Survey of resources and needs of the professional nursing practice in Brazil: strategies for its implementation

Objective: To describe the preliminary steps for enabling the Survey and to analyze the strategies used by the nurses involved, aimed at conducting the Survey. Methods: It is a social-historical study, where the sources used were written documents found in the Documentation Center of the School of Nursing Anna Nery located at Universidade Federal do Rio de Janeiro and in the Memory Center of the Brazilian Nursing Association. Results: The timeframe covered is from 1954 to 1958, covering, thus, the period of planning and implementing the mentioned Investigation by the Brazilian Nursing Association. From the 7th Brazilian Professional Nursing Practice Congress in 1954 until the delivery of the Final Report of the research in 1958, the nurses involved in the Investigation, through the Association, had to develop strategies to enable and complete this research. Conclusion: From this perspective, the different types of capital (economic, social and symbolic) that they were able to accrue and collect proved to be an effective strategy during the implementation of the Investigation.


INTRODUCTION
The study discusses the strategies of the Brazilian Nursing Association (ABEn) to survey the Resources and Needs of the Professional Nursing Practice in Brazil.The timeframe covers the years between 1954 and 1958, covering, thus, the period of planning and implementing the mentioned Investigation.
The ABEn, that is the entity responsible for the implementation of the Investigation of Resources and Needs of the Professional Nursing Practice in Brazil was established on 12 August 1926, by a group of nurses who had been students of the School of Nursing Anna Nery (EEAN), with the purpose of reinforcing the idea that, for an occupation to develop, it needed an association and a periodical 1 .Since then, the ABEn might have been the greatest asset of the Brazilian Professional Nursing Practice, ahead of all the important events and battles that left a mark in relation to the occupation 2 .
The formalization of the commitment to carry out the Investigation of Resources and Needs of the Professional Nursing Practice in Brazil During the 7 th Brazilian Professional Nursing Practice (CBEn), then called Professional Nursing Practice National Congress held in August 1954 in São Paulo (President Glete de Alcantara, Administration from 1952 to 1954), which, among other issues, discussed the need to conduct a study about the needs of the Professional Nursing Practice in Brazil.After this Congress, the ABEn started to develop strategies to collect financial and human resources in order to implement this study.
The justification of the ABEn to carry out a nationwide study such as the Investigation of Resources and Nurses of the Professional Nursing Practice in Brazil was supported in several arguments, and among them the following can be highlighted: the need to answer the various requests made to the Association for information with the purpose of knowing the exact number of nurses in Brazil and better understanding the situation of the Professional Nursing Practice in its different aspects, in order to have information that would allow the recommendation of actions to correct the quantitative and qualitative deficiencies in the nursing field 3 .
It was crucial to know the needs of the country in relation to the qualification of nursing professionals, the chances of absorption of nursing professionals in the near future, the resource required for the training of these professionals, and the reasons for the disregard of the society in relation to the professional nursing practice and also the way to stop this behavior.The ABEn recognized the importance of these data for the development of the profession, due to the possibility of using them as arguments for discussions with legislators, government officials, authorized people and the nurses themselves.
Since the 7 th CBEn, when the ABEn publicly committed itself to implement the Investigation, until the delivery of the Final Report of the research in October 1958, the nurses involved in the Investigation, through the Association, were forced to develop strategies to enable and complete this research.Based on this, the following targets were set: to describe the preliminary steps to enable the Investigation and analyze the strategies used by the nurses involved in the project in order to implement the Investigation of Resources and Needs of the Professional Nursing Practice in Brazil.
The study is justified by its contribution to the Brazilian nursing history and the progress of knowledge generated about the subject.The said Investigation became a symbol for professional nursing research in Brazil, establishing a "generation of self-taught nurses" 4 , due to the fact that they were the pioneer of scientific studies in the nursing area, with a large number of them.Furthermore, despite the importance of the Investigation of Resources and Needs of the Professional Nursing Practice in Brazil, the historical studies more recently published make few references to the Investigation, which also had its dissemination hindered at the time of conclusion by the fact that the number of copies of the Final Report was limited 5 .From the social point of view, the study is relevant because of the possibility to confirm the importance of the ABEn for the development of the profession, as well as its contribution to history, as a place of memory of the Brazilian Professional Nursing Practice.

