Rev. Enferm. UFSM, v.12, e55, p.1-23, 2022
https://doi.org/10.5902/2179769270726
ISSN 2179-7692
Submission: 6/18/2022 - Acceptance 10/25/2022 - Publication: 12/6/2022
Original article
A Historical-documentary Study of the Journal Annaes de Enfermagem (1932–1988): Mapping Productions and Scientific Knowledge of Nursing
Estudo histórico-documental na revista Annaes de Enfermagem (1932-1988): mapeando produções e conhecimentos científicos de enfermagem
Estudio histórico-documental de la revista Annaes de Enfermagem (1932-1988): mapeando producciones y conocimientos científicos de enfermería
Kely Cristina Garcia VilenaI
Rodrigo Lopes MirandaI
I Universidade Católica Dom Bosco. Campo Grande, MS, Brazil
Objective: To describe and analyze nursing productions published in the journal Annaes de Enfermagem between 1932 and 1988 in Brazil. Method: A bibliometric and historiographic study, where primary sources were texts from the cited journal, analyzed quantitatively and qualitatively. Results: The analysis indicated a significant number of publications by anonymous authors, predominant female authorship, connections between the careers and activities of the authors and their relationships with the productions published in the Annaes de Enfermagem, an exclusive space for graduate nurses to socialize their production and an effort to define the profession, redefining it as "modern and scientific." Conclusion: The productions published in the journal focused on qualifying the nurse's education and institutionalizing laws that would defend the nursing profession and its socioeconomic interests. The discussions represent concerns of the collective thought by electing the "nursing problems" that shaped its professionalization.
Descriptors: History of Nursing; Education, Nursing; Schools, Nursing; Public Health Nursing; Nursing
Resumo
Objetivo: descrever e analisar produções de enfermagem, no Brasil, que circularam na revista Annaes de Enfermagem, entre 1932 e 1988. Método: pesquisa historiográfica de cunho bibliométrico, cujas fontes primárias foram textos da referida revista, analisados de maneira mista: quantitativa e qualitativamente. Resultados: as análises indicaram número expressivo de publicações por autores anônimos; predominância de autoria feminina; relativa conexão entre as carreiras e as atuações das autoras e suas relações com a produção circulante nos Annaes; espaço exclusivo para enfermeiras diplomadas socializarem suas produções; e um esforço de definição da profissão, redefinindo-a como “moderna e científica”. Conclusão: as produções que circularam, no periódico, focalizavam qualificar a formação da enfermeira e institucionalizar leis que garantissem a defesa da classe profissional e de seus interesses socioeconômicos. As discussões representaram preocupações do coletivo de pensamento, ao eleger os “problemas de enfermagem” que conformavam sua profissionalização.
Descritores: História da Enfermagem; Educação em Enfermagem; Escolas de Enfermagem; Enfermagem em Saúde Pública; Enfermagem
Objetivo: describir y analizar las producciones escritas en enfermería, en Brasil, que circularon en la revista Annaes de Enfermagem, entre 1932 y 1988. Método: investigación historiográfica de carácter bibliométrico, cuyas fuentes primarias fueron textos de la revista, analizados de forma mixta: cuantitativa y cualitativamente. Resultados: los análisis indicaron un número significativo de publicaciones de autores anónimos; predominio de autoría femenina; conexión relativa entre las carreras y actividades de los autores y su relación con la producción escrita que circulaba en los Annaes; espacio exclusivo para que los enfermeros graduados socialicen sus escritos; y un esfuerzo por definir la profesión, redefiniéndola como "moderna y científica". Conclusión: las producciones escritas que circularon en la revista se centraron en la cualificación de la formación de la enfermera y en la institucionalización de leyes que aseguraran la defensa de la clase profesional y de sus intereses socioeconómicos. Las discusiones representaban preocupaciones del colectivo de pensamiento, al elegir los "problemas de enfermería" que conformaban su profesionalización.
Descriptores: Historia de la enfermería; Educación en Enfermería; Facultades de Enfermería; Enfermería en salud pública; Enfermería
The mapping of productions and knowledge contributes to learning the history of institutionalizing and forming the nursing profession; it becomes relevant when one seeks to understand the current conceptions of training and the structuring values of professionals in this area, in addition to unveiling what such productions clarify about this group. Currently, Law No. 7.498/1986 regulates the nursing profession in Brazil. From a historiographical perspective, several authors have discussed the history of nursing education, as well as its official education system.1-3
Historians agree that the official milestone of institutionalizing the nursing profession in Brazil was in the 1920s, in the context of Sanitary Reform, with the active participation of the Rockefeller Foundation, which was operationalized with the creation of a School of Nursing according to the American standards.2,4 The school, created in 1923, was initially called the School of Nurses of the National Department of Public Health (DNSP). In 1926, it was renamed Anna Nery School and, subsequently, Anna Nery School of Nursing (EEAN) of the Universidade Federal do Rio de Janeiro (UFRJ).2
With the concern to maintain the teaching model and professional profile of the official school, in 1923, the female professors created a students' association called the Association of Internal Government of Students (AGIA), which, after the first class of the School of Nurses of the DNSP (1923/1925) graduated, emerged as the National Association of Graduate Nurses (ANED) in 1926. In 1929, the word "Brazilian" was added, and ANED became the National Association of Brazilian Graduate Nurses (ANEDB). Later, in 1944, the ANEDB was renamed the Brazilian Association of Graduate Nurses (ABED); since 1954, it has been known as the Brazilian Nursing Association (ABEn).
