Realidad investigadora de los enfermeros en atención primaria de salud: ¿cuál es la situación? / Research reality of nurses in primary health care: what is the situation?

Objetivo: Examinar la actividad investigadora de los enfermeros en atención primaria de salud y conocer su divulgación. Metodología: Se trata de un estudio transversal descriptivo realizado entre el 27 mayo hasta el 29 de junio de 2022, en un Área de Gestión Sanitaria a través de un cuestionario electrónico autoadministrado. Contestaron el cuestionario 242 enfermeros. Un 5.2% posee el grado de Máster y ninguno el de Doctor. Un 8.3% ha colaborado en algún proyecto de investigación financiado, siendo la suscripción a grupos del Plan Andaluz de Investigación, Desarrollo e Innovación (PAIDI) de un 0,4%. La participación es principalmente colaborativa con sólo 1 caso como IP en proyectos financiados. La aportación a congresos u otras actividades de divulgación es de un 23% para comunicaciones orales y de un 26,1 % para comunicaciones escritas. Resultados: Sobre la publicación de resultados, un 16,5%, han publicado al menos 1 artículo científico, siendo un 1,3% en revistas de impacto (ninguna en Q1 y Q2). La temática de las publicaciones es muy diversa. La colaboración en investigaciones realizadas con otras disciplinas ha sido de un 10,4 % y en estudios de investigación realizados con otras instituciones o servicios de salud de un 11,3%. Conclusión: Se concluye que la actividad investigadora realizada en atención primaria es de bajo nivel y calidad. Existe dispersión tanto en la temática como en los perfiles enfermeros que desarrollan actividad investigadora, lo que implica inexistencia de una red consolidada en investigación en cuidados que sustente la práctica asistencial basada en la evidencia científica. (AU)

Aim: The aim of this study is to examinate the research activity of nurses in primary health care and to know his dissemination. Method: It is a descriptive cross-sectional study carried out between May 27 and June 29, 2022, in a Health Management Area Through a self-administrated questionnaire. A total of 242 nurses answered the questionnaire. A total of 5,2% have a Master ́s degree and none have a PhD. Some 8,3% have collaborated in a funded research project, with 0,4% subscribing to PAIDI groups. Participation is mostly collaborative with only 1 case as PI in funded projects. Contribution to congresses or other dissemination activities is 18.7% for oral communications and 16,5% for written communications. Results: Regarding the publication of results, 16,5% have published at least 1 scientific article, 1,3% in impact journals (none in Q1 or Q2). The subject matter of the publications is very diverse. Collaboration in research with other disciplines was 10,4%, and in research studies carried out with other institutions or health services are 11,3%. Conclusion: It is concluded that the research activity carried out in primary care is of low level and quality. There is dispersion both in the subject matter and in the nursing profiles that carry out research activity, which implies the lack of a consolidated network in research in care that supports care practice based on scientific evidence. (AU)

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

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

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

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

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

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

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

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

Acciones del enfermero en la consulta de enfermería de puericultura en la atención primaria / Nurses' actions in childcare Nursing consultations in Primary Care

Introducción: En la Consulta de Enfermería de Puericultura, el enfermero realiza el seguimiento delcrecimiento y desarrollo del niño, práctica fundamental para la promoción y prevención de la salud. Sin embargo, hay fragilidades en la implementación, como vacíos en los registros y fallas en la evaluación preventiva de resultados importantes en la infancia, como obesidad y desnutrición. Objetivo: Identificar las acciones del enfermero en la consulta de enfermería de puericultura en la red de Atención Primaria de un municipio de la región semiárida del Nordeste de Brasil. Método: Estudio cualitativo descriptivo-exploratorio realizado con 9 enfermeros que trabajan en las Estrategias Salud de la Familia de la Atención Primaria de un municipio del estado de Río Grande del Norte, en la región semiárida del nordeste de Brasil. Los datos fueron recolectados a través de entrevistas semiestructuradas entre enero y marzo de 2021 y analizados mediante Análisis de Contenido Temático. Resultados: Surgieron 5 categorías de análisis y discusión: acogida para el vínculo; antropometría y examen físico; seguimiento del desarrollo infantil; educación para la salud: comportamiento para el cuidado; Dificultades para completar la libreta de salud del niño. Conclusión: Se observó que el enfermero es capaz de realizar una evaluación integral de la salud del niño, el vínculo y la acogida y la educación para la salud forman parte de la atención. Se verificó que hay deficiencias en la cumplimentación de la cartilla y que el proceso de enfermería no sigue la estructura esperada, lo que puede comprometer la calidad de la atención (AU)

