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Alba-Leonel A, Hernández-Falcón J. Representación social de enfermería a través del dibujo infantil. Rev Enferm Inst Mex Seguro Soc. 2016;24 (1):5-10.

Nursing social representation through the children’s drawing

Adela Alba-Leonel,¹ Julio Hernández-Falcón¹

¹Escuela Nacional de Enfermería y Obstetricia, Universidad Nacional Autónoma de México. Distrito Federal, México

Correspondence: Adela Alba Leonel

Email: adelaalbaleonel@yahoo.com.mx

Date received: July 2nd, 2014

Date judged: October 24th, 2014

Date accepted: February 7th, 2015

Abstract

Introduction: Draw let’s say with signs or images that are hard to put into words, so the social representation through drawing is significant through the collection of individual beliefs, opinions, attitudes or associations also reveal the organizing principles of social groups linked to their culture.

Methodology: The study is part of the phenomenological perspective of discourse analysis. From the 1st call. Children’s Drawing Contest “A dedicated nurses” Were invited to participate children who had a minimum of 7 years of age and maximum of 11 years 11 months.

Results: We emphasize the predominantly female nature of nursing practice. The representation is predominant to the techno - scientific; even though numerous scenes highlights embrace the approach and empathic relationship. The child’s imagination is rooted in everyday practices such as preventive vaccination and routine procedures such as injections or measuring vital signs.

Discussion: Nurses, social status focused on his performance of patient care where the desire to serve and help the sick and denoted there is little perception of their scientific knowledge , because by recognizing the images drawings nursing activities as a trade rather than a profession is most noted .

Keywords: Nursing; Nursing staff; Nurse´s role; Social representations

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Introduction

Based on the theory of social representations, Moscovici states that collective forms of thought and belief communicate allusive propositions and images he called "canonical themata".

"Popular knowledge is imbued with ‘canonical themata,’ which encourage people in their cognitive search and sprout in their minds when they learn unfamiliar information or comment about it".¹

The issue of social representations is not trivial, since the collection of individual beliefs, opinions, associations, or attitudes reveal organizing principles of social groups linked to their culture.

Social representation is constructed collectively, it is what individuals say and do, it is what builds and strengthens the community.

For Wagner et al.² social representation is "a social constructivist approach and a discursively constructed approach."

Lina María Martínez Gonzáles,³ in her work on social representations, quotes Robert Farr⁴ who conceptualizes these representations as "cognitive systems with their own logic and a language, they do not simply represent opinions about images, attitudes, but rather theories or branches of knowledge with faculties for the discovery and organization of reality, and with a dual function: to make the strange familiar and the invisible visible".

Social representation is achieved through two mechanisms: objectification and anchoring. The first means identifying or building the iconic look for a concept or idea; anchoring refers to the social rootedness of representation and its object.

Any representation is organized around a central core that guarantees the generating and organizing function. Any change in the nucleus results in a complete transformation of the representation.

There are a variety of topics under investigation related to social representation through the image. For Kosslyn,⁵ the theory of the image refers to descriptive representations that are formed in a structure, a visual separator whose spatial limits restrict the resolution. If the object is imagined so small or so large that it cannot represent a part associated with a certain detail, then the detail is added to the description. If asked to create a small image, it will be generated with few details because a small object is perceived as if it were a distant object.

Experimental investigations have revealed that the images have an internal structure and are constructed by the short-term memory of the work; however, long-term memory is used during the construction process.

Meanwhile, nursing care has been a topic of study on its meaning and representation. In 2008, Francisco Javier Báez Hernández et al.⁶ conducted a study to identify the representation of nursing professionals and their work. The study concludes by noting that the social representation of care is formed based on an organized body of knowledge and psychic activities, for which the nursing professional makes the physical and social reality of care intelligible, integrating into a daily relationship of exchanges between the person and the nursing staff. 

As for the meaning of care reported by the subjects of this study, these coincide with reports by Leonardo Boff when considering that care involves the capacity to feel like the other, which drives the creation of science with a conscience, directed toward life, a situation in which the meanings given by nursing professionals manage to transcend beyond others.⁷ This phenomenon happens through the solidarity of being with the person, which allows a consciousness that real practice is possible in which the nurse and the patient are no longer objects of the health-disease process but become true subjects of action, with their own identity and ability to transform their world.