In 1932, the journal Annaes de Enfermagem was created to act as the official communication media between the ANEDB and its members and to disseminate nursing productions in Brazil. From the mid-1940s, the ABEn expanded with sections in other Brazilian states; for example, in 1945, the São Paulo section of the ABEn and, in 1946, the section of the Federal District (DF) were created.5 Subsequently, several authors have discussed the movements organized by the ABEn and its role and influence on the formation of Brazilian nursing practices, aligned with the current State policies.5-6
Modern nursing practices in Brazil were developed according to the Brazilian public health model, which had the following regulations: First, Decree No. 19.402/1930 created the Ministry of Education and Public Health Affairs; however, it was renamed the Ministry of Education and Health in 1937. Second, Law No. 1.920/1953 divided the ministries into the Ministry of Health and the Ministry of Education (MEC). Third, the 1988 Federal Constitution determined that it was the duty of the State to ensure healthcare to the entire population, creating the Unified Health System (SUS) and, above all, instituting changes in the medical professions. Given this, the study aimed to describe and analyze nursing productions in Brazil published in the journal Annaes de Enfermagem between the period 1932 and 1988.
This is a historiographic research that uses bibliometric7 strategies and document analysis,8 which falls within the field of History of Sciences. The primary sources were the texts published in the journal Annaes de Enfermagem between 1932 and 1988. This time frame refers to (i) the year of creation of the journal until (ii) the year the SUS was created; however, the journal was regulated in 1990 by Laws No. 8.090 and No. 8.142. Thus, the analysis includes a period in which the first issue of the journal was published, soon after the regulation of the Ministry of Education and Public Health Affairs and before the 1988 Federal Constitution and the SUS.
The nature of the sources was the main criterion for defining the methodological resources because, as they were serializable documents, they could be analyzed with bibliometric strategies. As their content was also subject to critical-reflexive reading,9 they could be analyzed as a documentary. The analysis of the sources focused on two main questions: (i) Who were the people who published in the journal? (ii) What were the themes of interest there?
The investigation was based on Fleck's proposals,10 which are, in turn, based on the concepts of Collective Thinking and Thinking Style. The first concept designates the social unity of the scientific community of a discipline, and the second one designates the assumptions of thought on which the collective constructs its knowledge.10:16 Consequently, the answers to those questions constitute the results of this research and suggest that the circulation of productions and knowledge in nursing is connected to interests in recognizing and valorizing the profession.
Journal definition
The journal was chosen because it was the first one that was specifically associated with nursing in Brazil, and it has been the official publication media of the ANEDB, currently, ABEn, since 1954. It was created in 1932 as a communication medium directed at the nursing community in order to disseminate scientific production from different areas of knowledge related to nursing, including those relevant to the political project of the ANEDB.7 The journal continued with its publications, with only one interruption between the years of 1942 to 1945. However, its name went through three changes: First, Annaes de Enfermagem, published from 1932 to 1942. Second, Anais de Enfermagem, from 1946 to 1954. Finally, Revista Brasileira de Enfermagem (REBEn), in circulation since 1955. The title Annaes de Enfermagem has been used throughout the text because that was the name used when it was first published.
Definition of the documental corpus
Between 1932 and 1988, the journal published a total of 209 issues. Except for the first two years that saw the release of an annual issue, three to five issues were published annually between 1934 and 1938. The journal was not published in the years 1939 and 1940 and released one issue in the year 1941. The publication was interrupted between 1942 and 1945, resuming in 1946 with four annual issues until 1960, six annual issues between 1961 and 1973, and four annual issues between 1974 and 1988. The sources that comprise the years 1932 to 1962 were printed and manually accessed in the library of the Faculty of Public Health of the Universidade de São Paulo (USP). The sources from 1963 onwards were accessed at the REBEn online library. Among the 209 published issues, a total of 2805 entries were identified; their categories are summarized in Table 1.
Table 1 - Category and description of the publication in the Annaes de Enfermagem (1932–1988).
|
Categories |
Description |
|
Tribute, In memoriam |
It contained texts about recognizing, celebrating, and informing about a person and their services. |
|
Editorial |
It comprised texts and editorials by the journal's editors. |
|
General Interest |
It included texts with varied themes and research results following the same pattern, which today refer to scientific articles and texts with different themes, varied proposals, and diversified objectives. Unlike the articles, they were not derived from research. |
|
Service |
It had texts with themes focused on medical and nursing procedures and techniques. |
|
Education |
It comprised texts related to the theme of education. |
|
Student Page |
It had texts with approaches directed to nursing students. |
|
Legislation |
It published, in full, laws of interest to nursing. |
|
News and Commentary |
They reported facts and events pertinent to nursing. |
|
ABEn |
They carried information and addresses of the ABEn. |
|
Miscellaneous |
Category created to include various texts, which did not appear in all issues of the journal, such as book reviews and texts from congresses and synthesis of conference discussions, among others. |
Procedures and instruments
All 2805 entries were tabulated in a Microsoft Excel spreadsheet. In the tabulation, the following information was compiled: (i) manuscript identifier, (ii) year of publication, (iii) journal volume, (iv) issue number, (v) text title, (vi) category, and (vii) authors' names. The information was manually entered into the spreadsheet from the printed sources accessed at USP, as well as from the Portable Document Format files that were on the journal’s website, starting from the abstracts (e.g., text title, author, year of publication, and volume). The information that could not be computed by accessing the abstract was extracted, when possible, by checking the content of the texts.
