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1.
Enferm. clín. (Ed. impr.) ; 29(6): 365-369, nov.-dic. 2019.
Artigo em Espanhol | IBECS | ID: ibc-184657

RESUMO

El/la enfermero/a de familia y comunitaria es el profesional que a través de una mirada integral y holística asume la misión de acompañar a las personas desde su nacimiento hasta la muerte para desarrollar su potencial de salud, promocionando los diferentes entornos familiares, laborales y sociales para facilitar dicho desarrollo. A lo largo de la historia, diversos organismos de ámbito internacional, europeo y nacional, han ido regulando la figura de estos profesionales de enfermería de familia y comunitaria, hasta la fecha actual, donde existe normativa que regula de pleno derecho sus funciones, atribuciones y desempeño profesional. El personal de enfermería de familia y comunitaria puede dar respuestas a las necesidades de una población cambiante, y que asume nuevas responsabilidades en la gestión y la investigación. Sus amplias competencias básicas y avanzadas recogidas en un riguroso programa formativo suponen una mejora para el sistema sanitario, la profesión enfermera y la ciudadanía y la comunidad en la que vive. Aún existen muchos retos para que cada Consejería de Salud de cada comunidad haga posible que esta especialidad desarrolle todo su potencial de mejora de los cuidados


It is the mission of the Community and Family Nurse through an integral and holistic approach to accompany people from cradle to death in developing their health potential, and promote different family, work and social environments to facilitate this development. Throughout history, various international, European and national organizations have regulated the figure of the Community and Family Nurse, and now their functions, powers and professional performance are fully regulated. The Community and Family Nurse can respond to the needs of a changing population and take on new responsibilities in management and research. Their extensive basic and advanced skills gathered under a rigorous training programme, benefit the health system, the nursing profession, citizenry and its communities. Many challenges remain for the Health Departments of each Autonomous Region to make it possible for this specialty to develop its full potential for improving care


Assuntos
Humanos , Enfermagem em Saúde Comunitária/tendências , Enfermagem Familiar/tendências , Atenção Primária à Saúde , Enfermagem Primária/organização & administração , Enfermagem Primária/tendências , Enfermagem Baseada em Evidências/métodos , Saúde Pública , Sistemas de Saúde/tendências
5.
Rev. pesqui. cuid. fundam. (Online) ; 11(2, n. esp): 540-546, jan. 2019. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-969328

RESUMO

Objective: The study's goal has been to identify the needs of the relatives of people hospitalized in an Intensive Care Unit from the interior of the Paraná State. Methods: Data were collected from May to September 2017, through the application of the Critical Care Family Needs Inventory (CCFNI) to 55 patients' family members. It was performed a descriptive and inferential analysis. Results: The most valued needs were those related to information, safety in knowing that the family member is receiving the best treatment and having access/ possibility of being able to talk with the physician at the visit time. Conclusion: Knowing the needs of family members is an important tool to assess the aspects related to the delivered care, and also provides subsidies for implementing actions that guarantee better quality of care for the patients and their families


Objetivo: Identificar as necessidades dos familiares de pessoas internadas em uma Unidade de Terapia Intensiva (UTI) no interior do Estado do Paraná. Método: Os dados foram coletados no período de maio à setembro de 2017, por meio da aplicação do Inventário de Necessidades e Estressores de Familiares em Terapia Intensiva (INEFTI) a 55 familiares. Realizado análise descritiva e inferencial. Resultados: As necessidades mais valorizadas foram as relacionadas com informação, segurança em saber que o familiar está recebendo o melhor tratamento e de ter acesso/possibilidade de poder conversar com o médico no momento da visita. Conclusão: Conhecer as necessidades dos familiares se faz como uma importante ferramenta de avaliação dos aspectos relacionados ao cuidado prestado e fornece subsídios para implementação de ações que garantam melhor qualidade da assistência ao paciente e a família


