ORIGINAL

Perceptions of nursing students about the professional recognition in pandemic times: a descriptive-exploratory study

Norma Valéria Dantas de Oliveira Souza1, Marcia de Souza Silva1, Anna Beatryz Marques Roque1, Desuite Helena Peçanha da Silva de Araujo1, Raquel Soares Pedro1, Giulia Campbell Saija1, Sheila Nascimento Pereira de Farias2, Samira Silva Santos Soares1

1State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil

2Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil

ABSTRACT

Objective: To analyze undergraduate nursing students' perception of professional recognition and the situations that enhance or diminish this issue. Method: A qualitative research was conducted with 40 nursing students from a public university in Rio de Janeiro. The data collection technique was a semi-structured interview conducted between May and June 2021. The Interface de R pour les Analyzes Multidimensionnelles de Textes et de Questionnaires (Iramuteq) software was used for data processing. Results: The performance of nurses during the pandemic and the embracement during care services enhanced professional recognition. Historical issues, gender, and the technical and social division of labor negatively impacted professional recognition, in addition to failures in the execution of clinical procedures. Conclusion: Despite the media's relevant emphasis on nursing, the students consider that society's mistaken perception of nursing work affects the profession's recognition.

Descriptores: Work; Social Desirability; Students, Nursing.

INTRODUCTION

The work of nursing focuses on caring for human beings, aiming at promoting health, preventing injuries, and contributing to the cure and rehabilitation of patients in the health-disease process. Nursing is a relevant profession for society since health, or the lack of it, in a macrostructural scope, impacts the economy, politics, education, and public safety. Furthermore, in the subjective dimension of human beings, the absence of health results in psychophysical and social suffering for patients and their families(1). However, a study points to low professional nursing recognition in the Brazilian context, despite its relevance to society(2).

This situation is reflected in disproportionate and outdated wages compared to the work undertaken and the prevailing economic indices, long and exhausting workdays, inadequate and unworthy environments for resting, sleeping, or eating at work, high and exhausting work pace imposed by the under sizing of personnel, and inappropriate working conditions that almost make the work process unfeasible, due to the qualitative and quantitative scarcity of material resources(3).

Professional recognition is not a minor issue but an element that protects and strengthens the worker's subjectivity. In this perspective, professional recognition eases the worker's usual daily experiences of suffering and, at the same time, fosters a sense of belonging and job satisfaction(4).

Work has personal and social value, imprinting subjective ties on the subject, causing both well-being and malaise, the latter also being mobilized by the lack of recognition at work, which can negatively affect workers' health, inappropriately impacting the quality of the service offered(5).

It is important to consider the centrality that nurses play in the organization of the health sector and the assistance provided. This fact was symbolically recognized by society and the media during the Covid-19 pandemic(6). However, this recognition still proved contradictory because, despite the applause and honors received, these professionals were faced daily with inadequate working conditions causing illnesses and death of many professionals during the pandemic(7).

From the point of view of the challenges for the material recognition of nursing work, it appears, for example, that even after the approval and sanction of the Law that deals with the profession's minimum salary and the respective sources of funding, professionals still await the concreteness of these acts in the paychecks of the category(8). This fact indicates that, among other aspects, nursing students need, throughout their training, to develop critical-reflective thinking and appropriate political skill, engage in political debates, and struggle for the appreciation and recognition of the profession.

In this sense, we considered it relevant to investigate how undergraduate students initially evidence the recognition of nursing from the perspective they bring from the social contexts in which they are inserted, in line with the experiences, even if preliminary, arising from their training process. Through this angle, we seek to capture the perception that is little or not at all impregnated with acting in the world of work based on what surrounds society.

A bibliographical search for studies on the theme identified a gap in scientific knowledge, as we found only one study approaching the theme, published in 2014 and nationally(9). Given the problem surrounding the present study's theme, we outlined the following objective: to analyze undergraduate nursing students' perception of professional recognition and the situations that enhance or diminish this issue.

METHOD

This study is characterized as qualitative, descriptive, and exploratory, conducted at a public university in Rio de Janeiro, Brazil. The participants were 40 undergraduate nursing students from a universe of 355 students enrolled in the nine terms of the program.

