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NURSING CARE FOR THE HEALTH OF INDIGENOUS POPULATIONS: SCOPING REVIEW

ABSTRACT

Objective:

to identify in the literature the nursing care actions for the health of indigenous populations.

Method:

this is a scoping review, whose search was conducted in September 2022 in the following databases: Nursing Database (BDENF), CAPES Theses and Dissertations Catalog, Google Scholar, Latin American and Caribbean Literature on Health Sciences (LILACS), Pan American Health Organization (PAHO), National Library of Medicine and National Institutes of Health (PUBMED) and Scientific Electronic Library Online (SCIELO). The results were evaluated by summarizing the selected articles.

Results:

the main actions directed to the indigenous population were nursing consultations and health promotion and prevention activities. The main difficulty encountered in relation to indigenous peoples is the language barrier.

Conclusion:

the nursing team encounters difficulties, such as: the difficult location of the villages; high work overload due to the lack of medical professionals; language barrier; and inadequate conditions.

DESCRIPTORS:
Indigenous Peoples; Health of Indigenous Peoples; Nursing Care; Health Care; Comprehensive Health Care

RESUMO

Objetivo:

identificar na literatura as ações de assistência de enfermagem à saúde das populações indígenas.

Método:

trata-se de uma revisão de escopo, cuja busca foi realizada no mês de setembro de 2022 nas seguintes bases de dados: Base de Dados de Enfermagem (BDENF), Catálogo de teses e dissertações da CAPES, Google Scholar, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Pan American Health Organization (PAHO), National Library of Medicine and National Institutes of Health (PUBMED) e Scientific Electronic Library Online (SCIELO). Os resultados foram avaliados por meio de sumarização dos artigos selecionados.

Resultados:

as principais ações dirigidas à população indígena foram: consultas de enfermagem e atividades de promoção e prevenção da saúde. A principal dificuldade encontrada em relação aos povos indígenas é a barreira linguística.

Conclusão:

a equipe de enfermagem encontra dificuldades, como: a difícil localização das aldeias; alta sobrecarga de trabalho em decorrência da falta de profissionais médicos; barreira linguística; e condições inadequadas.

DESCRITORES:
Povos Indígenas; Saúde de Populações Indígenas; Cuidado de Enfermagem; Atenção à Saúde; Assistência Integral à Saúde

RESUMEN

Objetivo:

identificar en la literatura las acciones de cuidados de enfermería para la salud de las poblaciones indígenas.

Método:

se trata de una revisión de alcance, cuya búsqueda fue realizada en septiembre de 2022 en las siguientes bases de datos: Base de Datos de Enfermería (BDENF), Catálogo de Tesis y Disertaciones de la CAPES, Google Scholar, Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Pan American Health Organization (PAHO), National Library of Medicine and National Institutes of Health (PUBMED) y Scientific Electronic Library Online (SCIELO). Los resultados se evaluaron resumiendo los artículos seleccionados.

Resultados:

las principales acciones dirigidas a la población indígena fueron: consultas de enfermería y actividades de promoción de la salud y prevención. La principal dificultad encontrada en relación a la población indígena es la barrera lingüística.

Conclusión:

el equipo de enfermería encuentra dificultades como: la difícil localización de las aldeas; la elevada sobrecarga de trabajo debido a la falta de profesionales médicos; la barrera lingüística; y las condiciones inadecuadas.

DESCRIPTORES:
Pueblos Indígenas; Salud de Poblaciones Indígenas; Atención de Enfermería; Atención a la Salud; Atención Integral de Salud

HIGHLIGHTS

  1. Nursing consultation is the tool to identify problems.

  2. In indigenous area, the nurse assumes a central role in the health teams.

  3. Nursing professionals are part of a collective and collaborative work.

  4. The limitation found when the barrier is language can also be highlighted.

HIGHLIGHTS

  1. Nursing consultation is the tool to identify problems.

  2. In indigenous area, the nurse assumes a central role in the health teams.

  3. Nursing professionals are part of a collective and collaborative work.

  4. The limitation found when the barrier is language can also be highlighted.

INTRODUCTION

In Brazil, the indigenous population has been the target of violence since its first contacts with the Portuguese colonization in the 16th century. At that time, these peoples - seen only as obstacles for the extraction of resources or as suppliers of low-cost labor - began to be exploited by the invaders of their lands11 Nicacio K, Cavalcante G, Martins K, Barbosa R, Gonçalves S, Lins MA, et al. Saúde pública voltada para a população indígena. Cad Grad Ciênc Hum Soc Unit. [Internet]. 2019 [cited in 2022 Sept 15]; 5 (3): 75-84. Available in: https://periodicos.set.edu.br/fitshumanas/article/view/6883/3693.
https://periodicos.set.edu.br/fitshumana...
. Considering this reality, from 1500 to the 1970s, the indigenous population decreased considerably, and many peoples became extinct². Moreover, the Portuguese colonization process in Brazil, which lasted from 1530 to 1822, brought with it changes in the Indians’ lifestyles, who were subjected to infectious diseases that did not previously exist in their sphere and for which they did not have sufficient immune defense mechanisms, resulting in increased morbidity and mortality among this population, which at the time consisted of more than five million inhabitants and currently totals less than one million, representing 0.4% of the country’s total population1, 3-4.

At present, the indigenous population in Brazil is made up of 305 ethnicities, comprising an average of 817,000 individuals speaking 274 languages, and distributed in 683 indigenous lands22 Fundação Nacional do Índio (FUNAI). Quem são? Brasília: Ministério da Justiça e Segurança Pública [Internet]. 2020 [cited in 2022 sep 15]. Available in: https://gov.br/funai/pt-br/atuacao/povos-indigenas/quem-sao.
https://gov.br/funai/pt-br/atuacao/povos...
,44 Silva EC da, Silva NCD de L e, Café LA, Almeida PMO de, Souza LN, Silva AD da. Dificuldades vivenciadas pelos profissionais de saúde no atendimento à população indígena. REAS/EJCH [Internet]. 2021 [acesso em 2022 Oct. 14]; 13 (1): e5413. Available in: https://acervomais.com.br/index.php/saude/article/view/5413/3609.
https://acervomais.com.br/index.php/saud...
. Male presence is predominant within the lands, representing 51.6% of the total. Outside the indigenous lands, the population corresponds to 48.4%, while the female represents the majority when it comes to the peoples residing outside the lands, 51.3%, and inside the indigenous lands corresponds to 48.7%55 Fundação Nacional do Índio (FUNAI). O Brasil indígena. [Internet]. Brasília: Ministério da Justiça e Segurança Pública; 2020 [cited in 2022 Sept. 15]. Available in: https://www.gov.br/funai/pt-br/atuacao/povos-indigenas/o-brasil-indigena-ibge-1.
https://www.gov.br/funai/pt-br/atuacao/p...
. Furthermore, the literacy rate of indigenous people 15 years of age or older is below the national average, which is 90.4%, while in indigenous lands, there is an illiteracy rate of 32.3%, demonstrating the lack of expansion of public policies around education, especially for the population residing on these lands55 Fundação Nacional do Índio (FUNAI). O Brasil indígena. [Internet]. Brasília: Ministério da Justiça e Segurança Pública; 2020 [cited in 2022 Sept. 15]. Available in: https://www.gov.br/funai/pt-br/atuacao/povos-indigenas/o-brasil-indigena-ibge-1.
https://www.gov.br/funai/pt-br/atuacao/p...
.

