¹Jefferson Wildes da Silva Moura

²Débora Rinaldi Nogueira

³Fábila Fernanda dos Passos da Rosa

⁴Thiago Lopes Silva

⁵Evangelia Kotzias Atherino dos Santos

⁶Soraia Dornelles Schoeller

¹Doctorate student of the Graduate Program in Nursing at the Universidade Federal de Santa Catarina. Florianópolis, Brazil. ORCID: https://orcid.org/0000-0002-7192-1099

²Doctorate student of the Graduate Program in Nursing at the Universidade Federal de Santa Catarina. Professor at the Instituto Federal de Santa Catarina. Joinville, Brazil. ORCID: https://orcid.org/0000-0001-6653-1830

³Doctorate student of the Graduate Program in Nursing at the Universidade Federal de Santa Catarina. Florianópolis, Brazil. ORCID: https://orcid.org/0000-0002-4171-9965

⁴Doctorate student of the Graduate Program in Nursing at the Universidade Federal de Santa Catarina. Florianópolis, Brazil. ORCID: https://orcid.org/0000-0002-6310-5825

⁵Permanent professor of the Graduate Program in Nursing at the Universidade Federal de Santa Catarina. Florianópolis, Brazil. ORCID: https://orcid.org/0000-0002-5970-020X

⁶Permanent professor of the Graduate Program in Nursing at the Universidade Federal de Santa Catarina. Florianópolis, Brazil. ORCID: https://orcid.org/0000-0002-2822-4407

ABSTRACT

Objective: reflect on the milestones of Nursing visibility in the contemporary era in the light of Wanda Horta. Method: This is a theoretical-reflective study based on the theory and assumptions of Wanda Horta. Result: Two main categories were listed: Nursing in the perception of Wanda Horta and Nursing as an art and science. Wanda Horta actively participated in the transformation process of the Nursing Profession in Brazil, corroborating systematized care through the development of the Nursing Process and in the scientificity of the profession by elaborating its theory focused on basic human needs. In addition, she collaborated in the teaching-learning process, training new nurses, and disseminating Nursing as an art and science. Final remarks: Horta contributed to the advancement of Nursing in the practical, scientific, and professional dimensions, revolutionizing Nursing care in Brazil.
Keywords: Nursing; Nursing Care; Philosophy in Nursing; Nursing Theory; History of Nursing.

RESUMEN

Objetivo: reflexionar sobre los hitos de la visibilidad de la enfermería en la era contemporánea a la luz de Wanda Horta. Método: se trata de un estudio teórico-reflexivo, basado en la base teórica de los supuestos de Wanda Horta. Resultados: se seleccionaron dos categorías centrales: Enfermería en la percepción de Wanda Horta y Enfermería como arte y ciencia. Wanda Horta participó activamente en el proceso de transformación de la profesión de enfermería en Brasil, corroborando para la atención sistematizada a través del desarrollo del Proceso de Enfermería, así como en la cientificidad de la profesión a través de la elaboración de su teoría centrada en las necesidades humanas básicas. Además, colaboró en el proceso de enseñanza-aprendizaje y formación de nuevas enfermeras, así como en la difusión de la Enfermería como arte y ciencia. Consideraciones finales: Horta contribuyó al avance de la Enfermería en la dimensión práctica, científica y profesional, revolucionando el cuidado de enfermería en Brasil.

Palabras clave: Enfermería; Atención de Enfermería; Filosofía en Enfermería; Teoría de Enfermería; Historia de la Enfermeria.

