CONTRIBUTIONS BY LEONARDO BOFF FOR THE UNDERSTANDING OF CARE CONTRIBUIÇÕES DE LEONARDO BOFF PARA A COMPREENSÃO DO CUIDADO CONTRIBUCIONES DE LEONARDO BOFF PARA LA COMPRENSIÓN DEL CUIDADO

Objective: to reflect on the contributions of Leonardo Boff ́s literature to the understanding of nursing care. Method: this is a qualitative, descriptive study of the critical-reflexive type, which had the books Knowing to Care and The Necessary Care by Leonardo Boff as a reference for the analysis. It was considered as a philosophical reference that would attend to an ontological, epistemological and phenomenological questioning and as an anthropological reference that would be directed to a philosophical anthropology. Results: from the analysis of the chapters of the books of Leonardo Boff, three themes emerged: understanding of care, care as the core of a paradigmatic transformation and care in health and nursing praxis. Conclusion: according to the literature of Leonardo Boff, it was observed that care is conceived as the meaning of existence, that the way of caring must meet the respect for the singularity and human dignity, that the phenomenon of caring is characterized as the essence of nursing and nursing care must have an ethical commitment to the patient. Descriptors: Nursing; Nursing Care; Philosophy, Nursing; Anthropology; Health; Ethics. RESUMO Objetivo: refletir sobre as contribuições da literatura de Leonardo Boff para a compreensão do cuidado em enfermagem. Método: estudo qualitativo, descritivo, do tipo crítico-reflexivo, o qual teve como referencial para a análise os livros Saber Cuidar e O cuidado necessário, de Leonardo Boff. Considerou-se como referencial filosófico o que atendesse a um questionamento ontológico, epistemológico e fenomenológico e como referencial antropológico o que fosse voltado a uma antropologia filosófica. Resultados: da análise dos capítulos dos livros de Leonardo Boff, emergiram três eixos temáticos: compreensão do cuidado, cuidado como cerne de uma transformação paradigmática e cuidado na práxis em saúde e enfermagem. Conclusão: de acordo com a literatura de Leonardo Boff, constatou-se que o cuidado é concebido como o sentido da existência, que o modo de cuidar deve ir de encontro com o respeito à singularidade e dignidade humana, que o fenômeno do cuidar caracteriza-se como essência da enfermagem e que o cuidado de enfermagem deve ter compromisso ético com o paciente. Descritores: Enfermagem; Cuidados de Enfermagem; Filosofia em Enfermagem; Antropologia; Saúde; Ética. RESUMEN Objetivo: reflexionar sobre las contribuciones de la literatura de Leonardo Boff para la comprensión del cuidado en enfermería. Método: estudio cualitativo, descriptivo, del tipo crítico-reflexivo, el cual tuvo como referencial para el análisis los libros Saber Cuidar y El cuidado necesario, de Leonardo Boff. Se consideró como referencial filosófico lo que atendiese a un cuestionamiento ontológico, epistemológico y fenomenológico y como referencial antropológico lo que fuese dirigido a una antropología filosófica. Resultados: del análisis de los capítulos de los libros de Leonardo Boff, surgieron tres ejes temáticos: comprensión del cuidado, cuidado como núcleo de una transformación paradigmática y cuidado en la práctica en salud y enfermería. Conclusión: de acuerdo con la literatura de Leonardo Boff se constato que el cuidado es concebido como el sentido de la existencia, que el modo de cuidar debe ir de encuentro con el respeto a la singularidad y dignidad humana, que el fenómeno del cuidar se caracteriza como esencia de la enfermería y que el cuidado de enfermería debe tener compromiso ético con el paciente. Descriptores: Enfermería; Atención de Enfermería; Filosofía en Enfermería; Antropología; Salud; Ética. Master ́s degree, Master Program in Nursing, University of Pernambuco and State University of Paraíba/UPE/UEPB. Recife (PE), Brazil. E-mails: edutgs@hotmail.com ORCID iD: https://orcid.org/0000-0002-9506-5303; bri.melo@hotmail.com ORCID iD: https://orcid.org/0000-0002-2296-6688; Ph.D., Master and Ph.D. Programs in Nursing, University of Pernambuco and State University of Paraíba/UPE/UEPB. Recife (PE), Brazil. E-mails: abraofatima@gmail.com ORCID iD: https://orcid.org/0000-0003-3254-2851; simonemunizm2@gmail.com ORCID iD: https://orcid.org/0000-0002-0974-1409 REFLECTIVE ANALYSIS ARTICLE Gomes ET, Brandão BMGM, Abrão FMS et al. Contributions by Leonardo Boff for the... English/Portuguese J Nurs UFPE on line., Recife, 12(2):531-6, Feb., 2018 532 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i2a23563p531-536-2018 At the core of a paradigmatic transformation of health, in the transition from a biomedical model to a holistic approach, nursing must always keep updated of the reflection and the search for clarification of the values and ideals of the profession. Throughout a long process of professionalization that culminated in the models known today and enshrined in the first half of the last century, nursing plays a leading role in the recognition of the human being as a person, providing him with a humanized and individualized assistance, according to his needs. Some authors point out that nurses in direct patient care have understandings of care clearly marked by the tone of production, being more significant than the extended, integrative perspectives that are elaborated as metaparadigms for the theoretical framework of nursing. Such a phenomenon is also indicative of a possibility of non-full realization of nursing in