Effectiveness of a home health monitoring and education program for complex chronic patients, led by primary care nurses.

Background: The challenge of chronicity has led developed countries to design strategies to respond to the new needs of complex chronic patients (CCP). There is evidence supporting better beneficial effects and more efficient care for CCP when home-base care programs are provided by Primary Health Care professionals. The main objective of the present study was to assess the effectiveness of a nursing intervention program of home visits for CCP analyzing the use of health services in terms of hospital admissions, emergency care unit visits, and mortality rate. Methods: A quasi-experimental study was designed to retrospectively evaluate the effectiveness of a 3-year proactive, individualized nursing intervention in improving health outcomes measured by health service utilization (hospitalization, emergency care, and nursing home visits) in these patients. Of the 344 complex chronic patients participating in the study, 93 were assigned to the intervention group (IG) and 251 to the control group (CG). Results: Along the period of study, the number of home visits in the IG almost tripled in relation to the CG (14.29 ± 4.49 vs. 4.17 ± 2.68, p < 0.001). Admissions in the first and second year of the study period were lower in the intervention group p = 0.002 and p < 0.001 respectively. All the participants in the control group were admitted at least once during the study period. In contrast, 29.0% of the participants in the intervention group never had a hospital admission during the 3-years study period. The number of ED visits to the emergency department was significantly lower in the IG during the 3 years of the study periods. The cumulative number of emergency visits in the IG was half that in the CG (5.66 ± 4. vs. 11.11 ± 4.45, p < 0.001, Cohen'd,1.53). A total of 35.5% of the participants in the intervention group visited the emergency department on three or fewer occasions compared to 98% of the subjects in the control group who visited the emergency department on more than six occasions (p < 0.001). The 3-year overall mortality rate was 23.5% in the control group and 21.6% in the nursing home visit program. These differences were not statistically significant. Conclusion: The program demonstrated its effectiveness in reduction of hospital admissions and visits to the emergency department. The program had no impact on mortality rate. This program of home visits reinforces the role of primary care nurses in advanced competencies in chronicity.

Primary care patterns among dual eligibles with Alzheimer's disease and related dementias.

BACKGROUND: Primary care is essential for persons with Alzheimer's disease and related dementias (ADRD). Prior research suggests that the propensity to provide high-quality, continuous primary care varies by provider setting, but the settings used by Medicare-Medicaid dual-eligibles with ADRD have not been described at the population level. METHODS: Using 2012-2018 Medicare data, we identified dual-eligibles with ADRD. For each person-year, we identified primary care visits occurring in six settings. We calculated descriptive statistics for beneficiaries with a majority of visits in each setting, and conducted a k-means cluster analysis to determine utilization patterns, using the standardized count of primary care visits in each setting. RESULTS: Each year from 2012 to 2018, at least 45.6% of dual-eligibles with ADRD received a majority of their primary care in nursing facilities, while at least 25.2% did so in physician offices. Over time, the share relying on nursing facilities for primary care decreased by 5.2 percentage points, offset by growth in Federally Qualified Health Centers (FQHCs) and miscellaneous settings (2.3 percentage points each). Dual-eligibles relying on nursing facilities had more annual primary care visits (16.1) than those relying on other settings (range: 6.8-10.7 visits). Interpersonal care continuity was also higher in nursing facilities (97.0%) and physician offices (87.9%) than in FQHCs (54.2%), rural health clinics (RHCs, 46.6%), or hospital-based clinics (56.8%). Among dual-eligibles without care continuity, 82.7% were assigned to a cluster with few primary care visits. CONCLUSIONS: A trend toward care in different settings likely reflects improved access to patient-centered primary care. Low rates of interpersonal care continuity in FQHCs, RHCs, and physician offices may warrant concern, unless providers in these settings function as a care team. Nonetheless, every healthcare system encounter presents an opportunity to designate a primary care provider for dual-eligibles with ADRD who use little or no primary care.

Nursing Services in the First Level of Care in Colombia. Analysis of the Offer 2002-2020 / Servicios de enfermería en el primer nivel de atención en Colombia. Un análisis de la oferta 2002-2020 / Serviços de enfermagem no primeiro nível de atenção na Colômbia. Uma análise da oferta 2002-2020

Objective. This work sought to characterize the primary care nursing consultation services reported in the official systems of health services records in Colombia between 2002 and 2020. Methods. This was a cross-sectiona, retrospective study. Node geographic analysis and descriptive statistics were performed for quantitative data from the Special Registry of Health Providers and the Ministry of Health and Social Protection. Results.The study identified 6079 nursing services of which 72% are outpatient, 95.05% are assigned to institutions providing health services, 99.75% are of low complexity, and 48.22% of the offer was created in the last five years. The nodes with the highest increase in the offer of services are Caribbean (n = 909) and Pacific (n = 499), while Amazon (n = 48) showed the lowest offer in the last five years. Conclusions.Disparity is evident in the availability of services by region and node, in addition to a low liberal exercise to provide nursing care.

