angels and heroes” given by society during the pandemic of COVID-19.

METHODS

Ethical Aspects

This is a documental research that used public access documents. According to Resolution No. 510/2016, which deals with research in Human and Social Sciences, studies that use information in the public domain are exempt from submission to the REC/CONEP⁽¹¹⁾. However, to maintain the anonymity of the professionals who had their speeches included in this study, the findings are identified by the letter E for nursing, followed by an Arabic number referring to the order of data collection. It is noteworthy that the content of the text and videos was maintained in all its form.

Type of study

This is qualitative research, from a post-structuralist perspective, with a descriptive and exploratory design, of the documentary type, and follows the guidelines of the Equator Network’s SRQR instrument. The documental research, as a research method, allows the gathering of empirical evidence in primary sources, that is, documents that have not received scientific treatment⁽¹²⁾. As a technique, this type of research includes the reading, selection, classification, and archiving of topics of interest to the study at hand.

Collecting and organizing data

The data was collected between the months of October and November 2020. Initially, a free internet search was performed with the terms “angels and heroes AND nursing AND COVID-19”. Among the results of this search, the site of the Regional Council of Nursing of the State of Alagoas (COREN/AL) was intentionally selected, which reported the launch of a campaign entitled “Neither angels, nor heroes. We are professionals, we are NURSING”⁽¹³⁾.

The campaign invited nursing professionals to share videos about their routines during the pandemic, at work or at home, and these would be posted on the Council’s social networks. Then, three researchers viewed all the videos shared through the Instagram social network, on the COREN/AL page; selected those that met the objective of this study; and proceeded to transcribe.

Thus, the empirical material used as the corpus of analysis was composed of the web page on which the news about the campaign was published and 16 reports from professionals shared on COREN/AL’s Instagram.

Data analysis

The data was analyzed from the perspective of Discourse Analysis (DA) proposed by Michel Foucault. To analyze the speeches of nursing during the pandemic of COVID-19, the concepts of enunciation, discourse, discursive formation, discursive practice, and device were used as analytical tools.

The discourse does not represent only a meaning or a truth, but a history crossed by a subject, in a certain time and place, defining the conditions for the exercise of the enunciative function. Thus, we perceive an enunciated (said) discourse and another, hidden (unspoken), which contribute to the construction of the device⁽¹⁰⁾. Thus, the discursive practices correspond to what is said by the nursing professionals about how they feel when they are entitled angels and heroes, while the non-discursive practices represent what is not said by society when they are entitled this way.

To account for the subjectivity that permeates this analysis, the speeches were analyzed in relation to the context in which they were produced, the colors used, the nature of the vocabulary, the ideas mentioned and those that were implied, making it possible to know elements silenced by the participants of the campaign.

RESULTS

Based on data analysis, two discursive formations were elaborated: “Angels and heroes? The (not) heroic reality of nursing during the pandemic”; “The search for social recognition of nursing professional work: between what is said and what is not said”.

Angels and heroes? The (un)heroic reality of nursing during the pandemic

It was with the phrase “Neither angels, nor heroes. We are professionals, we are NURSING” that the Regional Council of Nursing of the State of Alagoas (COREN-AL) launched a campaign in allusion to the nursing month, inviting professionals to share with colleagues and society in general, through videos recorded by themselves, the changes in their daily lives, both personally and professionally, during the pandemic period. The purpose of the campaign was to give visibility to the routine of the profession to the population, showing that despite the adversities and privations that the period imposes, these professionals remain committed to their work.

Through the campaign proposal, it is possible to notice that COREN-AL assumes, through the speech of its representative, an antagonistic position to that of society in general, showing that, many times, professionals do not feel like angels or heroes, especially when they have unfavorable conditions for the execution of their work, such as the lack of PPEs, which are indispensable tools for a safe and quality assistance.

From the DA perspective, the COREN-AL, as a device, produces discursive arrangements and practices that print an appeal directed to society, so that these efforts are also used to claim decent working conditions, effectively contributing to the valorization of nursing in the various scenarios of action, an aspect that has been sought, tirelessly, since the origin of the profession.

The videos sent by professionals and shared on the social network Instagram, through the official page of COREN-AL, aim at the interaction between the profession and Brazilian society, perhaps worldwide, given the power of social media reach nowadays. It also reverberates the production of meaning in the collective, based on the statements produced by the nursing professionals themselves, i.e., by those who are experiencing the reality on the frontline of the pandemic, but do not feel like superheroes when they receive an unfair wage for the work they perform, given the difficulties reported.

