Introduction

The presence of nursing work in indigenous health practice in Brazil dates back to the 21st century, keeping a relationship with the political, economic and social history of the country and with public health policies aimed at indigenous peoples. ¹ Nurses contribute to collective and collaborative work developed together with other health professionals, including indigenous professionals. ²

In the promotion of health of indigenous communities, the importance of nurses emerges, who must respect the organizational and religious culture, seeking to articulate technical knowledge with the traditional knowledge of the community, developing values related to quality of life in this population. ³

A study ³ states that for nurses' work in indigenous health it is essential to understand the health-disease process in a broader way, including the ethnic-cultural aspect. The issues related to the indigenous health situation contributed to the concern of the authors of this study in the search to deepen the knowledge about this reality and broaden the discussions in the academic scenario involving the health of this population. It is intended to emphasize the importance of the work of the nursing teams that provide care within the indigenous communities, always respecting the culture and beliefs and thus working with health promotion, improving the quality of life of indigenous people.

The daily care of the relationships and interventions of non-indigenous health professionals follows a compartmentalized model of care that excludes otherness, denoting the lack of training and unpreparedness of these professionals to work in contexts of multi-ethnicity and interculturality, especially with indigenous populations.⁴ Knowing the work that has been developed by nurses in indigenous territories is a possible way to understand the dimensions that make up the professional competence for working in intercultural contexts. ¹ Thus, in view of this scenario, this review aims to describe the production of nursing knowledge about health care for the Brazilian indigenous population.

Método

This is a scoping review, a type of literature review aimed at mapping the main concepts and limitations of a particular research area, as well as evidence for professional practice, guided by the assumptions of the JBI Institute Reviewer's Manual.⁵ The steps of the scope review were followed: 1) Development of guiding question 2) Definition of inclusion and exclusion criteria for studies 3) Selection of data sources 4) Collection and organization of results 5) Presentation of results​. ⁵

Collection and organization of results

To systematize the study inclusion process, the PRISMA Extension for Scoping Reviews (PRISMA ScR) methodology was chosen. ⁶ Figure 1 shows the search, exclusion and selection process of found studies.

Figure 1: Flowchart of the selection of studies that made up the research according to the PRISMA ScR. ⁶ Porto Alegre-RS, Brazil, 2020. 

Data was organized using a structured instrument developed in Microsoft Office Word, allowing the main findings of the searches to be synthesized, highlighting: author, year of publication, journal, place of study, setting, participants, approach, data collection and analysis of data and the main results.

Results

Of the 958 studies found in the searches, 16 studies were included in the review. Most studies (n=4) were published in 2014. Most studies (n=12) were published in scientific journals, dissertations (n=3) and one thesis (Box 1).

As it was an inclusion criterion, the studies should include in their sample health professionals that included nurses and/or indigenous people. Adding the participants of each study, our study compiled data from at least 55 nurses and 108 indigenous people. In addition, it is worth noting that four studies were carried out in the Sanitary District and two in the Support House for the Health of Indigenous People (Box 1).

Of the 16 studies, (n=15) used a qualitative methodology. As for the type of data collection, most (n=7) were through interviews. As for data analysis, most (n=6) used ethnography (Box 1).

Box 1: Characterization of articles according to author, year of publication, journal, and place of study, setting, participants, approach, data collection and data analysis. Porto Alegre, Rio Grande do Sul, Brazil, 2020 

The results will be presented through two predefined categories at the time of data extraction: 1. Nursing actions in the care of the Brazilian indigenous population and 2. Care modalities that are used by nursing in the care provided to the indigenous population.

Discussion

Analyzing the care actions developed by nursing, most refer to immunization, medication administration, dressings, nebulization and collection of laboratory tests. Studies^{(15, 16)} report that health units collected material for routine tests, dressings, inhalation and immunization. In this sense, it is possible to notice the predominance in the studied literature of an approach to individual technical procedures that meet the episodic and punctual demand of the indigenous people who seek the health service. A study ²³ corroborates this result by reporting that care actions are among nurses' practices in PHC.

Other activities identified in our review were the programmatic actions of nursing to certain groups of indigenous people such as: children, women, pregnant women, in addition to carrying out rapid tests to detect sexually transmitted infections and the monitoring of patients with tuberculosis. A study ⁷ states that the Rapid Test for Diagnosis of HIV and viral hepatitis exam was carried out in health units.

