Primary Healthcare Case Management Nurses and Assistance Provided to Chronic Patients: A Narrative Review.

Population aging is causing increases in the numbers of chronic diseases, with the consequent need for changes in health systems to better assist patients with chronic conditions. A narrative review was conducted in this study with the objective of analysing the scientific evidence on the care and assistance provided by Case Management Nurses (CMNs) to chronic patients in primary healthcare. A total of 15 articles published in English, Spanish, and Portuguese were selected in the following databases: PubMed, Embase, Cochrane Library, Scopus, Dialnet, Cinahl, and Web of Science. In total, 46.6% of the studies showed the assistance provided by CMNs for chronic pathologies. Most of the articles selected (80%) considered that the assistance offered by case management nurses in relation to chronic diseases is effective, enabling cost reductions, which supposes benefits at the economic and political levels. It was concluded that CMNs have proven to be efficient in caring for people with chronic diseases, improving the quality of life of these people and their caregivers; therefore, they have a fundamental role in the PHC.

Intensive Primary Care Nursing: Exploring the Impact of a Nurse-Led Model for Medically and Social Complex Patients.

Lack of access to primary care contributes to health inequities. Treatment settings that utilize the full experience and training of nurses, both registered nurses (RNs) and advanced practice registered nurses (APRNs), can expand in primary care and successfully address health inequities. This small study describes the implementation of a model of primary care called intensive primary care (IPC), which has eight elements that support the full utilization of a nurse's experience and training. This is a mixed method qualitative study, which reports the observations of the implementation and pre- and post-intervention measures. The IPC model was implemented at a free clinic, which targeted underserved population between 2020 and 2023. Participants were selected as a convenience sample. Participants were to have two or more chronic health problems The participants received primary care using the IPC model, which included setting self-management goals, and meeting with RN or APRN on a monthly basis (face to face, via phone or zoom) to monitor progress toward goals. Twenty-two people were approached, and 19 completed the intervention. Pre- and Post-intervention measures (Patient Assessment of Chronic Illness Care [PACIC]-20); Functional, Communicative, Critical Thinking Health Literacy; Perceived Stress; Patient Activation; Perceived Self Efficacy for Chronic Disease; EuroQo- 5 Dimension (EQ-5D); Trust in Provider; Emotional Support-Patient Reported Outcome Measure Information System (PROMIS); and Patient Health Questionnaire-9) were obtained and analyzed with paired T test (α < .05). Nurses involved meet weekly to share observations recorded in free form notes. These observations were summarized by two of the authors (MD and KF) at the end of the study. All patients had improved physical health outcomes, but more importantly, there were significant improvements in measures known to impact health and health outcomes, specifically, patient activation, self-efficacy for chronic illness, PACIC, and trust in provider. Time spent with patients, both duration and frequency of contact, was observed to have significant impacts.

Autonomia profissional do enfermeiro na atenção primária à saúde: perspectivas para a prática avançada / Professional autonomy of nurses in primary health care: perspectives for advanced practice / Autonomía profesional de los enfermeros en la atención primaria de salud: perspectivas para la práctica avanzada

Objetivo: Descrever como os enfermeiros atuantes na Atenção Primária identificam sua autonomia profissional no desenvolvimento das práticas de Enfermagem. Métodos: Trata-se de uma pesquisa exploratória, descritiva, de abordagem qualitativa. Participaram de entrevistas online 28 enfermeiros que atuam na Atenção Primária de um município do Sul do Brasil, entre o período de outubro de 2020 até fevereiro de 2021. Para tratamento dos dados, foi utilizada a análise de conteúdo temática. Resultados: Emergiram duas categorias: 1) Resolutividade das práticas da Enfermagem; 2) Respaldo nas regulamentações profissionais e evidências científicas. A Enfermagem dispõe de maior autonomia frente à atenção à saúde da mulher, Infecções Sexualmente Transmissíveis e no cuidado à pessoa com feridas, pois no momento da consulta do enfermeiro, despontam habilidades e competências para a tomada de decisão na prática clínica. Em relação à regulamentação para exercício profissional, os profissionais enfatizaram a importância dos protocolos para respaldar as ações. Conclusão: O protagonismo do enfermeiro e sucesso nas experiências indicam um caminho promissor para a discussão e implementação da Enfermagem de Prática Avançada no Brasil. (AU)

