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ORIGINAL ARTICLES

 

 

Documentary research: the background to fundraising for nursing necessities in Brazil (1956-1958)

 


Mary Ann Menezes Freire1, Wellington Mendonça de Amorim1

1Rio de Janeiro State Federal University


ABSTRACT
This is a study about the research entitled “Fundraising and the Necessities of Nursing in Brazil”, coordinated by the Brazilian Nursing Association. Aim: Analyze the background for the development of the research project entitled “Fundraising and the Necessities of Nursing in Brazil”, coordinated by the Brazilian Nursing Association from 1956 to 1958. Method: An investigation based on the new cultural history approach, which has been developed based on documentary analysis. Results and discussion: The characterization of the conditions that aid the development of the research went through the identification of the basis for this study, the needs of Brazilian nursing, and then, finally, the investigative essays that preceded it. Conclusion: there was a necessity to know the historical situation of Brazilian nursing so it was later possible to plan for its future. Then, there was a need for fundraising; the construction of a network involving many different institutions, sectors, field agents and places, aimed to undertake research that could answer these objectives.
Keywords: History of Nursing; Research in Nursing; Nursing.


INTRODUCTION

“Fundraising and the Necessities of Nursing in Brazil” (LRNEB, in Portuguese) is considered by many researchers as the first piece of research in Brazilian nursing. This study, sponsored by the Rockefeller Foundation and supported by many other national and international institutions, was carried out between 1956 to 1958. Such an initiative was considered the most major enterprise which the Brazilian Nursing Association (ABEn, in Portuguese) had engaged in until then(1).

The need for a study that provided data about the nursing situation in Brazil wasn’t new. The topic came up in 1939, when the President of the Association at that time, Hilda Anna Krish (1938 – 1941), asked for support to perform a study such as this one. However, she was not successful(1).

At that time, it was considered that any medical-sanitation planning demanded a previous knowledge of the number of professionals involved. It was ABEn’s responsibility to have updated information about the national nursing situation, so that, at any moment, it would be able to contribute with the information needed for this sort of planning(1).

In the work plans of the Association, the solicitations that had to be presented to the government created a even more profound conviction that a study of this nature should be carried out(1). Without up-to-date and accurate data, ABEn could hardly present well-based future plans or even justify, with solid arguments, any solicitation for an increase in nursing staff.

For the first time,the Fundraising and Necessities of Nursing in Brazil identified, in a systematic form, the difficulties found by nursing professionals in terms of their working conditions, turnover, high level of drop-out from the profession, dissatisfaction and lack of motivation, low demand for college-entry courses, school drop-out and difficulties during the process of professional development(2).

After successful demands for this research, and based on the interest of the Rockefeller Foundation and the performance of the Brazilian Nursing Association, the above-mentioned “Fundraising and Necessities of Nursing in Brazil” was produced, and it is considered to be the first piece of research into Brazilian nursing in mid-20th Century.

Therefore, after a period of uncertainty, the need to seek answers for questions involving the demands and conditions that supported the execution of the first scientific research into nursing on a national level emerged. That is why this research, whose content was the responsibility of many organizations and which was of fundamental importance for the future planning of nursing in Brazil, deserves to be revisited and investigated, with the objective of understanding the demands and conditions that helped the development of this research.

As such, we are interested in considering the actions of the Brazilian Nursing Association, and those of other national and international organizations which were involved, and the happenings and discussions which occurred before the execution of the research (1956 – 1958).  These are defined as the object of this study and involve a consideration of the movement of nurses to engage in the research, coordinated by ABEn, between the years 1956 and 1958.

Then, in order to carry out this study, the following objective was decided upon: Analyze the past actions associated with the development of the research “Fundraising and Necessities of Nursing in Brazil”, coordinated by the Brazilian Nursing Association, from 1956 to 1958.

More than just a subject, a study of the history of nursing has been a fundamental tool in terms of elucidating the subjacent facts and phenomena with regard to the development of nursing. This study of one of the most relevant publications in Brazilian nursing has accepted the challenge of complementing the historiography of nursing.

