Supporting the Mental Health of Primary Care Nurses and Staff through the Pandemic and Beyond.

As a clinical nurse specialist, I provide leadership and strategy for our primary care program where I lead clinical initiatives and develop practice tools and guidelines across our clinics. My portfolio encompasses five clinics, one perinatal program, an opioid agonist therapy (OAT) clinic and an intensive case management team, and in the past year I supported several teams that focus on COVID-19 testing and isolation support. Our clinics specialize in serving people who experience significant economic and social marginalization and those who are not well served by traditional health services. Our nurses, in particular, juggle many roles: providing both outreach- and clinic-based care and supporting our injectable OAT program, youth clinic and our transgender specialty care program. Our work has become increasingly complex as our clients navigate survival with competing syndemics - the opioid crisis, COVID-19, a Shigella outbreak and an ongoing housing crisis - among the many significant structural factors that impact our clients' health.

A Comparison of Moderate to Late Preterm Neonates Receiving Nasal Continuous Positive Airway Pressure in Australian Tertiary and Nontertiary Centers.

PURPOSE: Transfer of neonates ≥32 weeks' gestation with acute respiratory distress to tertiary (T) centers can be reduced by treatment with nasal continuous positive airway pressure (nCPAP) in nontertiary (NT) centers. This can lead to considerable financial and emotional benefits. The aim of this project was to compare management of nCPAP in T and NT centers. DESIGN: Five-year retrospective, observational cohort study (2010-2014). SAMPLE: All NT eligible neonates from four sites (n = 484) were compared with a similar randomized cohort of inborn neonates at two T centers (n = 601) in Victoria, Australia. MAIN OUTCOME VARIABLE: Any difference in management or short-term outcome. RESULTS: Moderately preterm and term neonates born in NT centers had lower Apgar scores at five minutes of age and received more conservative management delivered by different equipment. Despite a higher incidence of air leaks in NT centers, the short-term outcomes were otherwise similar between centers. T centers were more likely to administer nCPAP to term babies for <24 hours.

Measurement and Validation of Primary Care Nursing Indicators Based on a Wound Care Tracer Condition.

BACKGROUND: Access to both valid and reliable nursing-sensitive indicators is currently limited in primary care. PURPOSE: The objectives were to (1) measure primary care nursing indicators using a wound care tracer condition and (2) study the associations between process and outcome indicators. METHODS: We conducted a longitudinal study in an ambulatory care clinic in Quebec, Canada. The sample included 482 episodes of care. We studied 5 indicators related to processes and 3 to outcomes. RESULTS: Performance levels were moderately high for indicators of initial assessment and duration and low for those of continuity and education. Associations between nursing follow-up and continuity indicators and 3 outcome indicators were highly significant. CONCLUSION: Continuity and nursing follow-up are associated with improved outcomes. Increasing these indicators' performance level can improve both nursing processes and patient outcomes.

Quality of life in the climacteric of nurses working in primary care.

OBJECTIVE: to evaluate the quality of life of primary care nurses in the climacteric. METHOD: A cross-sectional descriptive-analytic study, performed with 98 female nurses, aged 40-65 years, using the WHOQOL-Bref questionnaire. RESULTS: the worst level of quality of life was observed for professionals aged 50-59 years, non-white, specialists, divorced or widowed, with children, a lower income, with another employment relationship, a weekly workload of more than 40 hours, who consumed alcoholic beverages weekly, with chronic disease, in continuous use of medications, sedentary, who did not menstruate and did not receive hormonal treatment, and who went through menopause between the ages of 43-47 years. CONCLUSION: Although the variables "physical activity" and "age" have a statistically significant association with quality of life, other variables seem to interfere in these professionals' lives, indicating the need for a more critical and deep reflection on these relations.