Objetivo.Caracterizar los servicios de consulta de enfermería de primer nivel de atención reportados en los sistemas oficiales de registros de servicios de salud en Colombia durante el periodo 2002-2020. Métodos.Estudio transversal de corte retrospectivo. Se realizó análisis geográfico por nodos y estadística descriptiva para los datos procedentes del Registro Especial de Prestadores en Salud (REPS) del Ministerio de Salud y Protección Social. Resultados.Se identificaron 6079 servicios de enfermería de los cuales el 72% son ambulatorios, el 95.05% están adscritos a instituciones prestadoras de servicios de salud, un 99.75% son de complejidad baja y, el 48.22% de la oferta se creó en los últimos 5 años. Los nodos que han mostrado mayor aumento en la oferta de servicios son Caribe (n=909) y Pacífico (n=499), mientras que Amazonia (n=48) ha mostrado la menor oferta en los últimos cinco años. Conclusión.Existe disparidad en la disponibilidad de servicios por región y nodo, además de un bajo ejercicio independiente para la provisión de atención en enfermería.

Objetivo.Caracterizar os serviços de consulta de enfermagem de primeiro nível de atenção informados nos sistemas oficiais de registro dos serviços de saúde na Colômbia durante o período 2002-2020. Métodos.Estudo transversal, retrospectivo. Foi realizada análise geográfica por nós e estatística descritiva para os dados do Cadastro Especial de Provedores de Saúde (REPS) do Ministério da Saúde e Proteção Social. Resultados.Foram identificados 6079 serviços de enfermagem, sendo 72% ambulatorial, 95.05% vinculados a instituições que prestam serviços de saúde, 99.75% são de baixa complexidade e 48.22% da oferta foi criada nos últimos 5 anos. Os nós que apresentaram maior aumento na oferta de serviços são Caribe (n = 909) e Pacífico (n = 499), enquanto a Amazônia (n = 48) apresentou a menor oferta nos últimos cinco anos. Conclusão.Há disparidade na disponibilidade de serviços por região e nó, além de um baixo exercício independente para a prestação de cuidados de enfermagem.

A análise da relação de enfermeiras(os) da estratégia saúde da família com a sua profissão / The analysis of the relationship of nurses in the family health strategy with their profession

Objetivo: Analisar a implicação profissional de enfermeiras(os) da Estratégia Saúde da Família (ESF). Métodos:Estudo descritivo, de abordagem qualitativa realizado com 19 enfermeiras(os) da ESF durante o primeiro trimestre de 2020. Foram realizadas entrevistas semiestruturadas, procedendo-se com a análise a partir das dimensões ideológica, libidinal e organizacional da implicação profissional, conforme referencial teórico da Análise Institucional. Resultados:Nas dimensões ideológica, libidinal e organizacional da implicação profissional foram identificados: a amplitude do trabalho da(o) enfermeira(o) na ESF; a sobrecarga de trabalho; a assistência de enfermagem e o trabalho em equipe; o vínculo com os(as) usuários(as); a falta de apoio da gestão e a ausência de articulação da rede de atenção à saúde. Conclusão: O trabalho em equipe corresponde ao vetor essencial para a prática profissional, o vínculo como principal motivador e a falta de apoio da gestão e da articulação em rede como dificultadores do exercício da enfermagem na ESF.

Objective: To analyze the professional involvement of nurses in the Family Health Strategy (FHS). Method:Descriptive study with a qualitative approach carried out with 19 nurses in the FHS during the first quarter of 2020. Semi-structured interviews were carried out, proceeding with the analysis from the ideological, libidinal and organizational dimensions of professional involvement, according to the theoretical framework of Institutional Analysis. Results:It was identified in the ideological, libidinal and organizational dimensions of professional involvement: the breadth of the nurse's work in the FHS; work overload; nursing care and teamwork; the bond with the users; the lack of management support and the lack of articulation of the health care network. Conclusion: Teamwork corresponds to the essential vector for professional practice, the bond as the main motivator and the lack of support from management and networking as obstacles to the exercise of nursing in the FHS.

