Prática avançada de enfermagem norte-americana: subsídios para reflexões da implementação no contexto obstétrico brasileiro

Abstract

This article aims to analyze Advanced Practice Nursing (APN), in particular the roles of Certified Nurse-Midwives and Nurse Practitioners, in the United States of America, in order to subsidise a reflection on the implementation process of this practice in the Brazilian obstetric context. This is a qualitative research, carried out over two stages. The first stage was a case study; and the second involved reflection study about the implementation processe of advanced practice in the Brazilian context, based on the PEPPA framework. The questions that guided the case study were: How the understanding of Advanced Practice Nursing, especially Certified Nurse-Midwives (CNMs) / Nurse Practitioners (NPs), in the United States of America (USA) can help the implementation process of this practice in Brazil? The research was based on the following assumptions: (a) Advanced Practice Nursing in United States of America allows nurses to have an autonomous and recognized practice, within an expanded scope of practice, that includes advanced clinical evaluation skills, diagnosis and treatment, in order to meet the health needs of a large part of the population; (b) Understanding the context of Advanced Nursing Practice in United States of America helps to identify the aspects of the Brazilian reality that need to be modified or encouraged to support an implementation proposal of this practice in Brazil. The unit of analysis was the practice of Certified Nurse-Midwives and Nurse Practitioners in New York, in United States of America. The reasoning that links the data to the assumptions is based on the relevant literature. The data were collected through a literature review; non-participant observation in a large hospital in New York State (USA); and interview with six Certified Nurse-Midwives / Nurse Practitioners. Throughout the interpretation of the findings, the method of analysis of responsive interviews was used, which is described in two phases: preparation of the transcripts, based on identifying the concepts, themes and events, with subsequent codification of this data; and, the construction of the narrative, which culminates in theorization. The data were examined through the lens of complexity theory and a context analysis framework, which is examined over four levels: the immediate, specific, general context and the metacontext. From this analysis, it was possible to clearly understand the elementary activities of the APN practice; how this practice can be defined and what differentiates it from the other health professions practice, especially physicians and registered nurses; and how these APNs are inserted within the the health system. The understanding of this practice supported the second stage of this study, the reflection about the implementation of Advanced Practice Obstetric Nursing in the Brazilian reality from using PEPPA framework. The reflection was directed from the principles of complexity theory. The results obtained demonstrate that the North American context can provide the necessary clarity to understand the functions of APN. Combining this understanding with the specific needs described in the Brazilian context, Advanced Practice Nursing can become a valid reality to the desired improvements in maternal and child health.