METHOD
This is a social and historical study, where the primary sources are the editions of the Brazilian Nursing Journal (RENEn) for the period between 1954 and 1958; two transcribed interviews from Maria Rosa Sousa Pinheiro and Haydée Guanais Dourado, granted to Vitória Secaf and Raquel Rapone Gardizinsk on 16 May 1988, which are part of the document named "Creation of Nursing History Sources"; Proceedings of the CBEn relevant to the timeframe of the study.These sources were found in the Documentation Center of the School of Nursing Anna Nery located at Universidade Federal do Rio de Janeiro EEAN-UFRJ.The book Investigation of Resources and Nurses of the Professional Nursing Practice in Brazil, edited by the ABEn in 1980, the Proceedings of the International Educational Workshop on Nursing Investigation held in 1958; and the book of the minutes of the Meetings of the Investigation Council were also primary sources for this study and were found in the Memory Center of the ABEn in Brasilia.The second sources, constituted by articles, dissertations, thesis and books related to the studied topic supported the analysis of the findings.Data collection took place between October 2010 and May 2012.
In line with the historical method, data analysis included the investigation and critical evaluation of data, and the analysis based on the knowledge produced about the topic 6 .In addition, the concept of symbolic capital of the French sociologist Pierre Bourdieu represented an important analytical tool for understanding the strategies used by the nurses in charge of the Investigation of Resources and Needs of the Professional Nursing Practice in Brazil in order to raise efficient capital (economic, social and symbolic) to make the project feasible.

Survey of nursing resources and needs
Malta DV, Santos TCF, Pereira LA, Gomes MLB, Lopes GT, Oliveira AB The concept of capital, borrowed from the field of Economics, is central to Pierre Bourdieu's ideas.Concerning the concept of social capital, this is understood by Bourdieu as the set of social relationships developed by people in certain social scenarios, where relationships are established and the way people interact is determined by the positions of the agents.As for the symbolic capital, this is related to the prestige or good reputation that a person or institution holds in a specific field or in general society 7 .In other words, this concept is related to the recognition received by people or institutions.
The project that gave rise to the present study was approved by the Research Ethics Committee of the EEAN-Hospital São Francisco de Assis (Registration 063-2011), on 27 September 2011.

Search for human and financial resources to enable the Investigation of Resources and Needs of the Professional Nursing Practice in Brazil
The 7 th CBEn constituted an event for important decisions that resulted in the first actions towards the completion of the Investigation.Concerning what is applicable to this study, at the end of the event, two recommendation proposals to the ABEn were approved: "To always maintain updated their registration as nurses and their file with the information about education and nursing practice; to analyze the needs of nursing in the country and the degrees of professional qualification based on the needs" 8:319 .
The dissemination of these recommendations, to everyone, has the power to socially establish and confirm the commitment with the development of the profession.With this in mind, from the 7 th CBEn, with the nurse Maria Rosa Sousa Pinheiro in the presidency of the ABEn, the first steps were taken to seek financial resources and the support of other institutions in order to implement the Investigation, given that the Association was aware that this study would only be feasible with support and partnership.
In relation to the need to seek resources to enable the implementation of the Investigation, the excerpt of the interview of Maria Rosa Sousa Pinheiro is explanatory:

