La superación de la enfermera en la atención integral a la familia con enfermo oncológico / The upgrade of the nurse in the comprehensive care to the family with oncological patients

RESUMEN Introducción: la enfermera que se desempeña en los consultorios de la Atención Primaria de Salud, asume la responsabilidad de propiciar una atención integral al familiar encargado del cuidado del enfermo oncológico. Objetivo: diseñar una propuesta de superación para el perfeccionamiento de la actuación de la enfermera en la atención integral a la familia con enfermo oncológico. Materiales y métodos: se efectuó una investigación de desarrollo en la Facultad de Ciencias Médicas de Matanzas Dr. Juan Guiteras Gener, durante el curso 2018-2019. Se utilizó una muestra de 23 enfermeras de los consultorios de la atención primaria del municipio de Matanzas. Se analizaron los documentos que avalan su desempeño profesional. Se diseñó una encuesta dirigida a la identificación de las necesidades de aprendizaje y una guía de observación para caracterizar el modo de actuación del profesional de Enfermería. Se aplicaron entrevistas a supervisoras y directivos. Resultados: el análisis de las encuestas aplicadas a la muestra seleccionada y las observaciones realizadas a las actividades en el hogar, permitieron detectar las necesidades de aprendizaje para el perfeccionamiento de la atención integral a la familia con enfermo oncológico. Las entrevistas realizadas a supervisoras y directivos corroboraron la necesidad de la propuesta. Conclusiones: se diseñó un curso de posgrado para el perfeccionamiento de la actuación de los profesionales de la Enfermería, relacionado con el cuidado integral a la familia con enfermos oncológicos en la Atención Primaria de Salud (AU).

ABSTRACT Introduction: the nurse who works in the primary health care consultations assumes the responsibility of providing comprehensive care to the relative who takes care of oncological patients. Objective: to design a proposal of upgrading to improve the performance of the nurse in the comprehensive care to the family with an oncological patient. Materials and methods: a development research was conducted in the Faculty of Medical Sciences Dr. Juan Guiteras Gener, of Matanzas, during the school year 2018-2019. The sample was 23 nurses from the primary health care offices of the municipality of Matanzas. The documents that support their professional performance were analyzed. A survey was designed to identify learning needs and also an observation guide to characterize the performance of the nursing professional. Interviews were conducted with supervisors and managers. Results: the analysis of the surveys applied to the chosen sample and the observations made to the activities carried out at home, made it possible to determine the learning needs for the improvement of the comprehensive care to the families with oncological patients. Interviews with supervisors and managers confirmed the necessity of the proposal. Conclusions: a postgraduate course was designed for the improvement of nursing professionals' performance, aimed to the comprehensive care to families with oncological patients in the primary health care (AU).

Historia de la Medicina Familiar en Colón / History of Family Medicine in Colón

RESUMEN La formación de un médico de nuevo modelo en Cuba surge de forma experimental por la necesidad que tenía la población de recibir una atención médica integral. Como siempre nuestro comandante con sus ideas revolucionarias plantea la necesidad de su creación para que cada familia cubana contara con un médico y una enfermera que les brindara apoyo y cuidado desde el punto de vista clínico, epidemiológico y social. El municipio de Colón fue el primero en implementar este novedoso programa en la provincia de Matanzas. Con el objetivo de dar a conocer el surgimiento y desarrollo del mismo en esta ciudad es que se realiza el siguiente trabajo (AU).

SUMMARY The training of a new model doctor in Cuba arises experimentally because of the need of the population to receive comprehensive medical care. As always, our commander with his revolutionary ideas raised the need for its creation so that each Cuban family would have a doctor and a nurse who could provide support and care from a clinical, epidemiological and social point of view. The municipality of Colón was the first to implement this novel program in the province of Matanzas. With the aim of publicizing its emergence and development in our city, the authors wrote the following article (AU).

Developing and Implementing the Family Nurse Practitioner Role in Eswatini: Implications for Education, Practice, and Policy.