Furthermore, the management of public health policies for these peoples began in the mid-twentieth century - with the creation of the Service of Aerial Health Units (SUSA- in Portuguese) - in which indigenous people began to have access to services of prevention, diagnosis, and treatment of endemic diseases, which caused a decrease in mortality. In this perspective, in 1967 the National Indian Foundation (FUNAI- in Portuguese) was created, with a team formed by nurses, doctors, dentists and laboratory technicians, however, it had low effectiveness44 Silva EC da, Silva NCD de L e, Café LA, Almeida PMO de, Souza LN, Silva AD da. Dificuldades vivenciadas pelos profissionais de saúde no atendimento à população indígena. REAS/EJCH [Internet]. 2021 [acesso em 2022 Oct. 14]; 13 (1): e5413. Available in: https://acervomais.com.br/index.php/saude/article/view/5413/3609.
https://acervomais.com.br/index.php/saud...
.

Currently, the health of the indigenous population in Brazil is subsidized by the National Policy for Health Care for Indigenous Peoples (PNAISP- in Portuguese), regulated by Decree No. 3,156 of August 27, 1999, which presents the conditions for the provision of health care to these peoples within the Brazilian Unified Health System (SUS). Moreover, with the publication of Decree No. 7,336/MS in 2010, the Special Secretariat of Indigenous Health (SESAI- in Portuguese) became responsible for managing the health subsystem of this population66 Brito AGL, Gomes ANH, Castro NRS, Pina RMP, Siqueira AAMG, Rocha ESC. Um olhar crítico-reflexivo sobre a saúde das populações indígenas utilizando a sistematização de experiências de Holliday. Res. Soc. Dev. [Internet]. 2020 [cited in 2022 Oct. 14]; 9 (7): e822974656. Available in: https://rsdjournal.org/index.php/rsd/article/view/4656/4247.
https://rsdjournal.org/index.php/rsd/art...
.

The Health Care Subsystem for Indigenous Peoples, in turn, was created in 1999, through Law no. 9,836/99 (Arouca Law) and is composed of Special Indigenous Health Districts (DSEI- in Portuguese) that constitute a network of health services implemented in indigenous lands to attend to this population. Currently, the organization for the assistance occurs through a Health Post, Basic Health Unit on the river, Base Center, Indigenous Health House (CASAI- in Portuguese), and a reference institution, which is generally a specialized hospital located in large cities. In Brazil, 34 DSEIS have been implemented aiming to offer Primary Health Care2, 6. However, according to the Brazilian Association of Collective Health (ABRASCO- in Portuguese), studies prove that indigenous peoples live in situations of vulnerability - due to the high rate of malaria cases, anemia, malnutrition, diabetes, and obesity - being extremely more prone to develop respiratory infections, as COVID-19, and evolve to Severe Acute Respiratory Syndrome (SARS) This is one of the reasons why Amazonas - the Brazilian state with the highest number of indigenous people - has reached the milestone of the highest number of deaths in Brazil during the pandemic44 Silva EC da, Silva NCD de L e, Café LA, Almeida PMO de, Souza LN, Silva AD da. Dificuldades vivenciadas pelos profissionais de saúde no atendimento à população indígena. REAS/EJCH [Internet]. 2021 [acesso em 2022 Oct. 14]; 13 (1): e5413. Available in: https://acervomais.com.br/index.php/saude/article/view/5413/3609.
https://acervomais.com.br/index.php/saud...
.

Moreover, even though several indigenous peoples are considered isolated, a large number are connected to urban areas, especially in the state of Amazonas, with a high potential for virus dissemination among these individuals. Geography is also an aggravating factor since most of these people live in places with difficult access to health services44 Silva EC da, Silva NCD de L e, Café LA, Almeida PMO de, Souza LN, Silva AD da. Dificuldades vivenciadas pelos profissionais de saúde no atendimento à população indígena. REAS/EJCH [Internet]. 2021 [acesso em 2022 Oct. 14]; 13 (1): e5413. Available in: https://acervomais.com.br/index.php/saude/article/view/5413/3609.
https://acervomais.com.br/index.php/saud...
. However, despite the obligation to update, train, and improve health care, only a minority of the professionals undergo some kind of preparation for the introduction to the Indian health care work, and among the problems reported by the nurses are the lack of vaccines and medicines, the poor structure of the buildings, the incomplete teams, and the lack of sanitation in the villages. Thus, these areas usually go through a high turnover because the professionals can often not do the internal articulations33 Viana JA, Cipriano DM, Oliveira MC de, Carneiro AM da CT, Ribeiro R de S, Feitosa M de O, et al. A atuação do enfermeiro na saúde indigena: uma análise integrativa da literatura. BJHR [Internet]. 2020 [cited in 2022 Sept 15]; 3 (2): 2113-2127. Available in: https://brazilianjournals.com/ojs/index.php/BJHR/article/view/7836/7572.
https://brazilianjournals.com/ojs/index....
.

Therefore, the present study is justified by the need to give more attention to indigenous populations, considering the social vulnerability and the precariousness of multi-professional assistance to which a large contingent of these peoples is subjected. Moreover, due to the scarcity of studies on the theme, we noticed the need to gather the most current nursing care for indigenous populations, to delimit the findings with scientific support and to improve the care practice of nursing professionals. Given this reality, this study aims to identify in the literature the nursing care actions for the health of indigenous populations.

METHODOLOGY

This is a scoping review, whose objective is to identify in the literature the main findings and possible gaps in knowledge about a theme and to promote the synthesis and dissemination of the results found. The present study, as well as the protocol and flowchart, was developed following the recommendations of the JBI77 Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter: Scoping Reviews (2020 version). In: Aromataris E, Munn Z, editors. Joanna Briggs Institute Reviewer´s Manual, JBI [Internet]. 2020 [cited in 2022 Oct. 14]. Available in: https://jbi-global-wiki.refined.site/space/MANUAL/4687342/Chapter+11%3A+Scoping+reviews.
https://jbi-global-wiki.refined.site/spa...
, in such a manner as to use the Checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR)88 Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ [Internet]. 2020 [cited in 2022 Sept. 15]. 372. Available in: https://www.bmj.com/content/372/bmj.n160.
https://www.bmj.com/content/372/bmj.n160...
.

In this sense, as established by Arksey and O’Malley, five steps were followed to prepare this article: 1) construction of the research question; 2) identification of relevant records for the study; 3) selection and inclusion of studies; 4) data summarization; and 5) synthesis of results99 Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol [Internet]. 2005 [cited in 2022 Oct. 14];8(1):19-32. Available in: https://doi.org/10.1080/1364557032000119616.
https://doi.org/10.1080/1364557032000119...
. To elaborate the research question, the mnemonic Population, Concept and Context (PCC) was used, being P: indigenous populations; C: nursing care to the health of indigenous populations; and C: health care. Based on this step, the guiding question was defined as: “What are the nursing care actions provided to the health of indigenous populations?”

