RESUMO Objetivo: analisar as ações de cuidado realizadas pelo enfermeiro durante as consultas de puericultura. Método: estudo observacional, quantitativo, realizado com 31 enfermeiros que realizavam consulta de puericultura na Estratégia Saúde da Família de um município da Paraíba (Brasil). Foram observadas três consultas aleatórias por cada enfermeiro participante, totalizando 93 consultas entre março e julho de 2016, por meio de um checklist previamente estruturado, baseado nas diretrizes das políticas nacionais de atenção à saúde da criança, contendo as ações de cuidados que deveriam ser implementadas pelos enfermeiros. A análise foi feita por meio de estatística descritiva, teste qui-quadrado, com nível de significância de 5% e análise de agrupamento. Resultados: as dimensões do cuidado realizadas em maior proporção foram a avaliação da imunização e as suplementações de ferro e vitamina A; a anamnese, o acolhimento, o exame físico/desenvolvimento neuropsicomotor e a educação em saúde foram as menos efetivadas pelos enfermeiros. Conclusão: o cuidado dos enfermeiros na consulta de puericultura está aquém do estabelecido pelas diretrizes de atenção à saúde da criança. Ações de educação permanente para qualificar os enfermeiros para o cuidado integral à criança podem superar essas lacunas.
The primary health care in the Spanish National Health System is organised in health centres with multi-professional teams, composed of doctors and nurses specialised in family and community health, in addition to other professionals. This article analyses the role of primary health care nurses in the Spanish National Health System. In the last decade, new concepts of task sharing between doctors and nurses as well as advanced nursing roles have been evolved in the health centres that focus on improving care for chronically ill patients and access to primary care. With shared responsibility, nurses are responsible for chronic patients in stable conditions, health prevention and promotion. The scaling up of advanced nursing tasks is limited by uncertainties of roles, disparities between states, and legislations that do not cover the full extent of advanced nursing tasks. The case study of Spain indicates that a strong multi-professional model of primary health care teams is a crucial basis for the evolvement of advanced nursing practice and its acceptance in daily routines. However, advantageous education structures and legislations are needed to allow nurses to develop their contribution in the full potential.
Objective: To describe the development of care for children with special health needs in Paraná services of homecare. Method: Quantitative, descriptive, exploratory, and multiple case study was applied. Data were collected by telephone and e-mail, with professionals from the eight services of homecare of Parana, from October 2016 to January 2017. The data was treated with descriptive statistics analysis. Results: Among 35 children in homecare, 25.7% had cerebral palsy, 60% had a tracheostomy. The care provided by the services includes a management of tubes, administration of medication, changing dressings, caregiver guidance for tracheostomy suctioning and a management of diet. Conclusions and implications for practice: Services weaknesses were mainly related to low utilization of the singular therapeutic project and the counter-reference to primary care. The flow of successful practices are developed in the municipality of an isolated manner. Showing positive experiences promotes reflection and improvement of the work process of caring for children with special health needs in homecare.
while early and challenging, the work of Brazilian nursing towards advanced professional practice seems to be interesting, since the possibilities of managing the care of this modality of nurses' performance are evident.
Presença e extensão dos atributos de atenção primária à saúde da criança em distintos modelos de cuidadoPresence and extent of primary care characteristics under different models for children's healthcare Presencia y extensión de las particularidades de la atención primaria, relacionadas con la salud del niño, en distintos modelos de cuidado Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições, desde que o trabalho original seja corretamente citado.
Objective: To analyze how the focus given nowadays in our country to good practices in the care process as centrality of Nursing offers support to the discussion about the expansion of nurses' performance through advanced practices. Method: This is a theoretical-reflexive article, based on critical reading of studies on the subject, focused on the need to discuss the training of nurses in the perspective of their role expansion. Results: The arguments for both subjects, based on the discussion of the theoretical reference of the two themes: good practices or practice based on evidences, and advanced practice nursing. Final considerations and implications for practice: It is proposed that, in addition to good practices, undoubtedly necessary, the appropriation of advanced nursing practice and the debate about its adoption in the country are fundamental to the new professional challenges facing nursing and the training of human resources for the Unified Health System. The arguments presented lead to the knowledge of the nursing topic of recent dissemination in Brazil, the advanced nursing practice, which can substantially change the nurses' performance in our reality.
PRÁTICAS AVANÇADAS DE ENFERMAGEM EM ATENÇÃO PRIMÁRIA: ESTRATÉGIAS PARA IMPLANTAÇÃO NO BRASILObjetivo: refletir acerca da enfermagem de prática avançada, abrangendo essa função em países desenvolvidos. Metodologia: reflexão teórica, descrevendo o conceito de enfermagem de prática avançada, abordando seus impactos na atenção primária à saúde e enfocando estratégias prioritárias para sua implantação no Brasil. Resultados: dentre as estratégias, destacamse investimentos na formação profissional, adoção de estratégias nacionais de educação permanente, adição da prática baseada em evidências como eixo norteador das ações do profissional enfermeiro na atenção primária, revisão e ampliação da legislação que norteia a prática e revisão da legislação do sistema de saúde para a prática ampliada. Conclusão: entende-se que os alicerces para a construção da adoção e regulamentação formal dessa prática já estão dados, desse modo, a enfermagem brasileira precisa conhecê-la e decidir se quer incorporá-la à profissão.Descritores: Prática Avançada de Enfermagem, Atenção Primária a Saúde, Conselho Internacional de Enfermagem, Papel do Profissional de EnfermagemADVANCED PRACTICE OF NURSING IN PRIMARY HEALTH CARE: IMPLANTATION STRATEGIES IN BRAZILObjective: addressing the advanced practice of nursing, covering this function in developed countries. Methodology: theoretical reflection, describing the concept of advanced practice nursing, reporting its impact on primary health care and focusing on priority strategies for its implementation in Brazil. Results: among the strategies, some may be highlighted, such as, investment in graduation nursing courses, national strategies adoption for follow up training at work, addition of practice based on evidences as a guideline for professional nursing actions in primary health care, legislation revision and expansion that guides the practice, and legislation review of the health care system for advanced practice. Conclusion: it is understood that the foundations for the construction of adoption and formal regulation of this advanced practice are ready, thus the Brazilian nursing needs to know about it and decide if it is aimed to be incorporated into the profession.Descriptors: Advanced Practice Nursing, Primary Health Care, International Nursing Council, Nurse’s Role.ENFERMERÍA DE PRÁCTICA AVANZADA EN ATENCIÓN PRIMARIA: ESTRATEGIAS PARA LA IMPLANTACIÓN EN BRASILObjetivo: analizar la práctica de enfermería avanzada, frente a esta función en los países desarrollados. Metodología: reflexión teórica, describiendo su concepto, analizando su impacto en la atención primaria de salud y enfocando las estrategias prioritarias para su implantación en Brasil. Resultados: entre las estrategias se destacan el investimento en la formación profesional, la adopción de estrategias nacionales de aprendizaje permanente, la adopción de la práctica basada en la evidencia como una guía para las acciones de enfermería profesional en la atención primaria, la revisión y ampliación de la legislación que guía la práctica y revisión de la legislación de salud para la práctica extendida. Conclusión: Se entiende que las bases para la construcción de la adopción y la regulación formal de esta práctica está disponible, por lo que la enfermería brasileña necesita saber y decidir si se debe incorporar en la profesión.Descriptores: Enfermería de Práctica Avanzada, Atención Primaria de Salud, Consejo Internacional de Enfermería, Rol de la Enfermera.
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