Professional identity of nurses in pandemic times: new/old challenges reproduced in news mediaABSTRACT
Objective: To analyze aspects related to the professional identity of nurses during the COVID-19 pandemic usingnews media as a source.
Method: Qualitative, and retrospective document study with 51 reports from Folha de São Paulo from March to December 2020. Data was organized using ATLAS.ti, with Thematic Content Analysis and discussion from the theoretical perspective of Claude Dubar.
Results: Three categories were formed: Identity captured by the images reflected on the text; The identity symbolized by the support of nurses to those who need care; and The identity symbolized by the support of nurses to those who need care.
Conclusion: Despite the fact that the image of nurses is still mistakenly apprehended, the way they provide care, their commitment to the population, and their scientific mindedness ensured visibility and enabled a more empowered and secure identity for their role in society.
Keywords: Nursing; COVID-19; Professional role; Pandemics; Mass media
RESUMEN
Objetivo: Analizar aspectos relacionados con la identidad profesional de las enfermeras durante la pandemia de COVID-19 a partir de contenidos periodísticos.
Método: Estudio cualitativo, documental y retrospectivo, con 51 reportajes del periódico Folha de São Paulo entre marzo y diciembre de 2020. La organización de los datos fue realizada por ATLAS.ti, con Análisis de Contenido Temático y discusión desde la perspectiva teórica de Claude Dubar.
Resultados: Se constituyeron tres categorías: la identidad captada por las imágenes reflejadas en el texto; La Identidad simbolizada por el apoyo dado por enfermeras a quienes necesitan cuidados; y La identidad como valor social del trabajo del enfermero.
Conclusión: A pesar de la imagen aún errónea y del contexto difícil, el compromiso con la población, la forma de cuidar y la cientificidad aseguraron visibilidad y posibilitaron una identidad más empoderada y segura de su papel en la sociedad.
Palabras clave: Enfermería; COVID-19; Rol profesional; Pandemias; Medios de comunicación de masas
RESUMO
Objetivo: Analisar aspectos relacionados à identidade profissional das enfermeiras durante a pandemia da COVID-19 a partir de conteúdo jornalístico.
Método: Estudo qualitativo, documental e retrospectivo, com 51 reportagens da Folha de São Paulo com recorte histórico entre março e dezembro de 2020. A organização dos dados se deu pelo ATLAS.ti, com Análise de Conteúdo Temática e discussão na perspectiva sociológica de Claude Dubar.
Resultados: Três categorias foram constituídas: a Identidade capturada pelas imagens refletidas no texto; Identidade simbolizada pelo apoio das enfermeiras a quem precisa de cuidado e; Identidade como um valor social do trabalho das enfermeiras.
Conclusão: Apesar da imagem ainda errônea e o contexto difícil, o compromisso com a população, a forma de cuidar e a cientificidade garantiram visibilidade e possibilitaram uma identidade mais empoderada e segura de seu papel na sociedade.
Palavras-chave: Enfermagem; COVID-19; Papel profissional; Pandemias; Meios de comunicação de massa
INTRODUCTION
A professional identity can be understood as a part of the construction of the identity of a person. It is developed via specific characteristics that vary from one person to the other. The characteristics change according with historical, social, and professional field1,2, which are influenced by the interaction of the trajectory of each individual, by the employment, work, and education systems, in a process of construction and reconstruction associated with successive socializations3.
Some aspects related to professional identity, formulated during the university formation trajectory, persist throughout one's adult and work life. However, one must consider that social experiences of the individual strongly influence the continuous (re)construction of their identity3-4.
The contemporary social debate reignites the interest for professional identity and all repercussions that emanate from it. The meaning of personal and professional identities has been going through a process of change that requires a closer look to the historical trajectory of the professions3. The professional identity of the nurse has been studied as time goes by, and presents important signs of transformation. Although nursing as a profession has existed for a long time, it is still limited in regards to technique, mother care, subordination, and little social recognition1.
A strategy to empower and value nursing workers began in 2018, with the Nursing Now campaign, promoted by the International Council of Nurses (ICN), the World Health Organization (WHO), and the organization All Party Parliamentary Group on Global Health , from the United Kingdom. In Brazil, the Federal Council of Nursing (COFEn) partnered with the WHO Collaboration Center of the Universidade de São Paulo to carry out the Nursing Now campaign5. This campaign would come to an end in 2020, with the celebration of the 200 years of Florence Nightingale (1820-1910), and as a result, the year was chosen to be the International Year of Nursing5. COVID-19 made this movement even larger, further making this empowerment a reality. Nonetheless, in addition to campaigns and commemorations, nurses hve been showing their worth in many ways - in social networks, journalistic media, and in their daily work, which is narrated using publications that clearly show the social relevance of the work of the nurse and the problems they face. A research carried out on Twitter and Instagram showed that nurses have used social media to call for society, asking them to comply with social isolation and value health professionals, and to complain about the lack of PPEs to carry out the attention6.
