Nursing care strategies such as well-being, from the social entrepreneurship perspectiveABSTRACT
Objective: to identify nursing care strategies such as well-being, from the perspective of social entrepreneurship.
Method: action research developed between March/2022 and December/2023 in a Recyclable Materials Association in the central region of Rio Grande do Sul. Data were collected through interviews with 28 women who work in the aforementioned association and coded based on Reflexive Thematic Analysis.
Results: the data categorized based on Reflexive analysis resulted in three thematic units: Dignification of recycling work and social recognition; Enhancement of the sense of belonging to the association; and Confirmation of the social and environmental value of work in a recycling association. It is demonstrated that nursing care plays a central role in promoting well-being and sustainable development. However, this process can be intensified through dialogical and collegial pathways focused on the basic human needs of individuals and communities.
Conclusion: nursing care strategies such as well-being are associated with the appreciation, respect and visibility of recycling work as a social, economic and environmental value. The study participants want to be recognized not only in their human and social essence, but as factual workers with rights.
Descriptors:
Nursing Care; Community Health Nursing; Entrepreneurship; Sustainable Development; Health Promotion
RESUMO
Objetivo: identificar estratégias de cuidado de enfermagem como bem-estar, na perspectiva do empreendedorismo social.
Método: pesquisa-ação desenvolvida entre março/2022 e dezembro/2023 em uma Associação de Materiais Recicláveis do Rio Grande do Sul. Os dados foram coletados por meio de entrevistas com 28 mulheres que trabalham na referida associação e codificados com base na Análise Temática do tipo Reflexive.
Resultados: os dados analisados resultaram em três unidades temáticas: Dignificação do trabalho de reciclagem e reconhecimento social; Potencialização do sentido e pertencimento à associação; e Confirmação do valor social e ambiental do trabalho em uma associação de reciclagem. Demonstra-se que o cuidado de enfermagem ocupa função central na promoção do bem-estar e do desenvolvimento sustentável. Esse processo pode ser aprimorado, no entanto, a partir de percursos dialógicos e colegiados centrados nas necessidades humanas básicas dos indivíduos e comunidades.
Conclusão: as estratégias de cuidado de enfermagem como bem-estar relacionam-se à valorização, o respeito e a visibilidade do trabalho de reciclagem como valor social, econômico e ambiental. As participantes do estudo desejam ser reconhecidas não apenas em sua essência humana e social, mas como trabalhadoras de fato e de direito.
Palavras-chave:
Cuidados de Enfermagem; Enfermagem em Saúde Comunitária; Empreendedorismo; Desenvolvimento Saudável; Programas de Bem-Estar
RESUMEN
Objetivo: identificar estrategias de atención de enfermería como el bienestar, desde la perspectiva del emprendimiento social.
Método: investigación-acción desarrollada entre marzo/2022 y diciembre/2023 en una Asociación de Materiales Reciclables de la región central de Rio Grande do Sul. Los datos fueron recolectados a través de entrevistas a 28 mujeres que trabajan en la asociación antes mencionada y codificados con base en el Análisis Temático Reflexivo.
Resultados: los datos categorizados a partir del análisis Reflexive resultaron en tres unidades temáticas: Dignificación del trabajo de reciclaje y reconocimiento social; Mejora del sentido de pertenencia a la asociación; y Confirmación del valor social y ambiental del trabajo en una asociación de reciclaje. Demostra que los cuidados de enfermería desempeñan un papel central en la promoción del bienestar y el desarrollo sostenible. Sin embargo, este proceso puede intensificarse a través de vías dialógicas y colegiadas centradas en las necesidades humanas básicas de los individuos y las comunidades.
Conclusión: las estrategias de cuidados de enfermería como el bienestar están asociadas a la valorización, respeto y visibilización del trabajo de reciclaje como valor social, económico y ambiental. Los participantes del estudio quieren ser reconocidos no sólo en su esencia humana y social, sino como trabajadores de hecho y de derecho.
