News on Brazilian Nursing in the COVID-19 pandemic

Abstract

Objective:

To analyze the impact and visibility that journalistic news brought to Brazilian Nursing during the COVID-19 pandemic.

Methods:

Documentary study developed based on information collected from news sites, news programs, radio programs and written press through clipping; as well as the monitoring of demands performed by the Communication Office of the Federal Nursing Council (Portuguese acronym: COFEN), based on articles of national and international scope. After selection, these were systematized based on the content analysis framework.

Results:

One hundred and thirty-six news from mass media published from March 16 to May 31, 2020 were selected. Through the analysis, narrative patterns were identified and classified into three thematic categories, namely: Political and Professional Protagonism of Brazilian Nursing; Working Conditions of Nursing Professionals; and Vulnerability, Illness and Death of Nursing Professionals.

Conclusion:

The news contributed to give greater visibility to the work of the Nursing team, warn of the precarious working conditions to which they are exposed, and raise public awareness of the disease progress among Nursing team professionals.

Keywords
Nursing; Pandemics; COVID-19; News; Brazil

Resumo

Objetivo:

Analisar o impacto e a visibilidade que as matérias jornalísticas trouxeram para a Enfermagem brasileira durante a pandemia da COVID-19.

Métodos:

Estudo documental, desenvolvido com base nas informações coletadas em sites de notícias, telejornais, programa de rádio e imprensa escrita, por meio de clipping ; bem como pelo acompanhamento de demandas atendidas pela Assessoria de Comunicação do Conselho Federal de Enfermagem (COFEN), a partir de matérias de alcance nacional e internacional, que após seleção, foram sistematizadas com base no referencial da análise de conteúdo.

Resultados:

Foram selecionadas 136 reportagens de grandes veículos de comunicação veiculadas de 16 março a 31 maio de 2020, e sua análise permitiu identificar os padrões narrativos, classificados em três categorias temáticas, que são: Protagonismo Político e Profissional da Enfermagem Brasileira, Condições de Trabalho dos Profissionais da equipe Enfermagem e Vulnerabilidade, Adoecimento e Morte de Profissionais de Enfermagem.

Conclusão:

As reportagens contribuíram para dar uma maior visibilidade ao trabalho da equipe de Enfermagem, bem como alertar para as precárias condições de trabalho a que estão expostos, além de sensibilizar a opinião pública sobre o avanço da doença entre os profissionais da equipe de Enfermagem.

Descritores
Enfermagem; Pandemia; COVID-19; Notícias; Brasil

Resumen

Objetivo:

Analizar el impacto y la visibilidad que las notas periodísticas proporcionaron a la enfermería brasileña durante la pandemia de COVID-19.

Métodos:

Estudio documental, desarrollado con base en información recopilada en sitios web de noticias, noticieros televisivos, programas de radio y prensa escrita, por medio de clipping , así como también mediante el seguimiento de demandas atendidas por la Asesoría de Comunicación del Consejo Federal de Enfermería (COFEN), a partir de notas de alcance nacional e internacional que, luego de la selección, fueron sistematizadas con base en el marco referencial del análisis de contenido.

Resultados:

Se seleccionaron 136 notas de grandes vehículos de comunicación publicadas del 16 de marzo al 31 de mayo de 2020. Su análisis permitió identificar los patrones narrativos, clasificados en tres categorías temáticas, a saber: Protagonismo político y profesional de la enfermería brasileña, Condiciones de trabajo de los profesionales del equipo de enfermería y Vulnerabilidad, enfermedad y muerte de profesionales de enfermería.

Conclusión:

Las notas contribuyeron para dar una mayor visibilidad al trabajo del equipo de enfermería, así como también para advertir sobre las precarias condiciones de trabajo a las que están expuestos, además de sensibilizar la opinión pública sobre el avance de la enfermedad entre los profesionales del equipo de enfermería.

Descriptores
Enfermería; Pandemia; COVID-19; Noticias; Brasil

Introduction

The first case of the new coronavirus (COVID-19/Sars-CoV-2) in China was identified in a 55-year-old resident of the city of Wuhan, Hubei province by epidemiological screening dated mid-November 2019, which was reported by the South China Morning Post.⁽¹⁾The rapid advance of cases of the new coronavirus, especially beyond China, reaching millions of people worldwide, led the World Health Organization (WHO) to declare a global emergency of international interest on January 30, 2020.^(2-5)

Due to the rapid expansion and dissemination of COVID-19 to 114 countries, registering 118,999 cases and 4,291 deaths, the severity of the situation led the WHO to raise the level of risk to humanity and classify the world situation as a pandemic on March 11.⁽⁶⁾The disease became a global threat to public health on a large scale, leading to the adoption of measures such as the closure of borders by several countries. As a result, governments around the world implemented important preventive measures, including travel tests to control the spread of the virus.⁽⁷⁾

Nowadays, the COVID-19 pandemic is the main subject in the press, digital media, in popular and political debate and pages of scientific literature. This reality is a result of the impact caused by the crisis in people's lives, fear, and, above all, the lack of knowledge about the behavior of the disease and its real consequences.⁽⁸⁾COVID-19 has spread across a highly connected world, where all people are virtually connected to each other by cell phone, using global digital social networks such as Facebook or Twitter to facilitate human interaction and the sharing of information about the virus.⁽⁹⁾

COVID-19 has influenced people's daily lives, starting with the obligation to follow rules of social distancing, up to the planning and adoption of health measures to face the crisis. The fact is that COVID-19 has become dominant, especially in the lives of health professionals at the forefront of combating the new coronavirus. In the world, we see the population's solidarity with health professionals. However, this manifestation should not only occur through “clapping campaigns”, but also by mitigating the workload on their families, as they are undergoing stress, isolation and emotional distress of exceptional intensity.⁽¹⁰⁾

In this context, nursing professionals have gained prominence in the fight against the new coronavirus, as they constitute more than half of health workers in Brazil and worldwide, have wide territorial capillarity and are essential in combating the disease against which there is not yet a vaccine or treatment proven to be effective. Care based on the clinical management of symptoms and meeting the basic needs strengthens the role of the category.