Objetivo: Identificar las necesidades de los familiares de personas internadas en una Unidad de Terapia Intensiva (UTI) en el interior del Estado de Paraná. Método: Los datos fueron recolectados en el período de mayo a septiembre de 2017, por medio de la aplicación del Inventario de Necesidades y Estresores de Familiares en Terapia Intensiva (INEFTI) a 55 familiares. Realizado análisis descriptivo e inferencial. Resultados: Las necesidades más valoradas fueron las relacionadas con información, seguridad en saber que el familiar está recibiendo el mejor tratamiento y de tener acceso/posibilidad de poder conversar con el médico en el momento de la visita. Conclusión: Conocer las necesidades de los familiares se hace como una importante herramienta de evaluación de los aspectos relacionados al cuidado prestado y proporciona subsidios para implementación de acciones que garanticen mejor calidad de la asistencia al paciente y la familia


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Família/psicologia , Determinação de Necessidades de Cuidados de Saúde/tendências , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Enfermagem Familiar/tendências , Unidades de Terapia Intensiva
7.
Rev. Rol enferm ; 41(7/8): 512-517, jul.-ago. 2018. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-179692

RESUMO

Las competencias en la especialidad de enfermería familiar y comunitaria las establece la ley, tanto en términos de formación como del ejercicio de la especialidad. Son de adquisición progresiva y plantean tres cuestiones: qué debemos enseñar cada año, qué no podemos enseñar porque no lo sabemos y qué no podemos enseñar porque no lo hacemos. Se describe una línea de investigación con metodología mixta que responde a dos objetivos: facilitar el aprendizaje de residentes y una guía a los tutores; y, de otra parte, conocer la autopercepción de conocimientos y necesidades de formación de las enfermeras de Atención Primaria en sus perfiles y lugares de trabajo. Se diferencian estilos de práctica enfermera entre práctica técnica, controladora y metodóloga. Esta propuesta se basa en cruzar el proceso de resolución de problemas con la actitud resolutiva de la enfermera y su requerimiento de información para documentar el proceso. El número de especialistas es importante y va a aumentar a corto plazo. Son un recurso humano con un alto nivel de competencia avalado por la ley y disponible para desplegar un arsenal de competencias que mejorarán sin duda la calidad del sistema sanitario, público y privado. Sin embargo, en la actualidad, no se les utiliza como prestadores de servicios avanzados. La ley abre la posibilidad de seguir avanzando en la acreditación de competencias y para ello se dispone de dos caminos aún inexplorados por las enfermeras. Uno dentro de la especialidad, las áreas de capacitación, y otro fuera, los diplomas de acreditación y acreditación avanzada. El enfoque de competencias abre oportunidades para todo el sistema: pacientes, usuarios y cuidadoras; enfermeras y otros profesionales de la salud. El reto es llevar a la práctica las ventajas que ofrece la especialidad con la visión de enfermería de práctica avanzada, en la gestión clínica, la mesogestión y la política sanitaria. Tal vez, la participación de las enfermeras en la política sanitaria marcará el camino para ello


In terms of training and practice, the competencies required for community and family health nursing are established by law. They are acquired progressively and raise three educative issues: what should we teach each year; what we cannot teach because we do not know; and what we cannot teach because we do not do. The following article describes a line of research based on a mixed methodology that responds to two objectives: to facilitate residents' learning process and to provide a guide for tutors; while at the same time to learn about the self-perception of knowledge and training needs of primary healthcare nurses, consistent with their profiles and workplaces. Nursing practice styles can be classified as technical, controlling and methodological. This proposal aims at crossing nurses' problem-solving process and problem-solving attitude, together with their need for information in order to document the nursing process. The number of nursing specialists is significant and will increase in the short term. These specialists are a human resource with a high level of competency guaranteed by law, and are readily available to deploy an arsenal of skills that will undoubtedly improve the quality of the public and private healthcare system. Unfortunately, they are currently not being harnessed as advanced service providers. The current law opens up the possibility for further progress in the accreditation of competencies, opening two paths that still remain unexplored. One relies within the specialty, in the area of training; and the other one can be found outside, among the accreditation diplomas and advanced accreditation. The competency-approach opens up opportunities for the entire healthcare system: patients, users and caretakers, together with nurses and other health professionals. The challenge is to put into practice the advantages offered by nursing specialties, consistent with the vision of advanced practice nursing in clinical management, meso-management and health policy. Perhaps the involvement of nurses in health policy will pave the way for the desired outcome