Objective: To describe how nurses working in Primary Care identify their professional autonomy in the development of Nursing practices. Methods: This is an exploratory, descriptive research with a qualitative approach. Twenty-eight nurses who work in Primary Care in a municipality in southern Brazil participated in online interviews, between October 2020 and February 2021. For data processing, thematic content analysis was used. Results: Two categories emerged: 1) Resolving nursing practices; 2) Support in professional regulations and scientific evidence. Nursing has greater autonomy in the care of women's health, Sexually Transmitted Infections and in the care of the person with wounds, because at the time of the nurse's consultation, skills and competences for decision-making in clinical practice emerge. Regarding regulation for professional practice, professionals emphasized the importance of protocols to support actions. Conclusion: The role of nurses and success in the experiences indicate a promising path for the discussion and implementation of Advanced Practice Nursing in Brazil. (AU)

Objetivo: Describir cómo los enfermeros que actúan en la Atención Primaria identifican su autonomía profesional en el desarrollo de las prácticas de Enfermería. Métodos: Se trata de una investigación exploratoria, descriptiva, con abordaje cualitativo. Veintiocho enfermeros que actúan en la Atención Primaria de un municipio del sur de Brasil participaron de entrevistas en línea, entre octubre de 2020 y febrero de 2021. Para el procesamiento de datos, se utilizó el análisis de contenido temático. Resultados: Emergieron dos categorías: 1) Prácticas resolutivas de enfermería; 2) Apoyo en normativa profesional y evidencia científica. La enfermería tiene mayor autonomía en el cuidado de la salud de la mujer, Infecciones de Transmisión Sexual y en el cuidado de la persona con heridas, porque en el momento de la consulta del enfermero emergen habilidades y competencias para la toma de decisiones en la práctica clínica. En cuanto a la regulación para la práctica profesional, los profesionales destacaron la importancia de los protocolos para apoyar las acciones. Conclusión: El papel de los enfermeros y el éxito de las experiencias indican un camino promisorio para la discusión e implementación de la Enfermería de Práctica Avanzada en Brasil. (AU)

Realidad investigadora de los enfermeros en atención primaria de salud: ¿cuál es la situación? / Research reality of nurses in primary health care: what is the situation?

Objetivo: Examinar la actividad investigadora de los enfermeros en atención primaria de salud y conocer su divulgación. Metodología: Se trata de un estudio transversal descriptivo realizado entre el 27 mayo hasta el 29 de junio de 2022, en un Área de Gestión Sanitaria a través de un cuestionario electrónico autoadministrado. Contestaron el cuestionario 242 enfermeros. Un 5.2% posee el grado de Máster y ninguno el de Doctor. Un 8.3% ha colaborado en algún proyecto de investigación financiado, siendo la suscripción a grupos del Plan Andaluz de Investigación, Desarrollo e Innovación (PAIDI) de un 0,4%. La participación es principalmente colaborativa con sólo 1 caso como IP en proyectos financiados. La aportación a congresos u otras actividades de divulgación es de un 23% para comunicaciones orales y de un 26,1 % para comunicaciones escritas. Resultados: Sobre la publicación de resultados, un 16,5%, han publicado al menos 1 artículo científico, siendo un 1,3% en revistas de impacto (ninguna en Q1 y Q2). La temática de las publicaciones es muy diversa. La colaboración en investigaciones realizadas con otras disciplinas ha sido de un 10,4 % y en estudios de investigación realizados con otras instituciones o servicios de salud de un 11,3%. Conclusión: Se concluye que la actividad investigadora realizada en atención primaria es de bajo nivel y calidad. Existe dispersión tanto en la temática como en los perfiles enfermeros que desarrollan actividad investigadora, lo que implica inexistencia de una red consolidada en investigación en cuidados que sustente la práctica asistencial basada en la evidencia científica. (AU)

Aim: The aim of this study is to examinate the research activity of nurses in primary health care and to know his dissemination. Method: It is a descriptive cross-sectional study carried out between May 27 and June 29, 2022, in a Health Management Area Through a self-administrated questionnaire. A total of 242 nurses answered the questionnaire. A total of 5,2% have a Master ́s degree and none have a PhD. Some 8,3% have collaborated in a funded research project, with 0,4% subscribing to PAIDI groups. Participation is mostly collaborative with only 1 case as PI in funded projects. Contribution to congresses or other dissemination activities is 18.7% for oral communications and 16,5% for written communications. Results: Regarding the publication of results, 16,5% have published at least 1 scientific article, 1,3% in impact journals (none in Q1 or Q2). The subject matter of the publications is very diverse. Collaboration in research with other disciplines was 10,4%, and in research studies carried out with other institutions or health services are 11,3%. Conclusion: It is concluded that the research activity carried out in primary care is of low level and quality. There is dispersion both in the subject matter and in the nursing profiles that carry out research activity, which implies the lack of a consolidated network in research in care that supports care practice based on scientific evidence. (AU)

Qualitative study on shared decision making in cystitis management in general practice.