In February 2020, the first cases of COVID-19 appeared in Brazil. In March of the same year, the WHO declares the disease as a pandemic. The SARS-CoV-2, which causes COVID-19, brought in its wake a series of unmeasurable consequences, becoming a powerful enemy of humanity. The pandemic also had a profound impact on health work, especially that of nurses since these workers are in a strategical position in the front line of treatment, prevention, and recovery of the diseased in all health institutions. In Brazil, there are 2,644,000 nursing workers7. In this setting, nurses have a very important role. Not only they are in the proximity of the infected, but they also suffer with the consequences of the pandemic, becoming diseased and dying. In Brazil, until December 2020 (before the advent of the vaccines), almost 500 nursing workers had died to the virus. Until January 21, 2022, there were 872 deaths, representing 2.57% of the 60,185 cases reported8.
In the first year of the pandemic, while the nursing team incessantly worked, became diseased, and die due to covid-19, national and international media gave special attention to these professionals. They highlighted, mainly, the adaptations in the health services, and the field hospitals that had to be set up. The focus was on the attention to symptomatic cases of the disease, Intensive Care Units (ICU), emergencies and nursing wards, called "covidaries", which were always full9,10. Therefore, the work of the nurses was essential to prevent the disease, to treat the disease, to manage services in the context of the crisis, and to develop studies related with the disease11.
In this regard, we believe that news media can contribute to the process of social and historical (re)construction of the identity of nursing, contribution not only for the memory of nursing, but also for the records of the essential role these workers must develop throughout the time.
Therefore, the guiding question of this research is: How was the identity of the nurse presented by the news media during the COVID-19 pandemic? This study aims to analyze aspects related with the professional identity of nurses during the COVID-19 pandemic, using news media content to do so.
METHOD
Qualitative, retrospective, and descriptive document study, using news media content. The data were collected from a primary source chosen due to its national reach and to the fact it broadcasts current social impact news from Brazil and the world. This outlet is Folha de São Paulo, a newspaper whose on-line version was considered in this particular occasion, from March 6 to December 31, 2020. The dates were chosen considering the beginning of the state of public emergency in the country, while the end date was a point before vaccination started.
Document research is pertinent when primary historical sources are available that allow searching, in man-made records, for facts from the recent or distant past. The justification of this study is the fact it allows uncovering objective elements included in the subjective context of the phenomenon that must be studied. Therefore, systematically using the documents to explore and analyze data from a historical perspective12.
Data collection carried out from December 2020 to February 2021, used, as search terms: nursing, covid, pandemic. The first search yielded 8,351 news pieces. After we read these, we excluded duplicates and those whose topics were not relevant to this study, in addition to those who were fake news. 51 news pieces were included. There was no need for double check, since the research was not attempting to review, but to find historical sources.
Reports went through Bardin's Thematic Content Analysis13, with the theoretician Claude Dubar as a reference3. We used the software ATLAS.ti® 9.5.0 to organize and code the data , considering the following stages: pre-analysis (exhaustive reading and initial coding - elaboration of primary codes to identify issues regarding identity, such as loving one's work, recognition, and team support); material exploration (search for determining words to structure sets of codes with the adequate association of said codes to the categories of analysis, with software support (example: image - angelical)); and treatment and interpretation of data (meaning networks were created to organize information obtained by inputting the information into the system)13. The news content is topicalized as the primary codes of questions regarding professional identities are selected. These codes emerged from the discourses in the news pieces, which were previously undefined. The theoretical references by Claude Dubar3 guided the investigation process as a whole. After we defined the register units, we carried out the process of thematic analysis of the content until we reached the final analysis categories12.
Because there is no direct involvement with human beings and the content analyzed is public domain, there was no need for research ethics committee evaluations, as per Resolution No. 510, from April 07, 2016, and Law No. 12.527/2011. Although the content is public and easy to access, we did not alter the news pieces, guaranteeing that.
RESULTS
According to the analysis of the 51 news pieces from the newspaper Folha de São Paulo, the professional identity of nurses was associated to three main aspects: image, support, and social value, which are detailed below. This association was based on the statements of nurses who gave interviews to the source of the data and to the content produced by journalists who produced the pieces.
