researches that contribute to understanding the perspectives, facilitators, and barriers for APN are necessary, as well as determining the population's health needs and expectations concerning the role of these professionals.

Objective: To analyze the perception of professionals who fi nish nursing residency or a professional master's degree on Primary Care regarding Advanced Nursing Practices in PHC and the required training model. Method: A descriptive, qualitative study, carried out with a workshop with six alumni graduates of the residency program in Primary Care Nursing in Family Health and two alumni graduates of the Professional Master's Program in Primary Care in the Unifi ed Health System, both from the Nursing School of the University of Sao Paulo. The data were submitted to discourse analysis. Results: Empirical categories constructed were: extension of the scope of practice and autonomy for the development of the nurse's clinical practice, decision-making based on the best scientifi c evidence and on the health needs of individuals and communities, professional training (professional residency, professional master's, concurrent residency and professional master's) and challenges for the training and implementation of Advanced Nursing Practices. Conclusion: The empirical categories show that, in the perception of the graduates, the Advanced Nursing Practices can expand the scope and the autonomy of the nurses' clinical practice, based on the best scientifi c evidence. There are also challenges for training and implementation. The articulation of residency and professional master's is seen as one of the effective models for the training of these nurses. ResumoObjetivo: Analisar a percepção de egressos da residência em enfermagem e do mestrado profi ssional na Atenção Básica sobre a Enfermagem de Práticas Avançadas na Atenção Primária à Saúde e o modelo de formação necessário. Métodos: Estudo descritivo, de abordagem qualitativa, realizado a partir de uma ofi cina de trabalho com seis egressos da residência em enfermagem na Atenção Básica na Saúde da Família e dois egressos do Mestrado Profi ssional em Atenção Primária do Sistema Único de Saúde da Escola de Enfermagem da Universidade de São Paulo. Os dados foram submetidos à análise de discurso. Resultados: As categorias empíricas construídas foram: ampliação do escopo de prática e da autonomia para o desenvolvimento da prática clínica do enfermeiro, tomada de decisões baseadas nas melhores evidências científi cas e necessidades de saúde dos indivíduos e coletividades, formação profi ssional (residência profi ssional, mestrado profi ssional, residência e mestrado profi ssional concomitantes) e desafi os para a formação e a implementação das Práticas Avançadas de Enfermagem. Conclusão: As categorias empíricas evidenciam que na percepção dos egressos as Práticas Avançadas de Enfermagem podem ampliar o escopo e a autonomia da prática clínica do enfermeiro, com base nas melhores evidências científi cas. Evidenciam ainda desafi os para sua formação e implementação. A residência articulada ao mestrado profi ssional é vista como um dos modelos potentes para a formação de tais enfermeiros. ResumenObjetivo: Analizar la percepción de egresados de la residencia en Enfermería y de la mae...

Background The balance between supply and demand for primary health care (PHC) services is one of the main challenges to the health system in Brazil. In this context, the application of planning methods could benefit the decision-making process for human resources organizations. Hence, the objective of this study was to assess the staffing needs for registered nurses (RNs) and licensed practical nurses (LPNs) at PHC services using the WISN method. Methods The Workload Indicators of Staffing Need (WISN) methodology was applied at 13 Primary Care Units (PCU) located in the city of São Paulo, Brazil. It included 87 RNs and 174 LPNs, and used data from 2017 to 2019. Results The WISN results found that RNs were under high workload pressure at 10 PCUs (77%) in 2017 and 2018, with a decrease to 8 PCUs (61%) in 2019. For LPNs, high workload pressure increased from 2 PCUs (15%) in 2017 to 13 PCUs (100%) in 2018, with a decrease to 11 (85%) in 2019. Conclusion The assessment of staffing needs for RNs and LPNs at the PCUs included in the study identified a consistent deficit in the number of professionals, and high workload pressure in most services throughout the study period.

Dedico este estudo a meus pais, Eugenio e Zélia, meus irmãos, Tatiana e Igor, minhas sobrinhas, Beatriz, Julia e Valentina, e meus cunhados Leandro e Francys, por toda a paciência e compreensão durante minhas ausências. Ao meu "anjo da guarda" pela proteção e pelos direcionamentos. A todos os enfermeiros que, assim como eu, acreditam e lutam pela profissão. A minha avó Rosalina, que partiu desse plano durante minha trajetória no mestrado. Rewa T. Competências para práticas avançadas de Enfermagem na Atenção Primária à Saúde no contexto brasileiro [dissertação].

