Processos de reflexividade dos psicólogos do esporte e coaches: um estudo fenomenológico / Reflexivity processes of sport psychologists and coaches: a phenomenological study / Procesos de reflexividad de psicólogos del deporte y coaches: un estudio fenomenológico

O objetivo desta pesquisa é identificar e compreender fenomenologicamente, por meio de relato de Psicólogos de Esporte (PE) e de Coaches, em sua vivência prática, como ocorrem os processos reflexivos em sua atuação, conforme apreendidos a partir de relatos de experiências. O método de investigação escolhido foi a fenomenologia, pois oferece os recursos necessários para tal mergulho junto à experiência reflexiva. A amostra intencional foi delineada por PE e Coaches (profissionais de Educação Física que recorrem ao Coaching) em atividade em esportes de alto rendimento, que tenham atuado ou estejam atuando em modalidades esportivas coletivas e/ou individuais. Realizaram-se nove entrevistas (cinco com PE, quatro com Coaches). O acesso ao objeto desse estudo se deu por meio de entrevistas em profundidade e semiestruturadas, orientadas pela escuta suspensiva. As questões disparadoras foram formuladas com base no Procedimento Estruturado de Reflexão adaptado. Para análise das entrevistas, realizou-se uma síntese de cada relato, seguindo-se de cruzamento intencional. Como resultados, percebeu-se que PE e Coaches trazem algumas similaridades no que se refere aos modos de refletir sobre sua prática. No entanto, as experiências que eles fazem desses processos reflexivos é que podem tomar rumos distintos. Os(as) PE amparam-se na regulamentação da profissão e resguardam-se em seus apontamentos, trazendo suas experiências e reflexões sobre os processos vividos. Os(as) Coaches trazem em suas explanações um trabalho coerente, organizado e compatível com o método do Coaching. Problematizar os processos reflexivos desses profissionais permite diferenciar qualitativa e eticamente suas atuações, possibilitando o fomento multiprofissional no esporte.(AU)

The aim of this study consists in phenomenologically identifying and understanding, by the report of Sport Psychologists (SP) and coaches, in their practical experience, how would be the reflexive processes that take place in their performance, as learned from reports of their experiences. The research method chosen was phenomenology, since it offers the necessary resources for such a dive along with the reflective experience. The intentional sample was outlined by SP and coaches (Physical Education professionals who use coaching) active in high performance sports, who have or are working in collective and/or individual sports. Nine interviews were conducted (five with SP, four with coaches). Access to the object of this study took place by in-depth and semi-structured interviews, guided by suspensive listening. The triggering questions were formulated based on the adapted Structured Reflection Procedure. For the analysis of the interviews, a synthesis of each report was carried out, followed by the intentional crossing. As results, it was noticed that SP and coaches bring some similarities regarding the ways of reflecting on their practice. However, their experiences of these reflective processes are that they can take different directions. The SP are based on the regulation of the profession and guard themselves in their notes, bringing their experiences and reflections on the processes experienced. Coaches bring in their explanations a coherent, organized, and compatible work with the coaching method. Problematizing the reflective processes of these professionals allows to differentiate their actuation qualitatively and ethically, making the multiprofessional phenomenon in sport possible.(AU)

El objetivo de este estudio consiste en identificar y comprender fenomenológicamente, a partir de la experiencia práctica de psicólogos del deporte (PD) y coaches, cómo serían los procesos reflexivos que se llevan a cabo en su rendimiento, tal y como se desprende de los informes de experiencias. El método de investigación elegido fue la fenomenología, ya que ofrece los recursos necesarios junto con la experiencia. La muestra intencional fue delineada por PD y coaches (profesionales de la educación física que utilizan el coaching) activos en deportes de alto rendimiento, que tienen o están trabajando en deportes colectivos e/o individuales. Se realizaron nueve entrevistas (cinco con PD, cuatro con coaches). El acceso al objeto de este estudio fue entrevistas en profundidad y semiestructuradas, guiadas por escuchas suspensivas. Las preguntas se formularon desde el procedimiento de reflexión estructurado adaptado. Para el análisis de las entrevistas, se hizo una síntesis de cada informe, seguida del cruce intencional. Como resultados, se notó que los PD y coaches tienen algunas similitudes con respecto a las formas de reflexionar sobre su práctica. Sin embargo, las experiencias que hacen de estos procesos pueden tomar diferentes direcciones. Los(las) PD se basan en la regulación de la profesión y se protegen en sus notas, aportando sus experiencias y reflexiones sobre los procesos vividos. Los(las) coaches plantean en sus explicaciones un trabajo coherente, organizado y compatible con el método de Coaching. Problematizar los procesos reflexivos de estos profesionales permite diferenciar sus acciones de manera cualitativa y ética, además de posibilitar la promoción multiprofesional en el deporte.(AU)

Percepção sobre o cuidado à perda gestacional: estudo qualitativo com casais brasileiros / Perceptions on pregnancy loss care: a qualitative study with brazilian couples / Percepción sobre la atención a la pérdida del embarazo: estudio cualitativo con parejas brasileñas

