The Impact of Advance Care Planning on Healthcare Professionals' Well-being: A Systematic Review.

CONTEXT: Advance care planning (ACP) improves care for patients with chronic illnesses and reduces family stress. However, the impact of ACP interventions on healthcare professionals' well-being remains unknown. OBJECTIVE: To systematically review the literature evaluating the impact of ACP interventions on healthcare professionals' well-being. METHODS: We followed the Joanna Briggs Institute methodology for systematic reviews and registered the protocol in PROSPERO (CRD42022346354). We included primary studies in all languages that assessed the well-being of healthcare professionals in ACP interventions. We excluded any studies on ACP in psychiatric care and in palliative care that did not address goals of care. Searches were conducted on April 4, 2022, and March 6, 2023 in Embase, CINAHL, Web of Science, and PubMed. We used the Mixed Methods Appraisal Tool for quality analysis. We present results as a narrative synthesis because of their heterogeneity. RESULTS: We included 21 articles published in English between 1997 and 2021 with 17 published after 2019. All were conducted in high-income countries, and they involved a total of 1278 participants. Three reported an interprofessional intervention and two included patient partners. Studies had significant methodological flaws but most reported that ACP had a possible positive impact on healthcare professionals' well-being. CONCLUSION: This review is the first to explore the impact of ACP interventions on healthcare professionals' well-being. ACP interventions appear to have a positive impact, but high-quality studies are scarce. Further research is needed, particularly using more rigorous and systematic methods to implement interventions and report results.

Evidence on Scaling in Health and Social Care: An Umbrella Review.

Policy Points More rigorous methodologies and systematic approaches should be encouraged in the science of scaling. This will help researchers better determine the effectiveness of scaling, guide stakeholders in the scaling process, and ultimately increase the impacts of health innovations. The practice and the science of scaling need to expand worldwide to address complex health conditions such as noncommunicable and chronic diseases. Although most of the scaling experiences described in the literature are occurring in the Global South, most of the authors publishing on it are based in the Global North. As the science of scaling spreads across the world with the aim of reducing health inequities, it is also essential to address the power imbalance in how we do scaling research globally. CONTEXT: Scaling of effective innovations in health and social care is essential to increase their impact. We aimed to synthesize the evidence base on scaling and identify current knowledge gaps. METHODS: We conducted an umbrella review according to the Joanna Briggs Institute Reviewers' Manual. We included any type of review that 1) focused on scaling, 2) covered health or social care, and 3) presented a methods section. We searched MEDLINE (Ovid), Embase, PsycINFO (Ovid), CINAHL (EBSCO), Web of Science, The Cochrane Library, Sociological Abstracts (ProQuest), Academic Search Premier (EBSCO), and ProQuest Dissertations & Theses Global from their inception to August 6, 2020. We searched the gray literature using, e.g., Google and WHO-ExpandNet. We assessed methodological quality with AMSTAR2. Paired reviewers independently selected and extracted eligible reviews and assessed study quality. A narrative synthesis was performed. FINDINGS: Of 24,269 records, 137 unique reviews were included. The quality of the 58 systematic reviews was critically low (n = 42). The most frequent review type was systematic review (n = 58). Most reported on scaling in low- and middle-income countries (n = 59), whereas most first authors were from high-income countries (n = 114). Most reviews concerned infectious diseases (n = 36) or maternal-child health (n = 28). They mainly focused on interventions (n = 37), barriers and facilitators (n = 29), frameworks (n = 24), scalability (n = 24), and costs (n = 14). The WHO/ExpandNet scaling definition was the definition most frequently used (n = 26). Domains most reported as influencing scaling success were building scaling infrastructure (e.g., creating new service sites) and human resources (e.g., training community health care providers). CONCLUSIONS: The evidence base on scaling is evolving rapidly as reflected by publication trends, the range of focus areas, and diversity of scaling definitions. Our study highlights knowledge gaps around methodology and research infrastructures to facilitate equitable North-South research relationships. Common efforts are needed to ensure scaling expands the impacts of health and social innovations to broader populations.

