Ecological care: meaning for health care professionals from a general hospital

Abstracts

OBJETIVO: Compreender à luz do pensamento complexo, o significado do cuidado ecológico e como este vem sendo associado à prática de profissionais que trabalham em um hospital geral. MÉTODOS: Estudo descritivo de natureza qualitativa realizado com 15 profissionais que atuam em três diferentes setores: Serviço de Lavanderia, Serviço de Nutrição e uma Unidade de Internação. Os dados foram coletados por meio de um questionário semi-estruturado e submetidos à análise de conteúdo proposta por Bardin. RESULTADOS: As categorias encontradas foram: Significando o cuidado ecológico, Salientando a importância do cuidado ecológico para a prática profissional e Medidas preventivas em saúde associadas ao cuidado ecológico. CONCLUSÕES: O estudo evidenciou que existe uma preocupação geral, ainda que incipiente, a respeito da problemática ambiental. A preocupação principal está relacionada à separação, reciclagem e destino adequado do lixo, mesmo que alguns profissionais tenham sinalizado para a importância de medidas preventivas como a lavagem das mãos, utilização de produtos biodegradáveis, entre outros.

Meio ambiente; Saúde; Ambiente de trabalho

ORIGINAL ARTICLE

Ecological care: meaning for health care professionals from a general hospital^*

Cuidado ecológico: el significado para profesionales de un hospital general

Marli Terezinha Stein Backes^I; Alacoque Lorenzini Erdmann^II; Dirce Stein Backes^III

^IGraduate student (Doctoral) of the Post graduation course in nursing at the Universidade Federal de Santa Catarina – UFSC; Member of GEPADES (Study and Research Group on Nursing and Health Administration) - Florianópolis (SC), Brazil

^IIPh. D on Nursing Philosophy, Assistant Professor at the Universidade Federal de Santa Catarina – UFSC; Coordinator at GEPADES (Study and Research Group on Nursing and Health Administration) - Florianópolis (SC), Brazil

^IIIGraduate student (Doctoral) of the Post graduation course in Nursing at the Universidade Federal de Santa Catarina – UFSC; Member of GEPADES (Study and Research Group on Nursing and Health Administration) - Florianópolis (SC), Brazil, Fellowship holder at CNPq (Brazilian Scientific and Technologic Development Council

Corresponding Author

ABSTRACT

OBJECTIVE: To understand the meaning of ecological care in view of complex thinking and how ecological care had been associated with the clinical practice of health care professionals from a general hospital.

METHODS: This was a qualitative descriptive study among 15 health care professionals working in the laundry, nutrition, or inpatient unit. A semi-structured questionnaire was used to collect the data. Bardin's recommendations guided the content analysis.

RESULTS: The following categories emerged: Meaning of ecological care, significance of ecological care for clinical practice, and preventive measures associated with ecological care.

CONCLUSIONS: Although incipient, the findings suggest that there is a general concern regarding environmental issues. Even though some health care professionals stated the significance of hand washing and use of biodegradable products as preventive measures, the main concern was related to the separation, recycling, and disposal of trash.

Keywords: Environment; Health; Working environment

RESUMEN

OBJETIVO: Comprender a La luz del pensamiento complejo, el significado del cuidado ecológico y cómo éste viene siendo asociado a la práctica de profesionales que trabajan en un hospital general.

MÉTODOS: Estudio descriptivo de naturaleza cualitativa realizado con 15 profesionales que actúan en tres diferentes sectores: Servicio de Lavandería, Servicio de Nutrición y una Unidad de Internamiento. Los datos fueron recolectados por medio de un cuestionario semi-estructurado y sometidos al análisis de contenido propuesto por Bardin.

RESULTADOS: Las categorías encontradas fueron: Significando el cuidado ecológico, resaltando la importancia del cuidado ecológico para la práctica profesional y Medidas preventivas en salud asociadas al cuidado ecológico.

