Improving interprofessional teamwork in a community mental health team: a team building circle program based on the restorative justice paradigm.

Improving teamwork among mental health practitioners is crucial. However, there have been few intervention studies on teamwork enhancement among community mental health practitioners in South Korea. We aimed to determine the effectiveness of the Team Building Circle program (TBC) based on the restorative justice paradigm, which sought to promote integration and cohesion. The TBC was developed to improve conflict interpretation mind-set, interpersonal skills, and teamwork among practitioners in community mental health centers. We conducted a quasi-experimental study using a pre and posttest design with a non-equivalent control group. The participants were 44 practitioners from four community mental health centers. Data were collected before the implementation TBC (pretest), just after (posttest), and 3 months after TBC (follow-up test). A generalized estimating equation model was used for analysis. Our findings indicate that the intervention group had improved scores in the ability to cope with interpersonal stress in a constructive way, interpersonal relationship skills, and teamwork compared to the control group. To improve teamwork among community mental health practitioners, managers are encouraged to consider providing TBC intervention.

Los programas de especialización para el equipo básico de salud en la medicina familiar / Specialization Programs for the Basic Health Team in Family Medicine

El Programa del Médico y la Enfermera de la Familia, que brinda cobertura al 100 por ciento de la población cubana, se encuentra en un proceso de desarrollo permanente y, en el momento actual, presenta una etapa cualitativamente superior, en la que la calidad de su atención y el desarrollo científico técnico de los recursos humanos adquiere especial significación. En la actualidad existen más de 11 128 equipos básicos de salud (médico y enfermera)1,2 y hasta el año 2021 se formaron 61 9931,3) y 16854) especialistas de primer grado en Medicina General Integral (MGI) y en Enfermería Comunitaria respectivamente. En enfermería se dejaron de formar sin justificación de la decisión. El nuevo programa dirigido a los profesionales de la enfermería pretende formar un profesional de perfil especializado en Enfermería Comunitaria Integral (ECI), preparado para desarrollar funciones asistenciales, administrativas, docentes e investigativas, con competencias laborales para dar solución a los problemas que identifique en individuos, familia, comunidad y entorno, en áreas e instituciones de salud.1,2 Los futuros especialistas del equipo básico de salud (EBS) se formaron a partir del 2020 en las mismas unidades docentes, lo que constituye una oportunidad para el aprendizaje interprofesional y de competencias compartidas que faciliten el cumplimiento de los objetivos del Programa del Médico y Enfermera de la Familia. Estos programas de especialización tienen muchos puntos de coincidencia, no solamente en la duración de tres años con dedicación a tiempo completo en el consultorio del médico y enfermera de la familia y una frecuencia de 44 horas semanales, sino también en los principios científico pedagógicos y algunos contenidos de las competencias dirigidas a la atención del individuo, la familia, la comunidad y el entorno.5,6 El nivel primario de salud, el Consultorio del Médico y Enfermera de la Familia y el policlínico son los elementos de referencia fundamentales de estos programas de especialización y la educación en el trabajo su principal forma de organización de la enseñanza que se concreta con el aprendizaje en los diferentes servicios por donde rotan, como actividad docente-asistencial-investigativa-administrativa, actividades que se realizan, además, en los hospitales clínico quirúrgico, pediátricos, ginecobstétricos, hogares maternos y de ancianos, círculos infantiles y otros. Los futuros especialistas en MGI y ECI ejecutan las guardias de conjunto con los profesores médicos, para desarrollar y adquirir habilidades propuestas en su plan de estudio. Las guardias se realizan en el área de salud donde están ubicados y en los centros por donde rotan, con una frecuencia semanal y un fin de semana en el mes como mínimo. Para las actividades académicas teóricas colectivas se destinan cuatro horas semanales para discusión de problemas de salud, seminarios, conferencias, revisiones bibliográficas, entre otras; estas se realizarán en el área de salud y para exámenes de promoción, se definen tres semanas al finalizar cada año. La evaluación de graduación se realiza al concluir los tres años designados para la especialidad. Comprende la presentación y defensa del trabajo de terminación de la especialidad, así como la realización de un examen práctico y uno teórico de forma oral. Aprobar este examen estatal certifica que el graduado está apto para ejercer como especialista en Medicina General Integral o Enfermería Integral Comunitaria. La realidad es que en Cuba estos especialistas tienen como una de sus premisas fundamentales, que la comunidad se transforme en su verdadero sujeto-objeto de las acciones de salud, que las modificaciones en los perfiles de salud-enfermedad sean el resultado no solo de los cambios conductuales individuales, sino de la adopción colectiva de un modo de vida más sano, para lo cual los fundamentos teóricos y prácticos de las ciencias sociomédicas deberán constituirse en sus herramientas de trabajo cotidiano. La actualización del Programa del Médico y la Enfermera de la Familia constituye un nuevo desafío para el Ministerio de Salud Pública y sus instituciones de educación superior y representa un compromiso con el objetivo de mejorar el estado de salud de la población. Esperamos que estas especialidades sean líderes en ello(AU)

