Intensive Primary Care Nursing: Exploring the Impact of a Nurse-Led Model for Medically and Social Complex Patients.

Lack of access to primary care contributes to health inequities. Treatment settings that utilize the full experience and training of nurses, both registered nurses (RNs) and advanced practice registered nurses (APRNs), can expand in primary care and successfully address health inequities. This small study describes the implementation of a model of primary care called intensive primary care (IPC), which has eight elements that support the full utilization of a nurse's experience and training. This is a mixed method qualitative study, which reports the observations of the implementation and pre- and post-intervention measures. The IPC model was implemented at a free clinic, which targeted underserved population between 2020 and 2023. Participants were selected as a convenience sample. Participants were to have two or more chronic health problems The participants received primary care using the IPC model, which included setting self-management goals, and meeting with RN or APRN on a monthly basis (face to face, via phone or zoom) to monitor progress toward goals. Twenty-two people were approached, and 19 completed the intervention. Pre- and Post-intervention measures (Patient Assessment of Chronic Illness Care [PACIC]-20); Functional, Communicative, Critical Thinking Health Literacy; Perceived Stress; Patient Activation; Perceived Self Efficacy for Chronic Disease; EuroQo- 5 Dimension (EQ-5D); Trust in Provider; Emotional Support-Patient Reported Outcome Measure Information System (PROMIS); and Patient Health Questionnaire-9) were obtained and analyzed with paired T test (α < .05). Nurses involved meet weekly to share observations recorded in free form notes. These observations were summarized by two of the authors (MD and KF) at the end of the study. All patients had improved physical health outcomes, but more importantly, there were significant improvements in measures known to impact health and health outcomes, specifically, patient activation, self-efficacy for chronic illness, PACIC, and trust in provider. Time spent with patients, both duration and frequency of contact, was observed to have significant impacts.

Autonomia profissional do enfermeiro na atenção primária à saúde: perspectivas para a prática avançada / Professional autonomy of nurses in primary health care: perspectives for advanced practice / Autonomía profesional de los enfermeros en la atención primaria de salud: perspectivas para la práctica avanzada

Objetivo: Descrever como os enfermeiros atuantes na Atenção Primária identificam sua autonomia profissional no desenvolvimento das práticas de Enfermagem. Métodos: Trata-se de uma pesquisa exploratória, descritiva, de abordagem qualitativa. Participaram de entrevistas online 28 enfermeiros que atuam na Atenção Primária de um município do Sul do Brasil, entre o período de outubro de 2020 até fevereiro de 2021. Para tratamento dos dados, foi utilizada a análise de conteúdo temática. Resultados: Emergiram duas categorias: 1) Resolutividade das práticas da Enfermagem; 2) Respaldo nas regulamentações profissionais e evidências científicas. A Enfermagem dispõe de maior autonomia frente à atenção à saúde da mulher, Infecções Sexualmente Transmissíveis e no cuidado à pessoa com feridas, pois no momento da consulta do enfermeiro, despontam habilidades e competências para a tomada de decisão na prática clínica. Em relação à regulamentação para exercício profissional, os profissionais enfatizaram a importância dos protocolos para respaldar as ações. Conclusão: O protagonismo do enfermeiro e sucesso nas experiências indicam um caminho promissor para a discussão e implementação da Enfermagem de Prática Avançada no Brasil. (AU)

Objective: To describe how nurses working in Primary Care identify their professional autonomy in the development of Nursing practices. Methods: This is an exploratory, descriptive research with a qualitative approach. Twenty-eight nurses who work in Primary Care in a municipality in southern Brazil participated in online interviews, between October 2020 and February 2021. For data processing, thematic content analysis was used. Results: Two categories emerged: 1) Resolving nursing practices; 2) Support in professional regulations and scientific evidence. Nursing has greater autonomy in the care of women's health, Sexually Transmitted Infections and in the care of the person with wounds, because at the time of the nurse's consultation, skills and competences for decision-making in clinical practice emerge. Regarding regulation for professional practice, professionals emphasized the importance of protocols to support actions. Conclusion: The role of nurses and success in the experiences indicate a promising path for the discussion and implementation of Advanced Practice Nursing in Brazil. (AU)