Este artigo analisou a percepção e os sentimentos de casais sobre o atendimento recebido nos serviços de saúde acessados em função de perda gestacional (óbito fetal ante e intraparto). O convite para a pesquisa foi divulgado em mídias sociais (Instagram e Facebook). Dos 66 casais que contataram a equipe, 12 participaram do estudo, cuja coleta de dados ocorreu em 2018. Os casais responderam conjuntamente a uma ficha de dados sociodemográficos e uma entrevista semiestruturada, realizada presencialmente (n=4) ou por videochamada (n=8). Os dados foram gravados em áudio e posteriormente transcritos. A Análise Temática indutiva das entrevistas identificou cinco temas: sentimento de impotência, iatrogenia vivida nos serviços, falta de cuidado em saúde mental, não reconhecimento da perda como evento com consequências emocionais negativas, e características do bom atendimento. Os achados demonstraram situações de violência, comunicação deficitária, desvalorização das perdas precoces, falta de suporte para contato com o bebê falecido e rotinas pouco humanizadas, especialmente durante a internação após a perda. Para aprimorar a assistência às famílias enlutadas, sugere-se qualificação profissional, ampliação da visibilidade do tema entre diferentes atores e reorganização dos serviços, considerando uma diretriz clínica para atenção ao luto perinatal, com destaque para o fortalecimento da inserção de equipes de saúde mental no contexto hospitalar.(AU)

This study analyzed couples' perceptions and feelings about pregnancy loss care (ante and intrapartum fetal death). A research invitation was published on social media (Instagram and Facebook) and data collection took place in 2018. Of the 66 couples who contacted the research team, 12 participated in the study by filling a sociodemographic questionnaire and answering a semi-structured interview in person (n=04) or by video call (n=08). All interviews were audio recorded, transcribed, and examined by Inductive Thematic Analysis, which identified five themes: feelings of impotence, iatrogenic experiences in health services, lack of mental health care, not recognizing pregnancy loss as an emotionally overwhelming event, and aspects of good healthcare. Analysis showed experiences of violence, poor communication, devaluation of early losses, lack of support for contact with the deceased baby, and dehumanizing routines, especially during hospitalization after loss. Professional qualification, extended pregnancy loss visibility among different stakeholders, and reorganization of health services are needed to improve the care offered to grieving families, considering a clinical guideline for perinatal grief care with emphasis on strengthening the insertion of mental health teams in the hospital context.(AU)

Este estudio analizó las percepciones y sentimientos de parejas sobre la atención recibida en los servicios de salud a los que accedieron debido a la pérdida del embarazo (muerte fetal ante e intraparto). La invitación al estudio se publicó en las redes sociales (Instagram y Facebook). De las 66 parejas que se contactaron con el equipo, 12 participaron en el estudio, cuya recolección de datos se realizó en 2018. Las parejas respondieron un formulario de datos sociodemográficos y realizaron una entrevista semiestructurada presencialmente (n=4) o por videollamada (n=08). Los datos se grabaron en audio para su posterior transcripción. El análisis temático inductivo identificó cinco temas: Sentimiento de impotencia, experiencias iatrogénicas en los servicios, falta de atención a la salud mental, falta de reconocimiento de la pérdida como un evento con consecuencias emocionales negativas y características de buena atención. Los hallazgos evidenciaron situaciones de violencia, comunicación deficiente, desvalorización de las pérdidas tempranas, falta de apoyo para el contacto con el bebé fallecido y rutinas poco humanizadas, especialmente durante la hospitalización tras la pérdida. Para mejorar la atención a las familias en duelo, se sugiere capacitación profesional, ampliación de la visibilidad del tema entre los diferentes actores y reorganización de los servicios, teniendo en cuenta una guía clínica para la atención del duelo perinatal, enfocada en fortalecer la inserción de los equipos de salud mental en el contexto hospitalario.(AU)

A disciplina psicologia do esporte nos cursos de psicologia e educação física / Sports psychology in psychology and physical education courses / La materia psicología del deporte en los cursos de psicología y educación física

Este discute a representatividade da disciplina Psicologia do Esporte nos cursos de Psicologia e Educação Física em instituições de ensino superior reconhecidas pelo MEC e situadas na região Sul do país. Foi realizado um estudo documental, com base nos currículos das Instituições. Os resultados revelaram que no Sul do Brasil 21,02% dos cursos de Psicologia, 41,96% dos cursos de bacharelado em Educação Física e apenas 14,83% dos cursos de licenciatura em Educação Física apresentam a disciplina Psicologia do Esporte em sua grade curricular. Observou-se que a disciplina é ofertada mais frequentemente em regime obrigatório nos cursos de bacharelado em Educação Física. Nos cursos de Psicologia, quando ofertada, costuma ser optativa. Os resultados evidenciam uma maior oferta da disciplina para os estudantes de Educação Física, em relação aos de Psicologia, o que pode estar relacionado ao próprio contexto de surgimento da disciplina e sua popularização no meio acadêmico. Para que esse panorama possa mudar e se possa oferecer uma formação adequada no curso de Psicologia para fomentar essa opção de carreira, há necessidade de se repensar o currículo e o próprio perfil do egresso, de forma a dar mais oportunidade aos estudantes para que conheçam as bases teóricas e os campos de aplicação da Psicologia do Esporte. Tal lacuna pode acarretar a fragilização da disseminação desse conhecimento aos estudantes de graduação e a consequente ocupação do mercado de trabalho.(AU)

This study discusses the representativeness of Sports Psychology in Psychology and Physical Education courses at higher education institutions from Southern Brazil. A documentary study was conducted based on the institutions' curricula. Results show that 21.02% of the Psychology major, 41.96% of the bachelor's in Physical Education, and only 14.83% of the license in Physical Education offer Sports Psychology in their curricula. Sports Psychology is most often offered as a compulsory subject in the bachelor's program in Physical Education, whereas Psychology courses offer it mainly as an elective. Physical Education students have greater contact with the discipline when compared with Psychology students, which may be explained by its context of development and popularization in the academic environment. To change this scenario and offer adequate education in the Psychology programs to foster this career option, institutions must rethink their curriculum and the graduate profile itself. This would give students better opportunity to get to know its theoretical bases and fields of application. Such a gap can hinder the dissemination of this knowledge to undergraduate students and the consequent labor market occupation.(AU)