praxis with patients by still repeating models of other professions and insufficient ways of looking at the individual. Care is a primordial and constitutive state of being, giving meaning to the being-in-theworld, at the same time as being an existential way of being in the world with the other, in the Heideggerian perspective. Thus, for the nurses, the commitment to focus on the understanding of care in all its dimensions and expressions goes through the need to self (re) know in the condition of being-in-the-world before interacting with the individuality of others and recognizing as being-with-each other. Theorists of the area are the foundation for understanding the unfolding of care in the exercise of the nurse ́s profession, from the conception of the care to the development of strategies and technologies that support its praxis. However, Leonardo Boff also offers significant content for reflection, particularly in his books Knowing to Care and The Necessary Care. The second book is a consequence of the first one and at the same time, complement and update it. ● To reflect on the contributions of Leonardo Boff ́s literature to the understanding of nursing care. This is a qualitative, descriptive study of the critical-reflexive type, which had the books Knowing to Care and The Necessary Care by Leonardo Boff as a reference for the analysis. Initially, both groups were read as a prerequisite to the elaboration of a working group among the students of the subject Theoretical, Historics and Philosophers Foundations of Caring for the Associated Program of Nursing Postgraduate Program of the University of Pernambuco and State University of Paraíba (PAPGEnf UPE/UEPB). The reflections that emerged and motivated this study had the guiding question of which would be the contribution of the author to a philosophical and anthropological understanding of the nursing care perspective. Then, a new reading was made with the critical-reflexive analysis. From the texts, it was considered as a philosophical reference that would attend to an ontological questioning (What is nursing care?), Epistemological (How does nursing care? How does nursing know?) and phenomenological (Which and how are the phenomena that occur in nursing care?) and as an anthropological reference point that is directed to a philosophical anthropology, starting from the reflection on how the nursing understands the being and accepts of its relationships with itself and with the other. In the anthropological aspect, it should be emphasized that the scope of the analysis presented below was not the same as that traditionally recognized in the investigations in health anthropology, whose aim is directed towards the health-disease-finitude process, but rather having as reference the being-care and the being-caregiver, both as individuals who have the essential care. After the reading and discussion in a working group with postgraduate nurses, from the chapters presented in the two works, the corpus of analysis and reflection were selected for those who answered the questions proposed. Then the product of the analysis performed is presented as thematic categories. From the analysis of the chapters of Leonardo Boff's books, three thematic axes emerged: “Understanding care”, “Care at the heart of the paradigmatic change in health: implications for nursing” and “Care in the health and nursing praxis”. INTRODUCTION


At
the core of a paradigmatic transformation of health, in the transition from a biomedical model to a holistic approach, nursing must always keep updated of the reflection and the search for clarification of the values and ideals of the profession. 1 Throughout a long process of professionalization that culminated in the models known today and enshrined in the first half of the last century, nursing plays a leading role in the recognition of the human being as a person, providing him with a humanized and individualized assistance, according to his needs. 24] Such a phenomenon is also indicative of a possibility of non-full realization of nursing in praxis with patients by still repeating models of other professions and insufficient ways of looking at the individual.
] Thus, for the nurses, the commitment to focus on the understanding of care in all its dimensions and expressions goes through the need to self (re) know in the condition of being-in-the-world before interacting with the individuality of others and recognizing as being-with-each other.
Theorists of the area are the foundation for understanding the unfolding of care in the exercise of the nurse´s profession, from the conception of the care to the development of strategies and technologies that support its praxis.However, Leonardo Boff also offers significant content for reflection, particularly in his books Knowing to Care 7 and The Necessary Care 8 .The second book is a consequence of the first one and at the same time, complement and update it.

Leonardo
Boff´s literature to the understanding of nursing care.This is a qualitative, descriptive study of the critical-reflexive type, which had the books Knowing to Care 7 and The Necessary Care 8 by Leonardo Boff as a reference for the analysis.Initially, both groups were read as a prerequisite to the elaboration of a working group among the students of the subject Theoretical, Historics and Philosophers Foundations of Caring for the Associated Program of Nursing Postgraduate Program of the University of Pernambuco and State University of Paraíba (PAPGEnf UPE/UEPB).