An electronic form was used in the participants' recruitment step, comprising the Free and Informed Consent Form and closed questions referring to the participants' profiles. The class representatives were asked to forward the form via messaging application (WhatsApp) or electronic mail to the respective classes as an invitation to participate in the research. As those interested in contributing to the research filled out the electronic form, contact was established to continue data collection.

The information recurrence criterion was considered to determine the number of participants, which becomes applicable when the information content is repeated, indicating the possibility of ending the collection and signaling data saturation.

It should be noted that, due to the health situation in the country resulting from the Covid-19 pandemic, it was impossible to hold a face-to-face meeting with the participants, as the health authorities instituted isolation and social distancing measures.

Students from the nine terms of the program were contacted, as it was understood to be important to capture different and comprehensive perspectives on the subject. The inclusion criteria of the participants were: to be a student, regardless of gender, aged 18 years and over, and to be a high school graduate from private or public institutions. The exclusion criterion was being away from the institution due to illness or withdrawal during the data collection period.

Data were collected from May to June 2021 through the semi-structured interview technique. The interview script contained three questions: "talk about your perception of professional nursing recognition", "discuss situations that enhance nursing professional recognition," and "talk about situations that may weaken nursing professional recognition". The interviews were recorded using a telephone device and later transcribed by the research team. The average duration of the interviews was 30 minutes, and the content transcription accounted for 40 pages, single-spaced, and in Times New Roman font size 12.

The Interface de R pour les Analyzes Multidimensionnelles de Textes et de Questionnaires (Iramuteq) software was used for data processing, allowing the performance of statistical analyzes on texts(10). Iramuteq has five possibilities for data analysis: lexicographical analysis, search by group specificity, descending hierarchical classification, similarity analysis, and word cloud. Our study adopted lexical analysis using a word cloud graphically displaying words according to frequency. The bigger the words appear, the more frequent they are in the analyzed content, and the smaller the words, the less frequent they are(10).

From the treatment of the data carried out through Iramuteq, the meaning of the words was interpreted, and when accessing the text segments in which the words appeared, the most frequent lexicon made sense concerning the context of the discussion. The data was interpreted by establishing comparisons with the literature on the study subject.

The research project was submitted to the Research Ethics Committee (CEP) of the State University of Rio de Janeiro (UERJ) and followed Resolution 466/12, being approved through opinion 4,681,711. In order to guarantee the anonymity of the participants, codes were created using the letter E for evaluation and a cardinal number denoting the sequence in which these interviews were carried out.

It is also noteworthy that the study considered the Consolidated Criteria for Reporting Qualitative Research (COREQ) and the Standard for Reporting Qualitative Research (SRQR) tools that support qualitative investigations and are recurrently used in investigations similar to ours(3,7).

RESULTS

The characterization of the participants showed that 35 (87.5%) were female and five (12.5%) were male. The average age was 24.2 years. Regarding the type of high school, 18 (45%) graduates completed high school in a public institute, while 22 (55%) completed in a private institute. As for the distribution of participants by term, the following results were obtained: four participants were at the 1st term, five at the 2nd, one at the 3rd, three at the 4th, four at the 5th, 12 at the 6th, three at the 7th, four at the 8th, and four at the 9th.

Through the word cloud method, we identified that some words appeared more frequently: vaccine/vaccination, procedure, wrong, nursing technician, bed, medication, apply, and care, among others. From the investigation of these words in the text segments, it was possible to identify the results that enabled the achievement of the study objective.

Figure 1 represents the word cloud generated by Iramuteq. The bigger words were the most cited; consequently, the smaller ones were the least incident words in the interviews.

Source: Prepared by the authors, 2022.

Figure 1 - Word cloud generated by Iramuteq. Rio de Janeiro, RJ, Brazil, 2022

The analysis of the word cloud and text segments revealed some situations that enhance professional recognition and other aspects that negatively impact this issue.

Situations that enhance professional recognition

The Covid-19 pandemic was important in strengthening nursing recognition, highlighting the relevant role of nurses in vaccination campaigns against the new coronavirus.