The titles of the manuscripts were translated from the language in which they appeared into English. The translation was necessary so that part of the information — including titles — could be exported to EndNote, a bibliographic management software. In this software, the ambiguous names of the authors were manually corrected by the team responsible for the research. That is: (i) the names that had different spellings but referred to the same person (e.g., Bertha Pullem and Bertha Pullen) and (ii) the initials and acronyms that matched authors' names that, in other places, had been spelled in full (e.g., Z. C. Vidal and Zaira Cintra Vidal).
Analysis procedures
The data extracted from the documental corpus were analyzed in two ways. Quantitatively, they were analyzed by descriptive statistics, that is, the frequency of some occurrences from the tabulation in Microsoft Excel. In addition, the information exported to EndNote allowed its use in Biblioshiny for the bibliometrix R program.11 Thus, it was possible to analyze a data matrix based on the characteristics of the production published in the Annaes de Enfermagem, as well as its trend topics, that is, the most frequently used subjects in the same time frame. Qualitatively, some of the texts were read according to the techniques of selective reading and reflective reading9 in order to assist in interpreting the context of the production of those documents. This selection occurred randomly to interpret the material according to the convenience of the researchers. Considering the nature of the documental sources, the ethical care was restricted to not making heroes out of the characters unveiled by the investigation. Therefore, these authors and their institutions and interests were inserted in the historicity regime.
The production and its authors
The 2805 entries, referring to 209 issues, were produced by 981 authors. Regarding the writing pattern, it was noted that 99.4% (n=976) had singular authorship, against documents with multiple authorship, that is, 0.5% (n=5). However, regarding authorship, a large number of publications, 41.2% (n=1156), remain unidentified, that is, the documents were not signed. Of the total of 2805 entries, 1649 contained the name of their respective authors, resulting in the identification of 981 authors. The results indicated that women authored in greater numbers: 82.5% (n=1361) are texts of exclusively female authorship; in addition, 19 of the most relevant authors were women (see Figure 1).
Figure 1 – The most relevant authors
Note: List of the 19 most relevant authors, extracted from the total production of Annaes de Enfermagem, 1932–1988.
Figure 1 indicates the 19 most relevant authors, namely: Amália Corrêa de Carvalho (CARVALHO AC), Haydée Guanais Dourado (Dourado HG), Glete de Alcantara (Alcantara G), Ermengarda de Faria Alvin (Alvin EF), Marina de Andrade Resende (Resende MA), Marina de Vergueiro Forjaz (Forjaz MV), Ieda Barreira e Castro (Castro IB), Rosaly Rodrigues Taborda (Taborda RR), Taka Oguisso (Oguisso T), Edith de Souza (Souza ED), Zaira Cintra Vidal (Vidal ZC), Wanda de Aguiar Horta (Horta WA), Izaura Barbosa Lima (Lima IB), Maria Ivete Ribeiro de Oliveira (Oliveira MIR), Waleska Paixão (Paixão W), Bertha L. Pullem (Pullem BL), Ruth Borges Teixeira (Teixeira RB), Judith Feitosa de Carvalho (Carvalho JF), Circe de Melo Ribeiro (Ribeiro CM).
Figure 2 – The most frequent authors and their production over time
Note: The size of the node indicates the number of productions per year, while the line shows the continuity between the first and the last publication, in Annaes de Enfermagem, 1932–1988.
However, regarding authorship, five major groups have been configured (see Figure 2). One author stands out, who published for more than 40 years (n=1), Haydée Guanais Dourado. There was a group that published for 30 to 39 years (n=5), which comprised Amália Corrêa de Carvalho, Ieda Barreira e Castro, Edith de Souza, Izaura Barbosa Lima, and Maria Ivete Ribeiro de Oliveira. Another group that published for 20 to 27 years (n=7) is also highlighted: Glete de Alcantara, Marina de Andrade Resende, Rosaly Rodrigues Taborda, Waleska Paixão, Judith Feitosa de Carvalho, and Circe de Melo Ribeiro. A third group that published for 10 and 19 years (n=4): Ermengarda de Faria Alvin, Marina de Vergueiro Forjaz, Taka Oguisso, and Ruth Borges Teixeira. Finally, we noted a group that published for 4 and 9 years (n=2): Wanda de Aguiar Horta and Bertha L. Pullem.
Interestingly, being more frequent did not seem to have a direct relationship with the dispersion of publications over time. As an example: in the second group of authors who published for 30 and 39 years, we see Maria Ivete Ribeiro de Oliveira, who published in the Annaes de Enfermagem for 36 years and was the 13th most frequent author. Simultaneously, we can see the dispersion of the nodes among the unidentified texts (see Figure 2), noting that there is an increase in the size of the node between the years 1948 and 1968. The texts with unidentified authors were mostly institutional, that is, those that clarify the informative character of the journal, such as laws, minutes, speeches of installation of congresses, congress commissions, announcements and editorials.
The productions and their themes: trend topics
Figure 3 - Thematic map, indicating density and centrality of the co-occurrences of terms in the documental corpus of the Annaes de Enfermagem, 1932–1988
The analysis of the most recurrent themes and topics for a co-occurrence analysis, that is, the terms that appear together, showed the relationship between density — the number of times the term appears — with centrality, that is, the place it occupies (see Figure 3). An analysis of the thematic map, represented in Figure 3, identified that the journal had as a driving theme — the central and most frequent theme — nursing in its relationship with healthcare; here, healthcare is a basic theme, and education seems to be the connector of this debate. This analysis is justified because education appears with median density but with high centrality; nursing appears with high density and median centrality, whereas healthcare is not very central and is relatively dense.