CONCLUSIONES: El estudio evidenció que existe una preocupación general, todavía incipiente, respecto a la problemática ambiental. La preocupación principal está relacionada a la separación, reciclaje y destino adecuado de la basura, aunque algunos profesionales hayan destacado la importancia de medidas preventivas como el lavado de las manos, utilización de productos biodegradables, entre otros.

Descriptores: Ambiente; Salud; Ambiente de trabajo

INTRODUCTION

So that life is preserved and lived in full, it must be cared for in its different dimensions. " To care for and to provide care is first of all an act of life, in the sense that it represents several activities to maintain and support life for it to continue and reproduce" ⁽¹⁾.

The word care, besides its broad discussion in the field of nursing, has also been questioned in the context of health as a whole. The questions posed go from care for human beings to care for the earth, the planet, and the environment; that is, care for our surroundings.

The care as a systemic process does not represent a punctual and unilateral action; it involves a feeling of belonging and communication with the whole, that is, with the social surroundings. Under this perspective, care becomes an attitude of occupation, concern, responsibility and effective and affective involvement with the other. This dialogic and interconnected relationship of care with nature and the universe as a whole shows that nature and the universe are not only a set of existing objects as believed by modern science. But it is rather a web of relations in a constant interaction as seen by contemporary science. Interacting beings are no longer only objects. They become related and interconnected subjects forming a complex system of relationship and interactions. The universe is, therefore, the set of relations among subjects⁽²⁾.

Nature and the universe cannot be understood as a relational object but rather they must be understood within a dialogical perspective of care. This relation implies reorganizing the supporting bases of Earth. These bases are both elementary, almost naive, practices such as throwing paper on the ground, polluting water, consumption practices, and complex with the creation of public and environmental policies driven by the process of health living.

It is essential for governmental and non-governmental organizations, researchers, professionals and the population in general to reexamine their relations with the natural and social world. New and increasingly complex problems are arising, such as the case of global warming and its disastrous consequences to the environment. Major international organizations, such as the United Nations, plea for multilateral cooperation between governmental and non-governmental companies to think of actions to solve the environmental problems faced by the planet and which concern life in all its expressions.

An important strategy to rethink environmental sustainability has to do with Environmental Education, as a process that is part of the critical principles of sustainability, complexity and interdisciplinarity^(3-6). The concept of education must incorporate the complexity of the systemic interrelations of the environmental issue. It should assess sociocultural and environmental meanings, values and potential in order to build new and ever complex interactions of men among themselves and with nature.

Educational practice and those in health research must contribute with activities that have meaning and that enable rethinking and reorganizing ways of thinking and acting regarding the process of health living and its implications and interactions with broader environmental issues. In other words, the health/nursing sector should develop educational practices to enable rethinking care for oneself, for the others and its several interactions, so that individuals can be guided by care in its several dimensions.

However, to encourage a broad and effective awareness, we should use new references that can answer, at least in part, the great questions from contemporary society. Especially in the 20^th century a new world perception was formed, a systemic perception from the reality: complexity as a thought that distinguishes and connects, instead of isolating, separating and reducing the whole to parts^(4-6). This new thinking has, as a background, the ability to articulate parts that were scattered by the reduced knowledge and, from a new perspective; it can understand the multiple relationships, causalities and interdependences among natural and social processes.

With complex thinking, using a systemic perspective, the environment, living beings and inert beings are studied in full and interrelated, they are studied in their interactions and interrelations rather than in an isolated and fragmented way, guided by the traditional hegemonic thinking.

Thus, we define ecological care as the type of care that triggers attention and actions to defend the environment, at households, in the workplace, in schools, universities, public and private places, in all places, being part of the relations, of the interactions and associations of human beings and the other beings that are part of nature, in an ethical commitment with one's self, with the others, and with the cosmic universe, in a broad and integrating manner.

Immediately, the following questions are posed: What are the implications of ecological care in the process of health living? What are the meanings given by health professionals to ecological care and how can they effectively contribute to the environmentally sustainable development? What kind of preventive strategies should be introduced in health care organizations to ensure health and safety to all?

