Educational actions conducted during the pandemic with primary health care professionals: a scoping review

OBJECTIVES

to map the educational actions conducted with primary health care professionals during the COVID-19 pandemic.

METHODS

a scoping review conducted in August 2023, which covered databases such as CINAHL, Medline, LILACS, IBECS, BDENF, and Web of Science. In total, 32 publications were analyzed through content analysis.

RESULTS

the primary beneficiaries of the educational actions included 69% physicians, 56% nurses, 25% pharmacists, 13% social workers and dentists, 9% psychologists, community health agents, and laboratory professionals, and 6% nursing technicians, nutritionists, and physical educators. The predominant educational interventions were training sessions (mentioned in 19 publications), followed by Continuing Health Education (10 publications) and Continuing Education (three publications).

FINAL CONSIDERATIONS

the educational interventions demonstrated positive impacts on professional practice, particularly the Continuing Health Education actions, which were notable for stimulating critical problem-solving among professionals.

Bioethical issues in the family health strategy: Considerations for nursing care management

OBJECTIVE

To understand the bioethical issues involved in the care management of nurses working in the Family Health Strategy.

METHOD

A qualitative study was conducted through five focus groups with 36 nurses selected in the sample. Thematic content analysis was performed based on the bioethical framework, and the synthesis was presented in a conceptual map.

RESULTS

Bioethical issues were identified in the nursing care practice, related to both specific bioethical themes and the peculiarities of the work. Additionally, challenges and facilitators that interfere with addressing these issues were identified.

FINAL CONSIDERATIONS

Understanding the bioethical issues involved in the care management of nurses was possible with the theoretical support of different bioethical perspectives. The identified issues relate to persistent and current themes in the field of bioethics. However, some aspects intrinsic to daily practice are still imperceptible to professionals, contributing to the difficulty of discussing bioethics in this care model.

Primary Health Care in transitional care of people with stroke

OBJECTIVES

to understand the role of Primary Health Care teams in caring for people with stroke after hospital discharge.

METHODS

single case study, with integrated units of analysis, with a qualitative approach. Data triangulation occurred through interviews with professionals and family caregivers involved in transition of care, in addition to direct observations in rounds and document analysis. For the analyses, the analytical strategies of theoretical propositions and construction of explanations were used, with the help of ATLAS.ti®.

RESULTS

the importance of counter-referral, the role of community health workers and the multidisciplinary team, health promotion, secondary prevention, home visits as a visceral attribute and nurses as care managers are evident.

FINAL CONSIDERATIONS

the high demand on teams and the Social Determinants of Health interfere with adequate continuity of care. Transitional care programs that enable continuity of care are recommended.

[National health systems, legislation, and social determinants: a comparative study of Brazil, Spain, Portugal, and Italy]

This is a documentary, exploratory, descriptive study, which is part of a multicenter international study assessing the national health systems with a care model based on primary health care of Brazil, Spain, Italy, and Portugal, funded by the Brazilian National Research Council (CNPq, acronym in Portuguese). It aims to identify the basic health legislation, the right to health, and the doctrinal and organizational principles of each country with a focus on the impact of social determinants of health on the national health systems. The results showed these countries have similar legislation and doctrinal principles, with a constitutional right to health, based on primary health care, and with a care model of the family health type. The challenges identified were low birth rate and high life expectancy at birth in European countries and criteria for access to medication and care financing. Based on our findings, the countries with higher investment in a structural basis, ensuring more dignified, solid, and vigilant socioeconomic and sanitary conditions, provide an important differentiation in responsiveness and sustainability of the national health system and direct impact on the quality of life.

[Organization of local healthcare systems in remote rural Brazilian municipalities to combat the COVID-19 pandemic]

During the COVID-19 pandemic, populations living further away from urban centers faced immense difficulties accessing health services. This study aims to analyze how Brazilian remote rural municipalities faced the COVID-19 pandemic based on their political, structural, and organizational response to access to healthcare. A qualitative study of multiple cases was conducted with thematic and deductive content analysis of 51 interviews conducted with managers and healthcare professionals in 16 remote rural municipalities in the states of Rondônia, Mato Grosso, Tocantins, Piauí, Minas Gerais, and Amazonas. With their socio-spatial dynamics and long distances to reference centers, the remote rural municipalities responded to the demands of the pandemic but did not have their needs met promptly. They preserved communication with the population, reorganized the local system centered on primary health care (PHC), and changed the functioning of healthcare units, exceeding the limits of their responsibilities to provide the necessary care and awaiting referral to other levels of complexity. They faced a shortage of services, gaps in assistance in the regional network, and inadequate healthcare transport. The pandemic reiterated PHC's difficulties in coordinating care, exposing care gaps in reference regions. The equitable and resolute provision of the local health system in the remote rural municipalities implies inter-federative articulation in formulating and implementing public policies to ensure the right to health.

