Nurse Navigator: development of a program for Brazil

Impact of multicomponent intervention on hospitalized clinical patient outcomes: A pre-post study in a university hospital

BACKGROUND AND OBJECTIVE

Hospitalization significantly interferes with the individual's well-being and it occurs both during and after the hospitalization period. Different approaches to minimize morbidity related to hospitalization and the post-discharge period have been proposed, especially to those aimed at reducing readmission rates. The aim of this study is to evaluate the effect of multicomponent intervention (MI) on operational indicators and continuity of care outcomes.

MATERIALS AND METHODS

A quasi-experimental study conducted in a Brazilian university hospital in order to compare the impact of the intervention with usual care. The MI was the implementation of multidisciplinary rounds, the inclusion of the role of the navigator nurse, and care transition actions with half of the Internal Medicine teams in a clinical unit of a general hospital. Adult patients hospitalized were included in 2 periods and divided in 3 groups - Group A: before the intervention; Group B: after and with MI; Group C after and without MI.

RESULTS

A total of 2333 hospitalizations were evaluated. There was a reduction in the rate of intensive care transfers to intensive care unit (ICU) and in the length of stay (LOS). LOS, discharge before noon, and transfers to ICU improved when comparing before and after the intervention, but were not different in post-intervention groups with and without MI.

CONCLUSION

These results reflect the improvement of care provided by MI, an effect that could be due to cross contamination also to teams without the intervention.

Primary health care as a tool to promote equity and sustainability; a review of Latin American and Caribbean literature

Primary health care (PHC) has increased in global relevance as it has been demonstrated to be a useful strategy to promote community access to health services. Multilateral organizations and national governments have reached a consensus regarding the basic principles of PHC, but the application of these varies from country to country due to the particularities of local health systems.This article aims to review and summarize PHC strategies and the configuration of health networks in Latin American and Caribbean countries.The review was carried out using keywords in at least 9 databases. Papers in languages other than English, Portuguese, and Spanish were excluded, while non-refereed articles and regional gray literature were incorporated. As a result, 1,146 papers were identified. After three instances of analysis, 142 articles were selected for this investigation. Data were analyzed according to an analysis by theme.The evidence collected on health reforms in the region reflects the need to intensify care strategies supported by PHC and care networks. These must be resilient to changes in the population's needs and must be able to adapt to contexts of epidemiological accumulation.

Care Transition From the Perspectives of Oncological Patients and the Multiprofessional Care Team: A Mixed Methods Study

BACKGROUND

Integration into the health system is essential for safe care and efficient use of resources.

OBJECTIVES

The aims of this study were to analyze the transition of care from the perspective of adult patients with neoplasia of the digestive tract and the multiprofessional care team, identify factors that influence the transition of care, and, collectively with professionals, create actions to improve the transition of care at the study site.

METHODS

The Care Transitions Measure-15 was administered in a mixed methods study, with a QUAN→QUAL sequential explanatory approach. The principles of deliberative dialogue were used as a knowledge translation strategy, and data integration was carried out.

RESULTS

The average score of the Care Transitions Measure-15 considered satisfactory was 74.3. The care plan factor had an unsatisfactory score of 66. Strategies to improve the care transition were listed by the focus group participants, such as supplementary care protocol for patients with neoplasms of the digestive tract, and providing a single discharge plan containing all information relevant to the treatment and continuity of patient care.

CONCLUSION

The low score for the care plan factor indicates weakness in the care transition.

IMPLICATIONS FOR PRACTICE

The integrated analysis results indicated that the care transition can be improved by an educational process during discharge planning, implementation of protocols for patients with neoplasia of the digestive tract, and identification of a reference caregiver to help patients navigate the healthcare system.

"Fala-M@no-COVID-19": technological development of a health navigation program for men during the pandemic

OBJECTIVE

to develop a care-educational technology similar to a health navigation program for men during the COVID-19 pandemic.

METHODS

a methodological and qualitative study of a care-educational technology of health navigation program, structured by Program Development Cycle, with 16 patient navigators and 10 professional navigators. It used reflective thematic content analysis and an adaptation model for data processing.