Objetivo: Describir cómo los enfermeros que actúan en la Atención Primaria identifican su autonomía profesional en el desarrollo de las prácticas de Enfermería. Métodos: Se trata de una investigación exploratoria, descriptiva, con abordaje cualitativo. Veintiocho enfermeros que actúan en la Atención Primaria de un municipio del sur de Brasil participaron de entrevistas en línea, entre octubre de 2020 y febrero de 2021. Para el procesamiento de datos, se utilizó el análisis de contenido temático. Resultados: Emergieron dos categorías: 1) Prácticas resolutivas de enfermería; 2) Apoyo en normativa profesional y evidencia científica. La enfermería tiene mayor autonomía en el cuidado de la salud de la mujer, Infecciones de Transmisión Sexual y en el cuidado de la persona con heridas, porque en el momento de la consulta del enfermero emergen habilidades y competencias para la toma de decisiones en la práctica clínica. En cuanto a la regulación para la práctica profesional, los profesionales destacaron la importancia de los protocolos para apoyar las acciones. Conclusión: El papel de los enfermeros y el éxito de las experiencias indican un camino promisorio para la discusión e implementación de la Enfermería de Práctica Avanzada en Brasil. (AU)

Qualitative study on shared decision making in cystitis management in general practice.

BACKGROUND: Cystitis are commonly treated with antibiotics, although non-antibiotic options could be considered for healthy non-pregnant women. Shared decision making (SDM) can be used in cystitis management to discuss the various treatment options but is not frequently applied in general practice. AIM: Identifying barriers and facilitators for applying SDM in cystitis management in general practice. DESIGN & SETTING: Qualitative explorative research in general practice with healthcare professionals (HCPs; general practitioners (GPs) and GP assistants) and healthy non-pregnant women with a recent history of cystitis (patients). METHOD: Individual semi-structured interviews were conducted between May and October 2022. We applied a combination of thematic and framework analysis. RESULTS: Ten GPs, seven GP assistants, and fifteen patients were interviewed. We identified three main barriers and one key facilitator: 1) applying SDM is deemed inefficient; 2) HCPs presume that patients expect antibiotic treatment and some HCPs consider non-antibiotic treatment inferior; 3) Patients are largely unaware of the various non-antibiotic treatment options for cystitis; 4) HCPs recognise some benefits of applying SDM in cystitis management, including reduced antibiotic use and improved patient empowerment, and patients appreciate involvement in treatment decisions, but preferences for SDM vary. CONCLUSION: SDM is infrequently applied in cystitis treatment in general practice due to the current efficient cystitis management, HCPs' perceptions, and patient unawareness. Nevertheless, both HCPs and patients recognise the long-term benefits of applying SDM in cystitis management. Our findings facilitate the development of tailored interventions to increase the application of SDM which should be co-created with HCPs and patients and fit into the current efficient cystitis management.

The process of clinical decision-making in chronic wound care: A scenario-based think-aloud study.

AIMS: To undertake a comprehensive investigation into both the process of information acquisition and the clinical decision-making process utilized by primary care nurses in the course of treating chronic wounds. DESIGN: Scenario-based think-aloud method, enriched by the integration of information processing theory. The study was conducted within the framework of home care nursing organizations situated in Flanders, the Flemish speaking part of Belgium. A cohort of primary care nurses (n = 10), each possessing a minimum of one year of nursing experience, was recruited through the collaboration of three home care nursing organizations. METHODS: Two real-life clinical practice scenarios were employed for the interviews, with the researcher adopting the roles of either the patient or another clinician to enhance the realism of the think-aloud process. Each think-aloud session was promptly succeeded by a subsequent follow-up interview. The Consolidated criteria for Reporting Qualitative research checklist was followed to guarantee a consistent and complete report of the study. RESULTS: Amidst noticeable variations, a discernible pattern surfaced, delineating three sequential concepts: 1. gathering overarching information, 2. collecting and documenting wound-specific data, and 3. interpreting information to formulate wound treatment strategies. These concepts encompassed collaborative discussions with stakeholders, while the refinement of wound treatment strategies was interwoven within both concepts 2 and 3. CONCLUSIONS: Evident variations were identified in chronic wound care clinical decision-making, regardless of educational background or experience. These insights hold the potential to inform the development of clinical decision support systems for chronic wound management and provide guidance to clinicians in their decision-making endeavours.

