História e memória da profissão de psicólogo no Brasil: Legislações e contexto sócio-histórico (1940-1950) / History and memory of the profession of psychologist in Brazil: Legislation and sociohistorical context (1940-1950)

A formação do psicólogo, sua profissionalização e regulamentação da Psicologia são temáticas recorrentes de pesquisas e discussões, no Brasil. Nessa direção, objetivamos identificar e caracterizar condições do campo científico-profissional da Psicologia que estiveram envolvidas no processo da regulamentação da profissão entre as décadas de 1940 e 1950. Metodologicamente, esta é uma pesquisa na interlocução entre História Social da Psicologia e a História do Tempo Presente. As fontes primárias foram prioritariamente aqueles presentes no Dossiê Legislativo vinculado à proposição da Lei nº 4.119/62. Os resultados indicam a existência de condições típicas das comunidades científico-profissionais (e.g., sociedades, revistas, exercício profissional, etc.) antes da referida regulamentação. Tais condições respondiam ao projeto de "modernização" nacional a partir de aplicações e da formação de "especialistas" em Psicologia. Assim, o que nos parece é que, para que profissão e a formação fossem legisladas, parte das condições necessárias para sua existência já estavam presentes no país.

The training of psychologists, their professionalization and regulation of Psychology are recurrent themes of research and debates in Brazil. Therefore, we aim to identify and characterize conditions in the scientific-professional field of Psychology involved in the process of regulation of the profession between the 1940s and 1950s. Methodologically, this research operates in between Social History of Psychology and History of the Present Time. The primary sources were first and foremost those present inthe Law No. 4,119/62's legislative process. The results indicate the existence of typical conditions of scientific-professional communities (e.g., societies, journals, professional practice, etc.) before the aforementioned regulation. Such conditions werealigned to the national "modernization" project with its applicationsand the training of "specialists" in Psychology. Thus, one would see that, for the profession and training to be legislated, part of the necessary conditions for its existence were already present in the country.

Judicial Vulnerability on the Exercise of Orthodontics: Construction and Validation of a Questionnaire

Abstract Objective: To develop and validate a questionnaire to measure the vulnerability of orthodontists, measuring the risks of being involved in civil liability lawsuits. Material and Methods: In-depth interviews were performed with three groups: G1- law professionals, G2 - orthodontists, and G3 - orthodontic patients. From the analysis of the content of Bardin, domains for the construction of the first version of the 53-question questionnaire were identified. The questionnaire was submitted to experts for validation, inclusion and exclusion of questions, but maintaining the 53-question format. It was submitted to the test-retest phases and verification of internal consistency. Results: 247 professionals answered the final version of the questionnaire. The intraclass correlation coefficient was 88.8%. Cronbach's alpha was 0.946, with high internal consistency. The Kaiser-Meyer-Olkin and Bartlett's tests confirmed internal consistency showing the values of 0.909 and significance of <0.001, respectively. From the total score and factorial analysis, the sample was divided into three groups of judicial vulnerability. Conclusion: The results of this study demonstrated that the questionnaire is a valid tool to measure the risks of involvement in civil liability lawsuits by orthodontists. It presented a multidimensional character and might be applied as well as face to face or online, without prejudice to quality (AU).

Análise de processos éticos: tipos penais no exercício da enfermagem / Análisis de procesos éticos: tipos penales en el ejercicio de la enfermería / Analysis of ethical issues: criminal acts in nursing practice

Resumo Objetivo: Identificar tipos penais no exercício da enfermagem e a existência de fatores relacionados a conduta profissional nas ocorrências éticas envolvendo tipos penais a partir da análise de depoimentos contidos nos processos éticos julgados no Conselho Regional de Enfermagem de São Paulo (Coren/SP). Método: Estudo exploratório-descritivo de abordagem quanti-qualitativa, nos processos éticos contendo ilícitos éticos considerados tipos penais. Os dados foram coletados nos processos ético-profissionais de enfermagem julgados pelo Coren/SP em 2012 e 2013. Resultados: Os tipos penais evidenciados na análise foram: abandono de incapaz; apropriação indébita; importunação sexual; estelionato; exercício ilegal de profissão; exercício ilegal da medicina; falsidade ideológica; extravio, sonegação ou inutilização de livro ou documento; falsificação de documento; falsificação, corrupção, adulteração ou alteração de produto destinado a fins terapêuticos ou medicinais; furto; homicídio; lesão corporal; maus tratos; peculato; tráfico de entorpecentes; uso de documento falso e vilipêndio a cadáver. Dos depoimentos emergiram sete categorias temáticas: Arrependimento Posterior; Percepção do ato ilícito; Fatores relacionados às condições de trabalho; Fatores Psicológicos e/ou sociais; Fatores Financeiros; Inobservância da responsabilidade e Dualidade. Conclusão: Os resultados do estudo foram de suma importância para identificar as ocorrências envolvendo tipos penais e com isso, a necessidade de se aprofundar a discussão sobre os problemas éticos na prática cotidiana do trabalho em enfermagem. Nessa perspectiva, o estudo denota a necessidade de se investir em melhores condições de trabalho e na formação qualificada dos profissionais de enfermagem no seu cotidiano, valorizando-os e incentivando-os à prática ética e humanizada do outro e de si.