'Depression is not a familiar word': A mixed-methods approach to describe the experience of primary care nurses treating depression in rural Guatemala.

BACKGROUND: As the burden of mental health disorders continues to increase worldwide, there is significant need to describe the cultural variations in presentation, diagnosis and treatment of these diseases. An understanding of these variations can lead to the development of more effective programs to manage these conditions. In Guatemala, depression is the second-leading cause of disability and yet mental health treatment resources are scarce, particularly for indigenous individuals. AIMS: The primary research aim was to describe primary care nurses' explanatory models of depression in their clinical work in indigenous communities in Guatemala. A secondary research aim was to describe training and resources which would support and empower these nurses, in order to lessen risk for burnout. METHODS: A cross-sectional mixed methods survey was designed to elicit nurses' perspectives on the presentation, cause and treatment of depression in the communities they serve, as well as their clinical and emotional comfort in working with depressed individuals. Two subsequent focus groups gathered qualitative commentary which informed training and resource recommendations. Theoretical thematic analysis was used to generate codes and themes from focus group transcripts and survey responses. RESULTS: Guatemalan primary care nurses described symptoms of depression in their cultural context, identified socioeconomic factors which contribute to depression in their communities, and detailed treatment preferences. Limited referral options and concern for privacy made connecting patients to mental health care difficult. Nurses emphasized the need for community education on depression and for supplemental mental health resources which would increase their capacity to identify and treat depression. CONCLUSIONS: Primary care nurses in Guatemala identify and treat depression despite limited resources. Further investigations should focus on creating training modalities which include front-line nurses, given their critical role in the health system.

Indicadores de boas práticas em saúde para a população de rua: revisão de escopo / Indicadores de buenas prácticas en salud para los habitantes de la calle: revisión de alcance / Indicators of good health practices for the homeless population: a scoping review

Resumo Objetivo Identificar os indicadores utilizados para embasar as Boas Práticas em Saúde à população de rua. Métodos Trata-se de uma revisão de escopo cuja seleção dos artigos ocorreu em dezembro de 2019 e foi atualizada em agosto de 2020. Os termos utilizados para a busca foram: homeless persons, homeless, runway, foster care, street people, health status indicators, primary care nursing e primary health care. Foram incluídos estudos publicados em língua inglesa, espanhola e portuguesa, sem delimitação de tempo de publicação. Resultados Foram selecionados 29 artigos. A partir da leitura na íntegra, houve a emergência de quatro categorias empíricas de indicadores: Relação do usuário com o serviço de atendimento; Avaliação das condições de saúde e doença; Avaliação da inclusão social e Avaliação das mudanças nas características comportamentais e psicológicas. Os estudos encontrados utilizaram-se de indicadores majoritariamente para perceber a adesão ao propósito do projeto de intervenção tendo por alvo a população de rua. Conclusão A forma para verificação destes indicadores foi variada, assim como os projetos de intervenção, não há um consenso acerca de que tipo de indicadores seria fértil para a avaliação das ações realizadas.

Resumen Objetivo Identificar los indicadores utilizados para basar las Buenas Prácticas en Salud de los habitantes de la calle. Métodos Se trata de una revisión de alcance, cuya selección de artículos se realizó en diciembre de 2019 y fue actualizada en agosto de 2020. Los términos utilizados para la búsqueda fueron: homeless persons, homeless, runway, foster care, street people, health status indicators, primary care nursing y primary health care. Se incluyeron estudios publicados en idioma inglés, español y portugués, sin restricción del tiempo de publicación. Resultados Se seleccionaron 29 artículos. A partir de su lectura completa, surgieron cuatro categorías empíricas de indicadores: Relación del usuario con el servicio de atención, Evaluación de las condiciones de salud y enfermedad; Evaluación de la inclusión social y Evaluación de los cambios de características de comportamiento y psicológicas. Los estudios encontrados utilizaron mayormente indicadores para percibir la adherencia al propósito del proyecto de intervención que tiene como destinatarios a los habitantes de la calle. Conclusión La forma de verificación de estos indicadores fue variada, así como los proyectos de intervención. No existe consenso sobre qué tipo de indicadores sería provechoso para la evaluación de las acciones realizadas.