RESULTS

the "Fala-M@ano-COVID-19"; navigation program was developed by: I) Observation of reality, problem mapping, needs assessment: content selection, creation of domains and questions; II) Theoretical-conceptual and methodological definition, creation of product under the elaboration of care plans, based on theory, process and taxonomies by a flowchart of operationalization of actions; and III) Self-assessment: qualitative research with professional navigators.

FINAL CONSIDERATIONS

the technology developed, with theoretical and methodological support, allowed to derive a viable navigation program compatible with reality based on the audience's needs.

The impact of patient navigation on glycemic control, adherence to self-care and knowledge about diabetes: an intervention study

BACKGROUND

Patient navigation helps with better adherence to treatment, as well as better knowledge about diabetes and greater interest in performing, monitoring, and seeking health care. Therefore, this study aims to evaluate the effect of patient navigation on glycemic control, disease knowledge, adherence to self-care in people with type 1 diabetes mellitus.

METHODS

This is an intervention study using a single group pre-test post-test design, carried out in a tertiary public teaching hospital in Southern Brazil. Participants over 18 years of age and diagnosed with type 1 diabetes were included. In total, three teleconsultations and one face-to-face consultation were carried out, with three-month intervals, until completing one year of follow-up. The nurse navigator conducted diabetes education based on the guidelines of the Brazilian Diabetes Society and the Nursing Interventions Classification. The differences between glycated hemoglobin, adherence to self-care, and knowledge about initial and final diabetes were estimated to verify the effect of patient navigation by nurses, according to the tool applied in the first and last consultations. Interaction analyses between variables were also performed. Student's t-test, Generalized Estimating Equations, Wilcoxon test, and McNemar test were used.

RESULTS

The final sample consisted of 152 participants, of which 85 (55.9%) were women, with a mean age of 45 ± 12 years, and diabetes duration of 23.6 ± 11.1 years. Nurse navigators conducted 812 teleconsultations and 158 face-to-face consultations. After the intervention, glycemic control improved in 37 (24.3%) participants (p < 0.001), and knowledge about diabetes also improved in 37 (24.3%) participants (p < 0.001). Adherence to self-care increased in 82 (53.9%) patients (p < 0.001). The analysis of the interaction between glycemic control and the results from the questionnaire of knowledge about diabetes showed an interaction effect (p = 0.005). However, we observed no interaction effect between glycemic control and the results from the questionnaire on adherence to self-care (p = 0.706).

CONCLUSIONS

Our results showed improvement in glycemic control, adherence to self-care, and knowledge of diabetes in the study participants. In addition, they suggest that patient navigation performed by nurses is promising and feasible in improving care for patients with type 1 diabetes.

Coordination Models for Cancer Care in Low- and Middle-Income Countries: A Scoping Review

Background: The coordination of cancer care among multiple providers is vital to improve care quality and ensure desirable health outcomes across the cancer continuum, yet evidence is scarce of this being optimally achieved in low- and middle-income countries (LMICs). Objective: Through this scoping review, our objective was to understand the scope of cancer care coordination interventions and services employed in LMICs, in order to synthesise the existing evidence and identify key models and their elements used to manage and/or improve cancer care coordination in these settings. Methods: A detailed search strategy was conducted, aligned with the framework of Arksey and O’Malley. Articles were examined for evidence of coordination interventions used in cancer care in LMICs. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension Guidelines for Scoping Reviews, which included a checklist and explanation. The PRISMA flow diagram was utilised to report the screening of results. Data were extracted, categorised and coded to allow for a thematic analysis of the results. Results: Fourteen studies reported on coordination interventions in cancer care in LMICs. All studies reported a positive impact of cancer coordination interventions on the primary outcome measured. Most studies reported on a patient navigation model at different points along the cancer care continuum. Conclusions: An evidence-based and culturally sensitive plan of care that aims to promote coordinated and efficient multidisciplinary care for patients with suspicion or diagnosis of cancer in LMICs is feasible and might improve the quality of care and efficiency.

Breast cancer screening in Primary Health Care in Brazil: a systematic review

OBJECTIVES

to analyze care strategies for breast cancer screening in Primary Health Care in Brazil.