Validation of the Brazilian Version of the Modified Scale for Delineating Advanced Practice Nursing Roles

OBJECTIVES

to validate the Brazilian version of the Modified Scale for Delineating Advanced Practice Nursing Roles.

METHODS

this was a methodological study for the clinical validation of an instrument, conducted with 207 nurses working in primary care. Exploratory and confirmatory factor analysis, Cronbach's alpha test, and z-test for proportion comparison were used.

RESULTS

the internal reliability of the scale was 0.944, with alpha greater than 0.80 in most domains, except for Education (0.786). In the exploratory factor analysis, considering the criterion of eigenvalue greater than one, eight factors were identified, explaining 79.38% of the variance. In the comparison of proportions, the adequate responses (≥ 2) in the domain of Comprehensive Direct Care, in both analyzed groups, were statistically equal. This domain had the highest score of adequate responses, followed by Education and Systems Support. Insufficient scoring was observed in the domains of Publication and Professional Leadership.

CONCLUSIONS

the instrument demonstrated stability and reliability to be used in the evaluation of advanced nursing practice.

Drug-resistant tuberculosis: integrative review of nursing care in primary health care

OBJECTIVES

to identify, in the scientific literature, the care that should be provided to individuals with drug-resistant tuberculosis by nurses in primary health care.

METHODS

integrative review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses study selection flowchart. Data collection was conducted in November 2022, across ten databases.

RESULTS

six studies emphasized that nurses should perform directly observed treatment; two highlighted the importance of integrated care management between tuberculosis and human immunodeficiency virus; two demonstrated comprehensive nursing consultation using the nursing process; one emphasized person-centered care, with discharge planning and improved hospital communication with primary health care services.

FINAL CONSIDERATIONS

the care that nurses should provide to individuals with drug-resistant tuberculosis in primary health care, for care resolution, is evidence-based.

Validation of an instrument for assessing leprosy care in children and adolescents

OBJECTIVES

to validate the content of an instrument for assessing leprosy care in individuals under 15 years old in the context of Primary Health Care.

METHODS

methodological study of content validation, based on the evaluation of essential and derived attributes in primary care, in the professional version. For data analysis, the Content Validation Index (CVI ≥ 0.8) and Cronbach's Alpha were calculated.

RESULTS

a higher percentage of judges among nurses (61.5%) was observed; with a doctorate (46.2%), and engaged in teaching and research (77%). The overall Content Validation Index of the instrument was 0.98. In the analysis of Cronbach's Alpha of the instrument, the assigned value was 0.717.

CONCLUSIONS

the instrument represents an advancement in the measurement of health evaluation policies and can significantly contribute to improving the quality of care provided to children and adolescents with leprosy.

Understanding intimate self-care among riverine women: qualitative research through the lens of the Sunrise Model

OBJECTIVES

to contribute to the change in understandings and knowledge of the popular system among riverine women about female intimate self-care before and after the application of an educational dynamic.

METHODS

a qualitative-participative study based on the Sunrise Model. Twenty women registered at a Basic Health Unit on the Combu island, state of Pará, Brazil, participated in the second half of 2022. Semi-structured interviews were conducted before and after the educational dynamic; followed by reflective inductive analysis.

RESULTS

these are pointed out: a female mechanism of generational education; the cultural act of bathing as synonymous with intimate self care and disease prevention; intimate care with medicinal herbs; lack of professional system approach to the topic; fear of using "muddy water"; and lack of financial resources to purchase specific products for genitourinary care.

FINAL CONSIDERATIONS

companionship and social factors drive intimate self-care; however, riverine women experience taboos, ignorance, and poverty.

