[Skill mix of nurses and primary health care professionals: a systematic review]. / Combinação de tarefas do enfermeiro e de outros profissionais na atenção primária em saúde: uma revisão sistemática.

OBJECTIVE: To evaluate the effectiveness of the strategy of skill mix of nurses and other health care professionals in primary health care. METHODS: Systematic review of the literature aligned with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), including observational and intervention studies. No restrictions were established for period or country of publication; studies published in Spanish, English and Portuguese were included. The search was carried out in MEDLINE, CINAHL, LILACS, EMBASE and Web of Science electronic databases. RESULTS: Eighteen studies were analyzed, including 6 from the United States; 3 from the Netherlands; 2 from the United Kingdom; 1 each from Australia, South Africa, South Korea, Scotland, Haiti and Japan; and 1 study with a prospective observational design from 8 countries. The studies reported that the skill mix among health professionals enables a better use of material resources; optimizes time spent on care; improves adhesion to treatment, quality of care and commitment and satisfaction with the work; and reduces the level of psychological distress in nursing professionals. CONCLUSIONS: The expansion of tasks of nurses and other health care professionals, and the skill mix as well as the development of interprofessional teams, are strategies that help to face a scarcity and poor distribution of human resources in urban and non-urban areas with improvement of the health care of the population and satisfaction of professionals and clients.

Combinação de tarefas do enfermeiro e de outros profissionais na atenção primária em saúde: uma revisão sistemática

[RESUMO]. Objetivo. Avaliar a efetividade da estratégia de combinação de tarefas dos profissionais de saúde, e do enfermeiro na Atenção Primária de Saúde. Método. Revisão sistemática da literatura alinhada com as recomendações do protocolo dos Principais Itens para Relatar Revisões Sistemáticas e Metanálises, incluindo estudos observacionais e de intervenções, sem estabelecimento de período de publicação, independentemente do país de origem e publicados nos idiomas espanhol, inglês e português. As buscas ocorreram nas bases de dados eletrônicas da MEDLINE, CINAHL, LILACS, EMBASE e Web of Science. Resultados. Incluídos 18 estudos, dos quais 6 foram desenvolvidos nos Estados Unidos; 3 na Holanda; 2 no Reino Unido; um na África do Sul, Austrália, Coreia do Sul, Escócia, Haiti e Japão; e um estudo com desenho observacional prospectivo em 8 países. Os estudos relataram que, a combinação de tarefas entre os profissionais de saúde, possibilita melhor aproveitamento de recursos materiais, otimização do tempo gasto no atendimento, retenção do paciente no tratamento, melhora na qualidade do trabalho com diminuição dos níveis de sofrimento psicológico do enfermeiro e comprometimento e satisfação com o trabalho. Conclusão. A expansão de tarefas do enfermeiro, assim como de outras categorias de profissionais da saúde, a combinação de tarefas, bem como o desenvolvimento de equipes interprofissionais, são estratégias que podem ser empregadas em situações de escassez de recursos humanos e de má distribuição em áreas urbanas e não urbanas com resultados positivos na melhoria da atenção em saúde da população e satisfação dos profissionais e clientes.

[ABSTRACT]. Objective. To evaluate the effectiveness of the strategy of skill mix of nurses and other health care professionals in primary health care. Methods. Systematic review of the literature aligned with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), including observational and intervention studies. No restrictions were established for period or country of publication; studies published in Spanish, English and Portuguese were included. The search was carried out in MEDLINE, CINAHL, LILACS, EMBASE and Web of Science electronic databases. Results. Eighteen studies were analyzed, including 6 from the United States; 3 from the Netherlands; 2 from the United Kingdom; 1 each from Australia, South Africa, South Korea, Scotland, Haiti and Japan; and 1 study with a prospective observational design from 8 countries. The studies reported that the skill mix among health professionals enables a better use of material resources; optimizes time spent on care; improves adhesion to treatment, quality of care and commitment and satisfaction with the work; and reduces the level of psychological distress in nursing professionals. Conclusions. The expansion of tasks of nurses and other health care professionals, and the skill mix as well as the development of interprofessional teams, are strategies that help to face a scarcity and poor distribution of human resources in urban and non-urban areas with improvement of the health care of the population and satisfaction of professionals and clients.

Corrigendum a Distribución de la fuerza de trabajo en enfermería en la Región de las Américas

[ESPAÑOL]. Corrigendum a Distribución de la fuerza de trabajo en enfermería en la Región de las Américas. La Revista Panamericana de Salud Pública llama la atención a los lectores sobre un error en el siguiente artículo, señalado por los autores: Cassiani SHB, Hoyos MC, Barreto MFC, Sives K, da Silva FAM. Distribución de la fuerza de trabajo en enfermería en la Región de las Américas. Rev Panam Salud Publica. 2018;42:e72. https://doi.org/10.26633/RPSP.2018.72 . En la página 3, cuadro 1, el número de enfermeros por 10 000 habitantes en Argentina (2015) es 42,4 en lugar de 4,24.