Among the programmatic actions identified for the care of the indigenous population, a study¹² refers to the prevention of cervical cancer through the collection of cytopathological tests, the control of communicable diseases; monitoring the development of children and pregnant women and patients with chronic diseases.

The managerial activities of nurses were also identified, with emphasis on the supervision of technicians and nursing assistants and indigenous health agents.¹⁶ In addition to the organization of the unit's activities and referrals to other reference services.¹⁸⁾ A study ¹¹ also states that the activities carried out by nurses in the health unit include training, updating and supervision of indigenous health agents and nursing assistants. Thus, nurses need to be prepared to work in primary care, plan and implement, together with the team, actions and programs, carry out follow-up, supervision and evaluation of the indigenous health agent and the nursing assistant. ³

In this sense, a study²¹ reports that nurses showed greater concern with managerial activities, which for them was limited to activities such as filling out forms and consolidating data, scheduling exams and travels of indigenous people, releasing fuel for the team travel and return of indigenous people to the villages, bureaucratic activities for organizing services, preparing monthly reports, supervising the IHA and the nursing staff.

The findings reveal that the organization of nursing activities in the unit and the referral of indigenous people to other reference services were recurrent in publications. A study ²⁴ corroborates this result by reporting that care coordination in the field of humanized health is usually performed by primary care nurses, who mediate the flow of users in the services of the health care network.

It is worth highlighting the turnover of professionals ^(8,9) who work with the indigenous population, which is a factor that compromises the quality of actions offered in the indigenous health subsystem. A study ²⁵ corroborates this finding, referring to a high turnover of professionals in indigenous health services. The working conditions of the teams, hired under a precarious relationship, do not favor the continuity of the teams of professionals who work in the Special Indigenous Sanitary District. ²⁶

The findings regarding the care modalities that stood out in the studies were Home Care. The results indicate that home visits are the most used by nurses and other health team professionals. ¹⁵ In Brazil, the figure of Indigenous Health Agents (IHA) is fundamental for health care actions in villages, whose main activity is home visits. These are responsible for serving as a communication and education link between the families and the other team members. ¹¹

The nursing consultation was another care modality developed by nurses in the context of indigenous health identified in the studies. The nursing consultation is a private activity of nurses in Brazil, which uses components of the scientific method to identify health/disease situations, prescribe and implement nursing measures that contribute to the promotion, prevention, health protection, recovery and rehabilitation of the individual, family and community. ²⁷

Nurses need to be aware of the beliefs and legends of the indigenous people, in order to diagnose and prescribe nursing care. As in our findings, a study²⁸ refers to the importance of carrying out actions that take into account the particularities of indigenous peoples, so that prevention, promotion and recovery are carried out in PHC.

A study ¹⁷ also identified that among the difficulties faced by nurses is the difficulty of communication and the lack of specific training to work with indigenous people. Communication can be a hindrance to nursing consultations, as some terms and expressions that are very specific to indigenous peoples can make care more difficult. ²⁹

The educational group was also identified as a tool capable of enabling, through the link between the participants, the understanding of life situations, health and illness, and health promotion.³⁰ In this review, the importance of nurses as subjects of development of health promotion in indigenous communities was identified, respecting their cultural and religious organization, articulating technical knowledge and traditional indigenous knowledge. ¹⁰

According to a study, ² an educational action with awareness and popular mobilization enables indigenous people not only to perceive, but also to adopt healthy behaviors, and knowledge about health rights, promoting indigenous autonomy in the search for alternatives for coping with their health needs. Therefore, health education actions carried out by nurses need to be integrated and articulated with the behavior of the indigenous community, focused on their cultural environment and their lifestyle. ²

Finally, it is worth noting that this study sought to assess most of the existing literature, however, some limitations in this process occurred, as there are probably studies published in other languages and in indexing databases not included in this study. Likewise, the authors acknowledge that important published research may have been omitted using our search strategy.

Conclusion

The results of this review reveal that the production of knowledge in nursing about health care for the Brazilian indigenous population is essentially centered on care actions that involve technical procedures, as well as on managerial actions that involve the organization of care in the unit. The most described care modality in the investigated literature was home visits.

The main finding of this study is that the production of knowledge is still based on individual technical procedures, which leads us to think about the tendency of a fragmented, episodic and reactive care to the demands of the indigenous people. Thus, it is believed that the results of this research are useful for rethinking the practice and training of nurses.

Therefore, the evidenced results indicate the need for training nurses to work in indigenous health services, recognizing all the peculiarities that humanized care implies, such as protection, respect for the way of life, values and knowledge of indigenous peoples.