Compartir
array:23 [ "pii" => "S1130862110002032" "issn" => "11308621" "doi" => "10.1016/j.enfcli.2010.11.001" "estado" => "S300" "fechaPublicacion" => "2011-01-01" "aid" => "214" "copyright" => "Elsevier España, S.L.. All rights reserved" "copyrightAnyo" => "2010" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Enferm Clin. 2011;21:35-42" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 69 "PDF" => 69 ] "itemSiguiente" => array:18 [ "pii" => "S1130862110001890" "issn" => "11308621" "doi" => "10.1016/j.enfcli.2010.09.009" "estado" => "S300" "fechaPublicacion" => "2011-01-01" "aid" => "200" "copyright" => "Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Enferm Clin. 2011;21:43-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 144 "formatos" => array:2 [ "HTML" => 2 "PDF" => 142 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Cuidados</span>" "titulo" => "Aplicación de apósitos de membrana amniótica en pacientes con deterioro de la integridad cutánea" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "43" "paginaFinal" => "46" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Application of amniotic membrane dressings in patients with skin damage" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elier Carrera González, Jose Eduardo Noa Hernández, Carlos A. Marín Rojo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Elier" "apellidos" => "Carrera González" ] 1 => array:2 [ "nombre" => "Jose Eduardo" "apellidos" => "Noa Hernández" ] 2 => array:2 [ "nombre" => "Carlos A." "apellidos" => "Marín Rojo" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862110001890?idApp=UINPBA00004N" "url" => "/11308621/0000002100000001/v2_201305101341/S1130862110001890/v2_201305101341/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1130862110001907" "issn" => "11308621" "doi" => "10.1016/j.enfcli.2010.07.008" "estado" => "S300" "fechaPublicacion" => "2011-01-01" "aid" => "201" "copyright" => "Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Enferm Clin. 2011;21:30-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 82 "formatos" => array:3 [ "EPUB" => 1 "HTML" => 3 "PDF" => 78 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original breve</span>" "titulo" => "Anestesia tópica faríngea en endoscopia digestiva para pacientes no sedados" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "30" "paginaFinal" => "34" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Use of topical pharyngeal anaesthesia in esophagogastroduodenoscopy in unsedated patients" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gema Jiménez-Puente, Margarita Hidalgo-Isla" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Gema" "apellidos" => "Jiménez-Puente" ] 1 => array:2 [ "nombre" => "Margarita" "apellidos" => "Hidalgo-Isla" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862110001907?idApp=UINPBA00004N" "url" => "/11308621/0000002100000001/v2_201305101341/S1130862110001907/v2_201305101341/es/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special Article</span>" "titulo" => "Nursing in Brazil a critical-holistic perspective" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "35" "paginaFinal" => "42" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Maria da Gloria M. Wright, Jaqueline Da Silva, Maria Cecilia Puntel de Almeida, Maria Itayra Coelho de Souza Padilha, Helena M.S. Leal David, Gelson Luiz de Albuquerque" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Maria da Gloria M." "apellidos" => "Wright" "email" => array:1 [ 0 => "gwright@oas.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Jaqueline" "apellidos" => "Da Silva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Maria Cecilia Puntel de" "apellidos" => "Almeida" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Maria Itayra Coelho de Souza" "apellidos" => "Padilha" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Helena M.S. Leal" "apellidos" => "David" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "Gelson Luiz de" "apellidos" => "Albuquerque" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Demand Reduction Section, Inter-American Drug Abuse Control Commission, CICAD, Multidimensional Security Secretariat, MSS, Organization of American States, OAS, US" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Federal University of Rio de Janeiro, School of Nursing, Brazil" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "University of São Paulo, School of Nursing, Brazil" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "University of Santa Catarina, Nursing Department, Brazil" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "State University of Rio de Janeiro, Faculty of Nursing, Brazil" "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermería en Brasil: perspectiva crítica y holística" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2910 "Ancho" => 3167 "Tamanyo" => 432861 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Critical-Holistic Paradigm Theoretical Model for Brazilian Nursing (used with permission <span class="elsevierStyleSup">©</span> Wright. M.G.M., 2004).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Nursing in Brazil is embedded in the national social structure and, as a profession, reflects the country's political, economic, technological, social and cultural development. Nursing evolved from its 17th century roots when it was an ‘informal practice’ dispensed by healers, midwives, religious, and lay people to the 19th century, at which time it became a ‘formal institutionalized practice’ within the evolving capitalist system.</p><p id="par0010" class="elsevierStylePara elsevierViewall">From the 19th and 20th centuries onward, the country's development into what is an essentially capitalist system obviously changed economic, political, social, and health policies. And in late 20th and early 21st century, globalization provided new directions for policy design and decision-making, resulting in health care services with improved access, more efficient organization, and new funding and management opportunities. Nursing also sought scientific and technological advances in education, professional practice, and research in order to face the challenges of globalization.</p><p id="par0015" class="elsevierStylePara elsevierViewall">This paper examines Brazilian nursing through different perspectives: 1) the macro-political, emphasizing international and national scenes; 2) the micro-political, discussing international and national market demands as they influence national health care system; 3) the perspective of social and professional demands, highlighting professional practice, nursing organization and social-cultural issues, such as racism and gender; and finally through 4) the perspective of science and technology demands, highlighting higher nursing education, graduate education, and research evolution and consolidation.