Percepção de enfermeiras sobre a autonomia na atenção primária à saúde em cenários rurais e urbanos
DOI:
https://doi.org/10.34019/2446-5739.2026.v12.51709Palabras clave:
Atenção Primária à Saúde, Enfermeiras e Enfermeiros, Autonomia ProfissionalResumen
Objetivo: Analisar a percepção das enfermeiras na Atenção Primária à Saúde sobre sua autonomia profissional em municípios rurais e urbanos. Metodologia: Estudo qualitativo, descritivo e exploratório, derivado do estudo multicêntrico Práticas de Enfermagem no Contexto da Atenção Primária à Saúde: estudo nacional de métodos mistos. As participantes foram 53 enfermeiras de três municípios rurais e três munícipios urbanos da Bahia, Brasil. A coleta de dados foi por meio de entrevista semiestrutura e analisado por meio de análise de conteúdo temática. Resultados: A análise dos dados revelou duas categorias temáticas: a primeira destaca a área de identificação da autonomia da enfermeira, enquanto a segunda aborda a autonomia para prescrição e solicitação de exames e seus limites na Atenção Primária à Saúde. Considerações Finais: As enfermeiras percebem sua autonomia profissional associada a um grupo específico de atendimento, baseado em protocolos assistenciais. Na maioria das vezes, não precisam de outro profissional para concluir o atendimento.
ABSTRACT
Objective: To analyze the perception of nurses in Primary Health Care regarding their professional autonomy in rural and urban municipalities. Methodology: Qualitative, descriptive, and exploratory study derived from the multicenter study Nursing Practices in the Context of Primary Health Care: a national mixed methods study. The participants were 53 nurses from three rural and three urban municipalities in Bahia, Brazil. Data were collected through semi-structured interviews and analyzed using thematic content analysis. Results: Data analysis revealed two thematic categories: the first highlights the area of identification of nurse autonomy, while the second addresses autonomy for prescribing and requesting tests and its limits in in Primary Health Care. Final Thoughts: Nurses perceive their professional autonomy as associated with a specific care group, based on care protocols. In most cases, they do not need another professional to complete the care.
Descargas
Citas
Mrayyan MT, Abu Khait A, Rababa M, Algunmeeyn A, Al‐Rawashdeh S, Al‐Atiyyat N, et al. Professional autonomy in nursing: a concept analysis. SAGE Open [Internet]. 2024 [citado 20 set 2025];14(4). Disponível em: https://doi.org/10.1177/21582440241302129
Tavani FM, Rahmani P, Behshid M, Sheikhalipour Z, Zadi O. Professional autonomy and its relationship with patient safety competency among nurses. JCCNC [Internet]. 2024 [citado 20 set 2025];10(4):297-306. Disponível em: https://doi.org/10.1371/journal.pone.0336430
Melo CMM, Florentino TC, Mascarenhas NB, Macedo KS, Silva MC da, Mascarenhas SN. Professional autonomy of the nurse: some reflections. Esc Anna Nery [Internet]. 2016 [citado 20 set 2025];20(4):e20160085. Disponível em: https://doi.org/10.5935/1414-8145.20160085
Soares SGA, Camponogara S, Vargas MA de O. What is said and unspoken about the autonomy of a nurse: (dis) continuity in discourses. Rev Bras Enferm [Internet]. 2020 [citado 20 set 2025];73(6):e20190401. Disponível em: https://doi.org/10.1590/0034-7167-2019-0401