The reflections that emerged and motivated this study had the guiding question of which would be the contribution of the author to a philosophical and anthropological understanding of the nursing care perspective.Then, a new reading was made with the critical-reflexive analysis.
From the texts, it was considered as a philosophical reference that would attend to an ontological questioning (What is nursing care?), Epistemological (How does nursing care?How does nursing know?) and phenomenological (Which and how are the phenomena that occur in nursing care?) and as an anthropological reference point that is directed to a philosophical anthropology, starting from the reflection on how the nursing understands the being and accepts of its relationships with itself and with the other.
In the anthropological aspect, it should be emphasized that the scope of the analysis presented below was not the same as that traditionally recognized in the investigations in health anthropology, whose aim is directed towards the health-disease-finitude process, but rather having as reference the being-care and the being-caregiver, both as individuals who have the essential care. 9 After the reading and discussion in a working group with postgraduate nurses, from the chapters presented in the two works, the corpus of analysis and reflection were selected for those who answered the questions proposed.Then the product of the analysis performed is presented as thematic categories.

 Understanding the care
Nursing theories elaborate the metaparadigm of nursing, always presenting care in its essence as a profession.In the understanding of care that Boff presents, conceptions emerge that touch the nursing at some point or reach it in full in its praxis.
In Knowing to Care, Boff had already presented a perspective of care from an understanding of the word etymology.However, in The necessary Care, he goes beyond and presents other perspectives useful to the ontological understanding of nursing care.
Boff begins the necessary care by discussing the concept of care.All this work is marked by the tonic of the paradigm changes with a broadening of the visions about human relationships and an expanded focus on the relationships between humanity and nature.Thus, for a more precise understanding of the role of care today, it is necessary to have the vision of man as part of nature with the responsibility of protecting, regenerating and caring for it.:21 He also repeats that care is not limited to an act that begins and ends in itself, but it is an attitude, a permanent source of acts, that derives from the nature of the human being.Of this significance, two implications are derived.In the first implication, care as care, solicitude, attention, diligence, and zeal, shows that the other has importance because he feels involved in his life and his destiny.In the second implication, derived from the first, care becomes concern, restlessness, making the other a precious reality. 8e importance given by Boff to care resembles that given by several nursing literatures since the professional identity of the nurse was built on the concept of care and is permeated by the dedication given to the other. 10ff develops a sense of care based on the base theory of the pediatrician and English thinker Winnicott on the holding, which translates into the set of devices of support and protection without the human being does not live. 8This author is one more than advocates caring as a constituent of the human essence, expressed in two inseparable movements: the will to care and the need to care.
From a perspective of epistemological contribution, Boff differentiates two care: the natural-objective and the ethical-conscious.
In the first instance, care takes place with one's own existence.:37 The dimension of ethical-conscious care encompasses the care taken consciously, as a reflex, as a value, intentionally internalized and made an attitude and life project.
In the meantime, Boff cites and discusses Martin Heidegger's construction of caring, emphasizing his work as the major work that brings together Western thought on the subject. 8Heidegger considers that care should not be seen only as an action based on a theory that has an end in itself, but as an ontological-existential basic phenomenon and ontological constituent of human nature.Boff ratifies Heidegger´s understanding by stating that care is part of human nature and we cannot think about what a human being is or think about his or her work without caring: Because the human being carries essential care, the condition is created for him to feel consciously as a being-in-the-world.Care prefigures existence, being turned outwardly.In a word, care is the 'relational sense of life', 'the original intentionality of life'.It is, therefore, more than a mere uneasiness; is the original structure of Dasein, of human existence, in time and in the world. 8king an analogy between the Heideggerian perspective and Boff´s perspective and bringing it into the context of nursing, we see that care takes place in a two-way street, since the process involves a connection between two social actors, is the holder of the technical-scientific knowledge (nurse) who will give the necessary attention to the restoration of health and the other is the recipient of the attention (patient), 11 which reinforces, once again, care as intrinsic to nursing and fundamental to the existence and the professional-client relationship.

 Care at the heart of the paradigm change in health: implications for nursing
Boff, in Knowing to Care, points to necessary reflections that contribute a great deal to a paradigm change in the worldview, from the old Cartesian mechanism to a holistic, integrative paradigm that has had significant repercussions in the health field.He says that "a new ethic presupposes a new view".In spite of the visions that persisted in the field of health for a long time, in which the being was fractioned and the interventions were directed to the parts, the new paradigm for health comprises the being as part of a great web, a network of intercommunicating systems and interdependent.This new vision should guide the practice of healthcare, with care centered on the person as an integral entity. 12 a new worldview, Boff states that: The view from the care is another: the citizen is always connected, reconnected and involved in a network of connections.Care as an ontological and anthropological dimension shows this connection of all with all, due to the general reciprocity and the logic of caring and being cared, assumed as frontal reality and relational commitment. 8om a phenomenological perspective of care, Boff shows that there are two modes of being-in-the-world: work and care.