Resumen Objetivo: Identificar tipos penales en el ejercicio de la enfermería y la existencia de factores relacionados con la conducta profesional en los casos éticos que incluyen tipos penales a partir del análisis de declaraciones en procesos éticos juzgados en el Consejo Regional de Enfermería de São Paulo (Coren/SP). Métodos: Estudio exploratorio y descriptivo, de enfoque cuantitativo y cualitativo en procesos éticos que contienen ilícitos éticos considerados tipos penales. Los datos se recolectaron de los procesos ético-profesionales de enfermería juzgados por el Coren/SP en 2012 y 2013. Resultados: Los tipos penales encontrados en el análisis fueron: abandono de incapaz; apropiación indebida; hostigamiento sexual; estafa; ejercicio ilegal de la profesión; ejercicio ilegal de la medicina; falsedad ideológica; pérdida, apropiación o inutilización de libro o documento; falsificación de documento; falsificación, corrupción, adulteración o modificación de producto destinado a fines terapéuticos o medicinales; hurto; homicidio; lesión corporal; malos tratos; malversación; tráfico de estupefacientes; uso de documento falso y profanación de cadáver. De las declaraciones surgieron siete categorías temáticas: Arrepentimiento posterior; Percepción del acto ilícito; Factores relacionados con las condiciones de trabajo; Factores psicológicos o sociales; Factores financieros; Incumplimiento de responsabilidad y Dualidad. Conclusión: Los resultados del estudio fueron de suma importancia para identificar los casos que incluyen tipos penales y, por lo tanto, también lo es la necesidad de profundizar la discusión sobre problemas éticos en la práctica cotidiana del trabajo de enfermería. Bajo esta perspectiva, el estudio denota la necesidad de invertir en mejores condiciones de trabajo y en la formación calificada de los profesionales de enfermería en su cotidianidad, además de valorizarlos e incentivarlos a una práctica ética y humanizada del otro y de sí mismo.

Abstract Objective: To identify criminal acts in nursing practice and the existence of factors related to professional behavior in ethical issues involving crime, based on the analysis of testimonies contained in ethical lawsuits judged by the Regional Nursing Council of São Paulo (Coren/SP). Method: Exploratory descriptive study with a quantitative and qualitative approach, analyzing ethical lawsuits containing ethical illicit acts considered criminal acts. Data were collected in the ethical-professional nursing lawsuits judged by Coren/SP in 2012 and 2013. Results: The criminal acts evidenced in the analysis were: abandonment of disabled person; embezzlement; sexual abuse; swindling; criminal impersonation; illegal practice of medicine; identity fraud; loss, fraud or destruction of a book or document; forgery of document; counterfeiting, contamination, adulteration or alteration of product intended for therapeutic or medicinal purposes; theft; bodily injury; maltreatment; peculation; drug trafficking; use of false document and abuse of corpse. The testimonies gave rise to seven thematic categories: Repentance for the past; Perception of the illegal act; Factors related to working conditions; Psychological and/or social factors; Financial factors; Non-admission of liability; with responsibility and Duality between perception and fact. Conclusion: The results of the study were extremely important to identify the occurrences involving criminal acts and demonstrate the need to broaden the discussion on ethical issues in daily nursing practice. In this perspective, the study demonstrates the need to invest in better working conditions and quality training for nursing professionals in their daily lives, valuing them and encouraging them to have an ethical and humane practice towards the other and themselves.