Condições de trabalho de enfermeiros da atenção primária à saúde nas capitais da região sudeste do Brasil / Working conditions of primary health care nurses in the capitals of the southeastern of Brazil / Condiciones de trabajo de las enfermeras de atención primaria de salud en las capitales de la región sureste de Brasil

Introdução: As condições de trabalho de enfermeiros que atuam na Atenção Primária à Saúde se relacionam a questões de ordem interpessoal, política, organizacional e de infraestrutura. Objetivo: analisar a categoria "condições de trabalho" oriunda da pesquisa "Práticas de Enfermagem na Atenção Primária à Saúde: estudo nacional de métodos mistos", com foco nas capitais da região Sudeste do Brasil. Métodos: estudo qualitativo que analisou 108 entrevistas de enfermeiros residentes em Belo Horizonte, Rio de Janeiro, São Paulo e Vitória, realizadas entre novembro de 2020 e setembro de 2021. Os dados foram submetidos à análise temática, com apoio do software MAXQDA®. Resultados: os participantes eram majoritariamente do sexo feminino (88,0%), idade média de 42 anos, cor ou raça parda e tempo de atuação em atenção primária superior a 12 anos. Há uma diversidade temática quanto às condições de trabalho referidas por enfermeiros, destacando-se positivamente relacionamentos interpessoais. Infraestrutura das unidades de saúde e a fragilidade dos vínculos empregatícios foram referidos como dificultadores do trabalho na APS. Conclusão: Há uma diversidade de fatores que se relacionam com as condições de trabalho dos enfermeiros, sendo necessário intervenções sobre aquelas que trazem prejuízos, como o excesso de atribuições e infraestrutura das unidades de saúde. (AU)

Background: The working conditions of nurses working in Primary Health Care are related to interpersonal, political, organizational and infrastructure issues. Objective: to analyze the category "working conditions" from the research "Nursing Practices in Primary Health Care: a national study of mixed methods", focusing on the capitals of the Southeast region of Brazil. Methods: qualitative study that analyzed 108 interviews with nurses residing in Belo Horizonte, Rio de Janeiro, São Paulo and Vitória, carried out between November 2020 and September 2021. Data were subjected to thematic analysis, with the support of the MAXQDA® software. Results: the participants were mostly female (88.0%), mean age of 42 years, brown color or race, and working in primary care for more than 12 years. There is a thematic diversity regarding the working conditions mentioned by nurses, with positive emphasis on interpersonal relationships. Infrastructure of the health units and the fragility of employment relationships were mentioned as obstacles to work in PHC. Conclusion: There are a variety of factors that are related to the working conditions of nurses, requiring interventions on those that bring harm, such as excess attributions and infrastructure of health units. (AU)

Introducción: Las condiciones de trabajo de los enfermeros que actúan en la Atención Primaria de Salud están relacionadas con cuestiones interpersonales, políticas, organizativas y de infraestructura. Objetivo: analizar la categoría "condiciones de trabajo" de la investigación "Prácticas de Enfermería en la Atención Primaria de Salud: un estudio nacional de métodos mixtos", con foco en las capitales de la región Sudeste de Brasil. Métodos: estudio cualitativo que analizó 108 entrevistas con enfermeros residentes en Belo Horizonte, Rio de Janeiro, São Paulo y Vitória, realizadas entre noviembre de 2020 y septiembre de 2021. Los datos fueron sometidos a análisis temático, con el apoyo del software MAXQDA®. Resultados: los participantes eran mayoritariamente del sexo femenino (88,0%), edad media de 42 años, color moreno o raza, y actuaban en la atención primaria hace más de 12 años. Hay diversidad temática en cuanto a las condiciones de trabajo mencionadas por los enfermeros, con énfasis positivo en las relaciones interpersonales. La infraestructura de las unidades de salud y la fragilidad de las relaciones laborales fueron mencionadas como obstáculos para el trabajo en la APS. Conclusión: Hay una variedad de factores que se relacionan con las condiciones de trabajo de los enfermeros, requiriendo intervenciones sobre aquellos que traen perjuicio, como el exceso de atribuciones e infraestructura de las unidades de salud. (AU)