The analysis of the documental corpus suggests that a large part of the productions that were published in the Annaes de Enfermagem was directly related to the frequency of some particular types of publication, such as editorials, academic news, tributes, speeches on the installation of congresses, legislation, and bibliography, whose authorship did not imply a recognizable intellectual property. One of the purposes of the journal was to publish news, as a kind of newsletter, coexisting with the aim to publish scientific articles. This is in line with the journal’s purpose at the time it was created, that is, to be the spokesperson of the ABEn among graduate nurses, especially the associated nurses. Access to the journal occurred through a subscription system, whose value was included in the annual membership fee, a practice that lasted from 1962 to 1991.12 In addition, the content of the editorials was prepared by the presidency of the ABEn or the journal editor, a person who was authorized to give a speech on behalf of the organization to the readers and members.6
The concentration of this type of publication seems to be related to several legal events in the scientific-professional formation of Brazilian nursing practices, which, in this period, would be of interest to that collective thought. For example, first, the first federal law to regulate nursing education in Brazil was promulgated. Law No. 775/1949 defined two basic levels for nursing education: the Undergraduate Nursing course, which should take 36 months, and the Nursing Assistant course, to be completed in 18 months. This law recognized nursing schools, which no longer had to be equated with the Anna Nery Nursing School in order to function. Second, Law No. 2.604/1955 was promulgated, which regulated professional nursing practices in the country, and was later revoked by Law No. 7.498/1986. Third, in 1958, the Code of Ethics of the ABEn was approved. Fourth, technical nursing courses were created (1966), by Law No. 4.024/1961, based on the Directives and Bases of National Education. Fifth, Brazilian congresses were held annually from 1947, adding up to a total of 37 national congresses, until 1985, when complete issues of the journal started to be published. Six, at the end of the 1950s, the ABEn created the "Research Follow-up Commission", which functioned at the São José School of Nursing, in São Paulo, until 1964, when it was transformed into a permanent commission of the ABEn with the name "Commission of Documentation and Studies". In 1971, it was transformed into the "Center for Nursing Studies and Research" (CEPEn). In this way, the CEPEn began to contribute substantially to the production of knowledge in nursing, which culminated with the realization of the first National Nursing Research Seminar (SENPE) in 1979 at the USP School of Nursing,5 in the city of Ribeirão Preto.
The strong female presence in the organization and publication of manuscripts in the journal corroborates what the literature on the history of nursing indicates, that is, their participation and influence in the scientific-professional formation of nursing practices in Brazil.1 Subsequently, it is hypothesized that, as the journal was linked to the ABEn and published texts of its members, the entity was almost exclusively female, that is, the journal of the association would have a similar authorship profile of its members; however, this inference would need to be investigated in future studies. This suggests a relationship with a general context that the modern nursing profession has been historically built by women. According to the sources researched, this characteristic was part of the formation of nursing practices in Brazil. For example, the requirement to enter the first school for nurses in the country, the EEAN, was to be a woman, be between 18 and 35 years of age, be of good moral standing, have a 4-year high school education, and pass an admission exam. Even in the sources, we read: "It is an essentially feminine profession, one in which the woman is in her element, bringing scope for continuous development and improvement whether moral, mental and intellectual, bringing out their best qualities”. 13:8 To better understand this feminization of this profession, it is important to locate, in time, the moment in history when it was first called "modern nursing".
The first nursing school in Brazil was created in September of 1890 by Marshal Deodoro da Fonseca, at the National Asylum for the Insane and was called the Professional School of Male and Female Nurses (EPEE).1 Initially, this school followed the French teaching model. With the creation of the EEAN in 1923, the EPEE, similar to the other nursing education schools at the time, underwent changes to equate it to a standard school. This was provided by Federal Decree No. 20.109/1931, which regulated nursing practices in Brazil and established the conditions for standardizing nursing schools.
In 1942, the EPEE was renamed as Escola de Enfermagem Alfredo Pinto, today belonging to the Universidade Federal do Estado do Rio de Janeiro (UNIRIO). In turn, the EEAN, established under the direction of American nurses, adopted the English system proposed by Florence Nightingale (1820–1910). By implementing professional nursing in Brazil, the American nurses supported the archetype of the modern nurse in Brazilian society. According to the sources researched, this implied maintaining the organizing principles proposed by Nightingale, that is, discipline, rigorous technical and scientific education, and the construction of the image of a solidly prepared professional. Meeting the requirements, the selection was composed of female candidates, young, white and of high social position.13
The dominant historiography indicates Nightingale's various contributions to the reform of nursing education and healthcare;1 however, it is outside the purview of this study to detail such contributions. It is worth mentioning, however, that the repercussion of this teaching model, called scientific or modern nursing, constituted the Anglo-American nursing model, which was reflected in the configuration of the Brazilian nursing profile until today.
The analysis of author participation (see Figure 1) indicated that Amália Corrêa de Carvalho (Carvalho AC) was the most relevant author, followed by Haydée Guanais Dourado (Dourado HG), Glete de Alcantara (Alcantara GD), and Ermengarda de Faria Alvin (Alvin EF). The first aspect to be observed is the frequency in which the name Amália Corrêa de Carvalho appears. This author worked in two of the largest nursing bodies in the country: the ABEn and the Federal Council of Nursing (Cofen), contributing to the elaboration of the Nursing Code of Deontology.14 In addition, she was part of the faculty of the School of Nursing of the USP (EEUSP) between the years 1947 and 1980, in addition to being the director responsible for the journal from 1969.
