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rev latino am enfermagem 2009 maio junho 17 3 396 402 artigo original www eerp usp br rlae 396 nursing nutrition and physiotherapy students career choice 1 beatriz sebben ojeda ...

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                                                                                                Rev Latino-am Enfermagem 2009 maio-junho; 17(3):396-402
                   Artigo Original                                                                                                       www.eerp.usp.br/rlae        396
                                 NURSING, NUTRITION AND PHYSIOTHERAPY STUDENTS: CAREER CHOICE
                                                                                                                                                                           1
                                                                                                                                             Beatriz Sebben Ojeda
                                                                                                                                                  Marion Creutzberg2
                                                                                                                                         Ana Maria Pandolfo Feoli3
                                                                                                                                                                           4
                                                                                                                                             Denizar da Silva Melo
                                                                                                                                                                           5
                                                                                                                                           Valéria Lamb Corbellini
                   Ojeda BS, Creutzberg M, Feoli AMP, Melo DS, Corbellini VL. Nursing, nutrition and physiotherapy students:
                   career choice. Rev Latino-am Enfermagem 2009 maio-junho; 17(3):396-402.
                   In the perspective of career choice, entering university encompasses meanings of self-accomplishment and
                   social status, which are permeated by concepts and ideals people construct in their lives. This study aimed to
                   analyze regimes of truth that permeate career choice in nursing, physiotherapy and nutrition. This qualitative-
                   descriptive study was carried out with undergraduate freshmen. Data were collected through focus groups,
                   evaluated by discourse analysis from a Foucaultian perspective. The following themes emerged from the
                   analysis: - career choice: crowning a process of social differentiation, - reflexes of professions’ history of
                   acknowledgement; - career choice beyond professional projects. Discourse highlights that scientific knowledge
                   acquires status in relations of power between different professions and society and is essential that health
                   professional education is linked to public policies that expand the participation of different professions so as to
                   meet demands in favor of integral care.
                   DESCRIPTORS: career choice; power (Psychology); nursing; physical therapy (speciality); nutritionist; health
                   personnel
                                           ESTUDIANTES DE ENFERMERÍA, NUTRICIÓN Y FISIOTERAPIA:
                                                                       LA ELECCIÓN PROFESIONAL
                   Bajo el aspecto de la elección profesional, el ingreso a la Universidad trae embutido significados de autorrealización
                   y de status social, los cuales contienen conceptos e ideales construidos en el vivir cotidiano de las personas. El
                   objetivo del estudio fue analizar regímenes de verdad contenidos en la elección profesional de enfermería,
                   nutrición y fisioterapia. Se trata de un estudio descriptivo, de abordaje cualitativo realizado en los estudiantes
                   que ingresan a la Graduación. La recolección de datos fue realizada en Grupos Focales, evaluados por medio
                   del Análisis del Discurso, bajo el marco teórico de Focault. Del análisis emergieron las temáticas: Elección
                   profesional; Coronamiento de un proceso de diferenciación social; Reflejos de la historia del reconocimiento de
                   las profesiones; La elección profesional – más allá de proyectos profesionales. Los discursos señalan que el
                   conocimiento científico adquiere status en las relaciones de poder entre las diferentes profesiones y en la
                   sociedad, siendo fundamental que la formación de los profesionales de la salud esté articulada a las políticas
                   públicas que amplían la participación de las diferentes profesiones, con la finalidad de atender las demandas
                   en pro de una atención integral.
