Educação permanente no sistema único de saúde: concepções de profissionais da gestão e dos serviços / Continuing permanent education in the brazilian national health system: conceptions from management and care professionals / Educación continua en el sistema único de salud brasileño: concepciones de los profesionales de gestión y servicios

Este artigo pretende compreender as concepções de profissionais da gestão e dos serviços do Sistema Único de Saúde (SUS) sobre Educação Permanente em Saúde (EPS), bem como seus desafios e potencialidades. Utilizou-se de grupo focal para coleta, seguido de análise lexical do tipo classificação hierárquica descendente com auxílio do software Iramuteq. Os resultados delinearam quatro classes: a) EPS - entendimentos e expectativas; b) entraves à EPS; c) ETSUS e EPS por meio de cursos e capacitações; e d) dispositivos de EPS: potencialidades e desafios. Os participantes apontaram equívocos de entendimentos acerca da EPS ao equipará-la à Educação Continuada (EC) voltada à transferência de conteúdo, com repercussões negativas na prática de EPS. Discute-se o risco em centralizar o responsável pela concretização dessa proposta, que deveria ser coletiva e compartilhada entre diferentes atores. Reivindica-se, portanto, uma produção colaborativa, que possa circular entre os envolvidos, de modo que cada um experimente esse lugar e se aproprie da complexidade de interações propiciadas pela Educação Permanente em Saúde.(AU)

This article aims to understand the conceptions of professionals from the management and services of the Unified Health System (SUS) on Permanent Education in Health (EPS), as well as its challenges and potential. A focus group was used for data collection, followed by a lexical analysis of the descending hierarchical classification type using the Iramuteq software. The results delineated four classes: a) EPS - understandings and expectations; b) obstacles to EPS; c) ETSUS and EPS by courses and training; and d) EPS devices: potentialities and challenges. Participants pointed out misunderstandings about EPS, when equating it with Continuing Education (CE) focused on content transfer, with negative repercussions on EPS practice. The risk of centralizing the person responsible for implementing this proposal, which should be collective and shared among different actors, is discussed. Therefore, a collaborative production is claimed for, which can circulate among those involved, so that each one experiences this place and appropriates the complexity of interactions provided by Permanent Education in Health.(AU)

Este artículo tiene por objetivo comprender las concepciones de los profesionales de la gestión y servicios del Sistema Único de Salud (SUS) sobre Educación Continua en Salud (EPS), así como sus desafíos y potencialidades. Se utilizó un grupo focal para la recolección de datos, seguido por un análisis léxico del tipo clasificación jerárquica descendente con la ayuda del software Iramuteq. Los resultados delinearon cuatro clases: a) EPS: entendimientos y expectativas, b) Barreras para EPS, c) ETSUS y EPS a través de cursos y capacitación, y d) Dispositivos EPS: potencialidades y desafíos. Los participantes informaron que existen malentendidos sobre EPS al equipararla a Educación Continua, con repercusiones negativas en la práctica de EPS, orientada a la transferencia de contenidos. Se discute el riesgo de elegir a un solo organismo como responsable de implementar esta propuesta colectiva, que debería ser colectiva y compartida entre los diferentes actores. Se aboga por un liderazgo colaborativo, que pueda circular entre los involucrados, para que cada uno experimente este lugar y se apropie de la complejidad de interacciones que brinda la Educación Continua en Salud.(AU)

Determinantes de la elección del primer nivel de atención en medicina como ámbito de formación y laboral: un estudio cualitativo / Determinants of the choice of the first level of care in medicine as a field of training and work: A qualitative study