This study is part of the registered investigations associated with the CNPq research group, the Laboratory of Scientific Approaches in the History of Nursing (LACENF, in Portuguese).  This group has developed and validated activities as part of the Laboratory of Research in the History of Nursing (LAPHE, in Portuguese), which is associated with the Alfredo Pinto School of Nursing (EEAP, in Portuguese) of the Rio de Janeiro State Federal University (UNIRIO, in Portuguese).

 

METHOD

Conceptual Aspects and Methodological Proceedings
This a study performed under the perspective of new Cultural History of the historian Roger Chartier, and is based on documentary analysis. The present investigation follows the methodological proceedings already adopted in a study entitled “The Contributions of Preventive Medicine in the Re-dimensioning of the Practices of Nursing in Brazil (1977 – 1980)”(3). It was considered that minutes could be used as a source of information, allowing us to identify general principles and rules that regulated the relationships that were established among the different groups(4). However, the documents were not only seen as a source of information, but as something that we could analyze, interpret and comprehend in such a way as to produce certain historical information. The proposal of the analysis was that a text is always a carrier of a discourse and, as such, it cannot be seen as something transparent(5).

This study is part of a Master’s Dissertation entitled “Fundraising and Necessities of Nursing in Brazil: from research to publication (1956 - 1980)”, presented in March 2011, as a requisite of the Post-Graduate Nursing Program of the Center of Biological  and Health Sciences of the Rio de Janeiro State Federal University (UNIRIO).

As a preferential source, the document used in this study was one entitled “Fundraising and Necessities of Nursing in Brazil”, edited by the Brazilian Nursing Association, and published in 1980. During the study, a copy from the Library of ABEn in Brasilia was used, together with an original version lent by the researcher, Taka Oguisso, from her private files. Other documents were used to undertake the analysis of the conditions which pertained at that time, and which resulted in the publication of “Fundraising and necessities of Nursing in Brazil”. These sources were reports, minutes and publications selected from the ABEn-RJ library. Other collections were also used: the Sectorial Archive of Nurse Maria de Castro Pamphiro and the Laboratory of Scientific Approaches in the History of Nursing, both in the School of Nursing Alfredo Pinto; the EEAN Library, and some personal files of the researchers.

The historiography of nursing in Brazil and of health education counted as a side issue in the literature for the analysis and interpretations of the study. This was available from the Bank of Texts of the Laboratory of Researches in the History of Nursing of EEAP/UNIRIO.

We decided to limit the period of study to the years between 1939 and 1955 that preceeded the years of research of the LRNEB (1956 to 1958).  This was the period of time in which we were able to identify the demands that led to the undertaking of the study “Fundraising and Necessities of Nursing in Brazil”. It was also important to determine this time frame so that we could link the demands and the conditions associated with the production of the LRNEB.

The analysis and the interpretation of the information were done through a search of the relationships between the data obtained in the documents and the historiographical production of this study. Then, after gathering all the necessary information, the historical operation was to dissect and critique the group of available documents, determine the order of the many components of the studied topic, and the construction of an interpretation which would give them coherence and meaning(6).

 

RESULTS

The Basis for the First Institutional Research into Nursing in Brazil
When characterizing the conditions that aided the development of the research entitled “Fundraising and the Necessities of Nursing in Brazil”, it is possible to observe a vast network of public institutions, sectors and field agents and places that came together and crisscrossed, built and undertook the above-mentioned study.
In relation to that, Samara & Tupy affirm that:

(…) A text, first and foremost, is the physical representation of the language. Its decoding imposes the knowledge of the very precise context in which it was produced or was produced by… Then, identifying with precision the symbology contained in a written text implies, initially, to establish the historical context of a document, not only defining the connection among its contents and the time it was produced, but also recognizing its authors. (6:121-122)

Within this perspective, the descriptions of some historical aspects that can contribute to the composition of contextual approximations will be provided, in order to understand its vast scientific and economic support, which led to the first investigation into Brazilian nursing. Besides that, this investigation is also a b symbolic landmark, because it delimited the generation of pioneer researchers into nursing in Brazil.

Necessities of Brazilian Nursing
The preoccupation of the Association of Brazilian National Graduated Nurses (ANEDB, in Portuguese, from 1929 to 1944) with the publication of contents of wide interest to nursing started at the end of 1920.