                   DESCRIPTORES: selección de profesión; poder (Psicología) ; enfermería; terapia física (especialidad); nutricionista;
                   personal de salud
                                           ACADÊMICOS DE ENFERMAGEM, NUTRIÇÃO E FISIOTERAPIA:
                                                                        A ESCOLHA PROFISSIONAL
                   Sob o aspecto da escolha profissional, o ingresso na universidade traz embutido significados de autorrealização
                   e status social, nos quais perpassam conceitos e ideais construídos no viver da pessoa. O objetivo do estudo foi
                   analisar regimes de verdade que permeiam a escolha profissional da enfermagem, fisioterapia e nutrição. É um
                   estudo descritivo, de abordagem qualitativa, com ingressantes na graduação. Coleta de dados foi realizada com
                   grupos focais, avaliados pela análise de discurso, sob o olhar de Focault. Da análise emergiram as temáticas: -
                   escolha profissional: coroamento de um processo de diferenciação social, - reflexos da história de reconhecimento
                   das profissões, - a escolha profissional para além de projetos profissionais. Os discursos assinalam que o
                   conhecimento científico adquire status nas relações de poder entre as diferentes profissões e a sociedade, sendo
                   fundamental que a formação de profissionais de saúde esteja articulada às políticas públicas que ampliam a
                   participação de diferentes profissões, a fim de atender às demandas em prol da atenção integral.
                   DESCRITORES: escolha da profissão; poder (Psicologia); enfermagem; fisioterapia (especialidade); nutricionista;
                   pessoal de saúde
                                                                                                                                     1
                   Faculdade de Enfermagem, Fisioterapia e Nutrição, Pontifícia Universidade Católica do Rio Grande do Sul, Brasil:  Ph.D. in Psychology, Adjunct Professor,
                                       2                                                                                  3
                   bsojeda@pucrs.br;  Ph.D. in Biomedical Gerontology, Adjunct Professor, e-mail: marionc@pucrs.br;  Ph.D. in Biochemical, Adjunct Professor, e-mail:
                                       4                                                                   5
                   anafeoli@pucrs.br;  Ph.D. in Medical Clinic, Adjunct Professor, e-mail: dmelo@pucrs.br;  Ph.D. in Education, Adjunct Professor, e-mail: vlamb@pucrs.br.
                                                                              Disponible en castellano/Disponível em língua portuguesa
                                                                                                                      SciELO Brasil www.scielo.br/rlae
                         Rev Latino-am Enfermagem 2009 maio-junho; 17(3):396-402                                             Nursing, nutrition and physiotherapy students…
                         www.eerp.usp.br/rlae                                                                    Ojeda BS, Creutzberg M, Feoli AMP, Melo DS, Corbellini VL.       397
                         INTRODUCTION                                                                        becomes the truth, which will be the result of
                                                                                                                                                                 (5)
                                                                                                             discourse, practices and knowledge .
                                     The fragmentation of health practices is a                                          Entering university reports to career choice,
                         modern reality, concretized in multiple professions and                             which encompasses the meaning of self-
                         specializations. In this perspective, each professional                             accomplishment and economic autonomy, permeated
                         in the different scenarios of practice, is responsible                              by concepts and ideals constructed across the
                         for a share of care in which invisible knowledge is                                 person’s life. Regimes of truth, which determine
                         used, for example, the naturalization of female and                                 hierarchy among health professions, seem to be
                         male practices immersed in the various health                                       present in social discourse and academic and health
                         professions(1).                                                                     institutions. In this perspective and with the
                                     Modern scientific development was essential                             development of modern medicine, medical knowledge
                         for the emergence of professions like nutrition,                                    shaped social, political and economic relations and
                                                                 (2-4)                                                                                                  (5)
                         physiotherapy and nursing                    . The construction of                  became imperative to health knowledge .
                         nutrition science was stimulated by the European                                                Discourse is formed in statements, theories
                         industrial revolution (18th century), and became visible                            and institutions in the way practices are organized
                         as from World War I, due to the need for studies and                                and transmitted. The acceptance of a discourse comes
                         research and also because of the need to train                                      from repetition and dissemination of statements. There
                         professional experts, culminating in the creation of                                are many sources of language that build statements
                                                                                                  (3)
                         the first nutrition control and intervention agencies                       .       and which can be viewed in different forms of social
                         The development of this area in Latin America became                                discourse, such as in the media, in the academic and
                                                                                  th
                         more systematized as from the mid 19  century and                                   professional areas. These practices tell us about the
                         was integrated into medical knowledge.                                              truth, regimes of truth, and are strong enough to
                         Physiotherapist resources integrated medical                                        become unquestionable in power relations, regardless
                         treatment(2) in Brazil in the 19th century. Increased                               of what is determined by law and what people or
                         physiotherapist demands as from World War II                                        groups of people wish. They become naturalized!(5)
                         required non-physician professionals to deliver                                                 Integrated in this social structure, this study
                         physiotherapy care. Nursing was born in England in                                  analyzes the discourse of students entering nursing,
                         the mid 19th century with Florence Nightingale, whose                               physiotherapy and nutrition programs, because they
                         model was influenced by British disciplinary                                        represent a reality where regimes of truth are
                         conceptions, with rigid rules based on military and                                 produced on these professions, and which are
                         moral customs recommended in monasteries. Based                                     expressed in social policies, health institutions, the
                         on statistical bases, her knowledge and concerns with                               media and institutions.