Introdução: Na Consulta de Enfermagem em puericultura, o enfermeiro realiza a vigilância do crescimento e desenvolvimento da criança, prática essencial para promoção e prevenção da saúde. Entretanto, evidencia-se fragilidades na sua implementação como lacunas de registros e debilidades na avaliação preventiva de desfechos importantes na infância, como obesidade e desnutrição. Objetivo: Identificar as ações do enfermeiro na consulta de enfermagem em puericultura na rede de Atenção Básica de um município do Semiárido Nordestino brasileiro.Métodos: Estudo qualitativo descritivo-exploratório realizado com 9 enfermeiros atuantes nas Estratégias de Saúde da Família da Atenção Básica de um município do Estado do Rio Grande do Norte, interior do semiárido nordestino brasileiro. Os dados foram coletados por entrevista semiestruturada entre janeiro e março de 2021 e analisados por Análise de Conteúdo do tipo Temática. Resultados: Emergiram 5 categorias de análise e discussão: acolhimento para o vínculo; antropometria e exame físico; vigilância do desenvolvimento infantil; educação em saúde: atitude de cuidado; dificuldades no preenchimento da caderneta de saúde da criança. Conclusão: Percebeu-se queos enfermeiros conseguem realizar ampla avaliação de saúde das crianças, perpassando o cuidado pelo vínculo e acolhimento e pela educação em saúde. Evidencia-se que as deficiências no preenchimento da caderneta existem e que o processo de enfermagem não obedece a estrutura prevista, podendo comprometer com a qualidade da assistência (AU)

Introduction: In Childcare Nursing Consultations, nurses monitor children's growth and development, an essential practice for health promotion and prevention. However, there are weaknesses in their implementation, such as gaps in records and deficits in the preventive assessment of important outcomes in childhood, such as obesity and malnutrition. Objective: To identify nurses' actions in childcare Nursing consultations in the Primary Care network of a municipality in the semi-arid region of northeastern Brazil. Methods: A qualitative and descriptive-exploratory study carried out with 9 nurses working in the Family Health Strategies of Primary Care in a municipality from the state of Rio Grande do Norte, in the inland of the semi-arid region of northeastern Brazil. The data were collected through semi-structured interviews between January and March 2021 and analyzed using Thematic Content Analysis. Results: A total of 5 analysis and discussion categories emerged: welcoming for the bond; anthropometry and physical examination; child development surveillance; health education: caring attitude; and difficulties completing the children's health booklets. Conclusion: It was noticed that nurses are able to carry out a comprehensive assessment of children's health, permeating care through bonding, welcoming and health education. It is evidenced that there are deficiencies in completing the booklets and that the Nursing Process does not follow the expected structure, which may compromise care quality (AU)

Implementación de Enfermería Basada en la Evidencia en Atención Primaria / Implementation of Evidenced- Based Nursing in Primary Care