The descriptors used for the search were selected from the Health Sciences Descriptors (DeCS) platform, which were: “Indigenous Peoples”; “Health of Indigenous Peoples”; “Nursing”; “Nursing Care”; “Health Care”; and “Comprehensive Health Care” and from the Medical Subject Headings (MeSH) platform, which were: “Indigenous Peoples”; “Health Services, Indigenous”; “Nursing”; “Nursing Care”; “Management, Nursing Care”; “Delivery of Health Care”; and “Comprehensive Health Care”, as shown in Table 1. The Boolean operators “AND” and “OR” were used to elaborate the search syntax, adapted to each data source, to promote the combination between the descriptors.

Chart 1
Descriptors used for research in the data sources. Redenção, Ceará, Brazil, 2022.

The searches were performed in September 2022 in the following data sources: BDENF (Nursing Database); CAPES Theses and Dissertations Catalog; Google Scholar; LILACS (Latin American and Caribbean Literature on Health Sciences); PAHO (Pan American Health Organization); PUBMED (National Library of Medicine and National Institutes of Health); and SCIELO (Scientific Electronic Library Online). The syntaxes performed in each data source are shown in Chart 2.

Chart 2
Search syntax in the data sources. Redenção, Ceará, Brazil, 2022

Thus, to identify possible studies like this review, a preliminary search of the topic was conducted in the Open Science Framework (OSF), JBI Clinical Online Network of Evidence for Care and Therapeutics (COnNECT+), Database of Abstracts of Reviews of Effects (DARE), The Cochrane Library, and International Prospective Register of Ongoing Systematic Reviews (PROSPERO) data sources, in which no similar studies were found.

The search process, in turn, occurred through the Periodical Portal of the Coordination for the Improvement of Higher-Level Personnel (CAPES) through the Federated Academic Community (CAFe).

The inclusion criteria for the study were publications without a time frame that met the study objective; publications available in full and free of charge in electronic media; dissertations, theses, ministerial orders, guidelines, and scientific articles. However, abstracts, letters to the editor, opinion articles, studies not related to the theme, and duplicate records in data sources were excluded.

The search for the studies was performed simultaneously and in different devices by two independent researchers. For extraction and summarization of the results, a table was prepared according to the variables “author/year”, “type of study”, “country”, “study objectives”, “health actions performed”, and “difficulties encountered in assistance”.

RESULTS

The searches were initially performed in five electronic data sources, resulting in a total of 1,167 records, found by searching PubMed Central (n=161), LILACS (n=5), SciELO (n=0), BDENF(n=1), PAHO (n=0), Google Scholar (n=979) and the CAPES Theses and Dissertations Catalog (n=24). A manual search for four potentially eligible articles in the reference list of the selected studies was also performed. After the screening process, eight eligible records were selected for the composition of the results. The steps of the screening process are detailed in the flow chart in Figure 1.

Figure 1
Search flowchart adapted from the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA ScR). Redenção, CE, Brazil, 2022

The eight articles selected to compose the results of this study were categorized in Chart 2, containing author/year, type of study/country, nursing actions, and difficulties encountered in care.

Chart 2
Summary of the articles included in the scoping review. Redenção, Ceará, Brazil, 2022.

The year that obtained the highest scientific production on this theme was 2018, totaling three studies, being 37.5%1111 Rodrigues GASC, Terra MF. Nursing assistance to the indigenous population: a bibliographic study. Arq Med Hosp Fac Cienc Med Santa Casa São Paulo [Internet]. 2018 [cited in 2022 Sept. 15];63(2):100-4. Available in: https://doi.org/10.26432/1809-3019.2018.63.2.100.
https://doi.org/10.26432/1809-3019.2018....

12 Batista FCS, Albuquerque FHS, Rolim KMC, Xavier MV, Pinheiro MCD, Fernandes HIVM, et al. Health care of Brazilian indigenous peoples: post-implementation of the National https://doi.org/10.30574/wjarr.2021.10.1.0166.
https://doi.org/10.30574/wjarr.2021.10.1...
-1313 Rocha ESC, Gonçalves MJF, Cruz MJF da, Baroni RAL. Profile of nurses who work in indigenous and non-indigenous health care. Ciênc cuid saúde [Internet]. 2018 [cited in 2022 Sept. 15]; 17(4):1-8. Available in: https://periodicos.uem.br/ojs/index.php/CiencCuidSaude/article/view/45195/751375139159.
https://periodicos.uem.br/ojs/index.php/...
of the articles, followed by the years 2010, 2012, 2014, 2017 and 2021, totaling one study, being 12.5%1010 Maia AS, Nascimento EM do, Carvalho TP de, Sousa CG de. Os desafios da enfermagem na atenção integral à saúde dos povos indígenas. Enferm Foco. [Internet]. 2021 [cited in 2022 Sept. 15];12(2):333-8. Available in: https://doi.org/10.21675/2357-707X.2021.v12.n2.4166.
https://doi.org/10.21675/2357-707X.2021....
,1414 Martins JCL. O trabalho do enfermeiro na saúde indígena: desenvolvendo competências para a atuação no contexto intercultural [Dissertation] São Paulo, 2017. 174 p. Available in: https://ds.saudeindigena.icict.fiocruz.br/bitstream/bvs/720/2/520576206.pdf.
https://ds.saudeindigena.icict.fiocruz.b...

15 Rissardo LK, Carreira L. Organização do serviço de saúde e cuidado ao idoso indígena: sinergias e singularidades do contexto profissional. REEUSP [Internet].2014 [cited in 2022 Sept. 15];48:72-79. Available in: https://doi.org/10.1590/S0080-623420140000100009.
https://doi.org/10.1590/S0080-6234201400...

16 Marinelli N, Nascimento DF, Costa AIP, Posso MBS, Araújo LP. Assistência à população indígena: dificuldades encontradas por enfermeiros. Rev Univap [Internet]. 2012 [cited in 2022 Sept. 15]; 18(32): 52-65. Available in: http://revista.univap.br/index.php/revistaunivap/article/view/93.
http://revista.univap.br/index.php/revis...
-1717 Pellon LHC, Vargas LA. Cultura, interculturalidade e processo saúde-doença:(des) caminhos na atenção à saúde dos Guarani Mbyá de Aracruz, Espírito Santo. Physis: Ciênc Saúde Colet [Internet]. 2010 [cited in 2022 Sept. 15]; 20(1)1377-97. Available in: https://doi.org/10.1590/S0103-73312010000400017.
https://doi.org/10.1590/S0103-7331201000...
in each year. The methods used in the articles were varied, with descriptive study predominating representing the total of three studies, being 37.5%1010 Maia AS, Nascimento EM do, Carvalho TP de, Sousa CG de. Os desafios da enfermagem na atenção integral à saúde dos povos indígenas. Enferm Foco. [Internet]. 2021 [cited in 2022 Sept. 15];12(2):333-8. Available in: https://doi.org/10.21675/2357-707X.2021.v12.n2.4166.
https://doi.org/10.21675/2357-707X.2021....
,1414 Martins JCL. O trabalho do enfermeiro na saúde indígena: desenvolvendo competências para a atuação no contexto intercultural [Dissertation] São Paulo, 2017. 174 p. Available in: https://ds.saudeindigena.icict.fiocruz.br/bitstream/bvs/720/2/520576206.pdf.
https://ds.saudeindigena.icict.fiocruz.b...
,1616 Marinelli N, Nascimento DF, Costa AIP, Posso MBS, Araújo LP. Assistência à população indígena: dificuldades encontradas por enfermeiros. Rev Univap [Internet]. 2012 [cited in 2022 Sept. 15]; 18(32): 52-65. Available in: http://revista.univap.br/index.php/revistaunivap/article/view/93.
http://revista.univap.br/index.php/revis...
of the sample. All studies had Brazil as the country of publication.