Descriptores:
Atención de Enfermería; Enfermería en Salud Comunitaria; Emprendimiento; Desarrollo Sostenible; Promoción de la Salud
INTRODUCTION
Nursing is a profession that is central to the structure of health services in Brazil and worldwide. As a science, Nursing promotes health, care and well-being of individuals, families and communities, based on processes that share life in its entirety1-2. Nevertheless, nursing professionals have been challenged to lead strategies that strengthen care as well-being and ensure a healthy life for everyone, at all ages, in view of achieving the Sustainable Development Goals (SDGs)3-4
The SDGs aim to guarantee people human development with dignity, equity, respect, a healthy environment, among other aspects relevant to the dissemination of individual and collective well-being. The promotion of well-being suggests a multidimensional, transdisciplinary and systemic approach, supported by social, relational, environmental, cultural and economic dimensions, in order to simultaneously achieve sustainable development and human and social well-being. Taking on such a broader and contextualized perspective requires a user-centered approach - human beings - in order to meet needs without compromising the capacity of future generations5-6. In this sense, a study shows that Nursing has demonstrated growing potential to proactively meet health demands and promote community participation7
Under the impetus of the SDGs, social entrepreneurship has been gaining ground and prospecting in the science of implementation in Nursing and health. By integrating the social, economic, and environmental dimensions, social entrepreneurship in nursing has, in its essence and specifically last, to ensure human and social well-being. Nursing is eminently constituted in the social entrepreneurial practice, although the profession itself does not recognize its identity and is still unable to clearly express its political and social engagement8-10
Social entrepreneurship is characterized, even when explored from different perspectives, as an indicator and aggregator of well-being, by fostering innovative and transformative solutions to emerging social challenges. Social entrepreneurs, whether they are researchers, businesspeople, community leaders, or nurses, are people who are sensitive to pressing social issues and are attentive to opportunities and possibilities for dialogue and social development11-12
In order to contribute to strengthening the social and political identity of Nursing, this study has the following research question: which nursing care strategies as well-being, from the perspective of social entrepreneurship, can be expanded and strengthened to achieve the Sustainable Development Goals? The objective was to identify nursing care strategies as well-being, from the perspective of social entrepreneurship.
METHOD
This is an action research13, adopted due to the possibility of investigating new knowledge and, at the same time, intervening in the research scenario. The action research was developed between March/2022 and December/2023, in a Recyclable Materials Association in the central region of Rio Grande do Sul, which provides work and income for 33 workers/families who depend solely on this source of income.
The daily eight-hour work at the mentioned association is carried out by 28 women and five (5) men. The women are responsible for separating recyclable materials whereas the men separate materials for the final disposal of non-recyclable waste (external work). The individual monthly income varies between 600 and 1,100 reais. The work is led by one of the women, elected by the workers themselves. In addition to recurring complaints of muscle pain due to repetitive efforts, the women appear tired and unmotivated by the double workday - recycling association and household chores.
Action research aims to articulate action and reflection in order to achieve viable strategies that are in line with the issues of interest to the people involved. It includes identifying the problem by inserting the researcher into the research scenario; collecting relevant data; analyzing and giving meaning to the data collected by the participants; identifying the need for changes; identifying possible solutions and the intervention/action itself in order to combine research and action simultaneously13. In this study, action research was adapted to the following methodological phases: a) Insertion into the daily work of the recycling association; b) Identification and exploration of relevant data; c) Analysis and giving meaning to the data investigated and d) Discussion of nursing care strategies such as well-being and the collection of possible solutions to be considered in biannual intervention schedules in the recycling association, based on prior agreements with the participants. a) Inclusion in the daily work of the recycling association
Nursing care is included in the daily work of the recycling association, through the welcoming professional presence, the promotion of regular listening and conviviality spaces, the holding of self-care workshops, as well as gatherings on special dates in the academic calendar and others. In this association, nursing assumes a proactive role in identifying care needs and in promoting and protecting the health of both workers and their families. Interventions in the context of recycling, guided by the theoretical framework of social entrepreneurship, occur in a systematic and participatory manner, based on a biannual schedule of activities previously agreed upon with all workers.
b) Identification and exploration of relevant data
The 28 women who worked at the recycling association were invited to participate in the study through a formal face-to-face invitation, and they promptly responded to the invitation. Data were collected through individual interviews and transcribed for later analysis and discussion of nursing care strategies such as well-being. The interviews were conducted by the main researcher, with expertise in action research, in a private location in the work environment and scheduled in advance with each participant. During the data collection process, the main researcher had the support of nursing students, duly qualified, to record perceptions and transcribe the research data. The interviews were conducted based on the following guiding questions: What do health and well-being mean to you? How can nursing care contribute to promoting well-being? What strategies do you consider important and should be strengthened through nursing care? The interviews were recorded using digital audio and lasted an average of 50 minutes.
