Autonomia do enfermeiro obstetra na assistência ao parto de risco habitual

Abstract

The health care model denotes the obstetrical nurse´s importance for the improvement of quality care for the pregnant or puerperal woman. However, the presence of this professional in the birthing process in institutions is a challenge primarily because of the beliefs, values, strutural and organizational conditions of the work places that model the power relations of the professional. This is a qualitative study with an ethnographic theoretical-methodological and conducted in three public maternities in the State of Rio Grande do Norte, Brazil. Three managers and 23 obstetrical nurses participated in the study. Data was collected during July and October in 2016 after approval from the Research Ethics Committee of the Universidade Federal do Rio Grande do Norte, CAAE n° 55187716.9.0000.5537. Information was collected by participant observation, individual and focal group interviews with nurses, and registered in field notes. The collection was halted when no new data emerged. The Atlas.ti software and Spradley´s tenets were used for data analysis conducted simultaneously with the date collection. Three cover terms emerged: Obstetrical nurse´s experience in diferent hospital care contexts; Social relations and power presente in the institutional care to minimal risk births; Professional and institutional aspects related to the obstetrical nurse´s autonomy. The themes were conceptualized based on Foucault´s principles about power and autonomy construction. The concepts and their relations conform a theoretical explanation of the obstetrical nurse´s autonomy is a contribution to the care of the minimal risk birth in the hospital cultural context. The connstructed model unveils the obstetrical nurse in the experience with diferent structural conditions, oranized practies, and the hospital´s cultural ambiance that influence the decision power in birthcare. This space, the institutions and the professionals develop social and power relations that enhance the concept of autonomy connected to the dominant individualistic paradigm and dominance/submissive relations. The model projcts an autonomy constructed by a power/knowledge that expands and supports the nurse´s actions by an ethical value it enhances the multiprofissional work in that the challenges and barriers are resolved by dialogue, not imposition. Those considerations enable to affirm that autonomy is not given but conquered by those that are aware of their role in the transformation of the práxis based on the power relations that are established with others in a perspective for joint growth.