Regarding the other information extracted from the articles, most of the studies had the objective of identifying the difficulties encountered by nurses in assisting the indigenous population1010 Maia AS, Nascimento EM do, Carvalho TP de, Sousa CG de. Os desafios da enfermagem na atenção integral à saúde dos povos indígenas. Enferm Foco. [Internet]. 2021 [cited in 2022 Sept. 15];12(2):333-8. Available in: https://doi.org/10.21675/2357-707X.2021.v12.n2.4166.
https://doi.org/10.21675/2357-707X.2021....
,1616 Marinelli N, Nascimento DF, Costa AIP, Posso MBS, Araújo LP. Assistência à população indígena: dificuldades encontradas por enfermeiros. Rev Univap [Internet]. 2012 [cited in 2022 Sept. 15]; 18(32): 52-65. Available in: http://revista.univap.br/index.php/revistaunivap/article/view/93.
http://revista.univap.br/index.php/revis...
, as well as analyzing the actions11 taken and the profile of these professionals1111 Rodrigues GASC, Terra MF. Nursing assistance to the indigenous population: a bibliographic study. Arq Med Hosp Fac Cienc Med Santa Casa São Paulo [Internet]. 2018 [cited in 2022 Sept. 15];63(2):100-4. Available in: https://doi.org/10.26432/1809-3019.2018.63.2.100.
https://doi.org/10.26432/1809-3019.2018....
-1212 Batista FCS, Albuquerque FHS, Rolim KMC, Xavier MV, Pinheiro MCD, Fernandes HIVM, et al. Health care of Brazilian indigenous peoples: post-implementation of the National https://doi.org/10.30574/wjarr.2021.10.1.0166.
https://doi.org/10.30574/wjarr.2021.10.1...
. The other studies focused on the National Policy for Health Care for Indigenous Peoples12, 15-17. The main actions provided by nurses to the indigenous population were nursing consultations1010 Maia AS, Nascimento EM do, Carvalho TP de, Sousa CG de. Os desafios da enfermagem na atenção integral à saúde dos povos indígenas. Enferm Foco. [Internet]. 2021 [cited in 2022 Sept. 15];12(2):333-8. Available in: https://doi.org/10.21675/2357-707X.2021.v12.n2.4166.
https://doi.org/10.21675/2357-707X.2021....

11 Rodrigues GASC, Terra MF. Nursing assistance to the indigenous population: a bibliographic study. Arq Med Hosp Fac Cienc Med Santa Casa São Paulo [Internet]. 2018 [cited in 2022 Sept. 15];63(2):100-4. Available in: https://doi.org/10.26432/1809-3019.2018.63.2.100.
https://doi.org/10.26432/1809-3019.2018....
-1212 Batista FCS, Albuquerque FHS, Rolim KMC, Xavier MV, Pinheiro MCD, Fernandes HIVM, et al. Health care of Brazilian indigenous peoples: post-implementation of the National https://doi.org/10.30574/wjarr.2021.10.1.0166.
https://doi.org/10.30574/wjarr.2021.10.1...
,1414 Martins JCL. O trabalho do enfermeiro na saúde indígena: desenvolvendo competências para a atuação no contexto intercultural [Dissertation] São Paulo, 2017. 174 p. Available in: https://ds.saudeindigena.icict.fiocruz.br/bitstream/bvs/720/2/520576206.pdf.
https://ds.saudeindigena.icict.fiocruz.b...

15 Rissardo LK, Carreira L. Organização do serviço de saúde e cuidado ao idoso indígena: sinergias e singularidades do contexto profissional. REEUSP [Internet].2014 [cited in 2022 Sept. 15];48:72-79. Available in: https://doi.org/10.1590/S0080-623420140000100009.
https://doi.org/10.1590/S0080-6234201400...

16 Marinelli N, Nascimento DF, Costa AIP, Posso MBS, Araújo LP. Assistência à população indígena: dificuldades encontradas por enfermeiros. Rev Univap [Internet]. 2012 [cited in 2022 Sept. 15]; 18(32): 52-65. Available in: http://revista.univap.br/index.php/revistaunivap/article/view/93.
http://revista.univap.br/index.php/revis...
-1717 Pellon LHC, Vargas LA. Cultura, interculturalidade e processo saúde-doença:(des) caminhos na atenção à saúde dos Guarani Mbyá de Aracruz, Espírito Santo. Physis: Ciênc Saúde Colet [Internet]. 2010 [cited in 2022 Sept. 15]; 20(1)1377-97. Available in: https://doi.org/10.1590/S0103-73312010000400017.
https://doi.org/10.1590/S0103-7331201000...
and health promotion and prevention activities1111 Rodrigues GASC, Terra MF. Nursing assistance to the indigenous population: a bibliographic study. Arq Med Hosp Fac Cienc Med Santa Casa São Paulo [Internet]. 2018 [cited in 2022 Sept. 15];63(2):100-4. Available in: https://doi.org/10.26432/1809-3019.2018.63.2.100.
https://doi.org/10.26432/1809-3019.2018....
,1313 Rocha ESC, Gonçalves MJF, Cruz MJF da, Baroni RAL. Profile of nurses who work in indigenous and non-indigenous health care. Ciênc cuid saúde [Internet]. 2018 [cited in 2022 Sept. 15]; 17(4):1-8. Available in: https://periodicos.uem.br/ojs/index.php/CiencCuidSaude/article/view/45195/751375139159.
https://periodicos.uem.br/ojs/index.php/...

14 Martins JCL. O trabalho do enfermeiro na saúde indígena: desenvolvendo competências para a atuação no contexto intercultural [Dissertation] São Paulo, 2017. 174 p. Available in: https://ds.saudeindigena.icict.fiocruz.br/bitstream/bvs/720/2/520576206.pdf.
https://ds.saudeindigena.icict.fiocruz.b...
-1515 Rissardo LK, Carreira L. Organização do serviço de saúde e cuidado ao idoso indígena: sinergias e singularidades do contexto profissional. REEUSP [Internet].2014 [cited in 2022 Sept. 15];48:72-79. Available in: https://doi.org/10.1590/S0080-623420140000100009.
https://doi.org/10.1590/S0080-6234201400...
, as recommended by the Ministry of Health.