However, due to the lack of access and scarcity of Personal Protective Equipment (PPE), the downsizing of professionals in the teams, exposure of risk groups, the need for ongoing education, establishment of conflicting public policies to combat the virus and disease mitigation, Brazilian nursing professionals were the health workers most affected by COVID-19.

On August 10, the Nursing Observatory, created by the Federal Nursing Council (Portuguese acronym: COFEN) to monitor cases of COVID-19 in the profession, already counted more than 32 thousand nurses, technicians and nursing assistants away from work on suspicion of COVID-19. Of these, 15,642 have tested positive for the new coronavirus and 340 have died, a fatality rate of 1.96%,⁽¹¹⁾representing the highest number of affected health workers in the world. With this reality, Brazilian Nursing has emerged as one of the main institutional sources of information for national and international journalism, becoming evident in the media on a daily basis, which motivated the development of this study, aimed at analyzing the impact and visibility brought by journalistic news to Brazilian Nursing during the COVID-19 pandemic.

Methods

Documentary study developed based on information collected from news sites, news programs, radio programs and written press through clipping (monitoring, analysis and archiving of citations made by the media), and by the monitoring of demands performed the Communications Office of COFEN in the period from March 16 to May 31, 2020.

The study was developed based on information from written press, news programs and digital media of national and international reach, open/free access. Those with restricted access to subscribers were also used as a source of information after digital subscription by researchers.

The initial database was created by means of Google clippings, using the keywords “ Enfermagem ” (“Nursing”), “COFEN” and “ Conselho Federal de Enfermagem ” (“Federal Nursing Council”), in addition to the active search with these keywords and the monitoring of demands performed by the Communications Office of COFEN.

The inclusion criterion was to have “national reach”. Media based in Brasília, Rio de Janeiro and São Paulo prevailed, which reflects the centralized structure of the communication and information industry in Brazil. As for newspapers of international impact, mass media who sought COFEN's Press Office in search of guidelines on Brazilian Nursing were selected, such as the Americans “New York Times”, “Wall Street Journal” and “Bloomberg”, the Australian “ABC News”, the Spanish “El País”, the French “France 24”, the Chilean “El Ciudadano”, the Venezuelan “Telesur”, the South Korean “KBS”, the Russian “Sputnik”, and the British “Daily Mail” and “The Guardian”.

Reports published in media without national coverage were excluded, considering aspects such as access, circulation, views and impact. Advertorials and articles broadcast by institutional channels were also excluded, albeit with a national reach, such as “TV Justiça” and “Agência Senado” (Brazilian TV channel and news agency, respectively, both owned and administered by governmental bodies), seeking a reliable representation of the “mass media”. When the same news was published by different media, only one medium was considered and the one with the greatest coverage was selected. The total of 183 reports that met the criteria and had the COVID-19 pandemic theme explicitly in the title or lead were identified. After applying the exclusion criteria, 136 reports remained.

The information was collected for the period between March 16 and May 31, 2020, and cataloged in an Excel^®spreadsheet with the transcription of contents and speeches in different languages. After systematization, these were analyzed by the content analysis method based on Minayo's framework⁽¹²⁾and using the thematic analysis technique, which involves pre-analysis, material exploration and treatment of results, skim reading; constitution of the corpus; formulation of hypotheses and objectives; clipping of the text in record units; identification of the nuclei of meanings, and the classification and aggregation of information.⁽¹²⁾

The definition of categories demanded a qualitative analysis of the content of news in order to identify narrative patterns that are also the object of the present study. It is not only a matter of measuring the reach of Nursing as a source during the COVID-19 pandemic, but above all, evaluating its effect on the journalistic narrative and the themes of greatest repercussion for the working conditions and professional visibility experienced by the category in such a diverse moment as the pandemic, when the entire network of services and work processes of health professionals are undergoing a reorganization. After the detailed assessment of the content of reports, the three following thematic categories emerged: “Political and Professional Protagonism of Brazilian Nursing”, “Working Conditions of Nursing Professionals” and “Vulnerability, Illness and Death of Nursing Professionals”. After the definition of categories, the information was systematized in tables and the titles of reports inserted in the “Wordart.com” tool for the construction of word clouds for each category, which characterized the product of the thematic analysis of contents.⁽¹²⁾

Ethical aspects such as transparency and publicity were observed and complied with in the performance of the study. Since it is based on news already published by the open access media (press, television, radio and digital), there is no additional risk involved to the authors, interviewed persons and networks. Anyhow, the ethical and legal principles of research involving human beings were respected, as issued by Resolutions number 466/2012 and number 510/2016 of the National Health Council.

Results

The central role of professionals in news of mass media when making complaints about working conditions (such as the absence of inputs and PPE, the situation of health units and the reality of how the pandemic is being tackled in the country), vulnerability, illness and death placed Brazilian Nursing in the daily life of the national and world media.

In relation to the media, the 136 reports selected for this study are distributed as follows: 66.2% are news sites (internet), including media with printed editions, 25.0% news programs (TV), 7.4% radio broadcasting stations (radio), and 0.7% are in auditorium shows (TV). The results are presented by categories identified in the study.