Sensitized and, at the same time, concerned with care for the environment and its relationship with health, as nursing professionals and researchers we felt compelled to understand, at the light of complex thinking, the meaning of ecological care and how this has been associated to the practice of professionals working in a major hospital in the far South of the State of Rio Grande do Sul.

METHODS

The present descriptive and qualitative study has been developed in the Hospital da Santa Casa de Misericórdia de Pelotas, a major institution located in the South of the State of Rio Grande do Sul, in February 2008.

The hospital presents 10 admission wards, encompassing General Practice, Surgery, Pediatrics, Maternity as well as Intensive Care Unit, Cardiology Unit, Surgical Center and several support services. Care is mostly performed to Single Health System patients and to other private and/or insured patients.

Among the criteria adopted to select sectors, we have chosen the laundry and nutrition sector on purpose, because there is only one sector for each of these services. Among the admission wards, we had a draw to choose one among the ten existing wards.

Individuals' selection was made by a draw. In each unit four employees were randomly chosen and we have also included the chief of these sectors, who are professionals with a university degree, that is, a domestic economist, a nutritionist, and a nurse.

We had 15 professionals working in the following sectors: 5 Laundry professionals, 5 Nutrition professionals, and 5 nursing professional in an admission ward.

The Laundry service works in morning and afternoon shifts with about 25 employees, among them a domestic economist. The Nutrition service works 24 hours a day, with 86 employees, among them three nutritionists. It is responsible for the kitchen, bakery, cafeteria of the admission wards and the restaurant.

The admission ward drawn was a sector that cares for insured and private patients 24 hours a day. We have chosen to interview only nurses, the team is formed by nursing assistants and technicians (totaling 10), and two nurses. This unit currently has 18 beds.

Data were collected with the use of a semi-structure questionnaire with the following questions: what do you understand by ecological care? What is the meaning of ecological care in your professional practice? What attitudes do you adopt or would adopt regarding ecological care in your work environment?

Questionnaires were given in person to the chosen individuals who accepted taking part in the study and were collected as soon as they had been answered. We asked participants to answer questions individually. In the results, individuals were identified according to the sector/working unit (L – Laundry; N – Nutrition and N – Nursing), and also according to their level of schooling.

Data have been transcribed and underwent content analysis, then, the core ideas and/or reference categories have been withdrawn⁽⁷⁾. The purpose of content analysis is to deduce messages in a logical order with a justification, complementing and validating the results of the interpretation. This process consist the " classification of elements into different folders, establishing an order of issues that will depend on the choice of such classification criteria" ⁽⁸⁾.

As for the ethical aspects, we have taken into account Resolution # 196/96 of the National Health Council on research involving human beings^(9-10). To that end, the project has been approved by the Local Ethical Research Committee in February 2008. We have also requested consent to the Hospital manager and the Informed Consent from each participant to perform the study. Confidentiality of participants' information and identity was assured.

RESULTS

Fifteen employees of the hospital mentioned took part in the study, most were females. As for schooling, three had completed university, seven had finished high school, two had finished elementary school and two had incomplete elementary school. Individuals' age ranged from 24 to 51 years old, with predominance of age from 40 to 50. Professions varied: one domestic economist, a nutritionist, a nurse, a nursing technician, two nursing assistants, four laundry assistants, a kitchen janitor, a kitchen assistant, an employee for general services and two individuals that did not identify their profession.

Results will be presented as charts based on the categories found: Giving meaning to ecological care; Stressing the importance of ecological care in the professional practice and, Preventive Health Measures associated with ecological care.

DISCUSSION

The category referring to Chart 1 – Giving meaning to ecological care – show us that the environment is also a concern in the health area. All professionals, regardless of education, showed one way or another they had knowledge on the issue. They mentioned the need for routine care attitudes that can be expressed in different ways, but especially with sorting, recycling and proper garbage disposal.