Six studies reported that, among the main difficulties encountered in providing care to indigenous peoples, one of the most recurrent is the language barrier, which was unanimously addressed in the studies1010 Maia AS, Nascimento EM do, Carvalho TP de, Sousa CG de. Os desafios da enfermagem na atenção integral à saúde dos povos indígenas. Enferm Foco. [Internet]. 2021 [cited in 2022 Sept. 15];12(2):333-8. Available in: https://doi.org/10.21675/2357-707X.2021.v12.n2.4166.
https://doi.org/10.21675/2357-707X.2021....

11 Rodrigues GASC, Terra MF. Nursing assistance to the indigenous population: a bibliographic study. Arq Med Hosp Fac Cienc Med Santa Casa São Paulo [Internet]. 2018 [cited in 2022 Sept. 15];63(2):100-4. Available in: https://doi.org/10.26432/1809-3019.2018.63.2.100.
https://doi.org/10.26432/1809-3019.2018....

12 Batista FCS, Albuquerque FHS, Rolim KMC, Xavier MV, Pinheiro MCD, Fernandes HIVM, et al. Health care of Brazilian indigenous peoples: post-implementation of the National https://doi.org/10.30574/wjarr.2021.10.1.0166.
https://doi.org/10.30574/wjarr.2021.10.1...

13 Rocha ESC, Gonçalves MJF, Cruz MJF da, Baroni RAL. Profile of nurses who work in indigenous and non-indigenous health care. Ciênc cuid saúde [Internet]. 2018 [cited in 2022 Sept. 15]; 17(4):1-8. Available in: https://periodicos.uem.br/ojs/index.php/CiencCuidSaude/article/view/45195/751375139159.
https://periodicos.uem.br/ojs/index.php/...

14 Martins JCL. O trabalho do enfermeiro na saúde indígena: desenvolvendo competências para a atuação no contexto intercultural [Dissertation] São Paulo, 2017. 174 p. Available in: https://ds.saudeindigena.icict.fiocruz.br/bitstream/bvs/720/2/520576206.pdf.
https://ds.saudeindigena.icict.fiocruz.b...

15 Rissardo LK, Carreira L. Organização do serviço de saúde e cuidado ao idoso indígena: sinergias e singularidades do contexto profissional. REEUSP [Internet].2014 [cited in 2022 Sept. 15];48:72-79. Available in: https://doi.org/10.1590/S0080-623420140000100009.
https://doi.org/10.1590/S0080-6234201400...

16 Marinelli N, Nascimento DF, Costa AIP, Posso MBS, Araújo LP. Assistência à população indígena: dificuldades encontradas por enfermeiros. Rev Univap [Internet]. 2012 [cited in 2022 Sept. 15]; 18(32): 52-65. Available in: http://revista.univap.br/index.php/revistaunivap/article/view/93.
http://revista.univap.br/index.php/revis...
-1717 Pellon LHC, Vargas LA. Cultura, interculturalidade e processo saúde-doença:(des) caminhos na atenção à saúde dos Guarani Mbyá de Aracruz, Espírito Santo. Physis: Ciênc Saúde Colet [Internet]. 2010 [cited in 2022 Sept. 15]; 20(1)1377-97. Available in: https://doi.org/10.1590/S0103-73312010000400017.
https://doi.org/10.1590/S0103-7331201000...
. In addition, other problems were identified in the studies, such as: the geographical location of villages that are difficult to access, lack of basic sanitation, precarious infrastructure, and equipment to provide care, unpreparedness of the team, difficulties in forming bonds, and lack of adequate salaries.

DISCUSSION

Indigenous beliefs consider disease as an event that is closely related to the social body, whose implications are more collective than individual, characterizing the health-disease process as sociocultural, which opposes the biomedical model in several perspectives. Thus, when inserted into this reality, health professionals often experience conflicting relationships because the ethical and moral values of their own cultures are often at odds with the practices and conceptions of the communities1111 Rodrigues GASC, Terra MF. Nursing assistance to the indigenous population: a bibliographic study. Arq Med Hosp Fac Cienc Med Santa Casa São Paulo [Internet]. 2018 [cited in 2022 Sept. 15];63(2):100-4. Available in: https://doi.org/10.26432/1809-3019.2018.63.2.100.
https://doi.org/10.26432/1809-3019.2018....
,1414 Martins JCL. O trabalho do enfermeiro na saúde indígena: desenvolvendo competências para a atuação no contexto intercultural [Dissertation] São Paulo, 2017. 174 p. Available in: https://ds.saudeindigena.icict.fiocruz.br/bitstream/bvs/720/2/520576206.pdf.
https://ds.saudeindigena.icict.fiocruz.b...
,1616 Marinelli N, Nascimento DF, Costa AIP, Posso MBS, Araújo LP. Assistência à população indígena: dificuldades encontradas por enfermeiros. Rev Univap [Internet]. 2012 [cited in 2022 Sept. 15]; 18(32): 52-65. Available in: http://revista.univap.br/index.php/revistaunivap/article/view/93.
http://revista.univap.br/index.php/revis...
-1717 Pellon LHC, Vargas LA. Cultura, interculturalidade e processo saúde-doença:(des) caminhos na atenção à saúde dos Guarani Mbyá de Aracruz, Espírito Santo. Physis: Ciênc Saúde Colet [Internet]. 2010 [cited in 2022 Sept. 15]; 20(1)1377-97. Available in: https://doi.org/10.1590/S0103-73312010000400017.
https://doi.org/10.1590/S0103-7331201000...
. Moreover, the lack of specific training to work in indigenous health care can lead the multi-professional team to contradictions between the desire to respect and the anxiety to solve the problems of the population, which can harm the quality of care offered, as reported even by indigenous people assisted by non-trained professionals1313 Rocha ESC, Gonçalves MJF, Cruz MJF da, Baroni RAL. Profile of nurses who work in indigenous and non-indigenous health care. Ciênc cuid saúde [Internet]. 2018 [cited in 2022 Sept. 15]; 17(4):1-8. Available in: https://periodicos.uem.br/ojs/index.php/CiencCuidSaude/article/view/45195/751375139159.
https://periodicos.uem.br/ojs/index.php/...

14 Martins JCL. O trabalho do enfermeiro na saúde indígena: desenvolvendo competências para a atuação no contexto intercultural [Dissertation] São Paulo, 2017. 174 p. Available in: https://ds.saudeindigena.icict.fiocruz.br/bitstream/bvs/720/2/520576206.pdf.
https://ds.saudeindigena.icict.fiocruz.b...

15 Rissardo LK, Carreira L. Organização do serviço de saúde e cuidado ao idoso indígena: sinergias e singularidades do contexto profissional. REEUSP [Internet].2014 [cited in 2022 Sept. 15];48:72-79. Available in: https://doi.org/10.1590/S0080-623420140000100009.
https://doi.org/10.1590/S0080-6234201400...
-1616 Marinelli N, Nascimento DF, Costa AIP, Posso MBS, Araújo LP. Assistência à população indígena: dificuldades encontradas por enfermeiros. Rev Univap [Internet]. 2012 [cited in 2022 Sept. 15]; 18(32): 52-65. Available in: http://revista.univap.br/index.php/revistaunivap/article/view/93.
http://revista.univap.br/index.php/revis...
.