Independent prescribing in the UK: insights from the Department of Health Allied Health Professions Medicines Project team.

BACKGROUND: The UK medicines legislation was amended ten years ago (2013) to allow podiatrists and physiotherapists independent prescribing rights, the first of the allied health professions to do so. Non-medical prescribing formed one part of a broader policy agenda promoting role flexibility in response to the challenge of an ageing population and the need to maintain effective health provision in the face of a contracting workforce. AIM: The aim of this study was to outline the experiences of the Department of Health AHP medicines project board team in working towards independent prescribing for podiatry and physiotherapy, with a particular focus on the challenges encountered. METHODS: In depth, open-ended interviews were conducted with eight of the core members of the project team, drawn from those individuals who served throughout the duration of the project (2010-2013). Included were the former Department of Health Chief and Deputy Chief Allied Health Professions Officers; the Department of Health Engagement and Communications Officer; representatives of the Health and Care Professions Council; the Medicines and Healthcare products Regulatory Agency; the Council of Deans of Health; the Royal College of Podiatry and the Chartered Society of Physiotherapy (The team also included the representative of the Allied Health Professions Federation. However, as that representative is also a researcher in this study, he has recused himself from any role as a participant.). Data were transcribed and subject to a thematic analysis. RESULTS: A complex picture of the project emerged revealing a range of obstacles and challenges, including inter-professional role boundary tensions and negative prior assumptions about the two professions. Success hinged upon the adoption of a dual strategy involving submission of a robust case of need focused on patient benefit coupled with the careful management of professional expectations. Underpinning theory from the sociology of the professions offers a supportive explanatory framework for understanding the relationships between the various stakeholders involved. CONCLUSIONS: Ultimately, success depended upon aligning the project aims with healthcare policy through a clear focus on patient benefit. Balancing competing professional and policy demands through a continual emphasis on improved patient care laid the foundations for future projects by other allied health professions.

Beyond the Prescription Pad: Clinical Pharmacists as Integral Members of Cardiology Care Teams, A Comprehensive Review of Their Expanding Roles and Contributions.

In recent years, the role of clinical pharmacists in cardiology care teams has evolved significantly. Traditionally known for their expertise in medication management, clinical pharmacists are now being recognized as integral members of interdisciplinary teams in cardiology settings. This review article aims to explore the expanding roles and contributions of clinical pharmacists in cardiac care, going beyond their traditional responsibilities. It examines their involvement in patient care, medication therapy management, collaborative decision-making, patient education, and research activities. By highlighting the value they bring to the table, this article emphasizes the need for incorporating clinical pharmacists as vital team members in cardiology care.

Estrategias para la reconversión del ejercicio profesional: Proyecto Bioquímico Nexo / Strategies for the reconversion of professional practice: Biochemical Nexus Project

El avance de la ciencia y la tecnología en el área de la bioquímica clínica ha ocasionado la necesidad de reflexionar acerca de una reingeniería de la práctica profesional. El proceso diagnóstico es complejo y dinámico, requiere del trabajo interdisciplinario y de la comunicación efectiva, además de un cambio en el accionar profesional, con el eje centrado en el paciente y en un laboratorio "a puertas abiertas". En este marco se planteó el Proyecto Bioquímico Nexo (BN) con el propósito de lograr las competencias y habilidades necesarias para formar profesionales bioquímicos clínicos integrales que puedan cumplir con este nuevo rol sobre la base de una construcción colectiva de los saberes (AU)

Advances in science and technology in the area of clinical biochemistry have prompted the need to reflect on the reengineering of professional practice. The diagnostic process is complex and dynamic, requiring interdisciplinary work and effective communication, as well as a change in professional action, with the focus on the patient and an "open-door" laboratory. Within this framework, the Biochemical Nexus Project (BN) was proposed with the purpose of achieving the competencies and skills necessary to comprehensively train clinical biochemists who can fulfill this new role based on a collective construction of knowledge (AU)