Assuntos
Humanos , Enfermagem em Saúde Comunitária/tendências , Enfermagem Familiar/tendências , Padrões de Prática em Enfermagem/tendências , /tendências , Enfermagem em Saúde Comunitária/educação , Enfermagem Familiar/educação , Educação em Enfermagem/tendências , Pesquisa em Enfermagem/tendências , Resolução de Problemas
8.
Enferm. clín. (Ed. impr.) ; 27(5): 303-307, sept.-oct. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-166587

RESUMO

Objetivo: Valorar la adquisición de competencias en investigación y Salud Pública de los especialistas en Enfermería Familiar y Comunitaria. Método: Estudio descriptivo y analítico sobre población de enfermeros especialistas asociados a la Sociedad Enfermera Valenciana de Atención Primaria. Medido con cuestionario anónimo y autoadministrado sobre actividades implementadas y tiempo de rotación en el periodo de formación. Cuestionario realizado y revisado en base al programa formativo de la especialidad. Resultados: Responden 16 de los 41 especialistas. Existe representación de las cuatro promociones que han acabado su formación y siete unidades docentes nacionales. Los resultados muestran alta heterogeneidad en las actividades desarrolladas en la formación. La estancia media en Salud Pública es de 7,07 semanas, con rango de 0 a 16 semanas. El número de sesiones educativas medio es de 2,69 en los dos años. La media de proyectos de investigación es de 1,19. Conclusión: El resultado muestra un proceso de especialización con carencias formativas en las competencias de investigación y Salud Pública que podrían subsanarse. Algunos profesionales afirman que acaban la especialización sin desarrollar actividades de investigación y con rotatorios que no alcanzan los mínimos propuestos. No se observa proceso de mejora en las cuatro promociones estudiadas (AU)


Objective: To evaluate the acquisition of skills in research and public health specialists in family and community nursing. Method: Descriptive and analytical study on a population of specialist nurse members of with the Valencian Primary Nurse Society. Measured with anonymous self-administered questionnaire on activities implemented and turnaround time in the training period. The questionnaire was conducted and reviewed based on the training programme of the specialty. Results: Sixteen of the 41 specialists responded. The four year groups of nurses who had finished their training were represented as well as seven national teaching units. The results show high heterogeneity in the activities developed in the training. The average rotation in public health is 7.07 weeks, with range of 0 to 16 weeks. The mean number of educational sessions is 2.69 in the two years. The average number of research projects is 1.19. Conclusion: The result shows a specialisation process with training gaps in the skills of research and public health that could be remedied. Some practitioners claim that they finish their specialisation without undertaking research activities or completing the minimum proposed shifts. There is no process of improvement in the four year groups studied (AU)


Assuntos
Humanos , Pesquisa em Enfermagem Clínica/tendências , Enfermagem em Saúde Comunitária/tendências , Enfermagem Familiar/tendências , Competência Clínica , Enfermagem em Saúde Pública/tendências , Especialização/tendências , Estudos Transversais , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos
10.
Metas enferm ; 20(3): 49-55, abr. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-163392

