Percepção dos profissionais de enfermagem e gestores de uma maternidade de alto risco de Manaus sobre violência institucional

Abstract

Introduction: Introduction: Institutional violence is a phenomenon that compromises the quality of care and violates women's rights during labor and birth. In the hospital context, the perception of nursing professionals and managers is fundamental to understanding how these practices develop and perpetuate. During the pregnancy-puerperal period, this violence becomes even more impactful, harming women's health and well-being and subverting the right to respectful and humanized care. Objective: To understand the perception of nursing professionals and managers regarding institutional violence in a high-risk maternity hospital in Manaus, Amazonas. Method: This is qualitative, exploratory and descriptive research. The target population of this study was made up of nursing professionals and managers. Data collection took place between January and February 2025, in a high-risk maternity hospital, a reference in humanized care for pregnant women, women in labor, postpartum women and newborns. Data were collected using two printed instruments, which contained variables to characterize the sociodemographic and professional profile of nursing professionals and managers. In addition to a semi-structured script that sought to investigate professional experiences regarding the object of the study. The interviews were recorded in audio using an electronic device with an average duration of 18 minutes. They were later transcribed in full, analyzed and interpreted according to the content analysis technique, proposed by Bardin, to assist in the analysis of the interviews. The results were analyzed in two different files in the IRaMuTeq software, one referring to managers and the other to nursing professionals, using the techniques of similarity analysis and descending hierarchical classification. Results: 17 professionals participated in the study, of which 4 were managers. The sector with the highest number of participants was pre-delivery, childbirth and post-partum with 7 professionals (53.8%), followed by the obstetric surgical center, with 6 (46.2%). The similarity analysis for the group of managers identified three main nuclei: patient, speaking and professional. For nursing professionals, the similarity analysis highlighted connections between terms such as patient, professional, doctor, and obstetric violence, which corroborates the perception that care practices are linked to situations of violence. In the CHD analysis, the textual corpus of nursing professionals and managers showed a success rate of more than 80%. From the dendrogram generated by CHD, it was possible to divide into thematic categories according to the interpretation of the words grouped in the classes and elementary context units. For managers, the following categories emerged: 1. Management, Infrastructure and Organizational Challenges; 2. Communication, Coordination and Institutional Violence; 3. Patient Care and Service Practices. For nursing professionals, the following categories resulted: 1. Clinical Practices and Conduct during Childbirth; 2. Structure, Resources and Organization of Work; 3. Women’s Rights, Companions and Humanized Care. Conclusion: Institutional violence manifests itself both in structural limitations and in care relationships. Despite the presence of humanized practices, they are still incipient and often limited by institutional conditions.