Abstract Objective To identify the indicators used to support good health practices for the homeless population. Methods This is a scoping review whose selection of articles took place in December 2019 and was updated in August 2020. The terms used for the search were: homeless persons, homeless, runway, foster care, street people, health status indicators, primary nursing care and primary health care. Studies published in English, Spanish and Portuguese were included, without limitation of publication time. Results A total of 29 articles were selected. From the reading in full, four empirical categories of indicators emerged: User relationship with service; Assessment of health conditions and disease; Assessment of social inclusion; and Assessment of changes in behavioral and psychological characteristics. The studies found used indicators mostly to perceive compliance with the purpose of the intervention project targeting the homeless population. Conclusion The way to verify these indicators was varied, as well as the intervention projects, there is no consensus about what type of indicators would be fertile for assessment of the actions carried out.

Personal and professional characteristics of the primary care nurse in the cultural care of migrant populations.

OBJECTIVE: To analyze the personal and professional characteristics perceived by primary nurses from a province located in the Maule region, Chile, regarding care with cultural relevance of the migrant person. METHOD: Qualitative paradigm with an instrumental case study design, participated 9 professionals from 3 Family Health Centers, meeting inclusion criteria. The article is part of the doctoral thesis work and has the approval of the Scientific Ethics Committee of the Universidad Católica Del Maule. Data collection was through in-depth semi-structured interviews, between January and February 2020. The analysis was carried out from Albert Schütz's sociophenomenology with hermeneutical components. RESULTS: Empathy and cultural knowledge stand out as personal characteristics and in the professional area, comprehensive knowledge, and care. FINAL CONSIDERATIONS: Caring with cultural relevance is a challenge for nursing, training in cultural competence is required and continue researching on the subject.

Overwhelmed by Emotional Job Demands in High Vigor Days! Its Detrimental Effects on Daily Recovery from Work among Health-Care Workers.

The objective of this study is twofold: first, to analyze whether the daily level of energy in terms of vigor at work could explain the way in which workers psychologically detach from their work, relax, practice challenging activities, and have the feeling of having control over their leisure time when arriving home. Second, to check if the daily emotional job demands could hinder that relationship, reversing the positive effect of vigor in recovery. For this purpose, a multilevel study with a diary methodology was designed. In total, 94 nurses from various hospital and primary care centers in Madrid and Basque Country (Spain) participated in this study. They completed daily questionnaires twice a day (in the afternoon after work and at night before going to bed) for five consecutive workdays from Monday to Friday (N = 94*5 = 470). The results revealed that on days that vigor at work was high, nurses experienced more psychological detachment, relaxation, feelings of mastery, and time control at home. Moreover, on days that emotional job demands were high, vigor was more negatively related to psychological detachment and time control at home. Additionally, vigor was more positively related to all recovery experiences at home in days that emotional demands were low. Therefore, daily vigor can act as an energy resource that helps the worker to recover. However, this effect can occur in situations in which stressors are not present in high intensity. These results have clear practical implications for both health organizations and workers.

Os significados acerca da Estratégia Saúde da Família para uma comunidade / The meanings about the family health strategy for a community / Los significados acerca de la estrategia de salud de la familia para una comunidad

Objetivos: identificar os significados acerca da Estratégia Saúde da Família para uma comunidade. Método: estudo qualitativo, exploratório, descritivo e transversal, amostragem não probabilística e intencional, realizado com 20 participantes, com a utilização de dois instrumentos. Os dados das entrevistas foram avaliados considerando a abordagem do Discurso do Sujeito Coletivo pautados na Teoria das Representações Sociais. Quanto aos dados do questionário foram tratados de forma percentual. O estudo foi aprovado pelo Comitê de Ética em Pesquisa. Resultados: 75% eram do gênero feminino, faixa etária de 61 a 70 anos, 30% possuem ensino médio completo e 6 meses a 10 anos em que residem próximo a ESF. Emergiram duas ideias centrais "muito bom" e "nenhum". Conclusão: a maioria dos entrevistados atribuiu significados positivos diante da inserção da unidade em sua área de moradia. Porém, apesar da facilidade de acesso, ressaltam a necessidade de melhorias nos serviços.(AU)

Objectives: to identify the meanings about the Family Health Strategy for a community. Method: the study is a qualitative, exploratory, cross-sectional, non probabilistic and intentional sampling, composed with 20 participants using two instruments. The data from the interviews were evaluated considering the collective subject discourse approach based on the Theory of Social Representations. Regarding the data from the questionnaire, they were treated in a percentage way. The study was approved by the Research Ethics Committee. Results: 75% were female, aged 61 to 70 years, 30% had completed high school and 6 months to 10 years in which they live near the ESF. Two central ideas emerged "very good" and "none". Conclusion: the most of the interviewees attributed positive meanings to the insertion of the unit in their housing area. However, despite the ease of access, they still emphasize the need for improvements in services.(AU)