Background The gap in care for psychological distress has been one of the greatest challenges for health systems. Stepped care models represent attempts to maximize the effectiveness and efficiency of decisions about resource allocation in therapy. In Brazil, there are no tools that support this process. The Hospital Israelita Albert Einstein executes the project entitled PlanificaSUS to organize the health care network and strengthen PHC. We aimed to develop and search for evidence of Content validity on the Mental Health Care Needs Stratification Scale. Methods The latent variable is the need for mental health care. The 130 items considered the literature and 73 experts' opinion. The items were categorized into six dimensions referred by users (social, autonomy, functionality, interpersonal relationship, spirituality, and clinical history) and a dimension evaluated by the professional (clinic). The invitation was made by the snowball method. Content validity was based on clarity, relevance, and semantics, and calculated by Content Validity Ratio (CVR), considering a critical CVR value> 0.11. This study was approved by the research ethics committee. Results A total of 73 professionals including health service professionals, teachers, and psychometrists, from all regions of Brazil participated, most of them female (73%), the average age was 40 years old, most with specialization (47%). Most were nurses (36.8%), psychologists (15.8%), PHC doctors (10.5%), social workers (9.2%), with more than 10 years of experience in the service (28.9%). At the end of the content validation, the scale presented 43 items with CVR between 0.11 and 0.25. Conclusions There is evidence of content validity of the scale, and it will supports professionals in making decisions about which is the right therapy, at the right time, for the right patient. Key messages The scale will be a powerful tool for the coordination of care between Primary Health Care and Mental Health specialized services. For practice use, it still is necessary to validate the internal structure.

Background The balance between supply and demand for primary health care (PHC) services is one of the main challenges to the health system in Brazil. In this context, the application of planning methods could benefit the decision-making process for human resources organizations. Hence, the objective of this study was to assess the staffing needs for registered nurses (RNs) and licensed practical nurses (LPNs) at PHC services using the WISN method. Methods The Workload Indicators of Staffing Need (WISN) methodology was applied at 13 Primary Care Units (PCU) located in the city of São Paulo, Brazil. It included 87 RNs and 174 LPNs, and used data from 2017 to 2019. Results The WISN results found that RNs were under high workload pressure at 10 PCUs (77%) in 2017 and 2018, with a decrease to 8 PCUs (61%) in 2019. For LPNs, high workload pressure increased from 2 PCUs (15%) in 2017 to 13 PCUs (100%) in 2018, with a decrease to 11 (85%) in 2019. Conclusion The assessment of staffing needs for RNs and LPNs at the PCUs included in the study identified a consistent deficit in the number of professionals, and high workload pressure in most services throughout the study period.

Background Mental health disorders represent the top leading causes of burden worldwide. At this context, initiatives to identify Care Needs in Mental Health (CNMH) are urgent, to assure integral and quality care. Nonetheless, there is a gap in valid tools to support primary healthcare (PHC) professionals’ decision-making to the provision of the proper mental health care, at the right place. The present study aimed to develop and search for evidences about the validity of the Brazilian Scale for Evaluation of Mental Health Care Needs (MHcare-BR). Methods Considering CNMH as the latent variable, a group of experts developed 130 dichotomous items, which were submitted to assessment by a heterogeneous panel of judges from different regions in Brazil (n = 73). Collected data subsidized the Content Validity Ratio (CVR) calculation, which resulted in a second version of the scale comprising 43 items. Subsequently, it was applied to 879 individuals to find evidences about the internal-structure validity by using the Exploratory Factor Analysis (EFA). Dimensionality was assessed through Robust Parallel Analysis and the model was tested through cross-validation to find MHcare-BR final version. Further, the MHcare-BR’s score was subjected to normalization. Results The final version of MHcare-BR comprised 31 items, which were divided in two blocks: “self-referred” block, with 5 dimensions (social relationships; functionality; autonomy; impulsiveness and aggressiveness”; and spirituality); and “health professional evaluation” block, comprising 3 dimensions (violence; self-aggression and suicidal behavior; and caregiving plan). Model explained variance reached 62.70%. Closeness of dimensionality values pointed out a multi-dimensional model (UNICO = 0.79; ECV = 0.0.69 and MIREAL = 0.22). All indicators were within adequate and satisfactory limits, without any cross-loading, Heywood Case or collinearity/multi-collinearity issues capable of pointing out items redundancy and overlapping. Reliability indices also reached adequate levels (α = 0.82; ω = 0.80; glb = 0.93 and ORION ranging from 0.79 to 0.95, between domains). MHcare-BR’s score normalization pointed towards four CNMH strata (Low CNMH: 0 to 1; Moderate CNMH: 2 to 3; High CNMH: 4 to 6; Very High CNMH: 7 or more). Conclusions The MHcare-BR scale is a synthesized instrument, comprising users’ self-evaluation and PHC professionals’ clinical assessment. It showed satisfactory validity evidences, which were consistent, reliable and robust; capable of accurately measuring CNMH in the primary care territory, in Brazil.

Objective: To describe the experience of implementing a satellite vaccination unit in a drive-through system during a campaign against COVID-19. Method: This is an experience report carried out in a drive-through vaccination satellite unit. The study development was guided by the triad structure-process-results, proposed by Donabedian. Results: The unit was structured in a soccer stadium, allowing it to serve large audiences safely. Care flow occurred in stages and professionals were organized by sectors, with emphasis on the nursing team’ work. Initially, screening was performed; later, users went to the registration sector, and, finally, they were forwarded to the application station. The unit also had emergency sectors, a cold chain, space for professionals and a Basic Health Unit as a point of support. In 25 days of operation, 9698 doses were administered, with 1.8% of doses lost. Conclusion: The implementation of this system required planning, structure, process development and intense team articulation, with emphasis on the fundamental and strategic role of nurses in different points of action and leadership.