Simulação realística: tecnologia para consolidação de competências profissionais para segurança do paciente / Realistic simulation: technology for consolidating professional skills for patient safety

Resumo: Segurança do paciente é tema transversal na assistência e no ensino em saúde. Esta pesquisa metodológica enfoca a simulação como metodologia educacional, realizada entre abril e dezembro de 2022, com objetivo de estruturar, validar, aplicar e analisar tecnologia educativa, com vistas a consolidar competências em segurança do paciente para profissionais de enfermagem e medicina em formação nos programas de residência em saúde. O percurso metodológico ocorreu em duas fases. A primeira fase compilou competências para a formação em saúde e a segurança do paciente (etapa 1). Este material foi utilizado em reunião de grupo focal com líderes e chefias de serviços associados à qualidade e educação para subsidiar a identificação de fragilidades em segurança do paciente (etapa 2). A segunda fase correspondeu ao cenário de simulação, composta por oito etapas. A partir das fragilidades, definiram-se os objetivos de aprendizagem (etapa 1) que guiaram a elaboração de compilado teórico-prático nos subtemas educacionais (etapa 2), o qual foi discutido em workshop com os residentes (etapa 3). O cenário foi elaborado a partir de texto narrativo, concebido em ambiente assistencial hipotético, desenvolvido em ambiente simulado (etapa 4); esse foi avaliado pelos componentes do grupo focal (etapa 5). Após treinamento e orientações, ocorreram a simulação e observação crítica da cena pelos participantes (etapas 6 e 7). A oitava etapa correspondeu ao debriefing, com análise do desenvolvimento dos subtemas educacionais; e análise da simulação como recurso para o desenvolvimento e a consolidação de competências em segurança do paciente. Empregou-se a técnica de análise de conteúdo dos depoimentos transcritos; as fases foram registradas descritivamente; os resultados quantitativos foram analisados a partir de números absolutos e relativos. Para a validação do cenário foram utilizados os resultados do ranking médio e de confiabilidade. As fases e etapas sistematizadas foram compiladas em formato de Guia. As lacunas vinculadas às competências e que perfizeram os subtemas educacionais foram relativas à comunicação, adesão aos protocolos de segurança, continuidade do cuidado e trabalho em equipe. Foram objetivos educacionais: desenvolver a comunicação entre a equipe interprofissional; entender a importância dos protocolos e da inserção do paciente no processo de cuidar; desenvolver e consolidar competências profissionais relativas à segurança do paciente. Síntese da literatura subsidiou a contextualização das lacunas, guiando a compreensão e aproximação entre a teoria e a prática, a partir da discussão de casos, revisando e agregando conhecimentos. O cenário simulado foi elaborado e validado de acordo com os objetivos educacionais, observando-se os indicadores estabelecidos; a cena se desenvolveu concomitantemente à observação, propiciando análise crítica dos participantes da pesquisa. A tecnologia de modelagem educacional foi avaliada positivamente quanto às contribuições para o aprendizado e a consolidação de competências; concorreu para simular o cotidiano assistencial e fomentar a reflexão acerca de ações preventivas ao risco para o paciente. A estratégia educacional contribuiu para vigorizar competências em segurança do paciente entre profissionais em formação, cujo método para desenvolvimento e avaliação, compilado na forma de Guia, permite a replicação do percurso metodológico, com vistas à promoção da segurança do paciente.