Objetivos: Identificar los significados sobre la Estrategia de Salud Familiar para una comunidad. Método: Estudio de enfoque cualitativo, exploratorio, descriptivo y transversal, muestreo no probabilístico e intencional, con un total de 20 participantes, con el uso de dos instrumentos. Los datos de las entrevistas fueron evaluados considerando el enfoque del discurso de sujeto colectivo basado en la Teoría de las Representaciones Sociales. En cuanto a los datos del cuestionario, fueron tratados de manera porcentual. El estudio fue aprobado por el Comité de ética de la investigación. Resultados: el 75% eran mujeres, de 61 a 70 años, el 30% habían completado la escuela secundaria y 6 meses a 10 años en los que viven cerca del FSE. Dos ideas centrales surgieron "muy buenas" y "ninguna". Conclusión: La mayoría de los entrevistados atribuyeron significados positivos a la inserción de la unidad en su área de vivienda. Sin embargo, a pesar de la facilidad de acceso, siguen insistiendo en la necesidad de mejorar los servicios.(AU)

Remote area nursing: best practice or paternalism in action? The importance of consumer perspectives on primary health care nursing practice in remote communities.

This paper reports on a study that aimed to understand how remote area nurses implemented primary health care principles in the Australian remote health care setting. Twenty-four Registered Nurses and Nurse Practitioners who worked in remote health services without inpatient facilities were interviewed using constructivist grounded theory methods. Findings revealed that nurses in this study aimed to practice in a way that was guided by Indigenous empowerment and social justice. However, some nurses questioned elements of their practice such as 'chasing' people for appointments or routine screening required by clinical guidelines that may not reflect the values of Indigenous peoples. Nurses expressed concern that they may be reinforcing past colonising practices and their actions may be considered paternalistic rather than empowering. Nurses in this study wanted to develop partnerships and provide nursing care that aligned with the health and wellbeing expectations of communities. However, ways of communicating the needs of communities and the development of partnerships between health providers and communities need to be developed. The present study calls for further research from the perspective of remote community members in order to develop ways of sharing knowledge about health and wellbeing between remote area nurses and communities.

Women's alcohol consumption in a Primary Health Care service / Consumo de alcohol de mujeres en un servicio de Atención Primaria de Salud / Consumo de álcool de mulheres em um serviço de Atenção Primária à Saúde

ABSTRACT Objective: To identify alcohol consumption patterns in people cared by a Primary Health Care service and verify the association between the patterns and the variables of the sample. Method: Our observational study used both the Alcohol Use Disorders Identification Test instrument and a questionnaire with socio-demographic, clinical, and behavioral questions for data collection. We carried out the descriptive and univariate analysis with Kendall and Kruskal-Wallis correlation tests. We introduced variables with p ≤ 0.2 values in the multiple logistic regression - Mann-Whitney test. Results: The sample of the study was constituted by 561 women. The analysis results indicated relevant influence for higher patterns of consumption: not having a partner, not having a religion, smoking and drug habits, and having arterial hypertension. Besides that, within each additional year in women's age, the alcohol consumption decreases. Conclusion: We endorsed data that female alcohol consumption is presenting a tendency to increase especially among younger women, this information is essential for the promotion of Primary Health Care.

RESUMEN Objetivo: Identificar el patrón del consumo de alcohol de usuarias de un servicio de Atención Primaria de Salud, examinando la asociación entre los patrones y las variables de la muestra. Método: Se trata de un estudio observacional que utilizó el Test de Identificación de Trastornos por Consumo de Alcohol y un cuestionario con preguntas sociodemográficas, clínicas y conductuales para la recogida de los datos. Se realizó un análisis descriptivo y univariado con las pruebas de correlación de Kendall y Kruskal-Wallis. Se introdujeron variables con valores de p≤0,2 en el modelo de regresión logística múltiple - Prueba de Mann-Whitney. Resultados: La muestra del estudio estaba formada por 561 mujeres. Los resultados del análisis señalan influencias relevantes en los patrones de consumo más elevados: no tener pareja, no tener religión, consumir tabaco y drogas y padecer hipertensión. Además, con cada año que aumenta la edad de la mujer, su patrón de consumo de alcohol disminuye. Conclusión: Se refuerzan los datos de que el consumo de alcohol tiende a aumentar en las mujeres, sobre todo en las más jóvenes, una información fundamental para los cuidados en la Atención Primaria de Salud.