El profesionalismo médico / The medical professionalism

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[The responsibilities arising from the use of information and communication technologies in health professional practice]. / Las responsabilidades derivadas del uso de las tecnologías de la información y comunicación en el ejercicio de las profesiones sanitarias.

The increasing use of Information and Communication Technologies (ICT) in the health setting has given rise to the current phenomenon of eHealth or eMedicine, terms equivalent to the cyberspace concept, but refer exclusively to health. Due to the appearance of Web 2.0 it can be stated that we are dealing with a phenomenon much greater than just using the technologies: we are facing a real social change, giving rise to that called Health 2.0. The legal regulation of this cyberspace requires two different types of rules. Some that regulate cyberspace itself, and others, the actions performed with its use and to those that appear applicable to conventional law. In this latter case, we are referring to the applying of already existing laws to actions performed using ICT, as is the case of medical actions. Within these latter situations, two clearly different ones have to be distinguished: the professional responsibilities arising from medical actions carried out within health organisation settings when the use of ICT is introduced, and those other actions carried out voluntarily, individually and privately, using personal media and devices. It is in these types of actions where the legality, as regards data protection and privacy of the patient, appears to be violated, and at the same time the professional may be held responsible.

Clinical negligence: Understanding why things go wrong.

Clinical negligence claims are on the rise, with lawyers often playing a leading part in ascertaining what went wrong, why it went wrong and what lessons can be learned. I present a schema which may help lawyers better understand what goes wrong in clinical negligence cases.

The Scope of Midwifery Practice Regulations and the Availability of the Certified Nurse-Midwifery and Certified Midwifery Workforce, 2012-2016.

INTRODUCTION: Studies have linked midwifery practice laws to the availability of midwives but have generally not related workforce data to potential demand for reproductive health services. We examined state regulatory structure for midwives and its relationship to midwifery distribution and vital statistics data at the state and county level. METHODS: Midwifery distribution data came from the Area Health Resources Files, distribution of women of reproductive age came from the US Census, and birth statistics came from US Natality Files from 2012 to 2016. Midwifery regulations were drawn from American College of Nurse-Midwives Annual Reports. We used bivariate analysis to examine the relationship between state midwifery practice regulations and the number of midwives available in states and counties to potentially meet women's health care needs. RESULTS: Twenty states and the District of Columbia had autonomous practice regulatory frameworks, whereas 24 states had collaborative practice regulatory frameworks during the years between 2012 and 2016. Six states changed regulations during that period. In 2016, the number of midwife-attended births per number of midwives in a state was not related to the regulatory framework. However, states with autonomous frameworks had 2.2 times as many midwives per women of reproductive age (P < .0001) and 2.3 times as many midwives per total births when compared with states with collaborative statutory frameworks (P < .0001). At the county level, 70.1% of US counties had no midwife. Of those states with autonomous practice, only 59.7% of counties had no midwives, compared with 74.1% in states with collaborative models (P < .0001). DISCUSSION: Midwives have the potential to help address the shortage of maternity and reproductive health service providers. Our research suggests that increasing the number of states with autonomous regulatory frameworks can be one way to expand access to care for women in the United States.

Professional practice following regulatory change: An evaluation using principles of "Better Regulation".

BACKGROUND: The provisions in place internationally to regulate the practice of healthcare professionals have undergone significant change. However, this changing regulatory environment as experienced by healthcare professionals in the practice setting has not to date been widely researched. OBJECTIVE: To describe the "lived experience" of pharmacists in community practice in Ireland of the model of regulation introduced by the Pharmacy Act 2007 and their perception of it as fulfilling the seven principles of "better regulation": Necessity; Effectiveness/Targeted; Proportionality; Transparency; Accountability; Consistency and Agility. METHOD: 20 community pharmacists purposively selected, shared their lived experiences of the Act, as implemented in a semi-structured interview. A qualitative content analysis incorporating a framework analysis based on the seven principles of better regulation was used to analyze the data. RESULTS: The Act and its implementation by the Pharmaceutical Society of Ireland (PSI) was not perceived by community pharmacists overall as fulfilling the principles of better regulation. While there was agreement that the Act was necessary, its implementation by the PSI was not viewed as being effective, targeted, proportional and consistent. The PSI was considered to act as a deterrence regulator that is not adequately transparent or accountable. The Act is not sufficiently agile to respond to changes in pharmacy practice. CONCLUSION: Community pharmacists acknowledge the need for the Pharmacy Act but perceive that the PSI needs to adopt a more responsive approach to implementation if the Act is to be considered a model of better regulation. The study findings are of interest as there is little published research on how regulation is experienced by healthcare professionals who are subject to its provisions. The principles of better regulation provide an effective qualitative methodology to examine models of professional regulation based on the "lived experience" of regulatees.

