A formação do enfermeiro e a ampliação do escopo de prática na Atenção Básica no Brasil.

Abstract

The expansion of Primary Health Care (PHC) in Brazil has been restricted due to the scarcity and poor distribution of physicians, especially in less developed regions. As one of the strategies for coping with this scenario, we are studying the implementation of the PHC advanced practice nurse (APN), such as international experiences that provide evidence that the incorporation of medical practices by nurses results in equivalent or more effective qualified care, compared to those undertaken by doctors. This implementation should be preceded by a diagnosis of nurses' training in order to identify their adherence to the needs of the Unified Health System (UHS) and to evaluate whether the competencies that result from it are sufficient for advanced nursing practice. This study tried to prove the thesis that the training of nurses, at the undergraduate level, does not allow the extension of its scope of practice in PHC, through the incorporation of medical activities. For this, national exploratory research was developed between December 2015 and September 2016, through a survey (n=94) and in-depth interviews (n=16) with course coordinators, and documental analysis of pedagogical projects. Quantitative data was analyzed statistically and qualitative data was submitted to content analysis. Next, they were confronted with the National Curricular Guidelines (NCG) for undergraduate nursing courses and were discussed in the perspective of international experiences and the demands of PHC. There were pedagogical projects that showed adherence to the NCG and the needs of the UHS; however, the statements indicate institutional fragilities that make it difficult to materialize what is proposed. There were profiles of varied graduates, with a higher tendency towards basic or hospital health practices, with competencies for a fragmented health care, but they were strong for the development of actions of promotion, prevention, management and nursing techniques. From the procedural point of view of the training, the bachelor nurses can promote the advanced practices of nursing. From the point of view of the acquisition of competencies for these practices, there is limited potential for the development of actions understood as medical, especially prescription drugs. However, it is necessary to consider the legislative fragilities that govern and define the fields of action of health professionals, who acted as an intervening factor in the coordinators' response pattern. The fact is that, once the comparison of the PHC assignments of APN at the international level is established, and considering the NCGs and the legislation that governs the scope of the profession, the nursing graduates are able to develop a large part of the actions demanded by the PHC. It is necessary, however, to define the APN model to be adopted, to then identify if the competences developed in the undergraduate course are compatible.