Culture circle in primary care: dialogues with managers on health promotion

OBJECTIVE

To identify health promotion strategies used by managers in primary health care.

METHOD

Qualitative research, of a participant action nature, which adopted the Culture Circle proposed by Paulo Freire as its methodological reference. Eleven primary health care managers from a medium-sized municipality in southern Brazil took part.

RESULTS

Nine generative themes emerged, categorized into four themes that highlight the interconnection between health promotion, social determinants and primary health care. These themes highlight preventive approaches, healthy habits and underline the need for a multidisciplinary approach to health care, recognizing the complexity of the dimensions involved, the influence of social determinants, environmental and health issues. These aspects call for intersectoral policies and actions, demonstrating the viability of health promotion in line with the principles of the Unified Health System.

FINAL CONSIDERATIONS

The autonomy of professionals working in primary health care services is highlighted, especially that of nurses, who play a central role in connecting and organizing health promotion actions.

Validity of the TBApp mobile application for self-care management for people with tuberculosis

OBJECTIVES

to describe the validity process of the TBApp mobile application for self-care management for people with tuberculosis linked to Primary Health Care.

METHODS

methodological research developed with ten expert judges, carried out virtually. The application was assessed in relation to content and technology quality in seven domains (objectivity; structure and appearance; relevance; functionality; reliability; usability; and efficiency), using an instrument with a Likert scale.

RESULTS

TBApp was considered valid, relevant, functional, reliable and effective by expert judges. The objectives, structure and presentation and relevance domains presented an overall Content Validity Index of 0.93, and the functionality, reliability, usability and efficiency domains presented characteristics and sub-characteristics values greater than 0.80.

CONCLUSIONS

TBApp is a creative and innovative tool that can be used by people with TB and disseminated in the scientific community.

Primary health care professionals' practice in the face of leprosy: a scoping review

OBJECTIVES

to identify Primary Health Care professionals' practice in the face of leprosy.

METHODS

a scoping review, carried out between November 2022 and January 2023, conducted according to the methodological structure proposed by JBI and checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews in six databases and additional literature.

RESULTS

the sample consisted of 11 articles, published between 2008 and 2022. The findings were synthesized into three categories: Early diagnosis and timely treatment; Physical disability prevention; and Household and social contact surveillance.

FINAL CONSIDERATIONS

there is a need to align the practices carried out with those recommended by the Brazilian National Program for Leprosy Control and Elimination, as some were not identified in studies, which implies losses to qualified assistance directed to patient demands, with a view to control and elimination of leprosy.

Child health nursing consultation and competencies for Advanced Practice Nurses

OBJECTIVE

To analyze nurses' practice in child health nursing consultations and the presence of care management competencies proposed for Advanced Practice Nurses (APN).

METHOD

Multicenter, exploratory sequential mixed methods research, carried out in 17 Basic Health Units in four Brazilian cities. Collection was carried out from May to July 2022 through filming of consultation and analysis of medical records. Consultations with compliance with the Nursing Process ≥50% were analyzed to identify the competencies proposed for APN.

RESULTS

24 child consultations carried out by 12 nurses were filmed. In the quantitative analysis, 11 nursing consultations, carried out by seven nurses, achieved ≥50% Nursing Process compliance. In the qualitative analysis of these consultations, some APN competencies in care management were identified, but incomplete.

CONCLUSION

child health nursing consultations present weaknesses in carrying out the Nursing Process, and nurses demonstrated a partial and superficial application of the care management competencies proposed for APN.

Lists of potentially inappropriate medications for older people in primary care: a systematic review of health outcomes

This study is a systematic literature review of the association between lists of potentially inappropriate medications (PIM) in clinical practice and health outcomes of older adults followed up in primary health care. For this purpose, the PRISMA protocol was used to systematize the search for articles in the PubMed, Web of Science, Scopus, Cochrane Central, LIVIVO and LILACS databases, in addition to the gray literature. Studies with randomized clinical trials were selected, using explicit criteria (lists) for the identification and management of PIM in prescriptions of older patients in primary care. Of the 2,400 articles found, six were used for data extraction. The interventions resulted in significant reductions in the number of PIM and adverse drug events and, consequently, in potentially inappropriate prescriptions (PIP) in polymedicated older adults. However, there were no significant effects of the interventions on negative clinical outcomes, such as emergency room visits, hospitalizations and death, or on improving the health status of the older adults. The use of PIM lists promotes adequate medication prescriptions for older adults in primary health care, but further studies are needed to determine the impact of reducing PIM on primary clinical outcomes.