.) At the Congress of 1954, I believe that it was Agnes Chagas who proposed to do an Investigation, to do an Investigation of Resources and Needs of the Professional
Nursing Practice in Brazil.I, who had just been elected president and was running the recommendations session, protested.I said: We do not have resources to do an investigation in the entire country... but the protest did not work, and it was voted, and I was with this huge task!Then, Haydée and I went to the Ministry of Education and the Ministry of Heath, we asked the SESP, but nobody had resources to give (...) 9:7 .
The first formal requests in the search for support were addressed to the general secretary Coordination for the Improvement of Higher Education Personnel (CAPES), in October 1954, and to the representative of the World Health Organization (WHO) in Rio de Janeiro, in February 1955.The requests, despite being considered by the CAPES and the WHO, that recognized their importance, could not be answered.However, the WHO made the representative of the Rockfeller Foundation in Brazil aware of the request.Maria Rosa, when made aware that the Rockfeller Foundation was willing to support, immediately sent a letter to its representative in July 1955, explaining the significance of such study for the Brazilian Professional Nursing Practice.From that point, the Foundation committed to provide financial support to the research 1 .
Concerning the financial support provided by the Rockfeller Foundation for the implementation of the Investigation, Maria Rosa Sousa Pinheiro declared the following: One day, I was in my office in the SESP and a representative of the Rockfeller Foundation arrived and said: Miss Pinheiro, I know that you have to do an Investigation of Resources and Needs of the Professional Nursing Activity.I said: Yes.He said: I came to offer you money from the Rockfeller Foundation.This money fell from the sky...They gave 30 thousand dollars and lent rooms from the Rockfeller Foundation located close to the SESP, in the Castelo, for the people who were going to work on it.We started to work 9:7 .
An offer like this from the initiative of the Rockfeller Foundation shows the symbolic credit of the ABEn and the Brazilian professional nursing practice before an international institution and shows the weight and volume of the symbolic capital of the Association.This support expresses the social recognition gained by the ABEn and adds value to the symbolic capital of the entity before the Brazilian professional nursing practice.
So much that, after the financial support given by the Rockfeller Foundation, other institutions decided to help, showing that the Foundation seal added symbolic profits to the ABEn project.With this support, the Investigation of Resources and Needs of the Professional Nursing Practice in Brazil had the technical assistance of the WHO and the Brazilian Institute of Geography and Statistics (IBGE), besides the cooperation of other important public and private institutions, civil and religious ones 1 .Therefore, through this support, it was possible to implement the first strategies to conduct the Survey of Resources and Needs of the Professional Nursing Practice in Brazil.

Strategies of the nurses involved in the project for the implementation of the Survey of Resources and Needs of the Professional Nursing Practice in Brazil
The first strategy to formalize the beginning of the Survey of Resources and Needs of the Professional Nursing Practice in

Survey of nursing resources and needs
Malta DV, Santos TCF, Pereira LA, Gomes MLB, Lopes GT, Oliveira AB Brazil was a meeting held on 8 July 1955 in the director's room of the Special Public Health Service (SESP).The invitation for that came from the nurse Agnes Chagas, then head of the Nursing Services of the Pan American Sanitary Bureau -WHO, who was in the country specially to work in this project 1 .
This first meeting was aimed at establishing the type of participation and the responsibilities of the institutions that had committed themselves to the ABEn to support the implementation of the Survey of Resources and Needs of the Professional Nursing Practice in Brazil.The event was attended by Dr Ernani Braga, representing the Rockfeller Foundation; Dr Henrique M. Penido, superintendent of the SESP; the nurse Agnes W. Chagas, representing the WHO; the nurses Maria Rosa Sousa Pinheiro and Haydée Guanais Dourado, president and vice-president of the ABEn, respectively 10 .
The need to collectively formalize the participation of the entities willing to support the Survey shows the concern of the nurses of the ABEn to secure such support, which was essential for its implementation.In this meeting, the convenience of establishing a Board of Directors of the Survey was discussed, as well as a plan for using the financial resources received from the Rockfeller Foundation and the appointment of a person to be responsible for the Survey.
The Board of Directors of the Survey was appointed as a maximum resolution department.It encompassed nine institutions and ten members.Maria Rosa Sousa Pinheiro and Haydée Guanais Dourado represented the ABEn; Dr Ernani Braga represented the Rockfeller Foundation; Anísio Teixeira represented the CAPES; Isaura Barbosa Lima represented the Ministry of Health (MS); Nair Fortes represented the Ministry of Education and Culture (MEC); Luíz Timóteo da Costa represented the IBGE; Henrique Maia Penido represented the SESP; Dr Kenneth Courtney represented the WHO through the Pan American Sanitary Bureau and, finally, Fabrício Gomdim represented the Ministry of Labor (MT) 11 .
With respect to the planning for the use of the financial resources that would be donated by the Rockfeller Foundation, it was decided that the Foundation would release the funds gradually due to the difficulty in estimating the total cost.Therefore, the total financial cost of the Survey was 40 thousand dollars, which was donated in two instalments: the first of 10 thousand dollars, in 1956, and the second of 30 thousand dollars, in 1957 1 .
In order to make public the implementation of the idea and the support received, the News and Commentaries Department of the REBEn published the first news about the Survey in its March 1956 issue.