Um olhar sobre a autonomia: percepções de enfermeiras sobre suas práticas na atenção primária / A look at autonomy: nurses' perceptions about their practices in primary care / Una mirada a la autonomía: percepciones de los enfermeros sobre sus prácticas en la atención primaria

Objetivo: Analisar a percepção de enfermeiras sobre a autonomia no exercício de suas práticas no contexto da atenção primária à saúde. Métodos: Estudo descritivo de abordagem qualitativa que analisou 108 entrevistas realizadas com enfermeiras(os) das quatro capitais da região sudeste do Brasil. As entrevistas, guiadas por roteiro semiestruturado, foram gravadas e transcritas. Os dados produzidos foram tratados e explorados com auxílio do software NVIVO®. Resultados: A maior parte das participantes eram mulheres, brancas, residiam na mesma cidade onde trabalham, graduaramse em instituições privadas. Foram organizadas duas categorias: repercussões da autonomia e seus desdobramentos para a resolutividade das necessidades em saúde dos usuários; e (des)conhecimento sobre a regulamentação das práticas da enfermeira: desafios para a autonomia. Conclusão: As enfermeiras compreendem a importância da autonomia para suas práticas, mas enfrentam interferências no cotidiano do trabalho, tanto por parte da gestão, da estrutura dos serviços ou da necessidade do uso de protocolos que garantam o exercício de sua atividade profissional de modo autônomo. (AU)

Objective: To analyze nurses' perception of autonomy to exercise their practices in the context of primary health care. Methods: A descriptive study with a qualitative approach that analyzed 108 interviews carried out with nurses from the four capitals of the southeastern region of Brazil. The interviews, guided by a semi-structured script, were recorded and transcribed. The data produced were processed and explored with the help of the NVIVO® software. Results: Most of the participants were women, white, lived in the same city where they work, and graduated from private institutions. Two categories were organized: repercussions of autonomy and its consequences for solving users' health needs; and (lack of) knowledge about the regulation of nursing practices: challenges for autonomy. Conclusion: Nurses understand the importance of autonomy for their practices, but they face interference in their daily work, either by management, the structure of services or the need for protocols that guarantee the exercise of their professional activity. (AU)

Objetivo: Analizar la percepción de autonomía de los enfermeros para ejercer sus prácticas en el contexto de la atención primaria de salud. Métodos: Estudio descriptivo con enfoque cualitativo que analizó 108 entrevistas realizadas con enfermeros de las cuatro capitales de la región sureste de Brasil. Las entrevistas, guiadas por un guión semiestructurado, fueron grabadas y transcritas. Los datos producidos fueron procesados y explorados con la ayuda del software NVIVO®. Resultados: La mayoría de los participantes eran mujeres, de raza blanca, vivían en la misma ciudad donde trabajan y egresaron de instituciones privadas. Se organizaron dos categorías: repercusiones de la autonomía y sus consecuencias para la solución de las necesidades de salud de los usuarios; y (falta de) conocimiento sobre la regulación de las prácticas de enfermería: desafíos para la autonomía. Conclusión: Los enfermeros comprenden la importancia de la autonomía para sus prácticas, pero enfrentan interferencias en su trabajo diario, ya sea por parte de la dirección, la estructura de los servicios o la necesidad de protocolos que garanticen el ejercicio de su actividad profesional. (AU)

Defining digital nursing.