                         sanitary, nutritional and environmental measures led                                            A study carried out with undergraduate
                         to the reformulation of military hospitals and army                                 students about professional prestige of 13 higher
                         health administration. Being a reference in sanitarian                              education professions hints that hierarchy is
                         issues, she participated in the elaboration of internal                             expressed in the judgment of each profession. In this
                         and external health policies, laying out the bases for                              study, the medical profession was identified as the
                                                                           (4)
                         nursing as a profession worldwide .                                                 one with the highest prestige, physiotherapy ranked
                                     These brief historical fragments reveal the                             sixth and nursing eighth, while nutrition was not
                         close relation of these professions with the medical                                                                                             (6). Another
                                                                                                             included in the list of evaluated professions
                         area. These were developed as from medical needs                                    recent study appoints the media’s influence on the
                         or demands for specialties. In this social construction,                            formation of statements present in the image of
                         the naturalization of occupations ranked under social                               professions like nursing, which require these
                                                    (1)
                         practices in health            becomes clear.                                       professions to seek strategies to provide more
                                                                                                  (5)
                                     Every society possesses regimes of truth ,                              information, visibility and to have a voice in the
                                                                                                                               (7)
                         which establish identities, determine rules, legitimate                             social scope . Reflections regarding the results of
                         or disregard practices, determine or impose different                               these studies indicate the need to broaden the
                         social valorizations. Regime of truth is what is                                    understanding of the scenario in which the choice
                         established by means of knowledge-power devices                                     of a career and the education of future health
                         capable of registering in reality something that                                    professionals take place.
                   Nursing, nutrition and physiotherapy students…                               Rev Latino-am Enfermagem 2009 maio-junho; 17(3):396-402
                   Ojeda BS, Creutzberg M, Feoli AMP, Melo DS, Corbellini VL.                                                            www.eerp.usp.br/rlae         398
                               In the analysis of freshmen’s discourse, we                         discussion were registered and tape-recorded with
                   seek what is naturalized, not questioned, dispersed                             the participation of an observer.
                   in different statements, transversalized as                                                 Data were analyzed through discourse analysis
                                                                                                                                      (5)
                   materialities of games of truth, which influenced the                           in Foucault’s perspective            . The analysis proposes to
                                      (5)
                   career choice . Hence, this study aims to instill a                             describe statements, which might be expressed in
                   critical perspective in students, professors and                                different ways: in a phrase, a figure or in an act of
                   researchers regarding the social scenario of health                             language. Social conceptions on the chosen area were
                   professions.                                                                    analyzed based on the participants’ discourse, seeking
                                                                                                   to put in evidence which regimes of truth permeate
                                                                                                   concepts and practices in these areas.
                   OBJECTIVE                                                                                   The project was funded by the Research
                                                                                                   Foundation of the State of Rio Grande do Sul, Brazil
                               To analyze regimes of truth that permeate                           and approved by the Research Ethics Committee at
                   the choice for nursing, physiotherapy and nutrition                             PUCRS and participants signed the free and informed
                   manifested by students entering the respective                                  consent term.
                   courses.