Introducción: La implementación de la Enfermería Basada en la Evidencia (EBE) destaca por sus múltiples beneficios, tanto para el paciente, como para las enfermeras. Sin embargo, existe dificultad en su implementación atribuida a diferentes causas.Objetivos: Conocer el uso diario, la actitud frente a la EBE y las habilidades y conocimientos para aplicarla por las enfermeras de varios centros de salud de la Región de Murcia, además de los factores autopercibidos que dificultan la implementación y las medidas para paliarlo.Métodos: Estudio de investigación mixta de estrategia concurrente de triangulación, transversal, descriptivo y multicéntrico compuesto de un cuestionario validado y dos preguntas abiertas.Resultados: Participaron 65 enfermeras, predominantemente mujeres, de las cuales el 50,8% ha recibido formación en EBE. Las puntuaciones de los apartados del cuestionario son: 27,02 (x̄) en el uso diario de EBE, 18 (m) en la actitud y 44,15 (x̄) en las habilidades y conocimientos de EBE. Algunos factores autopercibidos que dificultan la implementación de la EBE son la falta de formación y de tiempo y la precariedad laboral y algunas medidas que sugieren para paliarlo son: formación, contratación de personal y trabajo en equipo. Conclusiones: Los participantes muestran una actitud favorable frente a la EBE, pero el uso diario y las habilidades y conocimientos son moderados, observándose relación entre la formación en EBE y la especialización de enfermería con mayor habilidades y conocimientos en EBE. Se destaca la necesidad de realizar estudios de mayor impacto para una evaluación más completa e implementación de las estrategias oportunas (AU)

Introduction: The implementation of Evidenced- Based Nursing (EBN) is characterized by multiple benefits, for the patients and the nurses. However, the implementation is difficult for different reasons. Objectives: To evaluate the daily use of the EBN, the attitude towards EBN and the skills and knowledge of nurses to apply EBN in the selected health centers and also, to explore the self-perceived factors that may hinder the implementation of EBN at work and the possible measures to improve it by the nurses that work in PC. Methods: Cross-sectional, descriptive, multicenter and mixed concurrent triangulation strategy research, compose of a validated questionnaire and two open questions. Results: 65 nurses participated, mostly women, of whom 50,8% have received EBN’s formation. The punctuation of the different parts of the questionnaire are:27,02 (x̄) in the EBN’s daily use, 18 (m) in the attitude and 44,15 (x̄) in the EBN’s skills and knowledge. Some factors self-perceived that difficult the EBN’s implementation are the lack of formation and time and the job insecurity and there are some measures suggested for palliate it such as: formation, recruitment and teamwork. Conclusions: The participants show a favorable attitude towards EBN, but daily use and skills and knowledge are moderate, observing a relationship between training in EBN and nursing specialization with greater skills and knowledge in EBN. There is a need to carry out studies with a greater impact for a more complete evaluation and implementation of the appropriate strategies (AU)

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

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

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

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

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

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

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

Pain management in infant immunisation: A cross-sectional survey of UK primary care nurses.

BACKGROUND: Childhood immunisation is a critically important public health initiative. However, since most vaccines are administered by injection, it is associated with considerable pain and distress. Despite evidence demonstrating the efficacy of various pain management strategies, the frequency with which these are used during routine infant vaccinations in UK practice is unknown. AIM: This study aimed to explore primary care practice nurses' (PNs) use of evidence-based pain management strategies during infant immunisation, as well as barriers to evidence-based practice. METHODS: A questionnaire was developed and distributed to nurses throughout the UK via convenience sampling in paper and online formats. Questions assessed the frequency of pain management intervention use during infant immunisation and barriers to their use. FINDINGS: A total of 255 questionnaire responses were received. Over 90% (n = 226) of respondents never used topical anaesthetics or sweet solutions during immunisations, while 41.9% advised breastfeeding occasionally (n = 103). Parent-/caregiver-led distraction was the most frequently used intervention, with most nurses using it occasionally (47.9%, n = 116) or often (30.6%, n = 74). Most practices had no immunisation pain management policy (81.1%, n = 184), and most PNs' previous training had not included pain management (86.9%, n = 186). Barriers to intervention use included lack of time, knowledge and resources. Excluding distraction, pain management strategies were infrequently or never used during infant immunisation. Key barriers to using evidence-based strategies were lack of time, knowledge and resources.