Understanding the Role of Law in Reducing Firearm Injury through Clinical Interventions.

Firearm injury in the United States is a public health crisis in which physicians are uniquely situated to intervene. However, their ability to mitigate harm is limited by a complex array of laws and regulations that shape their role in firearm injury prevention. This piece uses four clinical scenarios to illustrate how these laws and regulations impact physician practice, including patient counseling, injury reporting, and the use of court orders and involuntary holds. Unintended consequences on clinical practice of laws intended to reduce firearm injury are also discussed. Lessons drawn from these cases suggest that physicians require more nuanced education on this topic, and that policymakers should consult front-line healthcare providers when designing firearm policies.

Nursing Specialities and professional practice: current situation and future perspectives. / Especialidades de Enfermería y ejercicio profesional: situación actual y perspectivas de futuro.

The establishment of nursing specialties that started in 1953 has contributed decisively to the quality of the medical care provided by the National Health System. Nowadays, a large number of nurses have an official specialist qualification achieved through different means of access established by Royal Decree on nursing specialties. Furthermore, the training programmes must continue to develop in order to complete the catalogue established under the aforementioned regulation. It should be pointed out that many specialists face difficulties in carrying out professional practice according to their education and training, due to the lack of job descriptions and identification of competences during recruitment processes and access to job positions, needed for appropriate professional performance. Therefore, it is essential to create a catalogue for specific job positions for each of the specialties to meet the expectations of professional nursing and enhance progress in quality patient care.

Engagement, not personal characteristics, was associated with the seriousness of regulatory adjudication decisions about physicians: a cross-sectional study.

BACKGROUND: Outcomes of processes questioning a physician's ability to practise -e.g. disciplinary or regulatory- may strongly impact their career and provided care. However, it is unclear what factors relate systematically to such outcomes. METHODS: In this cross-sectional study, we investigate this via multivariate, step-wise, statistical modelling of all 1049 physicians referred for regulatory adjudication at the UK medical tribunal, from June 2012 to May 2017, within a population of 310,659. In order of increasing seriousness, outcomes were: no impairment (of ability to practise), impairment, suspension (of right to practise), or erasure (its loss). This gave adjusted odds ratios (OR) for: age, race, sex, whether physicians first qualified domestically or internationally, area of practice (e.g. GP, specialist), source of initial referral, allegation type, whether physicians attended their outcome hearing, and whether they were legally represented for it. RESULTS: There was no systematic association between the seriousness of outcomes and the age, race, sex, domestic/international qualification, or the area of practice of physicians (ORs p≥0.05), except for specialists who tended to receive outcomes milder than suspension or erasure. Crucially, an apparent relationship of outcomes to age (Kruskal-Wallis, p=0.009) or domestic/international qualification (χ2,p=0.014) disappeared once controlling for hearing attendance (ORs p≥0.05). Both non-attendance and lack of legal representation were consistently related to more serious outcomes (ORs [95% confidence intervals], 5.28 [3.89, 7.18] and 1.87 [1.34, 2.60], respectively, p<0.001). CONCLUSIONS: All else equal, personal characteristics or first qualification place were unrelated to the seriousness of regulatory outcomes in the UK. Instead, engagement (attendance and legal representation), allegation type, and referral source were importantly associated to outcomes. All this may generalize to other countries and professions.

[Evolution of the legal and normative framework surrounding the practice of hospital pharmacy and the correct use of drugs in Quebec]. / Évolution du cadre juridique et normatif entourant l'exercice de la pharmacie hospitalière et le bon usage des médicaments au Québec.