The identity captured by the images reflected on the text
The first category is related to the image reported in the nes pieces analyzed, showing aspects associated to the profession that are related ot the way in which nurses see themselves and to the love they dedicate to the work. This image is also backed up by society, i.e., by how others perceive the nurses, associating them with figures such as angels and the science fiction imagery from Hollywood.
The uniform of nurses once again became a part of popular imagery, associating white clothes to health workers. Nonetheless, during the pandemic, it becomes a sign of danger for the nurses, as the uniform becomes associated to the possibility of infection in public transportation and similar environments, often leading to being treated with hostility by others.
The results found are detailed on Figure 1, below.
Professional identity associated to the image of nurses during the pandemic. Florianópolis, Santa Catarina, Brazil, 2021
The love for the profession, for what they do, and for the many ways in which they can make a difference in people's life is what motivates many nurses to act. According to the media, they can change the life of the person who care and of the person who receives care.
The identity symbolized by the support of nurses to those who need care
Considering the hardship nurses had to deal with during the pandemic, receiving support became a relief for their work. It can be an important aspect of their professional identities. The support reported in the news shows that bonds with patients and their families, as well as with work colleagues, is a strong weapon against the tiring days of hard work. Teamwork stands out to as it represents mutual support in an exhaustive routine. The support was felt on other fronts, such as the entities that organize the profession, as they made available resources for the nurses to be listened to, in addition to going public to contest or repudiate acts and norms unsafe for the workers. The statements related with this topic are shown in Figure 2.
Professional identity associated to the support from and to nurses during the pandemic. Florianópolis, Santa Catarina, Brazil, 2021
The findings of this study show that the perceived support during the pandemic was redirected by nurses to patients and their families, and to society as a whole. Furthermore, the support was recognized by them, as they received support from the entities of their organizations, even considering the numerous difficulties and exhaustion generated by the crisis that was installed.
Identity as a social value of the work of nurses
The social value of the work of nurses received special attention in communication media during the pandemic. Because nurses described themselves as professionals whose value was underestimated or even as invisible workers, this aspect manifested, mostly, in regard to professional recognition. Society in general may not be aware of the information revealed by these news pieces, in some cases not understanding that nursing is a profession, a science, a field of knowledge.
The news highlighted the social commitment of nurses with the population, considering a context where the knowledge, the technique, and the prepare of nurses were in the front line, in order to save many of the lives that were contaminated with the virus. Other elements understood as part of this identity were humane care and empathy towards those who were isolated for treatment, an aggressive and solitary treatment.
In most cases, women were the ones who looked empathetically at the other in this period. They are still a majority in nursing.
These aspects are treated in Figure 3.
Professional identity associated with the social value of the work of nurses during the pandemic. Florianópolis, Santa Catarina, Brazil, 2021
Finally, nurses showed that the compliments and associations with heroic acts are far from the professional recognition they have desired for so long.
DISCUSSION
The work of direct assistance nurses during the pandemic, whether they worked in the hospitals, in the primary health units, or in the vaccination efforts, is an adequate time to analyze the professional identity of these workers, as it would provide an opportunity to understand the perception of these workers and of society through the news media, also involving the processes of socialization that influence the (re)construction of the professional identity of nurses.
The use of Claude Dubar's work3 in this study allows to understand and reflect about the construction, deconstruction, and reconstruction of professional identity based on continuous socialization processes. In this study, the influence of media on the professional identity of nurses is remarkable. For Dubar's dualism3, the relational process is formed by the identity to the other, that is, what others say/see from/in the nurses, and the identity for the s elf, a biographical process where nurses say who they are, using statements reflecting what they see when they turn their gaze onto themselves.
The elaboration of news pieces of this nature tends to be guided by common sense. Its goal is to highlight te values of society in a specific historical and social moment14. In this regard, the findings of this study show that most news pieces discuss subjects related to nursing assistance/care to patients infected with the coronavirus and the role of nurses in this process.
The image of nurses in print media during the COVID-19 pandemic requires contexts to be carefully analyzed, especially considering how this issue is brought to light. Generally, it is projected by society in general and by whoever produces the news. There are many particularities in the way news are produced. The media has its own specific mechanisms, using rhetorical devices and persuasion techniques14. As a result, one must understand that, although the content published is not a projection of absolute truths onto reality, media is much more than a conduit for information. It is also an important source of research, contributing to formulate new concepts and opinions15.
As a result, we can see that each profession has many roles within society, and manifests an identity associated with what the field of their professional actions represent3. In regard to nursing, one must consider the representation according to sets of images, concepts, statements, and explanations, reproduced in daily social practices, internally and externally in regard to the profession16,17. These images are associated to the professional identity itself in an intricate network of meanings inherent to the profession, which become actualized through professional representation18.
