Construção de um protocolo de Enfermagem: urgência e emergência obstétrica em territórios indígenas no Amazonas

Abstract

INTRODUCTION:Obstetric urgencies and emergencies in Indigenous territories of the Amazon constitute a significant public health problem, exacerbated by geographic barriers, limitations in the organization of health services, and intercultural challenges in care delivery. In this context, the role of nurses in obstetric care requires technical-scientific, ethical, and cultural competencies capable of integrating biomedical practices with traditional knowledge. This approach aligns with the Sustainable Development Goals, particularly SDG 3 (Good Health and Well-Being) and SDG 10 (Reduced Inequalities), by promoting equity and qualified access to obstetric care in vulnerable contexts.OBJECTIVE: To participatorily develop a nursing protocol for the care of obstetric urgencies and emergencies in Indigenous territories of the state of Amazonas, grounded in the Theory of Cultural Care Diversity and Universality. METHOD: A qualitative study guided by Convergent Care Research. Twenty nurses working in the Special Indigenous Health District of Manaus participated. Data collection took place from August to September 2025 through semi-structured interviews conducted in convergence groups, supported by participant observation. The methodological pathway included the phases of conception, instrumentation, and analysis, permeated by the movements of scrutiny, interpretation, and reconduction, guided by the principles of immersibility, simultaneity, dialogicity, and expansibility. Textual data were processed using IRAMUTEQ® software. Interpretation was grounded in Leininger’s Transcultural Care Theory. The study was approved by the Research Ethics Committee of the Federal University of Amazonas and by the Brazilian National Research Ethics Commission (CONEP).RESULTS: Participants were predominantly female, with a mean age of 42 years. Textual analysis organized the corpus into four interrelated classes: (1) community and territorial dimension, highlighting the centrality of territory, transportation, and community mobilization in care; (2) culturally congruent care, emphasizing the integration and tensions between traditional and biomedical knowledge; (3) direct childbirth care, marked by critical situations, improvisation, and the need for rapid decision-making; and (4) technical-organizational strategies, revealing gaps in existing protocols and the importance of participatory construction of instruments adapted to the Indigenous context. Findings pointed to the need for culturally sensitive protocols incorporating the principles of care preservation, negotiation, and repatterning.CONCLUSION: The qualification of obstetric care in Indigenous territories depends on the integration of technical-scientific and traditional knowledge, mediated by culturally sensitive practices. The developed protocol constitutes an assistive technology that strengthens nurses’ autonomy, promotes clinical safety, and enhances the humanization of care in intercultural contexts.IMPLICATIONS FOR NURSING: The results reinforce the need for intercultural training and the strengthening of continuing education, as well as the development and implementation of contextualized protocols for remote areas. The study contributes to advanced nursing practice by offering a tool applicable to the Amazonian reality, with the potential to improve responses to obstetric emergencies, reduce health inequities, and expand nurses’ leadership in Indigenous health care.