RESUMO

Objetivo: refletir acerca dos marcos da visibilidade da Enfermagem na era contemporânea à luz de Wanda Horta. Método: trata-se um estudo teórico-reflexivo, fundamentado na base teórica e dos pressupostos de Wanda Horta. Resultados: foram elencadas duas categorias centrais: Enfermagem na percepção de Wanda Horta e Enfermagem enquanto arte e ciência. Wanda Horta participou ativamente do processo de transformação da profissão Enfermagem no Brasil, corroborando para a uma assistência sistematizada através do desenvolvimento do Processo de Enfermagem, bem como na cientificidade da profissão por meio da elaboração de sua teoria voltada para as necessidades humanas básicas. Além disso, colaborou no processo de ensino-aprendizagem e de formação de novos enfermeiros, assim como na divulgação da Enfermagem enquanto arte e ciência. Considerações finais: Horta contribuiu para o avanço da Enfermagem na dimensão prática, científica e profissional, revolucionando a assistência de Enfermagem no Brasil.

Palavras-chave: Enfermagem; Cuidados de Enfermagem; Filosofia em Enfermagem; Teoria de Enfermagem; História da Enfermagem.

INTRODUCTION

Caring is an important activity for maintaining human life. This task has been culturally entrusted to women over time. In health care, this responsibility was of the religious women who worked in the Holy Houses of Mercy caring for the sick until the mid-eighteenth century. Health care is (re)organized with the emergence of hospitals, under the doctor’s responsibility. Consequently, it was up to the religious women to exercise care subordinate to medical discipline^(1-3).

The importance of nursing care/work in the hospital setting is noted as necessary to carry out "nurse" training, which was only practical, without theoretical/scientific knowledge of Nursing. Despite being at the forefront of care narratives and even with the institutionalization of Nursing as a profession in the nineteenth century, the woman/nurse is placed in a position of subservience to the man/doctor. The knowledge and care practices that corroborated to support the health sciences and, consequently, nursing were disqualified^(2-3).

The history of the Nursing practice is inseparable from the women who performed it and who passed on their knowledge to new generations of women. There is a romanticization regarding the image of the nurse, who stops being the "lady in red" who serves the doctor to be the "lady in white" or "lady of the lamp", a selfless, decent woman who helps others without expecting retribution. Despite the prejudice and the “hostile” environment that persists to this day, it is clear that contemporary women have remained faithful to their purpose of offering quality, human, and effective care. This scenario instigated the advancement and changes in nursing practices through the reformulation of care^(4,2).

On the international stage, Florence Nightingale revolutionized Nursing. She contributed to its professionalization and solidification as a science from her experience in the Crimean War (1853-1856), recognizing the influence of the environment on the patient's health status, which generated the Environmental Theory, the first theory in the field of Nursing. In Brazil, Anna Nery served as a nurse in the Paraguayan War (1864-1870), facing the prejudices of the time related to her gender. Despite the difficulty, she managed to alleviate the suffering of the wounded soldiers, returning to her country as a hero of Brazilian Nursing^(2-3,5).

Wanda Horta was another woman who contributed to the recognition of Nursing as an autonomous science in Brazil. She was a precursor of the Nursing Process used in the systematization of Nursing Care and responsible for the Revista Enfermagem em Novas Dimensões (REND), in force between 1975 and 1979. REND aimed to promote the debate on advances in Nursing. Beyond scientific publications, there was room to share the concept of care as art⁽³⁾.

Art in Nursing is not only a resource used in the teaching and learning process, but it should also be practiced. Horta, for example, used art as self-care for the wounds of her soul caused mainly by the degenerative disease multiple sclerosis, of which she was a carrier. She reinforced that care was not just a primordial professional activity for the health area but that it would be a basic need of the human being. Therefore, she proposed scientific Nursing, but with humanized care practices, because we are "people who take care of people”, looking not only at the patient but also at the professional⁽²⁾.

For Horta, the Nursing philosophy is beyond a service provided to other individuals since it is based on a complex and subjective relationship between Nursing beings. The production of Horta, one of the leading Nursing theorists in Brazil, contributed to developing knowledge about care in the twentieth century, leading to what we call Nursing Science⁽²⁾. Thus, this work aims to reflect on the milestones of Nursing visibility in the contemporary era in the light of Wanda Horta.

