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Enfermería: Cuidados Humanizados

versión impresa ISSN 1688-8375versión On-line ISSN 2393-6606

Enfermería (Montevideo) vol.12 no.1 Montevideo  2023  Epub 01-Jun-2023

https://doi.org/10.22235/ech.v12i1.3122 

Original articles

Perception of users of health services on the social visibility of nursing professionals during the COVID-19 pandemic

Mónica Valenzuela-Vidal1 
http://orcid.org/0000-0002-6165-226X

Andrea Alvarado-Quinteros2 
http://orcid.org/0000-0002-9045-6647

Diego Márquez-Ossandón3 
http://orcid.org/0000-0002-3188-8706

María Cecilia Toffoletto4 
http://orcid.org/0000-0003-3484-6250

1 Universidad de Las Américas, Chile

2 Universidad de Las Américas, Chile

3 Universidad de Buenos Aires, Argentina

4 Universidad de Las Américas, Chile, mtoffoletto@udla.cl


Abstract:

Objective:

To know the perception of users of health services in three communes of Chile regarding the social visibility of nursing professionals during the period of the COVID-19 Pandemic.

Material and Method:

Qualitative study with a descriptive design that used the focus group technique. A focus group was carried out with an intentional sampling, made up of seven participants whose inclusion criteria were: being users of the Chilean Health System and, older than 18 years. The recruitment of the participants was conducted by a poster in social networks of the academic institution. The analysis strategy was content.

Results:

Three themes and seven sub-themes were found. The themes were, the visibility of the profession (social imaginaries, value of work, invisibility), first line (revaluation of professionals, safety, and trust) and gender (feminized profession, invisibility).

Conclusions:

Under the current context of health, the visibility of nursing has been sustained by situations that are precisely associated with invisibility, mental health, workload, gender issues, among others. It is suggested that research be conducted to demonstrate and disseminate the significant role of nursing professionals in society and promote their recognition.

Keywords: nursing; nursing staff; social perception; social desirability; coronavirus infections

Resumen:

Objetivo:

Conocer la percepción de usuarios de los servicios de salud de tres comunas de Chile sobre la visibilidad social de los profesionales de enfermería durante el período de la pandemia de COVID-19.

Material y Método:

Estudio cualitativo descriptivo que utilizó la técnica del grupo focal. Se realizó un grupo focal con un muestreo de tipo intencionado conformado por siete participantes cuyos criterios de inclusión fueron ser usuarios del sistema de salud de Chile y mayor de 18 años. El reclutamiento de los participantes fue realizado por un afiche en redes sociales de la institución académica. La estrategia de análisis fue el de contenido.

Resultados:

Se encontraron tres temas y siete subtemas: la visibilidad de la profesión (imaginarios sociales, valoración de la labor, invisibilidad), primera línea (revaloración de los profesionales, seguridad y confianza) y género (profesión feminizada, invisibilidad).

Conclusiones:

Bajo el actual contexto de salubridad, la visibilidad de la enfermería se ha sostenido por situaciones que justamente son asociadas a la invisibilidad, salud mental, cargas laborales, cuestiones de género, entre otras. Se sugiere la realización de investigaciones que demuestren y difundan el importante rol de los profesionales de enfermería en la sociedad y promuevan su reconocimiento.

Palabras clave: enfermería; personal de enfermería; percepción social; deseabilidad social; infecciones por coronavirus

Resumo:

Objetivo:

Conhecer a percepção de usuários dos serviços de saúde de três municípios do Chile sobre a visibilidade social dos profissionais de enfermagem durante o período da Pandemia da COVID-19.

Material e Método:

Estudo qualitativo descritivo que utilizou a técnica de grupo focal. Foi realizado um grupo focal com uma amostragem do tipo intencional, composta por sete participantes, cujos critérios de inclusão foram ser usuários do Sistema de Saúde do Chile e maiores de 18 anos. O recrutamento dos participantes foi realizado por um poster nas redes sociais da instituição acadêmica. A estratégia de análise foi de conteúdo.

Resultados:

Foram encontrados três temas e sete subtemas: a visibilidade da profissão (imaginários sociais, valorização do trabalho, invisibilidade), primeira linha (reavaliação dos profissionais, segurança e confiança) e gênero (profissão feminizada, invisibilidade).