Objetivo: Explorar los determinantes de la elección del primer nivel de atención como ámbito laboral y de formación para las y los profesionales de la salud.DiseñoEstudio cualitativo.EmplazamientoCuatro universidades del Área Metropolitana de Buenos Aires, Argentina.ParticipantesEstudiantes de medicina y médicos recientemente egresados.MétodoCon base en la teoría fundamentada constructivista se realizaron entrevistas semiestructuradas y grupos focales para la recolección y subsecuente análisis de datos.ResultadosSe realizaron 31 entrevistas y tres grupos focales durante 2019-2020. Se organizaron los conceptos emergentes en ejes temáticos de análisis. Se identificaron experiencias positivas y negativas en relación a la atención primaria de la salud (APS) en espacios curriculares y rotaciones prácticas, y un importante desconocimiento de los alcances de la misma. Para la elección de especialidades médicas son importantes los intereses personales, las proyecciones a futuro, el prestigio social, los ingresos económicos y los conocimientos de un área específica de la medicina. Existe una desvalorización en cuanto al rol y la capacidad resolutiva de la APS, y también se la asocia como más ligada a la asistencia de las poblaciones de bajos recursos socioeconómicos.ConclusionesEl desconocimiento de la APS, su desprestigio y la remuneración insuficiente de los profesionales del primer nivel de atención fueron identificados como principales barreras para la elección de la APS como lugar de trabajo y formación. En contrapartida, el compromiso social, la posibilidad de tener un mejor estilo de vida y el tipo de relación médico-paciente aparecen como principales facilitadores.

Objective: To explore the determinants of eligibility and the choice of the first level of care as a workplace and training environment for health professionals.DesignQualitative study.SettingFour universities in the Metropolitan Area of Buenos Aires, Argentina.ParticipantsRecently graduated doctors and medical students.MethodBased on the grounded constructivist theory, semi-structured interviews and focus groups were conducted for data collection and subsequent analysis.Results31 interviews and three focus groups were conducted during 2019–2020. Emerging concepts were organized in main axes for analysis. Positive and negative experiences were identified in relation to primary health care (PHC) in curricular spaces and practical rotations, and a significant lack of knowledge of its scope. For the choice of medical specialties, personal interests, future projections, social prestige, economic income and knowledge of a specific area of medicine are important. There is a devaluation in terms of the role and resolution capacity of PHC, and it is also associated with the assistance of populations with low socioeconomic resources.ConclusionsLittle knowledge of PHC, its lack of prestige, and insufficient remuneration for first-level care professionals were identified as the main barriers to choosing PHC as a place of work and training. In contrast, social commitment, the possibility of having a better lifestyle, and the type of doctor–patient relationship appear as the main facilitators.

Student experiences of a return to practice programme: a qualitative study.

BACKGROUND: Nurses, midwives and other health professionals who return to practice come from a range of backgrounds and return for a variety of reasons. Much of the research on return to practice concerns programme provision rather than returnee experience. AIM: This qualitative study focused on the experiences of nursing, midwifery and allied health students undertaking a return to practice programme at a higher education institute. It interpreted the perceptions of the student experience of returning to clinical practice following a lapse in professional registration. METHODS: Data collection methods were qualitative and involved focus groups. Findings were analysed using thematic analysis. FINDINGS: Several themes and subthemes emerged from the data, including 'the importance of returnee identity' and 'challenges and barriers'. Findings demonstrated different approaches to and influences on returnees' learning journeys. CONCLUSION: Previous knowledge, skills and experience were often hidden from view and hard to explain although crucial to returnee success.

Relaunching Nurses to the Forefront of the COVID-19 Pandemic: Heeding the Call Through an RN Refresher Program.

Nursing remains the largest health care profession in the nation and RNs comprise one of the largest segments of the U.S. workforce with just under 4 million RNs nationwide. Despite the large number of nurses in practice, a variety of factors contribute to the availability of RNs able to meet health care-related demands, leading out-of-practice nurses to seek reentry into the workforce. To develop the skills and knowledge needed to deliver safe and effective care, nurses seeking to return to practice need access to formally structured continuing education opportunities. Nursing refresher courses have historically filled this gap, effectively supporting the reemployment of nurses by preparing them for clinical practice. The COVID-19 pandemic is among the most recent factors encouraging nurse reentry, thus furthering the need for continuing education in support of license renewal. This article provides insight into the development of a university-based refresher program for Texas nurses seeking to reactivate licensure and gain the theoretical and clinical knowledge needed to return to nursing considering the health care demands produced by this unprecedented crisis. [J Contin Educ Nurs. 2021;52(2)67-71.].

[Autoimmunity accreditation: training, accreditation and maintenance of skills in indirect immunofluorescence]. / Accréditation en auto-immunité : formation, habilitation et maintien des compétences en immunofluorescence indirecte.