BACKGROUND: Cystitis are commonly treated with antibiotics, although non-antibiotic options could be considered for healthy non-pregnant women. Shared decision making (SDM) can be used in cystitis management to discuss the various treatment options but is not frequently applied in general practice. AIM: Identifying barriers and facilitators for applying SDM in cystitis management in general practice. DESIGN & SETTING: Qualitative explorative research in general practice with healthcare professionals (HCPs; general practitioners (GPs) and GP assistants) and healthy non-pregnant women with a recent history of cystitis (patients). METHOD: Individual semi-structured interviews were conducted between May and October 2022. We applied a combination of thematic and framework analysis. RESULTS: Ten GPs, seven GP assistants, and fifteen patients were interviewed. We identified three main barriers and one key facilitator: 1) applying SDM is deemed inefficient; 2) HCPs presume that patients expect antibiotic treatment and some HCPs consider non-antibiotic treatment inferior; 3) Patients are largely unaware of the various non-antibiotic treatment options for cystitis; 4) HCPs recognise some benefits of applying SDM in cystitis management, including reduced antibiotic use and improved patient empowerment, and patients appreciate involvement in treatment decisions, but preferences for SDM vary. CONCLUSION: SDM is infrequently applied in cystitis treatment in general practice due to the current efficient cystitis management, HCPs' perceptions, and patient unawareness. Nevertheless, both HCPs and patients recognise the long-term benefits of applying SDM in cystitis management. Our findings facilitate the development of tailored interventions to increase the application of SDM which should be co-created with HCPs and patients and fit into the current efficient cystitis management.

The process of clinical decision-making in chronic wound care: A scenario-based think-aloud study.

AIMS: To undertake a comprehensive investigation into both the process of information acquisition and the clinical decision-making process utilized by primary care nurses in the course of treating chronic wounds. DESIGN: Scenario-based think-aloud method, enriched by the integration of information processing theory. The study was conducted within the framework of home care nursing organizations situated in Flanders, the Flemish speaking part of Belgium. A cohort of primary care nurses (n = 10), each possessing a minimum of one year of nursing experience, was recruited through the collaboration of three home care nursing organizations. METHODS: Two real-life clinical practice scenarios were employed for the interviews, with the researcher adopting the roles of either the patient or another clinician to enhance the realism of the think-aloud process. Each think-aloud session was promptly succeeded by a subsequent follow-up interview. The Consolidated criteria for Reporting Qualitative research checklist was followed to guarantee a consistent and complete report of the study. RESULTS: Amidst noticeable variations, a discernible pattern surfaced, delineating three sequential concepts: 1. gathering overarching information, 2. collecting and documenting wound-specific data, and 3. interpreting information to formulate wound treatment strategies. These concepts encompassed collaborative discussions with stakeholders, while the refinement of wound treatment strategies was interwoven within both concepts 2 and 3. CONCLUSIONS: Evident variations were identified in chronic wound care clinical decision-making, regardless of educational background or experience. These insights hold the potential to inform the development of clinical decision support systems for chronic wound management and provide guidance to clinicians in their decision-making endeavours.

