The Pursuit of Nurse Practitioner Practice Legislation: A Case Study.

Across the United States, nursing practice acts (NPAs) have been revised to include provisions that promote full practice authority (FPA) for nurse practitioners (NPs). Such revisions provide a mechanism to better utilize the full scope of NP services to address growing demands for access to health care. Modernized NPAs that facilitate FPA for NPs are imperative, especially now with the unprecedented health care crisis that the world now faces: Coronavirus Disease 2019. This is the first known study to use an embedded single-case study design, guided by the Kingdon policy stream model, to provide a detailed account of how stakeholders for NP FPA determine the appropriate time to pursue legislative changes to NP scope of practice regulations. Qualitative data analysis revealed four themes which comprised the components considered by stakeholders during their decision-making processes related to NP FPA: participants, problem, policy development, and politics. Themes were further collapsed within concepts from the Kingdon model to form the case description. Study findings can be used to increase the competency among NP FPA stakeholders in determining the timing of legislative pursuits for regulatory change.

New Coronavirus: (Re)thinking the care process in Primary Health and Nursing.

OBJECTIVE: to reflect on the challenges and power of the nursing care process in Primary Health Care in the face of the New Coronavirus, COVID-19, in the Brazilian scenario. METHOD: reflective study, based on the discursive formulation in the context of COVID-19 in Primary Health Care, based on theoretical foundations and practical effects of neoliberal policy, the care process, and Nursing. RESULTS: in Brazil, COVID-19, has caused the need for challenges for strengthening primary care in the face of neoliberal policy, but it presents the potential of dialogue with communities and the (re)creation of the nursing care process through solidary collaborative networks. FINAL CONSIDERATIONS: reflecting on the nursing care process in primary care restores the strength present in the cooperation between health teams and community solidarity networks to change social and health circumstances, despite the challenge imposed by underfunding aggravated by neoliberalism.

In the Same Storm but Different Boats.

People's experiences of the COVID-19 pandemic vary widely, with some groups suffering disproportionately.

Negligence, trauma and nervous shock.

Richard Griffith, Senior Lecturer in Health Law at Swansea University, considers whether nurses who have suffered psychological trauma because of the negligent handling of the COVID-19 outbreak can claim compensation.

Hospital Pharmacist experience in the Intensive Care Unit: Plan COVID.

The Intensive Care Unit (ICU) of the University Hospital of Fuenlabrada was  forced to critically increase its capacity in the COVID-19 pandemic. The objective of this work is to describe the activities promoted by the pharmacist in the care  of the critically ill patient in this context. A new organizational structure was  designed, analyzing the tasks necessary to make the processes profitable. Two  pharmacists joined the critical patient care to help the pharmacist who was  already integrated in the ICU team. The development of the operational  structure was carried out on three levels. The healthcare activity highlights the  daily participation of pharmacists in the two clinical sessions in which the ICU  teams evaluated all cases and made decisions. This in turn facilitated the  pharmaceutical validation that was carried out in the critical units themselves. In addition, one of the pharmacists created the Immuno-COVID Committee, in  which they participated together with different specialists for therapeutic  decision-making in the most complex cases. On the other hand, the availability  of human and material resources allowed the implantation of centralized  elaboration in the Pharmacy Service of many intravenous mixtures, including  antibiotics elastomers Pumps for continuous infusion, and non-sterile  elaborations. In logistics management, in addition to the acquisition of COVID- 19 therapies, the reconciliation with nursing activity stands out. The physical presence of the pharmacist favored the detection of needs, the  availability in time of medications in the unit, including sterile and non-sterile  preparations, and coordination with the central pharmacy. In knowledge  management, the participation of the pharmacist in the working group for the  development of the hospital management protocol COVID-19 stands out. The  daily presence in the unit and the joint work with the entire multidisciplinary team demonstrate the value that the pharmacist can bring. In addition to  efficient resource management, support for clinical decision-making and  improvement actions, it provides the climate of inter-professional trust necessary to respond to the complexity of the critical patient and promote joint  projects.