Learning difficulties in school children: health and education professionals' perceptions

OBJECTIVES

to understand health and education professionals' perceptions regarding children's learning difficulties in public schools.

METHODS

qualitative research, of the participatory action type, linked to Paulo Freire's Research Itinerary. Forty-five professionals participated, through interviews and a Virtual Culture Circle. The analysis was developed through careful reading, reflection and interpretation of highlighted topics.

RESULTS

professionals discussed the (in)visibility of learning difficulties, strategies and resources in the educational sector and the search for solutions in the health sector. It was found that the production of complaints related to school learning is attributed predominantly as an individual problem of children or their family, exempting the educational institution from this process.

FINAL CONSIDERATIONS

greater investment in professional training and development policies is urgently needed to facilitate coordination between sectors, with a view to overcoming outdated pedagogical and health models.

[Effects of parliamentary amendments on municipal financing of primary health care in the Brazilian Unified National Health System]

This study aims to analyze the effects of the expansion of the federal transfer of parliamentary amendments for municipal financing of primary health care (PHC) in the Brazilian Unified National Health System (SUS), from 2015 to 2020. A longitudinal study was conducted using secondary data on transfers of parliamentary amendments from the Brazilian Ministry of Health and expenditure of municipalities' own resources on public health actions and services and PHC. The effect of the transfer of parliamentary amendments on municipal financing was verified in a stratified way by population size of the municipalities, using generalized estimating equation models. The transfer of parliamentary amendments for PHC showed a large discrepancy in per capita values among municipalities of different population sizes. No correlation with municipal spending on public health actions and services was observed in municipalities with more than 10,000 inhabitants, and the association with spending on PHC (p < 0.050) was inverse in all municipalities. Therefore, the increase in the transfer of parliamentary amendments by the Brazilian Ministry of Health favored a reduction in the allocation of municipal revenues to PHC, which may have been directed to other spending purposes in the SUS. These changes seem to represent priorities established for municipal budget expenditure, which have repercussions on local conditions for guaranteeing stable funding for PHC in Brazil.

Primary Health Care nurses' role in treating Lower Urinary Tract Dysfunction

OBJECTIVE

To understand Primary Health Care nurses' role in treating Lower Urinary Tract Dysfunction.

METHOD

Cross-sectional multi-methodological research, composed of quantitative and qualitative steps, independently and sequentially. Data collected remotely, through a questionnaire and focus group, analyzed using descriptive statistics and thematic analysis by Braun and Clarke, respectively. The project was approved under Opinion 22691119.0.0000.0030.

RESULTS

A total of 145 nurses participated in the study in the quantitative step and 20 in the qualitative step, working in Primary Health Care in Brazil. Of the 93.1% nurses who reported having already cared for people with Urinary Tract Dysfunction, only 54.4% provided guidance, mainly for training the pelvic floor muscles.

CONCLUSION

Even though they have legal support and access to demand, nurses do not have the knowledge to offer conservative treatment for Lower Urinary Tract Dysfunction. Despite this, they were motivated to do so as long as they received specific training.

Primary health care organization in municipalities of São Paulo, Brazil: a model of care aligned with the Brazilian Unified National Health System's guidelines

This study analyzes the main organization patterns used by primary health care (PHC) services in municipal networks and evaluates them according to indicators of local management-administration interface. Evaluative research analyzed 461 municipalities in São Paulo, Brazil, that participated in the Primary Care Services Quality Assessment Survey (QualiAB) in 2017/2018, classified according to the organizational arrangements composition of 2,472 PHC services. Eight indicators of local management and administration were selected to evaluate the identified patterns. Results indicate two groups of municipalities: homogeneous, with services presenting the same arrangement (43.6%); and heterogeneous, with different arrangements (56.4%). These were subdivided into seven patterns that ranged from homogeneous-traditional, homogeneous-Family Health Strategy, homogeneous-mixed, and different combinations in the heterogeneous group. All indicators showed significant differences between groups (p < 0.001), especially the homogeneous-traditional group, which presented an organizational pattern far from the desired model of a comprehensive and problem-solving PHC. Those integrated with family health units (FHU) and basic health units with community health workers and/or family health teams (BHU/FHU) showed a pattern closer to a comprehensive model - with planning and evaluation actions committed to the local reality and qualification of care. Implementation of federal and state policies are essential for defining the PHC health care model adopted by municipalities.