Atenção ao idoso: práticas de educação permanente do Núcleo de Apoio à Saúde da Família / Atención a la persona mayor: prácticas de educación permanente del Núcleo de Apoyo a la Salud de la Familia / Older adult care: permanent education practices of the Family Health Support Center

OBJETIVO: Desvelar as práticas de Educação Permanente em Saúde desenvolvidas pelo Núcleo de Apoio à Saúde da Família na atenção ao idoso. MÉTODO: Estudo qualitativo e exploratório-descritivo, desenvolvido em um município do estado do Paraná, com profissionais do Núcleo de Apoio à Saúde da Família. Os dados foram obtidos pela técnica de Grupo Focal e submetidos à Classificação Hierárquica Descendente utilizando o software IRaMuTeQ. Os referenciais teórico-analíticos foram a Política Nacional de Educação Permanente em Saúde e a Teoria Dialógica. RESULTADOS: Participaram 46 profissionais. Surgiram cinco classes que permitiram desvelar que as práticas de educação permanente na atenção ao idoso ocorrem durante os momentos de discussão de casos, no matriciamento, nas visitas domiciliares, nos grupos operativos e no cotidiano do trabalho de modo informal. CONCLUSÃO: As práticas de educação permanente desenvolvidas pelos profissionais na atenção ao idoso ocorrem em distintos momentos da atuação profissional e são permeadas pela prática

OBJETIVO: Desvelar las prácticas de Educación Permanente en Salud desarrolladas por el Núcleo de Apoyo a la Salud de la Familia en la atención a la persona mayor. MÉTODO: Estudio cualitativo y exploratorio descriptivo, desarrollado en un municipio del Estado de Paraná, con profesionales del Núcleo de Apoyo a la Salud de la Familia. Los datos fueron obtenidos por la técnica de Grupo Focal y sometidos a la Clasificación Jerárquica Descendiente utilizando el software IRaMuTeQ. Los marcos de referencia teóricos analíticos fueron la Política Nacional de Educación Permanente en Salud y la Teoría Dialógica. RESULTADOS: Participaron 46 profesionales. Surgieron cinco clases que permitieron desvelar que las prácticas de educación permanente en la atención a la persona mayor ocurren durante los momentos de discusión de casos, en el matriciamiento, las visitas domiciliarias, los grupos operativos y el cotidiano del trabajo de modo informal. CONCLUSIÓN: Las prácticas de educación permanente desarrolladas por los profesionales en la atención a la persona mayor ocurren en distintos momentos de la actuación profesional y traen consigo la práctica

OBJECTIVE: To unveil the Permanent Education in Health practices developed by the Family Health Support Center in the care provided to older adults. METHOD: A qualitative and exploratory-descriptive study developed in a municipality in the state of Paraná with professionals from the Family Health Support Center. Data were obtained by the Focus Group technique and submitted to the Descending Hierarchical Classification using IRaMuTeQ software. The implemented theoretical-analytical references were the National Policy of Permanent Education in Healthcare and the Dialogical Theory. RESULTS: Forty-six (46) professionals participated. Five classes emerged which revealed that the practices of permanent education in care provided to older adults occur during the moments of discussion of cases, in collaborative care planning (matriciamento ), in the home visits, in the operative groups and in the daily life of the informal work. CONCLUSION: The permanent education practices developed by the professionals in the care provided to older adults occur at different moments of professional performance and are permeated by the practice

Feelings of pleasure of nurses working in primary care.

OBJECTIVE: identify the sources that generate feelings of pleasure at work in the perception of primary care nurses. METHODS: this is a descriptive study with a qualitative approach, developed with eleven nurses working in Primary Health Care Units. Data were collected using semi-structured interviews, systematized and analyzed using Bardin's content analysis technique and based on the theoretical framework of Psychodynamics of Work. RESULTS: pleasure at work was related to the resolubility of the nurse's work, interpersonal relationship with the team, therapeutic relationship with the community, positive professional return, identification with work in nursing and public health. FINAL CONSIDERATIONS: The factors that generate feelings of pleasure may contribute to guide actions that value the optimization of the nurses' work and, consequently, the care provided to the primary care user.