RESUMO

Objetivo: comparar la efectividad de dos modelos organizativos de atención enfermera, el de Enfermería de Familia (MEF) y el de atención diferenciada de adultos/pediatría (MEA/MEP). Método: estudio observacional transversal. Se estudió la cobertura alcanzada de indicadores procedentes de la Cartera de Servicios y del Contrato Programa de 2014, en todos los Centros de Salud de la Dirección Asistencial Centro de Madrid. Se compararon los resultados entre los centros de salud que trabajaban con cada modelo: MEF vs. MEA/MEP. Resultados: se estudiaron los 49 centros de salud que conforman la Dirección Asistencial Centro de la Comunidad de Madrid, el 43% tenía el modelo de atención MEF y el 57%, el modelo MEA/MEP. Se registraron diferencias de cobertura estadísticamente significativas en 14 de los 15 indicadores, que muestran las desigualdades en los servicios de atención según el modelo MEF o MEA/MEP. Las mayores diferencias se constataron en los indicadores «Pacientes con resultados en planes de cuidados por CIAS de Enfermería», siendo la cobertura superior en el modelo MEF con una RC= 1,68 (IC95% 1,65-1,71) y «Promoción de hábitos saludables en la adolescencia» (201), con resultados de cobertura mayores en el modelo MEA/MEP con RC= 0,63 (IC95% 0,58-0,69). Los coeficientes de variación son excesivos en la práctica totalidad de los indicadores estudiados. Conclusiones: no se puede demostrar que alguno de los dos modelos de organización del trabajo enfermero en Atención Primaria sea claramente más efectivo que el otro. Se detectó una gran variabilidad de resultados entre los centros de salud, independientemente del modelo organizativo (AU)


Objective: to compare the effectiveness of two organization models for nursing care: the Family Nurse Model (FNM) and the Model for Differentiated Care for Adults / Paediatrics (ANM / PNM). Method: an observational transversal study on the coverage reached by the indicators from the Portfolio of Services and the 2014 Contract Program, in all Health Centres from the Healthcare Management for Central Madrid. There was a comparison of the outcomes between the health centres working with each model: FNM vs. ANM/PNM. Results: the study included the 49 health centres within the Healthcare Management for Central Madrid; 43% of them had the FNM Model of Care, and 57% had the ANM/PNM Model. There were statistically significant differences of coverage in 14 of the 15 indicators, showing the disparities in healthcare services according to the FNM or the ANM/PNM model. The highest differences were found in the indicators «Patients with results in healthcare plans by Nursing CIAS (Health Area Identification Codes): coverage was superior in the FNM Model with CR= 1.68 (CI 95% 1.65-1.71) and «Promotion of Healthy Habits in Adolescence» (201), with higher coverage results in the ANM/PNM Model with CR= 0.63 (CI95% 0.58-0.69). Variation coefficients are excessive in practically all the indicators studied. Conclusions: it cannot be demonstrated that any of the two models for the organization of nursing work in Primary Care is clearly more effective than the other. A great variability of results was found between health centres, regardless of their organization model (AU)


Assuntos
Humanos , Atenção Primária à Saúde , Enfermagem Pediátrica/tendências , Enfermagem Familiar/tendências , Modelos de Enfermagem , Modelos Organizacionais , Indicadores de Qualidade em Assistência à Saúde
12.
J Perinat Neonatal Nurs ; 30(3): 273-6, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27465465

RESUMO

The focus of neonatal nursing has shifted from a highly technical approach to one of supportive interventions and a more individualized developmental approach. Developmental care is described as a philosophy of care that requires rethinking the relationships between infants, families, and healthcare professionals. Various models of developmental care exist; however, they all include a variety of activities designed to manage the environment and individualize the care provided to premature and/or sick infants.


Assuntos
Desenvolvimento Infantil , Enfermagem Familiar , Terapia Intensiva Neonatal , Enfermagem Neonatal , Educação não Profissionalizante/métodos , Enfermagem Familiar/métodos , Enfermagem Familiar/tendências , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Terapia Intensiva Neonatal/métodos , Terapia Intensiva Neonatal/psicologia , Enfermagem Neonatal/métodos , Enfermagem Neonatal/tendências , Apoio Social
13.
J Neonatal Perinatal Med ; 8(3): 177-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26485558

RESUMO

Controversy regarding the optimal design for neonatal intensive care has existed for more than 20 years. Recent evidence confirms that in comparison with the traditional open-bay design, the single-room facility provides for improved control of excessive noise and light, improved staff and parental satisfaction with care and equal, or possibly reduced, cost of care. Single-room care was not associated with any increase in adverse outcomes. To optimize long term developmental outcomes, single-room care must be augmented with appropriate developmental therapy and programs to actively support parental involvement.