Abstract: Patient safety is a cross-cutting theme in health care and education. This methodological research focuses on simulation as an educational methodology, carried out between April and December 2022, with the objective of structuring, validating, applying and analyzing educational technology, with a view to consolidating competences in patient safety for nursing and medical professionals in training in the programs residency in health. The methodological course took place in two phases. The first phase compiled competences for training in health and patient safety (step 1). This material was used in a focus group meeting with leaders and heads of services associated with quality and education to support the identification of weaknesses in patient safety (stage 2). The second phase corresponded to the simulation scenario, consisting of eight stages. Based on weaknesses, learning objectives were defined (stage 1) that guided the elaboration of a theoretical-practical compilation on educational subthemes (stage 2), which was discussed in a workshop with residents (stage 3). The scenario was elaborated from a narrative text, conceived in a hypothetical care environment, developed in a simulated environment (step 4); this was evaluated by the components of the focus group (step 5). After training and guidance, the participants simulated and critically observed the scene (steps 6 and 7). The eighth stage corresponded to the debriefing, with analysis of the development of educational subtopics; and simulation analysis as a resource for the development and consolidation of patient safety skills. The technique of content analysis of the transcribed testimonies was used; phases were descriptively recorded; the quantitative results were analyzed from absolute and relative numbers. For the validation of the scenario, the results of the average ranking and reliability were used. The systematized phases and steps were compiled in a Guide format. The gaps linked to competences and that made up the educational subtopics were related to communication, adherence to safety protocols, continuity of care and teamwork. The educational objectives were: to develop communication between the interprofessional team; understand the importance of protocols and the insertion of the patient in the care process; develop and consolidate professional skills related to patient safety. Literature synthesis subsidized the contextualization of the gaps, guiding the understanding and approximation between theory and practice, from the discussion of cases, revising and adding knowledge. The simulated scenario was elaborated and validated according to the educational objectives, observing the established indicators; the scene developed concurrently with the observation, providing a critical analysis of the research participants. Educational modeling technology was evaluated positively in terms of contributions to learning and skills consolidation; contributed to simulate daily care and encourage reflection on preventive actions to risk for the patient. The educational strategy contributed to strengthening patient safety skills among professionals in training, whose method for development and evaluation, compiled in the form of a Guide, allows the replication of the methodological path, with a view to promoting patient safety.

Development of competencies to strengthen support for caregivers and enhance their capacity to provide care.

Nearly 53 million family caregivers in the United States provide care to older adults, performing tasks ranging from meal preparation and grocery shopping, to wound care and medication management. While caregivers are critical to the health care system, they are not adequately supported to serve in this role. Successfully integrating family caregivers into the health care team and supporting their health and well-being is a public health priority and should be a focus for clinical education programs. To address this gap, the Family Caregiving Institute at the Betty Irene Moore School of Nursing at UC Davis developed the Interprofessional Family Caregiving Competencies as a framework to guide the development of curricula to enhance health care providers' skills, knowledge, and abilities in family caregiving. Twenty-one competencies are categorized within the following four domains: the nature of family caregiving; family caregiving identification and assessment; providing family-centered care; and the context of family caregiving.

Developing evaluation capacities in integrated care projects: Lessons from a scientific support mission implemented in Belgium.

The capacity of self-assessment, to learn from experience, to make information-based decisions, and to adapt over time are essential drivers of success for any project aiming at healthcare system change. Yet, many of those projects are managed by healthcare providers' teams with little evaluation capacity. In this article, we describe the support mission delivered by an interdisciplinary scientific team to 12 integrated care pilot projects in Belgium, mobilizing a set of tools and methods: a dashboard gathering population health indicators, a significant event reporting method, an annual report, and the development of a sustainable "learning community." The article provides a reflexive return on the design and implementation of such interventions aimed at building organizational evaluation capacity. Some lessons were drawn from our experience, in comparison with the broader evaluation literature: The provided support should be adapted to the various needs and contexts of the beneficiary organizations, and it has to foster experience-based learning and requires all stakeholders to adopt a learning posture. A long-time, secure perspective should be provided for organizations, and the availability of data and other resources is an essential precondition for successful work.

O olhar das residentes de Ortopedia e Traumatologia sobre o Serviço Social na equipe de saúde em um hospital público no oeste do Pará

Resumo Objetivo: Averiguar a concepção das residentes do Programa de Atenção Integral em Ortopedia e Traumatologia, da Universidade do Estado do Pará, sobre a atuação do Serviço Social na equipe de saúde do Hospital Regional do Baixo Amazonas do Pará Dr. Waldemar Penna, em Santarém/PA. Métodos: A pesquisa teve o caráter descritivo e explicativo; utilizou-se a pesquisa de campo; os instrumentos como a entrevista semiestruturada com formulários de perguntas abertas e fechadas e o gravador de voz; os dados foram analisados a partir da abordagem qualitativa e da análise de conteúdo de Bardin; a base teórica norteadora foi o materialismo histórico-dialético; e a amostra consistiu em nove participantes residentes. Resultados: O estudo evidenciou duas categorias centrais para a discussão, a primeira "O Serviço Social na equipe do HRBA na ótica das participantes" e a segunda "Demandas pertinentes ao Serviço Social na concepção das participantes". Considerações Finais: identificou-se a necessidade de criar espaços de debates acerca da temática com vista a questionar as práticas verticalizadas em saúde e persistir em intervenções em equipes pautadas na interdisciplinaridade, construindo relações horizontais entre os profissionais com intuito de promover um atendimento integral e de qualidade aos usuários de saúde.