Regarding the image of the nurses, the identity for the other is marked by angelical and heroic figures. These images are strongly influenced by religiosity, which attributed to the work of nursing a divine meaning, permeated by thoughts associated with a spiritual propensity19. There is also a historical constitution marked by "religious women, Ladies of Charity, devoted, good, charitable, asexual, and virgin, dedicated to philanthropy, who negotiated their salvation through the practice of care"16.
This idea functioned as a base to instill in the nurses the idea that their work was the noblest way to serve God and their neighbor20. On the other hand, regarding their current uniforms, especially those used during the pandemic, this angelical image is deconstructed, and they begin to mark this new historical moment, associating nurses to science and to other health workers, and distancing them from the more intuitive and charitable aspects of that image.
The identity the nurses see in themselves they associate with the love they put into their work, the love for what they do, and the need to find meaning in their activities. The love this study analyzes does not represents nursing as an intuitive activity, focused around charity and giving to the other; it means the love and dedication provided within planned scientific criteria, a love for the profession in all its features. The identity transforms as professionals assimilate the look of the other on themselves, in such a way that there is a collective construction that takes into account that which is reflected of their professional image3, something which, in this case, is disseminated by the media.
Studies have shown that the pleasure and satisfaction of nurses are related with the recognition they receive for their work, which is a strong motivating factor for their work and professional growth21. This shows how dedicate the nurses are in a permanent process of subjective engagement, to win the daily barriers imposed by work conditions22.
The look to the self was prevalent in nurses, with a strong influence of the look of the other to the identity, showing how impossible it is to dissociate individual questions and social relations. Therefore, the professional identity is reconstructed by the acceptance or denial of these different looks17. Characterizing the nurses as angels and heroes does associate social value to them in a way. Nonetheless, it increases the pressure on their work, as it is understood that angels and heroines do not fail or get sick. This can lead to unprecedented psychic suffering23. When nurses are pictured as angels, this refers to their goodness, their charity, and the love they dedicate to their work. As nurses are pictured as heroines, it connotes that they are strong enough to overcome different types of adversity and do not give up easily.
The work in the hospitals has particular characteristics in the care to the health issues of individuals. This requires dedication, attention, competence, and technical knowledge, in addition to adequate work conditions. The pandemic and the issues it provoked made it clear that nurses are overworked, have inadequate work conditions, lack of PPEs, and have to deal daily with extreme situations that involve occupational risks. The work in hospital care implies in looking at another, at the needs of another, and, often, leads to feeling of impotence, as some lives cannot be saved. The nursing teams try to overcome these adversities through cooperation and the elaboration of efficient strategies, to allow for less suffering at work and better results24. Teamwork, in addition to providing efficient results in nursing assistance, tends to value communication and integrated activities, reducing the distance between professionals, patients, and families.
The establishment of bonds with the health team as a whole, with patients and families, is essential to understand the real needs of all those involved in the health work24. In this regard, when nurses receive support and give support to one another, professional recognition and valorization seem closer. This encourages them to continue committed and productive, allowing them to see their identity in their professional practice24.
Direct assistance nurses who work in hospital sectors where there are prolonged hospitalizations and deal with situations close to the end of life, tend to establish stronger bonds with relatives and families, and, consequently, suffer the most with the outcomes of more serious situations. Additionally, women are more than 80% of the workforce of nursing, and results show that, for that reason, professional recognition seems to be quite distant.
The professional identity of nurses can be threatened by the excessive workload during the pandemic and by the precariousness. It can lead to a process of alienation and suffering, considering that human needs are reconstructed throughout one's life by the successive socialization in the professional environment and in work relations3.
A study that investigated actions and interactions provoked by nurses who cared for patients as they and their families were going through the process of death and dying, showed that the nurses in these sectors are more sensitive to the death of a patient, since the feared outcome breaks a bond constructed through affective relations25.
Because of a overwhelming amount of feelings experienced due to the COVID-19 diagnosis, such as uncertainty, fear, anxiety, and solitude, patients and their relatives experience anguish that can only be minimized with the aid of then nurses. Authors highlight the singular relevance of promoting empathy with patients and relatives, with clear and accessible communication, and to use resources to include the family in care, even if at a distance24,25. The nurses male clear that scientific knowledge works with their vocation to guide their daily activities, also adding that competence, resilience, and spirit of facing a mission are determinant in the combat to the pandemic26.