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Guiding Framework</span><p id="par0020" class="elsevierStylePara elsevierViewall">Brazilian nursing as social practice must be considered outside the usual academic stratification with its emphasis on the immediate and direct application of technical and scientific knowledge. To break away from that stratified view, this paper relies on Wright's (2000) “<span class="elsevierStyleItalic">Critical-Holistic Paradigm for an Interdependent World</span>” as the framework for its analysis. The Critical-Holistic Paradigm provides a multidimensional view of Brazilian nursing by considering the relationships between the various international (macro) determinants and national (micro) conditions. The paradigm provides a framework for looking at: (a) international and national market demands, and their primary effects on the national health system; (b) social and professional demands, and their primary effects on nursing practice; and finally (c) the science and technology demands, with their primary effects on nursing higher education and research (<a class="elsevierStyleCrossRefs" href="#fig0005">figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Macro-political analysis</span><p id="par0025" class="elsevierStylePara elsevierViewall">The macro-level political analysis looks at relationships among determining factors (both international and national) that affect Brazil and its place in the globalization process. It is especially important to note that certain events within globalization have impeded the choices and opportunities available to nursing as a social practice.</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">National scene-the brazilian chronology</span><p id="par0030" class="elsevierStylePara elsevierViewall">Brazil was colonized primarily by Portugal and is the largest country in South America, with almost 200,000 million people, mainly of three races and ethnicities: European, Native Brazilian, and African. It is a complex country with many disparities and social injustices. Brazil's federal republic, democratic government consists of legislative, judiciary and executive offices. At the local level, the country consists of 27 states (including one federal district) and more than 5,500 municipalities, which are all autonomous.</p><p id="par0035" class="elsevierStylePara elsevierViewall">After a long period of colonization and imperial rule, Brazil declared independence from Portugal in 1822 and became a Federal Republic in 1889 with autonomous regions and states. Political upheaval and military rule marked the early years of the 20th century interspersed with some periods of democratic rule. By the 1950<span class="elsevierStyleHsp" style=""></span>s, Brazil had become dominated by a nationalist ideology, which saw “development” as the sole solution to social problems. The 1960<span class="elsevierStyleHsp" style=""></span>s were years of economic prosperity, controlled and dominated by multi-national and national <span class="elsevierStyleItalic">bourgeoisie</span> who were aligned with foreign capital and military forces. The control began in 1964, when military forces staged a successful <span class="elsevierStyleItalic">coup d’état</span> and installed an authoritarian military dictatorship with unlimited power that lasted 21 years.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The 1970<span class="elsevierStyleHsp" style=""></span>s was a decade characterized by the military dictatorship, with selected areas of capitalist development and the integration of Brazil into the world capitalist system. The government and prominent multi-national companies (e.g., automobile, chemical, pharmaceutical, mining and agriculture) celebrated the country's high rate of economic growth as the “Brazilian Economic Miracle.” During the 1980<span class="elsevierStyleHsp" style=""></span>s, the multinational capitalist growth and the military dictatorship began to lose its appeal within Brazil. International opinion and pressure also mounted against the dictatorship. In the 80<span class="elsevierStyleHsp" style=""></span>s (the “Lost Decade”) the country experienced considerable political and economic change, when Brazil and other Latin American countries acquired extensive external debt. In 1985 the military rule ended in a peaceful conversion to a transitional government termed the “<span class="elsevierStyleItalic">Openin</span>g” followed by democratic elections.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the 1990<span class="elsevierStyleHsp" style=""></span>s, Brazil adopted a new industrial paradigm derived from globalization processes, economic opportunities, privatization of public companies and industries, and labor <span class="elsevierStyleItalic">de-regulation.</span><a class="elsevierStyleCrossRef" href="#fn0005"><span class="elsevierStyleSup">a</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">During the 1990<span class="elsevierStyleHsp" style=""></span>s, globalization intensified via neoliberal economic policies, changed Brazil's relationship with international markets as the influx of foreign capital created significant changes in Brazil's social, judicial, and regulatory relations.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Micro-political analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Today's Brazilian nursing and universal health care system developed as a direct response to influences such as: (i) the country's political and administrative structures and ideologies; (ii) the effects of peoples movements; and (iii) nursing's history as pro-active advocates for universal health care.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Although globalization has shaped Brazil's and nursing's development, it is the micro-political aspects of globalization that have had the most powerful impact on Brazilian nursing. Analyzing the micro-political level helps elucidate the actual reality. The following three aspects of this level of analysis are most pertinent (i) international and national market demands, highlighting the Brazilian health care system, (ii) social and professional demands, highlighting nursing's position in the country's health care system and (iii) science and technology demands, highlighting an analysis of higher nursing education and research and its impact on the development of the profession. Each of these is discussed below:</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">International and national market demands</span><p id="par0065" class="elsevierStylePara elsevierViewall">Wright's 2000 “Operational Model of Brazilian Nursing Critical-Holistic Analysis”<span class="elsevierStyleSup">©</span> suggests that international and national market demands drive the NHS in three major areas (i) Historical and Social Development, (ii) Hegemonic and Counter Hegemonic Movements and (iii) Financial Health Sector Challenges.</p><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Socio-Historic Development - 16<span class="elsevierStyleSup">th</span> to 21<span class="elsevierStyleSup">st</span> Century</span><p id="par0070" class="elsevierStylePara elsevierViewall">In Imperialist Brazil, sick care was the province of religious hospital mercy orders and Jesuit priests. A more formal medical policy that targeted overall population health and welfare began in 1808, when Portugal's Royal family migrated to Brazil. At that time, keeping the country's population healthy helped to maintain the social order and the high immigration levels from different parts of Europe.