Acesso a rede de atenção a saúde em tempos de covid-19 por homens com diabetes / Access to the health care network in times of covid-19 for men with diabetes

Estabelecer como ocorreu o acesso ao serviço de saúde dos homens com diabetes durante a pandemia SARS-CoV-2, bem como identificar seu perfil sociodemográficos. Método: O estudo se trata de uma metodologia do tipo descritiva, exploratória com abordagem quantitativa. A pesquisa foi realizada na unidade de atenção primária à saúde pertencente à Regional VI. Participaram da pesquisa homens, selecionados de acordo com os critérios pré estabelecidos. Resultados: A faixa etária da população observada varia entre trinta e setenta anos de idade, sendo que a maioria dos pacientes (46,7%) possui entre 50 e 60 anos de idade. Cerca de 66,7% dos pacientes apresentam fatores de risco. Conclusão: As condições de oferta de serviços de saúde destinados aos pacientes do sexo masculino atendidos na atenção básica foram mantidas durante a pandemia, entretanto a adaptação de acompanhamento dos pacientes à distância foi insuficiente.(AU)

To establish how access to health services for men with diabetes occurred during the SARS-CoV-2 pandemic, as well as to identify their sociodemographic profile. Method: This is a descriptive, exploratory study with a quantitative approach. The research was carried out in a primary health care unit belonging to Regional VI. Men took part in the research, selected according to pre-established criteria. Results: The age range of the observed population varies between thirty and seventy years old, with the majority of patients (46.7%) being between 50 and 60 years old. Around 66.7% of the patients had risk factors. Conclusion: The conditions for offering health services to male patients treated in primary care were maintained during the pandemic, but there was insufficient adaptation to monitoring patients remotely.(AU)

Establecer cómo los hombres con diabetes accedieron al servicio de salud durante la pandemia de SARS-CoV-2, así como identificar su perfil sociodemográfico. Método: Se trata de un estudio descriptivo, exploratorio y con abordaje cuantitativo. La investigación se realizó en una unidad de atención primaria de salud perteneciente a la Región VI. Participaron de la investigación hombres, seleccionados de acuerdo con criterios preestablecidos. Resultados: El rango de edad de la población observada varía entre treinta y setenta años, con la mayoría de los pacientes (46,7%) entre 50 y 60 años. Alrededor del 66,7% de los pacientes presentaban factores de riesgo. Conclusión: Las condiciones para ofrecer servicios sanitarios a los pacientes varones atendidos en atención primaria se mantuvieron durante la pandemia, pero la adaptación del seguimiento a distancia de los pacientes fue insuficiente.(AU)

Condições de trabalho de enfermeiros da atenção primária à saúde nas capitais da região sudeste do Brasil / Working conditions of primary health care nurses in the capitals of the southeastern of Brazil / Condiciones de trabajo de las enfermeras de atención primaria de salud en las capitales de la región sureste de Brasil

Introdução: As condições de trabalho de enfermeiros que atuam na Atenção Primária à Saúde se relacionam a questões de ordem interpessoal, política, organizacional e de infraestrutura. Objetivo: analisar a categoria "condições de trabalho" oriunda da pesquisa "Práticas de Enfermagem na Atenção Primária à Saúde: estudo nacional de métodos mistos", com foco nas capitais da região Sudeste do Brasil. Métodos: estudo qualitativo que analisou 108 entrevistas de enfermeiros residentes em Belo Horizonte, Rio de Janeiro, São Paulo e Vitória, realizadas entre novembro de 2020 e setembro de 2021. Os dados foram submetidos à análise temática, com apoio do software MAXQDA®. Resultados: os participantes eram majoritariamente do sexo feminino (88,0%), idade média de 42 anos, cor ou raça parda e tempo de atuação em atenção primária superior a 12 anos. Há uma diversidade temática quanto às condições de trabalho referidas por enfermeiros, destacando-se positivamente relacionamentos interpessoais. Infraestrutura das unidades de saúde e a fragilidade dos vínculos empregatícios foram referidos como dificultadores do trabalho na APS. Conclusão: Há uma diversidade de fatores que se relacionam com as condições de trabalho dos enfermeiros, sendo necessário intervenções sobre aquelas que trazem prejuízos, como o excesso de atribuições e infraestrutura das unidades de saúde. (AU)

Background: The working conditions of nurses working in Primary Health Care are related to interpersonal, political, organizational and infrastructure issues. Objective: to analyze the category "working conditions" from the research "Nursing Practices in Primary Health Care: a national study of mixed methods", focusing on the capitals of the Southeast region of Brazil. Methods: qualitative study that analyzed 108 interviews with nurses residing in Belo Horizonte, Rio de Janeiro, São Paulo and Vitória, carried out between November 2020 and September 2021. Data were subjected to thematic analysis, with the support of the MAXQDA® software. Results: the participants were mostly female (88.0%), mean age of 42 years, brown color or race, and working in primary care for more than 12 years. There is a thematic diversity regarding the working conditions mentioned by nurses, with positive emphasis on interpersonal relationships. Infrastructure of the health units and the fragility of employment relationships were mentioned as obstacles to work in PHC. Conclusion: There are a variety of factors that are related to the working conditions of nurses, requiring interventions on those that bring harm, such as excess attributions and infrastructure of health units. (AU)

