NURSING REPRESENTATIVITY IN TELEVISION HEALTH SERIES

REPRESENTATIVIDAD DE LA ENFERMERÍA EN LAS SERIES DE TELEVISIÓN SOBRE SALUD

ABSTRACT

Objective:

to analyze how nursing is represented by the series that portray the context of clinical health care. v

Method:

a descriptive, exploratory study carried out in a public Higher Education Institution. Data collection was carried out through semi-structured interviews with nursing students. Data analysis was performed through content analysis, supported by IRAMUTEQ version 0.7 and Statistical Package for the Social Sciences version 22.0 software.

Results:

the analysis of the data allowed for the identification of two categories directly related to the role of nursing and to the power relations between the characters. Yet, although television series are common among nursing students, they have not influenced them in choosing the course. However, the positive perception on the part of some interviewees was related to admiration for the field of human health, but not with the nursing characters represented in the television shows.

Conclusion:

nursing in health series is not perceived as a leading category in its responsibilities in the care process, but only as an auxiliary group. It is noticed that the media reproduces the biomedical model, emphasizing the medical professional as the central character in clinical care.

DESCRIPTORS:
Clinical nurses; Communication; Audiovisual media; Social appreciation; Social power; Self-image

RESUMEN

Objetivo:

analizar cómo se representa la Enfermería en las series de televisión que retratan el contexto de los cuidados clínicos de la salud.

Método:

estudio descriptivo y exploratorio realizado en una Institución de Enseñanza superior pública. Los datos se recopilaron por medio de entrevistas semiestructuradas con estudiantes de la carrera de grado de Enfermería. El análisis de los datos se realizó por medio del análisis de contenido, con la ayuda de los programas IRAMUTEQ versión 0.7 y Statistical Package for the Social Sciences versión 22.0.

Resultados:

el análisis de los datos permitió identificar dos categorías relacionadas directamente al rol de la enfermería y las relaciones de poder entre los personajes. Sin embargo, a pesar de que los estudiantes de Enfermería son espectadores habituales de las series televisivas, estas no los influenciaron al elegir su carrera. No obstante, por parte de algunos entrevistados, la percepción positiva estuvo relacionada con la admiración al campo de la salud de los seres humanos, aunque no con los personajes de Enfermería representados en los programas de televisión.

Conclusión:

en las series de salud, la Enfermería no se percibe como una categoría protagonista en sus responsabilidades inherentes al proceso del cuidado, sino solamente como un grupo auxiliar de profesionales. Se percibe que los medios de comunicación reproducen el modelo biomédico, enfatizando al profesional de la Medicina como el personaje central en los cuidados clínicos.

DESCRIPTORES:
Enfermeras clínicas; Comunicación; Medio audiovisual; Valorización social; Poder social; Imagen propia

RESUMO

Objetivo:

analisar como a enfermagem é representada pelos seriados que retratam o contexto dos cuidados clínicos em saúde.

Método:

estudo descritivo e exploratório, realizado em uma Instituição de Ensino Superior Pública. A coleta de dados foi realizada por meio de entrevistas semiestruturadas com graduandos de enfermagem. A análise de dados foi feita por meio da análise de conteúdo, subsidiada pelos softwares IRAMUTEQ versão 0.7 e Statistical Package for the Social Sciences versão 22.0.

Resultados:

a análise dos dados permitiu a identificação de duas categorias relacionadas diretamente ao papel da enfermagem e as relações de poder entre os personagens. Ainda, apesar dos seriados televisivos serem comum entre os estudantes de enfermagem, estas não influenciaram os acadêmicos na escolha do curso. Entretanto, a percepção positiva, por parte de alguns entrevistados, esteve relacionada com a admiração ao campo da saúde humana, mas não com as personagens de enfermagem representadas nos shows televisivos.

Conclusão:

a enfermagem nos seriados de saúde não é percebida como categoria protagonista em suas responsabilidades no processo de cuidar, mas, somente como um grupo auxiliar. Percebe-se que a mídia reproduz o modelo biomédico, enfatizando o profissional médico como o personagem central no cuidado clínico.