Some professionals recorded in their working environments. Others preferred to record in the familiar surroundings of their homes. Still, there were those who made their recordings at COREN-AL’s headquarters. In common, the statements sustain the discourse about the changes that occurred in their routines as a result of the pandemic, whether at work, at home, or during their leisure time.

The feelings of fear and insecurity accompany the nursing work process in a pandemic situation and are related to the incorrect use of PPE, the deficiency in the supply of these products to workers or discomfort due to the physical barrier imposed between professionals and patients, hindering contact, touch, constituting other modes of care.

The speech of these professionals is loaded with meanings. On one side, the concern with work conditions and routines; and on the other, human beings who miss affectionate relationships, fear of contaminating their families and losing friends and coworkers due to the virus. An example of this is in the statement by a nurse who recorded her video in front of a panel called “Mural of Reasons”, with attached handwritten texts, clearly implying that these are the reasons why the professionals are working.

Notably, the discursive practices presented also reinforce the emotional aspects that permeate the daily work of nursing in times of pandemic, such as the concern about contaminating family members, co-workers, and the population in general. The forms of mobilization of nursing professionals produce effects of meaning in society through speeches that express the concern to protect everyone, reviewing behaviors and changing their routines beyond the workplace.

Still, the discursive regularity is perceived both in the positioning of COREN-AL and in the statements of the professionals, in relation to the dialogicity, between demanding better working conditions and demonstrating that the same fear felt by society also afflicts nursing professionals. And, therefore, there is nothing heroic and angelic in the feelings of fear and insecurity, nor in the inadequate working conditions, under which nursing has sometimes performed the care in the pandemic period.

The quest for social recognition of professional nursing work: between what is said and what is not said

In this discursive formation, the visible and said statements by nursing professionals about not feeling like angels and heroes are related, while at the same time presenting the subjective, hidden and unspoken by society when it calls them that way.

The news about the launching of the campaign was published on May 12, International Nurses Day and Nurses Day, resuming the speeches produced within the relations between nursing professionals, representative entities of the category and society over at least two centuries. This inter-relationship occurs when, even before explaining the campaign proposal, the bicentennial of Florence Nightingale’s birth is mentioned, recalling the historical trajectory of the revolution of care, attributed to her performance during the treatment of the wounded in the Crimean War.

At this moment, COREN-AL, as a political-educational device, reverberates a speech that rescues the identity of the profession, associating the importance of providing visibility to the work of nursing and to the precursor of the profession, especially in view of the COVID-19 pandemic and the contributions of professionals in caring for the sick and fighting the virus.

After the textual elements of the news, a six-second video is presented with the title of the campaign in two sentences “Neither angels, nor heroes. We are professionals, we are NURSING”, illustrating one of the possible ways of problematizing. The sequence of presentation of the sentence initially implies a speech of denial to the title of angels and heroes; and when the second sentence appears; another discursivity is enunciated with the use of the word “we are”, referring to the collective of nursing and the inclusion of the Council and professionals in the same space of struggle and claim. The use of the words “professionals” and “nursing” in the second sentence, associated with the presentation of the name of the profession in capital letters, enunciates the intentionality of social legitimization of the profession as a scientific discipline, as well as the recognition and appreciation of nursing professionals, scientifically trained and producers of knowledge and practices, and not as transcendental beings.

Complementarily, the colors used in the background of this video refer to the same “logos” standardized by the COREN-COFEN (Federal Council of Nursing) system, so that, based on this non-discursive formation and on the participation of the councilors in the video recordings, the COREN-AL assumes its position as a representative entity of nursing belonging to a federal autarchy, which deliberately acts to regulate and supervise the exercise of the profession.

In relation to the speeches produced by the professionals, aspects related to the idea of visibility of nursing as a scientific discipline and profession circulate, especially when they enunciate the changes in routines and professional practices, singularly related to the new scientific recommendations to avoid contamination in the work, family and social environment.

When considering the context of production of the statements, the various voices of nursing come together to support the discursive practice about “not feeling” and “not recognizing” themselves as angels and heroes. They seek to disassociate themselves from the image assigned to them by society, and there is a clamor to be recognized as nursing professionals.

Although hidden in the statements of the professionals who recorded in their workplaces, another nuance can be evidenced, whose idea is that, even in the face of the difficulties that permeate the daily work of nursing during the pandemic, it is necessary not to be silent, taking the opportunity to position themselves in any space, demonstrating to society that calling them angels and heroes may not contribute to the tireless struggles in search of social recognition of the professional work of nursing. However, if we add to what is said and not said by the nursing professionals, the never said by common sense, that is, when we call them angels and heroes, society stops calling them professionals.

