Primary care patterns among dual eligibles with Alzheimer's disease and related dementias.

BACKGROUND: Primary care is essential for persons with Alzheimer's disease and related dementias (ADRD). Prior research suggests that the propensity to provide high-quality, continuous primary care varies by provider setting, but the settings used by Medicare-Medicaid dual-eligibles with ADRD have not been described at the population level. METHODS: Using 2012-2018 Medicare data, we identified dual-eligibles with ADRD. For each person-year, we identified primary care visits occurring in six settings. We calculated descriptive statistics for beneficiaries with a majority of visits in each setting, and conducted a k-means cluster analysis to determine utilization patterns, using the standardized count of primary care visits in each setting. RESULTS: Each year from 2012 to 2018, at least 45.6% of dual-eligibles with ADRD received a majority of their primary care in nursing facilities, while at least 25.2% did so in physician offices. Over time, the share relying on nursing facilities for primary care decreased by 5.2 percentage points, offset by growth in Federally Qualified Health Centers (FQHCs) and miscellaneous settings (2.3 percentage points each). Dual-eligibles relying on nursing facilities had more annual primary care visits (16.1) than those relying on other settings (range: 6.8-10.7 visits). Interpersonal care continuity was also higher in nursing facilities (97.0%) and physician offices (87.9%) than in FQHCs (54.2%), rural health clinics (RHCs, 46.6%), or hospital-based clinics (56.8%). Among dual-eligibles without care continuity, 82.7% were assigned to a cluster with few primary care visits. CONCLUSIONS: A trend toward care in different settings likely reflects improved access to patient-centered primary care. Low rates of interpersonal care continuity in FQHCs, RHCs, and physician offices may warrant concern, unless providers in these settings function as a care team. Nonetheless, every healthcare system encounter presents an opportunity to designate a primary care provider for dual-eligibles with ADRD who use little or no primary care.

Performance management methods and practices among nurses in primary health care settings: a systematic scoping review protocol.

BACKGROUND: Nurses make up the largest constituent of the health workforce. The success of health care interventions depends on nurses' ability and willingness to provide quality health care services. A well-implemented performance management (PM) system can be a valuable asset in ensuring that nurses are motivated, promoted, trained and rewarded appropriately. Despite the significant benefits of effective PM such as improved motivation, job satisfaction and morale, PM systems are highly contested. Therefore, it is important to examine evidence on PM methods and practices in order to understand its consequences among nursing professionals in primary health care (PHC) settings. METHODS: The search strategy of this systematic scoping review will involve various electronic databases which include Academic Search Complete, PsycARTICLES. PsycINFO, Cumulative Index to Nursing and Applied Health Literature, Medline and Cochrane Library from the EbsocHost Database Platform. Electronic databases such as PubMed and Google Scholar, Union catalogue of theses and dissertations via SABINET online and WorldCat dissertations will be incorporated. A grey literature search will be conducted on websites such as the World Health Organization and government websites to find relevant policies and guidelines. The period for the search is from 1978 to 2018. This time period was chosen to coincide with the Declaration of Alma-Ata on PHC adopted in 1978. All references will be exported to Endnote library. Two independent reviewers will begin screening for eligible titles, abstracts and full articles. During title and abstract screening, duplicates will be removed. The Mixed Method Appraisal Tool will determine the quality of included studies. Thematic analysis will be used to analyse the included articles. DISCUSSION: Evidence of preferences on PM methods and practices will generate insight on the use of PM systems in PHC and how this can be used for the purpose of improving nurses' performance and in turn, the provision of quality health care. We hope to expose knowledge gaps and inform future research.