Percepción del entorno de práctica enfermera de Atención Primaria de la Comunidad Valenciana, en departamentos con gestión pública y privada / Perception of the professional nursing environment in Primary Care in the Valencian Community, in departments with public and private management

Fundamento: Los entornos para la práctica profesional enfermera (EPE) mejoran la calidad del cuidado, la satisfacción y los resultados en salud, no existiendo ninguna medición en Atención Primaria (AP) según su modelo de gestión. Pretendemos estimar y comparar la percepción de la calidad de dichos ERE en AP en tres departamentos de salud (DS) de la Comunidad Valenciana con modelos de gestión pública y privada (concesión administrativa). Material y métodos: Estudio transversal en profesionales de Enfermería de AP de tres DS, uno de gestión pública y dos de gestión privada. Se utilizó el cuestionario Practice Environment Scale-Nursing Work Index validado en España y se recogieron variables sociodemográficas y profesionales. Se determinaron las variables relacionadas con la puntuación mediante regresión lineal múltiple. Resultados: Se obtuvieron 269 respuestas (80,3%). Todos los DS percibieron la calidad de los EPE de forma positiva, tanto global como para las distintas dimensiones (excepto D4). La puntuación global fue más alta en los DS de gestión privada; la misma tendencia que se observó para D1 y D2, opuesta a la observada en D4. La puntuación global se relacionó con la edad, la experiencia profesional, ejercer un cargo de coordinación y el modelo de gestión, pero tan solo la edad y ejercer un cargo de coordinación mantuvo la relación en el modelo multivariante. Conclusiones: Los EPE de AP en la Comunidad Valenciana son positivos, y su calidad no se ve afectada por el modelo de gestión. Ejercer un cargo de coordinación y, especialmente, la edad son los factores que se relacionan de forma independiente con la puntuación obtenida

Background: Nursing practice environments (NPE) improve the quality of care, satisfaction and heath results; there are no studies that compare the Primary Health Care (PHC) environments according to their management model. Our aim is to estimate and compare the perception of the quality of the NPE in the PHC in Health Departments (HD) of the Valencian Community (Spain) with management model public or indirect-private (Administrative concession). Method: Transversal study on PHC nurses from three HD, one with direct public management and two with indirect-private management. The Practice Environment Scale-Nursing Work Index questionnaire, validated in Spain, was administered. Sociodemographic and professional variables were recorded. Variables related to test score were analyzed by multiple linear regression. Results: Two hundred and sixty-nine answers (80.3%). All HD perceived NPE quality in a positive way, both globally and for the different dimensions (except D4). Indirect private management model HD obtained higher global scores, the same tendency was observed for D1 and D2, and the opposite for D4. Global score was related to age, professional experience, being a coordinator and management model; only the age of the nurses and being a coordinator showed a significant relationship with the score in the multivariate regression model. Conclusions: The NPE of the PHC of the Valencian Community are of good quality, without significant differences according to different management models of the HD. Being a coordinator and, particularly, the age of the nurses are variables that are independently related to the global score obtained

Feelings of pleasure of nurses working in primary care / Sentimientos de placer de las enfermeras que trabajan en la atención primaria / Sentimentos de prazer no trabalho das enfermeiras na atenção básica

ABSTRACT Objective: identify the sources that generate feelings of pleasure at work in the perception of primary care nurses. Methods: this is a descriptive study with a qualitative approach, developed with eleven nurses working in Primary Health Care Units. Data were collected using semi-structured interviews, systematized and analyzed using Bardin's content analysis technique and based on the theoretical framework of Psychodynamics of Work. Results: pleasure at work was related to the resolubility of the nurse's work, interpersonal relationship with the team, therapeutic relationship with the community, positive professional return, identification with work in nursing and public health. Final considerations: The factors that generate feelings of pleasure may contribute to guide actions that value the optimization of the nurses' work and, consequently, the care provided to the primary care user.