BACKGROUND: The use of technology in health care, including nursing, is growing, owing in part to the COVID-19 pandemic and in response to national policy. AIMS: To investigate nurses' perceptions of digital nursing (DN). METHODS: Community and primary care nurses from across Wales were recruited (n=249) through a survey comprising open and closed questions. This was supplemented with semistructured interviews (n=25). Thematic analysis was used to analyse qualitative data. FINDINGS: Nurses had a broad range of perspectives on what DN meant, with four main themes being identified: access; impact on care; technology; and digital future. The positive impacts of DN on ways of working and patient outcomes were supported by answers to closed survey questions. CONCLUSION: Many nurses understand the value of digital tools within nursing and are clear about their benefits for patients, nurses and multiprofessional teams. However, there is a need for a clear definition and increased awareness of DN.

O cuidado ao paciente com câncer sob a ótica de enfermeiros da atenção primária à saúde / Cancer patient care from the perspective of primary health care nurses / La atención al paciente oncológico desde la perspectiva de los enfermeros de atención primaria a la salud

RESUMO Objetivo: descrever a percepção de enfermeiros sobre o cuidado ao paciente com câncer na Atenção Primária à Saúde. Método: estudo qualitativo, desenvolvido em 26 Centros de Saúde da Família de um município do Oeste catarinense - Brasil, entre setembro e outubro de 2022. Participaram 33 enfermeiros, que responderam um questionário on-line. O texto foi interpretado com base nos preceitos conceituais da cultura organizacional da teoria administrativa de Chiavenatto. Questões objetivas foram analisadas pela frequência das respostas; para as dissertativas, utilizou-se o Discurso do Sujeito Coletivo. Resultados: os enfermeiros percebem-se despreparados e identificam ausência de protocolos e fluxos organizacionais. Considerações finais: na Atenção Primária à Saúde há a crença consolidada no cotidiano laboral e que se torna integrante da cultura organizacional dos serviços de saúde, que o paciente com câncer deve seguir para o cuidado especializado. Nota-se desconhecimento das políticas de saúde, o que implica o profissional na atenção ao paciente com câncer.

ABSTRACT Objective: To describe nurses' perceptions of cancer patient care in Primary Health Care. Method: A qualitative study was conducted in 26 Family Health Centers in a municipality in western Santa Catarina - Brazil, between September and October 2022. A total of 33 nurses took part and completed an online questionnaire. The text was interpreted based on the conceptual precepts of organizational culture from Chiavenatto's administrative theory. The frequency of responses analyzed objective questions; the Collective Subject Discourse was used for the essay questions. Results: Nurses perceive themselves as unprepared and identify a lack of protocols and organizational flows. Final considerations: In primary Health Care, there is a belief consolidated in everyday work and becomes part of the organizational culture of health services, that cancer patients should go on to specialist care. There is a lack of knowledge of health policies, which implicates professionals in caring for cancer patients.

RESUMEN Objetivo: describir las percepciones de los enfermeros sobre la atención al paciente oncológico en Atención Primaria. Método: estudio cualitativo realizado en 26 Centros de Salud de la Familia de un municipio del oeste de Santa Catarina - Brasil, entre septiembre y octubre de 2022. Participaron 33 enfermeros que cumplimentaron un cuestionario en línea. El texto se interpretó basándose en los preceptos conceptuales de la cultura organizativa de la teoría administrativa de Chiavenatto. Las preguntas objetivas se analizaron por la frecuencia de las respuestas; para las preguntas de ensayo, se utilizó el discurso del sujeto colectivo. Resultados: los enfermeros no se sienten preparados e identifican una falta de protocolos y flujos organizativos. Consideraciones finales: en Atención Primaria existe la creencia, consolidada en el trabajo diario y que se ha convertido en parte integrante de la cultura organizativa de los servicios sanitarios, de que los pacientes con cáncer deben pasar a la atención especializada. Existe un desconocimiento de las políticas sanitarias, que implica a los profesionales en la atención a los pacientes con cáncer.