In their cultural and ethnic uniqueness, Indians demand differentiated care, and without training, the nursing professional strives to acquire specific knowledge, leading many of them to ask for help from colleagues who work or have worked in the area and/or to search the literature on the subject1616 Marinelli N, Nascimento DF, Costa AIP, Posso MBS, Araújo LP. Assistência à população indígena: dificuldades encontradas por enfermeiros. Rev Univap [Internet]. 2012 [cited in 2022 Sept. 15]; 18(32): 52-65. Available in: http://revista.univap.br/index.php/revistaunivap/article/view/93.
http://revista.univap.br/index.php/revis...
. These facts reveal the importance of the incentive for training, formation, permanent and continued education to guarantee the quality of health care for indigenous people, as suggested by the 5th National Conference on Indigenous Health1818 Ministério da Saúde (BR). 5ª Conferência Nacional de Saúde Indígena: relatório final. [Internet]. Brasília: Ministério da Saúde, 2015 [cited in 2022 Oct. 13]. 305 p. Available in: https://bvsms.saude.gov.br/bvs/publicacoes/5_conferencia_nacional_saude_indigena_relatorio_final.pdf.
https://bvsms.saude.gov.br/bvs/publicaco...
.

In this context, when considering nursing care for these people, tools such as the capacity for listening, dialogue, knowledge based on interculturality in the health-disease process, and anthropological knowledge are indispensable for the construction of an integral and truly respectful relationship between professionals and indigenous people, to improve the provision of health care1111 Rodrigues GASC, Terra MF. Nursing assistance to the indigenous population: a bibliographic study. Arq Med Hosp Fac Cienc Med Santa Casa São Paulo [Internet]. 2018 [cited in 2022 Sept. 15];63(2):100-4. Available in: https://doi.org/10.26432/1809-3019.2018.63.2.100.
https://doi.org/10.26432/1809-3019.2018....

12 Batista FCS, Albuquerque FHS, Rolim KMC, Xavier MV, Pinheiro MCD, Fernandes HIVM, et al. Health care of Brazilian indigenous peoples: post-implementation of the National https://doi.org/10.30574/wjarr.2021.10.1.0166.
https://doi.org/10.30574/wjarr.2021.10.1...

13 Rocha ESC, Gonçalves MJF, Cruz MJF da, Baroni RAL. Profile of nurses who work in indigenous and non-indigenous health care. Ciênc cuid saúde [Internet]. 2018 [cited in 2022 Sept. 15]; 17(4):1-8. Available in: https://periodicos.uem.br/ojs/index.php/CiencCuidSaude/article/view/45195/751375139159.
https://periodicos.uem.br/ojs/index.php/...
-1414 Martins JCL. O trabalho do enfermeiro na saúde indígena: desenvolvendo competências para a atuação no contexto intercultural [Dissertation] São Paulo, 2017. 174 p. Available in: https://ds.saudeindigena.icict.fiocruz.br/bitstream/bvs/720/2/520576206.pdf.
https://ds.saudeindigena.icict.fiocruz.b...
,1616 Marinelli N, Nascimento DF, Costa AIP, Posso MBS, Araújo LP. Assistência à população indígena: dificuldades encontradas por enfermeiros. Rev Univap [Internet]. 2012 [cited in 2022 Sept. 15]; 18(32): 52-65. Available in: http://revista.univap.br/index.php/revistaunivap/article/view/93.
http://revista.univap.br/index.php/revis...
. In indigenous areas, nurses have been assuming a central role in the health teams, both because of the time they have been working in the service and because of the demands inherent to their performance1313 Rocha ESC, Gonçalves MJF, Cruz MJF da, Baroni RAL. Profile of nurses who work in indigenous and non-indigenous health care. Ciênc cuid saúde [Internet]. 2018 [cited in 2022 Sept. 15]; 17(4):1-8. Available in: https://periodicos.uem.br/ojs/index.php/CiencCuidSaude/article/view/45195/751375139159.
https://periodicos.uem.br/ojs/index.php/...
. In this sense, from the analysis of the selected studies, a strong performance of the nursing team’s assistance is noted, mainly regarding supervision and management, health education, nursing consultation, and a strong participation in the promotion, protection, and recovery of health1111 Rodrigues GASC, Terra MF. Nursing assistance to the indigenous population: a bibliographic study. Arq Med Hosp Fac Cienc Med Santa Casa São Paulo [Internet]. 2018 [cited in 2022 Sept. 15];63(2):100-4. Available in: https://doi.org/10.26432/1809-3019.2018.63.2.100.
https://doi.org/10.26432/1809-3019.2018....

12 Batista FCS, Albuquerque FHS, Rolim KMC, Xavier MV, Pinheiro MCD, Fernandes HIVM, et al. Health care of Brazilian indigenous peoples: post-implementation of the National https://doi.org/10.30574/wjarr.2021.10.1.0166.
https://doi.org/10.30574/wjarr.2021.10.1...

13 Rocha ESC, Gonçalves MJF, Cruz MJF da, Baroni RAL. Profile of nurses who work in indigenous and non-indigenous health care. Ciênc cuid saúde [Internet]. 2018 [cited in 2022 Sept. 15]; 17(4):1-8. Available in: https://periodicos.uem.br/ojs/index.php/CiencCuidSaude/article/view/45195/751375139159.
https://periodicos.uem.br/ojs/index.php/...
-1414 Martins JCL. O trabalho do enfermeiro na saúde indígena: desenvolvendo competências para a atuação no contexto intercultural [Dissertation] São Paulo, 2017. 174 p. Available in: https://ds.saudeindigena.icict.fiocruz.br/bitstream/bvs/720/2/520576206.pdf.
https://ds.saudeindigena.icict.fiocruz.b...
.

As far as nursing supervision is concerned, the support given to nursing technicians or assistants during the performance of procedures, such as medication administration, vaccine application, and dressings, as well as the planning, evaluation, and execution of the work process of the health service team, stands out1111 Rodrigues GASC, Terra MF. Nursing assistance to the indigenous population: a bibliographic study. Arq Med Hosp Fac Cienc Med Santa Casa São Paulo [Internet]. 2018 [cited in 2022 Sept. 15];63(2):100-4. Available in: https://doi.org/10.26432/1809-3019.2018.63.2.100.
https://doi.org/10.26432/1809-3019.2018....
. Thus, the nurse also assumes a managerial role within the team and is responsible for organizing the service in the indigenous area1212 Batista FCS, Albuquerque FHS, Rolim KMC, Xavier MV, Pinheiro MCD, Fernandes HIVM, et al. Health care of Brazilian indigenous peoples: post-implementation of the National https://doi.org/10.30574/wjarr.2021.10.1.0166.
https://doi.org/10.30574/wjarr.2021.10.1...
. Health education, in turn, is a practice that should be constant in all nursing actions, focusing mainly on cultural issues of the communities, their lifestyles, and disease risks, besides being essential for the training of several indigenous professionals1111 Rodrigues GASC, Terra MF. Nursing assistance to the indigenous population: a bibliographic study. Arq Med Hosp Fac Cienc Med Santa Casa São Paulo [Internet]. 2018 [cited in 2022 Sept. 15];63(2):100-4. Available in: https://doi.org/10.26432/1809-3019.2018.63.2.100.
https://doi.org/10.26432/1809-3019.2018....