DISCUSSION

When considering that Foucault proposed to look at the relations, organizations, and knowledge that surround the subject and the way they inevitably interfere with his presentation in the world, sometimes in one way, sometimes in another⁽¹⁰⁾, we have in the DA different possibilities to reflect on the discursive formation “Angels and heroes? The (not) heroic reality of nursing during the pandemic” and problematize the meanings produced by nursing during the pandemic of COVID-19.

The DA uses the conditions of production and thus makes use of the combination of social, historical and cultural circumstances that influence the production of a given speech. In this sense, it is known that all countries have faced, with greater or lesser impact, the numerous difficulties that arose with the discovery of the new coronavirus, whether in relation to the collapse of health systems, the disorderly and growing number of infections and deaths or the shortage of professionals to assist the sick⁽³⁾.

In Brazil, it has been no different. More than 2 million nursing professionals are present daily in health services⁽¹⁴⁾ and act directly or indirectly in the front line of the pandemic. According to data from COFEN, by the end of June 2021, health institutions reported more than 57,000 cases, between suspected and confirmed, and 817 deaths as a result of COVID-19, estimating a lethality rate of 2.57% of nursing⁽¹⁵⁾.

Health professionals all over the world, among them the nursing class, experience numerous difficulties in their daily work, such as lack of PPE, reduction in the number of professionals in the workplace, fear of getting infected or infecting their relatives, which, associated with stress and exhaustion, are elements that hinder the execution of a safe and quality care⁽¹⁶⁾.

The reality of Brazilian nursing has been no different, and several studies^(3,9,17-19) have shown increasingly challenging scenarios, permeated by low wages, inadequate structures, managerial problems and illnesses resulting from overload. If the working conditions were already inadequate before the pandemic, one can imagine what it has been like to work on the front line of the largest global health crisis of the 21st century, dichotomizing the idealization of heroic performance seen by society with the reality experienced by nurses in their daily work and presented in this study.

Moreover, the pandemic has demanded quick actions from health professionals, such as decision making for the reorganization of health services and adaptation to the norms recommended by the scientific community for the care of suspected or infected patients⁽¹⁸⁾. The professionals’ speeches bring these elements to debate, especially regarding the importance of the availability of PPE and precautionary measures to avoid contamination, in line with the prescriptions to wear goggles or face shield, a cap, a prop, a surgical mask, a N95 mask, a waterproof apron, procedure gloves, and thorough hand washing⁽²⁰⁾.

The challenges presented by nursing professionals are also related to the difficulty of incorporating into practice the various protocols created since the discovery of the virus, such as the use of PPE throughout the workday, which makes it difficult to touch the patient and manage the technologies. Moreover, these should have been available in health services long before the pandemic; as this did not occur, it was necessary the sudden appropriation of knowledge.

Considering the nature of the nursing work, these professionals have contact with several infectious agents during their practice, being primordial exposure mitigation actions, through the adequate use of PPE, hygiene routines in the workplace and the removal of those who are part of risk groups from care activities that involve infected by the new coronavirus.

The discursivities presented by COREN-AL and professionals are consonant in relation to the potential and relevance of the work provided by nursing during the pandemic. However, meaning productions emerge related to feelings of uncertainty about the effectiveness of the use of PPEs, missing family and friends, and concern about close people who are part of the risk groups. Therefore, the emotional aspects that involve the worker’s mental health also need to be considered by the health services, aiming at the incorporation of protection strategies in the daily work of these professionals⁽²¹⁾.

Thus, although nursing has been considered heroic, since the beginning of the pandemic, their speeches signal feelings of fear and insecurity, common to those of society. This ambivalence, heroes versus reality, has been problematized, since the high number of deaths of the teams, inadequate remuneration, and organizational weaknesses have negatively affected the working conditions of nursing in the pandemic context⁽¹⁹⁾.

From one point of view, the stereotypes attributed by society associate the work performed by nursing with transcendental figures characterized by kindness and charity; from another point of view, the banging of pots and pans and applause movements conveyed by the media also contribute, in a certain way, to the visibility of the category’s struggles. Thus, the moment seems to be appropriate to propose an articulation between professionals and the various sectors of civil society, aiming at mobilizations that combat the precariousness of the work in health⁽⁴⁾.

One can see that the speeches of nursing rekindle the debate about old challenges, especially in relation to the inadequate conditions for professional practice and the visibility of the profession before society. In this panorama, the discursive formation “The search for recognition of the professional work of nursing: between what is said and what is not said” is brought up for discussion.