Category 1 - “Political and Professional Protagonism of Brazilian Nursing”

When analyzing the evolution of news themes, these started with complaints of lack of access, control or shortage of PPE, which were prevalent in the beginning of the pandemic in the country. Subsequently, there was a higher number of articles highlighting the progress of the disease and the deaths of professionals, as well as the political and professional central role of Nursing. This category represented 17.7% of the findings, as described in chart 1 .

Chart 1
Description of news on the Political and Professional Protagonism of Brazilian Nursing during the COVID-19 Pandemic

NR	NETWORK	DATE	HEADLINE/SUBJECT	MEDIUM
1	EBC	21/03	Health professionals run campaign on the internet asking people to stay at home	News Agency - Internet
2	Folha de São Paulo	25/03	Congress, governors, judiciary, businessmen and even allies react to Bolsonaro's speech	Online newspaper
3	Rádio Web	27/03	Entities ignore Bolsonaro and follow WHO recommendations	News Agency - Radio
4	CNN	29/03	Care taken by professionals and creation of the Observatory	TV
5	Rádio Web	01/04	Observatory will monitor nurses’ health after three deaths	News Agency - Radio
6	G1	13/04	MEC allows anticipation of graduation in health areas and excludes acting ‘exclusively’ in the fight against the pandemic	Digital newspaper
7	EBC	29/04	Council denounces the use of raincoats as aprons by health professionals	News Agency - Internet
8	EBC	30/04	Chamber approves priority for health professionals and funeral directors in tests for COVID-19	News Agency - Internet
9	O Globo	01/05	Nurses pay homage to colleagues killed by COVID-19, there are already 65 deaths	Online newspaper
10	UOL	02/05	Council identifies and says it will prosecute nurses’ aggressors	Digital newspaper
11	Rede Globo Jornal Hoje	05/05	PGR calls for investigation of aggression against nurses in protest on Labor Day	TV
12	Rede Globo Jornal Nacional	05/05	MP calls for police investigation into attacks on nurses and journalists in demonstrations	TV
13	IstoÉ	06/05	Entrepreneur says he criticized nurses’ protest for believing the act was false	Online magazine
14	EBC	07/05	Nursing Council receives more than 6 thousand complaints about lack of protective equipment	News Agency - Internet
15	Exame	08/05	Banksy's work shows nurses as real life heroines	Online magazine
16	EBC	12/05	COFEN advocates better working conditions for nurses	News Agency - Internet
17	Telesur	12/05	Nurses celebrate their day fighting coronavirus	Multimedia – Internet
18	Folha de São Paulo	12/05	Nursing pioneers are honored by Turma da Mônica	Online newspaper
19	RadioWeb	12/05	International Nursing Day: 200 years of courage and care	News Agency – Radio
20	Folha de São Paulo	13/05	Under attack and record of deaths, nursing receives tribute from Pope Francis	Online newspaper
21	France 24	13/05	“World's highest death rate”: Brazil's nurses protest as fatalities mount.	TV
22	Estadão	13/05	Health professionals issue a letter calling for an end to the circulation of fake coronavirus news	Online newspaper
23	Estadão	15/05	Nursing: the essential is no longer invisible to the eyes	Online newspaper
24	Folha de São Paulo	17/05	Nurses want to take advantage of visibility in the pandemic to approve a salary floor	Online newspaper

In chart 1 , news in the following media predominate: 70.1% on news sites (internet), including newspapers that also have print editions, 16.7% on news programs (TV), 12.5% on radio broadcasting (radio), related to the political performance of Nursing professionals and entities in the face of challenges in the COVID-19 pandemic, as well as the professional protagonism in the face of adversities and tributes from public people, such as religious personalities and artists. Figure 1 shows the word cloud that allows a better visualization of the most cited words.

Figure 1
Word cloud representative of Category 1 Political and Professional Protagonism of Brazilian Nursing

Category 2 - “Working Conditions of Nursing Professionals”

This category represented 23.5% of the findings. Among the 30 initial articles, 63% addressed the lack of PPE, demonstrating this was the main source of concern, when the virus had not yet arrived in Brazil, according to the description of articles in chart 2 .

Chart 2
Description of news on the Working Conditions of Nursing Professionals during the COVID-19 Pandemic