</p><p id="par0075" class="elsevierStylePara elsevierViewall">From late 19<span class="elsevierStyleSup">th</span> and early 20<span class="elsevierStyleSup">th</span> century onward, the country's development into what is an essentially capitalist system obviously changed economic, political, social, and health policies. In late 20<span class="elsevierStyleSup">th</span> and early 21<span class="elsevierStyleSup">st</span> century, globalization provided new directions for policy design and decision-making, resulting in health care services with improved access, more efficient organization, and new funding and management opportunities. The autonomy of Brazilian states and municipalities led to the decentralization of much of the country's healthcare system.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Currently, Brazil's health care is divided into three systems: (i) the public Unified Health System (UHS),<a class="elsevierStyleCrossRef" href="#fn0010"><span class="elsevierStyleSup">b</span></a> (ii) the private Supplementary Medical Care System (SMCS),<a class="elsevierStyleCrossRef" href="#fn0015"><span class="elsevierStyleSup">c</span></a> and (iii) the private Direct Disbursement System (DDS).<a class="elsevierStyleCrossRef" href="#fn0020"><span class="elsevierStyleSup">d</span></a> The private SMCS receives direct and indirect subsidies from the State under fiscal and contributive waivers and has four components (i) group medicine, (ii) self-management, (iii) medical mutual company and (iv) health insurance.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Hegemonic and Counter-Hegemonic Movements</span><p id="par0085" class="elsevierStylePara elsevierViewall">During the 1970<span class="elsevierStyleHsp" style=""></span>s and 1980<span class="elsevierStyleHsp" style=""></span>s, hegemonic and counter-hegemonic movements emerged in response to various national and international crises and to the profound national fiscal crisis. In the dominant health care model, which was based on curative procedures and technology, there was a move toward greater hegemony. This consolidation influenced both medical and nursing labor markets, professional education, and the private health sector.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The counter hegemonic movements that took place during the 70<span class="elsevierStyleHsp" style=""></span>s were influenced by the Alma-Ata report and the Health Movement that eventually became the Unified Health System (UHS). As a result, the National Constitution, in 1988, approved a health care system that established principles that were more inclusive (i) universal access, (ii) equity, (iii) people's participation, (iv) integrality and hierarchy and (v) regionalization.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Social and professional demands</span><p id="par0095" class="elsevierStylePara elsevierViewall">In keeping with Wright's 2000 <span class="elsevierStyleItalic">Operational Model,</span> the analysis of nursing's social and professional demands reviews how they are closely related to the career issues of nursing's professional practice, their professional organizations, as well as their social-cultural issues.</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Professional Practice</span><p id="par0100" class="elsevierStylePara elsevierViewall">Movements (both divergent and convergent with the profession's goals, as well as during periods of prosperity and decline) have punctuated nursing history.</p><p id="par0105" class="elsevierStylePara elsevierViewall">During the 1920<span class="elsevierStyleHsp" style=""></span>s, nursing was institutionalized as a career in response to both international macro- and national micro- level demands.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Nursing Education and Practice</span><p id="par0110" class="elsevierStylePara elsevierViewall">Early in the 1940<span class="elsevierStyleHsp" style=""></span>s, to address the shortage of registered nurses with Bachelor of Science degrees and the pressure from hospitals for a nursing professional category that could be educated in a shorter period of time, the profession created nurse auxiliaries.</p><p id="par0115" class="elsevierStylePara elsevierViewall">During the 1960<span class="elsevierStyleHsp" style=""></span>s, as health care became more sophisticated and technology dependent, demands for yet another category of nursing care worker emerged –that of nurse technicians– a category qualified to function in both public and private hospital networks. In 1962 Brazilian nursing became a liberal profession and entered the university as a legitimate educational program.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Currently there are three levels in the nursing team:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">RN-BS Nurses</span> are educated in 4-year university-based programs. Graduates are generalists who are prepared to accept management, direct health care, or university positions at schools of nursing.</p></li><li class="elsevierStyleListItem" id="lsti0010"><p id="par0130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Nursing Technicians</span> are high school graduates with additional diplomas from two year training programs. Graduates are prepared to accept positions that assist RN-BS nurses by providing medium-level complexity care.</p></li><li class="elsevierStyleListItem" id="lsti0015"><p id="par0135" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Nursing Auxiliaries are</span> high school graduates with one year of training courses. Graduates are prepared to perform low complexity care. In the absence of nurse technicians, they also perform medium-level complexity care. The nursing profession and the NHS are in the process of reclassifying these through further training courses - to become nursing technicians.</p></li></ul></p><p id="par0140" class="elsevierStylePara elsevierViewall">Overall, Brazil's nursing workforce includes 875,545 nursing professionals, divided into five different categories and five geographical regions. Nursing auxiliaries (504,885) represent the majority of the workforce, followed by nursing technicians (228,030), RN-BS nurses (116,457) and nursing attendants (26,132). Midwives (41) have the smallest numbers in both nursing and the NHS (Conselho Federal de Enfermagem<a class="elsevierStyleCrossRef" href="#fn0025"><span class="elsevierStyleSup">e</span></a>).</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Nursing Organizations</span><p id="par0145" class="elsevierStylePara elsevierViewall">The professional and labor organizations emerged, representing the diversity among Brazil's health professionals and workers, in the context of global and national economic and political development.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Brazilian Nursing Association</span><p id="par0150" class="elsevierStylePara elsevierViewall">RNs, nurse technicians, auxiliaries, and students are eligible to become voluntary members. Since the 1950<span class="elsevierStyleHsp" style=""></span>s, scientific events organized by the BNA have contributed to political strategies that have furthered nursing's transformation.