Geremia DS, Oliveira JS, Vendruscolo C, Souza JB, Santos JL, Paese F. Professional autonomy of nurses in primary health care: perspectives for advanced practice. Enferm Foco [Internet]. 2024 [citado 20 set 2025];15(Supl 1):e-202417SUPL1. Disponível em: https://doi.org/10.21675/2357-707X.2024.v15.e-202417SUPL1
Peacock M, Hernandez S. A concept analysis of nurse practitioner autonomy. J Am Assoc Nurse Pract [Internet]. 2020 [citado 20 set 2025];32(2):113-119. Disponível em: https://doi.org/10.1097/jxx.0000000000000374
Pursio K, Kankkunen P, Kankkunen P, Sanner-Stiehr E, Kvist T. Professional autonomy in nursing: an integrative review. J Nurs Manag. [Internet]. 2021 [citado 20 set 2025];6;29(6):1565–77. Disponível em: https://doi.org/10.1111/jonm.13282
Rouhi-Balasi L, Elahi N, Ebadi A, Jahani S, Hazrati M. Professional autonomy of nurses: a qualitative meta-synthesis study. Iran J Nurs Midwifery Res [Internet]. 2020 [citado 20 set 2025];25(4), 273–281. Disponível em: https://doi.org/10.4103/IJNMR.IJNMR_213_19
Costa RLM, Santos RM, Costa LMC. The professional autonomy of nursing in pandemic times. Rev Gaucha Enferm [Internet]. 2021[citado 20 set 2025];42(esp):e20200404. Disponível em: https://doi.org/10.1590/1983-1447.2021.20200404
Pereira JG, Oliveira MA. Nurses’ autonomy in primary care: from collaborative practices to advanced practice. Acta paul enferm [Internet]. 2018 [citado 20 set 2025];31(6):627-35. Disponível em: https://doi.org/10.1590/1982-0194201800086
Alvarenga J da PO, Sousa MF de. Work and practices of nursing in primary health care in the state of Paraíba – Brazil: professional profile and care practices in the care dimension. Saude debate [Internet]. 2022 [citado 20 set 2025];46(135):1077–92. Disponível em: https://doi.org/10.1590/0103-1104202213509
Silva BG, Silva LA, Silva RM, Leal AS, Filgueiras TF, Carício MR, et al. Interdisciplinary work and working conditions of nurses working in primary health care. Enferm Foco [Internet]. 2024 [citado 20 set 2025];15(Supl 1):e-202413SUPL1. Disponível em: https://doi.org/10.21675/2357-707X.2024.v15.e-202413SUPL1
Batista AP, Cardoso BC, Figueiredo RC. Perception of nurses as to its autonomy in primary health care. Rev Amazônia Science & Health [Internet]. 2020 [citado 10 out 2025];8(1):78-94. Disponível em: https://doi.org/10.18606/2318-1419/amazonia.sci.health.v8n1p78-94
Báfica AC, Gomes AM, Siqueira EF, Souza JM, Paese F, Belaver GM, et al. Comprehensive primary health care: expanding access for strong and resolute nursing. Enferm Foco [Internet]. 2021 [citado 10 out 2025];12(Supl.1):61-6. Disponível em: https://doi.org/10.21675/2357-707X.2021.v12.n7Supl.1.5190
Galvão JJ, Veloso CM, Pinho EC, Do Carmo BA, De Abreu JS, Vilhena FD, et al. Nurses autonomy in the exercise of nursing practices in primary health care. Enferm Foco [Internet]. 2024 [citado 10 out 2025];15(Supl 1):e-202415SUPL1. Disponível em: https://doi.org/10.21675/2357-707X.2024.v15.e-202415SUPL1
Bonatto SR, Steffani P, Lima LA, Silva RM, Machado ML, Mello AL. Nursing protocols in the municipality of jaraguá do sul/sc: transforming strategy for primary care. Enferm Foco [Internet]. 2021 [citado 10 out 2025];12(Supl.1):147-52. Disponível em: https://doi.org/10.21675/2357-707X.2021.v12.n7Supl.1.5173
Araújo MCC, Acioli S, Neto M, Silva HCD de A, Gláucia Bohusch G, Rocha FN da, et al. Nursing protocols in primary health care: instrument for quality of care. Cogitare enferm. [Internet]. 2020 [citado 10 out 2025]; 25 e71281. Disponível em: http://dx.doi.org/10.5380/ce.v25i0.71281.