El objetivo de este estudio es discutir la representatividad de la materia Psicología del Deporte en los cursos de Psicología y Educación Física en instituciones de educación superior de la región Sur de Brasil, reconocidas por el Ministerio de Educación (MEC). Se realizó un estudio documental, basado en los planes de estudio de las instituciones. Los resultados revelaron que, en el Sur de Brasil, el 21,02% de los cursos de Psicología, el 41,96% de los cursos de licenciatura en Educación Física y sólo el 14,83% de los cursos de profesorado en Educación tienen la materia Psicología del Deporte en sus planes de estudio. Se observó que la materia Psicología del Deporte se ofrece con mayor frecuencia como asignatura obligatoria en los cursos de licenciatura en Educación Física. Cuando se ofrece en los cursos de Psicología, es una materia optativa. Los resultados muestran una mayor oferta para los estudiantes de Educación Física en comparación con Psicología, lo que puede estar relacionado con el contexto del surgimiento de la Psicología del Deporte como materia y su popularización en el ámbito académico. Para que este escenario cambie y sea posible ofrecer una formación adecuada en el curso de Psicología con el fin de fomentar esta opción de carrera, es necesario repensar el plan de estudios y el perfil del egresado, así los estudiantes tendrán más oportunidades de conocer sus bases teóricas y sus campos de actuación. Tal brecha puede debilitar la difusión de este conocimiento a los estudiantes de grado y la consecuente ocupación en el mercado laboral.(AU)

Sistema de avaliação de práticas psicológicas Aluízio Lopes de Brito (SAPP) sobre políticas de cuidado / Aluízio Lopes de Brito psychological practices assessment system (SAPP) on care policies / Sistema de evaluación de prácticas psicológicas Aluízio Lopes de Brito (SAPP) sobre políticas de cuidado

O objetivo do presente manuscrito é caracterizar e descrever os fluxos do Sistema de Avaliação de Práticas Psicológicas Aluízio Lopes de Brito (SAPP), dispositivo instituído no âmbito do Sistema Conselhos de Psicologia e regulamentado pelo Conselho Federal de Psicologia através da Resolução CFP nº 15, de 18 de agosto de 2023. O SAPP surge da necessidade premente de orientação e qualificação profissionais frente às práticas emergentes que produzem o saber/ fazer da psicologia. Nesse sentido, trata-se de processo que busca orientar, qualificar e fazer conhecer práticas que sejam compatíveis ou não com o exercício profissional em psicologia. Com o trabalho realizado no SAPP serão produzidos pareceres que contribuirão minimamente para o conhecimento das fronteiras que delimitam os campos da psicologia e, por excelência, conheceremos melhor nossas próprias formas de atuação. Através da consideração do trinômio teoria-prática-ética, o CFP espera com o SAPP abrir diálogos com grupos, práticas e saberes fronteiriços e constantemente relegados pela psicologia hegemônica. Para tanto, parte do pressuposto de que os saberes e fazeres destas populações podem refinar as teorias psicológicas e fazer a psicologia avançar como ciência e profissão.(AU)

This manuscript aims to characterize and describe the flows of the Aluízio Lopes de Brito Psychological Practices Assessment System (SAPP), an instrument established within the framework of the Psychology Council System and regulated by the Federal Council of Psychology (CFP) with Resolution CFP No. 15, of August 18, 2023. The SAPP arises from the pressing need for professional guidance and qualification in the face of emerging practices that shape the knowledge/practice of psychology. In this sense, it is a process that seeks to guide, qualify, and make known practices that are compatible or not with the professional practice of psychology. The work carried out in the SAPP will produce opinions that will contribute minimally to the understanding of the boundaries that delimit the fields of psychology and, by excellence, we will better understand our own modes of operation. Considering the trinity of theory-practice-ethics, the CFP hopes with the SAPP to open dialogues with groups, practices, and knowledge that are in the borders and are constantly relegated by hegemonic psychology. To this end, it assumes that the knowledge and practices of these populations can refine psychological theories and advance psychology as a science and profession.(AU)

El objetivo de este manuscrito es caracterizar y describir los flujos del Sistema de Evaluación de Prácticas Psicológicas Aluízio Lopes de Brito (SAPP), un dispositivo establecido en el marco del Sistema de Consejos de Psicología y regulado por el Consejo Federal de Psicología a través de la Resolución CFP n.º 15, con fecha del 18 de agosto de 2023. El SAPP surge de la necesidad apremiante de orientación y calificación profesional frente a las prácticas emergentes que configuran el conocimiento y las habilidades de la psicología. En este sentido, es un proceso que busca orientar, calificar y dar a conocer prácticas que sean compatibles o no con el ejercicio profesional de la psicología. El trabajo realizado en el SAPP generará opiniones que contribuirán mínimamente a la comprensión de los límites que delimitan los campos de la psicología y, por excelencia, comprender mejor nuestras propias formas de actuación. A través de la consideración de la tríada teoría-práctica-ética, el CFP espera que con el SAPP puede llevar a cabo el diálogo con grupos, prácticas y conocimientos fronterizos y constantemente pasados por alto por la psicología hegemónica. Con este fin, se asume que los conocimientos y prácticas de estas poblaciones pueden refinar las teorías psicológicas y hacer avanzar la psicología como ciencia y profesión.(AU)