Evidence of intrauterine device insertion by nurses in Primary Health Care: an integrative review

OBJECTIVES

to synthesize and analyze evidence on intrauterine device insertion by nurses in Primary Health Care.

METHODS

an integrative review, carried out in the BDENF, CINAHL, LILACS, SciELO, Scopus, PubMed and Web of Science databases in June 2022, delimiting the period from 1960 to 2022.

RESULTS

141 articles were identified in the initial search, and 10 studies made up the final sample. Four (40%) were developed in the United States and one (10%) in Brazil, with publications from 1979 to 2021. The findings were grouped into three categories: Nurse training to insert an intrauterine device; Nurses' competency to insert an intrauterine device; and Women's access to intrauterine devices.

CONCLUSIONS

nurse theoretical and practical training is a prominent element, consolidated in the favorable outcomes of insertions performed by nurses and satisfaction among women, a practice that has expanded access to the contraceptive method in Primary Health Care.

ICNP® terminological subset for preventing falls in the elderly in primary care

OBJECTIVE

Build and validate a terminological subset of ICNP® for the prevention of falls in the elderly in the context of primary health care, in light of the Self-Care Deficit Theory.

METHOD

Methodological study developed in accordance with ICN recommendations and the Brazilian method for constructing terminological subsets, in two stages: 1) construction of ICNP® statements of nursing diagnoses, outcomes, and interventions; 2) content validation of statements by specialist nurses.

RESULTS

A total of 182 diagnoses/outcomes and 321 nursing interventions were constructed, which were subjected to content validation by 28 experts, being validated with a Content Validity Index ≥ 0.80. After validation, the statements were organized according to self-care requirements and the majority of diagnoses/outcomes (51.6%) and interventions (52.7%) were classified under health deviation requirements.

CONCLUSION

It was possible to construct and validate a terminological subset of ICNP® with a predominance of statements related to health deviation requirements, standing out for being the first terminological subset for the prevention of falls in the elderly in the context of primary care.

[Quality of anthropometric data of children under 5 years in the Brazilian National Food and Nutrition Surveillance System, 2008-2020]

The planning, monitoring, and evaluation of food and nutrition actions depend on reliable estimates based on adequate anthropometric data. The study aimed to analyze the quality of anthropometric data of children aged under 5 years in the Brazilian National Food and Nutrition Surveillance System (SISVAN) from 2008 to 2020. The sample comprised 23,453,620 children aged under 5 years. Initially, we evaluated the distribution of missing values and values outside the spectrum of the instrument, and calculated the digit preference index for weight and height. The nutritional indexes height for age (HAZ), weight for age (WAZ), and body mass index for age (BAZ) were calculated according to the World Health Organization 2006 child growth standards. Then, we identified the biologically implausible values (BIV) and calculated the standard deviation (SD) of the nutritional indexes. For each municipality, we calculated the mean and SD of HAZ and WAZ; and plotted the SD values as a function of the mean. In all Federative Units, the digit preference index reached a minimum value of 80 for height and 20 for weight. For the three nutritional indexes, there was a reduction in the frequency of BIV in the 2008-2020 period. Even after the exclusion of BIV, we identified high variability for the three nutritional indexes. The indicators evaluated showed low quality of measurement, especially in the North and Northeast regions. Our results indicate insufficient quality of anthropometric data in children aged under 5 years, and reinforce the need to invest in actions to improve the collection and recording of anthropometric information.

Nurses' perceptions about the patient safety climate in Primary Health Care

OBJECTIVE

to evaluate the patient safety climate in Primary Health Care from the perspective of nurses working in the services.

METHOD

a quantitative and cross-sectional study conducted with 148 nurses from a municipality in the state of São Paulo. The Brazilian version of the Primary Care Safety Questionnaire Survey and personal, professional, and organizational performance variables (intention to stay at work, job satisfaction, care quality, and frequency of incidents) were used. Parametric and non-parametric comparison tests and Spearman's correlation coefficient were performed, considering a 5% significance level.