Nunciaroni AT, Cunha CLF, Borges FA, Souza IL, Koster I, Souza IS, et al. Enfermagem na APS: contribuições, desafios e recomendações para o fortalecimento da Estratégia Saúde da Família. APS [Internet]. 2022 [citado 10 out 2025];4(1):61-80. Disponível em: https://doi.org/10.14295/aps.v4i1.234
Lazarini WS, Doriguetto MA, Busatto LS, Marinho GL, Lachtim SA, Lana FC, et al. A look at autonomy: nurses’ perceptions about their practices in primary care. Enferm Foco [Internet]. 2024 [citado 10 out 2025];15(Supl 1):e-202407SUPL1. Disponível em: https://doi.org/10.21675/2357-707X.2024.v15.e-202407SUPL1
Arruda NM. Maia AG, Alves LC. Inequality in access to health services between urban and rural areas in Brazil: a disaggregation of factors from 1998 to 2008. Cad Saude Publica [Internet]. 2018 [citado 10 out 2025];34(6):e00213816. Disponível em: https://doi.org/10.1590/0102-311X00213816
Fausto MCR, Almeida PF de, Bousquat A, Lima JG, Santos AM dos, Seidl H, et al. Primary health care in remote rural municipalities: context, organization, and access to integral care in the Brazilian National Health System. Saude soc [Internet]. 2023 [citado 20 set 2025];32(1):e220382pt. Disponível em: https://doi.org/10.1590/S0104-12902023220382pt
Lima ARA, González JS, Ruiz MCS, Heck RM. Nursing interfaces in rural care: an integrative review. Texto Contexto Enferm [Internet]. 2020 [citado 20 set 202529:e20180426. Disponível em: https://doi.org/10.1590/1980-265X-TCE-2018-0426
Souza VRS, Marziale MHP, Silva GTR, Nascimento PL. Translation and validation into Brazilian portuguese and assessment of the COREQ checklist. Acta Paul Enferm [Internet]. 2021 [citado 20 set 2025];34:eAPE02631. Disponível em: https://doi.org/10.37689/acta-ape/2021AO02631
Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em saúde. 14 ed. São Paulo: Hucitec; 2014. 24
Machado ALG, Vieira NFC. Use of webQDA software on qualitative nursing research: an experience report. Rev Bras Enferm [Internet]. 2020 [citado 20 set 2025];73(3):e20180411. Disponível em: https://doi.org/10.1590/0034-7167-2018-0411
Santos AM, Giovanella L, Franco CM, Pereira AG, Lima JG, Fausto MCR, et al. Nursing practices in primary care in remote rural municipalities. Cad Saude Publica [Internet]. 2025 [citado 20 set 2025];41(9):e00208124. Disponível em: https://doi.org/10.1590/0102-311XPT208124
Leal JAL, Melo CMM. The nurses’ work process in different countries: an integrative review. Rev Bras Enferm [Internet]. 2018 [citado 20 set 2025];71(2):413-23. Disponível em: http://dx.doi.org/10.1590/0034-7167-2016-0468
Santos EI, Oliveira JGAD, Ramos RS, Silva ACSS, Belém LS, Silva AL. Facilities and difficulties to the professional autonomy of nurses caring for people with wounds: a study of social representations. ESTIMA [Internet]. 2017 [citado 20 set 2025];15(1):3-9. Disponível em: https://doi.org/10.5327/Z1806-3144201700010002
Silva AV, Vieira LJES, Sousa AR. Ethical and legal aspects of medication prescription by nurses in the National Primary Care Policy of Brazil. REVISA [Internet]. 2020 [citado 20 set 2025];9(2): 222-30. Disponível em: https://doi.org/10.36239/revisa.v9.n2.p222a230
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2026 Priscila Araujo Rocha, Tatiane Araújo dos Santos, Daniela Gomes dos Santos Biscarde
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