It was interesting to observe that all professionals could be included in the process, that is, in the dynamic of ecological care, they perceived the ecological environment from a dialogical relation and/or as part of the process of health living.

The group of individuals formed by laundry professionals, in addition to reinforce the issue of garbage as a factor that pollutes the soil, also mentioned the necessary care with contaminated products which are common in a health institution.

The meaning of environmental care as being " all the things we do so that the environment will not be harmed by men's effect" , expressed by one of the professionals should be stressed because it is a systemic understanding of the phenomena. The expression " so that the environment will not be harmed by men's effects" , presents a vertical relationship of men, the environment, and the other beings that are part of the universe. It shows how difficult it is for men – human beings – to accept living harmonically and interconnected with everything that surrounds them and this is a reason for concern. Immediately afterwards, there is the questioning: Why do men – human beings – feel the need to control, impose and destruct the things and the environment that surround them? Why most of the times the men not bring off accept the other - being, from a dialogic and complementary relationship?

In this sense, a punctual attitude is not enough. Human beings should have an effective, ethical and responsible action. It is essential to think collectively and prospectively and " be aware that there must be a tomorrow for our children" . Thus, vertical and unilateral actions are not enough. We must have an integrating consciousness and strategies that can encourage rethinking the relationship human beings with their surroundings.

Recycling in this context is a significant action and an attitude internalized by most individuals. However, this is not enough. We must create an environmental awareness that sees the part in the whole and the whole in the parts⁽⁶⁾, an awareness that connects and interconnects all things, noticing the disastrous consequences of not recycling which is frequent in our environment.

The ecological movement, understood as being the study of the relations of living beings and the environment presents the need for ethical reflection by all social actors. There is also the awareness on how each individual can contribute to protect nature that is being threatened. We should understand how the ecological knowledge is incorporated by the several different kinds of knowledge that assume a new definition after this ecological question is posed.

The thinking of complexity sees the world and the different existential phenomena as an integrated whole, which can also be called ecological view⁽¹¹⁾. This view understands the essential interdependence of all phenomena, since individuals and society are interconnected by all cyclical process of nature.

Likewise, we may say that complex and ecological thinking can develop a set of aptitudes to contextualize and produce a broad and, at the same time, complementary awareness⁽⁴⁾, that is, that can establish a relationship of inseparability with the - cultural, social, economic, political and natural environment. Thus, only punctual actions are not enough. We must introduce an ecological process that goes beyond the different subjects and the different ways of being and thinking, as an integrated whole.

The category referring to Chart 2 – Stressing the importance of ecological care in professional practice – shows that overall professionals can understand the complexity of hospitals and their relationship and/or implications in the environment.

In addition to garbage care, highlighted as the main element on the table, they can extend discussions to preventive actions, expressed by taking care of " ventilation so the environment will not be polluted" , " reusing recycled materials" , " using water and electricity properly" , that is, the correct and conscious use of natural resources.

In professionals' understanding, hospitals are contaminated places with consequences in the ecological dynamics and sustainability, since they produce a great amount of contaminated products. This consciousness seems to be internalized when professionals mention that one should " be very careful when sorting the garbage" , take care about " food conservation" , " keep a clean environment" , it is also necessary to take care not to " hurt or contaminate work mates" and to be careful with sharp materials.

The elements mentioned by professionals are usually simple and routine attitudes but that are essential in the local and systemic context. Everyone is aware of the implications and consequences of hospital contamination and/or work accident caused by sharp materials. These implications, most of the times, cause not only physical damages but also moral and psychological ones, as well as economic, legal and other types of implications in the health system as a whole.