DESCRITORES:
Enfermeiras clínicas; Comunicação; Mídia audiovisual; Valorização social; Poder social; Autoimagem

INTRODUCTION

Television plays a relevant role in society because, in addition to informing and entertaining the public, it has the potential to encourage people to reproduce the practices they watch.1Among the different television formats, we highlight the audiovisual creations based on extensive narratives, transmitted over several episodes with an interconnected chronology, called series.2.

In society, it is common to be a TV viewer or to meet someone who follows or has already followed a series. And the influence arising from the consumption of this media material is already the subject of discussion in the scientific community while, little by little, researchers have sought to understand how these series influence the perception of the image of a profession, including for nursing professionals, as they are usually portrayed among the characters.

The series of American origin, disseminated around the world, including in Brazil, are quite popular and have high ratings. Among the health series, Dr. House, enshrined in eight seasons, and others like Grey's Anatomy, which has already reached its 13^th season, stand out.3Thus, in the face of so many television representations of nursing, the need emerges to analyze how it is represented in these series.

Nursing is an ancient science that has a framework of techniques and skills that underlie its professional practice.4However, this theoretical foundation of the principles of the nursing practice is still unknown to the majority of the Brazilian population, and it is common to have a negative portrait in view of the knowledge of their real actions and their importance, making up an image of Nursing submitting to the Medicine professionals.5^-6

As an example of this, in television series, it is common for physicians to be presented as the team leaders, while the nurse and all members of the nursing team are seen as mere assistants in medical functions. One of the reasons for this reality is the medical valuation in these channels, also associated with a scenario in which nursing has inadequate representativeness in these programs.7

Thus, given the potential for influence of the television series and of the presence of nursing in these shows, associated to the lack of studies on this theme, this study sought to analyze how nursing is represented by the series that portray the context of clinical health care.

METHOD

A descriptive and exploratory study which aims to report the characteristics of specific populations and events, in order to gather opinions on the facts experienced, and thus to group results, collaborating for the presentation of a real problem in a broad and systematic way.8

Data collection was performed in a public Higher Education Institution (HEI), located in the central region of Piauí, in the second half of 2017. The inclusion criteria were the following: nursing students over the age of 18, regularly enrolled in the researched HEI, who attended health series, and who were enrolled in the first, fourth and ninth semester of the university course. The exclusion criterion were participants with inactive registration at the HEI. The selection of this target audience occurred because nursing students are usually viewers of these audiovisual products.

The selection of semesters was made categorically, the first semester because it represents the phase in which the student has contact with the initial presentation of the course, its history and concepts; the fourth for being the moment of immersion of the student in the first experiences in the health services and, the ninth, for being the last semester of the students and the phase in which they have already had varied experiences during the graduation.

Data collection took place through semi-structured interviews, previously scheduled and held at the HEI, after the consent of the participants. The Android 4.1.2 JellyBean software was used to record the interviews. The script consisted of objective and discursive questions, seeking to understand the profile of the participants and their opinions regarding the theme of the study, adding reflections on the representation of nursing in television series and the influence of these series.

Data analysis consisted of using content analysis9,with the IRAMUTEQ (Interface de R pour lês Analyses Multidimensionnelles de Textes et de Questionnaires) software, version 0.7Alpha 2. The analysis process was divided into three stages following the order of pre-analysis, exploration of the material and treatment of the results, inference, and interpretation.9These stages are respected chronologically.

The IRAMUTEQ is a device that allows several possibilities for statistical investigations about the textual corpus.10 For this study, the following analyses were selected: similarity analysis and word cloud.

The similarity analysis recognizes the co-occurrences between words and their interconnections, grouping the relationships identified in the textual corpus and differentiating common parts and peculiarities in an illustrative way.11

The word cloud technique is an instrument that allows for the creation of images through pre-defined text. It highlights the keywords that appeared most frequently in the text.12

To process the statistical data, referring to the population profile, the Statistical Package for the Social Sciences (SPSS) program, version 22.0, was used. Subsequently, the data were grouped into tables, with the aim of clarifying and understanding the audience.

This study respects the ethical aspects related to research with human beings. To protect the study participants, the testimonies reported were coded according to their order of integration into the research. Each code was preceded by the vowel E, which refers to the word interview (“entrevista” in Portuguese), and was accompanied by numbers from 0 to 30, corresponding to the order of the interviews.