Modelo de atención sanitaria a la infancia y adolescencia en Atención Primaria. La realidad de una atención integral compartida / Health Care Model for Children and Adolescents in Primary Care. The reality of shared comprehensive care

En la actualidad, el modelo de asistencia sanitaria a la población infantojuvenil en Atención Primaria es variable en todo el territorio nacional. La Atención Primaria es el primer contacto del paciente pediátrico y su familia, atención que mayoritariamente recaía sobre el pediatra y que debe ser abordada de forma integral por las categorías profesionales implicadas en la promoción, educación para la salud y atención integral del menor, como son el pediatra, la enfermería pediátrica y la enfermería referente de centro educativos. El pediatra y el enfermero de Pediatría son los profesionales formados adecuadamente para atender a la población infantojuvenil en la Atención Primaria y una buena atención requiere de la interdependencia de ambos profesionales y de la cooperación con otras figuras profesionales del centro educativo y del centro de salud. Son necesarias actividades de salud comunitaria y trabajar con los activos de la comunidad para conseguir una atención sanitaria basada en la equidad y en la calidad desde una perspectiva global del niño en su naturaleza biopsicosocial. (AU)

Currently, the health care model for the paediatric and juvenile population in primary care varies throughout Spain. Primary care is the first contact for paediatric patients and their families, care that was mainly provided by paediatricians and which must be addressed in an integrated manner by the professional categories involved in the promotion, health education and comprehensive care of children, such as paediatricians, paediatric nurses and nurses in charge of educational centres. The paediatrician and the paediatric nurse are the professionals adequately trained to care for the paediatric population in primary care and good care requires the interdependence of both professionals and cooperation with other professional figures in the educational centre and the health centre. Community health activities are necessary, working with the assets of the community to achieve health care based on equity and quality from a global perspective of the child in his or her biopsychosocial nature. (AU)

A novel, multidomain, primary care nurse-led and mHealth-assisted intervention for dementia risk reduction in middle-aged adults (HAPPI MIND): study protocol for a cluster randomised controlled trial.

INTRODUCTION: Middle-aged multidomain risk reduction interventions targeting modifiable risk factors for dementia may delay or prevent a third of dementia cases in later life. We describe the protocol of a cluster randomised controlled trial (cRCT), HAPPI MIND (Holistic Approach in Primary care for PreventIng Memory Impairment aNd Dementia). HAPPI MIND will evaluate the efficacy of a multidomain, nurse-led, mHealth supported intervention for assessing dementia risk and reducing associated risk factors in middle-aged adults in the Australian primary care setting. METHODS AND ANALYSIS: General practice clinics (n≥26) across Victoria and New South Wales, Australia, will be recruited and randomised. Practice nurses will be trained to implement the HAPPI MIND intervention or a brief intervention. Patients of participating practices aged 45-65 years with ≥2 potential dementia risk factors will be identified and recruited (approximately 15 patients/clinic). Brief intervention participants receive a personalised report outlining their risk factors for dementia based on Australian National University Alzheimer's Disease Risk Index (ANU-ADRI) scores, education booklet and referral to their general practitioner as appropriate. HAPPI MIND participants receive the brief intervention as well as six individualised dementia risk reduction sessions with a nurse trained in motivational interviewing and principles of behaviour change, a personalised risk reduction action plan and access to the purpose-built HAPPI MIND smartphone app for risk factor self-management. Follow-up data collection will occur at 12, 24 and 36 months. Primary outcome is ANU-ADRI score change at 12 months from baseline. Secondary outcomes include change in cognition, quality of life and individual risk factors of dementia. ETHICS AND DISSEMINATION: Project approved by Monash University Human Research Ethics Committee (ID: 28273). Results will be disseminated in peer-reviewed journals and at healthcare conferences. If effective in reducing dementia risk, the HAPPI MIND intervention could be integrated into primary care, scaled up nationally and sustained over time. TRIAL REGISTRATION NUMBER: ACTRN12621001168842.

Effectiveness of a home health monitoring and education program for complex chronic patients, led by primary care nurses.