c) Analysis and meanings found in investigated data
The data were coded based on the Reflexive Thematic Analysis technique14. The Reflexive approach enabled fluid and flexible coding, as well as in-depth and meaningful immersion in the data. With an approach and adherence to social research, this analysis valued the researchers' previous experience and the systematic recording of ideas, insights, drafts and schemes, from the perspective of social entrepreneurship. This analysis was guided based on the following phases: familiarization with the data from repeated readings and a draft list of ideas; generation of initial codes, manually, by systematizing relevant extracts; identification of themes based on the classification of the different codes; refinement of the themes based on the validation of the initial themes; Naming of the themes based on the essence that each theme portrays in its set of codes; and Production of the report, based on a detailed description of the investigative process14.
d) Discussion of nursing care strategies such as well-being and the identification of possible solutions
Once organized, the compilation of collected data was presented to the study participants for validation of their statements, as well as for the collective discussion of nursing care strategies such as well-being and the identification of possible solutions, which were compared and incorporated into the thematic analysis of the Reflexive type. This phase was conducted by the main researcher, based on two specific meetings not included in the semiannual schedule of activities of the recycling association.
This study is part of the expanded action research project called “Social Entrepreneurship in Nursing: improving the quality of life of people in vulnerable situations”, funded by CNPq Call No. 04/2021 and approved by the Research Ethics Committee, under opinion: 5.615.579/2022 and CAAE: 55840116.7.0000.5306. To ensure anonymity, participants were identified throughout the text by the letter “M” Woman and a number according to the order of speech: M1...M28.
RESULTS
The data coded based on the Reflexive analysis and discussions outlined in the focus groups, from the perspective of social entrepreneurship, resulted in three thematic units, namely: Dignification of recycling work and social recognition; Enhancement of meaning and belonging to the association; and Confirmation of the social and environmental value of work in a recycling association.
Dignification of recycling work and social recognition
The need to empower the essence of being a woman, mother, and worker emerged in several interviews, as well as in focus group discussions. Although most participants have several children and exhausting domestic demands, they aspire to dignity, respect, and social visibility, not only in their essence as women and mothers, but as workers, in recognition of the work they do for society.
I don't want people to feel sorry for me and see me as a poor thing. I just want respect because my work deserves a lot of dignity and recognition. (M2)
Working in a recycling center doesn't mean working with dirty or disgusting things... it's a job as important as any other. Why do people think this? (M7)
The expression “dirty work” has been used many times by society in general. Health and well-being are associated, in this sense, with the recognition and visibility of work in an association, which for the participants has a sense of survival, autonomy and human dignity. This process involves self-confidence and social empowerment.
We need to believe in ourselves and our abilities. If we can be happy while earning the minimum wage, money is a consequence, this is well-being. We need to accept that situations may not go as planned, sometimes they may turn out unexpectedly and even if they don't work out. It's all a matter of balance and coexistence. We need to think positive thoughts and accept everything that comes our way to deserve the best. (M8)
My children respect me today as a recycler, a job that makes me very proud and gives me good feelings. It's a dignified job. I taught them that recyclers are people who fight, sacrifice themselves and try to bring food to their children. (M11)
Our work has value to society. We need to show this and raise awareness. We are capable and we have the conditions. (M14)
Other testimonies highlighted the power of the expression “you never gave up on us,” which denotes that society often promotes specific, welfare-based and discontinuous actions, that is, only to satisfy investigative and political interests. The expression “you never gave up on us” carries a sense of acceptance, connection, interest and recognition on the part of Nursing, whose care is not limited to specific and linear interventions, but it expands into acceptance and connection.
Just as we are important to you, you are also important to each one of us. You never gave up on us, but society doesn't think so. (M1)
We notice that you fight for our well-being and know that we can grow in life. You make us realize that nothing can stop us from realizing our dreams. (M17)
We don't want to be seen and used. I learned to deal with my feelings and share what is most precious to me in life, human values. (M22)
The participants defend recycling work as dignified and great, but also as an opportunity for life, growth and survival. For many women, this was and will be the only possibility of work and survival and, therefore, no less important than any other work. In recycling, women learned to fight, to defend themselves, to deal with adversity and to be autonomous as mothers, women and family leaders.