The initial work of the nursing investigation is in a preparatory stage. The first step was to install the Investigation Center of the Needs and Resources of the Professional Nursing Practice, which was established due to the Rockfeller Foundation making a place available in its own headquarters. (...) Mrs Zilda Carvalho Hughes and Haydée Guanais Dourado dedicate themselves full time to this great initiative of the ABEn. Mrs Maria Palmiro Tito de Moraes, from the WHO -Pan American Sanitary Bureau -that arrived in Brazil in March, is one of the Investigation advisors. Mrs Maria Rosa, President of the
Executive Committee was in town in March, attending to an invitation from the Rockfeller Foundation, in order to participate in the preliminary decisions, in conjunction with other authorities that support the Investigation.Monthly meetings are held, some in Rio de Janeiro, some in São Paulo, to discuss the main actions.The president has also informed at first hand that the association had obtained a donation from the Rockfeller Foundation for this important study, which should reveal the current conditions of the Professional Nursing Practice.All the sections of the ABEn and, through it, all its associates, should participate in the works.It is, therefore, important that they attend the monthly meetings of the Sections to have information about the issue.The Brazilian Nursing Journal will equally report the progress of the works 12:46 .
As it can be noted, the news published at the REBEn about the Survey widely addressed the first steps undertaken by the ABEn, the nurses involved in the initial stage of the research and their positions.In addition, the names recorded in the text excerpt published shows that the support provided to the Survey came from agents with professional authority recognized in the nursing field.The text informs the financial support of the Rockfeller Foundation and the commitment of the ABEn to maintain the communication about the issue, through the State Sections, their associates and the REBEn itself.
Regarding the division of tasks, a plan was formulated to establish the joint works with the members involved, distributing them into committees and councils, determining the responsibility of each one of them.The ABEn was appointed as the entity responsible for the development of the project, and its actual implementation would be the responsibility of the Investigation Center of the Needs and Resources of the Professional Nursing Practice, specifically established to perform this role.This Center was managed by a president who, in this case, was the president of the ABEn, Maria Rosa Sousa Pinheiro, and two directors: Haydée Guanais Dourado and Zilda Carvalho Hughes until 1956 and by Maria de Lourdes Verderese, from 1957.The general coordination position of the Investigation was given to Haydée Guanais Dourado, who exclusively dedicated herself to this role 12 .
The Rockfeller Foundation and the WHO, through the Pan American Sanitary Bureau, were in charge of providing financial and technical assistance, respectively.Two sections were created and were subordinate to the Investigation Center: one technical and one administrative: the Technical Section was exclusively composed of nurses who should dedicate full