The ISO 15189 accreditation of biological analysis needs the validation of the analytical methods allowing the evaluation of their performance including all the factors that could influence the quality of their results. The field of autoimmunity includes many analyses and methods such as the indirect immunofluorescence technique (IIF) and the performance of this technique largely depends on the competency of staff members. For each staff member, the required levels of competency have to be precisely defined and evaluated after a period of formation before the final habilitation for the IIF technique. The French group of the international group called EASI (European autoimmunity standardisation initiative) proposes two habilitation forms to be filled with criteria, evidence and maintenance of target skills for the IIF preparation of slides and reading. These forms could be used as a model for the IIF formation and habilitation and have to be adapted to the routine practice of the laboratories.

COVID-19 and respiratory support devices.

There are significant logistical challenges to providing respiratory support devices, beyond simple oxygen flow, when centres run out of supplies or do not have these devices at all, such as in low resource settings. At the peak of the COVID-19 crisis, it was extremely difficult to import medical equipment and supplies, because most countries prohibited the medical industry from selling outside of their own countries. As a consequence, engineering teams worldwide volunteered to develop emergency devices, and medical experts in mechanical ventilation helped to guide the design and evaluation of prototypes. Although regulations vary among countries, given the emergency situation, some Regulatory Agencies facilitated expedited procedures. However, laboratory and animal model testing are crucial to minimize the potential risk for patients when treated with a device that may worsen clinical outcome if poorly designed or misused.

Conhecimentos, satisfação e autoconfiança em profissionais de saúde: simulação com manequim versus paciente-ator / Knowledge, satisfaction, and self-confidence in health professionals: simulation with manikin versus simulated patient / Conocimiento, satisfacción y autoconfianza en los profesionales de la salud: simulación con maniquí frente a paciente-actor

Enquadramento: A associação de diferentes estratégias de ensino na saúde que articulem teoria e prática tem sido apontada como um mecanismo eficaz no ensino. Objetivo: Comparar o conhecimento, satisfação e autoconfiança de profissionais de saúde em relação à simulação clínica com manequim de alta fidelidade versus paciente-ator. Metodologia: Estudo quase experimental que ocorreu por meio de aplicação de prova de conhecimentos e Escala de Satisfação dos Estudantes e Autoconfiança na Aprendizagem durante um curso teórico-prático com a temática pré-natal para profissionais da saúde. Procedeu-se a análise estatística e inferencial. Resultados: Dos 44 participantes, a média de respostas corretas na primeira prova de conhecimentos foi de 7 e na segunda prova de conhecimentos de 8. O conhecimento aumentou após exposição teórica e simulação (p < 0,000). Pôde observar-se que não houve diferença significativa entre os grupos “Ator” e “SimMan” (p > 0,05) dos dois domínios que abordam a satisfação e a autoconfiança. Conclusão: A média geral da satisfação e autoconfiança foi maior no grupo com atores comparando com o “SimMan”.

Background: Combining various teaching strategies that merge theory and practice has been considered an efficient method in health education. Objective: To compare health professionals' knowledge, satisfaction, and self-confidence regarding clinical simulation with a high-fidelity manikin or a simulated patient. Methodology: A quasi-experimental study was carried out through the application of a theoretical knowledge test and the Student Satisfaction and Self-confidence in Learning Scale during a theoretical-practical course in prenatal care for health professionals. An inferential statistical analysis was performed. Results: Considering the 44 participants in the study, the mean of correct answers was 7 in the first theoretical knowledge test, and 8 in the second. Knowledge increased after theoretical explanation and simulation (p < 0.000). There was no significant difference between the “Actor” and “SimMan” simulation groups (p > 0.05) in the two dimensions concerning satisfaction and self-confidence. Conclusion: The overall mean of satisfaction and self-confidence was higher in the “Actor” group than in the “SimMan” group.

