Development and validation of a professional autonomy scale for Japanese midwives.

Japanese midwives are required to autonomously perform midwifery diagnosis and maternity care. However, education to promote the professional autonomy of midwives is inadequate, and previous studies have not been able to identify a measure for it. This study aimed to develop a professional autonomy scale for midwives, to be used for the education and career advancement of Japanese midwives. The Midwives Professional Autonomy Scale extracted items from the midwives' "autonomy" and "specialty" literature, and 10 professionals verified the surface and content validity of the scale. Overall, 695 Japanese midwives participated in a survey, of which a sample of 399 was recovered. Exploratory factor analysis was performed using the sample to confirm the validity of the construct and internal consistency of the scale (Cronbach's alpha value 0.95). Additionally, the validity of the criteria was confirmed using the self-efficacy scale, self-esteem scale, and job satisfaction, and the stability was confirmed by test-retest reliability. Consequently, the professional autonomy scale for Japanese midwives comprised 24 items and 5 factors. This scale can thus be used to evaluate the professional autonomy of Japanese midwives and for midwifery education.

Professional autonomy in dealing with complications: discourse of obstetric nurses working in planned home births.

OBJECTIVE: to understand the exercise of professional autonomy by obstetric nurses in dealing with complications in planned home births. METHODS: this is a qualitative study, supported by the Discourse of the Collective Subject methodological framework, whose data collection took place from January to March 2021, through interviews guided by a semi-structured script, in which seven midwives who are members of a childbirth care collective in northeastern Brazil and who work in the home context participated. RESULTS: four central ideas emerged from the collective discourses related to the exercise of professional autonomy by obstetric nurses: shared decisions; theoretical-practical instrumentalization; professional expertise; and teamwork. FINAL CONSIDERATIONS: obstetric nurses' autonomy in the face of complications reflects the safety of planned home births and is based on collective critical thinking, reinforcing this professional' leading role in obstetrics.

Processos de reflexividade dos psicólogos do esporte e coaches: um estudo fenomenológico / Reflexivity processes of sport psychologists and coaches: a phenomenological study / Procesos de reflexividad de psicólogos del deporte y coaches: un estudio fenomenológico

O objetivo desta pesquisa é identificar e compreender fenomenologicamente, por meio de relato de Psicólogos de Esporte (PE) e de Coaches, em sua vivência prática, como ocorrem os processos reflexivos em sua atuação, conforme apreendidos a partir de relatos de experiências. O método de investigação escolhido foi a fenomenologia, pois oferece os recursos necessários para tal mergulho junto à experiência reflexiva. A amostra intencional foi delineada por PE e Coaches (profissionais de Educação Física que recorrem ao Coaching) em atividade em esportes de alto rendimento, que tenham atuado ou estejam atuando em modalidades esportivas coletivas e/ou individuais. Realizaram-se nove entrevistas (cinco com PE, quatro com Coaches). O acesso ao objeto desse estudo se deu por meio de entrevistas em profundidade e semiestruturadas, orientadas pela escuta suspensiva. As questões disparadoras foram formuladas com base no Procedimento Estruturado de Reflexão adaptado. Para análise das entrevistas, realizou-se uma síntese de cada relato, seguindo-se de cruzamento intencional. Como resultados, percebeu-se que PE e Coaches trazem algumas similaridades no que se refere aos modos de refletir sobre sua prática. No entanto, as experiências que eles fazem desses processos reflexivos é que podem tomar rumos distintos. Os(as) PE amparam-se na regulamentação da profissão e resguardam-se em seus apontamentos, trazendo suas experiências e reflexões sobre os processos vividos. Os(as) Coaches trazem em suas explanações um trabalho coerente, organizado e compatível com o método do Coaching. Problematizar os processos reflexivos desses profissionais permite diferenciar qualitativa e eticamente suas atuações, possibilitando o fomento multiprofissional no esporte.(AU)

