Medication and test prescription by nurses: contributions to advanced practice and transformation of care

Abstract

Objective:To carry out a documentary study on the rules, guidelines, policies and institutional support for the nurse to prescribe medicines and request tests with a view to the advanced practice in the scope of Primary Health Care. Methods:Documentary research using open-access institutional documents - Federal Nursing Council (COFEN), its regional representations in the respective Brazilian states (COREN) and the Brazilian Nursing Association (ABEN). Results:Most of the news/notices were issued by the Regional Nursing Councils in the different Federative Units. The argumentation regarding the prescription of medicines and request for tests by nurses is based on three categories: Autonomy and competencies for the prescription of medicines and/or request of tests; Corporate policies that undermine the full exercise of nursing; and Transformation of health and nursing care in Primary Health Care. Conclusion:The prescriptive practice by nurses integrates health care and has been defended by the institutions that represent the category. It emerges as an important element of advanced practice and in the transformation of care in the context of health teams.

Condutas Que Podem Interferir Na Fase Pré- Analítica Do Exame Sumário De Urina

“…Em relação ao profissional solicitante, houve predominância do médico, embora os enfermeiros, principalmente da APS, também tenham liberdade para solicitar tal procedimento, atribuído como rotina estabelecida pelo Ministério da Saúde, e em rotinas aprovadas pelas instituições de saúde. Destarte, é imprescindível que os enfermeiros exerçam com plena capacidade e responsabilidade a compreensão sobre a solicitação e a interpretação dos resultados, associando clinicamente com os sinais e sintomas apresentados pelos pacientes (12) . Observou-se o predomínio da coleta da primeira amostra da manhã entre os entrevistados.…”

“…Tal fato demonstra que ainda existe um quantitativo significativo de usuários que recebem a requisição do exame e não são orientados corretamente. Pesquisas corroboram o referido achado, ao afirmar as dificuldades vivenciadas no dia a dia, como a sobrecarga de atividades, o não conhecimento da técnica adequada, as limitações frente ao entendimento, bem como a vergonha dos usuários em tirar dúvidas com os profissionais de saúde, o que favorecem a absorção de informações incorretas por meio de amigos e familiares (9)(10)(11)(12) . Ressalta-se ainda que o profissional que mais forneceu informações foi o médico, justificado pela predominância de exames solicitados por essa especialidade.…”

Análise de prescrições de antimicrobianos na Atenção Primária à Saúde

“…A recent documentary study on rules, guidelines, policies and institutional support for nurses to prescribe medications also highlights the existence of few studies which have analyzed medication prescriptions by nursing professionals. However, they emphasize that nurses' autonomy has been widely reaffirmed by the Nursing class entities and in the PHC protocols adopted by the Ministry of Health, with arguments about the prescription being based on three categories: autonomy and competence for prescribing medications; corporate policies which compromise the full exercise of Nursing; and transformation of health and nursing care in PHC (23) .…”

The euphemism of good practice or advanced nursing practice

“…As in our reality the ANP is not formally recognized, neither by legislation nor by professional training, according to the definitions given internationally to this practice, it is necessary to approach the subject, since some of these actions are adopted in the daily work, such as the prescription of medicines 4 from primary care protocols. 5 The adoption of clinical evidence to guide practice based on protocols and guidelines, as well as the expansion of functions, even if not widely regulated in the country, brought both prominence and difficulties to nurses, especially in primary care. 5 The prominence results from the increase in the autonomy derived from the daily routine of nurses.…”

“…5 The adoption of clinical evidence to guide practice based on protocols and guidelines, as well as the expansion of functions, even if not widely regulated in the country, brought both prominence and difficulties to nurses, especially in primary care. 5 The prominence results from the increase in the autonomy derived from the daily routine of nurses. 6 On the contrary, the difficulties which nursing currently faces in primary care in Brazil nowadays range from the lack of professional training for the application of complex skills and changes in basic health care legislation, to the recent attempts of two different professional councils, one to prevent the practice of requesting examinations and prescription of medicines by nurses 7 , regardless of whether they are guided by basic care protocols, and another to place under their auspices two practices that take part of the nursing core activities, the care of wounds and burns.…”