Assuntos
Enfermagem Familiar/tendências , Arquitetura Hospitalar/tendências , Unidades de Terapia Intensiva Neonatal/tendências , Equipe de Assistência ao Paciente/tendências , Alojamento Conjunto/tendências , Ambiente de Instituições de Saúde , Humanos , Recém-Nascido , Melhoria de Qualidade
15.
Early Hum Dev ; 90(12): 863-7, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25463833

RESUMO

BACKGROUND: Everyday care practices can facilitate or hinder parents' participation and involvement in neonatal care. AIMS: To evaluate trends in family-centered care practices in the Neonatal Intensive Care unit in Turku University Hospital. STUDY DESIGN AND SUBJECTS: In this retrospective study, the patient charts of very preterm infants were reviewed in 4 cohorts: 2001 to 2002 (n=72), 2006 to 2007 (n=69), 2009 to 2010 (n=76), and 2011 to 2012 (n=78). OUTCOME MEASURES: Care practices with parental involvement were evaluated: 1) thermoregulation; 2) nutrition and feeding; 3) the beginning and number of skin-to-skin care episodes. As safety measures, the length of stay and weight gain were recorded at discharge. RESULTS: The significant trends included: a decrease in gestational age at the end of incubator care (mean 33.4 [standard deviation (SD) 1.36] to 31.6 [SD 1.1], p<0.001) and at the beginning of breast-feeding (35.3 [SD 1.34] to 33.1 [SD 1.89], p<0.001), bottle feeding (from 34.1 [SD 1.04] to 33.3 [SD 1.51], p=0.003) and skin-to-skin care (from 32.8 [SD 1.99] to 29.9 [SD 2.34], p<0.001). The changes were most remarkable in the infants below 28 weeks. In addition, weight gain increased from 110 g to 159 g per week (p<0.001). CONCLUSIONS: The hospital care practices of very preterm infants developed during the study period support parental involvement. During the same time period, the weight gain of very preterm infants improved, significantly. These practices can serve as indicators of progressive trends in family centered care.


Assuntos
Recém-Nascido Prematuro/fisiologia , Unidades de Terapia Intensiva Neonatal/tendências , Pais , Regulação da Temperatura Corporal , Aleitamento Materno , Participação da Comunidade , Enfermagem Familiar/tendências , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Tempo de Internação , Masculino , Estado Nutricional , Alta do Paciente , Estudos Retrospectivos , Resultado do Tratamento , Ganho de Peso
16.
J Fam Nurs ; 20(4): 487-500, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25398384

RESUMO

Over the past 12 years, a strong foundation for family nursing has been built in Denmark, with rapid growth in the past 3 years. A review of nursing research conducted in Denmark and published between 2002 and 2013 found 15 studies that examined family phenomena. The majority of the studies used descriptive methods with data collected from surveys and interviews involving family members either together or individually. Only five of the studies examined interventions that included families' perspectives about the intervention being evaluated. Several current research projects lead by Danish nurses examine the implementation of family nursing knowledge to clinical settings. Integration of family nursing theory has begun in Denmark in undergraduate and graduate nursing curricula and in May 2013, the Danish Family Nursing Association was officially established. Infrastructure and financial conference support has made it possible to invite Nordic and international colleagues to meet in Denmark, which, reciprocally, expands understanding and support for family nursing within the country. Further collaboration between Danish nurse researchers, educators, and administrators will help sustain the growth of family nursing science and its application in family-focused nursing practice.


Assuntos
Atitude do Pessoal de Saúde , Bacharelado em Enfermagem/tendências , Educação de Pós-Graduação em Enfermagem/tendências , Enfermagem Familiar/educação , Enfermagem Familiar/tendências , Família/psicologia , Relações Profissional-Família , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Currículo , Dinamarca , Feminino , Grupos Focais , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Papel do Profissional de Enfermagem , Teoria de Enfermagem , Adulto Jovem
17.
Issues Ment Health Nurs ; 35(10): 761-7, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25259639