The aim of this study consists in phenomenologically identifying and understanding, by the report of Sport Psychologists (SP) and coaches, in their practical experience, how would be the reflexive processes that take place in their performance, as learned from reports of their experiences. The research method chosen was phenomenology, since it offers the necessary resources for such a dive along with the reflective experience. The intentional sample was outlined by SP and coaches (Physical Education professionals who use coaching) active in high performance sports, who have or are working in collective and/or individual sports. Nine interviews were conducted (five with SP, four with coaches). Access to the object of this study took place by in-depth and semi-structured interviews, guided by suspensive listening. The triggering questions were formulated based on the adapted Structured Reflection Procedure. For the analysis of the interviews, a synthesis of each report was carried out, followed by the intentional crossing. As results, it was noticed that SP and coaches bring some similarities regarding the ways of reflecting on their practice. However, their experiences of these reflective processes are that they can take different directions. The SP are based on the regulation of the profession and guard themselves in their notes, bringing their experiences and reflections on the processes experienced. Coaches bring in their explanations a coherent, organized, and compatible work with the coaching method. Problematizing the reflective processes of these professionals allows to differentiate their actuation qualitatively and ethically, making the multiprofessional phenomenon in sport possible.(AU)

El objetivo de este estudio consiste en identificar y comprender fenomenológicamente, a partir de la experiencia práctica de psicólogos del deporte (PD) y coaches, cómo serían los procesos reflexivos que se llevan a cabo en su rendimiento, tal y como se desprende de los informes de experiencias. El método de investigación elegido fue la fenomenología, ya que ofrece los recursos necesarios junto con la experiencia. La muestra intencional fue delineada por PD y coaches (profesionales de la educación física que utilizan el coaching) activos en deportes de alto rendimiento, que tienen o están trabajando en deportes colectivos e/o individuales. Se realizaron nueve entrevistas (cinco con PD, cuatro con coaches). El acceso al objeto de este estudio fue entrevistas en profundidad y semiestructuradas, guiadas por escuchas suspensivas. Las preguntas se formularon desde el procedimiento de reflexión estructurado adaptado. Para el análisis de las entrevistas, se hizo una síntesis de cada informe, seguida del cruce intencional. Como resultados, se notó que los PD y coaches tienen algunas similitudes con respecto a las formas de reflexionar sobre su práctica. Sin embargo, las experiencias que hacen de estos procesos pueden tomar diferentes direcciones. Los(las) PD se basan en la regulación de la profesión y se protegen en sus notas, aportando sus experiencias y reflexiones sobre los procesos vividos. Los(las) coaches plantean en sus explicaciones un trabajo coherente, organizado y compatible con el método de Coaching. Problematizar los procesos reflexivos de estos profesionales permite diferenciar sus acciones de manera cualitativa y ética, además de posibilitar la promoción multiprofesional en el deporte.(AU)

Threat to Professional Autonomy and Physicians' Intention to Use Acupuncture: A Study From Malaysia.

Despite its popularity, registered medical practitioners (RMPs) are reluctant to use acupuncture in their practice. The aim of this study is to determine the impact of Threat to Professional Autonomy (TPA) on RMPs' intention to use acupuncture in Malaysia. A cross sectional study was conducted using an online survey form. The survey was distributed to 250 registered medical practitioners who are affiliated with the Malaysian Medical Association. The questionnaire followed a modified technology acceptance theoretical framework including the three main constructs of ease of use, usefulness and intention to use with addition of TPA as a predictor of physician intention. Structural equation modeling (SEM) was utilized to test the relationship between the 4 constructs. Measurement model, discriminant validity and path analysis statistics were presented. Two hundred and seventeen returned the completed questionnaire yielding a response rate of 86.8%. In the measurement model, all items within each construct were highly correlated. The minimum average variance extracted (AVE) was 0.741. All constructs achieved a minimum of 0.896 reliability estimates. Discriminant validity was ascertained with the findings that the square root of AVE is larger than the correlation between each two constructs. TPA has a significant negative impact on ease of use (p < 0.001) and perceived usefulness (p = 0.002). There was no significant direct effect of TPA on intention (p = 0.0561). Fit indices showed adequate fit. In conclusion, TPA affects the intention to use acupuncture indirectly through its negative effect on perceived ease of use and perceived usefulness of acupuncture.