By the end of the decade, in 1929, members of this Association participated in a Congress of the International Counsel of Nurses (ICN) in Montreal, Canada. Right after this, the first discussions aimed at the creation of a Brazilian nursing journal commenced. This then generated the “Annaes de Enfermagem” (in English, “Annals of Nursing”, today’s “Revista Brasileira de Enfermagem”, or REBEn, which in English is “Brazilian Nursing Magazine”), the first magazine for Brazilian nursing, first published in 1932(7).

In a meeting in 1944 with the objective of reformulating the Association’s statute (the first amendment was in 1929), the representatives of the body promoted, among other alterations, a change in the name of the Association.  It was consequently named the Association of Brazilian Graduated Nurses (ABED, in Portuguese, from 1944 to 1954). This denomination lasted until 1954, when, during a General Assembly, the institution then renamed itself the Brazilian Nursing Association (ABEn, in Portuguese), and its official organ of communication the Brazilian Nursing Magazine(1). Both titles continue until today.

After many changes, the Association was considered to be a nationwide non-governmental private body, recognized as being of public utility according to Federal Decree #31.417/1952 published on the Brazilian Union’s Official Journal on September 11th 1952.

Because it had, in the Presidency, nurses who occupied high hierarchical positions in the health sector (such as the Ministry and some higher education institutions), the Brazilian Nursing Association was always asked by national institutions or international ones to give information about the exact number of existing and active nurses (1).

The interest in the nursing situation in the country was first called attention to in 1939. In April of that year, the President of the Association at that time, Hilda Anna Krisch (from 1938 to 1941 mandate), informed the Association that letters had been sent to the states of Brazil asking for the necessary information with regard to the nursing situation. However, the answers obtained were not considered satisfactory(1). The necessity for an inquiry that could provide these data was increasingly evident as nurses were being employed throughout the country, integrated to local and regional official health organizations. It was known, at that time, that any type of planning referring to public health, or to professional matters, demanded a bigger and deeper understanding of the category. It was the Association’s duty to gather and store this information, updating it whenever needed, as there was no other public agency responsible for the task.

Investigative Essays
The first study with this objective was performed in 1950, even though, since 1946, the Nursing Section of the Sanitary Organization Division (DOS, in Portuguese) of the Brazilian National Health Department (DNS, in Portuguese), a division of the Brazilian Ministry of Education and Health, had made efforts to get real data about the nursing personnel situation. The nurse, Isaura B. Lima, indicated that this effort was to identify both Brazilian nurses and foreign ones who were working in the field. Only by doing so, she said, could the disclosure of the true situation be achieved(8).

However, without the resources and the necessary support, this could not be successful. Only four years later, a study was carried out with the collaboration of the ABED, the Division of Education of Special Services in Public Health and the General Board of Directors of the DNS(1).

To chair the future census, Ms. Izaura Barbosa Lima was selected because she was the Head of the Section of Nursing of DOS. She was also nominated as ABED’s representative. Ms. Lima was able to create a group of professionals in the Federal District and in other states, and developed the Census Commission. Waleska Paixão, Clara Curtis, Haydée G. Dourado, Rosa de Paula Barbosa and Mirabel Smith Ferreira Jorge made up this Commission(1).

The final report of this first study on a national level was released at the 4th Brazilian National Congress of Nursing in 1950. It had a number of recommendations to be considered: the creation of a nursing section in the National Service of the Supervision of Medicine that, among other functions, should maintain an up-to-date register of graduated nurses in Brazil, and the undertaking of similar research to that of the census every five years, including other occupational categories(8).

This request of the nursing representatives indicated that the professional and occupational segments of this area were not easily qualitatively and quantitatively diagnosed. The recommendation indicated that the role of the National Service of the Supervision of Medicine was little integrated with the main nursing body in the form of the Brazilian Association of Graduated Nurses. This Association participated in all discussions related to the development of the profession, even though it didn’t at that time have the legal status to perform any supervision or to investigate the professionalism of nurses. ABED also did not have a database of nursing professionals, which would have provided easy access to the supervising institution, as the Association only had the information with regard to those who were members.