Another prominent author was Haydée Guanais Dourado. She was a teacher at the School of Nursing of the USP and held a position in the Division of Sanitary Organization of the National Health Department. She was the first director of the School of Nursing at the Universidade da Bahia. In addition, she participated in the management of the ABEn between 1944 and 1986 and also in creating the legal foundations that safeguarded and expanded the areas of professional nursing practice in Brazil.15 Several studies6,15 have focused on her and discussed her role in the formation of Brazilian nursing practices, especially that of an editorialist and a columnist of the journal Annaes de Enfermagem between the 1970s and 1980s, a period in which the editorials, although personalized by the author, meet the history produced in that time, that is, they reproduced the contemporaneous collective of dominant thought of the ABEn.
Glete de Alcantara, with a nursing career of 30 years, dedicated herself to various activities. For example, she was a professor of nursing at the University of Toronto (Canada) and an organizer and principal of the School of Nursing of Ribeirão Preto, at USP, between 1952–1971, where she remained as a professor after leaving the position of principal. She was the first nurse to achieve the title of Full Professor in Latin America. She held the position of President of the ABEn twice: the first time from 1952 to 1954 and the second time from 1971 to 1974. She was also the editor of the journal Anais de Enfermagem from 1947 to 1953.16
What draws the attention is the connections that seem to exist between the careers and activities of the authors and their relationships with the production, for example, (i) teaching at the School of Nursing of the USP, (ii) participating/contributing to the formation of the legislation of the professional nursing practice in the country, (iii) direction/participation in the regulatory bodies of Brazilian nursing (e.g., ABEn, Cofen), and (iv) constituting the editorial team of the journal. Such connections are in line with the aim of the political project when the journal was created, which was to disseminate scientific productions that were of interest to nursing practices, especially those that were relevant to the project. In this direction, one of our characters points out the following:
The presence of Edith Fraenkel at the head of the Brazilian delegation to the 1929 Congress in Canada was a decisive factor in the creation of the Brazilian Journal of Nursing. Determined with the conviction that ‘for a profession to progress, it is necessary to have an association and a journal,’ Edith Fraenkel brought from this International Congress the suggestion and plans for the creation of a nursing journal.17:8
To understand these connections, we retrieved information about the participation of Edith Magalhães Fraenkel (1889–1969) in this scenario. The character, who worked in the DNSP in the 1920s, was the first Brazilian woman to study higher education in nursing at the General Hospital of Philadelphia, with a scholarship from the Rockefeller Foundation.18 Upon her return, in October 1925, she was appointed to replace one of the American instructors at the School for Nurses of the DNSP, which, at the time, was composed of instructors from the United States (US). She was one of the creators of the ANEDB on August 12, 1926, becoming its first elected president between 1927 and 1938. In addition, she was one of the creators of the journal Annaes de Enfermagem, of which she was the editor from 1932 to 1938.19
Moreover, in the 1930s, Fraenkel also worked in the DNSP as the head nurse. In 1939, due to changes in the ministries, she became Superintendent of the Nursing Service of the Ministry of Education and Health, when she was invited to be the principal of the School of Nursing to be created in São Paulo, attached to the Medical School of the University of São Paulo, currently the School of Nursing of the USP. With this, she moved to São Paulo and, along with her, brought the ABED and the journal Anais de Enfermagem.20
Notably, similar to the EEAN, the School of Nursing attached to the USP School of Medicine was not an undergraduate school. The existing and regulated undergraduate courses in the country were Law, Engineering, Medicine, Pharmacy, and Dentistry. In 1963, the School of Nursing was detached from the School of Medicine through Decree No. 42,809/1963, which transformed the São Paulo School of Nursing into a higher education establishment, changing its name to the USP School of Nursing.
In this sense, the two events, that is, the creation of the class association and the creation of the first journal specific to the field, although distinct, were related and connected to the USP School of Nursing. In its first ten years of existence, the publications that circulated in the journal came from texts written by EEAN graduates and professors. Between the years 1946 and 1956, the collaboration was distinguished at the USP School of Nursing by its female professors and graduates. In the years after 1953, there was a contribution from the Sections of the DF, São Paulo and Bahia and, later, by the other states in variable proportions, gradually evolving after the University Reform of 1968.5,17 However, as indicated in the sources, the emphasis of the publications was on the USP School of Nursing.
In addition, a concern and interest that has remained constant since the first class of nurses graduated from the EEAN, in 1925, is the progress of the nursing profession, protected by the legislation on education and professional practice. Based on this assumption, the connections between the most relevant authors make sense; that is, during their careers, they (i) were part of the faculty of nursing schools, (ii) were editors and/or collaborators of the journal, and (iii) held positions of president and/or collaborator of the nursing association. That is, the most relevant authors maintained direct relationships with the journal.
Therefore, publishing in the Annaes de Enfermagem was similar to being a "spokesperson" for the work developed by that group. Furthermore, it was an exclusive space for graduate nurses to share their productions, which placed them as holders of wisdom and scientific knowledge. Therefore, they were redefining nursing, placing it as a modern and scientific profession and, consequently, adding prestige to the profession.