Desafios de enfermeiras obstétricas na assistência ao parto e nascimento: estudo descritivo e exploratório / Challenges of midwives in labor and birth care: a descriptive and exploratory study

OBJETIVO: identificar e analisar os desafios apresentados por enfermeiras obstétricas, quanto à inserção na assistência ao parto e nascimento. MÉTODO: estudo descritivo, exploratório, abordagem qualitativa, com realização de três grupos focais com 16 enfermeiras obstétricas do curso de aprimoramento, entre agosto e novembro de 2019. Os depoimentos foram gravados e submetidos à análise de conteúdo na modalidade temática. RESULTADOS: destacaram-se como desafios das enfermeiras obstétricas a demanda de trabalho e a sobrecarga com atividades burocráticas; os conflitos com a equipe de saúde na assistência compartilhada; o processo de autonomia limitada da enfermeira obstétrica; e a intensa necessidade de validar a própria competência técnica diante da equipe de saúde. CONCLUSÃO: ampliar os processos de trabalho e a gestão em saúde compartilhada em equipe interprofissional, alinhados às evidências científicas, favorece o aprimoramento de saberes e o diálogo coletivo.

OBJECTIVE: to identify and analyze the challenges faced by obstetric nurses regarding their insertion in labor and birth care. METHOD: descriptive exploratory study, with a qualitative approach, involving three focus groups with 16 nurse midwives from an improvement training, held between August and November 2019. The statements were recorded and submitted to a content analysis in the thematic modality. RESULTS: the main activities that stood out as challenges faced by obstetric nurses were the work demand, the overload of bureaucratic activities, conflicts with the health team in shared care, the process of limited autonomy of the obstetric nurse, and the intense need to validate one's own technical competence before the health team. CONCLUSION: expanding work processes and shared health management in an interprofessional team, in line with scientific evidence, favors the improvement of knowledge and collective dialogue.

Midwife experiences of providing continuity of carer: A qualitative systematic review.

PROBLEM: Continuity of carer models present positives and challenges for midwives working in them, and are difficult to sustain. BACKGROUND: Research shows midwifery continuity of carer improves perinatal outcomes and experiences, and is considered the optimal model of care. AIM: To synthesise existing research on midwives' experiences of providing continuity of carer and generate further understanding of what sustains them in practice. METHODS: Protocol for the review was developed using PRISMA guidelines and registered with PROSPERO. 22 studies were included with original themes and findings extracted using JBI tools and synthesised using meta-ethnographic techniques. GRADE CERQual assessment of review findings showed high confidence. FINDINGS: Midwives identified working in continuity of carer models as both fulfilling and challenging. Professional autonomy and ability to develop meaningful relationships were the most commonly cited positives, while lack of work life balance and conflict with the wider maternity team were the main challenges. 15 studies identified strategies employed by midwives which sustained them in practice. DISCUSSION: Midwife experiences of providing continuity are impacted by personal and professional factors. Of paramount importance to sustainability of the model is the support of the wider organisation, and their alignment with principles of person-centred, relational care. CONCLUSION: Relational models of care are desired by midwives, service users and are recommended in policy. Relational models of care must be responsive to midwives needs as well as birthing people, and therefore need to be designed and managed by those working in them and supported by the whole organisation to be sustainable.

Job satisfaction and sustainability of midwives working in caseload models of care: An integrative literature review.

BACKGROUND: Demand for caseload midwifery care continues to outstrip supply. We know little about what sustains midwives working in caseload models of care. AIM: This review systematically identifies and synthesises research findings reporting on factors which contribute to job satisfaction, and therefore the sustainability of practice, of midwives working in caseload models of care. METHODS: A comprehensive search strategy explored the electronic databases CINAHL Plus with Full Text, MEDLINE, PubMED, Cochrane Database of Systematic Reviews, and Scopus. Articles were assessed using the Crowe Critical Appraisal Tool. Data analysis and synthesis of these publications were conducted using a narrative synthesis approach. FINDINGS: Twenty-two articles were reviewed. Factors which contribute to the job satisfaction and sustainability of practice of midwives working in caseload models are: the ability to build relationships with women; flexibility and control over own working arrangements; professional autonomy and identity; and, organisational and practice arrangements. CONCLUSION: Insights into the factors which contribute to the job satisfaction and sustainability of practice of midwives in caseload models of care enables both midwives and healthcare administrators to more effectively implement and support midwifery-led caseload models of care which have been shown to improve outcomes for childbearing women.

The state of professionalisation of midwifery in Belgium: A discussion paper.