Here at the association, I had my first job opportunity, when I was very young. Here I grew, matured and became empowered as a woman, with the support of my colleagues and the University. I learned to enjoy working and to fight for my dreams. I learned to deal with and live with other people. Today I understand that everything that is done with love builds and transforms. (M9)
I think that this freedom that we have, the freedom to be able to work, to have our own things and not always be dependent on that person in the relationship, is priceless. There are women who don't work because their husbands won't let them or because they are jealous, so they can stay at home alone. No, women were not made to stay at home alone and follow orders. (M21)
The dignity of work does not reside, based on the statements expressed, in what the person develops and/or in the role they occupy, but in the ability to feel dignified, recognized, valued, free and autonomous as a professional, a human being, in their uniqueness and diversity. Human and social well-being is expanded, from this perspective, in the strategic capacity to promote an aggregating environment that promotes healthy and sustainable interactions and associations.
Enhancement of meaning and belonging to the association
All statements demonstrated that the participants feel happy and grateful for the opportunity to work in the recycling service, although the work is not properly recognized and there is no social appreciation. Several statements repeatedly converged on the statement “I can’t see myself doing anything else”. Thus, the participants indicated that the meaning of work is not limited to technical work or the fulfillment of a specific activity, however, it is expanded through coexistence and collective constructions.
I don't see myself working in any other job. I really like what I do. Here we are a big family, we are all colleagues. I don't work just for the money, but for all the learning and good things we achieve every day. (M13)
I don't see myself in any other job. I've had other offers, but I feel that this is my place, along with my colleagues from the association. We have disagreements, but this usually happens because of tiredness and exhaustion from work. We always try to do our best so that everyone is well and so that the energy in the environment is good. (M23)
It was also revealed that well-being and coexistence have a unique meaning that is incomparable to monetary value. The participants recognized and repeatedly mentioned the value of friendship, listening, support, sharing, and collective learning, which is enhanced by conflicts, disagreements, agreements, and alignments.
Here at the association, we feel supported and strengthened by our colleagues. This is my second home and family. I can't see myself working anywhere else. The work here at the association is very different from working on the street. Here we are family. (M5)
I've been at the association for five years. We are totally family, an extended family unit. When I can't work, I feel incomplete that day. When someone is not well, we come together, listen and offer help and comfort. (M22)
There are many opportunities for growth at the association. The work is tiring, but at the same time great for everyone. (M26)
It was noted that nursing care is associated with the ability to foster a welcoming and inclusive environment, which promotes health and well-being at an individual and collective level. Nursing care, therefore, is not limited to technical interventions, but expands into the possibility of fostering dialogical exchanges and the sharing of feelings that are both of pain and suffering, as well as of achievements, struggles, advances and accomplishments.
Here we work as a team and we are fighting to be better. You (Nursing staff) help us a lot and we feel stronger to fight and overcome difficulties. (M4)
You (Nursing staff) always have a way to lift us up and get us out of that situation. Sometimes it is just a gesture, a word, a caress and it seems like the day changes in no time. (M14)
The ambiance, positive synergy and welcoming attitude, based on the testimonies of the study participants, add value and human and social well-being and, consequently, impact healthy living and quality of life. Nursing care stands out, in this sense, for its ability to establish bonds and enable meanings of life and work that transcend the fulfillment of working hours and shifts. The participants recognized that it was not always like this and that they had already gone through turbulent and conflicting moments, because they did not recognize themselves in their life trajectories. The expression of one of the participants “you cannot judge the book by its cover, but by its content” was a topic of reflection in several collective moments.
Confirmation of the social and environmental value of work in a recycling association
Almost all of the participants' statements showed that they were aware of the value of their work for society, environmental sustainability and the support of their families. The statement made by one of the participants, “you can do a lot with a little”, was reinforced by several participants who acknowledged that, although low, their monthly salary is enough to support their children, grandchildren and other family members.