Sistema de avaliação de testes psicológicos: histórias contadas e não contadas / Psychological test evaluation system: stories told and untold / Sistema de evaluación de tests psicológicos: historias contadas y no contadas

O Sistema de Avaliação de Testes Psicológicos (SATEPSI) recebeu notoriedade entre brasileiros e estrangeiros por oferecer um complexo sistema de qualificação dos testes psicológicos, pouco visto em âmbito mundial. Sua elaboração dependeu de uma autarquia, que o financiou, normatizou e o mantém, mas também de pesquisadores docentes de avaliação psicológica, que trouxeram a expertise da área para que houvesse o pleno estabelecimento de seus parâmetros. Passadas duas décadas de seu lançamento, o SATEPSI foi tema de artigos, capítulos, lives e diálogos digitais, nos quais foram destaque, de modo geral, as Resoluções do Conselho Federal de Psicologia, que o normatiza, e seus impactos para a área de avaliação psicológica - como, por exemplo, o aumento do número de pesquisas e de testes brasileiros qualificados. O que se pretende neste artigo é mencionar sua construção, à luz dos autores que vivenciaram o SATEPSI em funções e tempos distintos. Atenção especial será dada aos Métodos Projetivos, cuja história ainda é pouco revelada.(AU)

The system to evaluate psychological tests (Satepsi) received notoriety among Brazilians and foreigners for offering a complex system of qualification of psychological tests, which is rarely seen worldwide. Its development depended on an autarchy (which financed, standardized, and maintains it) and on researchers teaching psychological assessment, who brought their expertise to the area so its parameters could be fully established. After two decades of its launch, Satepsi was the subject of articles, chapters, lives, and digital dialogues, which usually highlighted the Resolutions of the Federal Council of Psychology that normatize psychological evaluation and their impacts, such as the increase in the number of qualified Brazilian tests. This study aims to mention its construction in the light of the authors who experienced Satepsi in different functions and times, giving special attention to Projective Methods, whose history remains to be shown.(AU)

El Sistema de Evaluación de Tests Psicológicos (SATEPSI) ganó notoriedad entre los brasileños y los extranjeros por ofrecer un complejo sistema de calificación de los tests psicológicos, poco frecuente a nivel mundial. Su elaboración dependió de una autarquía, que lo financió, lo estandarizó y lo mantiene, pero también de investigadores docentes de evaluación psicológica, que trajeron la experiencia del área para que hubiera el pleno establecimiento de sus parámetros. Tras dos décadas de su lanzamiento, SATEPSI fue tema de artículos, capítulos, en directo y diálogos digitales, en los cuales destacaron, de modo general, las Resoluciones del Consejo Federal de Psicología que lo normatiza y sus impactos para el área de evaluación psicológica, como el aumento del número de investigaciones y de pruebas brasileñas calificadas. Lo que se pretende en este artículo es mencionar su construcción, a la luz de los autores que vivieron el SATEPSI en funciones y tiempos distintos. Se prestará especial atención a los métodos proyectivos cuya historia aún no se ha revelado.(AU)

Lineamientos técnicos de habilitación y rehabilitación en salud / Technical guidelines for habilitation and rehabilitation in health

En la habilitación y rehabilitación participan diversos tipos de profesionales de la salud, entre ellos: psicoterapeutas, fisioterapeutas y terapeutas ocupacionales, logopedas, ortesistas y protesistas, psicólogos clínicos, fisiatras y personal de enfermería especializado en rehabilitación entre otros. La habilitación y rehabilitación es una inversión que aporta beneficios en términos de costos, tanto a quien la precisa como a la sociedad en conjunto. Puede ayudar a evitar hospitalizaciones costosas, reducir la duración de estas, duplicidad de esfuerzos, y evitar reingresos. Asimismo, hace posible que quienes la reciben puedan participar en actividades educativas, ser económicamente activos y llevar una vida independiente. El presente documento, constituye una herramienta para el fortalecimiento del proceso de atención integral de las personas con limitación funcional o discapacidad del Sistema Nacional Integrado de Salud (SNIS) y de la cobertura universal de salud

Various types of health professionals participate in habilitation and rehabilitation, including: psychotherapists, physiotherapists and occupational therapists, speech therapists, orthotists and prosthetists, clinical psychologists, physiatrists and nursing staff specialized in rehabilitation, among others. Rehabilitation and rehabilitation is an investment that brings benefits in terms of costs, both to those who need it and to society as a whole. It can help avoid costly hospitalizations, reduce hospitalization durations, duplication of effort, and avoid readmissions. It also makes it possible for recipients to participate in educational activities, be economically active, and lead an independent life. This document constitutes a tool for strengthening the comprehensive care process for people with functional limitations or disabilities of the National Integrated Health System (SNIS) and universal health coverage

Qualificação dos profissionais da atenção básica para fortalecimento da vigilância do desenvolvimento infantil e ações intersetoriais / Qualification of primary care professionals to strengthen child development surveillance and intersectoral actions / Calificación de profesionales de atención primaria para el fortalecimiento de la vigilancia del desarrollo infantil y las acciones intersectoriales