AIM: To describe the state of the professionalisation of midwifery in Belgium, and to formulate recommendations for advancing the midwifery profession. METHODS: A descriptive overview of maternity care in Belgium and the professionalisation of midwifery through an analysis of relevant policy and academic texts, underpinned by Greenwood's sociological criteria for a profession: (1) own body of knowledge, (2) recognised authority, (3) broader community sanctions, (4) own code of ethics and (5) professional culture sustained by formal professional associations. From these insights, recommendations for advancing the midwifery profession in Belgium are formulated. FINDINGS: Current strengths of the professionalisation of midwifery in Belgium included unified midwifery education programmes, progress in midwifery research and overarching national documents for guiding midwifery education, practice and regulation. In contrast however challenges, such as the limited recognition of midwives' roles by its clientele, limitations of midwives' competencies and autonomy, lacking development of advanced roles in maternity care practice and a lack of unity of the organisation and its members, were also identified. Based on these, recommendations are made to strengthen Belgian midwifery. CONCLUSIONS: Recommendations for advancing the midwifery profession in Belgium includes in particular increasing public awareness of midwives' roles and competencies, implementing the full scope of midwifery practice and monitoring and advancing this practice. Thus, professional autonomy over both midwifery practice and working conditions should be enhanced. United midwifery organisations, together with women's groups, other maternity care professionals and policy-makers as equal partners are key to bring about changes in the Belgian maternity care landscape.

Midwifery Job Autonomy in New Zealand: I do it all the time.

INTRODUCTION: This research aimed to identify what supports and what hinders job autonomy for midwives in New Zealand. METHODS: Registered midwives participated in an open-ended, online survey in 2019. Anonymised participants were asked to describe an incident when they felt they were using their professional judgement and/or initiative to make decisions and the resultant actions. The data was analysed thematically. FINDINGS: The participants identified that autonomy is embedded within midwifery practice in New Zealand. Self-employed midwives who provide continuity of care as Lead Maternity Carers, identified they practice autonomously 'all the time'. The relationship with women and their family, and informed decision making, motivated the midwife to advocate for the woman - regardless of the midwife's work setting. Midwifery expertise, skills, and knowledge were intrinsic to autonomy. Collegial relationships could support or hinder the midwives' autonomy while a negative hospital work culture could hinder job autonomy. DISCUSSION: Midwives identified that autonomous practice is embedded in their day to day work. It strengthens and is strengthened by their relationships with the woman/whanau and when their body of knowledge is acknowledged by their colleagues. Job autonomy was described when midwifery decisions were challenged by health professionals in hospital settings and these challenges could be viewed as obstructing job autonomy. CONCLUSION: The high job autonomy that New Zealand midwives enjoy is supported by their expertise, the women and colleagues that understand and respect their scope of practice. When their autonomy is hindered by institutional culture and professional differences provision of woman-centred care can suffer.

Processo de Enfermagem como potencializador da prática da acupuntura / Proceso de Enfermería como potencializador de la práctica de acupuntura / Nursing Process as a potentializer of acupuncture practice

Resumo Objetivo Analisar a utilização do Processo de Enfermagem na prática da acupuntura, no período de 1997 a 2015. Método Qualitativo, com abordagem Histórico-Social, por meio da história oral temática aplicada a 20 enfermeiras especialistas em acupuntura, fundamentado na Sociologia das Profissões, de Eliot Freidson. Da análise temática, construíram-se duas categorias: Processo de Enfermagem como organizador da prática da acupuntura; e Desconhecimento da importância do Processo de Enfermagem na prática da acupuntura. Resultados A aplicação do Processo de Enfermagem na consulta de enfermagem, com foco na prática da acupuntura como cuidado e tratamento, possibilita uma atuação diferenciada, maior compreensão e reconhecimento diagnóstico, escolha mais adequada de técnicas favoráveis à qualidade e o bem-estar dos usuários, além de consolidar a sua utilização como prática especializada. Considerações finais O Processo de Enfermagem possibilita um avanço tecnológico aplicado na consulta de enfermagem, ao se implementar a acupuntura como tratamento e reabilitação, colaborando na evolução e prognóstico no atendimento, e uma estratégia facilitadora para a enfermeira acupunturista junto ao cliente.