Acumulação flexível e paradigma gerencial: os impactos na qualificação dos técnicos de enfermagem nos anos 2000 / Flexible accumulation and management paradigm: the impacts on qualification of nurse technician in the 2000s / Acumulacíon flexible y paradigma gerencial: los impactos en la cualificación de técnicos de enfermería en los años 2000

Resumo Neste artigo, identifico as determinações políticas e sociais que perpassam a gestão do trabalho no Sistema Único de Saúde durante os anos 2000 e discuto a configuração da qualificação do trabalho dos técnicos de enfermagem com base em documentos oficiais do período. O trabalho no Sistema Único de Saúde, nas últimas duas décadas, foi perpassado por dois movimentos centrais: ideias de gestão adotadas pelo Estado relacionadas ao paradigma da administração pública gerencial; e articulação das especificidades do trabalho em saúde, a um só tempo, com os princípios e diretrizes definidos para o sistema na Constituição Federal de 1988 e com os modos de organização do trabalho característicos do padrão de acumulação flexível. A conformação desses elementos, por sua vez, se expressa nas ações e programas do Ministério da Saúde como novas demandas para o trabalho em saúde, que dão ênfase aos aspectos subjetivos, emocionais e relacionais da atividade.

Abstract In this article, we identify the political and social determinations that underlie the work of management in the Brazilian Unified Health System during the 2000s and discuss the configurations of the qualification of nurse technicians based on official documents of the period. The work on the National Health System, in the last two decades, was permeated by two central movements: management ideas adopted by the State related to the paradigm of public administration management; and articulation of the specificities of the health work, at the same time, with the principles and guidelines defined by the Federal Constitution of 1988 and with the ways of organizing work characteristic of flexible accumulation pattern. The shape of these elements, in turn, is expressed in the actions and the Ministry of Health programs as new demands for health work, which give emphasis to the subjective, emotional and relational aspects of activity.

Resumen En este artículo, identifico las determinaciones políticas y sociales que discurren en la gestión del trabajo en el Sistema Único de Salud Brasileño durante los años 2000 y discuto la configuración de la cualificación del trabajo de los técnicos de enfermería con base en documentos oficiales del periodo. El trabajo en el Sistema Único de Salud, en las últimas dos décadas, fue discurrido por dos movimientos centrales: ideales de gestión adoptados por el Estado relacionados a lo paradigma de la administración pública gerencial; y articulación de las especificidades del trabajo en salud, a un solo tiempo, con los principios y directrices definidos para el sistema en la Constitución Federal de 1988 y con los modos de organización del trabajo característicos del estándar de acumulación flexible. La conformación de esos elementos, por su vez, se expresa en las acciones y programas del Ministerio de la Salud como nuevas demandas para el trabajo en salud, que dan énfasis a los aspectos subjetivos, emocionales y relacionales de la actividad.

O estado da arte da formação profissional do técnico em hemoterapia / The state of the art of professional training of hematology technicians

Neste artigo, o foco está direcionado para a trajetória formativa do técnico em hemoterapia. Por meio de um estudo comparado, foi realizada uma análise de documentos referentes ao processo de institucionalização do curso técnico em hemoterapia. O referencial teórico-metodológico utilizado na pesquisa foi o do materialismo histórico, tendo por eixo norteador o conceito de qualificação oriundo da sociologia do trabalho. O material analisado é composto por um parecer emitido pelo Conselho Federal de Educação, pelo Catálogo Nacional de Cursos Técnicos (CNCT) e pelo Programa de Formação de Profissionais de Nível Médio para a Saúde (PROFAPS). Desde a regulamentação do curso na década de 1990, a oferta do curso técnico em hemoterapia não se consolidou, bem como a regulamentação da profissão ou da ocupação. O que se pode depreender deste estudo é que os desafios tanto para a formação quanto para a profissionalização do técnico em hemoterapia estão postos e não são poucos. Isso porque a prática real da atividade do técnico em hemoterapia acontece no cotidiano dos hemocentros e laboratórios em geral.

In this article, the focus is directed to the training route for the hemotherapy technician. Through a comparative study, an analysis of documents concerning the institutionalization process of the technical course on hemotherapy was performed. The theoretical and methodological framework used in the research was that of historical materialism, with the guiding principle being the concept of classification derived from the sociology of work. The material analyzed consists of a report issued by the Federal Board of Education, the National Catalog of Technical Courses (CNCT) and the Program of Training of Professionals of High School Level for Healthcare (PROFAPS). Since the regulation of the technical course in the 1990s, the provision of technical course on hemotherapy has not been consolidated,neither has the regulation of the profession or occupation. What can be concluded from this study is that there are challenges both for training and for the professionalization of the hemotherapy technician, and they are numerous. This is due to the fact that the actual practice of hemotherapy technician takes place on everyday life of laboratories and blood banks in general.