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Federal and Regional Nursing Councils</span><p id="par0155" class="elsevierStylePara elsevierViewall">The regulation of professional nursing changed dramatically in 1973 with the authorization and creation of the Federal Nursing Council (FNC)<a class="elsevierStyleCrossRef" href="#fn0030"><span class="elsevierStyleSup">f</span></a> and the Regional Nursing Councils (RNCs)<a class="elsevierStyleCrossRef" href="#fn0035"><span class="elsevierStyleSup">g</span></a> within the Ministry of Labor (ML), which legitimatized Brazilian nursing. These councils regulate professional nursing practice and issue licenses to RNs, nursing technicians and auxiliaries. Thus, a total of 875,545 (100%) of nursing professionals are members.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Nursing unions</span><p id="par0160" class="elsevierStylePara elsevierViewall">The political development of nurses has been interwoven with their evolution as members of the labor force. Currently, the RNs’ Union<a class="elsevierStyleCrossRef" href="#fn0040"><span class="elsevierStyleSup">h</span></a> has 13 branches in different states and pre-union associations in 10 other states. Nursing auxiliaries and technicians are eligible to become members of the National Union of Nursing Auxiliaries and Technicians (NUNAT).<a class="elsevierStyleCrossRef" href="#fn0045"><span class="elsevierStyleSup">i</span></a></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Social and Cultural Issues</span><p id="par0165" class="elsevierStylePara elsevierViewall">Nursing faces issues that are inherent to Brazil's socio-cultural system. Among the many, two issues –racism and gender– are pertinent, though there have been few nursing studies conducted on them.</p><p id="par0170" class="elsevierStylePara elsevierViewall">An understanding of racism in nursing requires some knowledge about race in Brazilian society. The objects of racism in Brazil are Black (African heritage) and native Brazilian (Indian heritage) populations. Racist behaviors and prejudicial attitudes inherent in the country's socio-cultural system are common occurrences in the everyday lives of these populations.</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Science and technology demands</span><p id="par0175" class="elsevierStylePara elsevierViewall">As previously noted, science and technology demands also shape nursing higher education.</p><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Higher Nursing Education</span><p id="par0180" class="elsevierStylePara elsevierViewall">Brazil's undergraduate nursing programs are offered at federal, state and municipal public and private universities. Public universities at the three governmental levels are free of charge. Private universities have the largest number of nursing schools, but with less tradition and institutional accountability. Graduate programs –masters and doctoral– are predominantly offered in federal and state public universities. The Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)<a class="elsevierStyleCrossRef" href="#fn0050"><span class="elsevierStyleSup">j</span></a> and, at the Ministry of Science and Technology, the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)<a class="elsevierStyleCrossRef" href="#fn0055"><span class="elsevierStyleSup">k</span></a> are Brazil's major educational regulatory agencies.</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Undergraduate Education</span><p id="par0185" class="elsevierStylePara elsevierViewall">Nursing education initially - in the 19th century - focused on the preparation of nurses to function in public health (e.g., epidemic control and vaccination). During the first decades of the 20<span class="elsevierStyleSup">th</span> century, nursing education sought to support the health service model and meet the demands of an industrialized economy and urban workforce.</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">National Curriculum Guidelines and Expansion of Undergraduate Programs</span><p id="par0190" class="elsevierStylePara elsevierViewall">Nursing became a university-level, higher education career at public and private institutions, through the Law of Higher Education<a class="elsevierStyleCrossRef" href="#fn0060"><span class="elsevierStyleSup">l</span></a> passed in 1962. And by 1980 there were 79 undergraduate schools and programs. Of these, 49 were in public (i.e., 30 federal, 11 state, and 8 municipal), and 30 in private universities. Twenty years later, in the early 2000s, the number of nursing schools and programs had more than quadrupled to 354, with 114 are in public and 240 in private universities.</p><p id="par0195" class="elsevierStylePara elsevierViewall">Recently, the “National Curriculum Guidelines for Undergraduate Nursing Education”<a class="elsevierStyleCrossRef" href="#fn0065"><span class="elsevierStyleSup">m</span></a> changed the requirements for 4,000<span class="elsevierStyleHsp" style=""></span>hours and curricular content. Now baccalaureate students had to demonstrate the application of principles, foundations, conditions, and procedures in their early course work.</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Undergraduate Education Contrasts</span><p id="par0200" class="elsevierStylePara elsevierViewall">Some of the contrasts in higher education in general and in nursing education in particular are related primarily to the fact that tuition in Brazilian public universities is completely free. Public universities receive state financial support for the operating costs to develop and promote high quality teaching, research and extension<a class="elsevierStyleCrossRef" href="#fn0070"><span class="elsevierStyleSup">n</span></a> activities in underserved communities. Thus, the majority of public universities are able to attract students from high and upper middle class backgrounds and who have attended better preparatory schools.</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Graduate Education</span><p id="par0205" class="elsevierStylePara elsevierViewall">The establishment of graduate education occurred at the height of economic-industrial development in response to two main demands: The first, the need for a specialized workforce for new positions required by the expected economic development. The second, the need for scientists, researchers, and technicians capable of conducting research critical to the country's economic-industrial change.</p><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Specialization programs</span><p id="par0210" class="elsevierStylePara elsevierViewall">The specialization (or advanced practice) programs were created to meet the need for nurses with specific expertise. With a minimum of 360<span class="elsevierStyleHsp" style=""></span>hours, the goals of these programs were (in the 1950<span class="elsevierStyleHsp" style=""></span>s), and are (in the 2000s), to create high-quality nursing services, creating high levels of patient satisfaction.</p></span></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Masters and Doctoral rograms</span><p id="par0215" class="elsevierStylePara elsevierViewall">Early in the 21st century, Brazil, with a total of 40 programs, has the most nursing stricto sensu (masters and doctoral) graduate programs in Latin America. Of the 40 graduate programs, 13 offer doctorates; 23 offer masters, and 4 offer professional masters programs.<span class="elsevierStyleSup">15</span> The majority of graduate programs are in public federal and state universities and are located in the Southeast and South regions.