Resumen Objetivo Analizar el uso del Proceso de Enfermería en la práctica de la acupuntura de 1997 a 2015. Método Cualitativo con abordaje Histórico-Social, a través de la historia oral temática aplicada a 20 enfermeras especializadas en Acupuntura, basado en la sociología de las profesiones de Eliot. Freidson. A partir del análisis temático se construyeron dos categorías: Proceso de Enfermería como organizador de la práctica de la acupuntura; y desconocimiento de la importancia del Proceso de Enfermería en la práctica de la acupuntura. Resultados La aplicación del Proceso de Enfermería en la consulta de enfermería con un enfoque en la práctica de la acupuntura como cuidado y tratamiento, posibilita un desempeño diferenciado, mayor comprensión y reconocimiento diagnóstico, elección más adecuada de técnicas que favorezcan la calidad y el bienestar de los usuarios, además de consolidar su uso como práctica especializada. Consideraciones finales El proceso de Enfermería permite un avance tecnológico aplicado en la consulta de enfermería con la implementación de la acupuntura como tratamiento y rehabilitación, colaborando en la evolución y pronóstico en el cuidado y una estrategia facilitadora para la Enfermera Acupunturista con el cliente.

Abstract Objective To analyze the use of the Nursing Process in the practice of acupuncture, from 1997 to 2015. Method A qualitative, with a Social-Historical approach, through thematic oral history applied to 20 nurses specialized in acupuncture, based on Eliot Freidson's Sociology of Professions. From the thematic analysis, two categories were constructed: Nursing Process as an organizer of acupuncture practice; and Unawareness of the importance of the Nursing Process in acupuncture practice. Results The application of the Nursing Process in the nursing consultation, focusing on the practice of acupuncture as care and treatment, enables a differentiated performance, greater understanding and diagnostic recognition, more appropriate choice of techniques favorable to the quality and well-being of users, and consolidates its use as a specialized practice. Final Considerations The Nursing Process enables a technological advance applied in the nursing consultation, when implementing acupuncture as treatment and rehabilitation, collaborating in the evolution and prognosis in the care, and a facilitating strategy for the acupuncturist nurse with the client.

Selecting Treatment Options and Choosing Between them: Delineating Patient and Professional Autonomy in Shared Decision-Making.

Professional control in the selection of treatment options for patients is changing. In light of social and legal developments emphasising patient choice and autonomy, and restricting medical paternalism and judicial deference, this article examines how far patients and families can demand NHS treatment in England and Wales. It considers situations where the patient is an adult with capacity, an adult lacking capacity and a child. In all three cases, there is judicial support for professional autonomy, but there are also inconsistencies that have potential to elevate the importance of patient and family preferences. In combination, they may be perceived by healthcare professionals as an obligation to follow patient preferences, even where doing so conflicts with other professional obligations. It is argued that a more nuanced approach to shared decision-making could help clarify the boundaries of decision-making responsibility.

Acceptability of delivering an adapted Buurtzorg model in the Scottish care context.

OBJECTIVES: Given increasing epidemiological and financial pressures on services, there is a need to test new models of integrated health and social care. Crucial to this testing is determining acceptability, particularly to those delivering services. The Dutch 'Buurtzorg' model, characterised by self-managing nursing teams, has shown promise, but its principles are yet to be adapted and tested in Scotland. The study aim was to understand the experiences of working in a self-managing, integrated, health and social care team. STUDY DESIGN: This is a case study within a primary care setting. METHODS: The Integrated Neighbourhood Care Aberdeen (INCA) project comprised two self-managing teams of support workers and nurses working at different sites in Aberdeen. Acceptability was explored through semistructured interviews with staff. Data were recorded and analysed thematically. RESULTS: Staff reported high-quality patient care, which they attributed to autonomy over the frequency and duration of visits. Tensions between team members and between teams and management were apparent partly due to the predominantly social care caseload, confounding guidance on how to implement self-management and communication challenges. The team colocated within a General Practice reported positive relationships with other professionals. CONCLUSIONS: Self-management requires a clear framework in which to function. Allowing staff autonomy to vary care provision according to need may improve patient outcomes.

Medical care in unlicensed combat sports: A need for standardised regulatory frameworks.