La Unidad de Cuidados Intensivos del Hospital Universitario de Fuenlabrada se  vio obligada a aumentar de manera crítica su capacidad en la pandemia por  COVID-19. El objetivo de este trabajo es describir las actividades impulsadas por el farmacéutico en la atención del paciente crítico en este contexto. Se diseñó  una estructura organizativa nueva, analizando las tareas necesarias para  rentabilizar los procesos. Dos farmacéuticos se incorporaron a la atención del  paciente crítico para ayudar al farmacéutico que ya estaba integrado en el  equipo de la Unidad de Cuidados Intensivos. El desarrollo de la estructura  operativa se llevó a cabo en tres niveles. En la actividad asistencial destaca la  participación diaria de los farmacéuticos en las dos sesiones clínicas en las que  los equipos de la Unidad de Cuidados Intensivos valoraban todos los casos y  tomaban las decisiones. Esto, a su vez, facilitaba la validación farmacéutica que  se realizaba en las propias unidades de críticos. Además, uno de los  farmacéuticos ideó el Comité Inmuno-COVID, en el que participaban junto a  diferentes especialistas para la toma de decisiones terapéuticas en los casos más complejos. Por otro lado, la disponibilidad de recursos humanos y materiales  permitió implantar la elaboración de forma centralizada en el Servicio de Farmacia de muchas mezclas intravenosas, incluyendo elastómeros de  antibioterapia en perfusión continua, y de elaboraciones no estériles. En la  gestión logística, además de la adquisición de las terapias COVID-19, destaca la  conciliación con la actividad de enfermería. La presencia física del farmacéutico  favorecía la detección de necesidades, la disponibilidad en tiempo de  medicamentos en la unidad, incluyendo las elaboraciones estériles y no estériles, y la coordinación con la Farmacia central. En la gestión del conocimiento destaca la participación del farmacéutico en el grupo de trabajo para desarrollo del  protocolo hospitalario de manejo de la COVID-19. La presencia diaria en la  unidad y el trabajo conjunto con todo el equipo multidisciplinar ponen de  manifiesto el valor que el farmacéutico puede aportar. Además de una gestión  eficiente de los recursos, soporte en la toma de decisiones clínicas y acciones de  mejora, proporciona el clima de confianza interprofesional necesario para dar  respuesta a la complejidad del paciente crítico y promover proyectos conjuntos.

Duty, indemnity and immunity during the COVID-19 pandemic.

Richard Griffith, Senior Lecturer in Health Law at Swansea University, considers arrangements for indemnifying nurses returning to practice in the pandemic, and whether nurses might be given immunity from negligence claims.

Covid-19: Ethical Challenges for Nurses.

The Covid-19 pandemic has highlighted many of the difficult ethical issues that health care professionals confront in caring for patients and families. The decisions such workers face on the front lines are fraught with uncertainty for all stakeholders. Our focus is on the implications for nurses, who are the largest global health care workforce but whose perspectives are not always fully considered. This essay discusses three overarching ethical issues that create a myriad of concerns and will likely affect nurses globally in unique ways: the safety of nurses, patients, colleagues, and families; the allocation of scarce resources; and the changing nature of nurses' relationships with patients and families. We urge policy-makers to ensure that nurses' voices and perspectives are integrated into both local and global decision-making so as to minimize the structural injustices many nurses have faced to date. Finally, we urge nurses to seek sources of support throughout this pandemic.

De cuidador a paciente: na pandemia da Covid-19, quem defende e cuida da enfermagem brasileira? / De cuidador a paciente: en la pandemia de Covid-19, ¿quién defiende y cuida la enfermera brasileña? / From caregiver to patient: in the Covid-19 pandemic, who defends and cares for Brazilian nursing?

Objetivo: Refletir sobre a saúde do trabalhador de enfermagem diante da crise da pandemia pela Covid-19. Método: Artigo de reflexão cujo tema envolve a pandemia pela Covid-19 e a saúde do trabalhador de enfermagem. Desenvolveu-se a partir de duas seções teóricas: i) pandemia, aspectos epidemiológicos e recomendações para proteção do trabalhador de enfermagem; ii) saúde do trabalhador da enfermagem no contexto da Covid-19. Resultados. Os riscos à saúde do trabalhador de enfermagem, que já eram reocupantes antes da pandemia, tornaram-se alarmantes no atual contexto, especialmente por conta da incapacidade de um sistema de saúde há muito precarizado. Tal fato gera dilemas éticos, sofrimento físico e psíquico aos trabalhadores de enfermagem, além de adoecimentos e mortes. Conclusão e implicações para a prática. Logo, é preciso planejar e operacionalizar recursos materiais e humanos em quantidade e qualidade adequadas, considerando a premência do tempo, para dar suporte aos serviços de saúde e aos trabalhadores de enfermagem. Destaca-se o papel dos órgãos de classe, a necessidade da mobilização do coletivo profissional e o esforço de instâncias governamentais e sociais, como forma de mudar a situação apontada

Objective: Reflect on the health of nursing workers in the face of the pandemic crisis by Covid-19. Method: Reflection article whose theme involves the pandemic by Covid-19 and the health of nursing workers. It was developed from two theoretical sections: i) pandemic, epidemiological aspects and recommendations for the protection of nursing workers; ii) health of nursing workers in the context of Covid-19. Results. The risks to the health of nursing workers, which were already worrisome before the pandemic, have become alarming in the current context, especially due to the incapacity of a precarious health system existing for a long time. Conclusions and implications for practice. This fact generates ethical dilemmas, physical and psychic suffering for nursing workers, as well as illnesses and deaths. Therefore, it is necessary to plan and operationalize material and human resources in adequate quantity and quality, considering the last time, to support health services and nursing workers. We highlight the role of class organs, the need to mobilize the professional collective and the effort of governmental and social bodies, as a way to change the situation pointed out