Thus, we might pose the question: Regarding the environment, who is going to be responsible for the physical, moral, ethical, economic and other damages caused, many times, by thoughtless actions of human beings? Do we feel hurt and/or attacked when we see litter on the streets or in the nature, knowing that in a short time this may lead to irreparable damages to the environment? These questions and other issues seem to be very distant and far from our daily discussions

The expression " a better quality in the care provided to people avoids contaminations" reflects the dimension of actions and attitudes of human beings and their consequences to the overall context. Let's take the example of the intramuscular administration of medications. If professionals do not take the necessary measures to administer the medication, disposing the needle in the right place, this may lead to accidents, as well as to contamination and other implications. Therefore, my punctual action of not being careful may have irreparable implications in the hospital dynamics as a whole.

Under this perspective, all conscious and unconscious attitudes have a result that can be positive or negative. When we talk about ecological care, maybe we want or expect to achieve great results. These are important and necessary, however, we must start by routine practices of care either in the workplace, or at home, in our interaction with people, and even in the way we relate to things, so that this process does not become mechanical and punctual.

" Currently we are taking up some measures, but we are still very far from really understanding the meaning of ecological care" . Getting in to the dynamics of ecological care demands more than giving trainings, establishing routines, and performing punctual and individual actions. This is a process that involves permanent education, problematization, and sensitization through the use of systemic strategies that visualize the micro within the macro system and the macro within the micro.

The essence of human beings is not in the intelligence, freedom or creativity but rather in care⁽¹²⁾. On this aspect, lack of care threatens survival, not only of human beings but also of the planet, since there is a great interdependence between the macro and micro dimension of the planet.

Environmental and ecological awareness has always played an important role in care practices, in routine actions of individuals, regardless of sociocultural level. In other words, environmental problems are health problems since human beings and societies are affected in several different dimensions by them⁽¹³⁾.

Ecological care associated with professional practice and/or vice versa, involves commitment and responsibility with oneself, with the others and the cosmic universe. Ecological care seen as a set of aptitudes to contextualize and produce a broad and complementary awareness⁽⁴⁾, can change the environment, can make relations more humane and can work as a meeting point between human beings and the cosmos.

The category referring to Chart 3 – Preventive health measures associated with ecological care – refers to the measures adopted by professionals and that are directly associated with their environment and specific working conditions. Sorting the garbage, recycling, proper waste destination, and suitable packaging of sharp materials are basic and at the same time elementary actions. There are also other actions considered, such as the following: being careful not to waste water, using electricity unnecessarily, conserving food properly, using biodegradable products, eating food without pesticides, washing food correctly, washing the hands, etc.

Many of the care encouraged and used in the hospital environment can also be extended to the family environment and even to suppliers as mentioned by one of the professionals: " encourage suppliers to grow food free from pesticides" . This dynamics shows that there is commitment and co-responsibility in a network. Washing the hands before any procedure, as many other procedures, is a simple action that is, many times, taken for granted, becoming routine due to the mechanization of work process.

The statement: " washing the hands at each procedure and wearing gloves, thus avoiding the increase in patients' contamination, that is, length of stay, avoiding the unnecessary use of antibiotics and materials" gives the idea of a critical, reflective consciousness and at the same time systemic of the work process. Not washing the hands may have irreparable results, both for professionals, patients, the institutions, and the cosmos as a whole. And, as mentioned before, these results are not only physical or moral, but rather psychological and emotional. It is enough just to pose these questions: What would it represent for each of us to remain in hospital for over 10 days receiving antibiotics due to a hospital acquired infection? To be using a hospital bed when it could be available to other patients? To be using materials unnecessarily? Thus, because of a mechanized attitude, the consequences multiply, causing damages that many times cannot be calculated for the different systems.

These and other facts will make us gradually think and reflect upon strategies that go beyond our field of view, that is, the local approach. Developing an ecological awareness does go through punctual issues, however, these must present a broad and integrating view so that they do not become another unsuccessful initiative. In other words, they must develop, in addition to technological safety, interactive and associative knowledge and abilities that can consider the totality of individuals and their insertion and inseparability from the environment.