I think that mainly because of the Covid-19 pandemic, the nurse is very much in evidence, the nurse who is on the side of the patient, the nurse who has been carrying out the whole process and campaigns about vaccination, that is it. I think it has been putting nurses in evidence. (E12)

Embracement during care services was also highlighted, making it possible to create bonds and a relationship of trust with patients and family members. In order to facilitate that objective, professionals must be willing to care, listen, adapt to the patient's language, and clarify possible procedures that may be necessary. The professional's seriousness and competence make the patient feel special; in this way, nurses earn respect and admiration, enhancing recognition.

Strengthening our profession through empathetic care, providing care in a better way, with more attention, and understanding that each patient is unique, each person is unique and has a life context. We need to embrace the patient. (E14)

Aspects that negatively impact professional recognition

Despite the scientific knowledge, competencies, and nursing skills, society summarizes nursing activities based on procedures such as bed baths, changing dressings, and measuring vital signs. These practices are indispensable in health care, but there must be a social understanding that nursing practice goes beyond these procedures.

We are not there only to give bed baths or to change dressings but to provide humanized, scientific, and holistic care that involves many other things. For people unfamiliar with this area, it can look silly, but we know that it makes a difference in evidence-based care for the recovery of the patient's health. (E2)

Another mistaken perception of society, in general, is that nursing is submissive to medicine and that nurses and technicians have similar roles.

We still have much difficulty making our identity transparent within the hospital and with the patients, because if we don't arrive and introduce ourselves, sometimes we are treated as physicians, then we say: no, I'm from nursing. Or everyone thinks we are nursing technicians. (E35)

It turns out that there is still a lot of that view that the nurse is the doctor's assistant, especially on the part of people who are hospitalized, who sometimes have much difficulty identifying who is each one inside the hospital, so much so that sometimes they do not know how to identify who we are. We are nurses, not doctors. (E9)

Participants highlighted that nurses sometimes do not have appropriate knowledge nor assume their own autonomy, remaining at the mercy of the final decision of other professionals. These omissions and the lack of initiative strengthen the perception that nursing is a coadjuvant in people's health-disease process, weakening the profession's professional and social recognition.

Many professionals who do not see that they have autonomy and are also holders of knowledge are very submissive to doctors and accept any decision that doctors make. So, I think this contributes to the view that we are just doctors' assistants. (E27)

Another aspect that emerged was the mistakes made during labor processes. The administration of wrong medications is one of the main nursing mistakes. This adverse event, even when committed by a single person, affects the entire category, which loses credit in the work and social environments, especially when the media publicizes the cases.

The provision of the service itself can bring recognition, as it can interfere with this recognition, either due to a medication error or a service that was not done as it should have. (E38)

Thus, on the one hand, the vaccination campaign against Covid-19 highlighted the important work of nurses; on the other hand, errors in the application of vaccines, such as the so-called "wind vaccines" not containing the immunizer, as well as the theft of vials with the doses, which quickly spread through the media, weakened professional recognition.

Seeing professionals, both nursing technicians and nurses, getting and taking the vaccines home, stealing, or injecting "wind vaccines" was bad for us. We were frowned upon both by colleagues and by society. (E1)

DISCUSSION

Considering the students' perspectives evidenced through the word cloud and text segments, we verified that the advent of Covid-19 had a dialectical role in the professional recognition of nursing and the social visibility of the profession. Some facts positively impacted this recognition, but, on the other hand, some situations negatively impacted this identification.

Covid-19 is an infectious disease caused by a new type of coronavirus whose first identification occurred in December 2019, in Wuhan, China, with an appearance in Brazil in February 2020(11). Given this situation, vaccination against Covid-19 proved to be one of the main measures to mitigate the individual and social impacts of the disease(12).

In this context, the role of nurses in vaccination practices is well characterized since the category assumes the technical responsibility of the sector in primary health care units, where vaccines are administered. Around this practice are counseling and adherence to vaccination, bringing the population closer to the actions offered by health units with the possible creation of bonds, the generation of epidemiological data on vaccination coverage, safety practices in the administration and conservation of vaccines, and handling and disposal of waste(8).