                                                                                                   RESULTS AND DISCUSSION
                   METHOD
                                                                                                   Career choice: crowning a process of social
                               This is a qualitative-descriptive study.                            differentiation
                   Study participants were students entering the
                   nursing, physiotherapy and nutrition undergraduate                                          Entering university, which refers to the
                   programs at the Pontifical Catholic University of                               career choice, seems to crown a process of social
                   Rio Grande do Sul (PUCRS). Students were selected                               differentiation: […] Anything I wanted to study, since I
                   among classes at the beginning of the school year                               was little, had to do with the health area, medicine, nursing,
                                                                                                                                                 *
                   semesters (2006/1 and 2006/2), through voluntary                                I even consider psychology […] (G5) . The career choice
                   participation after a brief presentation of the project.                        also sustains a social image about a given area in
                   All students who met the inclusion criteria: availability                       the attempt to materialize the person’s wishes and
                   to participate in focus groups, entered university                              life plan(1).
                   through the required written exam, were attending                                           The process of choosing a career begins at a
                                                                                                                                                  (9)
                   the first course semester, were invited to participate.                         very young age in modern society , but society’s and
                               Data collection was carried out through                             families’ expectations about career choice are
                   focus groups. The focus group technique has been                                intensified at the end of high school with the perspective
                   increasingly used in several areas of research,                                 of attending the obligatory written exam, which
                   especially in research using qualitative methods                                requires one to opt for a bachelor’s degree, that is, a
                   aiming at social investigation. This technique                                  profession: […] I didn’t have the slightest idea when I was a
                   permits the researcher to know the opinion,                                     3rd year high school student, when I realized it, ‘Gosh, what am I
                   thoughts, feelings and actions of a given group in                              gonna do, I’ll be out of school, I’ll go to university’ and I had no
                                                                 (8)
                   relation to a social phenomenon . The seven focus                               idea of what program I was going to choose […] (G5).
                   groups with seven to 12 participants were                                                   Families influence adolescents’ career choice
                   conducted by researchers, with a maximum                                        because projects are constructed in the family through
                   duration of 90 minutes. The group discussion was                                parents’ and family members’ expectations and
                   based on the following guiding questions: How do                                wishes: […] I didn’t pass in medicine but the nursing program
                   you see the professional area you have chosen?                                  called me, they didn’t believe I’d study nursing after having
                   How do you see the insertion of this profession in                              tried medicine and they still don’t see it as a professional at the
                   the health area and in society? What do you expect                              end of the first semester […] (G2). Thus, the career choice
                   from these areas? Non-verbal information and                                    is also an opportunity to show loyalty to the family or
                   *
                    The groups are identified by the letter “G” followed by the group’s number.
                         Rev Latino-am Enfermagem 2009 maio-junho; 17(3):396-402                                             Nursing, nutrition and physiotherapy students…
                         www.eerp.usp.br/rlae                                                                    Ojeda BS, Creutzberg M, Feoli AMP, Melo DS, Corbellini VL.       399
                         the concretization of a collective family project: […]                              work began to expand in Brazil. However, it was only
                         when I said to my dad that I wanted to study nutrition, he said                     concluded in 1968 with the University Reform.
                         “you’re going to be a cook?” he wanted me to study medicine, to                     Because nursing education was viewed as a female,
                         be a doctor […] but I’m enchanting him, when I get home I tell                      domestic and auxiliary profession, students with a level
                         him about my classes, about what I’ve learned, related to medicine                  of education lower than the remaining students were
                                                                                                  (8)                                                                         (11)
                         and he’s encouraging me more […](G7). In another study                      ,       accepted in higher education for many years                          . This
                         students reported the strong influence parents exert                                particularity was reverted in 1962 with the Law of
                         to the extent of generating doubts in the decision-                                 Basic Tenets and Guidelines of National Education,
                         making process. Oftentimes, the family wishes to find,                              which required the completion of high school to enter
                         through the student’s choice, their own social                                      university in the same way other areas required it.