In the late 1940s, the editor of the journal, Edith Magalhães Fraenkel, invited graduate nurses from all over the country to submit scientific papers to the journal, in order to disseminate the "problems" inherent to the profession in Brazil:
With this January 1948 issue, volume I and number 1, a new phase begins for the ANAIS DE ENFERMAGEM. In giving this explanation, which we consider necessary, we earnestly request the collaboration of all Nurses to send us scientific papers of theoretical and practical nature, as well as suggestions. Although it is published in S. Paulo, the editorial staff of the ANAIS DE ENFERMAGEM is composed by Nurses from other States, and it is precisely so that the magazine can present Nursing problems related to the whole country that this contribution is essential. It is, therefore, necessary that everyone understands that without this spirit of cooperation, there will be no development of Nursing; we will not be able to move forward, and we will simply be taking useless steps.21:2
In its first issue, in 1948, the editorial staff of the journal tried to explain that the publication was moving into a new phase and, in a tone of "supplication", "earnestly" requested the collaboration of all nurses in the country in sending scientific papers to the journal. There was an attempt to instill in the graduates of nursing schools the need for that group to unite for developing incipient professional nursing practices in Brazil.
This fact can be observed in the organization of the Brazilian Nursing Congresses, with the exclusive participation of graduate nurses and members of the ABED, which at the time had Zaira Cintra Vidal (1903–1997) as the president, as we read in the editorial No. 22, vol. XVI of 1947, by the then editor Edith Magalhães Fraenkel:
The Brazilian Association of Registered Nurses organized this first National Nursing Congress so that the Nurses could fight for the achievement of a goal: to jointly elaborate an efficient Nursing program, aiming at the [sic] development of the profession on a high level.22:3
The arguments made in the organization of the first National Nursing Congress were operationalized in the style of thought in which that group was inserted. In other words, the topics of interest, concepts, and theories that composed that group of nurses, that is, the "nursing problems" discussed by them, shared the thought process.
In this sense, the way that the audience viewed its object — "nursing problems" — would form a collective of thought that would be the agenda of future research and discussions, such as the papers presented at nursing conferences, which became part of the full issues of the journal in subsequent editions. New studies could focus on the correlation between the participants of the conferences and the publications published in the Annaes de Enfermagem, considering the role that the meetings and their productions have in forming scientific communities.23 This would help to compose, more clearly, the connections in that collective of thought.
In addition, the relationship between these most frequent themes and the content of the publications of each author over time indicated the existing connections between their careers with the themes of their productions. The main areas of action among these authors were: (i) teachers of nursing schools, (ii) members of the editorial team of the journal, and (iii) constituting the board of the ABEn. In this context, Haydée Guanais Dourado, the second most frequent author, states as follows:
The concern with the educational problems and the regulation of the professional practice had always been a constant for the Nurses who directed the Nursing services and the Ana Nery School, even before the creation of the ABEn. The Association took on most of the responsibilities of overseeing the development of education and defending the class.17:8
The authors centered their discussions on "urgent" operational themes related to "nursing problems" at the time, which were directly related to the position they held or their area of work, as a way to defend and shape the profession, such as nursing schools, education, congresses, and the work of the ABEn. Based on Fleck's considerations,10 the arguments made by each author were operationalized in assumptions of thoughts on which their group built its knowledge. Notably, many of these authors actively participated in the process of forming and institutionalizing the nursing profession in Brazil and were considered "heroines" in the constitution of the profession in the country. For example, the title of honorary member of the ABEn, in 1977, was granted to the most frequent author, Amália Corrêa de Carvalho.24 It should be noted that, according to the statute of the ABEn, 1976, "Art. 13 - Honorary members are those who have made a relevant contribution to the cause of national nursing, to whom the [Assembly of Delegates] AD, by proposal of the Board of Directors, decides to render this tribute". 25:206
It is inferred that, in general, the discussion of the journal focused on the training of the nurses and the training in healthcare, which shaped and allowed the existence of national nursing practices. One example of the concern with the education and training of the nurses was on the cover of the journal between 1932 and 1954. In an article published in the Annaes de Enfermagem, one of the characters presented the Triangle of the Nurse, which was composed of three pillars: science, art, and ideal. In Vidal's words,
Once the geometric figure was determined, one sought to name its sides with the three words that, in short, should glorify the Nurse: Ideal, Science and Art. Three words only, however, so complex that they alone bring together all the attributes of the noble profession ‘[...] therefore, the attributes of the Modern Nurse.’26:11
In other words, ideals would be the foundation, that is, the spirit of intimate satisfaction, love for the profession — considering it a noble mission — an internal force capable of overcoming barriers to help those in need; for example, the ideals that moved the pioneer "heroines" of modern nursing, Anna Nery (1814–1880) and Florence Nightingale (1820–1910).
Science, in turn, was considered the second quality necessary for a nurse, consisting of the study of sciences such as Anatomy, Microbiology, Materia Medica, and Obstetrics. The following excerpt from the sources states:
How could a nurse know the action of a medicine if she has not studied Materia Medica? How could she take care efficiently of a case of [celiac disease] D.C. if she did not know the etiology and prophylaxis of the disease? And yet the science that distinguishes us from the attendants. It is she who raises the standard of our profession. What good would the practice be without scientific study? 26:12
In addition, on the one hand, every nurse trained in the Nightingale model should follow the scientific course, which would differentiate them from practical nursing and raise professional standards. On the other hand, practical knowledge was considered indispensable; therefore, the third attribute of the modern nurse was art, which represented the practical application of scientific knowledge, and this executive skill would determine the professional capacity of the nurse.