A mudança nas perceções dos enfermeiros de família sobre os pressupostos da intervenção familiar após o processo formativo MDAIF / Change in perceptions of family nurses about the assumptions of family intervention after the MDAIF formative process

The Dynamic Model of Family Assessment and Intervention (MDAIF) aims to constitute itself as a reference that promotes clinical decision processes based on systemic proposition. This study aimed to evaluate the changes in nurses' perceptions about the assumptions of family intervention after the training process centered on this referential. This is an exploratory and quantitative study with a sample of 553 family nurses who participated in the "MDAIF" training, organized by the Northern Regional Health Administration, until 2017. A 10 item Likert scale was used with responses between 1 "totally incompetent and 7" "fully compe-tent", based on MDAIF and applied in the pre and post training periods. T-test was performed for paired samples using SPSS version 23.0. There were very significant statistical changes regarding the perception of competence in all items evaluated, and participants after training perceived with higher competence on the assumptions of family intervention. The results confirm the importance of formative processes based on family health nursing theoretical references. May contribute to the development of family-centered practices as a client, as well as to investigate the health returns resulted from them

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Análisis de concepto: gestión enfermera de la demanda / Concept analysis: Nurse demand management

La gestión enfermera de la demanda (GED) es un concepto emergente que requiere una clarificación útil no solo para los profesionales y usuarios sino también para gestores. La GED nació en 2009 tras la necesidad de reorganizar los flujos de la demanda, pero se ha convertido en algo más que en eso. Se entiende la GED como un programa liderado por la enfermera de Atención Primaria para atender a personas con enfermedades agudas leves. La enfermera, bajo un protocolo consensuado y dentro de su ámbito competencial, puede ser autónoma en la atención al paciente y en la resolución de problemas agudos leves. Por tanto, siguiendo la filosofía de Atención Primaria, tanto el médico como la enfermera son los profesionales que darán continuidad en el proceso salud-enfermedad del usuario a lo largo de su vida. Este artículo ha sido escrito según la metodología descrita por Wilson

Nurse demand management (NDM) is an emerging concept that requires some useful clarification, not only for professionals and users but also for managers. The NDM was born in 2009 after the need to reorganize the flow of demand, but it has become more than this. NDM is understood as a program led by the primary care nurse to take care of people with acute minor illnesses. Nurses, under a consensual protocol and within their competence area, can be autonomous in patient care and in the resolution of acute minor illnesses. Therefore, following Primary Care's philosophy, both the doctor and the nurse are the professionals that will follow up the health-disease process throughout the user's life. This article was written according to the methodology described by Wilson

La resiliencia familiar como activo en salud / Family resilience as a health asset

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[Concept analysis: Nurse demand management]. / Análisis de concepto: gestión enfermera de la demanda.

Nurse demand management (NDM) is an emerging concept that requires some useful clarification, not only for professionals and users but also for managers. The NDM was born in 2009 after the need to reorganize the flow of demand, but it has become more than this. NDM is understood as a program led by the primary care nurse to take care of people with acute minor illnesses. Nurses, under a consensual protocol and within their competence area, can be autonomous in patient care and in the resolution of acute minor illnesses. Therefore, following Primary Care's philosophy, both the doctor and the nurse are the professionals that will follow up the health-disease process throughout the user's life. This article was written according to the methodology described by Wilson.

Trends in the primary health care nursing workforce providing diabetes care in Auckland, New Zealand: A cross-sectional survey.

AIMS: To describe trends from 2006-8 to 2016 in demographic, education and work settings of the primary health care nursing workforce who provide diabetes care in the Auckland region. METHODS: A total of 1416 practice, Accident and Medical, district and diabetes specialist nurses were identified who provide community-based care. Of those, 459 were randomly selected and 336 were interviewed in 2016, and were compared with 287 nurses interviewed in 2006-8. RESULTS: A 73% response rate was attained in 2016. Compared with nurses in 2006-8, primary health care nurses in 2016 were younger, less experienced, more likely to be Asian, undertook more post-graduate education, worked more in Accident and Medical Clinics and worked in larger practices with ≥4 doctors. However, less worked with a dietitian or received visits from specialist nurses compared with nurses in 2006-8. Significantly more nurses in 2016 had their own room for administrative work and the ability to email patients suggesting greater autonomy. CONCLUSIONS: Major demographic, educational and workplace changes have occurred in the Auckland primary health care nursing workforce from 2006-8 to 2016. A significant increase in practice nurses and a large decrease in the number of diabetes specialist nurses were evident, in the Auckland region.