A little goes a long way. Our work here at the association supports dozens of families. Our work contributes greatly to the environment. Where would all this material that we recycle and dispose of properly be today? Where would it be and what could it be causing? (M3)
Our work has great value for society. Where would we be today if we didn't work here? What would become of our children and our planet if we didn't take care of the environment? This is caring, taking care of ourselves, of others, of the planet. (M27)
The participants are aware of the social and environmental impact of their work and find value and meaning in everything they do and advocate for. They acknowledged, however, that they still suffer prejudice and humiliation for working with recyclable material, which many people consider to be nothing more than despicable and worthless “trash.”.
I have suffered a lot of prejudice and humiliation, but many people help and support me in this work. Many do not know or do not want to know that recycling contributes to environmental sustainability. Everyone should understand and value this. But many people deny this. (M10)
People need to become aware and support us with small gestures, starting with recycling in their homes. It may be a small gesture, but it makes a huge difference to us. (M21)
People need to be more aware of selective collection, separate the material correctly to help the work of the sorters. There are people who think they know everything, but they do not know how to take care of the environment. (M28)
The participants acknowledged that there is a sense of esteem for the work of collectors or recyclers of recyclable materials, work that is generally considered inferior, dirty, undignified or treated with contempt. They do not want or expect people to treat them with pity or as “poor things”. They only want respect, dignity, support and, from the community, greater awareness of the social value of recycling work.
People should not be prejudiced against us. We work with dignity, we are not stealing anything. It is a dignified job, just like any other. So don't be prejudiced against us. (M2)
It is a job that does not beg for mercy or pity, but rather demands dignity and respect. The worker shows awareness of the environment and the planet, which need to be preserved, because we inhabit it and depend on it. (M15)
Work in recycling should be valued. No one is stealing here. Everyone wants the best. My work is as important as the work of a professor at the university. Why do we need to be treated differently? (M24)
The participants demonstrated, under this thinking, that their work, in the association, is not carried out in any way or without minimum quality criteria. They emphasized, on several occasions, that their work needs to be carried out with high quality and resolution, since they work for the sustainability of the environment, the planet, and life in its various forms of expression.
In the association, everyone fights for quality. Recycling is a job that demands a lot of quality from everyone. We work with goals and targets. The support of the University has always been essential and has given us direction. (M6)
Our work depends on everyone's work. I hope that everyone knows how to separate and recycle materials correctly in their homes and businesses. Society needs to be more aware and fight more seriously for the quality of everyone's work. People should properly select recyclable materials in their homes, so that they can help us improve our work. (M11)
Nursing, through care, has the ability to understand the singular and the multiple and vice versa and, thus, establish relationships, collaborative networks and sustainability alternatives through the participation and engagement of all social actors. In addition to its social and environmental value, recycling has a highly contributing economic value to achieving the SDGs.
The results demonstrate, in short, that nursing care plays a central role in promoting well-being and sustainable development. This process can be improved, however, through dialogic and collegial approaches focused on the basic human needs of individuals and communities.
DISCUSSION
Promoting well-being and ensuring a healthy life for all, as estimated by the 2030 Agenda, requires collaborative momentum and proactive engagement of professionals from different areas of knowledge, in addition to systemic understanding and interdependence between different institutional arrangements. Perpetuating specific and linear thought models, however, will not enable progress or even result in better sustainable development practices.
In this evolutionary path, social entrepreneurship is characterized as a tool for mobilizing new attitudes, processes and services that enable the (re)construction of knowledge and professional practices, in addition to inducing well-being at an individual and collective level. It is also characterized by the inference of prospective movements that interconnect different agents and social segments, with the aim of enhancing initiatives and expanding associative networks among the various social actors15-16.
In this prospective and entrepreneurial dynamic, nursing care emerges as a technology that enhances healthy living and promotes well-being, based on professional attitudes and behaviors related to the care of life in its entirety. Nursing care is also expressed in the ability to contextualize, expand, interrelate and encompass both social and health conditions, as well as environmental, cultural, economic and sustainable conditions17.
In general, the participants in this study showed that they do not want or expect people to treat them with pity, but rather to recognize their dignity and the social, economic and environmental value of the work they perform. Well-being is therefore enhanced by the ability to recognize the human and social value of each individual in their uniqueness. Nursing care as a promoter of well-being transcends ideological-utilitarian perspectives and contributes to the resurgence of health concepts based on acceptance, bonding, and an aggregating environment, considered essential pillars for the promotion of healthy living18.