It is also important to say that, in terms of the conclusions of the study, some aspects weakened the proposals and demonstrated the necessity for a greater effort in any future census of that nature. Among the observed faults there was the distribution of questionnaires to the nurses in the country, in that only 40.39% answered. This was a clear message that it was impossible to create a real picture of the nursing situation at that time. Another weakness was the failure on the part of the respondents to adequately complete the questionnaire, which led to vague answers. In the end, it was concluded that the performance of a task of this nature required more time and greater financial resources, among other pre-requisites, to better identify and analyze the nursing situation in Brazil(8).

The nurses attending the 4th Congress decided to respond to the pleas in the report and recommended that the ABED meet with representatives of the Ministry of Education and Health, in order to “…create a Section of Nursing in the Brazilian National Department of Health”. The Association should also “…get support from the Ministry of Education and Health, to perform periodically a census of graduated nurses and the many categories of nursing assistant personnel”(1).

 

DISCUSSION

In 1951, the President of the Commission of Cultural and Professional Exchange, Ms. Clara Curtis, informed WHO?? that the First Reunion of Technicians in Nursing of the World Health Organization (WHO) recommended that all countries should engage specialized technicians to perform a study of national nursing resources. The WHO offered assistance to the countries that needed it in order to ensure a certain uniformity in tems of the studies. For this to happen, and as a first step, it should be done under the auspicies of WHO. A “Guide for National Studies of the Resources of Nursing” could be used by the countries involved, if needed(1).

The 5th Brazilian National Congress of Nursing in 1951 considered the WHO proposal as being of great importance for the future plans of nursing in Brazil and for exchanges with other countries in the technical assistance field. Therefore, the Exchange Commission proposed that the Congress recommended to ABED that it considered “…the possibility to perform, in the near future, a study of nursing resources in Brazil”. They also recommended that “…the Association contacted the National Commission of Technical Assistance to study the possibility of receiving and giving technical assistance in nursing”. In spite of the importance of the subject, as it was reported in the LRNEB study, the first recommendation was not even appreciated by the plenary(1).

The request from the Ministry of Education and Health for information about nursing in Brazil was even more insistant(1). At the same time, the former desire to quantify Brazilian  resources and necessities did not diminish, as well as the wish to learn about its quantitative and qualitative deficiencies. In 1952, the editors of the Annals of Nursing had the opportunity to satisfactorily register a demand for information on the part of the nurses of the United States about the development of Nursing Schools in that country. They observed, in the request, evidence that “…the profession was already imposing itself as an activity […] considered relevant, with projections beyond our borders”.

On 11th July 1951, the Campaign for the Improvement of Personnel of University Level (CAPES, in Portuguese) was launched by Decree 29,741, under the direct control of the educator, Anísio Spínola Teixeira, with the objective “…to ensure the existence of specialized personnel in enough quantity and quality to answer the needs of public and private enterprises that aim to ensure the development of the country". Professor Teixeira was designated as the General Secretary of the Commission.

This Commission was created under the presidency of the Ministry of Education and Health, and composed of representatives of the Ministry of Education and Health, the Administrative Department of Public Service (DASP, in Portuguese), the Getúlio Vargas Foundation, the Bank of Brazil, the National Commission of Technical Assistance, the Brazil-USA Joint Commission, the Research National Counsel, the Brazilian Institute of Geography and Statistics and the National Confederation of Commerce. The name of the Commission was later changed to “Coordination of Improvement of University Level Personnel”, keeping the same acronym CAPES(1).

Professor Teixeira asked Ms. Haydée G. Dourado, in 1952, to make an quantitative estimate of the need for nursing staff. It was indicated, then, that there was a need for a special commission to study the topic, under the presidency of this nurse. The Commission’s  elaborated plan had the following objectives: to undertake a survey of existing nurses and the need for additional nurses and auxiliary staff; to clarify the deficiencies in terms of the provision of nurses and auxiliary staff, and to present suggestions aimed at overcoming these deficiencies(1, 9).

The survey referring to auxiliary staff was performed using, as a source, information from the Division of Sanitary Organization and the Division of Hospital Organization. In relation to the nurses, the source was the 1950 Census. In a study published in 1954, Lourival Ribeiro, the President of the Brazilian Society of Tuberculosis at the time, analyzed the rise in the number of nurses between 1933 and 1952. Ribeiro mentioned the calculations by ABED about the need for nurses in hospitals, public health service institutions, clinics, teaching and private services.

