巴西初级卫生保健中引入高级实践护士的情境分析与反思。
Situational analysis and reflections on the introduction of advanced practice nurses in Brazilian primary healthcare.
机构信息
Department of Policy, Management and Health, School of Public Health, University of São Paulo (FSP/USP), Av. Dr. Arnaldo, 715, São Paulo, SP, 01246-904, Brazil.
Institute of Social Medicine, Rio de Janeiro State University (IMS/Uerj), Rio de Janeiro, Brazil.
出版信息
Hum Resour Health. 2021 Jul 22;19(1):90. doi: 10.1186/s12960-021-00632-w.
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.
背景
医生短缺且分布不均，这对推进初级卫生保健（PHC）和实现巴西有效全民医保覆盖构成挑战。为了更有效地利用护士的潜力，该国正在研究将高级实践护士（APN）引入 PHC。本文基于以下三个方面对巴西护士的实践情况进行了情境分析：规范、实践和教育。
方法
这是一项全国性的多方法研究，其数据来自文献研究、范围综述和探索性研究的三角分析。规范部分涉及对护理教育和护士实践范围的官方规范文件的分析。实践部分旨在根据初级研究确定巴西 PHC 中护士所执行的实践。教育部分旨在根据对本科护理项目主任的调查和访谈，确定护理培训中教授的实践。
结果
巴西联邦立法授权护理毕业生在 PHC 护士的日常工作中执行一系列高级实践。他们可以要求和解释补充检查并开出处方药物。然而，在当地环境下，市政当局根据技术规范或护理协议来定义这种援助的范围。此外，本研究表明，本科护理课程并没有充分准备学生来充分执行这些任务。
结论
在巴西 PHC 背景下，高级实践已经得到实施，并满足了主要的医疗需求。因此，没有必要引入 APN 作为新的专业类别。在发现培训过程中的缺陷后，当前的教育模式应进行改革，以纳入与规范的高级实践兼容的技能和在职培训，为执业护士提供培训。关于沿着国际路线引入 APN，本文提出了一些建议，这些建议可能支持巴西 APN 模式的实施。
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