</p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Research Evolution and Consolidation</span><p id="par0220" class="elsevierStylePara elsevierViewall">Nursing research in Brazil evolved with the creation of the masters (1970<span class="elsevierStyleHsp" style=""></span>s) and doctoral degree programs (1980<span class="elsevierStyleHsp" style=""></span>s). Nurse researchers gradually developed and refined both qualitative and quantitative scientific methods, as well as contributed to technological and scientific advancement for applied research in the day-to-day nursing practice.</p><p id="par0225" class="elsevierStylePara elsevierViewall">Despite these advances in the conduct of research, there is still not much international visibility. The most significant barriers to the international publication of Brazilian research reports and scholarly papers include: (i) English as a second language and Brazilian researchers’ limited English language proficiency; (ii) diverse criteria of international journals; and (iii) the power relationships among nurse scientists in different countries.</p></span></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Future challenges to transform nursing</span><p id="par0230" class="elsevierStylePara elsevierViewall">From the authors’ perspectives, nursing education and professional practice must be based on a socially responsive view of the world, while at the same time being constructed within the domains of science and technology. Nursing leadership in Brazil and beyond can benefit from collaborating with governments and international organizations to respond to economic, social, professional, scientific and technological market demands.</p></span></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Final considerations</span><p id="par0235" class="elsevierStylePara elsevierViewall">Nursing in Brazil has evolved over time within the context of the country's social, economic, political, scientific and technologic development. The primary challenge facing Brazilian nursing is where the majority of nurses are located, with a concentration in the southeast region. Salary disparities among the different regions contribute to nurses migrating for better pay.</p><p id="par0240" class="elsevierStylePara elsevierViewall">The number of nursing schools has expanded numerically and geographically, contributing to an increase in the programs for general practice. Scientific production and research projects by nurses, as principal investigators, have also increased exponentially. Brazilian researchers have fostered international research partnerships in order to overcome barriers to international publishing. Despite being the home of most graduate nursing programs in Latin America, Brazilian nursing practice and scientific production still face difficulties with international and national visibility and funding, as well as internal labor struggles and health care challenges common to a number of Latin American countries, although a few are common to North America as well. Using a <span class="elsevierStyleItalic">“Critical Holistic Paradigm”</span><span class="elsevierStyleSup">1</span> helped to identify the ideologies that have affected the profession of nursing and how current nursing education, research, and social practices were developed based on a strong political participatory tradition.</p><p id="par0245" class="elsevierStylePara elsevierViewall">In conclusion, Brazil is a country in transition, from a capitalist economy and deeply unequal society to a steady and self-sustained democratic country. In this sense, Brazil's nursing evolution reflects the socio-political and historical evolution of the country. Nursing research, education and practice in Brazil should continue effective participation in those social and political movements that favor inclusion and accessibility to a health care tailored to the needs of all Brazilian populations.</p></span><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0250" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres157776" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec145938" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres157777" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec145939" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Guiding Framework" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Macro-political analysis" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "National scene-the brazilian chronology" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Micro-political analysis" ] 2 => array:3 [ "identificador" => "sec0030" "titulo" => "International and national market demands" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Socio-Historic Development - 16 to 21 Century" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Hegemonic and Counter-Hegemonic Movements" ] ] ] 3 => array:3 [ "identificador" => "sec0045" "titulo" => "Social and professional demands" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Professional Practice" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Nursing Education and Practice" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Nursing Organizations" ] 3 => array:2 [ "identificador" => "sec0065" "titulo" => "Brazilian Nursing Association" ] 4 => array:2 [ "identificador" => "sec0070" "titulo" => "Federal and Regional Nursing Councils" ] 5 => array:2 [ "identificador" => "sec0075" "titulo" => "Nursing unions" ] 6 => array:2 [ "identificador" => "sec0080" "titulo" => "Social and Cultural Issues" ] ] ] 4 => array:3 [ "identificador" => "sec0085" "titulo" => "Science and technology demands" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0090" "titulo" => "Higher Nursing Education" ] 1 => array:2 [ "identificador" => "sec0095" "titulo" => "Undergraduate Education" ] 2 => array:2 [ "identificador" => "sec0100" "titulo" => "National Curriculum Guidelines and Expansion of Undergraduate Programs" ] 3 => array:2 [ "identificador" => "sec0105" "titulo" => "Undergraduate Education Contrasts" ] 4 => array:3 [ "identificador" => "sec0110" "titulo" => "Graduate Education" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0115" "titulo" => "Specialization programs" ] ] ] 5 => array:2 [ "identificador" => "sec0120" "titulo" => "Masters and Doctoral rograms" ] 6 => array:2 [ "identificador" => "sec0125" "titulo" => "Research Evolution and Consolidation" ] ] ] 5 => array:2 [ "identificador" => "sec0130" "titulo" => "Future challenges to transform nursing" ] ] ] 7 => array:2 [ "identificador" => "sec0135" "titulo" => "Final considerations" ] 8 => array:2 [ "identificador" => "sec0140" "titulo" => "Conflict of interest" ] 9 => array:2 [ "identificador" => "xack43199" "titulo" => "Acknowledgements" ] 10 => array:1 [ "titulo" => "<span class="elsevierStyleSectionTitle">Further reading</span>" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-10-28" "fechaAceptado" => "2010-11-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec145938" "palabras" => array:3 [ 0 => "Globalization" 1 => "Brazil" 2 => "Nursing" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec145939" "palabras" => array:3 [ 0 => "Globalización" 1 => "Brasil" 2 => "Enfermería" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Global and local insecurities influence the Brazilian health care system and the complexities of the healthcare workforce. Nursing in Brazil is shaped by socio-political and historical factors. This paper conceptualizes nursing as a social practice and uses Wright's (2000) <span class="elsevierStyleItalic">“Critical-Holistic Paradigm for an Interdependent World”</span> as a guide framework to analyze how nursing education and professional practice exist within the country's socio-economic and political reality while being constructed within the domains of science and technology.