Nursing carries all its historicity with pride, especially when it comes to Florence Nightingale, responsible for the recognition of nursing as a profession in the mid-nineteenth century, from the social division of labor and the idea of care being considered an object of study⁽²²⁾. The discursivities of nursing have been historically constructed and are loaded with meanings, considering that nursing seeks to be recognized by society as a scientific discipline⁽²²⁾ and for the work it performs, which is regulated by the Law of Professional Exercise No. 7,498⁽²³⁾.

When professionals are called angels and heroes, the unspoken by society emerges, that is, the implicit that relates the nursing work to the transcendent, as if the care provided by professionals was only of a humanitarian and charitable nature, regardless of who performs it and under what conditions, since angels and heroes are able to endure any adversity to “save” those under their protection. It was in this sense that the manifestations against this “deification” have taken strength.

Thus, problematizing the speeches produced within the relationships between nursing and society, we present some meanings for the words “hero” and “angel”. In the dictionary, “hero” can mean demigod; idol for whom one has great admiration; or courageous individual who is able to endure adversity without getting down⁽²⁴⁾. Regarding the word “angel”, it can mean a spiritual being who is the interlocutor between divinity and men; one who has the function of protecting the human being; or an individual with characteristics of extreme kindness⁽²⁵⁾.

Considering the meanings presented and correlating them with the meanings produced by the professionals who participated in the campaign, it is possible to see that society’s perception of the work of nursing has been, throughout the history of the profession, linked to kindness and charity⁽²⁶⁾. The pandemic brought about this movement in a more impactful way, reinforcing these ideas and promoting discussions about the collective imaginary about nursing professionals as angels and heroes.

The stereotypes projected by the media seem to go against the movements led by representative and professional entities in search of legitimization by society of professional nursing work, such as the campaign launched by COREN-AL. In this way, truths that constitute them as subjects emerge, and the media starts to act as a device⁽¹⁰⁾ pedagogical in relation to the new discourse that nursing intends to insert in the (un)conscious of society, that is, to be recognized as subjects with rights and duties, responsible and prepared to perform their functions based on scientific evidence.

The discursive representations show that the professionals emphatically repeat the phrase of the campaign as a way to present the profession and the professional work of nursing to the common sense, reinforcing that it was necessary to adapt the routines of the teams to the new scientific evidence. In this way, they demonstrate that the care provided by them is permeated by scientificity, acquiring characteristics of professional work⁽²²⁾.

The speeches denying the title of angels and heroes can be understood as invitations to unite and articulate the category with the various sectors of civil society in search of mobilizations that combat the precariousness of health work not only during the pandemic⁽³⁾. For this, the eyes of society and managers need to be directed to the nursing workforce, providing work means, both structural and managerial, that enable a more resolute and less stressful assistance⁽¹⁷⁾. Thus, the speeches of nurses reverberate the struggle for the recognition of professional work, by means of regulations such as a workload limit for the execution of the workday and the national wage floor.

Study limitations

A limitation refers to the choice of media that composed the empirical materials, which allow the analysis of the speeches of nursing professionals and the positioning of the representative entity of a region. These subjects, although they enunciate the sayings of a collectivity, may not portray the positioning of the other representative entities of nursing distributed throughout the country, as well as the speeches of all professionals in the category.

Contributions to the field of Nursing

This study contributes to highlighting the difficulties present in the nursing routine, which may also be experienced by other health professionals amid the changes imposed by COVID-19, supporting the creation of strategies aimed at improving working conditions in the health field. Furthermore, it is understood that the approach to the theme helps in the professional autonomy and legitimization of nursing, besides favoring this area of knowledge and new research related to the theme.

FINAL CONSIDERATIONS

The speeches analyzed according to the Foucauldian perspective demonstrate that nursing has always faced challenges regarding its visibility as a profession and decent working conditions. Through the analysis, old issues that permeate the profession were widely exposed, being possible to identify aspects that influence the quality of care and the health of those who care in times of the COVID-19 pandemic. Such topics are related to the knowledge-power relations in the workplace, society’s imaginary about the work of nursing, and the professionals’ risk of getting sick.

It is in this sense that the discursive practice of nursing in times of pandemic highlights the search for recognition of professional work by society. This implies movements that go beyond the banging of pots and pans/clapping in the windows: it is necessary that, through dignified working conditions and fair wages, the reality of those who perform nursing care during this critical period for humanity is effectively impacted.

REFERENCES

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