Marco contextual: La asociación de diferentes estrategias de enseñanza de la salud que articulan la teoría y la práctica se ha señalado como un mecanismo eficaz en la enseñanza. Objetivo: Comparar los conocimientos, la satisfacción y la autoconfianza de los profesionales de la salud en relación con la simulación clínica con un maniquí de alta fidelidad frente a un paciente-actor. Metodología: Estudio casi experimental realizado mediante la aplicación de la prueba de conocimientos y la Escala de Satisfacción de los Estudiantes y Autoconfianza en el Aprendizaje durante un curso teórico-práctico sobre el tema prenatal para los profesionales de la salud. Se realizó un análisis estadístico e inferencial. Resultados: De los 44 participantes, la media de respuestas correctas en la primera prueba de conocimientos fue de 7 y en la segunda prueba de conocimientos, de 8. El conocimiento aumentó después de la exposición teórica y la simulación (p < 0,000). Se pudo observar que no había una diferencia significativa entre los grupos “Actor” y “SimMan” (p > 0,05) de los dos dominios que abordan la satisfacción y la autoconfianza. Conclusión: La media general de la satisfacción y la autoconfianza fue mayor en el grupo con actores en comparación con el “SimMan”.

Retraining for prevention of peritonitis in peritoneal dialysis patients: A randomized controlled trial.

BACKGROUND: Peritonitis is more common in peritoneal dialysis (PD) patients nonadherent to the PD exchange protocol procedures than in compliant patients. We therefore investigated whether regular testing of PD knowledge with focus on infection prophylaxis could increase the time to first peritonitis (primary outcome) and reduce the peritonitis rate in new PD patients. METHODS: This physician-initiated, open-label, parallel group trial took place at 57 centers in Sweden, Denmark, Norway, Finland, Estonia, Latvia, the Netherlands, and the United Kingdom from 2010 to 2015. New peritonitis-free PD patients were randomized using computer-generated numbers 1 month after the start of PD either to a control group (n = 331) treated according to center routines or to a retraining group (n = 340), which underwent testing of PD knowledge and skills at 1, 3, 6, 12, 18, 24, 30, and 36 months after PD start, followed by retraining if the goals were not achieved. RESULTS: In all, 74% of the controls and 80% of the retraining patients discontinued the study. The groups did not differ significantly regarding cumulative incidence of first peritonitis adjusted for competing risks (kidney transplantation, transfer to hemodialysis and death; hazard ratio 0.84; 95% confidence interval (CI) 0.65-1.09) nor regarding peritonitis rate per patient year (relative risk 0.93; 95% CI 0.75-1.16). CONCLUSIONS: In this randomized controlled trial, we were unable to demonstrate that regular, targeted testing and retraining of new PD patients increased the time to first peritonitis or reduced the rate of peritonitis, as the study comprised patients with a low risk of peritonitis, was underpowered, open to type 1 statistical error, and contamination between groups.

The role and impact of the pharmacist in long-term care settings: A systematic review.

OBJECTIVE: Older adults in long-term care (LTC) are often frail and comorbid and have multiple medications. Although medication review by pharmacists has been integrated into LTC practice in many countries through policy and reimbursement models, the impact is variable in the literature. The purpose of our study was to review the literature regarding the impact of the pharmacist in LTC. DATA SOURCES: Four databases were searched from inception to September 2017, including Ovid MEDLINE, Ovid Embase, Ovid Evidence-Based Medicine Reviews (Cochrane Library), and Ovid International Pharmaceutical Abstracts. STUDY SELECTION: Studies in any language were included if they met the following criteria: (1) pharmacist involved in care, (2) quasi-experimental or experimental design, and (3) conducted in LTC. DATA EXTRACTION: Two reviewers independently reviewed the titles, abstracts, and full-text articles to determine if they met inclusion criteria, with a third researcher resolving discrepancies. Data of included studies were independently abstracted by 2 reviewers and confirmed by a third researcher. RESULTS: Twenty-six studies (total N = 20,228, median study duration = 12 months) met the inclusion criteria. Medication review was the most common intervention, evaluated in 24 studies (92%). Eleven studies (42%) reported on the total number of medications per patient, with 7 studies finding a statistically significant reduction in medication usage. Six studies focused on psychotropic medications, with 4 of those leading to a reduction in medication. Explicit medication appropriateness criteria showed improvement in 5 studies. Medication and health care costs were evaluated in 14 studies (54%), with 4 reporting a statistically significant reduction. Studies reporting hospitalizations (10, 38%) were moderately heterogeneous (I2 = 59%) and failed to demonstrate an impact. Studies reporting mortality (8, 31%) were less heterogeneous (I2 = 0%), but they also failed to show a change. CONCLUSION: There is evidence to support pharmacist intervention, primarily through medication review, to improve measures in medication appropriateness.