A vigilância do desenvolvimento infantil é composta por atividades que visam a promoção do desenvolvimento típico e a detecção de problemas, durante a atenção primária à saúde da criança. A Política Nacional de Atenção Integral à Saúde da Criança (Pnaisc) reconhece a criança como prioridade, como o grupo mais vulnerável e como o maior potencial transformador da humanidade, tornando a atenção integral à sua saúde uma ação com repercussões no presente e no futuro. O objetivo deste estudo foi relatar a experiência do curso de qualificação de profissionais da rede de atenção básica (AB) no cuidado à criança com deficiência, discutindo o uso da caderneta da criança para acompanhamento e vigilância do desenvolvimento infantil, bem como a identificação precoce dos sinais de alerta de prováveis desvios do desenvolvimento. O curso foi construído e organizado em três eixos temáticos distintos e complementares, a saber: Eixo I ­ Desenvolvimento global da criança de 0 a 5 anos, Eixo II ­ Identificação, acolhimento e encaminhamento da criança com provável atraso de desenvolvimento e/ou deficiência e Eixo III ­ Acompanhamento na rede de AB da criança com provável atraso de desenvolvimento e/ou deficiência. Por meio desta experiência relatada, destacamos a necessidade da elaboração de estratégias, como as qualificações profissionais, que fortaleçam a utilização adequada da caderneta da criança para que seja um instrumento que favoreça o cuidado integral desse grupo.

Child development surveillance comprises activities aimed at promoting typical development and detecting problems during primary child health care. The National Policy for Comprehensive Child Health Care recognizes children as a priority, as the most vulnerable group and as the greatest transformative potential of humanity, making comprehensive health care an action that affects the present and the future. This study reported on the experience of a qualification course for primary care professionals who attends children with disabilities, discussing the use of the child's booklet for monitoring and surveillance of child development, and the early identification of warning signs concerning probable development deviations. The course was elaborated and organized into three distinct and complementary thematic axes, as follows: Axis I ­ Global development of children aged 0 to 5 years; Axis II ­ Identification, reception, and referral of children with probable developmental delay and/or disabilities; and Axis III ­ Follow-up in the AB network of children with probable developmental delay and/or disability. This experience report allowed us to highlight the need to develop strategies, such as professional qualifications, to strengthen the proper use of the child's booklet so that it can be an instrument that favors the comprehensive care of this group.

La vigilancia del desarrollo infantil comprende actividades destinadas a promover el desarrollo y detectar problemas durante la atención primaria de salud infantil. La Política Nacional de Atención Infantil Integral del Niño (PNAISC) reconoce a los niños como una prioridad, como el grupo más vulnerable y como el mayor potencial transformador de la humanidad, haciendo de la atención integral de la salud una acción con repercusiones para el presente y el futuro. El objetivo de este estudio fue reportar la experiencia del curso de calificación para profesionales de la red de atención primaria (AP) en el cuidado de niños con discapacidad, discutiendo el uso del folleto del niño en el seguimiento y vigilancia del desarrollo infantil, así como la identificación temprana de alertas de signos y posibles desviaciones del desarrollo. El curso se construyó y se organizó en tres ejes temáticos distintos y complementarios: Eje I - Desarrollo global de niños de 0 a 5 años, Eje II - Identificación, recepción y derivación de niños con probable retraso y/o discapacidad en el desarrollo, y Eje III - Seguimiento en la red AP de niños con probable retraso y/o discapacidad en el desarrollo. Desde esta experiencia es necesario desarrollar estrategias, como la calificación profesional, que fortalezcan el uso adecuado del folleto del niño para que sea un instrumento de ayuda en la atención integral de esta población.

Impacts of the Certificates of Added Competence credentialling program: a qualitative case study of enhanced-skill family medicine practice across Canada.

BACKGROUND: In 2015, the College of Family Physicians of Canada (CFPC) expanded its Certificates of Added Competence (CAC) program to include enhanced-skill certification in Care of Elderly, Family Practice Anesthesia, Palliative Care, and Sports and Exercise Medicine. We aimed to describe the impact of these 4 CACs on the provision of comprehensive care in Canada, while also identifying the factors of influence that foster these impacts. METHODS: Between September 2018 and June 2019, we conducted qualitative case studies of 6 family medicine practices across Canada, sampled to represent geographic, population and practice arrangement diversity. We developed a framework of relevant factors and their relations to CAC-mediated comprehensive care delivery. We took an exploratory approach to the first 4 case studies, guided by theoretical propositions based on a literature review, and the CFPC's 4 principles of family medicine and goals for practice. The emerging theory was confirmed and adapted through the final 2 explanatory case studies. Data were obtained through semistructured qualitative interviews with enhanced-skill and generalist physicians, specialists, trainees and administrators associated with these cases. We performed a descriptive content analysis, within and across cases. RESULTS: Interviews with 48 participants showed considerable variation in the way CACs are operationalized related to the specific domain of care, the community, relationships among practitioners, motivations of the practitioner and needs of the patient population. The presence of CAC holders in communities expands the scope of available services, reduces the need for patients to travel and encourages continuity of care; however, comprehensive care may be negatively affected when CAC holders develop enhanced-skill practices according to clinical interests rather than community needs. Factors associated with collaborative care models, practice requirements, remuneration structure, community culture and individual aspirations interact to reinforce or undermine the effectiveness of enhanced-skill practices. INTERPRETATION: Holders of CACs have a positive impact when they work in collaborative models that align with the needs of communities and that support local generalist family physicians. Health care policies should incentivize CAC activities that contribute to planned care delivery at the practice and community levels.

It's...Complicated: A Theoretical Model of Music-Induced Harm.