Introduction: Eswatini, a small, largely rural country in Southern Africa, has a high burden of morbidity/mortality in the setting of a critical shortage of human resources for health. To help achieve universal access to healthcare across the lifespan, the advanced practice family nurse practitioner (FNP) role was proposed and is in the process of being implemented. Methods/Approach: The PEPPA framework (Participatory, Evidence-based, Patient focused Process for Advanced practice nursing) illustrates the steps in the process of developing and implementing the FNP role in a country. These steps include: determining the need for the role, deciding on a model of care, developing/implementing the curriculum, relevant policies, and scope of practice (SOP), and integrating the role into relevant nursing regulations and Ministry of Health (MOH) guidelines and documents. Outcomes: The assessment has been completed, a locally tailored competency-based FNP curriculum has been developed, revised, and implemented, the FNP SOP has been approved and MOH guidelines are being updated to reflect current evidence-based practice and to integrate the FNP role. Continuous cycles of improvement/revision were needed to adapt the curriculum and SOP to meet local needs. Clinical placements were challenging since this is a new health cadre, but most challenges were overcome and many resulted in important opportunities for interdisciplinary collaboration. Summary: Outcomes from this quality improvement initiative demonstrate that it is feasible to develop and implement a locally responsive, competency-based FNP program in a low resource setting and enroll students, despite time and financial constraints. Adapting the curriculum and SOP from western countries can provide a foundation for program development but revision to assure that the program is responsive to local context is then needed. There is general acceptance of the role among Eswatini communities and professional stakeholders with emphasis on the need for FNP graduates to be clinically competent and able to function independently. Policy work related to deploying new graduates is ongoing.

Meeting FNP students' and faculty clinical needs: Two perspectives.

Appropriate clinical practice sites with skilled preceptors are the backbone of family nurse practitioner (FNP) students' education. Faculty are also in need of practice sites to stay abreast of current clinical practice and maintain clinical hours for certification. The purpose of this article is to relate the process of developing a practice model to meet the needs of the FNP student and faculty. Academia and student life professionals collaborated to use an existing student health center on campus as an education site with an FNP nursing faculty member as a preceptor. This qualitative descriptive study presents reflections of the experience from the student perspective. Three main themes were identified: independence, confidence, and trust. Lessons learned from the faculty perspective are also reviewed. Benefits of the project ultimately outweighed barriers. The interdepartmental precepted practice experience completed its fourth successful year and maintains support through the university's student life division. The model may provide strategies, particularly for FNP programs and faculty in smaller universities, to increase and diversify clinical experiences and provide a faculty practice site.

Family nurse practitioner students' perceptions of readiness and transition into advanced practice.

BACKGROUND: Utilizing skills identified in previous research on successful role transition, this study evaluated the relationship between a strategically designed practicum course and the readiness for role transition to family nurse practitioner (FNP) in graduate nursing students. METHODS: A mixed methods approach evaluated pre- and post-participation survey data for the FNP role preparedness in graduate nursing students in a strategically designed practicum course. The survey addressed 22 skills associated with readiness for role transition and had three open-ended questions to collect narrative student perceptions. RESULTS: Mann-Whitney U tests revealed readiness for the FNP role increased from pre to post-participation in the course for 19 out of 22 skills with significant increases (P < 0.05) for one skill and marginally significant increases (P < 0.10) for three skills. Qualitative findings yielded an overall sense of readiness in students for novice FNP roles. CONCLUSION: A well-designed practicum course that reviews prior knowledge gained through the program and reinforces critical thinking, assessment, and decision-making skills facilitates role transition from registered nurse to novice FNP.

Interprofessional "on-call" e-learning for family nurse practitioner students: Preparing for primary care across the life span.