RESULTS

This research was composed of 30 nursing students who reported watching health series; the participants' ages ranged from 18 to 27 years old, with a mean of 19 years old. Regarding gender, 86.7% of the sample is female and, of the total respondents, 46.7% of the students were in the last semester of graduation.

Regarding the series they watched, exactly 50% of the sample reported watching only Grey's Anatomy, and 33.3% watched Grey’s Anatomy and House concomitantly. Regarding the frequency of times they watched, 33.3% said they watched five times a week, as detailed in Table 1.

Table 1 -
Sample characterization and frequency of television series watched by the interviewees. Picos, PI, Brazil, 2018. (n=30)

Variables	f	%
Course period
1st period	8	26.7
4th period	8	26.7
9th period	14	46.7
Series watched by the students
Only Grey’s Anatomy	15	50
Grey’s Anatomy and House	10	33.3
Grey’s Anatomy, House and others	3	10
Grey’s Anatomy and Sob Pressão	2	6.7
Frequency of times they watch the series
Once a week	8	26.7
Twice a week	3	10
Three times a week	3	10
Four times a week	4	13.3
Five times a week	10	33.3
Seven times a week	2	6.7

Still, according to the data analysis, two central categories of analysis emerged: the ways that illustrate the role of the nurse in the health series; and the relationship of influence and identification between the nurse characters envisioned in the health series and the view of the nursing students who are viewers of these media.

The ways that illustrate the role of the nurse in the health series

Based on what is presented in the health series, nursing is evidenced as a mere adjunct to the care process, contributing to the idea that the nursing character is presented in a stereotyped manner. This reality needs to be analyzed, because the series are opinion-forming media that can negatively sentence the credibility of a profession.

The following statements show how much nursing is devalued in the health series, according to the opinion of some research participants:

[...] he’s considered as a subordinate (e2).

[...] at least in the ones I've watched he doesn't have the main role (e4).

In addition, although there was a lack of representativeness of nursing, there are health series that report the daily lives of these professionals; however, as perceived, these series fail to maintain their success, and become forgotten.

[...] the only series that has been talking about nursing, the role on the nurse, is Nursie Jack, and she’s not so prominent, in fact, it’s even been canceled, if you go looking for it, you will hardly find the episodes of Nursie Jack (e14).

It is important to note that some participants in this study reported following Brazilian series that portray the hospital routine; however, it is important to highlight that, in these cases, the devaluation of the nursing professionals is even greater than in North American series.

In the international series the nurse is the link between the patient and the doctor, he’s more into the care and in the national there was no nurse, only the doctor [...] (e27).

[...] it demonstrated how the reality of a Brazilian hospital is, but didn’t seek, it’s taking this reality of how nurses work on a daily basis (e7).

However, using the word cloud technique, performed with the aid of the IRAMUTEQ software, which condensed the words and grouped them graphically in proportion to their frequency (f), it is noted that the words nurse (f=54), no (f=46) and doctor (f=41) were the most frequent in the corpus referring to the representation of nursing in the series, as can be seen in Figure 1, which allows us to graphically perceive the strong association of comparing the figure of the nurse professional to the medical professional. However,the subjects' discourse highlights that the representation of the nursing character does not match the real role of the nurse, and that the medical character is much more evident in the series.

Figure 1 -
Graphical analysis of the words generated about the question regarding the representation of nursing in television series. Picos, PI, Brazil, 2018

In short, it can be inferred from that nursing does have space in television series; however, it is a portrait that does not match the actions performed on a daily basis by the nursing category. Sometimes, the nursing characters represented in the television media are characterized as assistants to physicians or, still, as carriers of stretchers, chairs or receptionists. Which, in turn, are not unnecessary services, but services that are not characterized in the legal and scientific bases of nursing.

The relationship of influence and identification between the nursing characters seen in the health series and the view of nursing students viewers of these media

In relation to the influence provoked by these series, it was identified through the similarity analysis that, among the nuclei of ideas that concentrate the most recurrent words in the interviewees' speeches, there is a strong relationship between the following pairs: “influencing-because”, “influencing-no”, and “influencing-how”, as shown in Figure 2.