Specifically for nurses, the context of the Covid-19 pandemic made it possible to disclose a part of their unique work, acting on the front line of this health crisis(13). Vaccines were developed and approved as the pandemic progressed, making it possible to start vaccination campaigns conducted mainly by nurses. However, situations such as the administration of empty syringes not containing the immunizer and the theft of vials with doses, attributed to some nursing professionals, quickly spread through the media, weakening the profession's recognition(14).

It should also be noted that mistakes in nursing care are associated with the category's workforce, such as a shortage of professionals, work overload, lack of training, long working hours, and increased turnover of professionals. These situations highlighted by the students generate low concentration and attention, leading to errors(15).

Nursing work is based on competencies understood as the foundation for effective management, care, teaching, and research practices. Thus, this set of knowledge and skills is inherent to the scientific care exercised by the profession. Nursing professionals carry out their activities in different scenarios, dealing with social and political changes that require a holistic view and the ability to assess the context in which patients are inserted. Thus, professionals need to be able to assess, plan and implement actions in the different scenarios of action surrounding the health-disease process(16).

Considering what was highlighted by the participants, it is emphasized that care, the object of nursing work, needs to be evidenced in teaching and nursing care with the understanding of its uniqueness and must be exercised integrally, that is, attending to all the needs presented by those who are being taken care of. Moreover, this care must be provided with ethical and moral commitment(17). It is also emphasized that it is necessary to dialogue with society about the numerous areas of nursing activity, the skills and abilities of these professionals, and the technical division of work. It is also necessary to clarify the role of nurses in the health team and the different contexts of action, thus deconstructing the popular view that gives medicine a status of power. Such a view creates a hierarchy in which doctors are at the top of a vertical relationship, with skills acquired from qualification processes to the detriment of the functions performed by nurses. In turn, such functions would be linked to feminine qualities, requiring a submissive attitude towards other professionals (especially male professionals)(1,3).

Furthermore, as a historically female profession, nursing still needs to overcome the social inequalities and injustices arising from the social, gender, and sexual division of labor, which is anchored in concepts that establish the male skills to the detriment of female functions – the qualification process is linked to the qualities of sex.

It is noteworthy that, whatever the care practice and place of insertion, the nursing profession must be able to perform functions with theoretical and scientific basis and interference capacity, with the potential to contribute to improvements in the health processes of individuals. It is also relevant to think that, in the practice of care, different types of scientific technologies help nurses fulfill the social function of providing care to individuals(18).

This evidence-based care generates positive impacts on work practice and helps in decision-making. Thus, the scientific nature of nursing is assumed, which elevates the profession to being a producer and consumer of science and differentiates professional practice, whose knowledge has a deep foundation that supports it, in addition to strengthening its social relevance(19).

However, there are reasons why the population makes mistakes or has a superficial understanding of nursing, for example, not differentiating the nurse from the nursing technician, as evidenced in the texts highlighted in the study results. In this context, social differentiation often does not happen because society is unaware of the role of the nursing technician and the nurse and their attributions in the nursing team(20).

A study reveals that nursing technicians often perform the work nurses should perform, even though many of these activities are exclusive to these professionals, such as collecting arterial blood gases and performing urinary catheter insertion, among others(20). Therefore, the population's inability to differentiate between nurses and nursing technicians also occurs due to the improper delegation of activities.

The students pointed out another aspect that deserves mention, related to the profession's autonomy. Autonomy can be understood as moral and intellectual freedom or independence so that the individual can make decisions based on his values. In order to bring new meaning to professional practice, nurses must base their actions on a Code of Ethics, which has rights, responsibilities, duties, prohibitions, and legislation. According to the Code of Ethics, nurses must act autonomously and under ethical and legal principles, with technical, scientific, and philosophical rigor, respecting the integrality of the patient(21).