NR	NETWORK	DATE	HEADLINE/SUBJECT	MEDIUM
1	Marie Claire	19/03	How are the nurses on the front line against the coronavirus	Online magazine
2	Rede Globo Fantástico	22/03	Dráuzio Varella shows health professionals who are fighting the coronavirus	TV
3	Folha de São Paulo	23/03	In addition to long hours, nurses face the lack of protocol and protective equipment	Online newspaper
4	CNN	26/03	Nursing Council receives 1271 complaints of lack of protective equipment	TV - Internet
5	Estadão	29/03	With the lack of protective and medical items, the country may face workforce collapse	Online newspaper
6	Rede Globo Fantástico	29/03	Health professionals report a lack of protective equipment; complaints exceed 4 thousand	TV
7	Rede Record omingo Espetacular	29/03	Domingo Espetacular visits operating field hospitals	TV
8	SBT Conexão Repórter	30/03	Conexão Repórter shows the real situation of hospitals in the fight against coronavirus	TV
9	Rede Record Hoje em Dia	31/03	Health professionals report the lack of PPE	TV
10	El País	02/04	Without protective equipment, health professionals report concern after the deaths of two nurses in São Paulo	Digital newspaper
11	BandNews	03/04	The hospital network may feel the effects of the lack of professionals	Radio
12	Rede Record Domingo Espetacular	05/04	Doctors and nurses show the routine on the front line in the fight against coronavirus	TV
13	Globo Jornal Hoje	06/04	Complaints of lack of PPE among health professionals increase by 14% in AMB	TV
14	CNN	08/04	Situation of health workers in Brazil	TV
15	BBC	09/04	‘I sleep on the balcony so as not to infect my mother”, says nursing technician that earns R$ 80 per 12-hour shift	Digital newspaper
16	Rede Globo Jornal Nacional	11/04	Health professionals complain about the lack of personal protective equipment	TV
17	BandNews	13/04	Health professionals report lack of PPE	Radio
18	Sputnik	15/04	Brazilian nurses foresee serious problems due to lack of protection against COVID-19	Digital newspaper
19	CNN	15/04	E Tem Mais podcast - There is a lack of protective equipment against the pandemic	Multimedia Internet
20	Telesur	15/04	Complaints of lack of inputs for personal health in Brazil	Multimedia Internet
21	O Globo	16/04	Video shows patients sharing hospital ward with dead people on suspicion of COVID-19 in Manaus	Online newspaper
22	Rede Record Domingo Espetacular	19/04	Lack of protective equipment poses a risk to health professionals and patients	TV
23	G1	21/04	In 1 month, doctors registered 3,100 complaints of lack of protective equipment to act against the coronavirus, says the association	Digital newspaper
24	R7	28/04	Hinterland cities face fear and lack of structure against COVID-19	Digital newspaper
25	KBS	02/05	Brazil, serious infection and death of the health team… Lack of protective equipment	TV
26	Exame	01/05	Nurses protest for better working conditions in the country	Online magazine
27	SBT	07/05	Professionals denounce the lack of personal protective equipment	TV
28	CNN	09/05	COVID-19: Women represent 85% of nurses	TV
29	R7	12/05	“Every day, we hear that more colleagues fell ill and died because of COVID-19”, says a COFEN spokesman	Internet
30	El Ciudadano	12/05	Brazil is a danger for South America: on the way to being the global epicenter of COVID-19	Internet
31	New York Times	16/05	Brazil, Once a Leader, Struggles to Contain Virus Amid Political Turmoil.	Online newspaper
32	Época	19/05	Most nursing professionals with coronavirus are in their 30s	Online magazine

In chart 2 , reports in the following media predominate: 50.0% on news sites (internet), 40.6% on news programs (TV) and 9.4% on radio broadcasting stations (radio), related to unsatisfactory working conditions and, above all, the precarious and difficult access to PPE, such as surgical mask and N95, cloak/apron, eye protection (goggles or face mask), among others. In the word cloud shown in figure 2 , we can also highlight the words: Lack of professionals, protection, nurses, complaints, among others cited in the news.

Figure 2
Word cloud representative of Category 2 Working Conditions of Nursing Professionals

Category 3 “Vulnerability, Illness and Death of Nursing Professionals”

This category represented 58.8% of the identified findings. Although the first death of a nursing professional was registered on March 20, this is not the time frame related to media coverage. Only after the creation of the COFEN Nursing Observatory⁽¹¹⁾on 29 March, the absences and deaths of professionals emerged as a daily agenda in the media. These results and others are described in chart 3 .

Chart 3
Description of news about the Vulnerability, Illness and Death of Nursing Professionals during the COVID-19 Pandemic