12 Batista FCS, Albuquerque FHS, Rolim KMC, Xavier MV, Pinheiro MCD, Fernandes HIVM, et al. Health care of Brazilian indigenous peoples: post-implementation of the National https://doi.org/10.30574/wjarr.2021.10.1.0166.
https://doi.org/10.30574/wjarr.2021.10.1...

13 Rocha ESC, Gonçalves MJF, Cruz MJF da, Baroni RAL. Profile of nurses who work in indigenous and non-indigenous health care. Ciênc cuid saúde [Internet]. 2018 [cited in 2022 Sept. 15]; 17(4):1-8. Available in: https://periodicos.uem.br/ojs/index.php/CiencCuidSaude/article/view/45195/751375139159.
https://periodicos.uem.br/ojs/index.php/...
-1414 Martins JCL. O trabalho do enfermeiro na saúde indígena: desenvolvendo competências para a atuação no contexto intercultural [Dissertation] São Paulo, 2017. 174 p. Available in: https://ds.saudeindigena.icict.fiocruz.br/bitstream/bvs/720/2/520576206.pdf.
https://ds.saudeindigena.icict.fiocruz.b...
.

Regarding health promotion, protection, and recovery, the effective performance of nurses in the area includes a broad understanding of the health-disease process of users, to respect the ethnic-cultural peculiarities of indigenous peoples and constantly seek updates about health care. However, the team needs to have qualities that enable the identification of risk factors, planning, implementation, and preventive action1313 Rocha ESC, Gonçalves MJF, Cruz MJF da, Baroni RAL. Profile of nurses who work in indigenous and non-indigenous health care. Ciênc cuid saúde [Internet]. 2018 [cited in 2022 Sept. 15]; 17(4):1-8. Available in: https://periodicos.uem.br/ojs/index.php/CiencCuidSaude/article/view/45195/751375139159.
https://periodicos.uem.br/ojs/index.php/...
-1414 Martins JCL. O trabalho do enfermeiro na saúde indígena: desenvolvendo competências para a atuação no contexto intercultural [Dissertation] São Paulo, 2017. 174 p. Available in: https://ds.saudeindigena.icict.fiocruz.br/bitstream/bvs/720/2/520576206.pdf.
https://ds.saudeindigena.icict.fiocruz.b...
.

Nursing professionals are part of a collective and collaborative work developed with the other professionals on the team. In this sense, there must be integration of the multidisciplinary team and knowledge from other public services, seeking to aggregate popular and technical knowledge, aligned with the specific needs of the indigenous population1313 Rocha ESC, Gonçalves MJF, Cruz MJF da, Baroni RAL. Profile of nurses who work in indigenous and non-indigenous health care. Ciênc cuid saúde [Internet]. 2018 [cited in 2022 Sept. 15]; 17(4):1-8. Available in: https://periodicos.uem.br/ojs/index.php/CiencCuidSaude/article/view/45195/751375139159.
https://periodicos.uem.br/ojs/index.php/...
-1414 Martins JCL. O trabalho do enfermeiro na saúde indígena: desenvolvendo competências para a atuação no contexto intercultural [Dissertation] São Paulo, 2017. 174 p. Available in: https://ds.saudeindigena.icict.fiocruz.br/bitstream/bvs/720/2/520576206.pdf.
https://ds.saudeindigena.icict.fiocruz.b...
.

The Indigenous Health Agent (AIS- in Portuguese) is also part of the health teams and is the team’s interlocutor with the community, acting as a legitimate representative of his people and - concomitantly - as a professional in the process of appropriating knowledge from Western medicine. Also present in the patients’ therapeutic itinerary are the healers, shamans, midwives, shamans, and other specialists of traditional indigenous practices1414 Martins JCL. O trabalho do enfermeiro na saúde indígena: desenvolvendo competências para a atuação no contexto intercultural [Dissertation] São Paulo, 2017. 174 p. Available in: https://ds.saudeindigena.icict.fiocruz.br/bitstream/bvs/720/2/520576206.pdf.
https://ds.saudeindigena.icict.fiocruz.b...
.

The nursing consultation is the tool to identify problems, prescribe care, evaluate interventions and, if necessary, apply new actions. Generally, these consultations occur in the presence of the AIS, to facilitate communication, considering that most nurses are not indigenous. Although they are more directed to the individual user, they have a great impact on the family and the community as a whole1111 Rodrigues GASC, Terra MF. Nursing assistance to the indigenous population: a bibliographic study. Arq Med Hosp Fac Cienc Med Santa Casa São Paulo [Internet]. 2018 [cited in 2022 Sept. 15];63(2):100-4. Available in: https://doi.org/10.26432/1809-3019.2018.63.2.100.
https://doi.org/10.26432/1809-3019.2018....
.

Among the most relevant difficulties encountered during the nursing consultation is the habit of indigenous people of taking family members to participate in the consultation, which reduces the privacy between the professional and the patient, and may generate inhibition and, consequently, influence the patient’s response1616 Marinelli N, Nascimento DF, Costa AIP, Posso MBS, Araújo LP. Assistência à população indígena: dificuldades encontradas por enfermeiros. Rev Univap [Internet]. 2012 [cited in 2022 Sept. 15]; 18(32): 52-65. Available in: http://revista.univap.br/index.php/revistaunivap/article/view/93.
http://revista.univap.br/index.php/revis...
,1919 Reis LS dos, Borges RD de CF. Política nacional de atenção à saúde dos povos indígenas: atuação do enfermeiro no contexto intercultural. J Health Sci Inst [Internet]. 2019 [cited in 2022 Oct. 13];37(2):178-81 Available in: https://repositorio.unip.br/wp-content/uploads/2020/12/14V37_n2_2019_p178a181.pdf.
https://repositorio.unip.br/wp-content/u...
. Thus, the collective consultation is also a reality within the indigenous culture, perceived by many professionals as a factor that prevents a more intimate and closer professional-patient relationship1616 Marinelli N, Nascimento DF, Costa AIP, Posso MBS, Araújo LP. Assistência à população indígena: dificuldades encontradas por enfermeiros. Rev Univap [Internet]. 2012 [cited in 2022 Sept. 15]; 18(32): 52-65. Available in: http://revista.univap.br/index.php/revistaunivap/article/view/93.
http://revista.univap.br/index.php/revis...
.

The limitation found regarding the language barrier can also be highlighted. Due to the dialect of indigenous communities, the lack of understanding of the patient’s needs is a substantial obstacle in the care provided, since a reliable understanding of the complaints reported by the patient is essential for the nursing professional to understand the real needs of patients, as well as to create bonds1919 Reis LS dos, Borges RD de CF. Política nacional de atenção à saúde dos povos indígenas: atuação do enfermeiro no contexto intercultural. J Health Sci Inst [Internet]. 2019 [cited in 2022 Oct. 13];37(2):178-81 Available in: https://repositorio.unip.br/wp-content/uploads/2020/12/14V37_n2_2019_p178a181.pdf.
https://repositorio.unip.br/wp-content/u...