OBJECTIVES: To explore the provision of medical care at 'unlicensed', full-contact amateur and lower-level professional combat sports competitions in England. DESIGN: Qualitative, mixed methods. METHODS: Observations totalling 200h of fieldwork shadowing medical professionals at 27 individual combat sports events, alongside formal, semi-structured interviews with 25 medical professionals, 7 referees and 9 promoters/event staff. RESULTS: Practices and standards vary widely. Event organisers and promoters often have very little understanding of how different types of medical practitioners operate. They rarely, if ever, check that the staff they are hiring are qualified, sometimes resulting in unqualified staff being used to provide medical cover at events. Venues are often poorly equipped to accommodate basic medical procedures. Patient confidentiality is very often compromised. Medical professionals often have limited autonomy within the combat sports milieu and may find themselves marginalised, with their judgements overruled by non-medical staff during competitive events. Some practitioners are cognisant of the dangers such working environments pose to their professional reputations and livelihoods, but remain working within combat sports regardless. CONCLUSIONS: Despite pockets of good practice, the lack of standardised rules for medical care provision creates substantial risks to athletes, to practitioners and the standing of the profession. The development and implementation of standardised, enforceable regulatory frameworks for full-contact combat sports in England is urgently needed.

Parens Patriae and Parental Rights: When Should the State Override Parental Medical Decisions?

Alfie Evans was a terminally ill British child whose parents, clinging to hope, were desperately trying to save his life. Hospital authorities disagreed and petitioned the court to enjoin the parents from removing him and taking him elsewhere for treatment. The court stepped in and compelled the hospital to discontinue life support and claimed that further treatment was not in the child's best interest. This note discusses the heartbreaking stories of Alfie and two other children whose parents' medical decisions on their behalf were overridden by the court. It argues that courts should never decide that death is in a child's best interest and compel parents to withdraw life support from their children. Such a decision is outside the scope of the judiciary. Furthermore, it argues that even in those instances when the court may or must intervene, a new framework is necessary because the current framework used by the court to determine the best interest of the child ignores fundamental realities of child psychology. Too often, as a result of the court's mistaken framework, the court illegitimately trespasses into the parental domain. By adopting a new framework, the court will intervene only when actual abuse or neglect is suspected. In all other cases, judicial restraint will be practiced and the court will show greater deference to the parents' wishes.

Ethical challenges of integration across primary and secondary care: a qualitative and normative analysis.

BACKGROUND: This paper explores ethical concerns arising in healthcare integration. We argue that integration is necessary imperative for meeting contemporary and future healthcare challenges, a far stronger evidence base for the conditions of its effectiveness is required. In particular, given the increasing emphasis at the policy level for the entire healthcare infrastructure to become better integrated, our analysis of the ethical challenges that follow from the logic of integration itself is timely and important and has hitherto received insufficient attention. METHODS: We evaluated an educational intervention which aims to improve child health outcomes by making transitions between primary to secondary care more efficient, ensuring children and parents are better supported throughout. The programme provided skills for trainee paediatricians and general practitioners (GPs) in co-designing integrated clinical services. RESULTS: The key ethical challenges of integrated care that arose from a clinical perspective are: professional identity and autonomy in an integrated working environment; the concomitant extent of professional responsibility in such an environment; and the urgent need for more evidence to be produced on which strategies for integrating at scale can be based. CONCLUSIONS: From our analysis we suggest a tentative way forward, viewed from a normative position broadly situated at the intersection of deontology and care ethics. We adopt this position because the primary clinical ethical issues in the context of integrated care concern: how to ensure that all duties of care to individual patients are met in a newly orientated working environment where clinical responsibility may be ambiguous; and the need to orientate care around the patient by foregrounding their autonomous preferences and ensuring good patient clinician relationships in clinical decision-making.

Percepção de enfermeiras obstetras sobre o modelo e prática assistencial em uma maternidade filantrópica / Perception of obstetric nurses on the care model and practice in a philanthropic maternity hospital / Percepción de enfermeras obstétricas sobre el modelo de atención y práctica en una maternidad filantrópica