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los problemas globales y locales de seguridad, influyen sobre el sistema brasileño de asistencia sanitaria y las complejidades del personal de asistencia sanitaria de este país. La práctica de la Enfermería en Brasil está modelada por factores históricos y sociopolíticos. Este modelo concibe el ejercicio de la Enfermería como una práctica social y utiliza el trabajo de Wright (2000) <span class="elsevierStyleItalic">«Critical-Holistic Paradigm for an Independent World»</span> (Paradigma crítico y holístico para un mundo independiente) como marco para analizar la formación y la práctica profesional de la Enfermería en la realidad socioeconómica y política del país, a la par que basadas en los fundamentos de la ciencia y la tecnología.</p>" ] ] "NotaPie" => array:15 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">The opinions expressed in this article are the sole and exclusive responsibility of the authors and not represent the opinions of the organizations and the administration where they are employed. This article is a summary of Chapter 5 of the book entitled <span class="elsevierStyleItalic">“Nursing and Globalization in the Americas: A Critical Perspective,”</span> edited by Dr. Karen Breda, and published in 2009 by Baywood Publishing Company, Inc., Amityville, New York. The editor and the Baywood Publishing Company gave permission to publish the summary of Chapter 5 in August 2010.</p>" ] 1 => array:2 [ "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara">In terms of the health care system “de-regulation” means that health workers had, among others, precarious work contracts with low wages, excessive work hours per week, increased experience period, no social security or other benefits, and no dismissal wages.</p>" ] 2 => array:2 [ "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara">In Protuguese: Sistema Único de Saúde – SUS.</p>" ] 3 => array:2 [ "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara">In Portuguese: Sistema de Atenção Médica Suplementar – SAMS.</p>" ] 4 => array:2 [ "etiqueta" => "d" "nota" => "<p class="elsevierStyleNotepara">In Portuguese: Sistema de Desembolso Direto – SDD.</p>" ] 5 => array:2 [ "etiqueta" => "e" "nota" => "<p class="elsevierStyleNotepara"><span class="elsevierStyleUnderline">Translation</span>: Federal Council of Nursing, 2006.</p>" ] 6 => array:2 [ "etiqueta" => "f" "nota" => "<p class="elsevierStyleNotepara">In Portuguese: Conselho Federal de Enfermagem - COFEn.</p>" ] 7 => array:2 [ "etiqueta" => "g" "nota" => "<p class="elsevierStyleNotepara">In Portuguese: Conselhos Regionais de Enfermagem – COREns.</p>" ] 8 => array:2 [ "etiqueta" => "h" "nota" => "<p class="elsevierStyleNotepara">In Portuguese: Sindicato dos Enfermeiros.</p>" ] 9 => array:2 [ "etiqueta" => "i" "nota" => "<p class="elsevierStyleNotepara">In Portuguese: União Nacional dos Auxiliares e Técnicos de Enfermagem – UNATE.</p>" ] 10 => array:2 [ "etiqueta" => "j" "nota" => "<p class="elsevierStyleNotepara"><span class="elsevierStyleUnderline">Translation</span>: Coordination for Further Education of Graduate Personnel – CFEGP.</p>" ] 11 => array:2 [ "etiqueta" => "k" "nota" => "<p class="elsevierStyleNotepara"><span class="elsevierStyleUnderline">Translation</span>: National Council for Scientific and Technological Development – NCSTD.</p>" ] 12 => array:2 [ "etiqueta" => "l" "nota" => "<p class="elsevierStyleNotepara">In Portuguese: Lei de Educação Superior.</p>" ] 13 => array:2 [ "etiqueta" => "m" "nota" => "<p class="elsevierStyleNotepara">In Portuguese: Diretrizes Curriculares Nacionais do Ensino de Graduação de Enfermagem.</p>" ] 14 => array:2 [ "etiqueta" => "n" "nota" => "<p class="elsevierStyleNotepara"><span class="elsevierStyleUnderline">Cultural Note</span>: University faculty, staff and student extension (application) activities are community programs and services developed, implemented / delivered, and evaluated with community participation.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2910 "Ancho" => 3167 "Tamanyo" => 432861 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Critical-Holistic Paradigm Theoretical Model for Brazilian Nursing (used with permission <span class="elsevierStyleSup">©</span> Wright. M.G.M., 2004).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2306 "Ancho" => 3333 "Tamanyo" => 333325 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Operational Model of Brazilian Nursing Critical-Holistic Analysis (used with permission <span class="elsevierStyleSup">©</span> Wright, M.G.M., 2004).</p>" ] ] ] "lecturaRecomendada" => array:1 [ 0 => array:3 [ "vista" => "all" "titulo" => "<span class="elsevierStyleSectionTitle">Further reading</span>" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:42 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Albuquerque GL. O movimento participação na Associação Brasileira de Enfermagem – Seção Santa Catarina, na visão de suas principais lideranças. Florianópolis. Tese (Doutorado) - Departamento de Enfermagem, Universidade Federal de Santa Catarina; 2001." ] ] ] 1 => array:3 [ "identificador" => "bib0085" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A luta pela identidade profissional: participação e enfermagem" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G.L. Albuquerque" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2002" "editorial" => "UFSC/PEN" "editorialLocalizacion" => "Florianópolis" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Araújo AR. A assistência médica hospitalar no Rio de Janeiro no século XIX. Rio de Janeiro: Conselho Federal de Cultura; 1982. p. 16." ] ] ] 3 => array:3 [ "identificador" => "bib0080" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Abertura de cursos da área da saúde" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.B. Ceccim" 1 => "L.M. Feuerwerker" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2003" "editorial" => "Ministério da Saúde" "editorialLocalizacion" => "Brasília, D.F" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0090" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "O quadrilátero da formação para área da saúde: ensino, gestão, atenção e controle social" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.B. Ceccim" 1 => "L.M. Feurwerker" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2004" "editorial" => "Ministério da Saúde" "editorialLocalizacion" => "Brasília, D.F" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0095" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mudança na graduação das profissões de saúde sob o eixo da Integralidade" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.B. Ceccim" 1 => "L.M. Feurwerker" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2004" "editorial" => "Ministério da Saúde" "editorialLocalizacion" => "Brasília, D.F" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0060" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => """ COFEN/Brasil. Conselho Federal de Enfermagem. Available: \n <http: www.portalcofen.br.