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Why was this study done?
This study was carried out to demonstrate nursing working conditions during the COVID-19 pandemic, considering that the nursing team was at the forefront of caring for these patients during the pandemic and it was the health professionals who were most exposed to risk. contamination and death. Thus, there was a need to investigate the narratives about the availability and use of personal protective equipment (PPE), working hours, the psychological conditions of these professionals, considering the overcrowding of hospitals, the high rate of contamination and deaths and the exhaustive work load.
What did the researchers do and find?
As a result of the study, the researchers found a nursing team leading the care of COVID-19 victims, but exhausted, worn out and undervalued, in all aspects, including losing their own lives to save those infected. The pandemic revealed work safety issues in nursing, the precarious conditions with regard to PPE, the lack of human resources, the exhausting 24- to 36-hour workday, without a break for rest, the low wages, which force professionals to maintain more than one employment relationship. Thus, in view of the scenario of fear, sadness and mourning, physical and emotional morbid processes were triggered in health professionals, especially in nursing, such as anxiety and depression, among other alterations.
What do these findings mean?
They demonstrate how fundamental the performance of the nursing team was during the period of the pandemic caused by COVID-19 and when it is necessary to value them, professionally and financially. It is necessary to build public actions aimed at nursing that, with the support and political will, can promote improvements in the working conditions and quality of life of these professionals.
The precarious working conditions caused an increase in the rate of illness and death of these professionals, requiring a cry of revolt to demonstrate to the world the violence experienced in their daily work.
INTRODUCTION
The pandemic caused by the new Coronavirus disease, known as COVID-19, has caused many deaths and spread fear, sadness, grief and physical and emotional morbid processes in health professionals, especially in nursing, such as anxiety and depression, among others. changes. The virus, infecting and accounting for deaths, is a daily confrontation with health professionals and, according to the International Council of Nursing, has caused more than 600 deaths of nurses on all continents. It is estimated that over 450,000 healthcare workers across all sectors have been infected and the infection rate among healthcare workers is particularly high1.
The first death that occurred in Brazil was on April 4 and on September 17, 2020, we reached 924,770 deaths of people in the world, of which 134,174 were Brazilians2. Among these deaths, there are those of health professionals, mainly nursing professionals, followed by doctors. In Brazil, until September 2020, around 200 nursing professionals died, and the most affected, in descending order, were nursing technicians, nursing assistants and nurses. More than 19 thousand were infected due to the lack of dignified working conditions, such as continuous and quality access to personal protective equipment (PPE); proper sizing of teams and protection of workers who are part of the risk group3. In addition, COVID-19 brings indirect damage to the health service, causing a deficit in serving the population. As an example, on March 8, 2020, 504 nursing professionals were removed due to suspected illness in Brazil4.
On June 17, 2020, deaths in nursing professionals due to COVID-19 already represented more than 30% of the average number of deaths in the world3. These statistics have worried everyone and, in particular, national and international nursing leaders, who recommend attention and accurate registration of deaths, aiming at a real dimension of the human cost in the pandemic1.
The COVID-19 pandemic in Brazil corroborated the picture of profound social inequality and, in the field of health, revealed the safety issues at work in nursing, the precarious conditions regarding PPE, the lack of human resources, the workday 24- to 36-hour exhaustive work, without rest breaks, low wages, which oblige professionals to maintain more than one job, among other issues4,5. A study shows that 65.9% of nursing professionals consider the profession exhausting, with a growing increase in depression, obesity, extreme tiredness, feelings of devaluation, high rates (56.1%) of sick leave and accidents, and job insecurity6. This picture may have been exacerbated by the pandemic, influencing the high rates of infection and death of these professionals4.
It is noteworthy that Brazilian nursing is made up of a social body of approximately 2,400 professionals3, and in the Unified Health System (SUS), the largest employer of nursing in Brazil, it represents 58.9% of this total. It is present in the 5,570 municipalities of the 27 units of the Brazilian Federation7.
Given the above, this study aims to analyze aspects related to the working conditions of nursing professionals in the context of COVID-19.
METHODS
This is a qualitative study, exploratory type whose purpose is to discuss the subject addressed through documentary research, which uses a variety of procedures and instruments for data production and analysis, leaving it to the researcher to select and analyze the documents that will serve as the basis for their studies. It aims at the careful examination of a phenomenon in order to understand it, describe it in its meaning, thus answering very particular questions. It seeks to apprehend a non-quantifiable level of reality, involving beliefs, values, perceptions and feelings, which involve deeper aspects of the phenomena or investigated subjects, which can hardly be achieved through the objective operationalization of variables8.
To start the active search for documentary sources of narrative content conveyed on social media, the guiding question was defined, using the strategy of the PIO question (Population: nursing; Intervention: workers’ health during the pandemic; Outcome: safety): Has nursing, in the context of the COVID-19 pandemic, been working safely? As a data collection method, content analysis was applied according to Minayo9using the thematic analysis technique, which involves pre-analysis, material exploration and treatment of results, floating reading; constitution of the corpus, formulation of hypotheses and objectives, cutting of the text into record units, identification of meaning nuclei, and the classification and aggregation of information9.