In this sense, one of the concerns at the time was the students' practical training, which would be solved through the unification of theoretical and practical knowledge, with the help of the commitment of the nurses who had already graduated. In addition, considering the requirements to be a qualified nurse, the discussions that were published in the journal focused on nursing education, nursing schools, the role of nurses, and their areas of action (e.g., care, organization, public hospital, service, and administration). Moreover, "the problems of nursing" were acquiring sufficient prestige, appreciation, recognition and consolidation as a modern profession in Brazil.21
This scenario infers that the ABEn, which paid attention to the problems that it considered related to training nursing professionals and aligned with the current State policies, represented the collective thinking of Brazilian nurses in constructing their professional identity. However, in the 1970s, the creation of the Cofen and the Regional Councils of Nursing (COREN) promoted changes in the attributes and functions of the ABEn, with the Nursing Councils starting to supervise and regulate Brazilian nursing practices. In addition, in the 1980s, a movement emerged in opposition to the policy developed at the ABEn, which was then known as the Participation Movement. This movement won the elections in the ABEn and gained control over the organization, starting in 1986, including new practices in the formation of the profession.27
As for limitations of the study, the use of a single journal, although linked to the ABEn, did not allow us to generalize the results to the entire nursing community active in Brazil at the time. Second, the criterion for selecting and analyzing primary sources may have led to the exclusion of materials that would allow a more accurate understanding of how the productions and knowledge of nursing were published. Thus, other studies may be developed in order to build a historiography with greater detail on the development of the profession; however, the limitations do not seem to impair the conclusions presented here.
This study contributes to the literature in that it invites us to reflect on a part of the socialization process of the field of knowledge of the Brazilian nursing profession and how its formation was conceived and produced by those nurses. The Annaes de Enfermagem, thus, had a relevant role in institutionalizing the debate on Brazilian nursing. In this way, it contributes to the contemporary understanding of the conceptions of training nurses, especially in the search for recognition and professional appreciation, operationalized in the current bills for the definition of the salary floor and workload.
This study aimed to describe and analyze nursing production and knowledge in Brazil that were published in the journal Annaes de Enfermagem between the period from 1932 and 1988. Its analysis pointed to elements that helped to answer the two research questions: (i) Who were the people who published in the journal? (ii) What were the themes of interest present there?
The results indicated that the female gender was predominant, reflecting the influence of the first nursing schools, where candidates had to be female, young, white, and of high social positions. This predominance persisted even after the University Reform of 1968, which allowed the admission of men and women in nursing schools and broke the exclusion by ethnicity and gender.
In addition, until the 1980s, the ABEn enforced the State policies, which influenced the formation process and identity of the nursing profession in Brazil. The research also showed that the ABEn and the Annaes de Enfermagem, although distinct, were related to each other and, given these conditions, the most relevant authors had connections with the journal, either by constituting the editorial team of the journal, the board or committees of the ABEn or by being part of the faculty of nursing schools, especially the USP, which was the headquarters of the journal for a certain period. In other words, the ABEn and, consequently, the Annaes de Enfermagem were managed by teachers of the schools and not by other professionals, that is, the journal was the spokesperson of Brazilian nursing education.
The journal was identified as the means by which graduate nurses could socialize their productions, and it highlighted nursing problems, such as the predominance of unidentified publications, most of which are informative texts of the journal (e.g., laws, minutes, speeches on the installation of congresses, congress committees, announcements, and editorials). The recurrence of such texts suggests that this type of information was important to that group, the editorial team, and the board of directors of the ABEn.
The analysis of the themes indicated the prevalence of the following topics: nursing, healthcare, nurses, congress, teaching, assistance, report, service, public, and school. By analyzing the occurrence of these terms, we observed that all productions had one main function, that is, "to raise the level of the profession," or even to break with the old nursing model (without scientific techniques, performed by lay people or non-nurses), to aggregate prestige, especially through legislation that ensured the defense of the class and its socioeconomic interests.
In addition, the main issue discussed by the journal was the importance of training nurses according to the American nursing school standard. To this end, texts were published examining a relevant legislation that defined nursing education and care. The writings were about the quality of teaching and the role of the nurse in various fields of action — for example, public health and hospital care — in addition to texts indicating nursing procedures and techniques, and so on.
Thus, it may be affirmed that such discussions represented the collective thinking of this scientific community which, when electing the "Nursing problems," was interested in articulating a certain type of nursing practice, considered modern, converging with the recognition and valorization of the profession.
1. Costa R, Padilha MI, Silva AR, Bellaguarda MLR, Maia ARC. Florence Nightingale (1829–1910): as bases da Enfermagem moderna no mundo. In: Padilha MI, Borenstein MS, Santos I, Bellaguarda MLR, organizadores. Enfermagem: história de uma profissão. 3. ed. São Paulo: Difusão; 2020. p.19–20.