Manual clínico: atención integral de salud en situaciones de violencias por motivos de género. Herramientas para equipos de salud

Las violencias por motivos de género atraviesan a mujeres, LGBTI+, ni­ñeces y adolescencias con gran impacto en múltiples dimensiones de la vida y el sistema de salud tiene un rol fundamental en su detección tem­prana, en la evaluación del riesgo, en la prevención y la atención integral.Por eso, desde el Ministerio de Salud de la Nación y la Organiza­ción Panamericana de la Salud (OPS/OMS) presentamos el Manual Clínico “Atención integral de la salud ante situaciones de violencias por motivos de género. Herramientas para equipos de salud”, adaptado técnica y culturalmente a nuestro país a partir de la versión original de la Organización Mundial de la Salud (OMS). El presente manual está dirigido a todas las personas que integran equi­pos de salud interdisciplinarios e intersaberes del sistema sanitario (formadas en Medicina, Psicología, Enfermería, Trabajo Social, asesora­miento legal, agentes sanitarios, administración, promotoras y promo­tores de la salud, etc.) en especial a quienes trabajan en el primer nivel de atención. Su propósito es brindarles herramientas para la atención integral a mujeres, LGBTI+» y niñas, niños, niñes y adolescentes (en ade­lante, NyA) que atraviesan o han atravesado situaciones de violencias por motivos de género (en adelante, VMG). Es un documento muy completo que brinda orientaciones claras para los equipos de salud, especialmente para quienes no están especializados en el tema. Su aporte radica en brindar herramientas para identificar vio­lencias por motivos de género aún en aquellas personas que no consul­tan por ello. Su enfoque integral es clave para que los equipos de salud puedan reconocer oportunidades de detección, prevención temprana y abordaje de las violencias más allá de cuál sea el motivo específico de consulta. El manual llega en un momento particular. La violencia es un grave pro­blema de salud pública y de violación a los derechos humanos que no solo persiste, sino que, especialmente durante la pandemia de COVID-19, se ha visto incrementado. La violencia por motivos de género afecta a la salud en todas sus di­mensiones y el sistema de salud puede ser la primera y, a veces, la única opción con la que cuentan las personas para hablar sobre su situación. Esta, sin duda, es una herramienta concreta para continuar fortaleciendo el camino hacia su erradicación desde todos los ámbitos.

Establishing a Comprehensive Wound Care Team and Program.

A comprehensive, interdisciplinary wound care team is of great importance to the management of acute, chronic, and recurrent wounds. This management functions best for the patient when all members of the team are in regular discussion regarding the wound care plan, providing more efficient and timelier patient-centered care. This article reviews the roles of different disciplines in the management of wounds. These disciplines include rehabilitation physicians, wound care nurses, registered nurses and certified nursing assistants, surgical teams, specialists of infectious diseases and mental health, dieticians, and patients and caregivers. A case study is also provided.

How to Better Value EMS Clinicians as Key Care Team Members.

Emergency medical services (EMS) clinicians, including emergency medical technicians and paramedics, are skilled professionals whose expertise is leveraged routinely to meet a wide range of patient needs. Collaborative interdisciplinary care requires mutual understanding, trust, and respect. Yet, among EMS clinicians and in- and out-of-hospital clinicians, these values are too often not expressed in working relationships. This article offers guidance on how to nourish successful partnerships with EMS clinicians and motivate good care.

A Clareza de Papéis entre os Profissionais de Saúde do NASF: Você sabe o papel do seu colega de trabalho na equipe?

Este relato de experiência busca trazer discussões sobre a clareza de papéis entre profissionais a partir da observação participante realizada no Núcleo Ampliado de Saúde da Família, localizado em Santa Cruz, interior do Rio Grande do Norte. Durante o processo, o grupo de apoio matricial, do Programa de Educação pela Saúde no âmbito da Interprofissionalidade, se inseriu no dia a dia no serviço e, mais especificamente, nas visitas domiciliares realizadas pelos profissionais. A partir da observação participante, discutimos como parte dos profissionais ainda possui uma representação cotidiana sobre a atuação dos colegas e trabalham de maneira individualizada. Ainda, destacamos que os profissionais que atuam mais frequentemente juntos parecem ter uma melhor compreensão da atuação dos colegas, no entanto, o trabalho interprofissional propriamente dito não foi observado durante as visitas domiciliares realizadas.