RESUMEN Objetivo: identificar las fuentes que generan sensaciones de placer en el trabajo en la percepción del personal de enfermería de atención primaria. Método: se trata de un estudio descriptivo con un abordaje cualitativo, desarrollado con once enfermeras que trabajan en las Unidades de Atención Primaria de Salud. Los datos se recogieron mediante entrevistas semiestructuradas, se sistematizaron y analizaron utilizando la técnica de análisis de contenido de Bardin y se basaron en el marco teórico de la Psicodinámica del Trabajo. Resultados: el placer en el trabajo estaba relacionado con la resolución del trabajo de la enfermera, la relación interpersonal con el equipo, la relación terapéutica con la comunidad, el retorno profesional positivo, la identificación con el trabajo en la enfermería y en la salud pública. Consideraciones finales: los factores que generan sensaciones de placer pueden contribuir a orientar acciones que valoren la optimización del trabajo de las enfermeras y, en consecuencia, la atención al usuario de la atención primaria.

RESUMO Objetivo: Identificar as fontes geradoras de sentimentos de prazer no trabalho na percepção de enfermeiras da atenção básica. Métodos: Trata-se de um estudo descritivo com abordagem qualitativa, desenvolvido com onze enfermeiras atuantes em Unidades Básicas de Saúde. Os dados foram coletados por meio de entrevistas semiestruturadas, sistematizados e analisados utilizando-se a técnica de análise de conteúdo de Bardin e fundamentada no referencial teórico da Psicodinâmica do Trabalho. Resultados: O prazer no trabalho foi relacionado à resolutividade do trabalho do enfermeiro, relacionamento interpessoal com a equipe, relacionamento terapêutico com a comunidade, retorno profissional positivo, identificação com o trabalho na enfermagem e na saúde pública. Considerações finais: Os fatores geradores de sentimentos de prazer podem contribuir para orientar ações que prezem pela otimização do trabalho dos enfermeiros e, por conseguinte, do cuidado prestado ao usuário do serviço da atenção básica.

Understanding primary care nurses' contribution to cancer early diagnosis: A systematic review.

PURPOSE: Primary care nurses can contribute to cancer early diagnosis. The objective of this systematic review was to identify, appraise and synthesise evidence on primary care nurses' contribution towards cancer early diagnosis in developed countries. METHOD: The following databases were searched in September 2017: MEDLINE, PsychINFO, CINAHL, SCOPUS, and EMBASE. Data were extracted on nurses': knowledge of cancer; frequency of 'cancer early diagnosis-related discussions' with patients; and perceived factors influencing these discussions. Studies were appraised using the Mixed Methods Appraisal Tool. RESULTS: Twenty-one studies were included from: United States, United Kingdom, Ireland, Spain, Turkey, Australia, Brazil and Middle East. Studies were mostly of low quality (one did not meet any appraisal criteria, 15 met one, four met two, and one met three). Nurses' knowledge of cancer, and their frequency of 'cancer early diagnosis-related discussions', varied across countries. This may be due to measurement bias or nurses' divergent roles across healthcare systems. Commonly perceived barriers to having screening discussions included: lack of time, insufficient knowledge and communication skills, and believing that patients react negatively to this topic being raised. CONCLUSIONS: Findings suggest a need for nurses to be adequately informed about, and have the confidence and skills to discuss, the topic of cancer early diagnosis. Further high-quality research is required to understand international variation in primary care nurses' contribution to this field, and to develop and evaluate optimal methods for preparing them for, and supporting them in, this.

A scale to measure nurses' and providers' patient centered care in primary care settings.