In this perspective, the scientific nature of the profession is directly related to autonomy, allowing the execution of activities competently and resolutely. To promote practice based on science, the Brazilian Federal Council of Nursing (COFEN), through Resolution 358/2009, established the Systematization of Nursing Assistance (SNA) in order to organize the work in terms of method, personnel, and instruments, enabling the execution of the nursing process and standardizing it. Thus, the SNA becomes an important tool to promote and protect nursing autonomy. However, some difficulties, such as lack of interest, lack of time, lack of knowledge, and the great demand of patients, resulted in low adherence to this work method in the reality of professionals from many health institutions(23).

Nursing professionals are responsible for a series of care and management activities, and in order to develop their attributions in line with scientific and technological advances, permanent updating is necessary. In this context, Evidence-Based Practice (EBP) has proven to be a useful tool. EBP is a movement that started in Canada and aims to improve health care and education(24).

EBP encompasses three inseparable components, clinical experience, patient preference, and scientific evidence. In this sense, it is based on encouraging the use of research results to address the population's health problems resolutely and satisfactorily, combined with user choices and clinical practice, as well as to assist in decision-making(24).

Medical errors often involve the nursing profession, which culminates in the devaluation of the profession, especially when there is media coverage. However, little is reported about the working conditions to which nursing professionals are submitted, such as work overload, low wages, and the need for multiple jobs, which culminates in tiredness, poor attention/concentration, lack of material and personal resources, and high workload. These factors make nurses more vulnerable and favor the occurrence of incidents(25).

Other important aspects that emerged in the text segments were embracement and empathy during nursing care. Empathy originated in Germany and can be defined as the ability to understand someone's emotional components and values, free of judgment, and to help them find ways to deal with life's adversities. Thus, the caregiver must have basic therapeutic tools, such as active listening, empathy, embracement, and bonding, enabling the construction of a relationship of trust(26).

Communication between the nurse and the client is one of the fundamental points in care through which it is possible to build bonds. The professional's interpersonal skills, knowledge, emotional intelligence, and attitudes are involved in this communication. According to these variables, achieving an integral and constructive relationship with the other makes him/her feel welcomed and legitimized in the emotional, cultural, psychic, and social dimensions. Otherwise, there will be difficulties, such as communication barriers and distance from the patient(26).

It is understood that the study's limitation concerned that data collection occurred in a single scenario, which has region-related and teaching specificities related to the institution's location. In this sense, the results may not be generalizable. However, this research can serve as an increment for multicenter studies that more comprehensively map nursing students' perceptions, covering the country's different regions, about the profession's recognition.

CONCLUSION

Given the results, it was possible to verify that the role of nursing in the pandemic and patient embracement during assistance were recognized as situations that enhance professional recognition. The recognition was negatively impacted by historical and gender issues and those related to the technical and social division of labor, in addition to failures in the execution of medical procedures.

Furthermore, nursing students considered that despite the relevant emphasis given by the media to nursing, there is still a mistaken perception of society about the work of this professional group. Therefore, it is essential to discuss professional recognition in the undergraduate context, outside it, and in different social spaces, bringing to society the relevant clarifications on the attributions and competencies of nursing.

*Paper extracted from the Master's Dissertation “Analysis of professional recognition from the perspective of undergraduate nurses in Covid-19 times” presented to the State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

CONFLICT OF INTERESTS

The authors have declared that there is no conflict of interests.

FUNDING

This paper was carried out with the support of The National Council for Scientific and Technological Development (CNPq). Process No. 306056/2020-8.

REFERENCES

1. Farah BF.  O cuidado e as competências da equipe de enfermagem no processo de trabalho em enfermagem [Internet].  Juiz de Fora:  Universidade Federal de Juiz de Fora; 2019 [cited 31 mar 2022].  Available from: https://www.ufjf.br/admenf/files/2019/02/Aula-2-O-cuidar-e-as-compet%C3%AAncias-da-eq uipe-de-enfermagemProcesso-de-trabalho-em-enfermagem.pdf

2. Soares SSS, Souza NVDO, Carvalho EC, Varella TCMML, Andrade KBS, Pereira SEM, et al. De cuidador a paciente: na pandemia da Covid-19, quem defende e cuida da enfermagem brasileira?  Esc Anna Nery.  2020;24(spe):e20200161.  https://doi.org/10.1590/2177-9465-EAN-2020-0161