Human beings are not a chance in their existence and in their species, but rather they are part of the whole with a series of vital powers that are completed by their integration with everything that surrounds them⁽¹²⁾. Thus, teaching, technology, science, and professionals should leave the laboratories and go outdoors where everything is living together forming a huge ecological community. We should recover a global view of nature and, within it, the species and their individual representatives. Therefore, ecology is the knowledge of relations, interconnections, interdependences, and exchanges of the whole with everything in all places at all times. In this perspective, ecology cannot be defined in itself, outside its implications with other knowledge since it is not being aware of knowledge objects but rather being aware of the relations between the knowledge objects. Awareness of knowledge that is interrelated⁽¹²⁾.

More than quantifying ecological factors as careless, it is important to reflect on the importance of the quality of actions and interactions for the survival of human beings and the planet. Care occurs " when someone's existence matters. Then, we become dedicated, willing to take part in people's destiny, their search, sufferings and successes, that is, their whole life" ⁽¹²⁾. Within the same perspective: What is the importance and/or meaning of ecology to society and to the different social actors? What are their implications for the health of living beings and the planet? How important is ecological care for me?

From the results found in this study and the aspects on ecological care, we designed the following action proposals to be introduced with the working teams in the different sectors that are part of the hospital studied, as well as with other hospitals and health institutions:

- To raise awareness on the need for environmental care everywhere, with the ethical commitment of being responsible to oneself, to the others and to the environment; to provide knowledge, and interactive and associative skills that can consider the fullness of individuals and their insertion in the environment which they cannot be dissociated from; to foster awareness on the proper use of natural resources; to reinforce recycling and correct sorting of garbage inside and outside the hospital; to reinforce care with contaminated materials; to reinforce proper separation of hospital clothes and how to store them after use.

Thus, ecological care cannot be seen as something abstract and decontextualized. It is made real and stronger through reverence and respect to life, regardless of its conditions, space, time, organization and environment. Beyond their differences, all systems are sustained and they self-reproduce through complex care, that is, through full and integrating care. An ecological health approach will only make sense when it is followed by deep changes in our technology and in our social and economic structures⁽¹¹⁾.

CONCLUSION

The categories found: Giving meaning to ecological care, stressing the importance of ecological care for professional practice and Preventive health measures associated with ecological care show that there is a general concern, even if it is a small one, with the environmental issue among the participants of the study. The main concern seems to be related with sorting, recycling, and proper disposal of garbage, even though some professionals mentioned the importance of some preventive measures such as washing the hands, using biodegradable products, among others.

Individuals stated the need for a greater awareness, training, and environmental education not only for hospital employees, but for society as a whole. In this sense, we stress the importance of active and responsible insertion of forming schools to foster the sensitization and problematization for an integrating and systemic view of the facts.

Ecological care is a care attitude that triggers actions to defend the environment, not only in the workplace where many times the rules are already set by organizations, but also everywhere, including in family relations. Thus, care attitudes are not punctual and isolated facts, but rather part of all process of relations, interactions and associations.

The present study, complemented by the readings, debates, and observations, enabled to understand that care in health/nursing is not limited to the hospital environment and to health services. Health care, according to complexity, must be expanded to the ecological, cosmic, and planet dimension in a relationship of complementariness and interactivity. Health care is only a small part of this huge system of care.

Health professionals, under this perspective, need to enlarge gradually their field of vision and action going beyond their organizations and close relationships. We should understand the complexity of the systemic dynamics and we should include ourselves in this process as ethical and critical subjects, committed with the whole.

We do not aim here to answer all the questions pointed out by the text; this is a task for each reader. We want to examine the world we live in, that has no ecological reverence or care to health. We understand that this is the greatest challenge, since the health view that is still present focus only on individuals, disconnected from the rest and from the environment in which they live. No to mention that today, many times, the focus is not even the individuals but rather the disease they present.

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*

Estudo desenvolvido no Hospital da Santa Casa de Misericórdia de Pelotas (RS), Brasil.

Publication Dates

• Publication in this collection
  03 June 2009
• Date of issue
  2009

History

• Received
  11 June 2008
• Accepted
  01 Oct 2008