="">\n Accessed on: March 23, 2006.\n </http:> """ ] ] ] 7 => array:3 [ "identificador" => "bib0065" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Haddad S. Apresentação do livro “Racismo no Brasil.” São Paulo. Editores (Seyferth G, SilvaBento M, DaSilva MP, Borges Pereira JB, Siqueira ML, Silvério VR, et al., editors.). Petrópolis: Editora Fundação Petrópolis; 2002. p. 9." ] ] ] 8 => array:3 [ "identificador" => "bib0110" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "O capitalismo e a saúde pública" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E.E. Merhy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1987" "editorial" => "Papirus" "editorialLocalizacion" => "Campinas" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0070" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "MEC/CAPES. Infocapes: Edição comemorativa dos 45 anos. Boletim Informativo da CAPES; 1996." ] ] ] 10 => array:3 [ "identificador" => "bib0115" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Merhy EE, Chakkour M, Stéfano E, Stéfano ME, Santos CM, Rodrigues RA, et al. Em busca de ferramentas analisadoras das tecnologias em saúde: a informação e o dia a dia de um serviço, interrogando e gerindo trabalho em saúde. In: Merhy, E.E. & Onocko, R. (Org.). Práxis en Salud – desafo para lo público. São Paulo: Hucitec; 1997. p. 113–150." ] ] ] 11 => array:3 [ "identificador" => "bib0045" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Os grandes dilemas do SUS (Tomo I)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E.V. Mendes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2001" "editorial" => "Casa da Qualidade Editora" "editorialLocalizacion" => "Salvador" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0050" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Os grandes dilemas do SUS (Tomo II)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E.V. Mendes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2001" "editorial" => "Casa da Qualidade Editora" "editorialLocalizacion" => "Salvador" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0100" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Mendes EV. A evolução histórica da atenção primária á saúde no Brasil. In: A atenção primária à saúde no SUS. Fortaleza: Escola de Saúde Pública do Ceará; 2002. p. 23–29." ] ] ] 14 => array:3 [ "identificador" => "bib0105" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A atenção primária à saúde no SUS" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E.V. Mendes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2002" "editorial" => "Escola de Saúde Pública do Ceará" "editorialLocalizacion" => "Fortaleza" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0075" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => """ MEC/CAPES. Relação de Cursos Recomendados e Reconhecidos. Available: \n <http: conteudoweb.capes.gov.br="" onteudoweb="" rojetorelacaocursos="">\n Access: March 20\n </http:><span class="elsevierStyleSup">th</span>, 2007. """ ] ] ] 16 => array:3 [ "identificador" => "bib0135" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministério da Educação e Cultura, Departamento de Assuntos Universitários - MEC/DAU. Estudo sobre a formação e utilização dos recursos humanos na área de saúde. Brasília, D.F.; 1974. p. 15–22." ] ] ] 17 => array:3 [ "identificador" => "bib0140" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministério de Educação e Cultura, Departamento de Assuntos Universitários – MEC/DAU. Desenvolvimento do ensino superior de enfermagem no Brasil. Brasília, D.F.; 1977. p. 19–22." ] ] ] 18 => array:3 [ "identificador" => "bib0125" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministério da Previdência e Assistência Social - MPAS. Reorientação da assistência à saúde no âmbito da previdência social. Brasília, D.F.; 1982." ] ] ] 19 => array:3 [ "identificador" => "bib0145" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministério de Educação, Secretaria da Educação Superior, Comissão de Especialistas de Ensino de Enfermagem – MEC/SES/CEEE. Ensino superior de enfermagem – Relatório Final do Seminário Nacional. Rio de Janeiro; 1987. p. 107–111." ] ] ] 20 => array:3 [ "identificador" => "bib0120" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Não aos estereótipos. Vencer o sexismo nos livros para crianças e nos manuais escolares" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Michel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1989" "editorial" => "UNESCO" "editorialLocalizacion" => "São Paulo" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Miranda CML. O risco e o bordado - um estudo sobre formação de identidade profissional. Tese de Doutorado apresentada ao Centro Biomédico da UERJ - RJ, Rio de Janeiro;1996." ] ] ] 22 => array:3 [ "identificador" => "bib0130" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministério da Saúde. Secretaria de Gestão do Trabalho e da Educação na Saúde. Departamento de Gestão da Educação na Saúde. Política de educação e desenvolvimento para o SUS: caminhos para a educação permanente em saúde: pólos de educação permanente em saúde. Brasília, DF: Ministério da Saúde; 2004." ] ] ] 23 => array:3 [ "identificador" => "bib0155" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A mulher no terceiro milênio: uma história da mulher através dos tempos e suas perspectivas para o futuro" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.M. Muraro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1992" "editorial" => "Rosa dos Ventos" "editorialLocalizacion" => "Rio de Janeiro" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0160" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Novos caminhos da enfermagem" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.D. Nakamae" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1987" "editorial" => "Cortez" "editorialLocalizacion" => "São Paulo" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0165" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "National Institute of Consumers’ Protection – INPC; 2000." ] ] ] 26 => array:3 [ "identificador" => "bib0170" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Neves EP, Vargens OMC. La contribución de los programas de doctorados de enfermería ante los avances científicos y tecnológicos: el estudio de caso de Brasil – un análisis preliminar. In: CICAD. Los nuevos programas de doctorados en enfermería y su contribución en la reducción de la demanda de las drogas en América Latina: retos y perspectivas. Washington, D.C.; 2003. p. 9–24." ] ] ] 27 => array:3 [ "identificador" => "bib0040" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A mística do silêncio: a prática de enfermagem na Santa Casa de Misericórdia do Rio de Janeiro no século XIX" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.I.C.S. Padilha" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1998" "editorial" => "Palotti" "editorialLocalizacion" => "Pelotas" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0175" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Organizacion Mundial de la Salud – OMS. Atención Primaria de Salud-Informe de la Conferencia Internacional sobre Atención Primaria de Salud Alma-Ata. Genebra: Organización Mundial de la Salud; 1978." ] ] ] 29 => array:3 [ "identificador" => "bib0180" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Padilha MICS. O resgate das raízes - a influência da formação familiar e social na escolha e exercício da enfermagem. Tese de Livre docência apresentada a UNIRIO/RJ; 1990." ] ] ] 30 => array:3 [ "identificador" => "bib0185" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Padilha MICS, Borenstein MS, Santos MLSC, Cartana MH. Acordando a bela adormecida - gênero ou sexismo no discurso da enfermagem. Florianópolis: Revista Ciências da Saúde. 