NR	NETWORK	DATE	HEADLINE/SUBJECT	MEDIUM
1	BBC	16/03	“I thought I had been infected when attending a patient”: the routine of health professionals who take care of coronavirus cases in Brazil	Digital newspaper
2	BBC	24/03	“We take care of others, but nobody takes care of us”: nurses exposed to coronavirus by lack of equipment	Digital newspaper
3	Agência Pública	27/03	Health professionals: “either we care for ourselves or we fall ill”	News Agency - Internet
4	Rádio Web	30/03	Nursing professionals seek psychological care	Radio
5	CBN	31/03	Nursing professionals receive emotional support during the Covid-19 pandemic	Radio
6	Folha de São Paulo	06/04	Podcast debates pandemic pressures on health care professionals and the system	Online newspaper
7	UOL	07/04	Coronavirus: Council counts 16 deaths of nursing professionals	Digital newspaper
8	O Globo	07/04	Brazil has eight nurses killed by coronavirus and other nine deaths await confirmation	Online newspaper
9	G1	07/04	Coronavirus cases in Brazil on April 7	Digital newspaper
10	CBN	08/04	Council counts deaths of health professionals by COVID-19	Radio
11	Rede Record Fala Brasil	10/04	Nursing technician dies victim of coronavirus	TV
12	Época	11/04	On the front line of the fight, health professionals are diagnosed with COVID-19	Online magazine
13	Rede Globo Fantástico	12/04	COVID-19 makes victims among health professionals in Brazil	TV
14	Época	13/04	Groups of psychologists offer voluntary assistance to health professionals	Online magazine
15	CNN	13/04	Coronavirus has already infected 237 nursing professionals in the country	TV
16	O Globo	13/04	In Brazil, 14 nurses died from coronavirus and another 12 deaths are under investigation	Online newspaper
17	Estadão	14/04	Coronavirus: Council reveals 29 deaths of nurses and 36,000 complaints of lack of PPE	Online newspaper
18	UOL	14/04	Dead with symptoms of COVID-19, a nursing technician could not read the bride's farewell message in ICU	Digital newspaper
19	Revista Piauí	16/04	Fear wears white	Online magazine
20	RedeTV	17/04	COVID-19: 30 health professionals died in Brazil, says the Council	TV
21	IstoÉ	17/04	Health bottlenecks	Online magazine
22	G1	17/04	Brazil has 30 deaths of nursing professionals and more than 4 thousand on leave due to coronavirus	Internet
23	O Globo	19/04	Pandemic takes those working in the public health system to the extreme	Internet
24	Rede Globo Fantástico	19/04	ICU overcrowding: Fantástico shows the critical situation in capitals because of COVID-19	TV
25	EBC	20/04	Health care professionals should be careful with pressure and stress	News Agency - Internet
26	Rede Globo	21/04	Encontro com Fátima Bernardes - Rosana resigned from the hospital for fear of COVID-19	TV
27	O Globo	22/04	Coronavirus: four nurses report the exhaustive daily lives of those on the front lines of the fight against COVID-19	Online newspaper
28	UOL	23/04	Casualties in Health	Internet
29	Globo News	23/04	Nurses on leave because of Covid-19	TV
30	Estadão	23/04	Brazil has at least 38 coronavirus deaths in nursing, says COFEN	Online newspaper
31	EBC	24/04	“Together against the coronavirus” campaign tries to protect nursing professionals	News Agency - Internet
32	O Globo	26/04	Covid-19: Councils and psychologists offer online emotional support to healthcare professionals	Online newspaper
33	Rede Globo Fantástico	26/04	Health professionals deal with fear and pressure in the fight against coronavirus	TV
34	R7	27/04	Brazil has 4,602 nursing professionals away due to COVID-19	Online newspaper
35	Época	28/04	“I don't want them to go through this”: the alert made by the nursing technician during a live stream days before dying for COVID-19.	Online magazine
36	Telesur	28/04	More than 4,000 nurses are away by COVID-19 in Brazil	Internet
37	Rede Globo	01/05	Encontro com Fátima Bernardes - What is the feeling of Health Professionals?	TV
38	El País	02/05	The fight against coronavirus has women's face	Digital newspaper
39	BBC	02/05	Coronavirus: “Some will not be able to put their foot in an ICU anymore”, say therapists about health professionals	Digital newspaper
40	Rede Globo Fantástico	03/05	COVID-19 has saturated the health system in Brazilian capitals and is moving into the hinterlands of the country	TV
41	CNN	05/05	Brazil surpasses the USA in deaths of nursing professionals by COVID-19	Multimedia - Internet
42	El País	06/05	Brazil has already lost more nurses to coronavirus than Italy and Spain	Digital newspaper
43	Sputnik Mundo	06/05	More than 10,000 Brazilian nurses away from work on suspicion of COVID-19	Digital newspaper
44	G1	06/05	At least 76 nursing professionals have died as a result of COVID-19 in Brazil, according to the category council	Digital newspaper
45	UOL	06/05	Brazil exceeds 10,000 nurses on leave and 88 dead, double the number of Italy	Digital newspaper
46	GloboNews	07/05	91 deaths and more than 10,000 nurses away due to COVID-19	TV
47	Rede Globo Jornal Hoje	07/05	Brazil has more deaths of nurses than Italy	TV
48	R7	08/05	Brazil puts 504 nursing professionals on leave for COVID-19 in 24 hours	Digital newspaper
49	EBC	08/05	The number of nursing professionals who died of COVID-19 in Brazil is greater than in Italy	News Agency - Internet
50	Rede Record Fala Brasil	08/05	Professionals in a risk group are required to work at Grande SP	TV
51	Rede Globo Fantástico	10/05	COVID-19: Health professionals are exposed to the risk of contamination by Covid-19	TV
52	UOL	12/05	Survey shows death of 98 nurses due to coronavirus in 30 days	Digital newspaper
53	Band Jornal da Band	12/05	Risk profession in Brazil: 108 nurses died of COVID-19	TV
54	Daily Mail	12/05	Nearly 900 die from the coronavirus in a 24-hour period as Brazil's President Bolsonaro challenges reluctant governors by ordering gyms and hair salons to reopen.	Online newspaper
55	Rede Globo Jornal da Globo	12/05	One hundred and eight nursing professionals have already died from COVID-19.	TV
56	ABC News	13/05	Brazil's coronavirus cases pass Germany's as President Jair Bolsonaro fights to open gyms, beauty parlours.	Digital newspaper
57	Uol	13/05	“My mother wanted me to resign”, says a nurse who had COVID-19	Digital newspaper
58	R7	14/05	Brazil has 14,465 nursing professionals away due to COVID-19	Digital newspaper
59	TV Brasil	14/05	More than 30 thousand health professionals contracted COVID-19	TV
60	Uol	15/05	Coronavirus: Latest news and what we know until this Friday (15) - RJ: State has record of deaths of nurses	Digital newspaper
61	Crescer	15/05	#MomsinHealth: “Mom, when will coronavirus go away so I can kiss you?”, says a 6-year-old son to the nurse	Online magazine
62	Uol	15/05	Why hospitals in RJ have more deaths of nurses in the country	Digital newspaper
63	RadioWeb	16/05	Brazil already has more than 30 thousand health professionals contaminated	Radio
64	BBC	17/05	“I haven't seen my daughter in a month”: nurses live a routine of long hours, low wages and now, loneliness	Digital newspaper
65	CGTN	17/05	The unwanted record: 116 nurses succumbed to COVID-19 in Brazil	Multimedia Internet
66	Folha de São Paulo	17/05	Nurses at Risk	Online newspaper
67	Wall Street Journal	19/05	Brazil's Nurses Are Dying as COVID-19 Overwhelms Hospitals	Online newspaper
68	R7	19/05	Brazil loses 106 nursing professionals in the fight against COVID-19	Internet
69	Bloomberg	21/05	COVID-19 Is Killing Nurses in Brazil More Than Anywhere Else	News Agency - Internet
70	Uol	21/05	COVID: leave of absence could have saved 43 nurses’ lives, says council	Digital newspaper
71	Uol	21/05	Brazil leads ranking of deaths of nurses due to coronavirus	Digital newspaper
72	O Globo	22/05	Brazil surpasses the mark of one hundred doctors killed by COVID-19, two per day	Online newspaper
73	Uol	23/05	MPT investigates complaint of masks without filter for COVID in hospitals in RJ	Digital newspaper
74	Folha de São Paulo	26/05	Council of the Ministry of Health launches alert after a world record of 150 deaths of nurses in Brazil	Online newspaper
75	EBC	26/05	More than 5 thousand health professionals will be hired to fight COVID-19	News Agency - Internet
76	The Guardian	27/05	“My mother was murdered”: how COVID-19 stalks Brazil's nurses	Online newspaper
77	G1	27/05	Brazil is the country with more deaths of nurses due to COVID-19 in the world, say entities	Digital newspaper
78	SBT	28/05	COVID-19: 165 dead Nurses in Brazil	TV
79	Marie Claire	29/05	Who cares for the nurses’ children during the pandemic?	Online magazine
80	R7	31/05	The coronavirus death rate of Brazilian nursing professionals is the highest in the world	Digital newspaper