OBJECTIVES: The objective was to identify the main texts applicable to the practice of pharmacy in Quebec, then count the specific number of recommendations and criteria and describe the evolution of the legal and normative framework. METHODS: This is a descriptive and retrospective study of the main texts applicable to the legal and normative framework for the practice of pharmacy on January 1st, 2019. RESULTS: A total of 107 texts relating to the practice of pharmacy in Quebec were identified. They come from the legislator (53.1 %), the Order of pharmacists (26.1 %) or other organizations (20.8 %). These were laws/regulations (n=59), contributing to the optimal use of drugs (n=18), relating to hospital pharmacy management (n=18), the provision of pharmaceutical care (n=11), drug preparation (n=3), oncology practice (n=2) or health and safety at work (n=1). Thirty-three texts were considered for enumeration of recommendations and explicit criteria, for a total of 235 recommendations and 3703 explicit criteria applicable to the practice of hospital pharmacy in Quebec. CONCLUSION: There is a significant increase in the number of texts, recommendations and criteria applicable to the practice of hospital pharmacy in Quebec. Compliance with this legal and normative framework appears to be a considerable challenge for hospital pharmacists. It seems worthwhile to further promote discussion with text-issuing agencies in order to keep the search for compliance realistic.

Regulatory sanctions for ethically relevant GCP violations.

Although EU inspectors and clinical assessors are mandated to identify and act upon ethical issues, regulators lack guidance on how this can be done. Hence, we propose a four-step regulatory approach on ethically relevant GCP violation findings. The first step is identification of the ethical issue. Next is analysis [i.e., identifying the gravity (intensity or severity) and the magnitude (amount and duration) of the ethics violation as well as the responsible person(s) or entity or entities]. The third step is evaluation, (i.e., the process of deliberating to determine the significance of the ethics violation, with the intention of identifying the most reasonable sanction and/or corrective or reparative action). Last is decision-making or the process of choosing and implementing a regulatory course of action.

The continuing saga of patents and non-invasive prenatal testing.

OBJECTIVE: This paper examines the Intellectual Property (IP) landscape for non-invasive prenatal testing (NIPT) in three key regions: the United States; Europe, with particular focus on the United Kingdom; and Australia. METHOD: We explore the patent law issues against the commercial and healthcare environment in these regions and consider the implications for development and implementation of NIPT. RESULTS: There are many patents held by many parties internationally, with litigation over these patents ongoing in many countries. Importantly, there are significant international differences in patent law, with patents invalidated in the USA that remain valid in Europe. Despite the many patents and ongoing litigation, there are multiple providers of testing internationally, and patents do not appear to be preventing patient access to testing for those who can pay out of pocket. CONCLUSION: The patent situation in NIPT remains in a state of flux, with uncertainty about how patent rights will be conferred in different jurisdictions, and how patents might affect clinical access. However, patents are unlikely to result in a monopoly for a single provider, with several providers and testing technologies, including both public and private sector entities, likely to remain engaged in delivery of NIPT. However, the effects on access in public healthcare systems are more complex and need to be monitored.

Negotiating jurisdictional boundaries in response to new genetic possibilities in breast cancer care: The creation of an 'oncogenetic taskscape'.

Changes in the nature and structure of healthcare pathways have implications for healthcare professionals' jurisdictional boundaries. The introduction of treatment focused BRCA1 and 2 genetic testing (TFGT) for newly diagnosed patients with breast cancer offers a contemporary example of pathway change brought about by technological advancements in gene testing and clinical evidence, and reflects the cultural shift towards genomics. Forming part of an ethnographically informed study of patient and practitioner experiences of TFGT at a UK teaching hospital, this paper focuses on the impact of a proposal to pilot a mainstreamed TFGT pathway on healthcare professionals' negotiations of professional jurisdiction. Based upon semi-structured interviews (n = 19) with breast surgeons, medical oncologists and members of the genetics team, alongside observations of breast multidisciplinary team meetings, during the time leading up to the implementation of the pilot, we describe how clinicians responded to the anticipated changes associated with mainstreaming. Interviews suggest that mainstreaming the breast cancer pathway, and the associated jurisdictional reconfigurations, had advocates as well as detractors. Medical oncologists championed the plans, viewing this adaptation in care provision and their professional role as a logical next step. Breast surgeons, however, regarded mainstreaming as an unfeasible expansion of their workload and questioned the relevance of TFGT to their clinical practice. The genetics team, who introduced the pilot, appeared cautiously optimistic about the potential changes. Drawing on sociological understandings of the negotiation of professional jurisdictions our work contributes a timely, micro-level examination of the responses among clinicians as they worked to renegotiate professional boundaries in response to the innovative application of treatment-focused BRCA testing in cancer care - a local and dynamic process which we refer to as an 'oncogenetic taskscape in the making'.