METHOD

This is a theoretical-reflective study based on the assumptions theory of Wanda Horta and the current scientific literature relevant to the subject. This work was generated from the provocations in the elective discipline "Philosophy of Science, Nursing, and Health”, inherent to a Graduate Program in Nursing at a Federal University in southern Brazil. It was entrusted to the students of the doctoral program in Nursing as a stage of the evaluative process of the discipline to carry out a critical and reflective analysis of the proposed theme. Two main categories were listed for a better presentation: Nursing in the perception of Wanda Horta and Nursing as an art and science.

RESULTS AND DISCUSSION

Nursing in the perception of Wanda Horta

Understanding the knowledge of Nursing Science requires a look at the times lived and traveled by the profession and its historical characters that gave light, sustainability, and scientificity to the nurse-being, Nursing theorists.

In Brazil, the nurse, researcher, and theorist Wanda de Aguiar Horta was responsible for determining an exponential milestone in Brazilian Nursing, which was reflected internationally. She was a visionary in stating that nurses are active members and holders of knowledge in the health team and not only submissive to perform actions pre-established by the medical professional. Faced with this restlessness, added to the daily experience of hospital practice, Horta began the revolution and modernization of the profession in the 60s by elaborating a theory centered on basic human needs and a care method, the Nursing Process. Both had the objective of ordering care, adding the parts, and seeing the whole body-mind-spirit.

For a better reflection on the entire process of building a scientific and contemporary Nursing proposed by this nurse, it is necessary to understand who this woman was, ahead of her time, and how her bases influenced her art in a very humble and summarized manner. Born in Belém do Pará on August 11^th, 1926, the daughter of a military father and a mother very devoted to caring for her house and children's education, Horta grew up within the culture expected for the time and the northern region of the country. The historical accounts of family members describe a very demure girl, religious, unique lover of reading and music (piano), studious, and excellent school performance⁽⁶⁾.

As a teenager, she developed a natural interest in the human/biological sciences, specifically in microbiology, anatomy, and physiology. She was enrolled in high school and pre-medical, an orientation to working at the time. This initiative of her parents brought out in Horta the desire for care, also enhanced by another movement of the period, the 2nd World War, described by her as an inhuman act devoid of professionals trained to care for the wounded and their families. This fact motivated her to enroll at 16 in a program for volunteers at the Red Cross in Ponta Grossa, Paraná, where her family lived for a period⁽⁷⁾.

In 1944, already living in Curitiba with her family, the desire to study medicine arose since she did not know the Nursing program. However, she decided to go to work since she was not old enough nor had the financial conditions to take the entrance exam. She began her activities at the Posto de Puericultura da Legião Brasileira de Assistência through a friend named Rosalina Niepce da Silva, where she started to practice nursing in a very rudimentary way, performing procedures such as intramuscular medication administration and tuberculin tests. The following year, she was awarded a scholarship to the Nursing School at the Universidade de São Paulo (EEUSP). The first years of her profession were practiced in public health, mental health, and emergency room in different parts of the country until mid-1959 when she returned to USP as a professor⁽⁷⁾.

From that moment, Horta changes the course of the Nursing profession, not only as a science but also in its philosophical assumptions. Its constructs, both in the master's and doctorate degrees and later as an adjunct professor, are committed to systematizing and identifying nursing problems, seeking to balance biological, psychosocial, and spiritual imbalances, tracing the needs, planning care performed by both professionals and the individual themselves, thinking about a concept of self-care, and aiming at prevention, promotion, and rehabilitation in health⁽⁸⁾.

With the proposal of making the profession scientific, she studied several theorists from other countries, especially the North Americans, who at the time already showed interest and discussed a new horizon for Nursing, such as McDowell (homeostasis), Levine (holistic), Roy (adaptation), King (perception, transaction, and interaction), and Rogers (man in time and space), who influenced her theory in some way. Her ideas on the basic needs of the human being were based on two paradigms and Maslow and Mohana⁽⁸⁾.