Conclusões:

No contexto atual da saúde, a visibilidade da enfermagem tem sido sustentada por situações que se associam justamente à invisibilidade, saúde mental, carga de trabalho, questões de gênero, entre outras. Sugere-se a realização de pesquisas que demonstrem e divulguem o importante papel dos profissionais de enfermagem na sociedade e promovam seu reconhecimento.

Palavras-chave: enfermagem; pessoal de enfermagem; percepção social; desejabilidade social; infecções por coronavírus

Introduction

The concern for the social visibility of nursing as a profession has been present since it began as a technical discipline. However, in the daily routine of their work, users, other professionals, and even those of their category need to recognize the importance of nursing work. 1)

A study aimed at identifying the perception of the nursing team on motivational factors in the work environment found among the main components of demotivation, lack of recognition of the profession, and the value of their work. 2) Another investigation that analyzed the perception of undergraduate nursing graduates about the training process and the world of work in health evidenced that the graduates identified a low cultural and socioeconomic valuation of the discipline, as well as the lack of recognition by users, other professionals, and even health institutions. 3) Similarly, a cross-sectional descriptive study that sought to know the changes in the social representation of nursing due to the COVID-19 pandemic, generated as results of a total of 1.109 (100 %) participants, that nursing is a profession dedicated to the care and essential within healthcare for 83.7 % of the participants but little socially recognized (53.8 %), poorly remunerated (48.4 %), and perceived as a risky profession (93.3 %). 4) It is worth noting that the healthcare team’s lack of recognition of nursing professionals is corroborated in a study in Chile, which investigated the experience of nurses who exercise a leadership role in achieving professional leadership and autonomy. The barriers found within the healthcare team were related to the insistence on following the hegemonic medical model, which hinders the visibility of the role of nursing professionals.5

Associated with the lack of recognition, the literature reports the complex working conditions of nursing professionals. A literature review analyzing nursing professionals’ work found various characteristics that imply physical and psychological risks, such as caring for patients with infectious diseases, handling contaminated materials, working in shifts, subordination, disqualification, fragmented work, repetition of tasks, and gender. In addition, the lack of social recognition, together with the lack of autonomy in work, hostile relationships with colleagues, and scarce family and social support, are factors associated with stress, anxiety, and depression in professionals. 6,7

However, in the COVID-19 pandemic, this scenario of low recognition and (in)visibility has changed worldwide, mainly due to the news disseminated by the World Health Organization (WHO), which highlights the important role that nursing professionals have played by being directly associated with care provided to infected patients in primary or tertiary care levels. (8, 9) In addition, other studies have made clear the valuation of the nursing professional, considering the importance of this professional category in the field of health services. 10,11,12

In this context, nursing professionals from all over the world have been on the front line in the fight against the COVID-19 pandemic, demonstrating their professionalism, compassion, and courage, often in precarious working conditions due to a lack of adequate personal protective equipment, continuous training actions, and decent working conditions, and constantly exposed to contagion. 13,14

As a result, the importance of the role of nursing professionals in the pandemic has been highlighted. According to the WHO, in many countries, nursing professionals are key actors in health teams, working at various levels of health systems and playing an essential role in caring for individuals, families, and communities. 15

Therefore, evidence of the recognition and visibility of nursing professionals during the pandemic has been reported in reflection articles, web news, and reports from international organizations such as the WHO or the International Council of Nurses (ICN).15,16,17) However, studies have yet to be found that have investigated this visibility from the perspective of users of the health system in communities. Therefore, this study aims to know the perception of health service users from three communes in Chile about the social visibility of nursing professionals during the COVID-19 pandemic.

Methodology

Type of Study

This study consists of an exploratory, cross-sectional study with a qualitative approach. A focus group was used for data collection, and the content analysis strategy was employed for analysis. Collecting information through a focus group allows people to express their thoughts more comfortably and freely, as in real life. Therefore, it provides rich qualitative data that can enhance the understanding of the topic based on experiences shared freely by the participants. 18 This technique was considered appropriate for this study to facilitate interaction and active participation of participants in expressing their perceptions regarding the visibility of nursing professionals in the COVID-19 pandemic.