Development and evaluation of a strength-based method to promote employment of work-disability benefit recipients with multiple problems: a feasibility study.

BACKGROUND: For people with disabilities, chances to find or keep work are negatively affected by multiple problems like lower education, poverty and poor health. Furthermore, although active labour market policies proved to be effective for unemployed in general, success rates are poor for persons who are unemployed due to multiple problems. The present study aims to describe the development of a method as well as professional training to teach its application, and to assess the feasibility of method and training. The Strength-based method (CARm) aims to promote employment of work-disability benefit recipients with multiple problems. METHODS: The main principles of the Strength model were redesigned for better applicability in a population of work-disability beneficiaries, resulting in the CARm method. As part of the CARm method, a training module for Labour Experts (LEs) was developed. To assess the new designed method and training, a one-group, pre-post design was used. Data were collected from eight participating LEs, five female and 3 male, aged between 41and 55 years and having 2-17 years working experience. We used self-report questionnaires and a semi-structured discussion meeting after the training sessions with the LEs. RESULTS: Eight labour experts (LEs) from the Dutch Social Security Institute participated in the study. Most LEs felt an improvement in their ability to ascertain developmental needs, opportunities and threats in the client's situation. Three months after the training, LEs almost unanimously agreed on the statements 'I expect to use the CARm method more frequently in the future' and 'I use the CARm method in daily practice whenever possible'. The overall rating for the training on a scale from 1 to 10 was 7.6 (range 7-9). The overall satisfaction with the trainers was good. CONCLUSIONS: The CARm method and training was found to be a feasible approach to facilitate LEs working at the UWV reintegration service to support clients with multiple problems. Sufficient managerial support for participating LEs is a key factor for successful implementation of CARm. Results show that CARm is worth testing for efficacy in a future trial.

Increasing the use of continuing professional development courses to strengthen trauma care in Ghana.

Injury is a major cause of death and disability in Ghana. Strengthening care of the injured is essential to reduce this burden. Trauma continuing professional development (CPD) courses are an important component of strengthening trauma care. In many countries, including Ghana, their use needs to be more uniformly promoted. We propose lowcost strategies to increase the utilization of trauma CPD in Ghana, especially in district hospitals and higher need areas. These strategies include developing plans by regional health directorates and teaching hospitals for the regions for which they are responsible. Lists could be kept and monitored of which hospitals have doctors with which type of training. Those hospitals that need to have at least one doctor trained could be flagged for notice of upcoming courses in the area and especially encouraged to have the needed doctors attend. The targets should include at least one surgeon or one emergency physician at all regional or large district hospitals who have taken the Advanced Trauma Life Support (ATLS) (or locally-developed alternative) in the past 4 years, and each district hospital should have at least one doctor who has taken the Primary Trauma Care (PTC) or Trauma Evaluation and Management (TEAM) (or locally-developed alternatives) in the past 4 years. Parallel measures would increase enrollment in the courses during training, such as promoting TEAM for all medical students and ATLS for all surgery residents. It is important to develop and utilize more "home grown" alternatives to increase the long-term sustainability of these efforts. FUNDING: None.

Effectiveness of a self-management retraining program improving the quality of life of people receiving continuous ambulatory peritoneal dialysis.

People receiving continuous ambulatory peritoneal dialysis (CAPD) are often faced with technical difficulties while performing self-dialysis, which can compromise outcomes and health-related quality of life. This mixed-methods exploratory sequential study aims to implement a repeated-measures experimental design to assess the effectiveness of a self-management retraining program. The sample consisted of 41 participants living with chronic kidney disease aged 20 to 80 years who were receiving CAPD. Participants were purposively selected and randomized into experimental and control groups. The experimental group received the self-management retraining program. The control group received standard care. We compared health-related quality of life, self-management behavior, and perceived self-management self-efficacy levels at baseline and 3 and 6 months after enrollment. Participants demonstrated statistically significant increases in self-management behavior (medical adherence) and mental health status. Perceived self-efficacy in self-management was improved; however, this change did not reach statistical significance. We conclude that an self-management retraining program can improve self-management, self-efficacy behaviors, and health-related quality of life in persons receiving CAPD.