Educação em saúde como estratégia prestada por enfermeiros a pacientes com hipertensão na perspectiva dos cuidados primários / Health education as a strategy provided by nurses to patients with hypertension from the perspective of primary care / La educación sanitaria como estrategia proporcionada por enfermería a pacientes con hipertensión desde la perspectiva de la atención primaria

Objetivo: Descrever a importância do processo de educação em saúde reali- zado pelo enfermeiro aos pacientes hipertensos na atenção básica. Metodologia: Trata-se de uma revisão bibliográfica, onde foram utilizados artigos científicos identificados nas bases de dados: SciELO, LILACS e MEDLINE. Um total de 4.427 estudos foram encon- trados, após o refinamento oito foram selecionados para compor a amostra. Resultados: A estratégia educativa em saúde tem grande efetivação no tratamento da HAS, visto que o enfermeiro vai conhecer o paciente e direcioná-lo ao tratamento adequado, monitorando seu estado de saúde e evitando possíveis agravos. Contudo, o abandono do tratamento pelo cliente é uma das maiores dificuldades enfrentadas pelo o enfermeiro. Além disso, desafios no contexto do processo de trabalho em equipe e barreiras relacionadas à estru- tura física nas unidades de saúde. Considerações finais: O enfermeiro exerce um papel importante dentro do contexto da hipertensão arterial. Trazendo a prática baseada em evi- dências como abordagem, garantindo adesão ao tratamento e o controle dos níveis pres- sóricos da HAS.

Objective: To describe the importance of the health education process carried out by nurses with hypertensive patients in primary care. Methodology: This is a bibliographic review, where scientific articles identified in the databases: SciELO, LILACS and MEDLINE were used. A total of 4,427 studies were found, after refinement, eight were selected to compose the sample. Results: The health education strategy is highly effective in the treatment of SAH, as the nurse will get to know the patient and direct him to the appropriate treatment, monitoring his health status and avoiding possible injuries. However, abandonment of treatment by the client is one of the greatest difficulties faced by the nurse. In addition, challenges in the context of the teamwork process and barriers related to the physical structure in health units. Final considerations: Nurses play an important role within the context of arterial hypertension. Bringing evidence-based practice as an approach, ensuring adherence to treatment and control of blood pressure levels in SAH.

Objetivo: Describir la importancia del proceso de educación para la salud llevado a cabo por enfermeras con pacientes hipertensos en atención primaria. Metodología: Se trata de una revisión bibliográfica, donde los artículos científicos identificados en las bases de datos: SciELO, LILACS y MEDLINE. Fueron encontrados 4.427 estudios, después del refinamiento, ocho fueron seleccionados para componer la muestra. Resultados: La estrategia de educación sanitaria es altamente eficaz en el tratamiento de la HSA, ya que la enfermera conocerá al paciente y lo dirigirá al tratamiento adecuado, monitorizando su estado de salud y evitando posibles lesiones. Sin embargo, el abandono del tratamiento por parte del cliente es una de las mayores dificultades a las que se enfrenta la enfermera. Además, los desafíos en el contexto del proceso de trabajo en equipo y las barreras relacionadas con la estructura física en las unidades de salud. Consideraciones finales: Las enfermeras desempeñan un papel importante en el contexto de la hipertensión arterial. Traer la práctica basada en la evidencia como abordaje, garantizando la adherencia al tratamiento y el control de los niveles de presión arterial en la HTA.

El envejecimiento poblacional: una mirada desde la práctica de enfermería basada en el modelo de Nola J. Pender

El envejecimiento poblacional no es un fenómeno exclusivo de la sociedad moderna; ha estado presente en todas las etapas del desarrollo social y ha sido siempre de interés para la filosofía, el arte y la medicina. Se presenta una revisión bibliográfica, con el objetivo de valorar la aplicación del modelo de Nola J. Pender en la promoción de salud y su aplicabilidad desde su visión teórica en la práctica de enfermería comunitaria en el envejecimiento poblacional. Se analizan los aspectos teóricos expresados por ella, sus principales supuestos y su relación con el envejecimiento poblacional, además de exponer sus aportes teóricos, la importancia de su aplicación para la familia, la comunidad y su contribución al desarrollo de la enfermería no solo de Cuba sino en el mundo; si partimos de que Cuba está entre los países más envejecidos de Latinoamérica. La promoción de la salud motivada por el deseo de aumentar el bienestar y actualizar el potencial humano, es considerada en la actualidad una poderosa herramienta que permite promover actitudes, motivaciones y acciones a partir del concepto de autoeficacia, del compromiso de los individuos con el cambio de conductas para fomentar salud, no solo sobre el envejecimiento en sí, sino desde el envejecimiento. Los principales supuestos de Nola J. Pender en el modelo de promoción de salud la sitúan como marco de referencia en la investigación, al fortalecer la profesión y fundamentar su quehacer de manera objetiva hacia los intereses de los profesionales y las necesidades de las personas.