OBJECTIVES: 1) Refine pilot scale measuring patients' experiences of outpatient nurses' and providers' care; 2) Determine variance explained by (a) pilot scale items and (b) "Survey of Health Experiences of Patients" (SHEP)/"Consumer Assessment of Health Care Providers and Systems" (CAHPS) scale items. METHODS: Randomly selected Veteran patients with recent visits with primary care outpatient nurses and providers (n = 1192) completed scales: pilot "PCC in Primary Care: Nurses and Providers Scale" and SHEP/CAHPS scale items. Factor analyses conducted using structural equation modeling (SEM), variance measurement using regression strategies. RESULTS: SEM generated scale comprised 17 items in 3 factors; 2 operationalized nurses' care; 1 providers' care. Fit statistics were acceptable. Variance explained for total PCC: nurses = 42%, providers = 56%. Combined pilot and SHEP/CAHPS item analyses yielded similarly structured scale. 70% of provider care variance explained by single item. CONCLUSION: Appraisal of team, value-based care requires accrediting care to the appropriate clinician. The "PCC in Primary Care: Nurses and Providers Scale (PC2:NaPS)" provides a psychometrically sound measure for this purpose. PRACTICE IMPLICATIONS: PC2:NaPS use would improve primary care leaders' and clinicians' analyses of patient centered care and associated outcomes in their settings, and thus enhance success of quality improvement and organizational projects.

[Perception of the professional nursing environment in Primary Care in the Valencian Community, in departments with public and private management]. / Percepción del entorno de práctica enfermera de Atención Primaria de la Comunidad Valenciana, en departamentos con gestión pública y privada.

BACKGROUND: Nursing practice environments (NPE) improve the quality of care, satisfaction and heath results; there are no studies that compare the Primary Health Care (PHC) environments according to their management model. Our aim is to estimate and compare the perception of the quality of the NPE in the PHC in Health Departments (HD) of the Valencian Community (Spain) with management model public or indirect-private (Administrative concession). METHOD: Transversal study on PHC nurses from three HD, one with direct public management and two with indirect-private management. The Practice Environment Scale-Nursing Work Index questionnaire, validated in Spain, was administered. Sociodemographic and professional variables were recorded. Variables related to test score were analyzed by multiple linear regression. RESULTS: Two hundred and sixty-nine answers (80.3%). All HD perceived NPE quality in a positive way, both globally and for the different dimensions (except D4). Indirect private management model HD obtained higher global scores, the same tendency was observed for D1 and D2, and the opposite for D4. Global score was related to age, professional experience, being a coordinator and management model; only the age of the nurses and being a coordinator showed a significant relationship with the score in the multivariate regression model. CONCLUSIONS: The NPE of the PHC of the Valencian Community are of good quality, without significant differences according to different management models of the HD. Being a coordinator and, particularly, the age of the nurses are variables that are independently related to the global score obtained.

The Developmental Screening Behaviors, Skills, Facilitators, and Constraints of Family Nurse Practitioners in Primary Care: A Qualitative Descriptive Study.

INTRODUCTION: Researchers have found that many primary care providers are not following developmental screening recommendations. Few studies exist on the screening behaviors of advanced practice nurses. METHODS: A qualitative descriptive study explored the screening behaviors, skills, and environmental facilitators/constraints of 24 family nurse practitioners (FNPs) who cared for pediatric patients from birth to 5 years of age in primary care settings. An inductive approach to content analysis was used to interpret the data. RESULTS: Five main themes emerged: (a) Developmental Screening Behaviors During Well-Child Visits, (b) Developmental Screening Behaviors When a Concern Was Raised, (c) Need for Additional Developmental Screening Skills, (d) Factors That Support Developmental Screening, and (e) Factors That Limit Developmental Screening. Sixteen subthemes supported the main themes. DISCUSSION: Most FNPs were not using standardized tools. Behaviors mainly consisted of actions that were informal. FNPs were not familiar with current recommendations, and they had difficulty describing most instruments.

Quality of life in the climacteric of nurses working in primary care / Calidad de vida en el climaterio de enfermeras que actúan en la atención primaria / Qualidade de vida no climatério de enfermeiras atuantes na atenção primária

ABSTRACT Objective: to evaluate the quality of life of primary care nurses in the climacteric. Method: A cross-sectional descriptive-analytic study, performed with 98 female nurses, aged 40-65 years, using the WHOQOL-Bref questionnaire. Results: the worst level of quality of life was observed for professionals aged 50-59 years, non-white, specialists, divorced or widowed, with children, a lower income, with another employment relationship, a weekly workload of more than 40 hours, who consumed alcoholic beverages weekly, with chronic disease, in continuous use of medications, sedentary, who did not menstruate and did not receive hormonal treatment, and who went through menopause between the ages of 43-47 years. Conclusion: Although the variables "physical activity" and "age" have a statistically significant association with quality of life, other variables seem to interfere in these professionals' lives, indicating the need for a more critical and deep reflection on these relations.