How a problem-based learning approach could help Japanese primary care physicians: a qualitative study.

OBJECTIVES: This study aimed to identify training needs among primary care physicians in Japan who had no formal primary care training. METHODS:  We conducted a focus group interview with seven Japanese primary care physicians who had not previously undergone specialist training in primary care and had been recruited to a family medicine training program that used a problem-based learning approach. At the start of the program, the physicians attended the interview. The discussion was recorded, and the transcribed interview was analyzed using the Steps for Coding and Theorization method. RESULTS:  Three main themes emerged. First, there is a lack of standard re-education programs for physicians who move away from their specializations into primary care. Second, there is insufficient training on primary care in undergraduate and postgraduate medical education in Japan. Third, continuing professional development programs should cover the communication skills, attitudes, and behaviors necessary for primary care practice. CONCLUSIONS:  This study clarified the needs to be addressed in our training program for primary care physicians involved in retraining in primary care. It is important to consider how to best include the communication skills, attitudes, and behaviors necessary for primary care among the topics covered in the program. As the program undergoes further iteration, it will be important to check whether it meets the needs of primary care practitioners. It will be necessary to investigate the needs of re-education programs for more physicians in many areas, and to emphasize the importance of primary care re-education in these abilities in undergraduate and postgraduate medical education.

Exploring an Innovative Course Delivery Method for Accelerated BSN Students.

Background The purpose of the pilot study was to develop and implement an innovative hybrid-delivered professional development course and explore accelerated BSN student satisfaction and perceived learning. Methods The convenience sample consisted of 16 accelerated BSN students at one Midwestern university. The Student Evaluation of Learning and Feedback to Instructors online survey instrument used consisted of 21 five-point Likert-scale items. Results Students reported that the course was organized (M = 3.96) and promoted student learning (M = 4.53) and engagement (M = 3.97). Graded material was adequate (M = 4.31). The course created a supportive adult learning environment (M = 3.84) and instructor rapport (M = 4.47). Knowledge was applied during clinical experiences. Conclusions Hybrid courses can facilitate student learning and satisfaction. Further research is warranted to explore innovative hybrid course delivery methods with accelerated BSN students. It is critical to ensure quality education for this special nursing population.

Using Twitter to Engage Online RN-to-BSN Students in Health Care Policy.

BACKGROUND: Baccalaureate-prepared nurses have a professional responsibility to influence health care policy. This article describes a learning experience that effectively used Twitter to engage online RN-to-baccalaureate nursing (BSN) students in health care policy initiatives. METHOD: The learning experience included following individuals and groups involved in health care policy in specific categories that aligned with the weekly learning objectives in a 7-week online course. Effectiveness of the experience was evaluated through a final reflection. RESULTS: All 49 students enrolled in the online health care policy course participated in the learning experience and followed a total of 645 policy-related individuals and groups. Analysis of qualitative evaluation data revealed two themes: Staying Up to Date, and Opening My Eyes. CONCLUSION: The findings show that integrating microblogging into an online RN-to-BSN course is an effective approach to engage students in health care policy. [J Nurs Educ. 2019;58(2):107-109.].

Practical Nurses' Lived Experience of Returning to School.

The lived experience of licensed practical nurses (LPNs) pursuing Bachelor of Nursing (BN) education is not commonly studied in Canada. The aim was to understand the transition experience of LPNs who bridged into a BN program. Max van Manen's phenomenological methodology was used through use of a semistructured interview guide to explore the lived experience of LPNs who pursued baccalaureate nursing education. Five themes were found: seeking advancement; stepping back into the student role; juggling work, school, and family; struggling to be understood; and seeing things differently. In summary, LPN-to-BN students have a well-developed sense of identity as nurses. These students can benefit from a specifically designed, stand-alone bridge course to situate them within a BN program that leads to successful fulfillment of entry-to-practice competencies for RN licensure.