20 Borges JPA, Oliveira SM de. Atenção à saúde do recém-nascido e da criança indígena: perspectivas de atuação do enfermeiro. Rev Enferm Atenção Saúde [Internet]. 2016 [cited in 2022 Oct. 13]; 5 (2): 111-21. Available in: https://seer.uftm.edu.br/revistaeletronica/index.php/enfer/article/view/1426.
https://seer.uftm.edu.br/revistaeletroni...
-2121 Packeiser PB, Castro MS de. Avaliação do processo de dispensação de medicamentos na saúde indígena por meio de simulação de atendimento. Clin Biomed Res [Internet]. 2021 [cited in 2022 Oct. 13];41(1). https://www.seer.ufrgs.br/hcpa/article/view/105514
https://www.seer.ufrgs.br/hcpa/article/v...
.

Corroborating this finding, a retrospective cross-sectional study2121 Packeiser PB, Castro MS de. Avaliação do processo de dispensação de medicamentos na saúde indígena por meio de simulação de atendimento. Clin Biomed Res [Internet]. 2021 [cited in 2022 Oct. 13];41(1). https://www.seer.ufrgs.br/hcpa/article/view/105514
https://www.seer.ufrgs.br/hcpa/article/v...
found that, given the technical language used in the health area, it is impossible to affirm that a literal and full translation is possible; however, it is necessary to use non-verbal communication through visual resources such as symbols, images, and gestures2222 Guimarães VCB, Parente F de A. A Arte Indígena Asuriní como instrumento de comunicação e linguagem não verbal. Educamazônia-Educação, Sociedade e Meio Ambiente[Internet]. 2019 [cited in 2022 Oct. 13];22(1,), 302-313.Available in: https://periodicos.ufam.edu.br/index.php/educamazonia/article/view/5778/4498.
https://periodicos.ufam.edu.br/index.php...
. However, because it is a job that in many regions of Brazil is marked by an intense interpersonal relationship, whose professionals are forced to constantly adapt to other standards of comfort and privacy for long periods of time, the separation from their social environment can cause not only cultural, but also emotional and labor-related stress1414 Martins JCL. O trabalho do enfermeiro na saúde indígena: desenvolvendo competências para a atuação no contexto intercultural [Dissertation] São Paulo, 2017. 174 p. Available in: https://ds.saudeindigena.icict.fiocruz.br/bitstream/bvs/720/2/520576206.pdf.
https://ds.saudeindigena.icict.fiocruz.b...
. Therefore, besides the geographical barrier (facing long walks, strong sun, and river crossings), nurses need courage and motivation to promote quality care1616 Marinelli N, Nascimento DF, Costa AIP, Posso MBS, Araújo LP. Assistência à população indígena: dificuldades encontradas por enfermeiros. Rev Univap [Internet]. 2012 [cited in 2022 Sept. 15]; 18(32): 52-65. Available in: http://revista.univap.br/index.php/revistaunivap/article/view/93.
http://revista.univap.br/index.php/revis...
.

Moreover, in addition to geographic and language barriers, professionals in indigenous areas feel the impact of the precarious infrastructure, characterized by the lack of necessary equipment and materials, besides not always having access to adequate physical spaces in the villages to carry out procedures14, 16. Also, nurses often face an overload of work, due to the lack of medical professionals, especially in the hard-to-reach areas, increasing their level of responsibility. In these situations, nurses are often required to perform activities outside their competence, for which they have not been thoroughly prepared, such as prescribing drug treatments and assisting with intercurrence childbirths1313 Rocha ESC, Gonçalves MJF, Cruz MJF da, Baroni RAL. Profile of nurses who work in indigenous and non-indigenous health care. Ciênc cuid saúde [Internet]. 2018 [cited in 2022 Sept. 15]; 17(4):1-8. Available in: https://periodicos.uem.br/ojs/index.php/CiencCuidSaude/article/view/45195/751375139159.
https://periodicos.uem.br/ojs/index.php/...
-1414 Martins JCL. O trabalho do enfermeiro na saúde indígena: desenvolvendo competências para a atuação no contexto intercultural [Dissertation] São Paulo, 2017. 174 p. Available in: https://ds.saudeindigena.icict.fiocruz.br/bitstream/bvs/720/2/520576206.pdf.
https://ds.saudeindigena.icict.fiocruz.b...
.

In the selected studies, it was possible to identify that there are professionals who naturally have the vocation to practice nursing in these locations, however, most go searching for job opportunities and, when establishing the first contact with these peoples, they end up facing a great cultural shock1616 Marinelli N, Nascimento DF, Costa AIP, Posso MBS, Araújo LP. Assistência à população indígena: dificuldades encontradas por enfermeiros. Rev Univap [Internet]. 2012 [cited in 2022 Sept. 15]; 18(32): 52-65. Available in: http://revista.univap.br/index.php/revistaunivap/article/view/93.
http://revista.univap.br/index.php/revis...
,2323 Oliveira MLC de. Análise da capacitação dos enfermeiros que atuam na atenção à saúde das populações indígenas. [dissertation]. Amazonas, 2013. 137 p. Available in: https://tede.ufam.edu.br/handle/tede/3421.
https://tede.ufam.edu.br/handle/tede/342...
. It is also worth mentioning the relevant and comprehensive role of the nurse in the problematic issues that this work involves, whether in the ethnic, social, economic, and structural areas, among others. It is important to highlight that indigenous people have their own beliefs and behaviors about what health and disease represent to them; therefore, the professionals involved in the care of these people should take into consideration the needs of each one. For this, it is essential to construct new studies in the area, since there is a considerable scarcity of updated research on this theme, this being the major limitation of this study, due to the difficulty in obtaining adequate bibliographic references to compose the sample.

CONCLUSION

The main nursing actions provided for the health of indigenous populations are consultations and nursing supervision, health education, and protagonism in the activities of health promotion, protection, and recovery. Furthermore, it was possible to identify in the studies that the nursing team encounters several difficulties in the assistance, such as the difficult location of the villages, high work overload due to the lack of medical professionals, language barrier, inadequate working conditions, lack of water and basic sanitation.

Thus, this article is innovative in that it systematically investigates nursing care for indigenous populations and provides information to professionals in the area that can guide them about the assistance offered to this public, as well as the difficulties already faced by other professionals, which can guide them in planning care for this population. We emphasize the gaps found in the academic training of these professionals about this vulnerable population, highlighting the need for training, even during graduation, to act in indigenous health care because many professionals end up facing a great cultural shock, affecting the assistance provided.

With this article, we hope to stimulate the production of more studies with this public so that we can achieve specialized care, breaking the paradigms of the difficulties encountered, which have been the same for some decades. Even with some restriction on the articles found, it was evident that nurses play a primordial role in collective health practices directed at the indigenous population, being present in various actions and health planning.

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Edited by

Associate editor:

Dra. Virginia Souza

Publication Dates

  • Publication in this collection
    07 Aug 2023
  • Date of issue
    2023

History

  • Received
    16 Nov 2022
  • Accepted
    23 Mar 2023
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