While literature exists supporting the use of music for health promotion, scholars have also noted the potential for music-induced harm and other maladaptive effects of music. Harm is a multifaceted construct that can include affective, behavioral, cognitive, identity, interpersonal, physical, and spiritual aspects. As music also represents a multifaceted experience, the relationship between music and harm is complex and can include numerous contextual-, deliverer-, music-, and recipient-based factors. Music-induced harm (MIH) also needs to be clearly defined to understand and protect against it. Therefore, the purpose of this article was to explore the numerous factors influencing how music can result in harm and develop a theoretical model that could be used to inform safe music practices. Drawing from existing models of emotional responses to music, music intervention reporting guidelines, therapeutic functions of music, and holistic wellness, we explored how the interplay between the deliverer, music, and recipient can result in various types of MIH in diverse contexts. We then developed the MIH model to integrate these factors and connect the model with the existing literature. The MIH model highlights the relevance of academic and clinical training, credentialing, occupational regulation, continuing education, and professional organizations that provide accredited curricular oversight to protect people from MIH. Implications for clinical application, limitations, and suggestions for future research are provided.

Intrapartum fetal surveillance education in Victorian hospitals revisited.

Fifteen years ago a survey of Victorian public maternity services showed that the majority of services provided no fetal surveillance education to their staff and that only one in ten undertook any sort of assessment of staff knowledge. Today, all hospitals, public and private, provide training and all public hospitals require their midwifery and medical staff to undertake regular assessment of knowledge. The requirements of specialist obstetricians in private practice remain variable.

Development and content validation of the Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey.

AIM: To develop a validated tool to measure nursing and midwifery documentation burden. BACKGROUND: While an important record of care, documentation can be burdensome for nurses and midwives and may remove them from direct patient care, resulting in decreased job satisfaction, associated with decreased patient satisfaction. The amount of documentation is increasing at a time where staff rationalisation results in decreasing numbers of clinicians at the bedside. No instrument is available to measure staff perceptions of the burden of clinical documentation. DESIGN: Survey development, followed by rwo rounds of content validation (April and May 2019). METHODS: Based on the literature a 28 item survey, with items in 6 subscales, representing key areas of documentation burden was developed. Item (I-CVI), subscale (S-CVI/Ave by subscale) and overall content validity indexes (S-CVI/Ave) were calculated following two review rounds by an expert panel of clinical and academic nurses and midwives. RESULTS: Level of agreement for the first iteration of the survey was low, with many items failing to reach the critical I-CVI threshold of 0.78. No subscale reached a S-CVI/Ave above 0.8 and the overall scale only achieved a S-CVI/Ave score of 0.67. Thirteen items were removed, seven were edited and five new items added, based on the expert panel feedback, substantially improving the content validity. All individual items achieved an I-CVI ≥0.78, the S-CVI/Ave was above 0.85 for all subscales and the total S-CVI/Ave was 0.94. CONCLUSION: The Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey can be considered as content valid, according to the content validity analysis by an expert panel. IMPACT: The BurDoNsaM survey may be used by nurse leaders and researchers to measure the burden of documentation, providing the opportunity to review practice and implement strategies to decrease documentation burden, potentially improving patient satisfaction with the care received.

A Survey of Music Therapists Working in Pediatric Medical Settings in the United States.

Music therapy is becoming a standard supportive care service in many pediatric hospitals across the United States. However, more detailed information is needed to advance our understanding about current clinical practice and increase availability of pediatric music therapy services. The purpose of this cross-sectional survey study was to collect and summarize data about music therapists working in pediatric medical settings. Specifically, we collected information about (1) therapist demographics, (2) organizational structure, (3) service delivery and clinical practice, and (4) administrative/supervisory responsibilities. Board-certified music therapists working in pediatric medical settings (n = 118) completed a 37-item online questionnaire. We analyzed survey data using descriptive statistics and content analysis. Findings indicated that there is a ratio of approximately one music therapist for every 100 patient beds, that one-third of respondents are the only music therapist in their setting, and that half of the surveyed positions are philanthropically funded. Prioritizing patient referrals based on acuity was common (95.7%, n = 110), with palliative care and pain as the most highly prioritized needs. More than half of respondents reported serving in high acuity areas such as the pediatric intensive care, hematology/oncology, or neonatal intensive care units. We recommend replication of this survey in five years to examine growth and change in service delivery among pediatric music therapists over time, with additional studies to (a) explore how therapist-to-patient ratios influence quality of care, (b) identify factors that contribute to sustainability of programs, and (c) determine how expansion of services support a broader population of patients and families.

Knowledge of US Midwifery Credentials Among Members of the American College of Nurse-Midwives.

INTRODUCTION: Three midwifery credentials are granted in the United States: certified nurse-midwife (CNM), certified midwife (CM), and certified professional midwife (CPM). Confusion about US midwifery credentials may restrict growth of the midwifery profession. This survey assessed American College of Nurse-Midwives (ACNM) members' knowledge of US midwifery credentials. METHODS: ACNM members (N = 7551) were surveyed via email in 2017. The survey asked respondents to report demographic information and to identify correct statements about the education, certification, and scope of practice of CNMs, CMs, and CPMs. Responses to 17 items about all midwives certified in the United States, a 5-item subset specific to CNMs/CMs, and one item related to location of midwifery practice by credential were analyzed. RESULTS: Nearly a quarter of the membership (22.1%) responded to the survey. Higher scores on the survey indicated greater identification of correct statements about the education, certification, scope, and location of practice of CNMs, CMs, and CPMs. Significant differences in scores were found among ACNM members based on their level of education, degree of professional involvement in midwifery, and prior practice as a nurse. ACNM members with higher scores on the survey held a doctorate, worked in Region I, and had greater professional leadership involvement in midwifery organizations. Participants with less nursing experience prior to their midwifery education also scored significantly higher on the survey. DISCUSSION: Although two-thirds of respondents correctly answered items on the preparation, credentialing, and scope of practice of CNMs, CMs, and CPMs, a significant minority had gaps in knowledge. Results of this survey suggest the need for outreach about US midwifery credentials. Future research to replicate and expand upon this survey may benefit the profession of midwifery in the United States.