RESUMEN Objetivo: evaluar la calidad de vida de enfermeras en el climaterio que actúan en la atención primaria. Método: estudio descriptivo y de análisis, de cohorte transversal, realizado con 98 enfermeras, de entre 40 y 65 años de edad, en que se utilizó el cuestionario WHOQOL-Bref. Resultados: presentaron un peor nivel de calidad de vida las profesionales: de entre 50 y 59 años de edad, no blancas, con especialización, divorciadas o viudas, con hijos, con menor renta familiar, que tenían otro vínculo de empleo, con carga laboral semanal superior a 40 horas, que consumían alcohol semanalmente, portadoras de enfermedad crónica, en el uso continuo de medicamentos, sedentarias, que no menstruaban y no estaban bajo tratamiento hormonal, y cuya menopausia empezó entre 43 y 47 años de edad. Conclusión: a pesar de la variable "realización de actividad física" y de la variable "edad" haber presentado una asociación estadísticamente significativa con la calidad de vida, otras variables parecen afectar la calidad de vida de esas profesionales, lo que demanda una reflexión crítica y más profundizada sobre esas relaciones.

RESUMO Objetivo: avaliar a qualidade de vida de enfermeiras no climatério atuantes na atenção primária. Método: estudo descritivo-analítico, de corte transversal, realizado com 98 enfermeiras, com idade entre 40 e 65 anos, utilizando-se o questionário WHOQOL-Bref. Resultados: apresentaram pior nível de qualidade de vida as profissionais com idade entre 50 e 59 anos, não brancas, especialistas, divorciadas ou viúvas, com filhos, com menor renda, possuidoras de outro vínculo empregatício, carga horária de trabalho semanal acima de 40 horas, que ingeriam bebida alcoólica semanalmente, portadoras de doença crônica, em uso contínuo de medicamentos, sedentárias, que não menstruavam e não faziam tratamento hormonal, e que apresentaram a menopausa entre 43 e 47 anos. Conclusão: apesar das variáveis "realização de atividade física" e "idade" terem uma associação estatisticamente significante com a qualidade de vida, outras variáveis parecem interferir na dessas profissionais, indicando a necessidade de uma reflexão crítica e mais aprofundada sobre essas relações.

Process evaluation of a National Primary Eye Care Programme in Rwanda.

BACKGROUND: Visual impairment is a global public health problem, with an estimated 285 million affected globally, of which 43% are due to refractive error. A lack of specialist eye care in low and middle-income countries indicates a new model of care would support a task-shifting model and address this urgent need. We describe the features and results of the process evaluation of a national primary eye care (PEC) programme in Rwanda. METHODS: We used the Medical Research Council process evaluation framework to examine the implementation of the PEC programme, and to determine enablers and challenges to implementation. The process evaluation uses a mixed methods approach, drawing on results from several sources including a survey of 574 attendees at 50 PEC clinics, structured clinical observations of 30 PEC nurses, in-depth interviews with 19 key stakeholders, documentary review and a participatory process evaluation workshop with key stakeholders to review collated evidence and contextualize the results. RESULTS: Structured clinical assessment indicated that the PEC provided is consistent with the PEC curriculum, with over 90% of the clinical examination processes conducted correctly. In 4 years, programme monitoring data showed that nearly a million PEC eye examinations had been conducted in every health centre in Rwanda, with 2707 nurses trained. The development of the eye health system was an important enabler in the implementation of PEC, where political support allowed key developments such as inclusion of eye-drops on the essential medicines list, the inclusion of PEC on insurance benefits, the integration of PEC indicators on the health management information systems and integration of the PEC curriculum into the general nursing school curriculum. Challenges included high turnover of primary care nurses, lack of clarity and communication on the future funding of the programme, competing priorities for the health sector and sustained supervision to assure quality of care. CONCLUSIONS: A model of a national primary eye care programme is presented, with service delivery to all areas in Rwanda. Key learning from this evaluation is the importance of strengthening the eye health care system, together with a strong focus on training primary care nurses using a PEC curriculum.