Recycling work is carried out almost exclusively by women in various contexts. The stigmatization and exploitation of the occupational activity of female recyclers is aggravated, as evidenced by the participants in this study, by its social and cultural reproduction associated with “dirt” and the contamination of work called “garbage” or “dirty work”. In this context, female recyclers need to resist not only the different forms of social exclusion, but also the conditions of subordination, invisibility and social disintegration19-20.
Nursing can be associated to the work of female recyclers, as expressed in the statements of the study participants, by understanding health as a complex unit and by enhancing life in its self-organizing dynamics that encompasses both order and disorder21. Therefore, nursing care is capable of transcending specific technical and welfare paths and reaching the individual in their singularity and human multidimensionality22-23.
Nursing care as an inducer of well-being, from the perspective of social entrepreneurship, enables theoretical and practical advances and leads to healthy and sustainable development. Studies have shown that social entrepreneurship is highly associated with the promotion of individual, social and environmental well-being. However, it depends on people, entrepreneurial professionals capable of mediating innovative processes and generating impact not only in global terms, but also at a local level, resulting in individual and collective well-being24-25. The results of this study demonstrate that well-being is not limited to the type of work, functions or positions that a person occupies in society, but to interprofessional relationships and healthy coexistence in the work environment. The study corroborates this thinking, emphasizing that individual and collective well-being is associated with working conditions, interrelationships and personal and social recognition25.
In the same direction, another study previously conducted has demonstrated that nursing care from the perspective of social entrepreneurship is capable of inducing well-being and promoting human dignity, through relationships, interactions and systemic associations that transcend specific and linear interventionist approaches. There will be no evolutionary care committed to healthy and sustainable development, however, without entrepreneurial nurses committed to social transformation26.
Individual and collective well-being is directly associated with human relationships and interactions, social recognition and visibility, and a sense of belonging27-29. From this perspective, well-being is in line with the SDGs that aim to guarantee dignity, equality and human and social development, and healthy environments30.
Social entrepreneurship therefore emerges as a catalyst for more complex and contextualized ideas, initiatives, advances and political efforts to simultaneously achieve sustainable development and the promotion of well-being at an individual and collective level31-34. Nursing care as an inducer of well-being, from the perspective of social entrepreneurship, is not limited to an idea, recipe or specific action, but rather expands in the capacity to understand the human being in his/her context and in the scope of small/large prospective movements that occur in the invisibility of being and becoming human.
Prospecting sustainable development implies, in short, considering the different dimensions that encompass community life, especially of disadvantaged groups. Nursing care requires, in the light of social entrepreneurship, considering approaches that promote social and economic justice, non-violence, democracy and social inclusion, in addition to integrative approaches, with evident consequences in health care and well-being. To this end, it is essential that nurses have, in addition to technical skills, a critical-reflective attitude and prospective leadership to innovate and perceive the necessary transformations in the social and health fields.
It is suggested that studies be expanded that consider well-being and its relationship with healthy and sustainable development, in order to support future political decisions that prioritize local and regional needs. Sustainable development, as the central axis of the 2030 Agenda, needs to transcend political norms and reach the existential daily lives of users, especially vulnerable groups, in order to identify strategies and align collegiate processes aimed at human and social well-being.
The limitations of this study are associated with the inclusion of only female workers from the Recyclable Materials Association in the research, given that some men also work in this enterprise.
FINAL CONSIDERATIONS
Nursing care strategies as well-being are related to the appreciation, respect and visibility of recycling work with social, economic and environmental value. They also expand on the professional ability to promote acceptance, bonding, an aggregating environment and the construction of meaningful and collaborative learning.
The contributions of this study encompasses the expansion of the concept that nursing care, as a singular and multidimensional phenomenon, occupies a central role in promoting well-being and sustainable development. To this end, it is essential that Nursing appropriates this knowledge and conducts dialogic and collegial processes focused on basic human needs of users.
Acknowledgment
CNPq Call No. 4/2021 - Research Productivity Grants - PQ. Process: 308760/2021-2.
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Access to the dataset may be granted upon request to the corresponding author.