In 1954, the W. K. Kellogg Foundation asked that ABED to fill in a questionnaire providing complete information about the situation of nursing schools in Brazil. The information collected involved enrolled undergraduate or graduate students, andthe ones who had recently finished such programs, the teaching body and the legislation at the time. As a result, the directory of the Division of Education of ABED met, in February of that year, to discuss the matter. At this point, Haydée G. Dourado proposed that the Commission had indicated the need to undertake a study of nursing needs in Brazil. In spite of the arguments of Ms. Maria Rosa S. Pinheiro about the difficulties that ABED would have in performing such an investigation, the proposal was approved such that the Commission should “…search for an institution to perform such a study”. The topic was raised during the 7th Congress in August 1954 in São Paulo, for a wider discussion(1).

In this congress, Ms. Izaura Barbosa Lima, President of the Special Commission on Statistical Survey, presented an extensive report on the paper that this Commission had published at the request of the President of ABED. The study, which had added other informative elements beyond those asked for by the President, had many observations to make, such as the number and the administrative subordination of the nursing schools, the number of auxiliary staff throughout the country, supporting sources, the number of students in both careers from 1917 to May 1954, and the average number of graduates of each nursing school per annum. The paper also provided data related to the network of general hospitals, maternity units, tuberculosis clinics, institutions of mental health and psychiatric assistance, the number of beds available to the public and the number of bed-inhabitants in 1950, and also the budget for nursing schools from 1948 to 1954. As a conclusion to this report, the Commission suggested that the 7th Brazilian National Congress of Nursing advise the ABED to maintain a permanent updated file of the data collected in order to contribute with exact documentation for the planning of medical-sanitary services and the teaching of nursing for the country as a whole(10). However, this recommendation was against the imposed limitations set ABED’s bylaws, as it was observed that only nurses could be members of the organization.   As a result, the Association would be restricted to the data of the members. In contrast, the government’s supervising body and the institutions that employed the nursing workforce would have easier access to such information.

The two proposals, Ms. Dourado’s and the other from the Special Commission on Statistical Survey, were accepted by the Congress which approved the following recommendations to ABED (and it is good to remember that during this period, the Association was being pressed to give its opinion about Project 2,991/53, which would allow the entrance of the candidates who had finished the first year of High School into Nursing Schools): “Keep the register of nurses and its information files about the education and exercise of nursing always up-to-date; study the needs for nursing in the country and the level of professional formation; verify if it is sufficient to face the challenges of the profession; kindly ask Mr. Deputy Lauro Cruz to wait for the appreciation of this Association until March 1955. ABED would later report, to the Commission of Education and Culture, of the Brazilian Federal Deputies Chamber, their findings about Bill Project 2,991/53”(9,1). In a recorded interview given to the Special Commission of the Review of Data Survey, for further publication, Ms. Maria Rosa S. Pinheiro said:

In this situation I was recently elected the President of ABEn for the next two years. And I was shocked with this delegation, with this recommendation to ABEn. And I stood up at the moment of the voting to protest, to say that ABEn did not have resources to undertake such a survey. But the Assembly didn’t even care, and voted for the recommendation(1).

In this Congress, the participating groups that studied the position of the departments of nursing in modern hospitals - one of the official topics - demonstrated how the problem was negatively affecting the nurses. Based on this study, it was recommended that ABEn should organize tables of reference, based on national needs, that could help to plan the number and type of nursing personnel needed to allow the functioning of every hospital, according to its specialty.

In November 1954, the Board of Directors discussed the initiatives that needed to be taken to put into practice the resolutions of the Congress, and decided, among many items, that an annual inquiry with regard to Nursing Schools to obtain the most urgent information that was needed, should start in January 1955. According to the following speech, Resolution 14 of the Congress, which recommended the study of nursing needs in the country, had to be discussed in the following meeting:

The working plans of the Association, the need for answers to the government’s demands to aid the profession, and the responsibility to clarify the public needs, make it clear that a study of this nature needs to be done. Without the real data that it would present as a final result, ABEn could hardly elaborate well-based future plans or justify, with solid arguments, any solicitation in favor of nursing. It wouldn’t an easy task, especially in such a large country(1:298).