RESUMO Objetivo: Identificar o padrão de consumo de álcool de usuárias de um serviço de Atenção Primária à Saúde, verificando a associação entre padrões e variáveis da amostra. Método: Estudo observacional que utilizou para coleta de dados o instrumento Alcohol Use Disorders Identification Test e questionário com questões sociodemográficas, clínicas e comportamentais. Realizou-se análise descritiva e univariada - teste de correlação Kendall e Kruskal-Wallis. Variáveis com valores de p≤0,2 foram introduzidas no modelo de regressão logística múltipla - teste de Mann-Whitney. Resultados: A amostra do estudo constituiu-se de 561 mulheres. Os resultados da análise apontam influência relevante para maiores padrões de consumo: não ter acompanhante, não ter religião, fazer uso de tabaco e de drogas e ter hipertensão arterial. Além disso, a cada ano acrescido na idade da mulher o seu padrão de consumo de álcool diminui. Conclusão: Reforçam-se dados de que o consumo de álcool feminino vem apresentando uma tendência ao crescimento especialmente entre as mais jovens, informação fundamental para a prestação de cuidados na Atenção Primária à Saúde.

Percepção dos alunos sobre o trabalho da enfermeira na estratégia de saúde da família / Students' perceptions of the nurse's work in the family health strategy

RESUMO Objetivo compreender as percepções de estudantes de enfermagem sobre o trabalho do enfermeiro na Estratégia Saúde da Família. Métodos pesquisa qualitativa desenvolvida com 19 estudantes de diferentes períodos do curso de graduação em enfermagem. Foram realizadas entrevistas semiestruturadas, procedendo-se, depois de organizadas, à análise temática e confrontação com alguns conceitos da Análise Institucional. Resultados a análise dos dados deu origem a três temas: 1) Percepções dos estudantes sobre o processo de trabalho do enfermeiro, 2) O vínculo no trabalho do enfermeiro e 3) Limites estruturais e relacionais do trabalho do enfermeiro. Conclusão o trabalho do enfermeiro na Estratégia Saúde da Família é algo em constante processo de institucionalização, requerendo uma gama de conhecimento teórico-científico e habilidades que se expressam pela autonomia e vínculo com os usuários. Contudo, enfrenta alguns atravessamentos como a escassez de infraestrutura, recursos humanos, materiais e a dificuldade no trabalho em equipe.

ABSTRACT Objective to understand the perceptions of nursing students about the work of nurses in the Family Health Strategy. Methods qualitative research developed with 19 students from different periods of the undergraduate nursing course. Semi-structured interviews were carried out, proceeding, after being organized, to thematic analysis and confrontation with some concepts of Institutional Analysis. Results the data analysis gave rise to three themes: 1) Students' perceptions of the nurse's work process, 2) The bond in the nurse's work and 3) Structural and relational limits of the nurse's work. Conclusion the nurse's work in the Family Health Strategy is something in constant institutionalization process, requiring a range of theoretical and scientific knowledge and skills that are expressed through autonomy and bond with users. However, it faces some crossings such as the scarcity of infrastructure, human and material resources and the difficulty in teamwork.

Contribuciones de los profesionales de enfermería y de partería a la salud de las mujeres. Relatos de la Región de las Américas

[Introducción]. En el informe Situación de la enfermería en el mundo 2020: invertir en educación, empleo y liderazgo, publicado el mismo año por la Organización Mundial de la Salud (OMS), se estima que hay en el mundo cerca de 28 millones de profesionales de la enfermería, un número que representa más de la mitad de los profesionales de la salud. También se destaca que sigue existiendo un défi cit mundial de 5,9 millones de profesionales de la enfermería, la mayoría en países de África, Asia Sudoriental y la Región del Mediterráneo Oriental de la OMS, así como en algunos países de América Latina. Las acciones necesarias para disminuir el défi cit de estos profesionales son aumentar la inversión nacional para evitar una situación de escasez mundial, incrementar el número de graduados en enfermería, mejorar las opciones de empleo y retener a los profesionales en el sistema de salud. El informe también concluye que invertir en profesionales de enfermería y de partería permitirá lograr mejoras en el campo de la salud, pero también contribuirá a mejorar la calidad de la educación, promoverá la igualdad de género y garantizará el trabajo decente y el crecimiento económico, logros todos ellos en línea con los Objetivos de Desarrollo Sostenible. La OMS declaró el 2020 Año Internacional de los Profesionales de Enfermería y de Partería. Sin embargo, los planes de celebración resultaron afectados por el intenso trabajo de los profesionales durante la pandemia de COVID-19, declarada el 11 de marzo del 2020 por la OMS. En consecuencia, la OMS declaró el 2021 Año Internacional de los Trabajadores y Cuidadores de la Salud. La pandemia de COVID-19 ha evidenciado las desigualdades y las inequidades que existen en los sistemas de salud y en los países de la Región de las Américas. Los países han implementado medidas de salud pública no farmacológicas durante la respuesta a la pandemia, entre ellas el confi namiento domiciliario y el cierre de escuelas y negocios, que han tenido distintos efectos sobre las condiciones sociales, económicas y culturales de los diferentes grupos de población. En los países donde el acceso a la salud ha resultado aún más afectado por la pandemia, los profesionales y cuidadores de la salud han personifi cado una de las mejores respuestas para poder combatirla...