The initial base was raised through Google clippage, in addition to the search in the Virtual Health Library (VHL), through the descriptors “nursing”; “Worker’s health”; “coronavirus” and “narration”, combining strategies with the Boolean operator “AND”, in an attempt to access articles or other official documents that dealt with the subject. Consultations with the sites of the Regional Nursing Councils (COREN) of Espírito Santo and Pernambuco, Public University and social media were also conducted. The search took place from May to July 2020. As inclusion criteria, texts were used with narratives from professionals who answered the investigative question in the databases of the Federal Nursing Council, the Regional Nursing Councils, the Federal Public Universities and Social media. When it came to media, in virtual narrative, the content was transcribed by the researchers, crossing with the official database. Reports published in vehicles that did not have national coverage were excluded, considering aspects such as access, circulation, views and impact.
The data were compared and discussed for the formation of final categories that corresponded to the results of the study. The definition of categories required a qualitative analysis of the content of the reports, in order to identify narrative patterns, which are also the object of this study. The narratives were divided into three analytical categories: a) The working conditions of nursing, threatening the health and life of the worker; b) The autonomy of nurses in the full exercise of their profession and the cultural aspect of the dominant ideology; and c) Class entities, such as normalizing, disciplining, managing and controlling bodies for the professional practice of nursing.
In the treatment of the obtained results and interpretation, the records of the narratives were used and, in the process of their identification, the researched sources were attributed.
The ethical and legal principles of research involving human beings were respected, as issued by Resolutions nº 466/2012 and nº 510/2016 of the National Health Council (CNS). Thus, ethical aspects were observed and complied with in carrying out the research, which is based on openly published reports already published by communication vehicles and therefore does not involve any additional risk to the authors of the reports, interviewees and vehicles.
RESULTS
Eight documents were found, where three dealt with the “management of nursing work”, three works addressed “the working conditions of nursing in the COVID-19 pandemic” and two, the “complaints about the deaths of professionals due to the lack of conditions of work”. Of these, 36 texts were extracted, distributed in: category A) Social Media (seven); Regional Nursing Council (one) and Federal Nursing Council (one); category B) Social Media (one); Regional Council of Nursing (seven) and Federal Public University (three); category C) Social Media (two); Regional Council of Nursing (six); Federal Council of Nursing (seven) and Federal Public University (one). The results are shown in table 1.
Table 1 : Narratives about nursing working conditions during the COVID-19 pandemic. victory, 2020
Abbreviation: PPE - personal protective equipment.
DISCUSSION
This study highlighted the precarious working conditions of nursing professionals during the fight against the pandemic caused by COVID-19. This situation caused contamination and death of these professionals who work on the front line in the fight and treatment of this disease.
Nursing is an essential profession and is considered core in the structure of health professions in Brazil and worldwide. It is these professionals who are facing the health crisis caused by the COVID-19 pandemic. They are on the front line, present in all stages of human life and in all sectors of health, from basic health care, home, outpatient or hospital, in public management (federal, municipal and state) or private, in education, research, science and technology, social control and the provision of services of high social value15.
Unfortunately, contamination with removal and death of nursing professionals is a reality in the context of COVID-1916. It is an imminent risk of collapse of the health system that goes beyond the issue of the number of hospital beds or respirators, which gained space in the media and demanded efforts from public managers to solve problems4,15. It is important to reveal this reality because they are professionals who also get sick or are sick and who take care of other people, especially those in situations of suffering and illness16,17. In this way, the government and society need to guarantee dignified , decent, safe working conditions for these professionals, with working hours and fair wages, because they are not only essential in the context of COVID-19, but in all existence in its dynamics Social. Health is considered a human right and its essentiality cannot be restricted to a moment of chaos as is being experienced in the face of this pandemic17.
The illness and deaths of professionals expose the already precarious working conditions that were exacerbated by this pandemic. Thus, the situation of the pandemic was a concern of health professionals as a whole and class entities, due to studies that already exposed a somber diagnosis7,18. The problems presented are part of an agenda of struggles of the category in the perspective of turning the reality of these professionals into what the International Labor Organization has called “decent work”, capable of guaranteeing a dignified life or work based on a human conception19,20.
During the COVID-19 pandemic, Nursing revealed to the world the invisible and silent work of a profession so essential to humanity. Thus, a whole context experienced by professionals reveals the obscure facet of mercantilist health managers and entrepreneurs, in order to obtain more profits, in the 21st century, when they impose a relationship of domination and prejudice, of coronelismo, expressed in the relationship “of the servant and the master”, a relationship between oppressor and oppressed21.
We observed that the lack of human working conditions is narrated in this study by nursing professionals in the various areas of denouncements that gained national and international media.
Complaints about the working conditions that occurred during the pandemic period, originating from the public or private sectors, lead us to understand the logic of the world of nursing work, still based on the biomedical model, which imposes a culture based on the “symbolic power”17, which is centered on the social division of work: manual and intellectual, common in the hegemonic structures of health that still survives and attributes to “knowing how to do”, to manual work, performed by professionals as of “less value”; as if this work were devoid of the human condition of reflection-action-reflection mediation21.