2. Korndörfer AP, Ramacciotti KI. Uma proposta, duas experiências: a Fundação Rockefeller e a formação de Enfermeiras no Brasil e na Argentina (primeira metade do século XX). Descentrada. 2021;5(1):131. doi: 10.24215/25457284e131
3. Carvalho JB, Padilha MI, Costa R, Villarinho MV, Petry S. Reformas curriculares e a sua importância para um curso de graduação em enfermagem (1969–1991). Rev Enferm UFSM. 2022;12(1):e6. doi: 10.5902/2179769265680
4. Tamano LTO. O movimento sanitarista no Brasil: a visão da doença como mal nacional e a saúde como redentora. Khronos [Internet]. 2017 [acesso em 2022 maio 26];4:102–15. Disponível em: https://www.revistas.usp.br/khronos/article/view/131909/133454
5. Alvarez AM. ABEn 90 anos e a Revista Brasileira de Enfermagem. Rev Bras Enferm. 2016;69(6):1011–2. doi: 10.1590/2016690601
6. Oliveira NL, Ribeiro JC, Costa HOG, Melo CMM, Silva GTR. Cem anos de Haydée Guanais Dourado: contributos para a enfermagem brasileira. Rev Baiana Enferm. 2016;30(2):1–12. doi: 10.18471/rbe.v30i2.15041
7. Klappenbach H. Los aportes de la socio-bibliometría a la história de las disciplinas cientificas. Rev Guillermo Okham. 2017;15(2):5–7. doi: 10.21500/22563202.3497
8. Cellard A. A análise documental. In: Poupart J, Deslauries JP, Grourlx LH, Laperrière A, Mayer R, Pires A, organizadores. A pesquisa qualitativa: enfoques epistemológicos e metodológicos. Petrópolis: Vozes; 2008. p. 295–316.
9. Lima TCS, Mioto RCT. Procedimentos metodológicos na construção do conhecimento científico: a pesquisa bibliográfica. Rev Katálysis. 2007;10(N Esp):37–45. doi: 10.1590/S1414-49802007000300004
10. Fleck L. Gênese e desenvolvimento de um fato científico. Belo Horizonte: Fabrefactum; 2010.
11. Aria M, Cuccurullo C. Bibliometrix: an R-tool for comprehensive science mapping analysis. J Informetr. 2017;11(4):959–75. doi: 10.1016/j.joi.2017.08.007
12. Burlamaque CS. A Revista Brasileira de Enfermagem e seus compromissos. Rev Bras Enferm. 1987;40(2/3):87.
13. Fraenkel EM. A enfermagem no Brasil. Annaes Enferm. 1932;1(1):8–11.
14. Oguisso T. Amália: um gigante da enfermagem brasileira. Enferm Foco. 2016;7(3/4):81–5. doi: 10.21675/2357-707X.2016.v7.n3/4.922
15. Dias LPM, Monticelli M, Nazário NO. Editoriais dourados da REBEn. Rev Bras Enferm. 1998;51(4):547-60. doi: 10.1590/S0034-71671998000400002
16. Luchesi LB, Santiago ES, Oguisso T. Glete de Alcântara: legado centenario de la enfermería brasileña. Cult Cuid. 2019;23(53):97–108. Disponível em: https://pesquisa.bvsalud.org/portal/resource/pt/ibc-190051?lang=pt
17. Carvalho AC. Associação Brasileira de Enfermagem: 1926–1986. Rev Bras Enferm. 1986;39(1):7–12.
18. Associação Brasileira de Enfermagem. Notícias e Comentários. Rev Bras Enferm. 1956;9(2):83–4.
19. Santiago ES, Luchesi LB, Oguisso T, Porto F. Reflexões de Edith de Magalhães Fraenkel sobre o currículo de Enfermagem na década de 1940. Hist Enferm Rev Eletrônica [Internet]. 2021 [acesso em 2022 out 17;12(1):7–20. Disponível em: https://publicacoes.abennacional.org.br/ojs/index.php/here/article/view/35/5
20. Mancia JR, Padilha MICS. Trajetória de Edith Magalhães Fraenkel. Rev Bras Enferm. 2006;59(N Esp):432–7. doi: 10.1590/S0034-71672006000700009
21. Associação Brasileira de Enfermagem. Nota da redação. Anais Enferm. 1948;1(1):2.
22. Associação Brasileira de Enfermagem. Editorial. Anais Enferm. 1947;16(22):3–4.
23. Spiess MR, Mattedi MA. Eventos científicos: da pirâmide reputacional aos círculos persuasivos. Soc Estado. 2020;35(2):441–71. doi: 10.1590/s0102-6992-202035020004
24. Carvalho AC. Discurso ao ser agraciada com o título de sócio honorário da ABEn. Rev Bras Enferm. 1977;30(4):353–5.
25. Associação Brasileira de Enfermagem. Estatuto da Associação Brasileira De Enfermagem. Rev Bras Enferm. 1977;30(2):204–14.
26. Vidal ZC. O triângulo da enfermeira. Annaes Enferm. 1934;3(2):11–2.
27. Albuquerque GL, Pires DEP. O movimento participação (MP): uma contribuição à história da enfermagem brasileira. Rev Bras Enferm. 2001;54(2):174–84. doi: 10.1590/S0034-71672001000200003
Support / Acknowledgment: Universidade Católica Dom Bosco– UCDB (collaborating scholarship; doctoral scholarship). Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq – (productivity schoolarship holder, level 2).
Authorship Contributions
1 - Kely Cristina Garcia Vilena
Corresponding author
Teacher, master - E-mail: kelyvilhena@yahoo.com.br
Conception and/or development of the research and/or writing of the manuscript.
2 - Rodrigo Lopes Miranda
Professor, PhD - E-mail: rlmiranda@ucdb.br
Conception and/or development of the research and/or writing of the manuscript, review and approval of the final version.
Chief Scientific Editor: Cristiane Cardoso de Paula
Scientific Editor: Tania Solange Bosi de Souza Magnago
How to cite this article
Vilena KCG, Miranda RL. Historical-documentary study of the journal Annaes de Enfermagem (1932–1988). Rev. Enferm. UFSM. 2022 [Access at: Year Month Day]; vol.12, e55: 1–23. DOI: https://doi.org/10.5902/2179769270726