Closer to or Farther away from an Ideal Model of Care? Lessons Learned from Geographic Cohorting.

Geographic "cohorting," "co-location," "regionalization," or "localization" refers to the assignation of a hospitalist team to a specific inpatient unit. Its benefits may be related to the formation of a team and the additional interventions like interdisciplinary rounding that the enhanced proximity facilitates. However, cohorting is often adopted in isolation of the bundled approach within which it has proven beneficial. Cohorting may also be associated with unintended consequences such as increased interruptions and increased indirect care time. Institutions may increase patient loads in anticipation of the efficiency gained by cohorting-leading to further increases in interruptions and time away from the bedside. Fragmented attention and increases in indirect care may lead to a perception of increased workload, errors, and burnout. As hospital medicine evolves, there are lessons to be learned by studying cohorting. Institutions and inpatient units should work in synergy to shape the day-to-day work which directly affects patient and clinician outcomes-and ultimately culminates in the success or failure of the parent organization. Such synergy can manifest in workflow design and metric selection. Attention to workloads and adopting the principles of continuous quality improvement are also crucial to developing models of care that deliver excellent care.

A team-based learning model using clinical vignettes in an advanced undergraduate pre-health professional physiology course facilitated by medical students.

There is evidence that demonstrates that teaching preclinical and clinical material can have numerous benefits for both students and teachers, with the majority of literature focusing on peer medical student teaching. There is a dearth of literature exploring the benefit of medical students teaching undergraduate, pre-health professional students and using clinical cases in this setting. We explore our implementation of a team-based learning curriculum built around clinical cases to teach advanced physiology and introduce pathology, pharmacology, and interprofessional collaboration for pre-health students. This course was entirely taught by medical students. Course evaluations and future implications are discussed.

Manual clínico: atención integral de salud en situaciones de violencias por motivos de género. Herramientas para equipos de salud / Clinical manual: comprehensive health care in situations of gender-based violence. Tools for health teams

Dirigido a todas las personas que integran equipos de salud interdisciplinarios e intersaberes del sistema sanitario, en especial a quienes trabajan en el primer nivel de atención. Su propósito es brindarles herramientas para la atención integral a mujeres, LGBTI+, niñeces y adolescencias que atraviesan o han atravesado situaciones de violencias por motivos de género. Además cuenta con anexos, flujogramas y guías prácticas para la implementación de las herramientas propuestas.

Atuação da equipe multiprofissional de saúde ocupacional / The role of the multidisciplinary occupational health team

Apesar da denominação Equipe Multiprofissional de Saúde Ocupacional (EMSO) ainda ser utilizada, visto que está prevista no Manual de Saúde Ocupacional (MSO) e este encontrar-se em processo de revisão de seus marcos conceituais, atualmente se tem discutido a pertinência da substituição do termo "Saúde Ocupacional" pelo termo "Saúde do Servidor", considerando que: Saúde Ocupacional possui como base conceitual a ideia de que o objetivo seria adequar o ambiente de trabalho ao homem e cada homem ao seu trabalho, no qual a doença constitui objeto de ação da equipe (LACAZ, 2013). Saúde do Trabalhador traz a ideia de trabalho em equipe multiprofissional com atuação interdisciplinar com ampla abertura à participação dos trabalhadores, no qual o objeto de ação da equipe é a promoção da saúde (LACAZ, 2013). Cabe mencionar que o termo "Saúde do Trabalhador" está previsto na Política Nacional de Saúde do Trabalhador e Trabalhadora (PNSTT) (BRASIL, 2012). Tendo isso por base, considerou-se as especificidades e características próprias do serviço público estadual e o fato de que os servidores públicos representam uma parte específica dos trabalhadores, e desta forma, optou-se por utilizar o termo "Saúde do Servidor" assumindo o seguinte conceito: Saúde do Servidor: valor social público, relacionados a fatores ambientais, sociais, psicológicos, políticos, econômicos e organizacionais, que afetam o bem-estar e a qualidade de vida dos servidores públicos estaduais no trabalho.