Introducción: Las condiciones de trabajo de los enfermeros que actúan en la Atención Primaria de Salud están relacionadas con cuestiones interpersonales, políticas, organizativas y de infraestructura. Objetivo: analizar la categoría "condiciones de trabajo" de la investigación "Prácticas de Enfermería en la Atención Primaria de Salud: un estudio nacional de métodos mixtos", con foco en las capitales de la región Sudeste de Brasil. Métodos: estudio cualitativo que analizó 108 entrevistas con enfermeros residentes en Belo Horizonte, Rio de Janeiro, São Paulo y Vitória, realizadas entre noviembre de 2020 y septiembre de 2021. Los datos fueron sometidos a análisis temático, con el apoyo del software MAXQDA®. Resultados: los participantes eran mayoritariamente del sexo femenino (88,0%), edad media de 42 años, color moreno o raza, y actuaban en la atención primaria hace más de 12 años. Hay diversidad temática en cuanto a las condiciones de trabajo mencionadas por los enfermeros, con énfasis positivo en las relaciones interpersonales. La infraestructura de las unidades de salud y la fragilidad de las relaciones laborales fueron mencionadas como obstáculos para el trabajo en la APS. Conclusión: Hay una variedad de factores que se relacionan con las condiciones de trabajo de los enfermeros, requiriendo intervenciones sobre aquellos que traen perjuicio, como el exceso de atribuciones e infraestructura de las unidades de salud. (AU)

Um olhar sobre a autonomia: percepções de enfermeiras sobre suas práticas na atenção primária / A look at autonomy: nurses' perceptions about their practices in primary care / Una mirada a la autonomía: percepciones de los enfermeros sobre sus prácticas en la atención primaria

Objetivo: Analisar a percepção de enfermeiras sobre a autonomia no exercício de suas práticas no contexto da atenção primária à saúde. Métodos: Estudo descritivo de abordagem qualitativa que analisou 108 entrevistas realizadas com enfermeiras(os) das quatro capitais da região sudeste do Brasil. As entrevistas, guiadas por roteiro semiestruturado, foram gravadas e transcritas. Os dados produzidos foram tratados e explorados com auxílio do software NVIVO®. Resultados: A maior parte das participantes eram mulheres, brancas, residiam na mesma cidade onde trabalham, graduaramse em instituições privadas. Foram organizadas duas categorias: repercussões da autonomia e seus desdobramentos para a resolutividade das necessidades em saúde dos usuários; e (des)conhecimento sobre a regulamentação das práticas da enfermeira: desafios para a autonomia. Conclusão: As enfermeiras compreendem a importância da autonomia para suas práticas, mas enfrentam interferências no cotidiano do trabalho, tanto por parte da gestão, da estrutura dos serviços ou da necessidade do uso de protocolos que garantam o exercício de sua atividade profissional de modo autônomo. (AU)

Objective: To analyze nurses' perception of autonomy to exercise their practices in the context of primary health care. Methods: A descriptive study with a qualitative approach that analyzed 108 interviews carried out with nurses from the four capitals of the southeastern region of Brazil. The interviews, guided by a semi-structured script, were recorded and transcribed. The data produced were processed and explored with the help of the NVIVO® software. Results: Most of the participants were women, white, lived in the same city where they work, and graduated from private institutions. Two categories were organized: repercussions of autonomy and its consequences for solving users' health needs; and (lack of) knowledge about the regulation of nursing practices: challenges for autonomy. Conclusion: Nurses understand the importance of autonomy for their practices, but they face interference in their daily work, either by management, the structure of services or the need for protocols that guarantee the exercise of their professional activity. (AU)