Study participants

A homogeneous intentional sampling was used, and inclusion criteria for participants were users of the Chilean Health System, over 18 years old, and attending a health service during the pandemic. Seven people agreed to participate in the study. The sample was determined through saturation when data was repeated and the absence of new elements in the participants’ discourse.

Data collection

Recruitment of participants was done through a poster on the social networks of the academic institution, targeting academics, students, professionals in the fields of practice, employers, and communities linked to outreach activities in three communes of Chile. Interested people who met the inclusion criteria were directed to email one of the researchers. Following this first contact, the researcher invited the participants via email, and they were provided with informed consent. After receiving the accepted informed consent, another email was sent with a link to connect through the Zoom application with the date and time of the activity.

The meeting was held virtually through the ZOOM PRO platform on July 23, 2021, for 75 minutes. The invitation and informed consent were created on the Google Forms platform. A script was used during the meeting, through which participants were asked to describe their social perception and visibility of nursing professionals in the COVID-19 pandemic. One of the researchers acted as the moderator and another served as the observer responsible for note-taking and recording. Participants were not identified by name during the recording and were coded as P1, P2, P3, P4, P5, P6 and P7.

Qualitative data analysis and treatment procedures

The qualitative content analysis technique was used for data analysis. The development of the focus group was recorded, transcribed, and subsequently analyzed in three phases: pre-analysis, in which information was organized and related to the research problem, reviewed the evidence and stated objectives; exploration of the material, in which significant expressions from the interviews were read repeatedly, classified, and integrated into categories; treatment of results, in which inferences and interpretations of findings in previous phases were made. 19

Regarding qualitative rigor, rigor was guaranteed during the development of the focus group technique, the review of the transcripts, and the detailed discussion by the research team. In addition, the description and interpretation of the data began with coding and constructing dimensions and categories with units of meaning and were compared with the literature to avoid biases. Data analysis was carried out with the support of the ATLAS.ti program, version 22. The participants did not validate the data.

Ethical aspects

The proposal was evaluated and approved by the Institutional Ethics-Scientific Committee with the folio number CEC_FP_2021017. The confidentiality and anonymity of the participants were respected, as well as ethical provisions for research issued by the General Health Law, regulations of the World Medical Association, and the Helsinki Declaration.

Results

Out of seven participants, four were women and three were men, with an average age of 43 years. Six participants were heads of household and six did not have children. Regarding marital status, six were single and one participant was married. Regarding their health plan, five were users of the public health system and two were private. Regarding the highest level of education achieved, one participant had completed high school, as well as technical education at a higher level, two had a professional degree, and three had postgraduate studies. Regarding income from their main occupation, one participant received 250,000 or less, the same percentage received between 250,000 and 400,000, and those who earned between 401,000 and 850,000 were also the same percentage. Four of participants received more than 850,000 pesos or more from their main occupation. During the last six months, six had attended a health center either for personal reasons or to accompany someone (two attended once, one attended three times, and three attended four times or more), only one participant attended in 2020.

The participants’ perception of nursing professionals is certainly framed in the health context of the COVID-19 pandemic. Three categories emerged in the discourses: visibility of the profession, gender and front line.

Visibility of the profession

The descriptions of the narratives on visibility highlight everyday experiences. The mention of empathy is a quality, but one that would only be understood in a direct and permanent relationship with the professional. It is part of the analysis of daily work, which is generated with a close bond, where time is fundamental to acquire this bond.

I think that nurses are also exposed to very long shifts, and perhaps that should be taken into consideration... because they are also stressed, and with some patients, they will be able to have... this empathy that we speak of or this willingness to want to care for them or to want to create a much more human bond because we already come from a society that tries to normalize or objectify people, but I also feel that it has to do with the factor of time (P5).

Well, apart from being invisible... their function or how they relate to the patient will also depend a lot on time (P3).

The experiences are concentrated at the family level but also in health centers. Despite the pandemic, the participants have been in constant contact with nursing professionals in different situations, an aspect that manages to relate to visibility. This is not only the health care provided by the nursing professional doing their job, but rather a series of practices and attitudes that strengthen relationships and are only possible through daily life, generating affective ties given the health situation faced.

A nurse came because, well, he had to be with a bag... like he couldn’t defecate from the back but had to do it from the side and in a bag... so a nurse who was a friend of the family went to teach him how to change it and things like that and there... it changed my perspective again because the nurse was good, she was a teacher (P2).