BACKGROUND AND PURPOSE: Nurse practitioners (NPs) are expected to fill gaps in providing primary care in the United States and need vital skills to meet the growing need for primary care providers. One necessary skill is managing "on-call" clinical questions/concerns by patients across the life span. To date, there are no published studies that address "on-call" simulations for family NP (FNP) students across the life span. METHODS: This quasi-experimental, mixed-methods design used a confidence scale and Krippendorff's method for content analysis of discussion pages to determine the effectiveness and confidence of simulated "on-call" scenarios for FNP students during each of their clinical courses. CONCLUSIONS: There was a significant increase in the confidence level of students as measured by the confidence questionnaire (t = 3.07 [33]; p < .001), at the end of the FNP didactic and clinical courses. Krippendorff content analysis revealed three themes: self-reliance; thinking on your feet; and uncertainty of management. IMPLICATIONS FOR PRACTICE: "On-call" processing is a skill that is needed in graduate FNP programs so that these providers are fully prepared to meet any challenge they may encounter.

Addressing a Gap in Healthcare Access for Transition-Age Youth with Autism: A Pilot Educational Intervention for Family Nurse Practitioner Students.

A mixed-methods randomized controlled trial pilot study evaluated an educational curriculum focused on the medical needs of transition-age youth (TAY) with autism (ASD) for family nurse practitioner students. Fourteen out of a cohort of 16 (87.5%) nursing students consented to participate in the study and were randomly assigned to either a waitlist control group (WLC) (n = 8) or an intervention group (INT) (n = 6). Three measures were used to determine pre- and post-intervention levels of self-efficacy, knowledge, and attitudes. Quantitative and qualitative data provide preliminary support that participation in intervention may improve and enhance knowledge and level of self-efficacy in working with TAY with ASD.

Telemedicine simulation in online family nurse practitioner education: Clinical competency and technology integration.

BACKGROUND AND PURPOSE: Assessment of clinical competency in distance education programs presents new challenges and yet is imperative to patient safety and continued success of the profession. Furthermore, employers increasingly expect a skill set in current informational technologies. Clinical competence has been assessed using high stakes, standardized patient simulation in traditional, on-campus educational programs. Telemedicine technology integrated with standardized patient simulations may provide a solution for teaching the essentials of information technology and provide a modality for clinical competency assessment in distance education. METHODS: Telemedicine was introduced to students via a formative, didactic assignment. This preparation facilitated the use of telemedicine technology integrated with standardized patient simulations to assess clinical competency of online students. In addition, this format required students to apply the fundamentals of informational technologies. CONCLUSION: Combining the modality of telemedicine with high stakes, standardized patient simulation to assess clinical competence is innovative and ensures high standards in distant education while addressing the preparation of students in the use of emerging technologies. IMPLICATIONS FOR PRACTICE: Telemedicine integrated with human standardized patient simulation is a promising modality for clinical competency assessment and determination of program progression in distance education. In addition, students become accustomed to the informational technologies encountered in the workplace.

Flipping the Objective Structured Clinical Examination: A Teaching Innovation in Graduate Nursing Education.

Objective evaluation of distance-based family nurse practitioner (FNP) students can be challenging. One FNP program piloted a teaching innovation, the video-enhanced objective structured clinical examination (VE-OSCE) or "flip" of the traditional face-to-face OSCE, to assess student clinical performance in a controlled online environment using a teleconferencing platform. This project sought to assess the VE-OSCE design, implementation, and ability to identify FNP student learning needs.

A Rural "Grow Your Own" Strategy: Building Providers From the Local Workforce.

Rural health care leaders are increasingly tasked with the responsibility of providing health access to 21% of the national population with only 10% of the provider workforce. Provider recruitment strategies offering loan repayment have had some success in the short term but are less impactful at creating a long-term retention rate, unless the providers have an existing connection to either the community in which they are working or rural health care. Responding to these data, a demonstration project and study has been underway in Colorado to test a rural focused "grow your own" advanced practice registered nurse (APRN) model. Phase 1 is designed to measure recruitment of RNs from inside rural communities to return to school and become primary care providers within those communities. Phase 2 will measure completion of education and phase 3 will measure retention rates in those communities. This article reports on phase 1 of the project, which is recruitment. The project offers stipend support with assistance in the school application process, educational support, clinical and job placement assistance, and monthly coaching. In addition, communities were asked to provide matching funds to support the APRN students with a goal of creating a self-sustaining model that will build a continuous pipeline of APRN providers. This strategy avoids the costly need to recruit and relocate providers who have no ties to the community. Thirty-four of 36 nurses (94%) responded to the study survey. Survey results suggested that the combination of financial, community, and employer support utilized in this model could serve to create a new and sustainable strategy for building a rural APRN provider workforce pipeline. The ultimate outcome has the potential to ensure that all people in rural areas have access to a high-quality, well-educated primary care provider.

