Scope of practice in Primary Care: physicians and nurses in five health regions in Brazil

Girardi, Sabado Nicolau; Stralen, Ana Cristina de Sousa van; Lauar, Thaís Viana; Cella, Joana Natalia; Araujo, Jackson Freire; Pierantoni, Célia Regina; Carvalho, Cristiana Leite

doi:10.1590/1806-9304201700s100008

Cited by 5 publications

(7 citation statements)

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“…As the literature points out, which has been focusing more recently on the scope of practices of medical professionals and nurses who are part of FH teams, great obstacles still persist for the expansion of the offer of a strategic set of actions that would allow an increase in PC resolution (13)(14) . Often, teams do not offer or perform procedures due to lack of training to ensure the necessary skills for their proper technical execution, due to the lack or scarcity of materials and inputs essential for their performance, or even because they do not understand PH as the place for offering these shares (13)(14) . The restriction of the scope of procedures offered/performed in BHU is even greater in more populous cities that have a network of emergency and specialized services in greater number.…”

Section: Discussionmentioning

confidence: 99%

“…As a result of this increase in coverage and PC qualification, several studies have brought evidence on the results produced by FHS, revealing its ability to produce effects on the population's health conditions, with improved access to preventive and assistance services, reducing inequities and increasing SUS efficiency, in addition to contributing to reducing preventable hospitalizations (7)(8) . However, studies also show that, in spite of the good results, challenges still remain for the effectiveness of comprehensiveness in PC through the provision of care aimed at priority population groups (9)(10) ; health promotion and disease prevention actions (11)(12) ; procedures with a wide scope of practices (13)(14) ; oral health supply (15)(16) ; actions performed at users' homes (17)(18) ; support and articulation of actions between different professional categories (17,19) ; employing a comprehensive range of assistive technologies (20)(21) ; intersectoral actions (12,22) .…”

Section: Introductionmentioning

confidence: 99%

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Integrality and comprehensiveness of service provision in Primary Health Care in Brazil (2012-2018)

Sousa

Shimizu

2021

Rev. Bras. Enferm.

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Objectives: to analyze comprehensiveness elements in Primary Care in Brazil, between 2012 and 2018, considering preventive and assistance aspects, pointing out advances and obstacles to its improvement in different contexts. Methods: a retrospective longitudinal study using data from the Brazilian National Program for Improving Access and Quality in Primary Care. 15,378 teams were selected that participated in both 1st and 3rd cycles of the program. Results: improvements were found in the prevalence of teams that ensure preventive and assistance care for priority groups, who develop promotion actions, offer essential procedures, including oral health, carry out home visits, receive support from Extended Family Health and Primary Care Center, offer integrative and complementary practices and develop intersectoral actions. Conclusions: there has been an improvement in comprehensiveness in Primary Health services, but problems remain that still need to be faced for their improvement.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Integrality and comprehensiveness of service provision in Primary Health Care in Brazil (2012-2018)

Sousa

Shimizu

2021

Rev. Bras. Enferm.

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“…Nursing consultations constitute a strategy that favors performing the actions prescribed in programs that integrate PHC. Moreover, these actions are the main reasons why nurses provide care, such as management of chronic non-communicable diseases, sexual and reproductive health, women's health, and prenatal care [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]. In this dimension, the most common technical procedures include the administration of vaccines and medications, the collection of oncotic colpocytology (Pap smear) and test materials, and the application of dressings and glucose tests.…”

Section: Practicementioning

confidence: 99%

“…The reasons for their limited work practice were the lack of municipal clinical protocols and/or the existence of restrictive measures by the professional council. The nurses who performed exclusive medical activities-abscess drainage (30%), sutures (5%), and local anesthesia (6%)-did so either because there was a lack of doctors in the units or because the doctors did not have the technical skills to perform them [29,39,40].…”

Section: Practicementioning

confidence: 99%

Situational analysis and reflections on the introduction of advanced practice nurses in Brazilian primary healthcare

