Nursing in New Dimensions ( 1975-1979 ) : traces of care to newborns

One aimed to identify and analyze the nursing scientific production about maternal and child health published in the journal Nursing in New Dimensions. This is a historical study with documentary analysis carried. As the primary source, 27 issues of the journal Nursing in New Dimensions were used. Those that addressed newborns were included. The organization of data occurred through three figures. One included 12 articles in the study analyzed through three analytical categories: Nursing Health Care to Hospitalized Children; Concerns with Children’s Well-being; Encouragement for Research in Nursing. The subjects covered in the magazine seemed to herald a new dimension to the Brazilian nursing, in this case, the possibilities of performance in the maternal and child health area. Descriptors: Nursing; History of Nursing; Maternal-Child Nursing; Periodicals as Topic.


Introduction
The object of this study is the publications related to maternal and child health in the journal Nursing in New Dimensions during the 1970s.During this decade, Brazil was in a period marked by political changes, influencing explicitly the structuring of the public health sector.The dissatisfaction of the nation with the assistance offered in the services that excluded a lot of population groups was evident and materialized through social movements that later would claim better health conditions (1) .
During this period, the mother-child group, consisting of women of childbearing age, laboring women, postpartum women, newborns, children and adolescents, covered about 70% of the total Brazilian population.The maternal mortality rate was significant and had as its main causes toxemias, hemorrhages, infections and abortions.Regarding the infants' mortality rate, in the group from 0-4 years old there was an increase of 10.5 deaths/one thousand babies born alive in Porto Alegre to 64.5 deaths/one thousand babies born alive in Maceió, having as the most common causes gastro-enteritis, respiratory diseases, measles, whooping cough, tetanus, diphtheria, tuberculosis and malnutrition (1) .
Consequently, it is highlighted the precariousness of health care aimed at this population group, since the causes of deaths in most cases were preventable.In order to meet the needs identified and expressed statistically, the Ministry of Health created the Maternal and Child Health Policy in 1975, whose purpose would be to prioritize women during pregnancy, childbirth and postpartum and children under five years old, with the objective of contributing to the reduction of morbidity and mortality in this group (1)(2) .
To do this, some goals were proposed until 1979, among them: achieve a coverage of 50% of the pregnant population, 50% coverage in technical assistance during childbirth; coverage of 20% in postpartum care; 60% coverage in childcare for children under one year old and for children aged from two to four years old, to reach a care coverage of 50% in the Brazilian territory (1)(2) .
The period between 1970 and 1971, when the II Decennial Health Plan for the Americas was instituted, had as its main aim to discuss issues regarding human resources for health (2) .One emphasizes the interference of this pact for nursing, with proposals of reforms in teaching health professions with recommendation for a model of integration between professors and assistance (3) .
The proposed changes reflected in nursing in order to promote the creation of stricto sensu Postgraduate courses, a historic step in professional trajectory towards scientifization. .
Considering the situation addressed in the period mentioned, one chose to identify the reality portrayed in the Journal Nursing in New Dimensions (1975-1979), because this journal was created during the occurrence of several political and social movements such as the Alma-Ata conference in 1978, enabling a rethinking of the health-disease process, leading nursing to a change in the behavior of its professional practice in order to meet emerging demands, and for having as its founder (4) and creator the professor of the School of Nursing from the University of São Paulo, Dr. Wanda de Aguiar Horta.
Accordingly, the following question was proposed: What concerns related to maternal and child health can be evidenced in studies published in the Journal Nursing in New Dimensions?
The following objective was established: identify and analyze the nursing scientific production in the maternal and child area published in the magazine Nursing in New Dimensions (1975-1979).
It is hoped that this study may start a reflection about the nursing care given to the mother-child population, because by looking into the past, history can enable a better understanding of social and cultural facts showing alternatives changes, in this case, the role of nursing in the health and disease process of the mother and child group nowadays.

Method
This is a historical study whose technique used was the document analysis (5)(6) held between July and September 2013.As primary sources one used five volumes that cover twenty-seven issues of the journal Nursing in New Dimensions, published between the years of 1975 to 1979.
The five volumes of this magazine were found in the library of the Aurora Afonso Costa School of Nursing from the Fluminense Federal University.After authorization of the institution, copies of the original versions were made.As secondary sources one had scientific articles, dissertations, theses, books and documents that made reference to the topics covered.
To select the articles contained in the journal, there was an initial reading in order to identify those which made reference to the maternal and child health.Articles that addressed issues related to newborns or infants were included in the study, and articles that made reference to maternal and child health, but which gave emphasis to women only in their pregnancy and/or childbirth were excluded.
The instruments used were figures for the organization of data and files for document analysis of the selected articles.The interpretation of the findings demanded their contextualization, triangulation of data from different sources and their illumination by the theoretical framework.