Conocimientos y prácticas de los trabajadores de enfermería sobre riesgos laborales en la atención primaria de salud: un estudio de intervención / Saberes e práticas de trabalhadores de enfermagem sobre riscos ocupacionais na atenção básica à saúde: um estudo de intervenção / Knowledge and practices of nursing workers on occupational risks in primary health care: an intervention trial

Objetivo: Identificar los saberes y prácticas de los enfermeros sobre los riesgos laborales encontrados en las unidades de atención primaria estudiadas y evaluar el impacto de la intervención educativa en los saberes y prácticas de la enfermería del grupo experimental. Método: Estudio cuasi-experimental con un diseño pre-test / post-test con grupo de control no equivalente con un enfoque cuantitativo. El estudio fue desarrollado en dos unidades de Atención Primaria de Salud del Municipio de Niterói, en el estado de Río de Janeiro, y contó con 14 participantes. Se utilizaron dos cuestionarios aplicados en septiembre de 2015. El trabajo tiene aprobación del Comité de Ética e Investigación. Resultados: Se encontró una fuerte correlación positiva entre la aplicación de la intervención educativa y la mejora del conocimiento (r = 0,858) y el cambio en las prácticas preventivas (r = 0,992) sobre los riesgos ocupacionales por los profesionales de enfermería en el grupo experimental. Conclusión: La formación de los profesionales es una estrategia eficaz para la adquisición de conocimientos y promueve la adopción de prácticas preventivas

Objetivo: Levantar os saberes e práticas dos profissionais de enfermagem sobre os riscos ocupacionais encontrados nas unidades de atenção básica estudadas; e avaliar o impacto dessa intervenção educativa nos saberes e práticas da equipe de enfermagem do grupo experimento. Método: Estudo quase-experimental com desenho pré-teste/pós-teste com grupo controle não equivalente com abordagem quantitativa. O estudo foi desenvolvido em duas unidades de Atenção Primaria à Saúde do Município de Niterói, no estado do Rio de Janeiro e contou com 14 participantes. Utilizaram-se dois questionários aplicados em setembro de 2015. O trabalho tem aprovação do Comitê de Ética e Pesquisa. Resultados: Evidenciou-se uma correlação positiva forte entre a aplicação da intervenção educativa e a melhora dos saberes (r=0,858) e mudança nas práticas preventivas (r=0,992) acerca dos riscos ocupacionais pelos profissionais de enfermagem do grupo experimento. Conclusão: A intervenção educativa constitui-se estratégia eficaz para a aquisição de saberes e propicia a adoção de práticas preventivas e depromoção da saúde

Objective: To identify nurses' knowledge and practices about the occupational risks found in the primary health care units studied; And to evaluate the impact of the educational intervention on the nursing practices and knowledge of the experimental group. Method: Quasi-experimental study with design pre-test/post-test with non-equivalent control group, with quantitative approach. The study was developed in two units of primary health care in the city of Niterói, with 14 participants. Two questionnaires were applied in September 2015. The work is approved by the Ethics in Research Committee. Results: It is found a strong positive correlation between the implementation of educational intervention and improvement of knowledge (r = 0.858) and change in preventive practices (r = 0.992) about the occupational risks by nursing professionals in the experimental group. Conclusion: The educational intervention constitutes effective strategy for the acquisition of knowledge and promotes the adoption of preventive practices

Factors associated with final year nursing students' desire to work in the primary health care setting: Findings from a national cross-sectional survey.