The number of complaints, associated with deaths and sick leaves due to contamination by COVID-19, must mobilize everyone, due to the indignation at the trivialization of these professionals’ lives, due to the domination, oppression and violence in which they experience a world of slave labor21,22. Work is a “living act”, it is an activity that corresponds to the biological process of the body, whose spontaneous growth and decline are linked to vital needs, produced and provided by work, and the “human condition of work is life itself”20.
It is a fact that social distancing measures are non-pharmacological ways capable of reducing the total number of expected deaths related to COVID-19 in Brazil. However, this is not the reality of nursing professionals who work at the bedside in direct contact with the patient in various hospital sectors, at an accelerated pace and with an overload of work in the midst of chaos, increasing their risk of death where the priority it is the life of the other23. Reflecting on the dramatic picture of health professionals, The magazine Lancet described health professionals as the most valuable resource in each country and warned the need for nursing professionals to be treated as human beings, with adequate provision of PPE as the first step”24. This warning revealed the economic and social value of these professionals as a national asset of the health system.
As for the weaknesses of nursing professionals in relation to their skills, there is an emergence of creation of hospital beds and in particular Intensive Care Units25; the removal of more than 500 professionals infected in a single day2; suffering from human losses, among other factors that compromise the performance and safety of patients and health professionals3.
It should be noted that, mainly patients with COVID-19 hospitalized in a highly complex unit, they need trained professionals, team training and standardization of actions to recognize, measure and minimize the risks for the occurrence of adverse events and optimize the results therapeutic effects of pandemic-specific procedures26.
These professionals live with the unknown, with the emotional overload, with the stress exacerbated by the fear of contamination, with the pain and suffering of human losses and the death of the patient, with the removal due to the infection and the death of a colleague27-29. Daily life is characterized by the fear of taking the virus home and contaminating loved ones. Finally, they mourn the fear of their own death: “tomorrow it could be me”2, which determines a picture of deprivation and suffering.
In an attempt to minimize these challenges, as soon as the COVID-19 pandemic emerged in Brazil, the Federal Council of Nursing, together with the 27 Regional Councils located in all states of the Federation, created the Crisis Management Committee, organizing a set of actions to face the pandemic, demonstrating a commitment to nursing, quality in care and the pact with human life. From then on, he began to document information on the work carried out on a daily basis; to produce information on deliberations, such as agreements with universities to produce protocols, informative materials, courses to be taught at a distance; to provide professionals with physical and emotional security measures, including judicial measures; to accept and register denunciations of nursing work conditions and deliberate on them; to register deaths, among the many actions developed by the working group3,4,16.
We realized that, during the pandemic crisis, society needed a professional category able to carry out its competences, acting based on science and its art, dedicating itself to the health care of the population and watching over the lives of others. This commitment to life was and is being heroically developed by nursing professionals and in moments of great clarity about their social role, these workers ask: “we take care of others, but who takes care of us?”30.
The work of the Federal Nursing Council in partnerships with Public Universities, with the participation of Nursing courses and Departments, Study and Research Centers and Nuclei, integrating crisis management committees and composing commissions in the organization of actions in the quick response to the confrontation of the COVID-19 pandemic, as well as with organizations at the local, state, national and international level, reaffirms the social role of these institutions alongside the Brazilian population and the world. In addition to this role, it accompanied the death records of professionals who died from a mourning virus, in the full exercise of their duty: that of caring for others. The same is happening in the Regional Councils in all Brazilian states3.
Corroborating our findings, studies carried out with Nursing professionals in other countries, mainly in China, assessing the impact of diseases caused by viruses similar to SARS-CoV-2, show that these professionals developed diseases such as Burnout syndrome; stress triggered by pressure from organizations and society; ethical dilemmas in carrying out procedures; anxiety disorders; depressive disorders; post-traumatic stress disorder; excessive self-medication to overcome fatigue or mental illness; fear and insecurity in contaminating family members; in addition to deaths31-33.
CONCLUSION
During the COVID-19 pandemic, nursing has demonstrated its role through a lot of courage and determination in assisting contaminated patients with the aim of saving lives. However, we realize that all their sacrifice and personal abdications in favor of human life have cost them their lives.
The denouncements of premature deaths that occurred in nursing, predictable deaths that occurred due to the precarious working conditions, were externalized by means of voices that came to the public and exposed the blunt injuries of nursing, which caught the attention of the world, despite the applause, admiration and respect from society for the essentiality of its service to human beings.
However, the pandemic provided a moment of much learning. It is necessary to build actions aimed at nursing that, with the support and political will, can promote improvements in the working conditions and quality of life of these professionals.
Limitations
As limitations to the study, there is the restriction of data source, convenience sample, in front of a voluminous source of material available in social media, observing the criteria recommended in qualitative research.
Contributions to the practice
And as contributions to the practice of Nursing, the complaints about the precarious working conditions, culminating in the high rate of illness and death of professionals, the cry of revolt about the violence experienced in their daily work constituted a milestone of pain and learning that will subsidize teaching and practice projects based on liberating pedagogy in the perspective of changes.
