Práticas de enfermeiras no âmbito da Atenção Primária à Saúde na Bahia

Abstract

Introduction: Health practices are activities shaped by the relationships between individuals and social structures. In Public Health, they encompass actions that must be understood within the contexts in which they occur. Nursing, the largest workforce in Brazil’s Unified Health System (SUS), operates in a diverse and unequal national territory. In Bahia, regional particularities directly influence nurses’ practices in Primary Health Care (PHC), making it essential to map and analyze these actions to support policies and address local needs. Objective: To analyze the practices developed by PHC nurses in different socio-spatial contexts in Bahia. Method: This is a mixed-methods study, conducted as part of a nationwide multicenter investigation. Quantitative data were collected between November 2019 and August 2021, while qualitative data were gathered from November 2020 to April 2021. For the qualitative component, 12 municipalities in Bahia were selected, involving 60 professionals, with data collected through semi-structured interviews. For the quantitative component, the sample included 498 professionals, with data collected via a web survey. As an analytical strategy, a matrix was constructed considering five dimensions: actors, modes of organization and operation, health care, and outcomes. Results: Findings show that, in both contexts, nurses play a central role in PHC teams, and that other actors influence their practices, impacting the quality of care as political and community agents, particularly in rural contexts. Although organizational modes prioritize the community, they follow a bureaucratic-normative model, and in rural areas, a clientelistic model remains common. Regarding health care, nurses perform a broad scope of practices and accumulate both care and managerial functions, which contribute to work overload and dissatisfaction with professional recognition, with no significant variations across different socio-spatial contexts. While the relevance of their practices is recognized, working conditions are insufficient given the contexts in which they operate. Final Considerations: The study deepened the understanding of nurses’ practices, highlighting challenges, opportunities, and the influence of a variety of historical and contemporary determinants in the socio-spatial contexts analyzed. It is considered necessary to carry out a comprehensive reflection on the work process of primary health care nurses in Bahia, taking into account the conditions and interferences that shape their practices, the challenges they face, and the impacts of their work on public health.