In 2008, Claudia Patricia Rodríguez Hernández et al.⁸ conducted a study to learn the meaning assigned by nurses to the Nursing Process by its construction, in the context of social representations, concluding that the meaning attributed by the Nurse to the Nursing Process in practice is represented as a technical instrument and not with the holism with which it is supposed to be applied, and it is represented as "systemized care and actions that are given to a patient, related to the pathology and medical treatment," "plans and strategies to carry out a nurse’s duties aimed at improving the quality of nursing services."

Ligia Fahl Kemmer and Maria Júlia Paes da Silva⁹ seek to deepen understanding regarding the social representations of nurses and nursing by communications professionals, seeing that these are the intermediaries in codifying representations of images and texts on society; the study concludes that communications professionals perceive the difficulty in the labor market for nurses in the country, that the structure of health care is still deficient, and that these difficulties are experienced by other less recognized and less valued professions.

Thus, social representation allows access to people’s structures of meaning through images and daily speech that emerge as diverse individual constructions thematizing phenomena. In the case of nursing care, its social representation is mixed with various possibilities of the interpretation of life, health, disease, and social practices not only in the framework of the technical-scientific rationality, but in relation to the humanism required in the face of life crisis.

Children’s drawing is an example of social representation, which is a sign of the object and ourselves as stated by Philippe Wallon¹⁰ in his book The Child’s Drawing. Children’s graphic activity is a manifestation of a psychic state that assimilates the act of drawing behavior as the extension of self to a symbolic world. The image of the object is inscribed between multiple modes of semiotic function. Drawing allows us to say with signs or images what is hard to say in words. Javier Abad¹¹ also tells us that the drawing is the child's memory embodied on paper, offering us interpretations of what they do not yet know but intuit. So drawing is the symbolic interpretation of external reality and of their own feelings, or rather the image that represents that the child is conscious.

Images persist through time, and can transmit a message or knowledge even beyond one’s own lifetime.

Through drawing we can also express oral or written narrative, and it even helps us to put words to lived or imagined experiences, so that they are not forgotten.

We can say that the drawing is much more of a chronicle than an invention, since it by itself tells or relates significantly what the child has lived, since by expressing their experience, it reflects, rationalizes, and provides the image of what is transferred. It also allows us to share and communicate experiences with adults and other children.  

This study aims use children's drawing to highlight the social representation of the nursing professional and the social image of nursing seen by children.

Methodology

The study takes part in the phenomenological perspective of discourse analysis. It is based on the 1st Children’s Drawing Competition (Concurso de Dibujo Infantil), organized by posters printed by the Escuela Nacional de Enfermería y Obstetricia of the UNAM "What do nurses do," with the following basis:

Children at least 7 years old and maximum 11 years 11 months were invited to participate; they were divided into two categories: 7 to 9 years 11 months, and 10 to 11 years 11 months.

They were asked to do their drawing on cardboard medium (50 '32 cm) with freehand technique, where they would express: "What do nurses do". It also specified that the top five in each category would win a prize; for this a jury was formed consisting of representatives of the following disciplines: Arts, Sociology, Education, Nursing, and Educational Technology Communications, all graduates of UNAM. The deliberation was made with the symbols and icons that each child expressed in their drawing on the image of the nursing profession.

In total 394 works were reviewed that met the requirements of the competition and during the time period of submission. The result after release was the following:

With the theme "What do nurses do", children 7 to 9 years old were included in Category 1 with 232 works, and children 9 to 11 years old in Category 2 with 162 works (Tables I and II). 

In addition to the winning entries, the jury selected 40 works in order to present them to the student and academic community and the general public through an exhibition mounted in the lobby of the "Graciela Arroyo de Cordero" library at the ENEO-UNAM.

This work included only the sample of the 40 works mentioned above and their corresponding narrative descriptions, to be considered in the semiotic analysis in Greimas’ perspective.¹²

Results

The description of the participants were as follows:

Aspectualization

Participants always refer to nursing through their drawings; the nursing professional in its representation occupies the peculiarities of contextual origin. Nursing as a profession has a history, a formal training, a secular practice, a social recognition, and a legal basis. From the point of view of nursing science, it has its own body of knowledge that includes an emerging theoretical paradigm that expresses the terms and logic of their doing and knowing. This body of knowledge defines, at the same time, the object of study, which is expressed by children repeatedly in their drawings.