Survey of nursing resources and needs
Malta DV, Santos TCF, Pereira LA, Gomes MLB, Lopes GT, Oliveira AB time to the development of the project 6 .This Committee was responsible for the general orientation of the Survey; providing technical assistance; organizing and managing data collection; performing the analysis and interpretation of data; drafting the final report and the plans for further action 13 .The Administrative Section, managed by Haydée, was composed of a dissemination assistant and two secretaries.Their duties were: proposing the organization of the Center, coordinating the works, administering the budget, developing public relations and divulging, including in conjunction with the Councils 14 .
The Board of Directors, vested with administrative authority, had the role of administering the works involved in the Survey 13 .Their duties included: organizing the Assistant Council; establishing and restricting the areas of the issue to be studied; approving the rules and work plans; reviewing the findings of the Investigation; considering and adopting the final recommendations; planning the implementation of the recommendations; approving the final report and deciding about any matter not specified 15 .The Technical Council was composed of a nurse who provided consultancy to the WHO, Maria Palmira Tito de Morais, a statistician, a sociologist, an anthropologist, two public health doctors and two more nurses 12 .
The Assistant Council had the following duties: analyzing the general structure of the Survey; providing support and assistance, acting as assistants in various stages of the development of the work; developing action related to the divulgation and public relations; assisting with the resolution of problems; giving suggestions concerning the recommendations to be made and the ways and means to implement these recommendations.It was composed of 79 influential people, who represented different sectors, as follows: nursing, medicine, education, statistics and social research and community.These members were indicated by the Board of Directors.The constitution of this Council was not based on the criteria of assistance with technical or professional issues, but on the need to give each member a safe guidance concerning the Brazilian Professional Nursing Practice and its problems.Inviting influent people and representative of different professional fields was one more strategy used by the nurses involved to give clarity to the project.
With the Committees and Sections formed and their duties established, it was necessary to find a starting point.In order to decide on the next steps, meetings with everyone involved were held and minutes about the resulting planning were taken, to ensure the logical continuation of the work, based on agreed resolutions and actions.One of the first initiatives was the definition of the study's scope.
The determination of the areas of investigation took into account the material and human resources available and the frequent fact that specific problems often take more accurate proportions when jointly examined in the general context.It was then decided that the Survey would have a national scope 13 .A structure for the Survey was developed by the Center's Executive Committee, constituted by the Technical and Administrative Section 15 .As the meetings of the Board of Directors took place, the required changes were made to the structure, and the official data collection began in 1957 1 .
The structure involved five areas: Active and Inactive Nurses; Hospital Nursing; Public Health Nursing; Nursing schools and Nursing Assistant schools.The objectives were the following: placing the development of the Professional Nursing Practice on the Brazilian socioeconomic and cultural structure; finding out the human potential that the Professional Nursing Practice had available in its different areas of activities; determining if the kind of education provided in the nursing and nursing assistant courses and the quantitative production of the schools met the needs of the Professional Nursing Practice in the country; finding out the current conditions and determining the needs of the services of the Hospital and Public Health Nursing 1 .
As the data were collected, the results were divulged.The works related to the Hospital and Public Health Nursing areas, considered the most complex ones, started in August 1957.In the first semester of that year, there was careful planning and development of questionnaires, and definition of samples for studies in the two areas.Following this, the four field research nurses, under the coordination of Olga Verderese, started to perform data collection in these two areas, which was expected to be finished in December of the same year but only happened in January of the following year 1 .As previously mentioned, this was the most difficult part of the research, mainly due to the territorial extension of Brazil, as pointed out in the following excerpt: "Among the many difficulties that we had to face, one related to the distances.Travelling around Brazil in 1957 was not easy.Fortunately, we used the air transport existing in that time, the REAL, which went to almost everywhere in Brazil; where there was a small field, a DC3 landed there... Sometimes, we used to do the investigation of the data together, that is, the three nurses together; other times, we went by ourselves.For example, I did the center-west region on my own.The difficulty was exactly to arrive in the places that were in the sample.I travelled on a DC 3, bus, jeep, train; I only did not travel by boat, but I even had to walk...All this experience in approximately only two years, gave me a lot of knowledge, which corresponds to ten years of normal professional activity and that surely gave me a great advantage in the professional career" 1:308 .This statement shows the professional engagement of the nurses in the performance of duties that required mental and physical efforts.It was also clear that this hard stage of data collection should be the nurses' responsibilities, since they were the most interested ones in the quality of the research.Besides having the ability to perform the job, they were selected for being people trusted by Maria Rosa Sousa Pinheiro.