Integrating social justice advocacy into a family health team: Successes and lessons learned.

PROBLEM ADDRESSED: Health is largely determined by socioeconomic factors. Health care providers can potentially address these factors through social justice advocacy. However, many individual providers and teams have not taken on this role in Canada. OBJECTIVE OF PROGRAM: To address identified barriers in integrating social justice advocacy into the practice of individual health care providers and interdisciplinary teams. PROGRAM DESCRIPTION: An Advocacy Tool Kit was created in 2017 to build individual capacity for social justice advocacy. An advocacy framework was adopted in 2018 that reiterated the commitment of the Department of Family and Community Medicine at St Michael's Hospital in Toronto, Ont, to social justice advocacy and outlined 2 new processes: to adopt and implement specific departmentwide campaigns to advocate for social justice; and to respond to inquiries about social justice issues and external advocacy campaigns. CONCLUSION: The initiatives have helped integrate social justice advocacy into the core activities of the interdisciplinary primary care team and can likely be replicated by other interested groups across the country.

Clinical Pharmacist Integration Into Veterans' Primary Care: Team Members Perspectives.

BACKGROUND: With the restructuring of primary care into patient-centered medical homes (PCMH), researchers have described role transformations that accompany the formation of core primary care teamlets (eg, primary care provider, registered nurse care manager, licensed practical nurse, medical support assistant). However, few studies offer insight into how primary care teamlets, once established, integrate additional extended team members, and the factors that influence the quality of their integration. METHODS: We examine the process of integrating Clinical Pharmacy Specialists (CPS) into primary care teams in the Veterans Health Administration (VHA). We conducted semi-structured interviews with CPS (n = 6) and clinical team members (n = 16) and performed a thematic analysis of interview transcripts. RESULTS: We characterize 2 ways CPS are integrated into primary care teamlets: in consultative roles and collaborative roles. CPS may be limited to consultative roles by team members' misconceptions about their competencies (ie, if CPS are perceived to handle only medication-related issues like refills) and by primary care providers' opinions about distributing responsibilities for patient care. Over time, teams may correct misconceptions and integrate the CPS in a more collaborative role (ie, CPS helps manage disease states with comprehensive medication management). CONCLUSIONS: CPS integrated into collaborative roles may have more opportunities to optimize their contributions to primary care, underscoring the importance of clarifying roles as part of adequately integrating advanced practitioners in interprofessional teams.

Interprofessional collaboration among health professionals in cleft lip and palate treatment and care in the public health sector of South Africa.

BACKGROUND: Collaboration among different categories of health professionals is essential for quality patient care, especially for individuals with cleft lip and palate (CLP). This study examined interprofessional collaboration (IPC) among health professionals in all CLP specialised centres in South Africa's public health sector. METHODS: During 2017, a survey was conducted among health professionals at all the specialised CLP centres in South Africa's public health sector. Following informed consent, each member of the CLP team completed a self-administered questionnaire on IPC, using the Interprofessional Competency Framework Self-Assessment Tool. The IPC questionnaire consists of seven domains with 51 items: care expertise (8 items); shared power (4 items); collaborative leadership (10 items); shared decision-making (2 items); optimising professional role and scope (10 items); effective group function (9 items); and competent communication (8 items). STATA®13 was used to analyse the data. Descriptive analysis of participants and overall mean scores were computed for each domain and analysed using ANOVA. All statistical tests were conducted at 5% significance level. RESULTS: We obtained an 87% response rate, and 52 participants completed the questionnaire. The majority of participants were female 52% (n = 27); with a mean age of 41.9 years (range 22-72). Plastic surgeons accounted for 38.5% of all study participants, followed by speech therapists (23.1%), and professional nurses (9.6%). The lowest mean score of 2.55 was obtained for effective group function (SD + -0.50), and the highest mean score of 2.92 for care expertise (SD + -0.37). Explanatory factor analysis showed that gender did not influence IPC, but category of health professional predicted scores on the five categories of shared power (p = 0.01), collaborative leadership (p = 0.04), optimising professional role and scope (p = 0.03), effective group function (p = 0.01) and effective communication (p = 0.04). CONCLUSION: The seven IPC categories could be used as a guide to develop specific strategies to enhance IPC among CLP teams. Institutional support and leadership combined with patient-centred, continuing professional development in multi-disciplinary meetings will also enrich IPC.