A longitudinal online interprofessional education experience involving family nurse practitioner students and pharmacy students.

Interprofessional education (IPE) continues to gain traction worldwide. Challenges integrating IPE into health profession programmes include finding convenient times, meeting spaces, and level-appropriate assignments for each profession. This article describes the implementation of a 21-month prospective cohort study pilot programme for the Master of Science in nursing family nurse practitioner (FNP) and doctor of pharmacy (PharmD) students at a private university in the United States. This IPE experience utilised a blended approach for the learning activities; these students had initial and final sessions where they met face-to-face, with asynchronous online activities between these two sessions. The online assignments, discussions, and quizzes during the pilot programme involved topics such as antimicrobial stewardship, hormone replacement therapy, human papilloma virus vaccination, prenatal counselling, emergency contraception, and effects of the Affordable Care Act on practice. The results suggested that the FNP students held more favourable attitudes about online IPE and that the PharmD students reported having a clearer understanding of their own roles and those of the other participating healthcare students. However, the students also reported wanting more face-to-face interaction during their online IPE experience. Implications from this study suggest that effective online IPE can be supported by ensuring educational parity between students regarding the various topics discussed and a consistent approach of the required involvement for all student groups is needed. In addition, given the students desire for more face-to-face interaction, it may be beneficial to offer online IPE activities for a shorter time period. It is anticipated that this study may inform other programmes that are exploring innovative approaches to provide IPE to promote effective collaboration in patient care.

Os saberes que emergem da prática social do enfermeiro-preceptor na residência multiprofissional em saúde / The knowledge that emerges from the social practice of the nursepreceptor in the Multiprofessional Residence in Health

O objeto do presente estudo é a prática social educativa do enfermeiro-preceptor na Residência Multiprofissional em Saúde -RMS. Objetivos: descrever a prática social educativa do enfermeiro-preceptor na Residência Multiprofissional em Saúde; analisar o domínio dos saberes do enfermeiro-preceptor implicados na prática social educativa da Residência Multiprofissional em Saúde; discutir o domínio dos saberes do enfermeiro-preceptor para a prática social educativa no espaço de construção multiprofissional em saúde. Estudo qualitativo, descritivo e exploratório, cuja estratégia metodológica foi o Estudo de Caso Único. O cenário foi uma instituição de saúde de uma universidade pública localizada no Rio de Janeiro e, os participantes: 11 enfermeiros-preceptores, 02 profissionais preceptores de outras categorias, 06 tutores, 04 coordenadores, 02 docentes e 21 residentes dos 02 programas de RMS da instituição cenário: Saúde da Mulher - SM e Saúde da Família e Comunidade - SFC. A coleta de dados ocorreu de setembro/2014 a outubro/2015 por meio de entrevista aos participantes, observação direta e documentação. O projeto foi aprovado pelo Comitê de Ética e Pesquisa da Escola de Enfermagem Anna Nery (EEAN), em respeito à Resolução nº466/2012 do Conselho Nacional de Saúde. A partir da base teórica, Pedagogia Histórico- Crítica Social dos Conteúdos de Dermeval Saviani, e das demais referências sobre a temática, os dados foram analisados e categorizados os resultados em 03 unidades, com análise temática: os atores sociais da Residência Multiprofissional em Saúde do HESFA; a prática docente assistencial do enfermeiro-preceptor na RMS; os saberes que emergem do trabalho educativo do enfermeiro-preceptor na RMS. Do presente resultou a seguinte tese: A Prática Social Educativa do Enfermeiro-preceptor na Residência Multiprofissional em Saúde ocorre em concretude com os residentes, sendo desenvolvida com base em conhecimentos específicos, atitudinais e crítico contextuais, requerendo formação permanente para aprimoramento das ações contidas nos projetos de ensino dos programas.(AU)

Breastfeeding Curricular Content of Family Nurse Practitioner Programs.