Figure 2 -
Graphical analysis of the words generated about the questioning regarding the influence of television series when portraying the professional nurse in fiction Picos, PI, Brazil, 2018. (n=30)

Thus, it is noted that the series did not influence the participants in the choice of the course, but were the subject of debate by the representations of nursing in these series, helping them to realize how they can exercise care and, at the same time, be aware of the profession image.

On the other hand, the desire to show the nursing profession and its representation interfaces appears in a narrow way in relation to its interconnection with the central nucleus, a fact evidenced by the connection with the “way-influencing” nucleus. Here, the eagerness of the participants to discuss the relationships explored by the media stands out.

Still, through the relationship of influence and identification between the nursing characters seen in the health series and the view of nursing students viewers of these media, the predominance can be seen of statements that elucidate the non-influence of the nursing characters shown in the series, realizing, thus, that the students who follow these series are able to distinguish reality from fiction. However, it is also noteworthy that the gratification of care is a feeling that emphasizes the identification with the act of caring for the patient, given what is shown in the series.

To highlight the non-influence mentioned by the interviewees, regarding the choice of the nursing course, some statements below contextualize this relationship:

No, the role of the nurse didn’t influence me, because the nurse has almost no appearance [...] (e3).

It didn't influence me at all to do nursing, it influenced me to do medicine [...] (e11).

Although the majority of the interviewees claimed that the role of Nursing presented in these series has no influence on their professional practice, a minority reported identifying themselves with the way in which the nurse characters were shown in the series, evidencing the gratification of care, as can be seen below:

[...] i always liked nursing, I noticed that nurses are the most direct care for the patient, they’re directly involved in care, monitoring and communication, this influenced me a lot because I like this close contact (e6).

[...] influenced in a very positive way, showing how we can help, help, and also many things I saw there, I could identify in my reality (e16).

There were reports of people who were influenced not by the nurse characters, but by the hospital routine itself, as can be seen below:

[...] these series influenced me a lot so that I could want to be in the health area, we see all that dynamics and we want to be in that adrenaline rush (e1).

[...] influenced me to want to know the hospitals, the health area, I think it influenced me because I found the hospital setting interesting (e12).

It is clear how much nursing is present in a submissive and auxiliary way in the television series, which is the target of criticism by most of the interviewed viewers. However, some actions developed by the nursing characters are viewed positively by some of the interviewees. However, it is important to highlight that these actions have a greater influence on the valorization of human assistance itself than on the professional nurse.

DISCUSSION

The series that deal with medical dramas and hospital routines grant their audience limited or surreal information regarding the Nursing practices.

ER, Grey's Anatomy and House are three examples of series acclaimed by their audiences; however, in these three shows there is no evidence of nursing being represented in a positive and essential way to care13 Similarly to this finding, in this study the series Grey's Anatomy and House were the ones that most students reported watching and, based on these opinions as viewers, they generally highlighted the representations about nursing in these media as negative.

Another relevant aspect that was mirrored in the social context of nursing was the strong presence of the female audience in this study. It is noteworthy that in a survey with series viewers, 80% of the participants were female.14 Also emphasizing according to this study that women are intensely involved with fictional stories, which happens less frequently in men;14 nevertheless, the similarity between these findings is perceived, when confronted with the data found in this investigation in which 86.7% of the sample is female.

Regarding the representations highlighted by the research participants, it can be said that the nurse characters are not centrally presented in the hospital routine shown in the health series. Thus, its representation is made in an adjunctive way in the practice of clinical care, in which there is a great emphasis on the medical professionals, a fact that is also reflected in health care.

In these circumstances, the biomedical care model is taken into account, prevalent in Brazil and North America, where the series in focus are recorded.

In the biomedical model, the technical decisions regarding the treatment of patients are made based on the medical diagnosis, which implies limitations in the professional autonomy of nursing, as their actions will be built according to the physician's decision, so that their diagnostic practices and drug prescription make medical professionals sovereign, in the face of common sense, which helps to portray Medicine with absolute and crucial prominence.15 This fact is directly related to the economic and social valorization of Medicine.15 However, this situation limits the feasibility of growing professional autonomy in Nursing; after all, its importance is still suppressed before that of the medical professional which, consequently, is related to the mass valorization of these professionals in the media.