Magnago

Pierantoni

2021

Hum Resour Health

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Background The shortage of doctors and their unequal distribution serve as challenges to advancing primary healthcare (PHC) and achieving effective universal healthcare coverage in Brazil. In an effort to use nurses’ potential more efficiently, the country is investigating the introduction of the advanced practice nurse (APN) into PHC. This paper presents a situational analysis of the practices of Brazilian nurses based on the following components: regulation, practice, and education. Methods This is a national multi-method study with triangulated data from a documentary study, a scoping review, and an exploratory study. The regulation component involved the analysis of official normative documents on the regulation of nursing education and nurses’ scope of practice. The practice component aimed to identify the practices performed by nurses in Brazilian PHC based on primary studies. The education component intended to identify the practices taught in nursing training based on a survey and interviews with directors of undergraduate nursing programs. Results Federal legislation in Brazil authorizes nursing graduates to perform a set of advanced practices as part of the PHC nurse's daily routine. They can request and interpret complementary tests and prescribe medication. However, in the local context, municipalities define the scope of this assistance based on technical norms or nursing protocols. Furthermore, this study indicates that undergraduate nursing programs do not fully prepare students to adequately execute these tasks. Conclusions In the context of Brazilian PHC, advanced practices have already been implemented and respond to main healthcare demands. Therefore, it is unnecessary to introduce the APN as a new professional category. Upon detecting deficiencies in the training process, the current education model should undergo reforms that seek to incorporate the skills compatible with the regulated advanced practices and in-service training for practicing nurses. Regarding the introduction of APN along international lines, this article presents recommendations that may support the operationalization of a Brazilian APN model.

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“…The specialization course analyzed in this paper assumed that participants would develop professional skills based on the responsibility to act from a viewpoint that considered the entire lifespan of users, with emphasis on the lines of care and connecting to the healthcare network to optimize the resources available for the effective care. However, despite the importance of this course in boosting indicators of maternal and child health, some overarching structural barriers that weaken the SUS and small-scale impediments that affect the activities of health professionals and the population's access to health services in the FHS must be examined more carefully; notable among these are occupational stress [34], especially with regard to working conditions [35], inadequate supplies and infrastructure [36], lack of staff, lack of medications, underfunding of programs, and the precarious socioeconomic conditions faced by the population [37,38].…”

Section: Plos Onementioning

confidence: 99%

Impact of continuing education on maternal and child health indicators

et al. 2020

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This study investigated whether the presence of care workers who completed a specialization course on family health was associated with improved care and maternal and child health indicators in municipalities in the state of Mato Grosso do Sul, Brazil. Methods Negative binomial regression models with fixed effects were used for the 79 municipalities in the state of Mato Grosso do Sul, with repeated observations for the period 2009-2015. For our reference, the parameter "number of professionals who completed the course" calculated the proportion of professionals who completed the course, and was divided by the total number of primary health care professionals in the municipality to create a ratio. The cutoff points used represented tertile distribution: T3: high (0.35-1.00), T2: intermediate (0.02-0.33) and T1: low (0.00-0.01); to avoid biased results, the analysis was also performed for the years prior to the beginning of the course in question (2009 and 2010). Results During the study period, enrollment of pregnant women, exclusive breastfeeding for children under 4 months, and up-to-date vaccinations in children younger than 1 year to 23 months increased (high to intermediate categories) in municipalities where professionals who completed the specialization course worked. Growth in the intermediate ratio was also observed in indicators related to cervical cancer screening and new diagnoses of congenital syphilis in infants under one year of age.

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Scope of practice in Primary Care: physicians and nurses in five health regions in Brazil

Abstract: Objectives: The review on scopes of practice tends to gain importance in Human

Cited by 5 publications

References 10 publications

Integrality and comprehensiveness of service provision in Primary Health Care in Brazil (2012-2018)

Integrality and comprehensiveness of service provision in Primary Health Care in Brazil (2012-2018)

Situational analysis and reflections on the introduction of advanced practice nurses in Brazilian primary healthcare

Impact of continuing education on maternal and child health indicators

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