Background: The challenge of chronicity has led developed countries to design strategies to respond to the new needs of complex chronic patients (CCP). There is evidence supporting better beneficial effects and more efficient care for CCP when home-base care programs are provided by Primary Health Care professionals. The main objective of the present study was to assess the effectiveness of a nursing intervention program of home visits for CCP analyzing the use of health services in terms of hospital admissions, emergency care unit visits, and mortality rate. Methods: A quasi-experimental study was designed to retrospectively evaluate the effectiveness of a 3-year proactive, individualized nursing intervention in improving health outcomes measured by health service utilization (hospitalization, emergency care, and nursing home visits) in these patients. Of the 344 complex chronic patients participating in the study, 93 were assigned to the intervention group (IG) and 251 to the control group (CG). Results: Along the period of study, the number of home visits in the IG almost tripled in relation to the CG (14.29 ± 4.49 vs. 4.17 ± 2.68, p < 0.001). Admissions in the first and second year of the study period were lower in the intervention group p = 0.002 and p < 0.001 respectively. All the participants in the control group were admitted at least once during the study period. In contrast, 29.0% of the participants in the intervention group never had a hospital admission during the 3-years study period. The number of ED visits to the emergency department was significantly lower in the IG during the 3 years of the study periods. The cumulative number of emergency visits in the IG was half that in the CG (5.66 ± 4. vs. 11.11 ± 4.45, p < 0.001, Cohen'd,1.53). A total of 35.5% of the participants in the intervention group visited the emergency department on three or fewer occasions compared to 98% of the subjects in the control group who visited the emergency department on more than six occasions (p < 0.001). The 3-year overall mortality rate was 23.5% in the control group and 21.6% in the nursing home visit program. These differences were not statistically significant. Conclusion: The program demonstrated its effectiveness in reduction of hospital admissions and visits to the emergency department. The program had no impact on mortality rate. This program of home visits reinforces the role of primary care nurses in advanced competencies in chronicity.

Educational intervention in social skills for Primary Care nurses.

OBJECTIVE: to assess an educational intervention on social skills for nurses who work in Primary Health Care. METHOD: a qualitative research-intervention study, carried out in the municipalities covered by the 17th Health Regional of Paraná. It was developed in three interrelated stages: exploratory, where meetings were held with the managers to define the groups and logistics for running the course; intermediate, developed in meetings with different groups of nurses, addressing selected topics; assessment, in which the nurses developed a personal plan to improve their social skills. RESULTS: participants were 57 nurses who acted as coordinators of Primary Care. They considered the educational intervention in social skills fundamental for positive changes in their professional performance. FINAL CONSIDERATIONS: the educational intervention in social skills was assessed as an important strategy to strengthen the development of nurses' managerial and care skills.

Modifiable and non-modifiable risk factors for dementia: what primary care nurses need to know.

Dementia is an umbrella term used to describe a group of symptoms characterised by behavioural changes, loss of cognitive and social functioning brought about by progressive neurological disorders. There are estimated to be 944 000 people living with dementia in the UK and it is indicated that this will increase to 2 million by 2051. We are learning more about the risk factors for developing dementia over the life course. This paper discusses the modifiable and non-modifiable risk factors for dementia and considers health promotion and health education activities that can be used in a primary care setting.

Organizational factors associated with primary care nurses' self-efficacy in pandemic response: a multilevel study in China.

BACKGROUND: Building primary care nurses' self-efficacy in the pandemic response has great potential to improve their well-being and work performance. We identified the organizational factors associated with their self-efficacy in pandemic response and propose potential management levers to guide primary care response for the pandemic. METHODS: We conducted a cross-sectional survey with 175 nurses working in 38 community health centres varying in size and ownership in Shanghai, Shenzhen, Tianjin, and Jinan. Guided by self-efficacy theory, 4 nurse-level factors and 2 organization-level factors were selected, and a linear regression model accounting for the cluster-robust standard errors was built to examine their association with primary care nurses' self-efficacy in the pandemic response. RESULTS: Primary care nurses exhibited a high level of self-efficacy in responding to the pandemic (mean = 4.34, range: 0-5). For nurse-level factors, with a 1-point increase in job skill variety, job autonomy, work stress and perceived organizational support, primary care nurses' pandemic response self-efficacy increased by 0.193 points, 0.127 points, 0.156 points, and 0.107 points, respectively. Concerning organization-level factors, each point of improvement in organizational structure, representing higher mechanical organizational structure, was associated with a 0.145-point increase in nurses' self-efficacy. CONCLUSIONS: Our study added the knowledge of organizational factors' impact on the pandemic response self-efficacy among primary care nurses and identified the potential management levers for frontline primary care managers to build primary care nurses' self-efficacy in the pandemic response.