3. Soares SSS, Lisboa MTL, Queiroz ABA, Silva KG, Leite, JCRAP, Souza NVDO.  Dupla jornada de trabalho na enfermagem:  dificuldades enfrentadas no mercado de trabalho e cotidiano laboral.  Esc Anna Nery.  2021;25(3):e20200380. https://doi.org/10.1590/2177-9465-EAN-2020-0380

4. Dejours C.  A metodologia em psicodinâmica do trabalho.  In:  Lancman S, Sznelman LI, organizadores.  Christophe Dejours:  da psicopatologia à psicodinâmica do trabalho. Rio de Janeiro: Fiocruz; 2011. p. 105-26.

5. Cassiani SHB, Munar Jimenez EF, Umpiérrez, Ferreira A, Peduzzi M, Leija Hernández C.  La situación de la enfermería en el mundo y la Región de las Américas en tiempos de la pandemia de Covid-19. Rev Panam Salud Publica [Internet].  2020;44:e64.   https://doi.org/10.26633/RPSP.2020.64

6. Organização Pan-Americana da Saúde.  Diretriz estratégica para a enfermagem na região das Américas [Internet].  Washington: OPAS; 2019 [cited 30 out 2021]. Available from: https://iris.paho.org/handle/10665.2/50956

7. Soares SSS, Souza NVDO, Varella TCMM, Andrade KBS, Pereira SRM, Carvalho EC. The leading role of Nursing in the vaccination against COVID-19 versus questionable irregularities: a descriptive-exploratory study. Online Braz J Nurs. 2022;21(suppl2):e20226558. https://doi.org/10.17665/1676-4285.2022.6558

8. Conselho Federal de Enfermagem (BR). Piso da Enfermagem: “A espera é longa, mas a vitória é certa” diz autor da lei [Internet]. Brasília: COFEN: 2023 [citado 20 mar 2023]. Available from: http://www.cofen.gov.br/piso-da-enfermagem-a-espera-e-longa-mas-a-vitoria-e-certa-diz-autor-da-lei_106388.html

9. Beck CLC, Prestes FC, Silva RM, Tavares JP, Prochnow A. Professional identity as perceived by nursing students: from professional activity to acknowledgement and enhancement. Rev Enferm UERJ [Internet]. 2014 [cited 2021 Jan 05];22(2):200-5. Available from: https://www.e-publicacoes.uerj.br/index.php/enfermagemuerj/article/view/13587/10397

10. Souza YSO, Gondim SMG, Carias IA, Batista JS, Machado DCM. O uso do software Iramuteq na análise de dados de entrevistas.  Pesqui Prat Psicossociais [Internet].  2020 [cited 03 ago 2021];15(2):e3283.  Avilable from:  http://www.seer.ufsj.edu.br/index.php/revista_ppp/article/view/3283

11. Organização Pan-Americana da Saúde.  Folha informativa:  OMS afirma que Covid-19 é agora caracterizada como pandemia [Internet]. Brasília: OPAS; 2013 [cited 18 out 2021]. Available  from:  https://www.paho.org/pt/news/11-3-2020-who-characterizes-covid-19-pandemic

12. Saenz C.  Por que todos nós devemos tomar a vacina contra a Covid-19? Boletim de Imunização [Internet].  2021 [cited 10 nov 2021];43(2):6.  Available from:  https://iris.paho.org/handle/10665.2/54584

13. Nascimento CCL, Monteiro DS, Rodrigues ILA, Nogueira LMV, Santos FV, Pereira AA.  Práticas de enfermeiros sobre imunização:  construção compartilhada de tecnologia educacional. Enferm Foco [Internet].  2021 [cited 11 nov 2021];12(2):305-11.  Available from:  http://revista.cofen.gov.br/index.php/enfermagem/article/view/4065

14. Góis ARS, Barbosa PFC.  Representações sociais sobre a enfermagem durante a pandemia da Covid-19.  Av Enferm.  2020;38(Suppl):21-31. https://doi.org/10.15446/av.enferm.v38n1supl.89498