Gender

For the gender topic, some speeches highlighted the feminized vision of this profession, an aspect that opens up a discussion closely related to gender issues. Therefore, there is a specific social imagination regarding the link between the exercise of the profession and the feminine. In a way, it is an interpretative, symbolic, and identity framework since it was part of their experiences.

The profession (...) as mentioned, is a highly feminized profession that also responds to these gender stereotypes of assuming that care careers are much more linked to the feminine than the masculine (...) which is why it is also true that it is (...) undervalued, looked down upon (P6).

Thinking about my relationship with the nursing world, especially since it is a super feminized career and men are scarce (P4).

In the stories, it is described that the experiences have been positive, where it is also emphasized that there are men who practice the discipline. The evaluation of these maintains the descriptions made to their female peers in terms of highlighting personal aspects. One can continue the previous argumentative line that speaks of little appreciation for the discipline, although it is evident that talking about a gender perspective undoubtedly relates to discriminatory aspects towards women, something structural as mentioned: salaries, working hours, and aspects of private life.

I remembered my experiences regarding nursing and (...) well, I had surgery on my spine when I was about 13 years old and (...) also, I had a very good experience, they were very loving and caring, male nurses also attended to me, they gave me a lot of support because it was a super complex operation and well, I was also a little girl, but (...) I feel that it is super curious because in the end, nursing is supposed to be very invisible even though they are the ones who have the most contact with people and who are much more involved, probably the greatest empathy they have with certain patients (P3).

A lot of inequalities can be observed, from the amount of work, salaries, and treatment (P1).

Front line

The references to what was called the front line were closely related to the visibility and valuation of aspects that were previously analyzed. The most significant accounts can be summarized as follows:

The most invisible ones and I think that also includes the world of professional nursing, have been highlighted as part of the front line, which is quite invisible and exhausted by their work beyond the pandemic (P5).

It’s not just about doctors, but also the people who accompany them, not only nurses but also physiotherapists, therapists, and psychologists -it’s a whole team working behind them, not just the doctors who appear on screen (P7).

Well, personally, there was not a very abrupt change in my personal thinking, but obviously, the pandemic exacerbated or made more evident social issues. One of them was obviously the quality of work of nurses, the conditions under which they work, which may have been known to some but not to all. There were some catastrophic cases, where nurses took their own lives based on the conditions they were subjected to, right? The pandemic context increased this and allowed us to see it. If we hadn’t been in a pandemic, we might not have known about it, it wouldn’t have been such a big deal... so obviously, it exacerbates and makes these conditions evident (P4).

Discussion

The COVID-19 pandemic has marked the daily life and social relationships of millions of people, and the relationship in the contexts of the healthcare system and its professionals has become fundamental, specifically in nursing, as depicted in this work. In the current healthcare system, nursing professionals have played a leading role in the care and, in a way, redesigning their social status. 16 Regarding the visibility of nursing professionals, this is built not only in their space, which would be healthcare centers but also in their inclusion in the private or family sphere, where aspects about the person and their daily life can be better appreciated. 20

Although, during the pandemic period, the visibility of nursing professionals intensified in the media, 21) invisibility is observed in stories that describe close, work-related, family-related, or health-related everyday experiences, which can be linked to little knowledge of citizens about the composition of healthcare professionals and the hegemony of certain disciplines over others. It can be observed that, despite having a high value during the pandemic contingency, they are still not included in all social spheres since it is a slow process and does not ensure success in a certain way. Consequently, the prominence of nursing professionals cannot and should not be maintained only during the pandemic period. The (re)construction of professional identity needs constant reaffirmation. 22 A study that analyzed nursing students’ perception of the profession’s visibility in the media showed that students highlighted that nursing is devalued in the media, also highlighting the recurring valuation of medical professionals, where the authors conclude that Nursing is surrounded by stereotypes in its representation in the media, which implies its social devaluation and professional visibility. 23

Regarding the female development of the nursing profession, participants refer to the professionals’ gender, a matter that gave rise to perspectives associated with the feminization of this discipline. One perspective is clear, since according to the Pan American Health Organization, the Americas Region houses 30 % of the world’s nursing professionals, of which 87 % are women. 24