Objetivo: Analizar la percepción de autonomía de los enfermeros para ejercer sus prácticas en el contexto de la atención primaria de salud. Métodos: Estudio descriptivo con enfoque cualitativo que analizó 108 entrevistas realizadas con enfermeros de las cuatro capitales de la región sureste de Brasil. Las entrevistas, guiadas por un guión semiestructurado, fueron grabadas y transcritas. Los datos producidos fueron procesados y explorados con la ayuda del software NVIVO®. Resultados: La mayoría de los participantes eran mujeres, de raza blanca, vivían en la misma ciudad donde trabajan y egresaron de instituciones privadas. Se organizaron dos categorías: repercusiones de la autonomía y sus consecuencias para la solución de las necesidades de salud de los usuarios; y (falta de) conocimiento sobre la regulación de las prácticas de enfermería: desafíos para la autonomía. Conclusión: Los enfermeros comprenden la importancia de la autonomía para sus prácticas, pero enfrentan interferencias en su trabajo diario, ya sea por parte de la dirección, la estructura de los servicios o la necesidad de protocolos que garanticen el ejercicio de su actividad profesional. (AU)

Defining digital nursing.

BACKGROUND: The use of technology in health care, including nursing, is growing, owing in part to the COVID-19 pandemic and in response to national policy. AIMS: To investigate nurses' perceptions of digital nursing (DN). METHODS: Community and primary care nurses from across Wales were recruited (n=249) through a survey comprising open and closed questions. This was supplemented with semistructured interviews (n=25). Thematic analysis was used to analyse qualitative data. FINDINGS: Nurses had a broad range of perspectives on what DN meant, with four main themes being identified: access; impact on care; technology; and digital future. The positive impacts of DN on ways of working and patient outcomes were supported by answers to closed survey questions. CONCLUSION: Many nurses understand the value of digital tools within nursing and are clear about their benefits for patients, nurses and multiprofessional teams. However, there is a need for a clear definition and increased awareness of DN.

Implementación de Enfermería Basada en la Evidencia en Atención Primaria / Implementation of Evidenced- Based Nursing in Primary Care

Introducción: La implementación de la Enfermería Basada en la Evidencia (EBE) destaca por sus múltiples beneficios, tanto para el paciente, como para las enfermeras. Sin embargo, existe dificultad en su implementación atribuida a diferentes causas.Objetivos: Conocer el uso diario, la actitud frente a la EBE y las habilidades y conocimientos para aplicarla por las enfermeras de varios centros de salud de la Región de Murcia, además de los factores autopercibidos que dificultan la implementación y las medidas para paliarlo.Métodos: Estudio de investigación mixta de estrategia concurrente de triangulación, transversal, descriptivo y multicéntrico compuesto de un cuestionario validado y dos preguntas abiertas.Resultados: Participaron 65 enfermeras, predominantemente mujeres, de las cuales el 50,8% ha recibido formación en EBE. Las puntuaciones de los apartados del cuestionario son: 27,02 (x̄) en el uso diario de EBE, 18 (m) en la actitud y 44,15 (x̄) en las habilidades y conocimientos de EBE. Algunos factores autopercibidos que dificultan la implementación de la EBE son la falta de formación y de tiempo y la precariedad laboral y algunas medidas que sugieren para paliarlo son: formación, contratación de personal y trabajo en equipo. Conclusiones: Los participantes muestran una actitud favorable frente a la EBE, pero el uso diario y las habilidades y conocimientos son moderados, observándose relación entre la formación en EBE y la especialización de enfermería con mayor habilidades y conocimientos en EBE. Se destaca la necesidad de realizar estudios de mayor impacto para una evaluación más completa e implementación de las estrategias oportunas (AU)

Introduction: The implementation of Evidenced- Based Nursing (EBN) is characterized by multiple benefits, for the patients and the nurses. However, the implementation is difficult for different reasons. Objectives: To evaluate the daily use of the EBN, the attitude towards EBN and the skills and knowledge of nurses to apply EBN in the selected health centers and also, to explore the self-perceived factors that may hinder the implementation of EBN at work and the possible measures to improve it by the nurses that work in PC. Methods: Cross-sectional, descriptive, multicenter and mixed concurrent triangulation strategy research, compose of a validated questionnaire and two open questions. Results: 65 nurses participated, mostly women, of whom 50,8% have received EBN’s formation. The punctuation of the different parts of the questionnaire are:27,02 (x̄) in the EBN’s daily use, 18 (m) in the attitude and 44,15 (x̄) in the EBN’s skills and knowledge. Some factors self-perceived that difficult the EBN’s implementation are the lack of formation and time and the job insecurity and there are some measures suggested for palliate it such as: formation, recruitment and teamwork. Conclusions: The participants show a favorable attitude towards EBN, but daily use and skills and knowledge are moderate, observing a relationship between training in EBN and nursing specialization with greater skills and knowledge in EBN. There is a need to carry out studies with a greater impact for a more complete evaluation and implementation of the appropriate strategies (AU)