Throughout her academic life, she published many articles with themes that addressed the different basic human needs and their concepts and brought into detail possibilities for care planning, published even in REND, for which she was the founder, working with editor and writer. The ten years she worked in care served to alert her to an established problem; Nursing did not have a method of care. It was performed as a loose, rudimentary practice without foundation. This last look earned her a discipline in the Nursing program, fundamentals of Nursing, at the Escola de Enfermagem Anna Nery⁽⁹⁾.

The fact that there is no theoretical-methodological Nursing made Horta create the Nursing Process, which aimed to systematize the actions aimed at the human being, contemplating six stages: Nursing History; Nursing Diagnosis; Care Plan; Nursing Evolution; and Nursing Prognosis. Concomitant to this construction, she was elaborating a theory, based on scientific evidence, that was concerned with proving that humans are part of a whole, that they can be seen as a universe, and that they suffer the reflection of the entire and respond to this interference, and this affects their welfare. It also proves that Nursing is an integral part of the health team and this whole, and it makes it responsible for assisting human beings and their needs through its knowledge and technique, making it an active and participatory element of their self-care⁽¹⁰⁾.

A modest analysis shows that the family base sustained by the theorist guaranteed her an ethical, centered, and very secure posture of her purposes, even in a difficult time for professional advancement. Her polyglot status has guaranteed her information and engagements in scientific events in several countries, proving that knowledge is transcendent. The experience in different fields of work ensured their look and sensitivity to the various nuances of the human being and their needs, giving basis to the assumptions of her theory. Separating needs by categories and stratifying them showed that nurses must know to perform an assessment based not only on biological standards.

Horta died in 1981, at fifty-five years, as a result of a degenerative disease⁽⁸⁾ that did not prevent her from building knowledge until the end, leaving a legacy, an unfinished theory but grounded, current, and innovative, that serves as a reference in many health and educational institutions to subsidize the planning of Nursing Care. This Brazilian theorist represents a milestone for Nursing as care and science.

Nursing as an art and science

The discussions regarding the classification of a job as an occupation or profession are significant and based on the characteristics of the different positions, the ability of their professionals to demonstrate the importance of their work, and the need to have legal prerogatives of protection. From this perspective, to analyze the work of Nursing compared to the specificities of the profession, it is necessary to look at the social utility of this work and the historical-social determinants of its role in the multidisciplinary field of health. Nursing as a profession has been building its identity. However, it is in the process of transformation and continuous development, consolidating it as a science while increasing the practice of scientific evidence⁽¹¹⁾.

Sixteen Nursing programs were created in Brazil from the beginning of the 1920s to the end of the 1940s, representing the beginning of higher education in the country. This fact is deeply linked to the transformations produced in the country by urban and industrial growth⁽¹²⁾. Although Nursing programs were in an evident expansion during this period, the increase was intensified after the enactment of Law nº 2,024/61 of Guidelines and Bases of National Education. The stimulation of the research and the expansion of higher education begins with Law nº 5,540/68 on the Standards of Organization and Functioning of Higher Education and the creation of the Stricto Sensu Graduate Programs. According to the Census of Higher Education, Brazil currently has 1,041 undergraduate Nursing programs⁽¹³⁾.

Nursing Graduation programs in Brazil are celebrating 50 years and have qualified nurses for the care, assistance, and administration of different and complex needs and requirements of the population. The health sector and the continuity of the training of new nurses is a milestone for Brazilian nursing, enabling the support of the scientificity of the profession by demonstrating the efficiency of its actions.

It is essential to highlight that a fundamental character was necessary for implementing Nursing Graduate studies in the country: Wanda Horta, who collaborated in the creation of the first two Nursing master's programs in Brazil, the first at the Escola de Enfermagem Anna Nery and the second at EEUSP, and in the establishment of the first Nursing Doctoral program in Latin America at EEUSP together with the Escola de Enfermagem de Ribeirão Preto of USP⁽¹⁴⁾. Horta also contributed to the organization of the Nursing Graduate Program at the Universidade Federal de Santa Catarina⁽¹⁵⁾.