METHODS

this is a systematic review following the Cochrane Collaboration recommendations.

RESULTS

among 355 manuscripts, five were eligible. The patient navigation program by Community Health Agent stood out with the best result, among the strategies: flexibility of goals considering viability; community engagement; team training; active search of the target population by Community Health Agent; request for mammography by physicians; actions integrated to women's health; monitoring of mammography results, absent users, and population coverage by physician and nurse; and assessment of criteria for requesting screening mammography by means of an information system. The population coverage rate in the program ranged from 23% to 88%.

CONCLUSIONS

Primary Health Care in Brazil presents devices with potential to induce the production of care for breast cancer screening.

Nurse coordinator roles in the management of patients with hepatocellular carcinoma: A French national survey

Hepatocellular carcinoma (HCC) mostly occurs in patients with chronic liver disease (CLD). HCC treatment may have a direct impact on CLD prognosis. HCC management can therefore become complex, involving multiple health care providers, such as oncologists, hepatologists, radiologists, and surgeons. In France, dedicated nurses have been involved in patient care pathways. Their impact is poorly documented.

PURPOSE

To determine the country-wide distribution of HCC nurse coordinators in French health care settings and to describe their roles and responsibilities.

PATIENTS AND METHODS

A survey using a multi-item questionnaire (including center characteristics, nurse coordinator characteristics, and quality indicators such as patient care pathway initiation timeline, scheduled length of hospital stay, diagnostic disclosure process) was conducted. All French liver cancer centers planning to participate in a prospective national cohort study for patients with HCC (CHIEF Cohort) were invited to take part in the survey. Bivariate analysis compared centers with a nurse coordinator to those without.

RESULTS

Among the 42 of 72 centers that replied, 14 treated fewer than 75 HCC patients. Treatment mostly took place in hepatology units (34/42). Sixteen nurse coordinators were part of the health care team in 13 of the 42 centers. Among these 13 centers, 11 were university hospitals and 11 followed more than 75 patients per year. The median number of patients followed in these centers was 300 (min-max 44-600) in 2017. All nurse coordinators were involved in providing patient information and counseling. Other roles included treatment monitoring (13/16), care coordination (12/16), psychological support (12/16) and treatment planning (11/16). Thirteen nurse coordinators conducted diagnostic disclosure nurse consultations; seven conducted initial patient contact consultations; and six held outpatient nurse consultations, with wide heterogeneity between centers. The presence of a nurse coordinator was associated with completion of the full diagnostic disclosure process (p = 0.045).

CONCLUSION

In France, nurse coordinators for HCC patient pathway management are present mainly in university hepatology units with a caseload of more than 75 patients per year. All provide patient information and counseling but their roles in care coordination, patient support and holistic assessment are heterogeneous and not standardized.

PRACTICES OF HOSPITAL NURSES FOR CONTINUITY OF CARE IN PRIMARY CARE: AN EXPLORATORY STUDY

ABSTRACT Objective: to know the practices developed by hospital nurses for continuity of care for Primary Care. Method: this is an exploratory, qualitative research conducted in university hospitals in São Paulo and Curitiba, Brazil. For data collection, a semi-structured interview was conducted with the Director of Nursing and an online questionnaire through open-ended and closed-ended questions, with nurses between August 2018 and July 2019. The analyzes of the interviews were carried out as proposed by Minayo based on in the theoretical framework of continuity of care. Results: the research was conducted at three university hospitals, and one Director of Nursing and 48 nurses participated. From analysis of nurses’ answers, two categories of analysis emerged: identification of post-discharge patients’ care needs and the necessary competencies for continuity of care. Where it was perceived since patients’ admission, nurses’ concern for continuity of post-hospital discharge care, establishing flows together with nurses of the Internal Center for Regulation/Discharge Management Service for the Health Department of the municipality, which forwards to patients’ reference health unit. Conclusion: although nurses are professionals who actively participates in care at various points in the health care network and recognizes the importance of continuing post-discharge care, they remain a fragile point in the care chain, and it is necessary to strengthen this mechanism with Primary Care, optimize home care and avoid hospitalizations.