The observation of the nursing situation, in quantitative and qualitative terms, was a real necessity for the profession, as was demonstrated clearly in 1939. Other demands, including those from international bodies, came up later and consequently, with the rise and development of the profession, it was each and everyday increasingly visible that a study of the general aspect of nursing was necessary, and the data had to be updated. Because of a lack of resources and an adequate structure to perform this survey, ABEn was not even able to deliver a complete and flawless survey that could answer the needs of the profession and the request of the bodies interested in this data.

 

CONCLUSION

The ABEn, in its history, had many national and international requests for information about the numeric and qualitative status of the staff and the nursing services which existed in Brazil. The demands were many until the Association was able to organize and put in practice a study to respond to such requests.

Besides, although it was always asked for such data, the Association encountered some difficulties when it came to executing a study in order to provide such data. The reason was well known.  There was the lack of resources and an adequate structure to carry out such a complex task.

However, the demands were also important. There was a latent need to be aware of the real nursing situation through a complete study that detailed the reality of the times. This was the only way to adequately plan for the future of Brazilian nursing. At that time, there was a non-stop struggle for funds and for developing a network involving different institutes, sectors, field agents and areas. This mobilization aimed to put into place a research effort that could generate a perfect picture of the nursing situation as it was practiced in Brazil.

The Fundraising and Necessities of Nursing in Brazil (LRNEB, in Portuguese) was research that project answered those needs and demands. Developed between 1956 and 1958, the LRNEB was performed under the responsibility of ABEn, with technical assistance provided by the WHO (Pan-American Sanitary Partition), the Brazilian Ministry of Education and Culture, the Brazilian Ministry of Health, CAPES, the Special Service of Public Health (SESP, in Portuguese) and the Brazilian Institute of Geography and Statistics (IBGE, in Portuguese). The research was financed by the Rockefeller Foundation and had the collaboration of a great number of public, private, civil and religious institutions.

Considering to be the first research project associated with nursing on a national level, LRNEB provided a picture of Brazilian nursing until 1956 and put forward, in its final report, 46 recommendations with regard to many Brazilian institutions.

Therefore, the development of the  LRNEB study had a special motivation. Even though it was considered an important development in the history of Brazilian nursing, and is still used today in many studies, it is unfortunate that it is often unknown to the majority of professionals  and is not widely recognized by those who work in the field.

 

REFERENCES

1. Carvalho AC. Associação Brasileira de Enfermagem (1926 – 1976): Documentário. Brasília (DF): ABEn; 1976.

2. Duarte GG, Angerami ELS, Gomes DLS, Mendes IJM. Vida média de labor dos enfermeiros egressos da escola de enfermagem de Ribeirão Preto, USP – Brasil. Rev latino-am enfermagem. 2000;8(6): 91-5.

3. Mendonça ET, Amorim WM de, Porto FR. The contributions of Preventive Medicine at the resizing of the practice of nursing in Brazil (1977-1980). Online braz j nurs [ serial in the internet ]. 2011 [ cited 2011 jul 30 ]  10 (1). Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/j.1676-4285.2011.3212.1/html

4. Alves-Massaotti AJ, Gewandsznajder F. O método em ciências sociais: pesquisa quantitativa e qualitativa. São Paulo (SP): Pioneira; 1998.

5. Cardoso CF, Vainfas R. Domínios da História: ensaios de teoria e metodologia. 5ª ed. Rio de Janeiro: Campus; 1997.

6. Samara EM, Tupy ISST. História & Documento e Metodologia de Pesquisa. Belo Horizonte: Autêntica; 2007.

7. Mancia JR, Padilha MICS. Trajetória de Edith Magalhães Fraenkel. Rev Bras Enferm. 2006; 59(esp): 432-7.

8. Lima IB. Aspectos da Situação da Enfermagem no Brasil. Rio de Janeiro: Divisão de Organização Sanitária; 1950.

9. Associação Brasileira de Enfermagem. Levantamento de recursos e necessidades em enfermagem no Brasil, 1956–1958. Brasília: Associação Brasileira de Enfermagem; 1980.

10. Lima IB. Relatório da Comissão Especial de Levantamento Estatístico. Rio de Janeiro: ABEn; 1954.

 

 

Received: 28/09/2011
Approved: 23/07/2012