Developing modern primary care nursing in North Macedonia.

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

Primary care nursing competencies in Canadian undergraduate nursing programs: A national cross-sectional survey.

AIM: To assess the extent to which Canadian undergraduate baccalaureate nursing programs have incorporated Canadian competencies for Registered Nurses in primary care into their curricula. BACKGROUND: Canadian competencies for Registered Nurses in primary care have several benefits, including their ability to inform primary care education in undergraduate nursing programs and to assist in building a robust primary care nursing workforce. DESIGN: We conducted a national cross-sectional survey of undergraduate baccalaureate nursing programs (n = 74). METHODS: The survey was conducted between April-May 2022. We used a modified version of the "Community Health Nurses' Continuing Education Needs Questionnaire". Respondents indicated their level of agreement on a 6-point Likert scale with 47 statements about the integration of the competencies in their program (1 = strongly disagree; 6 = strongly agree). RESULTS: The response rate was 51.4%. The overall mean across the six competency domains was 4.73 (SD 0.30). The mean scores of each domain ranged from 4.23 (SD 1.27) for Quality Assurance, Evaluation and Research to 5.17 (SD 0.95) for Communication. CONCLUSIONS: There are gaps in how these competencies are included in undergraduate education programs and opportunities to strengthen education for this growing workforce in Canada.

Perspectives of Brazilian Primary Care Nurses on Mental Health Care for Hypertensive Older Adults: A Qualitative Study.

Population longevity has been growing globally. In developing countries such as Brazil, the impact of this reality is enormous. The aging process is challenging for the healthcare system, making individuals more susceptible to chronic health conditions and mental health-related diseases. Primary healthcare (PHC) providers must be able to accompany older adults with their singularities in their work processes. This study aims to understand PHC nurses' perspectives on the mental health care of hypertensive older adults. This is a study with a qualitative approach, using in-depth interviews and a focus group with 16 nurses from the five Brazilian municipalities with the highest number of older adults. The themes that emerged from the data collection were possibilities of PHC, characterization of PHC, and mental health care in PHC. The study findings contribute to the knowledge base on how PHC nurses provide care to hypertensive older adults and which weaknesses they should overcome in their work environment. The different ways providers have been developing strategies to improve their care should be encouraged, improved, and systematized.

Integrating shared decision-making, expressing preferences and active participation of older adults in primary care nursing: a systematic review of qualitative studies and qualitative meta-synthesis.

OBJECTIVES: To systematically synthesise the results of primary qualitative studies on how community-dwelling older adults experience shared decision-making processes, express preferences and actively participate in care. DESIGN: Systematic review of qualitative studies and qualitative meta-synthesis. METHODS: We focused on studies about community-dwelling participants aged ≥65 undergoing a health-disease process circumscribed to a primary healthcare setting, and the central theme should focus on either shared decision-making, expressing preferences or patient participation. We searched the following databases: MEDLINE, CINAHL, Web of Science, Scopus and PsycINFO (time publication frame 2012-2022). We excluded studies in those cases where the qualitative results were not analysed or unrelated to the phenomenon addressed, phenomena were not clear enough to be included or the setting did not occur in the community. RESULTS: A total of 12 studies were included in this meta-synthesis. We appraised the quality of the selected studies through Critical Appraisal Skills Programme (CASP) Checklist. The metasummary comprised the frequency and intensity of qualitative patterns across the included studies. The meta-synthesis revealed four influential elements in their interaction: recognising personal qualities, facing professional characteristics, experiences of discrimination and a double-edged context. CONCLUSIONS: The phenomena studied were influenced by how older people approached their role in their binomial relationship with healthcare professionals. Those with a reinforced self-concept were better aware of health-disease-related situations regarding shared decision-making and the importance of being communicatively assertive. Professional characteristics were also crucial in how older people modulated their acting ability through their personality, communication skills and the approach healthcare professionals used towards older adults. Situations of discrimination generated through an imbalance of power inhibited the expression of preferences and hindered the active participation of older people. The context surrounding the participants influenced all these situations, key in tipping the balance between a therapeutic and a harmful side. PROSPERO REGISTRATION NUMBER: CRD42022363515.