Survey of nursing resources and needs
Malta DV, Santos TCF, Pereira LA, Gomes MLB, Lopes GT, Oliveira AB While the Technical Section got involved in the data collection, the Center Administrative Section, coordinated by Haydée, developed actions for dissemination and relationship about the Survey with the public.Through this dissemination, it was sought to have the support and cooperation of different segments of society, especially the medical class, large public administration areas and the own nursing and nursing related professionals.The dissemination activities were constant from start to end of the works, through loud speaker advertisement, posters and prints, newspapers, magazines and TV images, the REBEn being the main dissemination vehicle of the Survey of the Resources and Needs of the Professional Nursing Practice in Brazil.
The dissemination of information about the influence and clarity that the Survey provided to the Brazilian Professional Nursing Practice reinforced the value and credibility of the research being conducted.The strategy intended to show trust and make the category to cooperate by providing data to the Survey, from which success depended on reliable data.
Simultaneously to the process of finalizing the research, between 6 and 15 July, an International Educational Workshop on Nursing Investigation was held in Salvador, Bahia.The event was an initiative of the WHO, attending a request from the ABEn to the Pan American Sanitary Bureau, through the Ministry of Health.The objective of the ABEn's request was to share the experience obtained during the Survey with the countries that had shown to be interested in knowing the techniques used and the results obtained 16 .Furthermore, the Association hoped to have the specialized support of the participants for the final development of the recommendations of the Survey 1 .
The implementation of the International Educational Workshop had a symbolic benefit resulting from the Survey, which made it possible to internationally divulge large researches conducted by Brazilian nurses through the Association.On the occasion, the nurses expanded and upgraded their social capital through the professional exchange.In more accurate terms, the Workshop also allowed the updating of knowledge aimed at the Final Report of the project, particularly concerning the recommendations.
At the end of 1958, one of the problems faced was the lack of funds for the printing of the Final Report and for its translation into English.In order to meet this demand, the possibility to request the support of the CAPES was considered.The need to request the support of the SESP for the multi-light printing (printing machine, commonly used to print commercial papers in offices, or small circulation brochures) of the Final Report was also identified 17 .
Despite the efforts to obtain financial resources, the final drafting of the Survey of Resources and Needs of the Professional Nursing Practice in Brazil was not concluded at the time the 11 th CBEn was held, carried out in Recife, between 14 and 17 October 1958.However, in this event, the Technical Section of the Center showed the main data of the Survey.
The Final Report of the Survey was delivered to the Board of Directors during a meeting held on 30 October 1958.This report has 46 recommendations to the Ministry of Education, the Ministry of Health, the universities and legislators, the Nursing Services at Healthcare and Hospital Units, the Brazilian Religious Conference, the institutions that maintained nursing schools, the Nursing schools and the Nursing Assistant schools and the ABEn itself 18 .
As a project supported by multiple institutions, it was not possible to establish a complete budget forecast and, therefore, the ABEn was not able to publish the Final Report shortly after its completion.The publication in Portuguese by the ABEn only happened in 1980 and, even so, with a limited number of copies that were distributed only to remarkable nursing libraries in the country and to the major nursing schools 18 .
Despite the difficulties faced concerning the implementation of the Final Report's recommendation, the relevance of the study was very expressive for the Professional Nursing Practice, since it contributed to increasing the influence and recognition of the ABEn, which started having an input when important issues related to the category were discussed.Specifically, the Survey influenced the legal, educational and nursing practice fields.

FINAL CONSIDERATIONS
The first strategy to make the Survey feasible was to seek partnerships with entities that had an interest in the subject.With this purpose, the ABEn resorted to its symbolic powers as strategy to give credibility to the research.With this effort, the Association managed to get the Rockfeller Foundation's financial support for the Survey, technically assisted by the WHO, and the support of other important institutions.
Another strategy used was to carefully plan the structure of the Survey, through the establishment of Councils and Committees, previously defining and distributing the responsibilities to each one of them.As a result of this planning, the Survey Chart and Structure can be highlighted.
Concerning dissemination, it can be concluded that these were the resources most used by the nurses involved in the Survey.Being a national research based on census information, in which a lot of the data was obtained through questionnaires, the research did not only depend on the efforts of those directly involved in the study, but also on the "goodwill" of everyone indirectly involved.
The initiative of the ABEn was effective in so far as this institution was seen and trusted through the implementation of the Survey, and, since then, it has won a recognized place for an authorized speech, based on solid data, in order to fight for the development of the Professional Nursing Practice in Brazil.From this perspective, the various types of capital (social, economic and symbolic) that it was able to accrue and collect were effective during the implementation of the Survey, also to give credibility to the research and obtain the support of other institutions to enable and implement the Study.
Undoubtedly, the Survey has left a legacy for the history of the Brazilian Professional Nursing Practice, because it marked the beginning of a large number of scientific nursing researches