This surface description highlights the predominantly female nature of nursing practice and the emerging participation of men. The representation is predominantly toward the techno-scientific, although many scenes show embraces, closeness, and empathic relationships. The child’s imagination is anchored in everyday preventive practices such as vaccination and routine procedures such as measuring vital signs (Figures 1 and 2).

It should be noted that the children’s drawings express the color scheme, which combines with the trivialization of disease within health institutions, and they even resemble iconic characters portrayed by nurses with wings, which is a maternal symbol of IMSS, created after the war; however, there is also a scene of crying for the loss of an infant to the influenza epidemic just a few years ago.

The drawings convey an ideal framework of nursing practice in a world where medical technology is a priority role. The conspicuous absence of the doctor only reinforces the materiality of their work, as medical services greatly supplement the linearity of medicine and its commitment to the promising infrastructure of hospitals. The presence of other scenarios proper to nursing practice, health centers, clinics, nursing homes, etc. highlight the need and the ideal of a wider participation for professional nursing.
Nodal points:

• Nurse versus nurse and others.
• Nurse versus the nurse-patient.
• The diseased versus health.
• Public space versus professional institutionalized space.
• Technical and scientific actions versus humanized actions.
• Nurse-child versus nurse-adult.
• Female nurse versus male nurse.
• Icon nurse versus real nurse.
• Pathogenic and non-pathogenic reasons for intervention.

The nurse is generally identified in her social character in three quarters of the drawings; this corresponds to a clear presence of the nurse and nursing as part of everyday life. Meanwhile patient care is also present in one of every four drawings, which accurately expresses and relates nursing activity in the character of close service to the patient. 

With regard to the orientation of care, more than half of the children through their work identified nursing related to health, while less than half associated it with pathology.

The location of the nurse’s work is seen in a predominantly scientific technical character, in nearly 7 of 10 drawings, while its humanist affiliation is only evident in three of every 10 children.

In most cases the relationship observed in the works is child-nurse, and only a small proportion show the nurse-adult relationship.

With regard to the nursing professional’s gender, this is still overwhelmingly feminine, although one in ten drawings refers to a male nurse.

In the representation of each work, two different iconographic approaches are incorporated that are compatible with imagination or reality, so the majority of works are centered on a real representation of the nursing professional, and only a minority show imaginary constructions (super nurses, dolphin) (Figures 1 and 2).

Finally, the activities described in the drawing have preventive and curative approaches in almost identical proportion.

Discussion

Our data are consistent with those of Burguete^13,14 and García,¹⁵ where the social image of nurses is seen as a primarily "female" profession, based on stereotypes from last century.

Of nursing professionals, the social status recognized is focused on their performance of patient care denoting the desire to serve and help the sick, with little perception of scientific knowledge, as the images of the drawings show nursing activities more as a trade rather than as a profession.^9,10,11,16

With respect to the nursing professional’s qualities, the children show them as friendly, helpful, humanitarian, good-hearted, with the spirit of service, responsibility, helping, caring for, and educating people. They also show them having social skills such as knowing how to listen to and treat people, which is consistent with García.¹¹

As for the part of having cognitive knowledge, they reflect only the part of the trade, because most drawings represent giving medications, checking vital signs, administering serums and injections, and healing wounds; however the main function attributed to nurses is patient care and attention, providing first aid, healing and responding to emergencies, and providing information to prevent diseases.^17,18

Another of the children’s perceptions of nursing is the assistant, helper, aide, collaborator, or "the doctor’s right hand".

On the other hand, their practice is identified as a subordinate relationship with doctors, which coincides with the general view of this profession.^19,20

The spaces where nursing practice is visualized is mainly in health institutions, mainly in public and private hospitals; other institutions where we are seen are health centers, Red Cross, Cruz Verde (Green Cross), and other public services.²¹

Conclusions

It is clear that despite advances in the professionalization of nursing, images associated with the female stereotypes of the past century persist.
The recognized social status is focused on their performance of patient care, denoting the desire to serve and help the sick, and with little perception of scientific knowledge. Also there is still the perception that the nurse is the doctor’s assistant.

In our country there is little research around the image we have of nurses, so more studies of this kind should be conducted to show more deeply the expectations and demands that the population has of this professional.

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