                         projection, which can lead to demands and even                                      Until the 1960s, nursing schools in the process of
                         greater indecision.                                                                 nursing education were attached to Medical schools
                                     The process of choosing a career does not                               attending the need for specialties. Nursing was a
                         cease with the student’s ingression in the chosen                                   subject in the medical area, called paramedic
                         program. At the beginning of their academic trajectory,                             profession. Only in 1968, with the University Reform,
                         students reevaluate their options in view of their                                  were nursing schools acknowledged as academic units
                         experiences and knowledge acquired on the                                           in the university context. Preconceptions in relation
                         profession, which can reaffirm their choice or put it in                            to nursing are present in social conceptions, from the
                         question(10).                                                                       process of career choice up to academic education
                                                                                                             and professional life. Professors and students from
                         Career choice: reflexes of professions’ history of                                  other areas frequently express preconceptions
                         acknowledgment                                                                      regarding the qualification of nursing knowledge(10).
                                                                                                                         Physiotherapy, also in the struggle to achieve
                                     In a way, the career choice also evidences                              social acknowledgement as a health profession, was
                         the historical process of each profession, its struggles,                           admitted to higher education in 1964, though at the
                         preconceptions, and perspectives of social                                          time it was seen as an auxiliary profession, subject
                                                                                                                                                                   (2)
                         acknowledgment: […] my first option was medicine but I                              to medical guidance and responsibility , which seems
                         started to see that not only medicine, but also nursing, nutrition                  to be present in the following discourse: […] everyone
                         or any other related to the health area would give me great pleasure,               thinks that physiotherapy is only clinics; there’s a lot of things
                         to be dealing with patients, and present in every moment, in each                   in physiotherapy, like in a basic health unit, which a
                         situation(G4).                                                                      physiotherapist can do, not only the physician. People don’t know
                                     The historical process of health professions                            that (G4). The acknowledgement of physiotherapy as
                         contains the struggle one has faced to enter higher                                 a higher education profession is one of its main
                         education as a strategy in search of legitimacy,                                    accomplishments because the development of
                         autonomy and social acknowledgement. Nutritionist                                   multiple demands is evidenced, entailing greater social
                         education in Brazil was idealized by the first generation                           visibility(2).
                         of nutriologist physicians at the start of the 1940’s                                           Although the highlighted historical facts focus
                                                                                           (3)
                         with the creation of new technical courses . The                                    only on nutrition, nursing and physiotherapy, they
                         struggle to have the nutrition program acknowledged                                 maintain a certain similarity with the struggle of health
                         as a higher education profession began in the 1950s                                 professions in higher education, like the search for
                         and was only won in 1962. In this historical process,                               social acknowledgement, autonomy and emancipation
                         a considerable enlargement of professional areas was                                of practices. In this perspective, the physician is still
                         evidenced, as well as the crescent process of                                       seen as the main health agent, which implies the
                         specialization/division of nutritionists’ object of work/                           secondary participation of the remaining professionals
                                                                                                                                                           (12)
                         study, with the development and qualification of                                    in the scope of health practices                  .
                         technical-scientific skills and competences. However,                                           In the historical process of the health area,
                         this struggle seems to be currently ongoing: […] I guess                            medicine became the knowledge matrix, establishing
                         nutrition has the same value as medicine […](G5).                                   itself as what Foucault calls biopower. This knowledge
                                     The acknowledgement of nursing as a higher                              broadens and comprises the different nuances of
                         education degree began in the 1930s, when women’s                                   human life, in their habits, customs and cultures,
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...Rev latino am enfermagem maio junho artigo original www eerp usp br rlae nursing nutrition and physiotherapy students career choice beatriz sebben ojeda marion creutzberg ana maria pandolfo feoli denizar da silva melo valeria lamb corbellini bs m amp ds vl in the perspective of entering university encompasses meanings self accomplishment social status which are permeated by concepts ideals people construct their lives this study aimed to analyze regimes truth that permeate qualitative descriptive was carried out with undergraduate freshmen data were collected through focus groups evaluated discourse analysis from a foucaultian following themes emerged crowning process differentiation reflexes professions history acknowledgement beyond professional projects highlights scientific knowledge acquires relations power between different society is essential health education linked public policies expand participation so as meet demands favor integral care descriptors psychology physical thera...

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