In this way, spaces are created for the reproduction of stereotypes and prejudices that continue to be reflected in common sense. What will later influence the way that Nursing is plotted in the health series, eliminating a historic and silent struggle that has not yet managed to give an active and important voice to Nursing in society.

The social devaluation of nursing is one of the main consequences of these stereotyped and prejudiced representations, so much so that, in a survey conducted with 269 high school students from São Paulo, a Multidimensional Questionnaire on the Social Image of Nurses (Questionário Multidimensional Sobre a Imagem Social do Enfermeiro, QMISE) was applied and, eventually, it was found that more than 70% of the sample did not consider nursing as a career to be followed.16 In line with this study, even though it was found that nursing, predominantly, is not highlighted in the health series, this generates many reflections in the interviewees.

It is necessary that nursing professors be attentive to the consumption patterns of the students, as the series are capable of provoking interesting and precious discussions,17 and this type of media can surpass its marketing objective and be used as an educational tool to elucidate constructive debates and enhance professional and social relationships.

In a study that brought together nursing students to discuss some scenes from the The Crimson Field series, which showed the routine of physicians and nurses who cared for victims of the First World War, the students reported the feeling of pride in having seen nursing played a crucial and significant role for the victims of the war.17 This highlights how much a positive social representation can bring new hopes to view Nursing as an important and valued profession.

However, to highlight the captivating power of the social media, a study with high school students sought to show them the professional careers they could choose when they entered higher education. At one point, these students watched a video that simulated Nursing care in an incident in the classroom. After the video, the students were asked whether they would be interested in entering the nursing career, and 92% of them said yes.18

Thus, it can be highlighted that the visibility of the Nursing team can be evidenced through actions that encourage the recognition of these professionals. Seeking to bring changes that alter the conception of the external audience before the notoriety of the Nursing area. Nevertheless, the professionals and their patients must be aware of the importance of nursing.19^-20

Some of the resources that can be used to disseminate professional information are the following: conversation circles with exchange of experiences, which are actions that can raise the audience awareness of the importance of this area. However, this action must be done in conjunction with all the nursing professionals.21

Thus, from the reports of this study, a new perspective can be constructed that seeks to alert people about how the characters of nurses are being shown in the media. After all, nursing needs visibility; however, nurses and other team members need to be portrayed as providers of care with scientific-legal bases, and not as mere assistants to the medical practices.

Therefore, it is pertinent that the television media understand that representing nursing is more than a dramatic act, it is a political act in favor of the merit of being a professional coming from this category, and it is essential to disclose the social relevance of the practices of this profession.22

CONCLUSION

Television and health series are powerful means of digital influence, having the power not only to entertain viewers, but also to positively or negatively influence a professional category.

In the case of Nursing, the influence of the category is still questionable, since it does seen that it does not have an active role in the series, sometimes having representations that cause shame and revolt in the viewers, who know the scientific and legal bases of the profession.

Still, both series of North American origin and those of Brazilian origin are usually watched by Nursing students and, in this audience, they awaken the perception that nurses are supporting members of the care process.

The dissatisfaction of the students is notorious in watching nursing be shown in an unrepresentative way in the series; however, reversing this situation requires initiatives related to the demands of society in general, and also to conducting further studies on the media influence of the biomedical model.

Researchers need to be aware of these series consumption practices, and how much they can influence the audience. It is recommended that more studies be carried out on this topic, in order to better understand this phenomenon and also to identify how the general population perceives and is influenced by these series.

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NOTES

• ORIGIN OF THE ARTICLE

  Extracted from the Course Conclusion Paper - Influence of television series on the representation of Nursing, presented to the Bachelor Course in Nursing of the Universidade Federal do Piauí, in 2017.

• APPROVAL OF ETHICS COMMITTEE IN RESEARCH

  Approved by the Ethics Committee in Research with Human Beings of the Universidade Federal do Piauí, opinion No. 2,269,337/2017, Certificate of Presentation for Ethical Appreciation: 70797517.4.0000.8057.

Publication Dates

• Publication in this collection
  20 Nov 2020
• Date of issue
  2020

History

• Received
  22 Feb 2019
• Accepted
  02 Sept 2019