BACKGROUND: Registered nurses are under-represented in the primary health care setting both internationally and in Australia, and this shortage is predicted to worsen. To address the increasingly complex healthcare needs of an ageing population, it is vital to develop and sustain a primary health care nursing workforce, yet attracting nurses is challenging. In Australia, registered nurses graduating from university typically commence their careers in hospital-based transition to professional practice programs. Similar programs in primary health care settings may be a valuable strategy for developing the primary health care nursing workforce, yet little is known about nursing students desire to work in this setting, factors that influence this, or their expectations of primary health care-focused transition to professional practice programs. OBJECTIVES: This study sought to identify factors associated with final year nursing students' desire to work in primary health care setting including demographic factors, expectations of future employment conditions, and job content. It also explored expectations of graduate transition programs based in primary health care. DESIGN: A cross-sectional survey design comprising a quantitative online survey. SETTING: 14 Australian universities from all states/territories, both rural and urban. PARTICIPANTS: 530 final-year nursing students. METHODS: Binary logistic regression identifying factors contributing to desire to work in primary health care. RESULTS: The desire of nursing students to work in primary health care is associated with older age, greater perceived value of employment conditions including flexibility, and less perceived importance of workplace support. CONCLUSIONS: Collaborative efforts from primary health care nurses, health professionals, academics and policy makers are needed to attract new graduate nurses to primary health care.

Factores de riesgo y niveles de burnout en enfermeras de atención primaria: una revisión sistemática / Risk factors and burnout levels in Primary Care nurses: a systematic review

OBJETIVO: Conocer los factores de riesgo y los niveles de burnout en enfermeras de :atención primaria. METODOLOGÍA: Se realizó una revisión sistemática. Fuentes de datos. Se consultaron CINAHL, CUIDEN, LILACS, Pubmed, ProQuest, ScienceDirect y Scopus. Las ecuaciones de búsqueda fueron: «burnout AND community health nursing» y «burnout AND primary care nursing». La búsqueda se realizó en octubre del 2015. Selección de estudios. La muestra final fue de n=12. Se incluyeron estudios primarios cuantitativos que utilizasen el Maslach Burnout Inventory para evaluar el burnout en enfermeras de atención primaria, sin restricción por fecha de publicación. Extracción de datos. Las principales variables fueron la media y desviación típica de las 3 dimensiones del burnout, las prevalencias de niveles bajos, medios y altos de cada dimensión, y los factores sociodemográficos, laborales y psicológicos que potencialmente influyen en su desarrollo. RESULTADOS: Los estudios muestran prevalencias de cansancio emocional alto, por lo general, entre el 23 y el 31%. Las prevalencias de despersonalización alta y realización personal baja muestran heterogeneidad, variando entre el 8-32 y el 4-92% de la muestra respectivamente. Los estudios informan de que las enfermeras con mayor edad, mayor antigüedad laboral, ansiedad y depresión, entre otras variables, presentan mayores niveles de burnout, mientras que aquellas con mayor sueldo, satisfacción laboral alta, apoyo de la organización y buen autoconcepto lo padecen menos. CONCLUSIÓN: El cansancio emocional alto es la principal dimensión del burnout afectada en la enfermería de atención primaria. En despersonalización y realización personal existe heterogeneidad. Debe prevenirse el burnout en estos profesionales potenciando los factores protectores y vigilando su aparición en los que presenten factores de riesgo