15. Conselho Federal de Enfermagem (BR). Falsa aplicação de vacina: Cofen orienta como evitar e denunciar crime [Internet].  Brasília: COFEN:  2021 [citado 11 nov 2021]. http://www.cofen.gov.br/falsa-aplicacao-de-vacina-conselho-de-enfermagem-orienta-como-ev  itar-e-denunciar-crime_85659.html

16. Forte ECN, Pires DEP, Martins MMFPS, Padilha MICS, Schneider DG, Trindade LL.  Work process:  a basis for undertanding nursin errors. Rev Esc Enferm USP.  2019;53:e0348.  https://doi.org/10.1590/S1980-220X2018001803489

17. Bezerra Sobrinho A, Vasconcelos AKA, Leite-Salgueiro CDB. O cuidado integral como uma missão da enfermagem:  uma revisão de literatura.  Id.  On Line Rev Psicol. 2018;12(42):790-804.  https://doi.org/10.14295/idonline.v12i42.1412

18. Silva IR, Leite JL, Trevizan MA, Silva TP, José SAP. Conexões entre pesquisa e assistência:  desafios emergentes para a ciência, a inovação e a tecnologia na enfermagem. Texto & Contexto Enferm.  2017;26(4):e2470016. https://doi.org/10.1590/0104-07072017002470016

19. Nobre T, Rosa DOS. Sentido do compromisso com o cuidado de enfermagem. Cultura de los Cuidados. 2020;24(58):89-98. https://doi.org/10.14198/cuid.2020.58.09

20. Ferreira Junior ARF, Fontenele MEP, Albuquerque RAS, Gomes FMA, Rodrigues MENG.  A socialização profissional no percurso de técnico de enfermagem.  Trab Educ Saúde.  2018;16(3):1321-35. https://doi.org/10.1590/1981-7746-sol00152

21. Conselho Federal de Enfermagem (BR).  Resolução COFEN nº 564/2017.  Aprovar o novo Código de Ética dos Profissionais de Enfermagem, conforme o anexo desta Resolução, para observância e respeito dos profissionais de Enfermagem [Internet]. Brasília: COFEN; 2017 [cited 16 fev 2022].  Available from: http://www.cofen.gov.br/resolucao-cofenno-5642017_59145.html

22. Petry S, Teixeira Filho CA, Mazero M, Scneider DG, Martini JG. Autonomia da Enfermagem e sua Trajetória na Construção de uma Profissão. Hist Enferm Rev Eletronica [Internet]. 2019 [cited 16 fev 2022];10(1):66-75. Available from:  http://here.abennacional.org.br/here/v10/n1/a7.pdf

23. Conselho Regional de Enfermagem da Bahia. Sistematização da Assistência de Enfermagem:  um guia para a prática [Internet].  Salvador:  COREN-BA; 2016 [cited em 16 fev 2022].  Available from: http://biblioteca.cofen.gov.br/wp-content/uploads/2020/09/sistematizacao-assistencia-enferma  gem-guia-pratico.pdf

24. Ferraz L, Schneider LR, Pereira RPG, Pereira AMRC.  Ensino e aprendizagem da prática baseada em evidências nos cursos de Enfermagem e Medicina. Rev Bras Estud Pedagog. 2020;101(257):237-50.  https://doi.org/10.24109/2176-6681.rbep.101i257.4424

25. Alves SR, Santos RP, Oliveira RG, Yamaguchi MU.  Serviços de saúde mental:  percepção da enfermagem em relação à sobrecarga e condições de trabalho. Rev Pesqui (Univ Fed Estado Rio J, Online).  2018;10(1):25-9. https://doi.org/10.9789/2175-5361.2018.v10i1.25-29

26. Zuchetto MA, Engel FD, Medeiros LSP, Hammerschmidt KSA, Schoeller SD.  Empatia no processo de cuidado em enfermagem sob a ótica da teoria do reconhecimento: síntese reflexiva.  Rev Cuid.  2019;10(3). https://doi.org/10.15649/cuidarte.v10i3.624

Submission: 08/02/2022

Approved: 04/24/2023