In chart 3 , there is a predominance of reports in the following media: 72.5% on news sites (internet), including media with print edition, 21.3% on TV news (TV), 5.0% on radio broadcasting stations (radio), and 1.2% in auditorium shows (TV), related to data from the COFEN Nursing Observatory, which show that working conditions make Nursing professionals vulnerable to illness and death. The word cloud in figure 3 also highlights the aspects in this category.

Figure 3
Word cloud representative of Category 3 Vulnerability, Illness and Death of Nursing Professionals

The coverage of deaths and absence from work of contaminated Nursing professionals continues to grow between April and May, and a deeper approach becomes more frequent, addressing aspects such as the availability of PPE, fears and desires, the possibility of contamination and exposure of family members, conflicts in working hours and issues related to the socioeconomic demands of these professionals. There is also the dissemination of other initiatives, such as the solidarity of Nursing that offers qualified care aimed at professionals working at the forefront of combating the pandemic.

Discussion

Nursing represents approximately 59% of the global health workforce and plays a central role in achieving universal coverage of health systems and in achieving the Sustainable Development Goals (SDGs) and national and global goals related to several health priorities, among them, responses to emergencies such as Public Health.⁽¹³⁾

In Brazil, Nursing gathers more than two million professionals, among nurses (569,189), nursing technicians (1,330,447) and nursing assistants (421,581),⁽¹⁴⁾and is the largest contingent of workers in the health macro sector. The Nursing Profile in Brazil survey ( Perfil da Enfermagem no Brasil )⁽¹⁵⁾conducted before the pandemic has shown that these professionals work hard and intensely and earn poorly; due to low wages, they resort to multi-employment to complement their monthly income, often in precarious conditions; structural unemployment is a reality, reaching almost 20% in some states; the feeling of devaluation of their work by the population is felt by more than half of the contingent; most do not feel protected in their work environment, and 20% have already suffered violence and aggression (physical, verbal or psychological) in the workplace; 60% report professional exhaustion; and 10% report having suffered a work accident recently.

Nursing experiences the inexistence of a salary policy, the precarious hiring and working conditions, the increase in outsourcing, social and economic vulnerability fostered by neoliberal policies. Moreover, with the increase of the economic crisis in the country, income has fallen and the real value of salaries has decreased, leading Nursing professionals to work double or triple shifts.⁽¹⁶⁾

The pandemic situation of COVID-19 has led Nations to seek the organization of their national health systems to mitigate the disease. This situation quickly showed the needs and weaknesses of health systems, including the protection and health of professionals. In Brazil it was no different, soon the vulnerability of Nursing professionals, doctors, physiotherapists, and other health workers was perceived, mainly due to the overload and precariousness of working conditions, the difficulty of access to PPE, among other reasons.

Brazilian Nursing was already vulnerable to several aspects related to working conditions, as indicated by the Nursing Profile in Brazil survey ( Perfil da Enfermagem no Brasil )⁽¹⁵⁾and had to fulfill the promise of “not leaving anyone behind”⁽¹³⁾with the COVID-19 pandemic. They experienced the aggravation of this situation both from the perspective of the scope of practices and as a result of the broadness and magnitude of the disease, since these professionals are working at the forefront in the care, surveillance and monitoring of COVID-19 cases in the different points of the Health Care Network, whether public (National Health Service, Brazilian SUS) or private/philanthropic.

According to the extract from articles observed in the national and international press about working conditions and the number of deaths, the main fear of nursing professionals is to contaminate themselves and put patients and their families at risk, given the alarming lack of access or inadequacy of PPE.

In March, when the pandemic in Brazil was still in its initial phase and the first death by COVID-19 in the country was recorded on the 17^th, the Brazilian show Fantástico (03/22)⁽¹⁷⁾on TV Globo, showed the routine and challenges of nursing professionals. A BBC news (24/03)⁽¹⁸⁾highlighted the fear of frontline workers, when little was known about the disease and the vital need to use PPE. The title of the article, “We take care of others, but nobody takes care of us”, was an alert with the testimony of a nurse who was infected while treating a patient in a private hospital, both not wearing a mask. The content of the text reveals the tip of the iceberg, showing the unpreparedness of the hospital and the total lack of knowledge about the severity of the disease in Brazil at that time, as the professional was instructed by the institution not to use the protective material “so as not to scare patients”. The article pointed to the urgent need for PPE, a situation that would worsen.