The way of being-in-the-world by the work is in the man´s need to go in search of the satisfaction of his needs and in the capacity to transform the nature to reach its objectives.With the expansion of the possibilities arising from the evolution of knowledge, the man goes throughout history having more needs than technologies could supply him and, after the industrial revolution, work is explored as a need to meet demands and just that.In this view of being-in-the-world, work configures to situate itself in the world over things to dominate them and put them at the service of personal interests. 7r this way of being-work, in the field of health, professionals tend to fall into the position of the producer of services, and only this, as only prescribing therapeutic treatments in series and without reflection.In the way of being careful, relationships are not based on the reality of a power or superiority, but of coexistence, interaction and communion.:96 There is a great challenge in allying work and care, with care being tied to more spiritual issues and working with objectivity.In priority to work, much of the vision of the human being as being of relationship, creativity, tenderness, care, and spirituality has been lost.
Boff points out that redemption of care should not be done at the expense of work, but in a different way of understanding and accomplishing it, redirecting it from production to care itself. 7erefore, care should be based on a commitment to the singularities and pluralities of the receiving entity, considering the entire historical-social context in which it is inserted, so the role of the nurse is not only that of caring to restore the physical, but also contribute to the emotional restoration and personal skills of each person.Thus, the action of caring will consider not only the concept of holism in isolation but also of ethics, respect, and appreciation of human life.

 Care in the health and nursing praxis
Specifically for the professional condition, little Boff wrote about it.In The Necessary Care, he cites the work of Vera Regina Waldow as a major contribution to the theme and introduces her contribution saying that from this referential he would include the discussion about the consideration of nature in the field of health. 8ff unfolds Heideggerian concepts and presents caring from the existential point of view, before all attitude and situation, being present in every relational conjuncture.Thus, it can be understood that nursing care must precede any intervention-action that is directed to the other.
In this way, care becomes the key to nursing art, aligning technical knowledge with a natural, conscious and intuitive reflection, with a bioethical commitment to beneficence and non-maleficence, being the basis for the attainment of the art of nursing in the capacity to unite technique and subjectivity in favor of the other.Care guides the reflection of the action to be performed and should be the basis on which relationships with patients and relatives are built.
Boff explains the Heideggerian concept of authentic and inauthentic care.For him, authentic care is self-care, and, in freedom, he realizes the possibilities of self-help.It is the care in which it is placed in the condition of being-with-the-other, and not for the other, allowing the other to autonomy and recognizing their individuality and integrality.Inauthentic care is care in which one takes care of everything and less of oneself, or taking care of the other to make it dependent and even submissive. 8ff questions, in an important and often overlooked aspect to professionals and scholars in the area, the World Health Organization (WHO) expanded the concept of health: well-being'.It would suppose the absence of the constraints that mortality of life always brings.It does not enjoy the conditions of being 'total', as this would nullify our intrinsic implicity and vulnerability, ranging from a small cold to the onset of a cancerous condition. 8 The author presents an evolution of health care.He presents the sequence of care as being initially centered on the subject (professionals, specializations, etc.), then on the means (techniques, protocols, scientific principles), finally, in the 60s and 70s, focus its centrality on patient care and care.In this last period, nursing theories arise, to which Boff refers to the best reflections on care that still thrive.
In this way, it is seen that nursing as a subject, profession or social practice that must have the capacity to act with solidarity and to see the person cared for in its totality as an axiological dimension.To this end, the nursing professional must be critical and able to identify the needs of the human being and, based on this discovery, promote actions aimed at improving the quality of care, through ethical and humanized care.Thus, it is observed that the nurse should aim at reflective practice (called praxis), contributing to the transformation of health. 13,14covering the philosophical referential of Leonardo Boff, when considering the ontological, epistemological and phenomenological aspects, it was found that care is conceived as the meaning of existence, that the way of caring should not only be based on prescriptions, but to meet with the commitment of interaction and respect for the singularity and human dignity and the phenomenon of caring is characterized as the essence of nursing.
From the anthropological point of view, the focus of nursing care should be to reflect on the activity to be performed and to have an ethical commitment to the patient, aiming at quality care.In this way, care is elevated to a prominent position and placed at the heart of a paradigmatic transformation of health, as well as of all forms of relationship between people.