Considering the relevance this study has uncovered, the image of dedication and commitment to one's work, as well as the love to the profession, the scientific mindedness, and the empathy and capacity of providing support and safety to colleagues and patients, nurses still see the lack of appreciation for them as a hindrance to their recognition. Since the number of women in the profession is quite large, nursing faces the consequences of the logic according to which it is a female's work, that is, an extension of the domestic activities of care19.
Considering that the identity is more than something inherited, but something reconstructed throughout one's professional life, this study shows that the press is characterized, on the relational process, as the identity to the other, that is, the way in which nurses are seen and re-seen by society according to the contents disseminated. Nurses report to the identity of their own biographic process, the identity to themselves, considering the processes experienced and distinguished that influence the construction of their identity3.
Despite being under a strong influence from these mistaken conceptions, nurses engaged in their social commitment to care for people, prioritizing science as well as acting humanely towards the diseased and their families, as well as towards society as a whole. These elements have repercussions on the specific attributions of nurses, especially in autonomy, personal satisfaction, and the recognition of the profession26. Even considering the negative effects of these elements on their motivation, they are still focused on providing humane care to the people. This is the social commitment of a profession carried out by a large number of women. They do so to such an extent that they forget their own self-care, so essential for nurses, which is forgotten so they can care for the diseased. This care is so primordial that it influences the care to others.
The COVID-19 pandemic had a strong impact on society as a whole, enabling a new perspective about nursing, which started to be perceived more frequently and regarding the importance of their professional actions. This visibility made it possible for nurses to assume the main role during the pandemic, which should be considered as an impulse to (re)construct professional identity16. Therefore, this was an important moment for nurses, as it provokes the profession as a whole to reclaim their space and their struggle for decent and healthy work conditions16.
With so many social and economic transformations, added to significant changes in the job market, identities also must be adjusted. Therefore, this is a change for nurses, as the professionals they are, to take ownership of identities that can overcome old understandings26, showing more reliable identities, that is, those that actually represent the greatness of being a nurse.
We believe this study will provide significant contributions to the teaching and practice of nursing, considering that it provides a reflection about the actions of nurses in situations of crisis, in specific, this particular worldwide health crisis, which led many to question existing work conditions, the structural plans to deal with emergencies, the suffering they bring to professionals, and also the need to improve nursing graduation courses, so students become proactive workers, empowered to act in local and global crises.
The fact that data were collected in a single large-circulation Brazilian newspaper can be considered as a limitation, since searching other newspapers could influence the results.
FINAL CONSIDERATIONS
(Re)constructing the professional identity of the nurses who have worked in the COVID-19 pandemic required an intense socialization process, a process towards developing new ways to act in an unprecedented context and related with the visibility the news media provided during the period.
The analysis of the aspects related with the professional identity of the nurses during the COVID-19 pandemic using news media allowed showing the shortcomings of health services, especially hospitals; nonetheless, it empowered nurses and nursing workers to fight for adequate work conditions, so they could approve the wage floor specific to the profession, which nurses have been fighting for so long.
The news media is an important means of disseminating identity processes and did so for nurses during the COVID-19 pandemic. Within the time frame we studied here, the nurses expressed their identity in their work, which, in accordance with the applied theoretical references, is not an essence, but a vector that expresses coherence and the continuity of the self. Although some issues still take time to be adequately represented in popular imagery, such as the idea of heroines and angels, and even considering that the lack of recognition is a constant in nursing, the nurses remained steady in their commitment to care for those with COVID-19 to the best of their abilities. To do so, they relied on their teams and on the love to the profession, so they could guarantee humane care. The support from entities that regulate the profession in an attempt to reach professional recognition, with better work conditions and fair wages, is an important prerogative.
One must consider how important this visibility is in the context of the pandemic, and, especially, in its maintenance after this period, so real changes can take place in regard to professional recognition. It should be highlighted that, even considering the situations that risked infection, the nurses still acted according with their commitment. This unique context influences the formation of a new group of professionals, a new identity, increasingly necessary for society.
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Publication Dates
-
Publication in this collection
24 Mar 2023 -
Date of issue
2023
History
-
Received
10 Feb 2022 -
Accepted
09 June 2022
Source: The authors.*The numbersinthe text boxes are related to the location of the coded citations within the ATLAS.ti software. Respectively, it indicates the number of documents, paragraph, and line.
Source: The authors.*The numbers in the text boxes are related to the location of the coded citations within the ATLAS.ti software. Respectively, it indicates the number of documents, paragraph, and line.
Source: The authors.*The numbers in the text boxes are related to the location of the coded citations within the ATLAS.ti software. Respectively, it indicates the number of documents, paragraph, and line.