In early April, the newspaper El País Brasil ⁽¹⁹⁾published a story with the title “Without protective equipment, health professionals report concern after the deaths of two nurses in São Paulo”. At the beginning of April, Brazil recorded 7,910 confirmed cases and 299 deaths of coronavirus, and the Ministry of Health recognized the difficulty in purchasing PPE, such as masks, due to the overheating of international demand for the pandemic, in addition to the recognized deficit in detection tests and the delay in obtaining the results of tests performed.

The topic gained more and more space in the media, with alerts in articles reporting that complaints about the lack of PPE increased by 14%. In the second week of April, the newspapers O Globo ⁽²⁰⁾and Estadão⁽²¹⁾highlighted the deaths and the lack of PPE, reporting the deaths of 29 health professionals and more than 3,600 complaints related to the risk situation of front line workers. On April 11, Fantástico denounced the deaths of these professionals.

The Folha de S. Paulo (17/05)⁽²²⁾highlighted the issue of lack of PPE days later with the article “Nurses at risk”. In the international press, The Wall Street (19/05),⁽²³⁾from New York, addressed the death of Brazilian nurses in the face of precarious working conditions in the pandemic with the article: “Brazil's Nurses Are Dying as Covid-19 Overwhelms Hospitals”. The International Council of Nurses (ICN) warns that nurses have been “cruelly exposed to danger due to the lack of appropriate, high-quality PPE”.⁽²⁴⁾

In view of the increase in cases of death and the news migrating to these records, the lack of PPE appears as one of the causes that contributed to the illness and death of Nursing professionals. The failure to protect health professionals has contributed to the spread of the disease, also from health services.⁽²⁵⁾In addition to this scenario, in Brazil there are still “downsized teams and maintenance of professionals of high risk groups on the front line of care”.⁽²⁶⁾

With the expansion of the pandemic, health professionals’ access to PPE has become an important global concern. Teams began to assist the supposedly infected population while waiting for access to PPE, or used what was available, although it did not meet the minimum safety requirements. Because of this, health professionals began to express their fear of contaminating their family members.⁽²⁷⁾

The international scarcity of inputs and PPE needed to combat the pandemic aggravated by the trade dispute between countries has caused international concern; so much so that on April 20, the General Assembly of the United Nations (UN) passed a resolution calling for global action to rapidly increase the development, manufacture and access to medicines, vaccines and equipment to face the pandemic of the new coronavirus.⁽²⁸⁾

The articles also addressed the fact that many professionals belonging to risk groups, older adults and people with comorbidities, who should have been removed from the front line in the fight against COVID-19, continued to work. Most nursing professionals who died during the months of March and April 2020 with suspicion and confirmation of COVID-19 belonged to this group. In this sense, The Guardian (27/05) has one of the most striking reports,⁽²⁹⁾in which the daughter of a nurse who was part of the risk group, says: “My mother was murdered”. The title unfolds on the subhead: “How COVID-19 stalks Brazil's nurses”. The article also reports that “according to the International Council of Nurses (ICN), this means that more nurses died in Brazil than anywhere else in the world - including other coronavirus hotspots, such as the USA, where at least 146 died, and the United Kingdom, where the number is at least 77”.

The advancement of cases of patients and death by COVID-19 among nursing professionals, the fear of contracting it or transmitting it to family members, the work overload, and the difficulty of access and the lack of appropriate high-quality PPE has led many to mental disorders. The impact on the mental health of professionals leads many to abandon their jobs, quit and develop depression or panic syndrome.

A multicentric study conducted with 906 health professionals (nurses, doctors, other health professionals, administrators, administrative staff and maintenance workers) of five large hospitals involved in the care of COVID-19 patients in Singapore and India pointed out that 5.3% had moderate to very severe depression, 8.7% moderate to extremely severe anxiety, 2.2% moderate to severe extremely severe stress and 3.8% had moderate to severe levels of psychological distress. Nurses represented 39.2% (355) of the study sample.⁽³⁰⁾

A cross-sectional study comparing two groups of nurses: those on the front line (exposure group) and others working in the usual wards (group without exposure) conducted in the city of Torbat Heydariyeh, Iran, indicated that the work stress and burnout scores in the group exposed to COVID-19 infection were significantly higher than in the group without exposure (p=0.006 and p=0.002, respectively). Despite the univariate regression analysis of employment status (p=0.047), experience in caring for confirmed or suspected patients with COVID-19 infection (p=0.006), hospital resources (p=0.047) and stress at work (p<0.001) were considered significant risk factors for COVID-19 related burnout. In the multivariate regression analysis, stress at work (p=0.031, β=0.308) was considered a single factor with a significant relationship with exhaustion related to COVID-19 from the front line, and the factor that exerted more influence was stress at work.⁽³¹⁾

Recently, from 16 to 18 June 2020, the 8^th“Triad Meeting” took place. The WHO, the ICN and the International Confederation of Midwives (ICM), brought together more than 600 heads of government, nurses and midwives, leaders and representatives of National Nursing Associations, WHO Collaborating Centers for Nursing and Midwifery, regulatory bodies and the Nursing Now campaign in 145 countries. The report of the meeting highlighted that “nurses and midwives put their lives at risk to respond to the pandemic and provide essential health services”. The Triad Meeting focused on “how nurses and midwives can be protected, their leadership maintained and supported, and their contributions to emergency response, universal health coverage and more health and wellbeing maximized now and in the future”.⁽³²⁾

In the context of the pandemic, given the double work shifts often without the necessary PPE, health professionals have increasingly gained the aura of heroes in the media. As evidenced by an article of Exame (08/05),⁽³³⁾showing an unprecedented work by British graffiti artist Bansky in honor of nurses: “Bansky's work shows nurses as real life heroines”. The work, signed by the most known and anonymous graffiti artist in the UK, shows a child setting aside superheroes like Batman and Spiderman and choosing a healthcare professional as inspiration.