RESUMO

Chronic obstructive pulmonary disease (COPD) could have a negative impact on quality of life (QoL) and is associated with anxiety and depression in both patients and informal caregivers. The aim of this study was to examine the relationships between anxiety, depression and QoL of both Jordanian patients with COPD and their spouses. The selected design used in this study was a cross-sectional, descriptive, correlational design. A total of 67 patients and spouses were interviewed in 2011, using self-administered questionnaires. Descriptive statistical analysis was applied. Bivariate correlation analysis was undertaken to examine the relationship between variables. The results showed that patients and spouses with high levels of anxiety and depression reported a poor QoL. Patients had a lower QoL than their spouses. A better understanding of patient and spouse psychological wellbeing and QoL will provide nurses with the information needed in terms of developing strategies for reducing patients' and spouses' anxiety and depression and thus improve their QoL. The health-service agencies and government should improve policy by improving family-centred services for both patients and spouses.


Assuntos
Transtornos de Ansiedade/enfermagem , Transtornos de Ansiedade/psicologia , Transtorno Depressivo/enfermagem , Transtorno Depressivo/psicologia , Doença Pulmonar Obstrutiva Crônica/enfermagem , Doença Pulmonar Obstrutiva Crônica/psicologia , Qualidade de Vida/psicologia , Cônjuges/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Efeitos Psicossociais da Doença , Estudos Transversais , Enfermagem Familiar/tendências , Feminino , Previsões , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Entrevista Psicológica , Jordânia , Masculino , Pessoa de Meia-Idade , Enfermagem Psiquiátrica/tendências , Estatística como Assunto , Inquéritos e Questionários , Adulto Jovem
20.
Enferm. clín. (Ed. impr.) ; 24(1): 5-11, ene.-feb. 2014.
Artigo em Espanhol | IBECS | ID: ibc-120805

RESUMO

Se estima que el paciente crónico complejo y/o frágil supone un 5% de la población y consume el 65% de la totalidad de los recursos sanitarios. Las personas mayores con problemas de dependencia, con enfermedades crónicas y comorbilidades necesitan cuidados profesionales que promuevan en las personas el autocuidado y la autogestión de la enfermedad. Es necesario plantearse un reenfoque donde adquieran un mayor protagonismo aquellos servicios relacionados con necesidades de cuidados profesionales. Las enfermeras y enfermeros son profesionales con una buena proyección para mejorar la sostenibilidad del sistema porque pueden responder de manera eficaz a las demandas de los pacientes en situación de cronicidad, dependencia y fragilidad. Para que la enfermera pueda dar respuestas eficientes y coste-efectivas a las necesidades de salud de las personas dependientes y/o con enfermedades crónicas, es necesario analizar y corregir los factores que limitan el crecimiento profesional y la oferta de una cartera de servicios enfermeros, entre los que se encuentran la ausencia de enfermeras en las decisiones estratégicas, la falta de objetivos e indicadores de cuidados, la escasa medida del producto, la falta de asignación de población a la enfermera, la indefinición de competencias, la heterogeneidad en la profesión y el escaso poder en el sistema para liderar un proyecto de cuidados con autonomía (AU)


It is estimated that the chronic, fragile and complex patient represents 5% of the general population, but uses up to 65% of the total amount of health care resources. Older people who are dependent, with chronic illnesses and comorbidities need professional care that promotes self-care and self-management of their illnesses. Thus, new strategies need to be considered to channel those professional care services to focus on this group. Nurse practicioners are professionals who could lead this change to improve the sustainability of the health care system, since they are in a position to respond in an effective way to the demands of patients with chronic illnesses, dependency or fragility. For the nurse working force to provide an efficient and cost-effective response to the health needs of chronically ill and disabled persons, an analysis needs to be made of the factors that restrict professional growth, as well as those nursing services where nurses do not take part in the decision making, as well as how to correct them. The lack of goals or quality care indicators, the measurement of the problem, the lack of patients assigned to a nurse practicioners, lack of training, the disparity of the profession in Spain, and the inability of the system to lead a self-sufficient care system project, should also be taken into consideration (AU)


Assuntos
Humanos , Doença Crônica/epidemiologia , Enfermagem Familiar/tendências , Enfermagem em Saúde Comunitária/tendências , Atenção Primária à Saúde/tendências , Processo de Enfermagem/tendências , Competência Profissional
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