The Malnutrition Quality Improvement Initiative: A Multiyear Partnership Transforms Care.

The Academy of Nutrition and Dietetics, representing credentialed nutrition and dietetics practitioners-registered dietitian nutritionists (RDNs) and nutrition and dietetics technicians, registered, and students and interns and professionals holding nutrition and dietetics undergraduate and advanced degrees-and Avalere Health, a Washington, DC-based strategic advisory services firm, have led the charge in closing malnutrition gaps with the Malnutrition Quality Improvement Initiative (MQii), a national nutrition-focused quality improvement initiative. The initiative's journey from 2013-2019 utilized technical advisors and stakeholders to improve care and outcomes for hospitalized adults age 65 and older with a series of innovations. These innovations include the development of the first malnutrition electronic clinical quality measures (eCQMs) and a complementary interdisciplinary quality improvement toolkit and establishing the first nutrition-focused national Learning Collaborative. MQii's vision for future directions and applications in 2020 and beyond will explore partnerships to include the malnutrition eCQM in available clinical data registries. Qualified Clinical Data Registries will provide a pathway for collecting nutrition data relevant to RDNs because as of 2020, payments for Medicare Part B nutrition services and quality improvement are available for eligible RDNs participating in the Centers for Medicare and Medicaid Services Quality Payment Program. The MQii Toolkit's technical specification manuals, data dictionaries, and implementation guides will help RDNs integrate the malnutrition quality measures into existing electronic health records and lead nutrition data collection and analysis. RDNs' continued advancement with information technology leaders to incorporate terminology and clinical standards into electronic health record platforms will provide for malnutrition data transfer across care settings. FUNDING/SUPPORT: Publication of this supplement was supported by Abbott. The Academy of Nutrition and Dietetics does not receive funding for the MQii. Avalere Health's work to support the MQii was funded by Abbott.

Expanded Practice in Midwifery: Designing, Implementing, and Maintaining Programs.

Advances in health care science and delivery, coupled with patient need for access to care, have driven expanded practice in midwifery for decades. The process for development and implementation of expanded practices for midwives and midwifery practices is described. Important components include assessment of need, identifying stakeholders and supporters, development of a program proposal, obtaining privileges, developing training programs, and conducting ongoing quality management and program evaluation. Examples of expanded practice in midwifery are presented.

Conhecimento e autoeficácia em cuidados paliativos dos enfermeiros da Atenção Primária à Saúde / Knowledge and self-efficacy of primary health care nurses

Introdução: A prestação de cuidados paliativos por profissionais generalistas da Atenção Primária à Saúde contribui para garantir o alívio do sofrimento, a melhora na qualidade de vida e a promoção do conforto dos indivíduos que deles necessitam e de suas famílias. Considerando a Atenção Primária à Saúde (APS) como o principal acesso do usuário ao Sistema de Saúde e o enfermeiro o gestor do cuidado neste nível de atenção, observou-se a necessidade de abordar esta temática. Objetivos: Avaliar o conhecimento e a autoeficácia em cuidados paliativos de enfermeiros da APS; compreender a experiência de enfermeiros da APS sobre o cuidado em uma abordagem paliativa e identificar as necessidades de educação permanente em CP na visão de enfermeiros da APS. Método: Estudo de método misto realizado com 383 enfermeiros que atuavam na APS de 21 municípios do sul e sudoeste de Minas Gerais, realizado em três etapas. Um questionário foi usado para verificar os dados sociodemográficos e profissionais e a versão adaptada culturalmente do instrumento Bonn Palliative Care Knowledge Test (BPW) para o contexto brasileiro foi aplicada aos enfemeiros para realização dos testes psicométricos e verificação do conhecimento e da autoeficácia em cuidados paliativos. Foram realizados 19 grupos focais, um para cada município participante, com a participação de enfermeiros da APS. O corpus dos dados foi armazenado e organizado no software WebQda e analisado por meio da análise temática sob a ótica da Teoria do Conforto de Katherine Kolcaba. Resultados: O processo de adatação transcultural foi realizado segundo o referencial adotado. As análises psicométricas indicaram inadequação do instrumento do ponto de vista da Teoria Clássica dos Testes. A confiabilidade do instrumento adaptado foi considerada crítica para o atributo conhecimento e ótima para a autoeficácia. Os resultados quantitativos referentes ao conhecimento e à autoefiácia obtidos por meio da aplicação do BPW corroboram os achados da abordagem qualitativa, evidenciando o conhecimento limitado em cuidados paliativos de enfermeiros da APS. Conclusões: O conhecimento de enfermeiros da APS em cuidados paliativos foi considerado limitado. Contudo, os profissionais sentem-se capazes de ofertá-lo. O BPW em sua versão para o contexto brasileiro foi considerado adaptado e sua validade de conteúdo confirmada. As análise psicométricas demonstraram sua inconsistência do ponto de vista da validade dos constructos (conhecimento e autoeficácia), o que indica a necessidade de novas análises para evidenciar sua validade. A compreensão da experiência de enfermeiros da APS no cuidado em uma abordagem paliativa possibilitou evidenciar como temas necessários à educação permanente desses profissionais a definição e a filosofia dos cuidados paliativos, a elegibilidade dos pacientes aos cuidados paliativos, o cuidado integral ao paciente e à família, a comunicação interpessoal e de notícias difíceis, a equipe multiprofissional em cuidados paliativos e os cuidados no final de vida.