Still, unfortunate facts occurred with Nursing professionals, such as aggressions suffered when they performed a peaceful act in honor of colleagues killed by COVID-19, on May 1 (International Labor Day), at the Esplanada dos Ministérios, in Brasília (DF). This contributed to the increase in the number of news explicitly addressing the actions of COFEN, which filed a claim against the aggressors. It was also the week in which the number of deaths of nursing professionals exceeded 100 and began to attract even more attention from the national and international press.

The word clouds figures corroborate this discussion. In category 1, the words Health-Nurses-Death-Nursing-Council were highlighted, showing that the news emphasized the extreme aspects of health and death in the category and highlighting COFEN. In category 2, the most prominent words were Professionals-Coronavirus-Covid19-Lack-Protection-Complaints, emphasizing the sad reality of the lack of personnel and supplies. In category 3, the most viewed were again Professionals-Health-Deaths-Coronavirus-Covid-19-Council.

Note that Nursing has historically played a major role in the different health systems worldwide, especially in remote locations, in situations of calamity, disasters, wars, terrorist attacks and pandemics. Despite this important health role, the political component still needs to be expanded and must come out of the condition of invisibility to the spotlight with strong leadership and empowerment.

Concerning invisibility around the world, since 2018, the Nursing Now Campaign has been taking place. This is a partnership between the WHO and the ICN that seeks to raise the profile and status of global Nursing by training “nurses that can make an even greater contribution for health improvement around the world” and assuming an “even more influential role in addressing the health challenges of the 21^stcentury. The Nursing Now particularly emphasizes extending the influence of Nursing on policies, leadership development and building a stronger evidence base to understand the triple impact of Nursing on health, women's empowerment and the economy”. This main role, influence and leadership have been occurring with the strong insertion of Nursing at the front of the COVID-19 pandemic.⁽³⁴⁾

In April, the ICN⁽³⁵⁾released 12 main priorities for combating the COVID-19 pandemic worldwide, especially for the nursing workforce operating in countries with a high disease burden. Among them, based on the results of this study, we highlight the two following priorities:

1. “Demonstrate public support and recognize the value of nurses to society” - “This pandemic highlighted Nursing as none of us could have predicted. Nurses are the largest group of health professionals and are critical in the response to COVID-19 for the health of populations and for keeping health systems functioning. The public has to play the important role of keeping nurses and other healthcare professionals safe. They can support nurses and show appreciation for them by continuing to strictly follow the latest public health advice, such as social distancing and self-isolation”; and

2. “Capitalize in Nursing leadership” - “It is imperative that the world's leading nurses are involved in decision making on policies and planning at the highest level to ensure that overworked health systems can offer the best possible care to the largest number of patients […]”. Governments must see National Nurses’ Agencies as key partners “in the formulation of policies, together with their heads of nursing and other professionals in senior positions […]”. “Health systems and policy makers must make use of their experience and support nursing leaders in clinical settings who are effectively managing various aspects of the response to COVID-19”.

Nurses are fully engaged in responding to COVID-19. They are essential to the pandemic prevention and response efforts by working on the front line, providing first-rate care, especially for complex cases demanding hospitalization. They represent one of the most reliable groups of health professionals, and must advocate for local, state and national policy responses to the COVID-19 outbreak. A global outbreak requires the active participation of the nursing workforce in clinical care, education/training and in the sharing of information on public health and policies. Nurses’ engagement and central role before the pandemic, whether in the development of care or control actions for its mitigation place them as key actors at the end of the outbreak.⁽³⁶⁾To this end, Brazilian and worldwide Nursing need support from the population, political legislators and government officials at different levels.

Conclusion

The pandemic emergency of COVID-19 has placed Nursing as an important media source in Public Health. Despite its capillarity and broadness of scope of practices at different levels of care and scenarios in the Brazilian SUS and an important contingent of professionals, Nursing and its entities (professional councils, unions and associations) have traditionally not had great visibility in the national and international media, even in agendas directly associated with the profession. The prominence of Nursing in the media during the pandemic offers a unique perspective of observing its impact on news coverage. The evaluation of articles also allows the observation of reasons for such reach, both external, associated with the severity of the health situation; as internal, resulting from the ability to generate reliable data and offer trained spokespersons in an emergency situation, contributing to improve health communication strategies. In addition to the visibility gained by Nursing professionals during the COVID-19 pandemic, the massive content of news demonstrates that the main media of national and international coverage contributed to raise awareness of the public opinion regarding the disease progress among professionals, revealing the precarious conditions under which many of them develop their practices, further aggravated during the health crisis, in addition to showing the world the importance and performance of these professionals. The articles strengthened the complaints of insufficient PPE, shedding light on the weaknesses of the health system (public and private). The recognition of public opinion achieved with the insistent exposure in the media favors the evolution of issues dear to the category, such as the minimum wage for the category and the 30-hour workday, which, unfortunately, only after a health tragedy like this started to be looked at and addressed with the attention, care and respect they deserve.

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Publication Dates

• Publication in this collection
  14 July 2021
• Date of issue
  2021

History

• Received
  19 Aug 2020
• Accepted
  05 Mar 2021