O cuidado ao paciente com câncer sob a ótica de enfermeiros da atenção primária à saúde / Cancer patient care from the perspective of primary health care nurses / La atención al paciente oncológico desde la perspectiva de los enfermeros de atención primaria a la salud

RESUMO Objetivo: descrever a percepção de enfermeiros sobre o cuidado ao paciente com câncer na Atenção Primária à Saúde. Método: estudo qualitativo, desenvolvido em 26 Centros de Saúde da Família de um município do Oeste catarinense - Brasil, entre setembro e outubro de 2022. Participaram 33 enfermeiros, que responderam um questionário on-line. O texto foi interpretado com base nos preceitos conceituais da cultura organizacional da teoria administrativa de Chiavenatto. Questões objetivas foram analisadas pela frequência das respostas; para as dissertativas, utilizou-se o Discurso do Sujeito Coletivo. Resultados: os enfermeiros percebem-se despreparados e identificam ausência de protocolos e fluxos organizacionais. Considerações finais: na Atenção Primária à Saúde há a crença consolidada no cotidiano laboral e que se torna integrante da cultura organizacional dos serviços de saúde, que o paciente com câncer deve seguir para o cuidado especializado. Nota-se desconhecimento das políticas de saúde, o que implica o profissional na atenção ao paciente com câncer.

ABSTRACT Objective: To describe nurses' perceptions of cancer patient care in Primary Health Care. Method: A qualitative study was conducted in 26 Family Health Centers in a municipality in western Santa Catarina - Brazil, between September and October 2022. A total of 33 nurses took part and completed an online questionnaire. The text was interpreted based on the conceptual precepts of organizational culture from Chiavenatto's administrative theory. The frequency of responses analyzed objective questions; the Collective Subject Discourse was used for the essay questions. Results: Nurses perceive themselves as unprepared and identify a lack of protocols and organizational flows. Final considerations: In primary Health Care, there is a belief consolidated in everyday work and becomes part of the organizational culture of health services, that cancer patients should go on to specialist care. There is a lack of knowledge of health policies, which implicates professionals in caring for cancer patients.

RESUMEN Objetivo: describir las percepciones de los enfermeros sobre la atención al paciente oncológico en Atención Primaria. Método: estudio cualitativo realizado en 26 Centros de Salud de la Familia de un municipio del oeste de Santa Catarina - Brasil, entre septiembre y octubre de 2022. Participaron 33 enfermeros que cumplimentaron un cuestionario en línea. El texto se interpretó basándose en los preceptos conceptuales de la cultura organizativa de la teoría administrativa de Chiavenatto. Las preguntas objetivas se analizaron por la frecuencia de las respuestas; para las preguntas de ensayo, se utilizó el discurso del sujeto colectivo. Resultados: los enfermeros no se sienten preparados e identifican una falta de protocolos y flujos organizativos. Consideraciones finales: en Atención Primaria existe la creencia, consolidada en el trabajo diario y que se ha convertido en parte integrante de la cultura organizativa de los servicios sanitarios, de que los pacientes con cáncer deben pasar a la atención especializada. Existe un desconocimiento de las políticas sanitarias, que implica a los profesionales en la atención a los pacientes con cáncer.

Práticas de cuidar realizadas por enfermeiros da atenção básica no território: um estudo em Boa Vista, Roraima

Objetivo: Identificar as práticas de cuidar realizadas por enfermeiros da atenção básica no território. Método: Estudo exploratório-descritivo com abordagem qualitativa realizado em dez unidades básicas de saúde situadas na cidade de Boa Vista, Roraima, Brasil. O grupo social foi constituído por oito enfermeiros do quadro efetivo do funcionalismo municipal. A produção dos dados ocorreu durante dezembro de 2022 a fevereiro de 2023 mediada por entrevistas semiestruturadas. Os arquivos em áudio totalizaram aproximadamente uma hora, foram transcritos manualmente e analisados segundo o referencial teórico de Bardin. Resultados: As práticas de cuidar foram organizadas em duas categorias temáticas centrais, a saber: práticas de educação em saúde realizadas por enfermeiros no território e vacinação como prática de cuidar realizada por enfermeiros no território. Conclusão: A educação em saúde foi decodificada como prática de cuidar pelos enfermeiros a partir de ações com grupos prioritários presentes no território orientada por rodas de conversas, palestras educativas e campanhas educacionais sobre infecções sexualmente transmissíveis, saúde mental e uso de drogas. A vacinação foi decodificada a partir da busca ativa de crianças no território, campanhas nas escolas e aplicação de vacinas contra a COVID-19 no território.