OBJECTIVE: To determine the risk factors and levels of burnout in Primary Care nurses. METHODS: A systematic review was performed. Data sources. CINAHL, CUIDEN, LILACS, PubMed, ProQuest, ScienceDirect and Scopus databases were consulted. Search equations were 'burnout AND community health nursing' and 'burnout AND primary care nursing'. The search was performed in October 2015. Study selection. The final sample was n=12 studies. Quantitative primary studies that used Maslach Burnout Inventory for burnout assessment in Primary Care nurses were included without restriction by publication date. Data extraction. The main variables were the mean and standard deviation of the three burnout dimensions, high, medium and low prevalence rates of each dimension, and socio-demographic, occupational and psychological variables that potentially influence burnout level. RESULTS: Studies show high prevalence rates, generally between 23% and 31%, of emotional exhaustion. The prevalence rates of high depersonalisation and low personal accomplishment show heterogeneity, varying between 8%-32% and 4%-92% of the sample, respectively. Studies show that older nurses with more seniority, anxiety and depression, among other variables, have higher burnout levels, while nurses with higher salary, high job satisfaction, organisational support, and good self-concept have less burnout. CONCLUSION: High emotional exhaustion is the main affected dimension of burnout in Primary Care nursing. There is heterogeneity in depersonalisation and personal accomplishment. Burnout must be prevented in these professionals, by increasing protective factors and monitoring its appearance in those with risk factors

Tutores y estudiantes de Enfermería con foco en Atención Primaria / Tutors and nursing students with focus on primary care

La Atención Primaria de Salud configura un área asistencial influenciada por la relación entre profesionales y usuarios, en la que distintas disciplinas, como enfermería, desarrollan su proceso de aprendizaje tanto en la enseñanza de grado como en la de posgrado y la formación especializada. En este contexto, los estudiantes son tutelados por profesionales que han ido desarrollando competencias docentes. Siguiendo esta línea argumental, este manuscrito pretende identificar las distintas tipologías de estudiantes de Enfermería y de tutores que desarrollan su competencia docente en los Centros de Atención Primaria (CAP). Con esta finalidad, invitamos al lector a conocer los hitos históricos y actuales que marcan los sistemas de aprendizaje e influyen en los perfiles de estudiantes y formadores (AU)

Primary Health Care sets up an area influenced by the relationship between professionals and users, in which different disciplines, such as nursing, develop their learning procedures both in graduate and postgraduate training. In this context, students are tutored by professionals who have developed teaching skills. Along these lines, this manuscript aims to identifying the different types of nursing students and tutors who develop their teaching skills in Primary Health Centers. To this purpose, we invite the reader to know the historical and current milestones that characterize teaching systems and influence learning profiles of students and teachers (AU)

Nursing students' intentions to enter primary health care as a career option: Findings from a national survey.

This paper reports findings from the first phase of a national study conducted to identify the intention of nursing students' to work in a Primary Health Care setting following registration. An online survey of final year nursing students enrolled at Australian universities offering education leading to eligibility for registration as a nurse with the Australian Health Practitioner Regulation Agency was undertaken during July-August 2014. Data were collected about students' intention to enter Primary Health Care as a career option, as well as their exposure to primary health care during their nursing education and whether they had undertaken practice placements in a primary health care setting. Analysis was conducted on 456 completed surveys. The findings demonstrated that, despite the majority (98.2%; n = 447) of students being exposed to Primary Health Care during their studies, less than a quarter (22.8%; n = 104) of the students who responded identified this as an area in which they intended to work following registration. No association was found between students' clinical experiences and their identification of primary health care as a career preference. Given the ageing population in Australia, the increased prevalence of chronic health issues and the predicted ongoing primary health care workforce shortages, educational and workplace strategies aimed at attracting new graduate nurse into Primary Health Care settings are imperative.

Ser residente de enfermería familiar y comunitaria ¿Cómo informarme para elegir unidad docente? / Finding information to choose a training unit to become a Family and Community Nursing Resident?

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¿Es válida la adaptación española de la Escala de Entorno de Práctica Enfermera del Nursing Work Index para Atención Primaria? / Is the Spanish adaptation of the Nursing Work Index for Primary Health Care in the Nursing Enviroment Scale valid?

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Observaciones al artículo publicado y titulado «Estudio descriptivo de la monitorización ambulatoria de la presión arterial en la consulta de Enfermería de Atención Primaria» / Observations to the article published and entitled «Descriptive study of ambulatory blood pressure monitoring in the primary care nursing clinic»

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