Another essential factor for Brazilian Nursing was the creation of scientific journals in the country, an important means of scientific dissemination of its activities and research. Headed in 1932 by the ANNAES DE ENFERMAGEM, edited in the Jornal do Brasil in Rio de Janeiro, which later became the Revista Brasileira de Enfermagem (REBEn), the Revista da Escola de Enfermagem da Universidade de São Paulo (REEUSP) began in 1967 and, in 1973, started the Revista Enfoque. The fourth Brazilian Nursing Journal created was REND, led by Horta in 1975⁽⁹⁾.

Horta's first publications connected with the theory that she would later develop were in REBEn, where she defended nursing practice based on science. Throughout her career, Horta has published 25 articles in REBEn and REEUSP and 14 in REND⁽⁹⁾. It is worth mentioning that the increase in the number of Nursing journals intensified after the establishment of Graduate programs, generating progress in research and, consequently, in the scientificity of nursing.

Another significant milestone for nursing was the creation of Nursing Theories, a formal expression of the empirical standard of knowledge - Nursing Science. They developed in the United States, driven by the need for changes in the educational formation of nursing and its confirmation as a scientific and professional discipline⁽¹⁶⁾. Although they began in Brazil in the 1950s, they became prominent in the 1970s.

There is a direct impact on care management when using a theory as a basis for clinical practice. This is because reasoned care indicates nursing means, goals, specific results, and actions for a rational and systematic approach ⁽¹⁷⁾. By developing the theory based on basic human needs and instituting the Nursing Process, Horta contributed to the scientificity of Nursing in Brazil. The nursing process is characterized as a care technology, making nursing evolve as a profession, preferably focused on understanding the integrality of the human being, supported by reflection on its practice⁽¹⁸⁾.

Thus, the Nursing Process allowed the building of a professional identity for Nursing, distinguishing it from other professions in the health area since it established space as a consulting profession, where the professional presents the commitment to meet the needs of people and maintain a direct relationship with them. Likewise, it provided opportunities for the construction and application of a body of Nursing knowledge, i.e., its expertise, a condition that contributes to an independent professional practice, an essential factor for establishing a professional identity⁽¹⁸⁾.

Horta thought of Nursing care as an emancipatory instrument. She understood patient care as a means by which nursing professionals would promote health through attention to the vulnerabilities of the other, dialogue, and assistance, contributing to people of different ages and contexts, instructing them so that they would not become ill due to the lack of knowledge on the care of their bodies⁽²⁾.

In her theory, Horta defended the primacy that the science of care should not be focused on the disease but on the patients and their needs. When studied in the academic environment, the theories show that the focus of care should be human needs. In other words, each person is unique, and nursing should be concerned with the subjectivity of each human being, a role that encompasses more than the technique but also the social, the psychic, and health in its most complex form⁽¹⁹⁾.

Her publications, dating from the 1970s, were considered a milestone in the development and modernization of Nursing practices. Based on the theory in question, the care provided by Nursing must consider the human being as a whole - body, mind, and spirit, because, when sick of the body or the mind, the person is affected in their entirety(6).

FINAL REMARKS

Wanda Horta contributed to the advancement and visibility of Nursing in the practical, scientific, and professional dimensions. In science, she developed a nursing theory in line with the Brazilian reality, perceiving the human being as a biopsychosocial being, stimulating Nursing practice to be holistic, integral, and humanizing. In practice, she revolutionized Nursing care by proposing the Nursing Process that began to guide/systematize the care provided by the Nursing team. Additionally, she dedicated herself to the scientific and artistic publication of the principles and assumptions of Nursing and was a pioneer in establishing the Stricto Sensu graduate program in Nursing in the country. This scenario strengthened Nursing as an autonomous, scientific profession responsible for providing/managing care in health services.

REFERENCES

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Submission: 11-07-2022

Approval: 18-07-2022