Population aging is not an exclusive phenomenon of modern society; it has been present in all social development stages and has always been of interest to philosophy, art and medicine. A bibliographical review is presented for evaluating the Nola J. Pender model application in health promotion, and its applicability from its theoretical vision in the community nursing practice in aging population. The theoretical aspects expressed by her, her main assumptions and her relationship with population aging are analyzed, in addition to exposing her theoretical contributions, the importance of her application for the family, the community and her contribution to the development of nursing not only in Cuba but in the world; if we start from the fact that Cuba is among the oldest countries in Latin America. Health promotion motivated by the desire to increase well-being and update human potential is currently considered a powerful tool that allows promoting attitudes, motivations and actions based on the concept of self-efficacy, the commitment of individuals to change of behaviors to promote health, not only about aging itself, but from aging. The main assumptions of Nola J. Pender in the health promotion model place it as a reference framework in research, by strengthening the profession and basing its work objectively on the interests of professionals and the people needs.

Enfermería de Práctica Avanzada en el Sistema de Salud: evolución, aceptación y reconocimiento / Advanced Practice Nursing in the Health System: evolution, acceptance and recognition

Introducción: se estima escasez de 5.9 millones de profesionistas de la salud a nivel mundial. La Enfermería de Práctica Avanzada (EPA), cuenta con conocimientos, competencias y habilidades clínicas específicas para actuar en situaciones de déficit de personal médico, tratando desde enfermedades agudas hasta crónico degenerativas, preservando tanto la salud mental como física. Objetivo: Determinar el desempeño de la Enfermería de Práctica Avanzada en el Sector Salud. Metodología: revisión sistemática sobre la EPA, que incluyó revisiones y artículos originales del periodo 2013-2022 en español e inglés, acerca de su desempeño: evolución, aceptación y reconocimiento. Para la identificación, cribado e inclusión de los artículos se utilizó el modelo PRISMA 2020. Resultados: de un total de 838 artículos identificados, se incluyeron 20 artículos y 7 de otras fuentes como citas y otros sitios web, obteniendo un total de 27 artículos de revisión, que abordan la evolución, la aceptación y reconocimiento. Se realizó análisis cualitativo. Conclusiones: el desempeño de EPA surge por las demandas poblacionales de atención primaria a la salud, diversos países ya cuentan con EPA, asistiendo a sus habitantes desde sus especialidades. La EPA es diversa y extensa, su profesionalización debe ser continua y permanente. En México falta camino para tomar la EPA como parte del equipo multidisciplinario

Abstract Introduction: About 5.9 millions healthcare professionals lack across the world. The Advanced Practice Nursing (APN), has specific knowledge, competences, and clinical abilities to act in medical absence, taking care from acute illness until chronic diseases, preserving both mental and physical health. Objective: To determine the Advanced Practice Nursing (APN) performance in the Health Sector. Methods: A systematic review about APN, including reviews and original articles from the period 2013-2022 in Spanish and English, about performance: evolution, acceptance and recognition. For the identification, screening, and inclusion of the articles the PRISMA 2020 model was used. Results: Of 838 total identified articles, 20 articles were included from the search and 7 from other sources such as citations and other websites, obtaining 27 total articles to be reviewed, which regard the evolution, acceptance and recognition. A qualitative analysis was performed. Conclusions: The APN performance arose because of demands for primary health care; several countries already have APN, providing care to inhabitants through their different specialties. APN is diverse and extensive, its professionalization must be continuous and permanent. In Mexico there is still some way to go to APN to take part in the multidisciplinary team.

