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Objectives To analyze the concept of virtual clinical simulation in nursing education. Methods The Walker and Avant concept analysis model guided the study process and the data collection followed the integrative literature review method. Databases searched were: CINAHL, PubMed, Education Resources Information Center, and Scopus. Search terms and Boolean operators were: e-simulation OR virtual clinical simulation OR computer-simulation OR computer simulation OR virtual gaming OR virtual reality AND nursing education OR nursing. The sample comprised 45 studies. Results Virtual clinical simulation in nursing education was defined as the innovative teaching and learning technological strategy that provides immersive self-regulated training of nursing practice, reproducing real-life experiences and feedback in a virtual environment that is safe, interactive, dynamic and enjoyable. Conclusions Clarification of this concept contributes to the development of a standardized terminology to include in the nursing nomenclature system and its dissemination for the construction of nursing science.

Confl itos de interesse: nada a declarar. Resumo Objetivo: Investigar como a implementação da Enfermagem de Prática Avançada poderia contribuir para melhorar o status atual dos cuidados maternos e infantis no Brasil. Métodos: Revisão da literatura realizada em novembro de 2018 a janeiro de 2019 através das seguintes bases de dados: CINAHL, PubMed, MEDLINE, Health Source: Nursing Academic edition e Biblioteca da Universidade PACE. Os dados foram categorizados e analisados considerando o conceito de acesso aos cuidados de saúde. Resultados: De uma revisão de 138 artigos, 10 preencheram os critérios de inclusão e foram revisados para análise. Com base no enfoque utilizado neste estudo, os pesquisadores identifi caram duas categorias principais de indicadores sociais para o conceito de acesso: processo e desfecho. Esses temas explorados na análise narrativa são os indicadores de processo e desfecho do sistema de saúde brasileiro, bem como os indicadores de desfecho esperado subsequentes à implementação do papel da enfermeira obstetra. Conclusão: O papel da enfermeira obstetra poderia ajudar o Brasil a melhorar o acesso e a qualidade dos cuidados de saúde materno-infantil e o custo-benefício dos cuidados prestados. Esse papel pode contribuir signifi cativamente para um dos principais problemas enfrentados por este país, como desigualdade na distribuição de profi ssionais de saúde em regiões geográfi cas.

This article discusses one of four findings of a larger descriptive correlational health policy study, the purpose of which was to investigate relationships among state regulation of nurse-midwifery practice, utilization of certified nurse-midwives (CNM) for Medicaid funded prenatal care, and maternal newborn outcomes. The larger study showed that use of accurate data about CNM practice and subsequent health care outcomes creates a challenge for researchers because of the paucity of data related to services provided by CNMs. Barriers to adequate data collection related to CNM services, specifically those funded by Medicaid, preclude legitimate conclusions about subsequent health care policy. Methods of workforce data collection need to be addressed by health care and health policy groups to facilitate further investigation of the relationships among state regulation of CNM practice, utilization of CNMs for Medicaid-funded prenatal care and maternal newborn outcomes as they affect access to care for vulnerable populations.

This JAMA Forum discusses community models of perinatal care, workforce challenges, and policies to reduce maternity deserts.

Objective: Was to analyze the concept of advanced practice nursing and elucidate the essential elements: attributes, antecedents and consequences. Methods: The methodological reference for the study was the Walker and Avant (2011) concept analysis model, structured by an integrative review of the literature conducted in May and June, 2017. The Scopus, PubMed, CINAHL, Web of Science, Science Direct, Cochrane and Lilacs databases were searched for studies that addressed the term and that were published in Portuguese, English or Spanish. Results: The sample consisted of 33 studies conducted in eight countries and dated from 2000 to 2016, with 56% published in the fi ve-year period of 2011-2016. Eight attributes were identifi ed: Educational preparation at the master's or doctoral level, and specialization in clinical area; Evidence-based practice; Ability to exercise judgement and critical thinking; High level of autonomy; Advanced and comprehensive assessment; Leadership; Capacity for diagnosis, management and administration; and Teaching other nurses. The antecedents and consequences were identifi ed, and a defi nition of the concept was constructed. Conclusion: Considering that the idea of advanced nursing is expanding worldwide, especially in Latin America, other studies related to Advanced Nursing Practice are recommended. An in-depth understanding of the implementation practice issues in Brazil is necessary, to aide in determining the forthcoming APN concept for the country. This study contributes to that understanding by defi ning the concept of APN, including its antecedents, attributes, and consequences. ResumoObjetivo: Analisar o conceito de Prática Avançada de Enfermagem e elucidar os elementos-chave: atributos, antecedentes e consequências. Métodos: O referencial metodológico para o estudo foi o modelo de análise conceitual de Walker e Avant (2011), estruturado mediante uma revisão integrativa da literatura conduzida nos meses de maio e junho de 2017. A busca foi realizada nas bases de dados Scopus, PubMed, CINAHL, Web of Science, Science Direct, Cochrane e Lilacs, considerando estudos que trataram do termo e que foram publicados em português, inglês ou espanhol. Resultados: A amostra foi composta por 33 estudos conduzidos em oito países entre os anos 2000 e 2016, sendo 56% publicado no quinquênio 2011-2016. Foram identifi cados oito atributos: Preparação educacional em nível de mestrado ou doutorado, e especialização em área clínica; Prática baseada em evidências; Habilidade de desenvolver raciocínio clínico e pensamento crítico; Alto nível de autonomia; Avaliação avançada e ampla; Liderança; Capacidades diagnóstica, gerencial e administrativa; Promoção do ensino às outras enfermeiras. Foram identifi cados os antecedentes e consequências e foi desenvolvida uma defi nição do conceito. Conclusão: Diante da expansão da ideia de enfermagem avançada pelo mundo, particularmente na América Latina, recomendam-se outros estudos relacionados à Prática Avançada de Enfermagem. É necessária uma compreensão aprofunda...

The Patient Protection and Affordable Care Act P.L. 111–148 (ACA) was projected to expand health insurance to about 32 million people by 2014. This influx presents significant pressures for primary health care providers (PCP) at a time when there is already a PCP shortage. The associations among prevention, equity, healthy environments, nurse practitioner (NP) regulatory policies, and access to primary care are well documented in the literature. This article presents relationships among NP scope of practice regulations in the 50 states and the District of Columbia and their potential impact on population health outcomes. Utilizing correlation and multiple regression analyses, this study identifies modest but significant associations. In accordance with Institute of Medicine (2011) recommendations, the authors suggest successful implementation of the ACA requires modernization and standardization of existing NP practice regulatory policies in order to build primary care capacity, increase access, and improve population health.