Understanding the most commonly billed diagnoses in primary care: Urinary tract infections.

This article, one of 12 in a series on most commonly billed diagnoses in primary care, provides a comprehensive overview of the pathophysiologic processes related to urinary tract infections (UTIs). The clinical manifestations, diagnostic tests, treatments, and billing codes associated with UTIs will be described.

Understanding the most commonly billed diagnoses in primary care: Headache disorders.

This article, part of a series about the most commonly billed diagnoses in primary care, describes the pathophysiologic processes of the three most common types of headache disorders as well as how the clinical manifestations and treatments are linked to the pathogenesis of the disorders.

How State Scope-of-Practice Policies Impact NP Care.

Three projects examine the effect of NP practice acts on access to health care.

The Experiences of Primary Healthcare Nurses During the COVID-19 Pandemic in Australia.

PURPOSE: The COVID-19 pandemic has presented an international health crisis of a scope not seen in our lifetime. While much attention has been paid to health workers in critical care and acute areas, nurses working outside of hospitals are also significantly affected. This study sought to investigate the experience of nurses working in Australian primary healthcare during the COVID-19 pandemic. In particular, it sought to understand the implications on their employment status, role, and access to personal protective equipment. DESIGN AND METHODS: Nurses employed in primary healthcare across Australia were invited to participate in a cross-sectional online survey through social media and professional organizations. The survey tool was composed of demographics, and of questions about the nurses' employment, work role, and access to personal protective equipment. FINDINGS: Of the 637 responses received, nearly half (43.7%) reported a decrease in hours and threatened or actual loss of employment. While most respondents felt that they had sufficient knowledge about COVID-19, they expressed concern about work-related risks to themselves and their family. Most respondents described never or only sometimes having sufficient personal protective equipment in their workplace. Just over half of respondents (54.8%) felt well supported by their employer. A third of respondents (34%) perceived that care provided in their workplace was significantly or slightly worse than before the pandemic. CONCLUSIONS: This is the first study of primary healthcare nurses' experiences during the COVID-19 pandemic. The study findings highlighted a concerning level of insecurity around primary healthcare nursing employment, as well as issues with the availability of personal protective equipment for these nurses. The perception that the pandemic has resulted in reduced quality of care needs further exploration to ensure that those with chronic conditions are supported to maintain and promote health. CLINICAL RELEVANCE: Understanding the implications of COVID-19 on the primary healthcare nursing workforce is vital to ensure staff retention and care quality. Ensuring that the community remains healthy and supported at home is vital to both reduce the burden on the health system and reduce secondary mortality.

The support needs of Australian primary health care nurses during the COVID-19 pandemic.

AIM: To identify Australian primary health care nurses' immediate support needs during the COVID-19 pandemic. BACKGROUND: COVID-19 has had widespread implications for primary health care nurses. Supporting these nurses' capacity to deliver quality care ensures that ongoing health needs can be met. METHODS: Primary health care nurses were recruited to an online survey via social media and professional organisations in April 2020. RESULTS: Six-hundred and thirty-seven responses were included in the analysis. Participants provided 1,213 statements about perceived supports required to provide quality clinical care. From these, seven key categories emerged, namely personal protective equipment, communication, funding, industrial issues, self-care, workplace factors and valuing nurses. CONCLUSION: A number of key issues relating to personal health and safety, care quality and job security need to be addressed to support primary health care nurses during the COVID-19 pandemic. Addressing these support issues can assist in retaining nurses and optimizing the role of primary health care nurses during a pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: Responding to the needs of primary health care nurses has the potential to facilitate their role in providing community-based health care. This knowledge can guide the provision of support for primary health care nurses during the current pandemic, as well as informing planning for future health crises across the health service.