Undoubtedly, this perspective is much deeper, as the identity of nursing is built around femininity and women’s social responsibility in the West in the context of modernity. Regarding visibility, women in public spaces are produced through the continuity of care they offer to others; they care for people affected by their health, and thus the discipline constitutes a social, predominantly feminized labor where their role in society is to care for people. 25

According to the International Council of Nurses (ICN), the COVID-19 pandemic highlighted gender inequalities, both for nursing professionals and women in general, where nurses continue to put their lives at risk for poorly paid and undervalued work. 17

Still, concerning gender, other studies have reflected on the impacts of the pandemic in the various contexts in which nurses act, making inequities, inequalities, and vulnerabilities evident. 26

In general terms, the conversation referred to contingent issues, visibility in reference to the concept of the healthcare front line. The pandemic brought nursing professionals, in addition to various challenges, many uncertainties, risks, and fears, due to the unknown and full of doubts scenario, as well as generating psychological suffering to deal more constantly with patient deaths. However, it is evident that nursing has made a difference in strengthening the bond between the team, as well as in the clinical care patterns and actions with patients and family members. 27

A Polish study aimed at exploring nursing professionals’ experiences regarding the influence of the COVID-19 pandemic on the social image of the profession corroborates this difference, in which the participants reported that the pandemic has helped to spread the image of professionals as highly skilled and independent workers, and in turn, helped improve their self-esteem and professional identity. 28

The mention of the first line is also associated with the distinction of visibility/invisibility. One aspect is observed in the mentions of the long working hours of health personnel. The literature has shown a high proportion of nursing professionals with symptoms of depression, anxiety, insomnia, and distress, as well as physical disorders such as headaches and back pain, fatigue, loss of appetite, irritability, fear, and despair. 29,30,31

It is observed that the COVID-19 pandemic mediates the social visibility of nursing professionals. One study proposes that the current world demands credibility, security, and confidence to generate leadership, power, positioning, and empowerment. Given the above, in the current health context, where visibility is primarily related to the frontline of health, nursing professionals carry out permanent care tasks that are less visible and do not have social recognition and appreciation. 32

A study that sought to understand the meanings of professional valorization and its implications for the actions of the subjects involved found political commitment, social feedback, resource investment, interpersonal relationships, and professional achievements as categories with a direct relationship with professional valorization and effective ways to achieve recognition. 33

Despite the importance of the findings, this study has certain limitations, the first of which is the small sample size and the scarcity of scientific production that added knowledge on the subject.

Conclusions

Under the current health context, the visibility of nursing has been sustained by situations that are precisely associated with invisibility, such as mental health, workloads, participants’ perceptionand gender issues, among others.

The perceptions of the participants regarding the visibility of nursing professionals in the COVID-19 pandemic give a sense of human and empathetic care, which is highlighted by the feminized view of the profession.

The results reveal that the appreciation of the profession is undoubtedly related to discriminatory aspects towards women, something structural, such as salaries, workloads, and aspects of private life. Participants articulate the visibility of nursing professionals with the concept of the front line in patient care during the COVID-19 pandemic. However, nursing professionals perform permanent care tasks that are less visible and need more social recognition and appreciation.

The contributions of the present study are in suggesting to nursing professionals to carry out research that demonstrates and disseminates the importance of the role in society and promotes its recognition. In addition, adequate communication with citizens and the responsibility of each professional are essential to promote a professional identity that recognizes the value of their professional and educational development.

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How to cite: Valenzuela-Vidal M, Alvarado-Quinteros A, Márquez-Ossandón D, Toffoletto MC. Perception of users of health services on the social visibility of nursing professionals during the COVID-19 pandemic. Enfermería: Cuidados Humanizados. 2023;12(1):e3122. doi: 10.22235/ech.v12i1.3122

Authors’ participation: a) Conception and design of the work; b) Data acquisition; c) Analysis and interpretation of data; d) Writing of the manuscript; e) Critical review of the manuscript. M. V. V. has contributed in a, c, d, e; A. A. Q. in a, c, d, e; D. M. O. in b, c, d, e; M. C. T. in a, b, c, d, e.

Scientific editor in charge: Dr. Natalie Figueredo

Received: November 09, 2022; Accepted: May 09, 2023

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