RESULTS

the safety climate was positive, varying from 4.52 to 5.33 and differing across districts for workload (p=0.0214) and leadership (p=0.0129). The safety climate professional variables and dimensions differed in relation to the frequency of incidents. Teamwork and safety and learning system were strongly correlated with job satisfaction and moderately with perceived care quality.

CONCLUSION

teamwork and safety and learning system stood out for their positive correlations with job satisfaction and care quality. A positive safety climate favors the involvement of Primary Care nurses to develop improvement plans aligned with the National Patient Safety Program.

BACKGROUND

(1) The safety climate is perceived differently across health districts. (2) There is a correlation between the climate dimensions and professional satisfaction. (3) Workload and leadership exert an influence on the safety climate perception. (4) There is a relationship between the safety climate and reporting of care-related incidents. (5) The safety climate is perceived differently among nurses regarding their role.

Educational action to monitor children's growth and development based on the theory of meaningful learning

OBJECTIVE

Evaluating the effect of an educational program on the knowledge of Primary Health Care nurses regarding the surveillance of growth and development during childcare appointments.

METHOD

A before-after intervention study with 30 nurses. The nurses' knowledge and practice assessment were done using a tool that had been developed and validated. The educational activity was carried out, linking child growth and development indicators with public policies for early childhood and nurses' practices. David Ausubel's Significant Learning Theory was used as a teaching-learning strategy. The same instrument was reapplied after one month. Descriptive statistics were used in the analysis and the proportion test, Wilcoxon test and Item Response Theory with the Rasch model were applied.

RESULTS

The nurses checked more items right in the instrument after the intervention; there was an increase in the scores of correct answers and a decrease in the item response difficulty index in the knowledge and practice section, post-intervention.

CONCLUSION

The educational activity had a positive effect, affecting changes in nurses' knowledge and practice, which enabled childcare consultations to become more qualified.

Nursing care for the Warao people: an experience report based on transcultural theory

OBJECTIVE

To report on the experience of nurses from the Street Clinic in caring for the Indigenous Venezuelan population of the Warao ethnic group in Maceió/AL based on Madeleine Leininger's Transcultural Theory.

METODOLOGY

A descriptive study, of the experience report type, based on the care of the Warao Indigenous population in the light of Madeleine Leininger's Transcultural Theory, carried out during the year 2022.

RESULTS

Light technologies were used to form bonds and understand the cultural universe of the Warao people. The concepts of preservation, accommodation and cultural restructuring of care from Leininger's transcultural theory helped to elucidate the practice. Comprehensive care was offered in accordance with the programs recommended by the Ministry of Health, with transcultural care, including respect for refusal of care. The language barrier and health beliefs represented challenges in the context of singular care.

FINAL CONSIDERATIONS

The experience of nurses from the Street Clinic in caring for the Indigenous population favored significant social interaction and expanded the possibilities for achieving comprehensive health care. The application of Transcultural Theory proved to be an effective and congruent device for health care.

[Evaluation of the impact of the implementation of the new primary health care information system on records of patient care and home visits in Brazil]

The replacement of the Primary Care Information System (SIAB, 1998-2015), as of January 2016, by the new Health Information System for Primary Care (SISAB) determined new forms of collecting, processing, and using information, with a possible impact on the records of activities carried out in primary health care in Brazil. This study aimed to evaluate the implementation impact of the new information system on records of physicians' and nurses' patient care and home visits of community health workers (CHW) in Brazil from 2007 to 2019. To this end, a Bayesian structural time-series model approach was used, based on a diffuse state-space regression. From 2016 to 2019, 463.47 million physician care, 210.61 million nursing care, and 1.28 billion CHW visits were recorded. Following the trend recorded before the implementation, 598.86 million, 430.46 million, and 1.5 billion physician and nursing appointments and CHW visits would be expected, respectively. In relative terms, there was a decrease of 25% in physician care, 51% in nursing care, and 15% in CHW visits when compared to the value expected by the Bayesian method. The negative impact on the records of patient care and home visits identified in this study, whether due to difficulties in adapting to the new system or a reduction in improper records, must be investigated so that the challenge of improving the primary care information system can be understood and overcome in a planned way.