Developing modern primary care nursing in North Macedonia.

BACKGROUND: Nurses have the potential to make a real impact on the health and well-being of people and populations and contribute to the realisation of delivery of Universal Health Coverage. However, in many parts of the world, the education and practice of nursing and nurses' position in health care and society are restricted by a range of social, cultural, economic and political factors. In North Macedonia, the Ministry of Health in partnership with the WHO Country Office launched a primary healthcare strategy supporting the development of nurses in primary care to fulfil their full scope of service. AIMS: To present information on the education, practice and position of nursing, in particular primary care nursing, in North Macedonia and to describe the ongoing initiatives to support the further development of nursing. APPROACH: Background documents reviewed, and visits to healthcare settings, organisations, interviews with individuals and groups and workshops undertaken in 2019-2020. FINDINGS: Three key areas of development were identified: education of nurses, their service delivery and practice in primary care, and their position in health care and society, all underpinned by the need for workforce planning. The findings formed the basis of a 10-year plan: Making Change Happen: The Nursing and Midwifery Development Roadmap. DEVELOPMENTS: To support the proposed primary care pilots, during the 2020/2021 COVID-19 pandemic, an on-line modular programme for primary care nurses was developed and delivered with the support of members drawn from The National Working Group for Moving Primary Care Nursing Forward in North Macedonia. Further work is planned to develop initial nurse education and to pilot changes in primary care. CONCLUSIONS: The launch of the primary healthcare strategy stimulated initiatives to improve the education, position and practice of primary care nursing. The COVID-19 pandemic required flexibility and changes to the original plans.

Development and Validation of Clinical Schedule for Primary Care Psychiatric Nursing (CSP-N) for Primary Care Nurses.

Introduction: As per the World Health Organization's mental health report for 2022, nearly a billion people have mental health issues, and 82% of them are in low and middle-income countries where mental health services are largely absent. For the successful integration of mental health into primary health care, proper training and education of primary care professionals are mandatory. Primary care nurses are in an excellent position to screen, identify, dual collaboration for treatment planning/referral, and follow-up of persons with mental illness (PMI), but they often lack the confidence and competence to tackle mental health problems. The study aimed to develop and validate the clinical schedule for primary care psychiatric nursing (CSP-N). Materials and Methods: It is conducted in two phases: the development and validation phases. An extensive literature search has been conducted, and the ten themes derived from the two-focused group discussions and three-direct one-to-one interviews and input from mental health experts were used to design the CSP-N. The CSP-N was checked for content validity by a panel of 17 experts using the item-level content validity index (I-CVI) and the scale-level content validity index (S-CVI). Results: The draft version 1 of the CSP-N showed high content validity for individual items (I-CVI range: 0.82 to 1.00) and high overall content validity (S-CVI = 0.95), and suggestions from the experts were incorporated. The CSP-N was developed in four modules. The single-measure two-way mixed absolute agreement ICC value was calculated (for 32 subjects) for the reliability test, and the ICC value was 0.97 with a 95% CI (0.94, 0.99). Conclusions: Using an iterative approach, the development and validation of the CSP-N demonstrated high I-CVI and S-CVI for screening and identification, dual collaboration for the treatment plan, referral, and follow-up of a person with mental illness by the nurses in the community.

The Work of Nurses in Primary Health Care: Crossings of the New Public Management.

The literature in the field of health management mentions a concept called new public management (NPM), introduced in Brazil and France at the end of the 20th century. The objective of the study was to analyze the repercussions of the work of nurses in primary health care in Brazil and France under the influence of NPM. This is an excerpt of a double-titled thesis, which is a research intervention with nurses from two Brazilian states and five French departments. Data were produced between February 2019 and July 2021. The public policy Health on the Hour acted as an institutional transducer, provoking a reduction in access and producing effects on professional practices. In both countries, NPM amplified the predominance of technical and quantifiable acts, the focus on individual care, and the loss of autonomy. Nurses reported insurmountable situations, using the metaphor "Sophie's choice". The results showed that making dilemmatic decisions has been the daily routine of nurses, which has not resulted in debureaucratization and higher quality of care.