Using the behavior change wheel to identify barriers to and potential solutions for primary care clinical guideline use in four provinces in South Africa.

BACKGROUND: Clinical practice guidelines risk having little impact on healthcare if not effectively implemented. Theory informed, targeted implementation may maximise their impact. Our study explored barriers to and facilitators of guideline implementation and use by South African primary care nurses and allied healthcare workers in four provinces in South Africa. We also proposed interventions to address the issues identified. METHODS: We used qualitative research methods, comprising focus group discussions using semi-structured topic guides. Seven focus group discussions were conducted (48 providers) in four South African provinces (Eastern Cape, Western Cape, Kwazulu-Natal, Limpopo). Participants included mostly nurses, dieticians, dentists, and allied health practitioners, from primary care facilities in rural and peri-urban settings. The analysis proceeded in three phases. Firstly, two analysts conducted inductive thematic content analysis to develop themes of data. This was followed by fitting emergent themes to the Theoretical Domains Framework and finally to the associated Behaviour Change Wheel to identify relevant interventions. RESULTS: Participants are knowledgeable about guidelines, generally trust their credibility and are receptive and motivated to use them. Guidelines are seen by nurses to provide confidence and reassurance, as well as professional authority and independence where doctors are scarce. Barriers to guideline use include: inadequate systems for printed book distribution, insufficient and substandard photocopies, linguistic inappropriateness (e.g. complicated language, lack of summaries, unavailable in local languages), unsupportive auditing procedures, limited involvement of end-users in guideline development, and patchy training that may not filter back to all providers. Future aspirations identified include: improving the design features of guidelines, accessible places to find guidelines, making digitally-formatted versions available, more supplementary materials (e.g. posters) to support patient engagement, accessible clinical support following training, and in-facility training for all professional cadres to ensure fair access, similar levels of capability and interdisciplinary consistency. CONCLUSIONS: South African primary care nurses and allied health practitioners have high levels of motivation to use guidelines, but face many systemic barriers. We used the Behaviour Change Wheel to suggest relevant, implementable interventions addressing identified barriers. This theory-informed approach may improve clinical guideline implementation and impact healthcare for South Africa.

Professional exhaustion, quality and intentions among family health nurses.

OBJECTIVE: to analyze how family health nurses assess quality of care; check if they have any intention of leaving their current job and nursing; estimate prevalence of professional exhaustion; and correlate these variables. METHOD: cross-sectional and correlational study with 198 nurses. The Maslach Burnout Inventory was applied, as it has questions for characterizing nurses, assessing perception on quality of care and of material and human resources, and verifying intention of leaving current work and nursing. RESULTS: most nurses assess quality of care as good, 28.0% present emotional exhaustion, there is intention of leaving current work and nursing. CONCLUSIONS: family health nurses experience professional exhaustion, which in turn presents correlation with decreased quality of care and increased intentions of leaving current work and nursing.

Health-Care Waste: Knowledge of Primary Care nurses.

OBJECTIVE: to describe the knowledge of nurses on Health-Care Waste Management (HCW) in Family Health Units (FHU) of São Carlos city, São Paulo State. METHOD: exploratory, descriptive and quantitative approach. The research was carried out with nurses of 16 FHU of the municipality of São Carlos-SP. Data were collected through an interview using a tool validated and analyzed using descriptive statistics. RESULTS: it is noteworthy that 68.7% (11) of the nurses did not know how to describe how chemical waste was sorted. In addition, regarding the treatment of HCW, 50.0% (8) of the nurses did not know if the general waste were subjected to some type of treatment. CONCLUSION: the HCW management can be considered a challenge in the nurses' agenda inserted in the Primary Care services, which refers to the need to implement periodic training on the management of this waste.