Objetivo: conhecer a percepção de enfermeiras obstetras sobre o modelo e prática assistencial em uma maternidade filantrópica. Método: estudo qualitativo com 13 enfermeiras obstetras que trabalham em uma maternidade mineira, coleta de dados de setembro de 2015 a fevereiro de 2016 por meio de entrevista semiestruturada, utilizando-se Análise de Conteúdo. Resultados: emergiram como categorias: Atuação pautada na humanização e nas boas práticas; Autonomia para atuar; Profissional de referência para tomada de decisões; Atuação em equipe e Modelo de atuação. Discussão: verificou-se que as enfermeiras atuam com autonomia em equipe, não nomeiam um modelo de assistência e apontam a demanda de serviço e o modelo tecnocrático como dificultadores. Considerações finais: apoio e suporte dos gestores são importantes para a atuação das profissionais, contribuindo para um trabalho autônomo. Apesar dos avanços, ainda há desafios a serem superados tanto no âmbito da equipe e comunicação, quanto do suporte dos gestores.

Objective: to identify the perception of obstetric nurses about the healthcare model and practice in a philanthropic maternity hospital. Method: qualitative study of 13 obstetric nurses working in a Minas Gerais maternity hospital. Researchers used semi-structured interviews for data collection which took place from September 2015 to February 2016. Data analysis used content analysis. Results: the following categories emerged: Performance based on humanization and good practices; Professional autonomy; Professional mentoring during decision making; Teamwork and Performance Model. Discussion: research revealed that nurses are autonomous and work as a team; they did not single out a healthcare model and identified work demand and technocratic model as obstacles. Final considerations: management support is important for the professionals' performance since it contributes to autonomy at work. Despite the progress made, there are still challenges both in terms of staff and communication, as well as management support

Objetivo: conocer la percepción de las enfermeras obstétricas sobre la práctica y el modelo de atención en una maternidad de beneficencia. Método: estudio cualitativo con 13 enfermeras obstétricas de una maternidad de Minas Gerais; los datos, recogidos de septiembre de 2015 a febrero de 2016 en entrevistas semiestructuradas, se analizaron según el análisis de contenido. Resultados: se identificaron las siguientes categorías: Desempeño basado en la humanización y en las buenas prácticas; Autonomía para trabajar; Coaching para la toma de decisiones; Trabajo en equipo y Modelo de desempeño. Discusión: las enfermeras actúan con autonomía, en equipo, no mencionaron ningún modelo de atención; la demanda de servicios y el modelo tecnocrático representaban obstáculos. Consideraciones finales: el respaldo de la gerencia es fundamental para el desempeño profesional y contribuye a que se trabaje con autonomía. Aún hay retos por superar, tanto a nivel de equipos y comunicación como de respaldo de la gerencia.

Autonomy for obstetric nurse on low-risk childbirth care / Autonomia do enfermeiro obstetra na assistência ao parto de risco habitual

Abstract Objectives: to understand the cultural context presented in hospitals and its relation to the obstetric nurse's autonomous practice on low-risk childbirth care. Methods: ethnographic research performed in three public maternities in Rio Grande do Norte, Brazil. Three managers and twenty-three obstetric nurses participated in this research. Results: distinctive on cultural, organizational and structural aspects of the hospital institution interfering directly with the obstetric nurse's autonomous practice. Among these aspects, professional appreciation on low-risk childbirth care contributes for the nurse's autonomy Conclusions: it was noticed that obstetric nurses undergo different contexts of action, which directly interfere with their autonomy on low-risk childbirth care and their decisionmaking abilities. It is necessary, then, to eradicate the relation of dominance and submission that it is still imposed by medical hegemony.

Resumo Objetivos: compreender o contexto cultural da instituição hospitalar e sua relação com a prática autônoma do enfermeiro obstetra na assistência ao parto de risco habitual. Métodos: pesquisa etnográfica desenvolvida em três maternidades públicas do Estado do Rio Grande do Norte, Brasil, com três gestores e 23 enfermeiros obstetras. Resultados: diferentes aspectos de ordem cultural, organizacional e estrutural da instituição hospitalar interferem diretamente na prática autônoma do enfermeiro obstetra. Dentre estes aspectos, a valorização profissional na assistência ao parto de risco habitual contribui para a autonomia do profissional em questão. Conclusões: constatou-se que o enfermeiro obstetra vivencia distintos contextos de atuação, os quais interferem diretamente na sua autonomia na assistência ao parto de risco habitual e no seu poder de decisão. Faz-se necessário, então, desvencilhar-se das relações de domínio e submissão, ainda impostas pela hegemonia médica.