1998; 17:43–66." ] ] ] 31 => array:3 [ "identificador" => "bib0190" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Padilha MICS, Silva AL, Borenstein MS. Os congressos brasileiros - pontes para a liberdade e transformação da enfermagem. Ribeirão Preto: Revista Latino-americana de Enfermagem. 2001;9:7–13." ] ] ] 32 => array:3 [ "identificador" => "bib0055" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Padilha MICS, Silva AL, Borenstein MS. Um contraponto entre os personagens dos congressos brasileiros de enfermagem e da Revista Brasileira de Enfermagem no período de 1977 a 1987. Brasília: Revista Brasileira de Enfermagem. 2002;55:323–30." ] ] ] 33 => array:3 [ "identificador" => "bib0010" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hegemonia médica na saúde e a enfermagem" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. Pires" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1989" "editorial" => "Cortez" "editorialLocalizacion" => "São Paulo" ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0020" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A década de 80: Brasil: quando a multidão voltou as praças" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Rodrigues" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "4<span class="elsevierStyleSup">a</span> ed." "fecha" => "2003" "editorial" => "Ática" "editorialLocalizacion" => "São Paulo" ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0195" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Racismo no Brasil" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Seyferth" 1 => "M.A. Silva Bento" 2 => "M.P. Silva" 3 => "J.B. Borges Pereira" 4 => "M.L. Siqueira" 5 => "V.R. Silvério" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2002" "editorial" => "Editora Fundação Petrópolis" "editorialLocalizacion" => "São Paulo" ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0015" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Singer P, Campos O, Oliveira EM. A evolução da situação de saúde no Brasil. In: Prevenir e curar - O controle social através dos serviços de saúde. Rio de Janeiro: Forense-Universitária; 1978. p. 88–137." ] ] ] 37 => array:3 [ "identificador" => "bib0025" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A década de 60: rebeldia, contestação e repressão política" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.H. Simões Paes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "4<span class="elsevierStyleSup">a</span> ed." "fecha" => "2002" "editorial" => "Ática" "editorialLocalizacion" => "São Paulo" ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0200" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Educação Popular e Saúde: trajetória, expressões e desafios de um movimento social. Critical Pedagogy and Health: history, expressions and challenges of a Brazilian social movement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E.N. Stotz" 1 => "H.M.S.L. David" 2 => "J.A. Wong-Um" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Revista de Atenção Primária à Saúde." "fecha" => "2005" "volumen" => "8" "paginaInicial" => "49" "paginaFinal" => "60" ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0205" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Desenvolvimento do ensino superior de enfermagem na região centro-oeste: indicadores de qualidade para cursos de graduação" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.G.M. Wright" 1 => "L. Paim" 2 => "K.H. Rodrigues" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Revista Brasileira de Enfermagem." "fecha" => "1982" "volumen" => "35" "paginaInicial" => "60" "paginaFinal" => "73" ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0210" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Espaço da mulher brasileira e o espaço da enfermeira brasileira" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.G.M. Wright" 1 => "A.M. Carneiro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Revista Gaúcha de Enfermagem." "fecha" => "1984" "volumen" => "5" "paginaInicial" => "341" "paginaFinal" => "356" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6571029" "web" => "Medline" ] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0005" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A critical-holistic paradigm for an interdependent world" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.G.M. Wright" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "American Behavioral Scientist." "fecha" => "2000" "volumen" => "43" "paginaInicial" => "808" "paginaFinal" => "823" ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "identificador" => "xack43199" "titulo" => "Acknowledgements" "texto" => "<p id="par0265" class="elsevierStylePara elsevierViewall">The authors would like to express a special thank you to Dr. Cornelia P. Porter, who assisted with multiple editions of the chapter, specifically the English edition, as well as Dr. Jaqueline Da Silva, who translated the Portuguese version of the chapter into English, for her effort, dedication, and suggestions to improve the editing process of the chapter. The authors also thank Cristiane Gramari Say, grantee of CNPq Technical Support in Dr. Maria Cecilia Puntel de Almeida project “Work Technological Organization in Health Care” for her valuable logistic and technological collaboration in the making of this chapter. We express special thanks to the InterAmerican Drug Control Commission – CICAD of the Organization of American States-OAS for fostering nursing integration and advance in the Americas, with special emphasis in Latin America and the Caribbean Region. With great sadness we inform the readers that Dr. Maria Cecilia Puntel de Almeida passed away on February 15, 2009. No words in Portuguese, Spanish or in English can translate how much she and her work will be missed – she truly was an admirable nurse scientist and a person who enriched the minds and lives of those she met. We were privileged to have had the opportunity to work with her in this endeavor and to share with you some of this experience.</p>" ] ] ] "idiomaDefecto" => "en" "url" => "/11308621/0000002100000001/v2_201305101341/S1130862110002032/v2_201305101341/en/main.assets" "Apartado" => array:4 [ "identificador" => "8742" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Artículo especial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/11308621/0000002100000001/v2_201305101341/S1130862110002032/v2_201305101341/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862110002032?idApp=UINPBA00004N" ]