Health-Care Waste: Knowledge of Primary Care nurses / Residuos de los Servicios de Salud: el conocimiento de enfermeros de la Atención Básica / Resíduos de Serviços de Saúde: conhecimento de enfermeiros da Atenção Básica

ABSTRACT Objective: to describe the knowledge of nurses on Health-Care Waste Management (HCW) in Family Health Units (FHU) of São Carlos city, São Paulo State. Method: exploratory, descriptive and quantitative approach. The research was carried out with nurses of 16 FHU of the municipality of São Carlos-SP. Data were collected through an interview using a tool validated and analyzed using descriptive statistics. Results: it is noteworthy that 68.7% (11) of the nurses did not know how to describe how chemical waste was sorted. In addition, regarding the treatment of HCW, 50.0% (8) of the nurses did not know if the general waste were subjected to some type of treatment. Conclusion: the HCW management can be considered a challenge in the nurses' agenda inserted in the Primary Care services, which refers to the need to implement periodic training on the management of this waste.

RESUMEN Objetivo: describir el conocimiento de los enfermeros sobre la gestión de los Residuos de Servicios de Salud (RSS) en Unidades de Salud de la Familia (USF) de São Carlos, Estado de São Paulo. Método: estudio exploratorio, descriptivo y de abordaje cuantitativo. La investigación fue realizada con los enfermeros de 16 USF del municipio de São Carlos-SP. Los datos se recogieron mediante entrevista, utilizando un instrumento validado y que fueron analizados usando la estadística descriptiva. Resultados: se destaca que 68,7% (11) de los enfermeros no supieron describir cómo los residuos químicos eran segregados. Además, en cuanto al tratamiento de RSS, 50,0% (8) de los enfermeros no supieron informar si los residuos comunes eran sometidos a algún tipo de tratamiento. Conclusión: la gestión de los RSS puede ser considerada un desafío en la agenda de los enfermeros insertados en los servicios de Atención Básica, lo que remite a la necesidad de la implementación de capacitación periódica sobre el manejo de esos residuos.

RESUMO Objetivo: descrever o conhecimento dos enfermeiros sobre o gerenciamento dos Resíduos de Serviços de Saúde (RSS) em Unidades de Saúde da Família (USF) de São Carlos, Estado de São Paulo. Método: estudo exploratório, descritivo e de abordagem quantitativa. A pesquisa foi realizada com os enfermeiros de 16 USF do município de São Carlos-SP. Os dados foram coletados por meio de entrevista, utilizando um instrumento validado e foram analisados por meio da estatística descritiva. Resultados: destaca-se que 68,7% (11) dos enfermeiros não souberam descrever como os resíduos químicos eram segregados. Além disso, quanto ao tratamento de RSS, 50,0% (8) dos enfermeiros não souberam informar se os resíduos comuns eram submetidos a algum tipo de tratamento. Conclusão: o gerenciamento dos RSS pode ser considerado um desafio na agenda dos enfermeiros inseridos nos serviços da Atenção Básica, o que remete à necessidade da implementação de capacitação periódica sobre o manejo desses resíduos.

Primary health care nurses' competencies in rural disasters caused by floods.

INTRODUCTION: The objective of this study was to identify primary health care nurses' competencies when responding to hydrological disasters in rural areas. METHODS: A descriptive, exploratory and qualitative study was developed. The Critical Incidents Technique was adopted. Twenty public health nurses who worked during the flood season in the years 2014 and 2015 in a rural area in southern Brazil were interviewed. Critical incidents and requirements identified in the data gave rise to the development of the competencies. RESULTS: Thirty competencies were identified and classified in the domains of leadership and management, teamwork, health care, being community-oriented, communication, psychological support, health surveillance and education. CONCLUSIONS: Although the competencies could be related to the established international competencies for nurses in disasters, a number were described only in this study. These competencies can contribute to the education and practice of nurses in primary health care, strengthening the capacity of the profession to face flood disaster situations in rural areas.