Results
A total of 317 articles were found from the five volumes analyzed of the Journal Nursing in New Dimensions, among which 22 were pre-selected after the reading of their title and abstract.Out of these, 12 articles were included, for addressing issues related to newborns, two of which addressed legal issues that would ensure the children's well-being; one emphasized research on mother-child as a field to be explored by nursing.However nine publications were focused on the area of nursing care for hospitalized children.
For best viewing and discussion of the data, the articles were divided according to the subjects in three figures (Figures 1, 2 and 3) containing the following topics: article title, year of publication, authors and synthesis:

Discussion
During the analysis process, after thorough reading of the Journal Nursing in New Dimensions three analytical categories were built: Nursing Care to Hospitalized Children; Concerns with Children's Welfare; and Encouragement for Research in Nursing.
1st Analytical Category: Nursing care to hospitalized children In the publications related to the maternal and child area of the journal Nursing in New Dimensions, one found out that 75% were directed to the area of hospital care.A study that portrays the historical nursing research in the 1970s also indicates that most of the publications (44.4%) refer to the involvement of nurses in hospital care (7) .
Such data reflects the political and economic scenario of the period from 1974 to 1979, where the National Health Policy was facing permanent tension among the expansion of specialized services, the availability of financial resources, the interests arising from connections between the government and the medical business sector, with the overvaluation of the hospital practice and of the biomedical model.During this phase, the priority for nursing was the performance of techniques and task division, which contributed to the fragmentation of the care provided (8) .
The elevated levels of infant mortality indicated an almost absence of health interventions in developing countries, making the Alma-Ata conference (1978) define health priorities, where governments would have responsibility for the health of their population, implying the adoption of appropriate sanitary and social measures.The measures were based on three target conditions: perinatal problems, especially low weight at birth, malnutrition and infectious diseases such as diarrhea, respiratory diseases and the ones preventable by vaccination (1,8) .
In this sense, scientific publications used to be written so that nurses could demonstrate their practice usually performed in outpatient clinics, surgical clinics, nurseries and childcare practices, as the need for attention to children's health was increasing.
Based on this new design and when analyzing the articles of the Journal Nursing in New Dimensions, texts involving the children's group were present since the first issue of the magazine, showing that childcare was already configured as an object of concern to nurses.Such articles were about the most common pathologies in the infant clientele; techniques in pediatric nursing; clinical case studies, organization of pediatric services, including one about care in neonatology, entitled: "Nursing Care in the Neonatal Unit", portraying nurses' role in newborns' attendance and give visibility to the profession that sought to specialize its practice (9)(10)(11)(12)(13)(14)(15).
However, it is noticed that the activities directed to children were guided to a view focused only on the biological aspect, especially when the documents published show a nursing practice based on hygienic and healing impulses, concerned mostly with the children's biological differences compared to other population groups, with timid approaches to the children's social issues and the individual context of their family life.
Surveys conducted on the role of nursing in the 1970s also report the strong influence of the biomedical model in guiding practice, in the way of thinking of pediatric nursing and in the way of understanding health.The programs that supported maternal and child health had as a strategy only the protection to risk groups, because of characteristics such as age and sex, and in a more vulnerable situation, including children, reflecting the high mortality rates that plagued the country (16)(17) .
In spite of risk indicators being epidemiological measurements that are not sensitive to an intervention, but that describe groups of individuals who are more vulnerable than others, due to attributes such as age, sex, social class, marital status, number of pregnancies, ethnic group, it is seen that the interaction of biological, assistance and socioeconomic factors as risk indicators for infant mortality were revealed as narrow (16)(17) .However, the goal was to eradicate the disease without the reflective process that generated the grievance, ie, there was no concern about the misery and the minimum hygiene practices of the Brazilian population.
Nevertheless, although most publications emphasize the direct approach about children and their illnesses, reductionist characteristics began to be substituted by concerns regarding a holistic look about children's health in the late 1970s, since two articles that were concerned with other aspects of the children's lives were found, besides the disease process.These articles were entitled "Psychological aspects of children's hospitalization" and "Roomingin System" published in the years 1977 and 1978 respectively (18)(19).
Probably these publications also occurred in tandem with the political and professional transformations at that time, both internationally and nationally.Internationally the American nurse Madeleine Leininger realizing that nursing was focusing its attention on new technologies, interested in biological explanations of care, decided to base her studies on anthropology in an attempt to structure a professional identity that would take into account social and cultural aspects of an individual's life, emphasizing the humanistic and primary care (20) .
Nationally the scenario was the beginning of the political exhaustion of the military dictatorship, when it was not possible anymore the occurrence of upright, normative and prescriptive health consultations, characterized by the lack of integration with other programs and actions proposed by the government (16) .
As a reflex nursing started the process of reorganization of assistance, mainly focused on children, making part of its practice to consider the integral aspects of children's health, such as the family approach (17) .