Introduction: The provision of palliative care by generalists of Primary Health Care contributes to ensure the relief of suffering, the improvement of quality of life and the promotion of comfort of individuals who need them and their families. Considering Primary Health Care as the main access of the user to the Health System and the nurse the care manager at this level of care, there was a need to address this issue. Objective: To evaluate the knowledge and self-efficacy in palliative care of PHC nurses; understand the experience of PHC nurses on care in a palliative approach and identify the needs of CP continuing education in the view of PHC nurses. Method: A mixed method study with 383 primary health care nurses from 21 municipalities in the south and southwest of Minas Gerais, in three stages. A questionnaire was used to verify sociodemographic and professional data and the culturally adapted version of instrument Bonn Palliative Care Knowledge Test (BPW) for the Brazilian context was applied to nurses to perform psychometric tests and to verify knowledge and self-efficacy in palliative care. Nineteen focus groups were conducted, one for each participating municipality, with the participation of primary health care nurses. The data corpus was stored and organized in the WebQda software and analyzed through the thematic analysis from the perspective of Katherine's Theory of Comfort. Kolcaba Results: The process of cross-cultural adatation was performed according to the adopted framework. The psychometric analyzes performed indicated inadequacy of the instrument from the point of view of the Classical Test Theory. The reliability of the adapted instrument was considered critical for the knowledge attribute and optimal for self-efficacy. The quantitative results regarding knowledge and self-efficacy obtained through the application of BPW corroborate the findings of the qualitative approach, evidencing the limited knowledge in palliative care of primary health care nurses. Conclusions: Primary health care nurses' knowledge in care palliative care was considered limited. However, professionals feel able to offer it. BPW in its version for the Brazilian context was considered adapted and its content validity confirmed. Psychometric analysis showed their inconsistency from the point of view of construct validity (knowledge and self-efficacy), which indicates the need for further analysis to highlight their validity. Understanding the experience of PHC nurses in palliative care made it possible to highlight as necessary themes for the permanent education of these professionals the definition and philosophy of palliative care, the eligibility of patients to palliative care, integral care for patients and their families. interpersonal and difficult news communication, the multiprofessional team in palliative care and end-of-life care.

Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Nutrition and Dietetics Technician, Registered.

The Academy of Nutrition and Dietetics (Academy) is the world's largest organization of food and nutrition professionals and the association that represents credentialed nutrition and dietetics practitioners-nutrition and dietetics technicians, registered (NDTRs) and registered dietitian nutritionists (RDNs). An NDTR's scope of practice in nutrition and dietetics has flexible boundaries to capture the depth and breadth of the individual's practice. The NDTR's practice expands with advances in many areas, including nutrition, food production, food safety, food systems management, health care, public health, community health, and information and communication technology. The Revised 2017 Scope of Practice for the NDTR reflects the position of the Academy on the essential role of the NDTR in the management and delivery of food and nutrition services. The scope of practice for the NDTR is composed of education and credentialing, practice resources, Academy Standards of Practice and Standards of Professional Performance, codes of ethics, accreditation standards, state and federal regulations, national guidelines, and organizational policy and procedures. The Revised 2017 Scope of Practice for the NDTR is used in conjunction with the Revised 2017 Standards of Practice in Nutrition Care and the Standards of Professional Performance for NDTRs. The Standards of Practice address activities related to direct patient and client care. The Standards of Professional Performance address behaviors related to the technical role of NDTRs. These standards reflect the minimum competent level of nutrition and dietetics practice and professional performance for NDTRs. A companion document addresses the scope of practice for the RDN.

Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Registered Dietitian Nutritionist.

The Academy of Nutrition and Dietetics (Academy) is the world's largest organization of food and nutrition professionals and the association that represents credentialed nutrition and dietetics practitioners-registered dietitian nutritionists (RDNs) and nutrition and dietetics technicians, registered (NDTRs). RDNs integrate research, professional development, and practice to stimulate innovation and discovery; collaborate to solve the greatest food and nutrition challenges now and in the future; focus on systemswide impact across the food, wellness, and health sectors; have a global impact in eliminating all forms of malnutrition; and amplify the contribution of nutrition and dietetics practitioners and expand workforce capacity and capability. The Revised 2017 Scope of Practice for the RDN reflects the position of the Academy on the essential role of the RDN in the direction and delivery of food and nutrition services. The scope of practice for the RDN is composed of education and credentialing, practice resources, Academy Standards of Practice and Professional Performance, codes of ethics, accreditation standards, state and federal regulations, national guidelines, and organizational policy and procedures. The Revised 2017 Scope of Practice for the RDN is used in conjunction with the Revised 2017 Standards of Practice (SOP) in Nutrition Care and the Standards of Professional Performance (SOPP) for RDNs. The SOP address activities related to direct patient and client care. The SOPP address behaviors related to the professional role of RDNs. These standards reflect the minimum competent level of nutrition and dietetics practice and professional performance for RDNs. A companion document addresses the scope of practice for the NDTR.