INTRODUCTION: Health care provider support is essential for breastfeeding success. Family Nurse Practitioners (FNP) are in a unique position to promote and manage breastfeeding. There is a gap in the literature regarding the amount and type of breastfeeding curricular content in FNP programs. METHOD: An online survey of FNP programs was conducted. Data collection included program descriptors, didactic breastfeeding coursework, and clinical breastfeeding opportunities available to students. RESULTS: No programs offered courses specific to breastfeeding: 82% of programs devoted 1 to 2 hours of didactic lactation content. More than three quarters of the programs offered students breastfeeding counseling opportunities; no programs, however, identified specific breastfeeding clinical competencies. DISCUSSION: FNPs can play an integral role in breastfeeding promotion and counseling. There appears to be a lack of education provided to FNPs regarding breastfeeding management. Creative approaches that incorporate lactation education into FNP programs may increase FNPs' breastfeeding knowledge and enhance their ability to provide support to breastfeeding families.

Building nurses' capacity to address health inequities: incorporating lesbian, gay, bisexual and transgender health content in a family nurse practitioner programme.

AIMS AND OBJECTIVES: To describe our experience in incorporating lesbian, gay, bisexual and transgender health content into the family nurse practitioner curriculum at a Midwestern college of nursing in the United States. BACKGROUND: Globally, lesbian, gay, bisexual and transgender people face disparities in the domains of physical health, behavioural risks, mental health and victimisation. There remains a paucity of nursing research on most aspects of lesbian, gay, bisexual and transgender health and access to care. To date, nursing leadership and curricular bodies have not provided clear guidance on the role of nurse educators in preparing nursing students to provide care to lesbian, gay, bisexual and transgender people. DESIGN: Discursive paper describing the development of a lesbian, gay, bisexual and transgender health learning module for inclusion in a family nurse practitioner programme. METHODS: We summarise health disparities experienced by lesbian, gay, bisexual and transgender people, describe the process of module development and outline the learning content included in the module. We also discuss challenges faced in incorporating lesbian, gay, bisexual and transgender content into nursing curricula. CONCLUSIONS: Despite the lack of formal direction from the nursing sector, nursing faculty should prepare nursing students to provide culturally sensitive and competent care to lesbian, gay, bisexual and transgender people. Our experience incorporating lesbian, gay, bisexual and transgender-specific content into the family nurse practitioner programme has proven to be positive for both students and faculty. RELEVANCE TO CLINICAL PRACTICE: Given their large numbers and presence across systems of care, nurses are uniquely positioned to address barriers to care faced by lesbian, gay, bisexual and transgender people. Modules such as the one described here can be used by nurse faculty to guide the inclusion of lesbian, gay, bisexual and transgender-specific content in family nurse practitioner or other nursing courses-as well as to guide the development of nursing competencies in the care of lesbian, gay, bisexual and transgender people.

If You Teach It, They Will Screen: Advanced Practice Nursing Students' Use of Screening and Brief Intervention in the Clinical Setting.

BACKGROUND: In the United States, approximately 30% of adults drink at risky levels or meet the criteria for harmful or dependent alcohol use. Screening, brief intervention, and referral to treatment (SBIRT) in primary care settings is indicated. This study assessed whether knowledge, attitudes, and beliefs about SBIRT, evaluated after a three-part, mixed-methods training, predicted whether 21 family nurse practitioner (FNP) students screened for alcohol use during clinical patient encounters. METHOD: After training, students completed a survey and documented implementation of SBIRT during their clinical practice-specific management courses. RESULTS: FNP students who reported higher levels of perceived competence in their posttraining surveys were more likely to screen for alcohol in the clinical setting. CONCLUSION: Screening for alcohol misuse and identifying patients engaged in hazardous drinking meet important nurse practitioner competencies. Further research is needed to explore training programs that specifically emphasize activities to increase perceived competence, knowledge, and comfort regarding SBIRT.