2nd Analytical Category: concerns about children's well-being
Two articles related to aspects of children's welfare were found, covering topics such as adoption and children's rights, respectively entitled "Adoption: Concept and problems" and "Children's Rights" both published in 1976 (21)(22) .
In spite of the fact that these publications were published amid the verticality of the Programa Nacional de Saúde Materno-Infantil [National Program of Maternal and Child Health] (1975), one notices nursing with a need to take care of the individual as a whole, prompting a reflection about the integration of public health policies with other government sectors, contributing to improve the quality of life of children and their families (23).
Then it is observed that the changes in the political and social scenario started to urge in nursing a look at issues related not only to cure diseases, but also to the need to engage with the children's rights to grow and live with health.
One started to wonder about the expansion of mortality rates, relating health and disease to a process whose result was determined by the performance of social, economic, cultural and historical factors, collaborating then to start the discussion in the profession about the profile of health and disease in childhood based on the economic, social and cultural development of the country (23) .
Children's health started to be associated to the external factors to which they were exposed to, their physical and mental immaturity, then they needed special care, including appropriate legal protection, especially to grow and develop fully (21) .
Given this reality, the government was proposing to increase the coverage of care in an attempt to increase the quality of life of the group in question, improving standards of production and productivity of the units that performed actions in health and child protection, improving and empowering human resources necessary to the development and effectiveness of the care provided, besides the proposal to start a systemic planning process, control and evaluation of child health in different places, respecting national and regional differences (3)(4).
The article from the Journal Nursing in New Dimensions entitled "Children's Rights" makes a reflection about the Declaration of Children's Rights proclaimed by the General Assembly of the United Nations in 1959.This document is an enumeration of rights and freedom to which, according to the consensus of the international community, any child should have access.Although this statement was in the 1950s, it is observed the concern with the publication in 1976 of nursing to support the organization of nursing care to the child population linked to the maintenance of their rights in order to identify the necessary actions and priorities, including the right to have and belong to a family (21) .
The right to have and belong to a family also encouraged nurses to reflect on the theme of adoption in the article "Adoption: Concepts and problems".Although only with the Constitution of 1988 that the law started to treat equally all the children, conceived or not within a marriage, or by adoption, it was in the late 1960s and early 1970s that the first steps towards the gradual expansion of the authority of the Brazilian government concerning adoption procedures were given.Thus, the article discussed how nurses should, through the Brazilian legal aspects, guide families that have adopted children at home (22)(23)(24).
This can be considered an innovative publication for its time, and despite being written in 1976, it becomes current mainly by the difficulty of finding scientific production in nursing that talks about adoption.