Objetivo. Reflexionar sobre la salud de los trabajadores de enfermería ante la crisis de la pandemia por Parte de Covid-19. Método. Artículo de reflexión cuyo tema implica la pandemia de Covid-19 y la salud de los trabajadores de enfermería. Se desarrolló a partir de dos secciones teóricas: i) pandemia, spectos epidemiológicos y recomendaciones para la protección de los trabajadores de enfermería; ii) la salud de los trabajadores de enfermería en el contexto de Covid-19. Resultados. Los riesgos para la salud de los trabajadores de enfermería, que ya eran preocupantes antes de la pandemia, se han vuelto alarmantes en el contexto actual, especialmente debido a la incapacidad de un sistema de salud hace ya tempo precarizado. Este hecho genera dilemas éticos, sufrimiento físico y psíquico para los trabajadores de enfermería, así como enfermedades y muertes. Conclusiones e implicaciones para la práctica. Por lo tanto, es necesario planificar y poner en práctica los recursos materiales y humanos en cantidad y calidad decuadas, teniendo en cuenta la urgencia del tiempo, para apoyar a los servicios de salud y a los trabajadores de enfermería. Destacamos el papel de los órganos de clase, la necesidad de movilizar al colectivo profesional y el esfuerzo de los organismos gubernamentales y sociales, como una forma de cambiar la situación señalada

New Coronavirus: (Re)thinking the care process in Primary Health and Nursing / Nuevo Coronavírus: (Re)pensando el proceso de cuidar en Atención Primaria y Enfermería / Novo Coronavírus: (re)pensando o processo de cuidado na Atenção Primária à Saúde e a Enfermagem

ABSTRACT Objective: to reflect on the challenges and power of the nursing care process in Primary Health Care in the face of the New Coronavirus, COVID-19, in the Brazilian scenario. Method: reflective study, based on the discursive formulation in the context of COVID-19 in Primary Health Care, based on theoretical foundations and practical effects of neoliberal policy, the care process, and Nursing. Results: in Brazil, COVID-19, has caused the need for challenges for strengthening primary care in the face of neoliberal policy, but it presents the potential of dialogue with communities and the (re)creation of the nursing care process through solidary collaborative networks. Final considerations: reflecting on the nursing care process in primary care restores the strength present in the cooperation between health teams and community solidarity networks to change social and health circumstances, despite the challenge imposed by underfunding aggravated by neoliberalism.

RESUMEN Objetivo: Hacer una reflexión sobre los desafíos y potencias del proceso de cuidado de Enfermería en la Atención Primaria de Salud frente al nuevo Coronavirus, COVID-19, en el escenario brasileño. Método: Estudio reflexivo, fundamentado en la formulación discursiva de la COVID-19 en la Atención Primaria de Salud, con base en fundamentos teóricos y efectos prácticos de la política neoliberal sobre el proceso de cuidado de Enfermería. Resultados: La COVID-19 en Brasil ha impuesto desafíos para la Atención Primaria en razón de la política neoliberal, pero trae como potencia un mayor diálogo con las comunidades y la (re)creación del proceso de cuidado de Enfermería, a través de redes colaborativas solidarias. Consideraciones Finales: Esta reflexión fortalece la cooperación entre equipos de salud y redes solidarias comunitarias, en la búsqueda de mejorías en lo social y en la salud, ante los desafíos impuestos por la política neoliberal.

RESUMO Objetivo: refletir sobre desafios e potências do processo de cuidado de enfermagem na Atenção Primária à Saúde diante do Novo Coronavírus, COVID-19, no contexto brasileiro. Método: estudo reflexivo, fundamentado na formulação discursiva no contexto da COVID-19 na Atenção Primária à Saúde, com base em fundamentos teóricos e efeitos práticos da política neoliberal, do processo de cuidado e da Enfermagem. Resultados e Discussão: a COVID-19, no Brasil, tem imposto os desafios do fortalecimento da atenção primária em face à política neoliberal, mas apresenta como potência o diálogo com as comunidades e a (re)criação do processo de cuidado de enfermagem por meio das redes colaborativas solidárias. Considerações finais: refletir sobre o processo de cuidado de enfermagem na atenção primária restabelece a força presente na cooperação entre equipes de saúde e redes solidárias comunitárias para mudar situações sociais e de saúde, a despeito do desafio imposto pelo subfinanciamento agravado pelo neoliberalismo.