[ENGLISH]. Corrigendum to Distribution of the nursing workforce in the Region of the Americas. The Pan American Journal of Public Health draws readers' attention to an error in the following article, pointed out by the authors: Cassiani SHB, Hoyos MC, Barreto MFC, Sives K, da Silva FAM. Distribución de la fuerza de trabajo en enfermería en la Región de las Américas. Rev Panam Salud Publica. 2018;42:e72. https://doi.org/10.26633/RPSP.2018.72. In page 3, table 1, the number of nurses per 10 000 inhabitants in Argentina (2015) is 42,4 instead of 4,24.

[PORTUGUÊS]. Corrigendum à Distribuição da força de trabalho de enfermagem na Região das Américas. A Revista Panamericana de Salud Pública chama a atenção dos leitores para um erro no artigo a seguir, apontado pelos autores: Cassiani SHB, Hoyos MC, Barreto MFC, Sives K, da Silva FAM. Distribución de la fuerza de trabajo en enfermería en la Región de las Américas. Rev Panam Salud Publica. 2018;42:e72. https://doi.org/10.26633/RPSP.2018.72. Na página 3, tabela 1, o número de enfermeiros por 10 000 habitantes na Argentina (2015) é de 42,4 em vez de 4,24.

Maternal health training priorities for nursing and allied health workers in Colombia, Honduras, and Nicaragua.

OBJECTIVE: To assess maternal health training priorities for primary care human resources for health (HRH) in nursing and allied health workers in Colombia, Honduras, and Nicaragua, to inform maternal care HRH strategic planning efforts. METHODS: This Washington, D.C.-based study utilized cross-sectional survey methodology to collect country-level data. From October 2016 to March 2017, a needs assessment tool was developed by the Pan American Health Organization/World Health Organization (PAHO/WHO) and PAHO/WHO Collaborating Centers. Data collection was completed by PAHO/WHO country offices, in collaboration with national health authorities and other high-level government personnel. The collected data included information on the composition, capacities, and training priorities of traditional birth attendants (TBAs), community health workers (CHWs), registered nurses (RNs), and auxiliary nurses in the three study countries; the findings were summarized in a report. RESULTS: Data on the health workforce composition in the three countries indicated reliance on HRH with low levels of education and training, with limited integration of TBAs. In all three countries, management of obstetric emergencies was a training priority for RNs, and identification of danger signs was a priority for CHWs and TBAs. Training priorities for auxiliary nurses varied widely across the three countries and included health promotion, preconception and prenatal care, and obstetric emergencies. There was also a wide range in the total number of HRH across the three countries. CONCLUSIONS: Reliance on health workers with low levels of training is concerning but can be mitigated through in-service training. Training priorities are consistent with the major causes of maternal mortality, and Latin America and Caribbean region training programs show promise for improving quality of care. In the long term, planning for maternal care HRH should seek to increase the concentration of health professionals that are more highly skilled.

[Distribution of the nursing workforce in the Region of the AmericasDistribuição de pessoal de enfermagem na Região das Américas]. / Distribución de la fuerza de trabajo en enfermería en la Región de las Américas.

OBJECTIVE: Describe the distribution of the nursing workforce in countries of the Region of the Americas and the relation between the number of human resources in nursing and maternal mortality ratios. METHODS: Descriptive and exploratory analysis of 27 countries of the Region. The variables in the study were the proportion of health professionals per country and subregion; professional category; and nurse-to-physician ratio. The maternal mortality ratio was used as an overall indicator of the health of the population to analyze its relationship to the number of nurses. Frequency distribution and density of human resources in nursing were analyzed per country and subregion. RESULTS: The distribution of nursing personnel was heterogeneous. Some countries had more than 80 nurses per 10 000 population and others had fewer than five professionals per 10 000 population. In 34.1% of the countries, the nurse-to-physician ratio was less than 1. Differences in the distribution of nursing personnel were observed between regions and subregions, and within countries. CONCLUSIONS: In several countries, the number of nurses per capita was less than expected. The majority of the countries showed a significantly lower proportion of licensed nurses with respect to technical and auxiliary personnel. It is necessary to implement initiatives to increase the number of licensed nurses throughout the Region.

OBJETIVO: Descrever a distribuição de pessoal de enfermagem nos países da Região das Américas e estabelecer a relação do número de profissionais de enfermagem com o índice de mortalidade materna. MÉTODOS: Estudo descritivo e exploratório conduzido em 27 países da Região das Américas. As variáveis estudadas foram proporção de profissionais por país e subregião, categoria profissional e relação enfermeiro-médico. O índice de mortalidade materna, por ser um indicador geral de saúde da população, foi usado para analisar a relação com o aspecto quantitativo de enfermeiros. Foram analisadas a distribuição de frequências e a densidade dos profissionais de enfermagem por país e sub-região. RESULTADOS: Verificou-se uma distribuição heterogênea do pessoal de enfermagem, com alguns países com mais de 80 enfermeiros por 10 mil habitantes e outros com menos de cinco profissionais por 10 mil habitantes. Observou-se uma relação enfermeiro-médico inferior a um em 34,1% dos países. Houve diferenças na distribuição de pessoal de enfermagem por região, sub-região e dentro do próprio país. CONCLUSÕES: Em vários países da Região das Américas, o número de enfermeiros por habitantes é menor que o esperado. A maioria dos países tem uma defasagem considerável na razão do número de enfermeiros licenciados em relação ao pessoal de enfermagem técnico e auxiliar. É necessário implementar iniciativas para aumentar o número de enfermeiros licenciados em toda a Região.