3rd Analytical Category: encouragement for research in nursing
One article encouraging scientific production in nursing was found, it was entitled "Nursing Research and development: Considerations about its importance in the Maternal-Child Area".It highlights the importance of creating centers of research in nursing, taking as example the activities of the Research Center of São Paulo that performed research in the maternal and child area (25) .
Although the manifestation of nursing as a science began in 1950, its practice was based on traditions and theories extracted from physical and biological sciences that gave it a scientific character, especially in relation to techniques, however, only in the late 1960s and early 1970s one intensified the concern with the aspect of nursing knowledge, concerns translated by the systematic ordering of its specific epistemological body and by the preparation of its own concepts and theories, so it was from 1972 on that the first master's courses in nursing appeared in the country (4,7) .
Among the scientific methods employed in master's degree research in nursing at that time, it is verified that the most widely used is the inductive method (89.5%), having the deductive method 10.4% of a total of 115 theses and dissertations produced in Brazil until 1979.Out of this total only 3.5% reached the last step of the scientific method, producing knowledge.In this context it is worth highlighting that nursing research was linked to a strong influence of positivism, with recent trends in the search of new theoretical foundation in the dialectic and phenomenology (4.7) .
Accordingly, when analyzing the article in question, written in 1976, one can take it as a response to the new perspective for the approach to knowledge that influenced the nursing scientific community that was emerging.It is observed that the creation of research groups sought to value the theoretical and methodological issues of knowledge and the individualized practice with people.
The experience revealed in the article emphasizes that through the Research Center of Sao Paulo one started to think of a nursing practice in the mother-child area that would only have satisfactory results if, in addition to obeying methodological rigors, worked accordingly with some fundamental principles in an attempt to minimize the processes of morbidity and mortality of this group.Therefore, the themes addressed reflect their concerns about child care, in order to build and disseminate a solid body of knowledge regarding the implementation of nursing care provided to this group (25) .
Within the context of changes in the scenario of the profession the maternal-child population became the center of attention, generating a concern by nurses to establish a methodology for assistance, which was already done by American nurses.Developing studies aimed at a vulnerable population which was being focused could represent a better visibility for research in the area, especially by the interest in the scientific side of the nursing profession (25) .

Conclusion
For a profession to be recognized nationally and internationally and to have visibility in the scientific field, it needs to produce science and disseminate what it produces.The Journal Nursing in New Dimensions collaborated with this perspective of the scientifization of nursing, because besides giving an opportunity for the discussion of relevant topics about professional practice, it provided visibility to Brazilian nurses in the scientific community, by publishing their texts.One notices that what was produced by this professional category had the symbolic effect of giving prestige to Brazilian nurses, through the knowledge and recognition of their competence in questions concerning maternal-child nursing, through publications in nursing journals.
The subjects covered in the issues of the Journal Nursing in New Dimensions appeared to herald a new dimension to the Brazilian nursing, in this case, the possibilities of performance in maternal and child area.The creation of policies for this group enabled to nursing its development in relation to the care provided to women and especially to newborns.
It was evidenced the concern of some nurses and researchers to ensure care aimed at this population group in question as a field of action for these professionals.Publishing scientific evidence related to the theme seemed to be the most appropriate strategy, whose purpose would be to draw the attention of the class for the promising opportunity that was announced.New born shave been the subject of some scientific studies which addressed aspects that should be considered in the act of taking care, as well as cultural and social aspects, which started to be seen as factors that interfere with their development.It was found that the care given to newborns during phototherapy remains very similar, and that there was a significant progress in the process of identifying a child after his birth.
It is also noteworthy that although the national programs developed for the maternal and child population had a more preventive approach, with emphasis on the so-called primary care, a relevant number of articles published in the Journal Nursing in New Dimensions emphasized nursing care within the hospital.In this context, as the intention of history is not living in the past, but knowing it to understand its path into the present, such emphasis on nursing care to newborns in the hospital field can be regarded as a warning to those professionals to a new field that should be explored: neonatology, which resulted in the expansion of Neonatal Intensive Care Units in Brazil in the late 1970s.

Collaborations
Nazareth IV and Oliveira ERV contributed to the design, analysis, data collection, data analysis and writing of the article.Santos IMM contributed to interpretation of data, drafting of the article and final approval of the version to be published.Amorim WM and Silva LR contributed to the data interpretation and writing of the article.

Figure 2 -
Figure 2 -Publications of the maternal-child area in the Journal Nursing in New Dimensions (1975-1979): Articles about the importance of research in the maternal-child nursing area

Figure 3 -
Figure 3 -Publications of the maternal-child area in the Journal Nursing in New Dimensions (1975-1979): Articles about nursing assistance to hospitalized children.
The possible journals for dissemination of studies produced by nurses consisted of the existing journals at that time, among them: Revista Brasileira de Enfermagem [Brazilian Journal of Nursing], Revista da Escola de Enfermagem da Universidade de São Paulo [University of São Paulo Nursing School Journal], Revista Enfermagemem Novas Dimensões [Nursing in New Dimensions Journal] and Revista Gaúcha de Enfermagem [Nursing Journal of Rio Grande do Sul]