Development and Assessment of an Application for Primary Care for Users with Diabetes Mellitus / Desarrollo y evaluación de una aplicación de atención primaria para usuarios con diabetes mellitus / Desenvolvimento e avaliação de um aplicativo para os cuidados primários aos usuários com diabetes mellitus

ABSTRACT Objective: To develop an application on primary nursing care for users with diabetes mellitus and to assess its usability in the light of the Unified Theory of Acceptance and Use of Technology. Materials and methods: A methodological study, which used a quantitative and cross-sectional approach, based on the Systematic Design of Instruction method. The product was validated for usability by 11 specialist nurses, using the System Usability Scale questionnaire, based on the Unified Theory of Acceptance and Use of Technology 2 by Venkatesh, Thong and Xu. Results: The application was developed through open and free frameworks, based on the updated content of the Nursing Protocol in Primary Care on Diabetes Mellitus, plus the International Classification of Nursing Practices in Public Health. In assessing usability, the application reached a score of 90 points, being classified on a scale of best achievable, with dimensions that ground the theoretical constructs. Conclusions: The technology named Diabetes em Foco (Diabetes in focus in English) is promising to improve and advance theoretical and practical knowledge, in addition to quick and easy access to the protocol, timely support for decision-making and strengthening the systematization of nursing care in primary health care.

RESUMEN Objetivo: desarrollar una aplicación de atención primaria de enfermería para usuarios con diabetes mellitus y evaluar la usabilidad a la luz de la Teoría Unificada de Aceptación y Uso de la Tecnología. Materiales y métodos: estudio metodológico, que utilizó un enfoque cuantitativo y transversal, basado en el método de diseño instruccional sistemático. El producto fue validado para la usabilidad por 11 enfermeros especializadas, mediante el cuestionario de escala de usabilidad del sistema, basado en la Teoría Unificada de Aceptación y Uso de la Tecnología 2, de Venkatesh, Thong y Xu. Resultados: la aplicación se desarrolló por medio de frameworks abiertos y gratuitos, basados en el contenido actualizado del Protocolo de Enfermería en Atención Primaria sobre Diabetes Mellitus, más la Clasificación Internacional de Prácticas de Enfermería en Salud Pública. Al evaluar la usabilidad, la aplicación alcanzó un puntaje de 90 puntos, clasificándose en una escala de la mejor calidad posible, con dimensiones que sustentan las construcciones teóricas. Conclusiones: la tecnología llamada "Diabetes em foco" es prometedora para mejorar y avanzar en el conocimiento teórico y práctico, además del acceso rápido y fácil al protocolo, el apoyo oportuno para la toma de decisiones y el fortalecimiento de la sistematización de la atención de enfermería en atención primaria a la salud.

RESUMO Objetivo: desenvolver um aplicativo sobre cuidados primários de enfermagem aos usuários com diabetes mellitus e avaliar sua usabilidade à luz da Teoria Unificada de Aceitação e Uso de Tecnologia. Materiais e métodos: trata-se de um estudo metodológico, que utilizou uma abordagem quantitativa e de delineamento transversal, a partir do método Design Instrucional Sistemático. O produto foi validado quanto à usabilidade por 11 enfermeiros especialistas, por meio do questionário System Usability Scale, fundamentado pela Teoria Unificada de Aceitação e Uso de Tecnologia 2 de Venkatesh, Thong e Xu. Resultados: o aplicativo foi desenvolvido por meio de frameworks abertos e sem custo, baseado no conteúdo atualizado do Protocolo de Enfermagem na Atenção Primária sobre Diabetes Mellitus, acrescido da Classificação Internacional das Práticas de Enfermagem na Saúde Coletiva. Na avaliação da usabilidade, o aplicativo alcançou um score de 90 pontos, sendo classificado numa escala de melhor alcançável, com dimensões que alicerçam os constructos teóricos. Conclusões: a tecnologia denominada "Diabetes em foco" apresenta-se promissora para melhorar e avançar o conhecimento teórico-prático, além do acesso rápido e facilitado ao protocolo, do apoio oportuno à tomada de decisões e do fortalecimento da sistematização da assistência de enfermagem na atenção primária à saúde.

Improving Continuity of Care: An Innovative Primary Care Role in an Acute Care Hospital.

This article describes an innovative organization-spanning collaboration between primary care and acute care in Calgary to support continuity of care for patients with complex needs. Mosaic Primary Care Network provides funding for a primary care navigation nurse to work at the Peter Lougheed Centre, an Alberta Health Services hospital. This role supports hospital in-patients with discharge planning, linking to family physicians and connecting to programs that provide support in the community to vulnerable populations. The commitment of leadership from both organizations was critical for getting this unique role implemented.