Objetivo: Identificar las prácticas asistenciales realizadas por enfermeras de atención primaria en el territorio. Método: Estudio exploratorio-descriptivo con énfasis cualitativo realizado en diez unidades básicas de salud localizadas en la ciudad de Boa Vista, Roraima, Brasil. El grupo social estuvo formado por ocho enfermeras de la administración pública municipal. La producción de datos se realizó entre diciembre de 2022 y febrero de 2023, mediada por entrevistas semiestructuradas. Los archivos de audio totalizaron aproximadamente una hora y veinte minutos, fueron transcritos manualmente y analizados según el marco teórico de Bardin. Resultados: Las prácticas de cuidados se organizaron en dos categorías temáticas centrales, concretamente: prácticas de educación en salud producidos por enfermeras en el territorio y la vacunación como práctica de cuidado realizada por enfermeros en el territorio. Conclusión: La educación en salud fue decodificada como una práctica de cuidado por parte de las enfermeras a partir de acciones con grupos prioritarios presentes en el territorio guiadas por mesas redondas, charlas educativas y campañas educativas sobre infecciones de transmisión sexual, salud mental y consumo de drogas. La vacunación fue decodificada a través de la búsqueda activa de niños en el territorio, campañas en escuelas y la vacunación contra el COVID-19 en el territorio.

Objective: Identify care practices produced by primary care nurses in the territory. Method: Exploratory-descriptive study with a qualitative approach carried out in ten basic health units located in the city of Boa Vista, Roraima, Brazil. The social group was made up of eight nurses from the municipal workforce. Data production took place between December 2022 and February 2023, mediated by semi-structured interviews. The audio files totaled approximately one hour, were transcribed manually and analyzed according to Bardin's theoretical framework. Results: The care practices were organized in two central thematic categories, named: health education practices produced by nurses in the territory and vaccination as a care practice carried out by nurses in the territory. Conclusion: Health education was decoded as a care practice by nurses based on actions with priority groups present in the territory guided by conversation circles, educational lectures and educational campaigns on sexually transmitted infections, mental health and drug use. Vaccination was decoded based on the active search for children in the territory, campaigns in schools and the application of vaccines against COVID-19 in the territory.

Aplicabilidade de teoria de enfermagem para intervenção práxica na atenção primária à saúde: revisão integrativa / Aplicabilidad de la teoría de enfermería para intervención práxica en la atención primaria de salud: revisión integrante / Applicability of nursing theory for praxis intervention in primary health care: an integrative review

Objetivo: analisar as evidências científicas acerca do uso da Teoria de Intervenção Práxica da Enfermagem em Saúde Coletiva na atenção primária à saúde por meio de estudos de fontes primárias. Método: trata-se de uma revisão integrativa, sem delimitação de tempo e idiomas, com pesquisas nas bases de dados LILACS, MEDLINE/PubMED, CINAHL, SCOPUS, EMBASE e Web of Science e na biblioteca eletrônica SciELO. Resultados: foram incluídos 15 artigos, que se restringiram às fases de captação (nas dimensões estrutural, particular e singular) e interpretação da realidade objetiva, o que evidenciou uma lacuna de conhecimentos quanto à efetividade da teoria em relação à intervenção na realidade objetiva. Considerações finais: a análise das evidências científicas ratificou, apesar da utilização discreta e pontual da Teoria de Intervenção Práxica da Enfermagem em Saúde Coletiva, o seu potencial para o direcionamento das práticas dos enfermeiros na atenção primária à saúde.

Objetivo: analizar las evidencias científicas acerca del uso de la Teoría de Intervención Práxica de la Enfermería en Salud Colectiva en la atención primaria de salud por medio de estudios de fuentes primarias. Método: se trata de una revisión integrativa, sin delimitación de tiempo e idiomas, con investigaciones en las bases de datos LILACS, MEDLINE/PubMED, CINAHL, SCOPUS, EMBASE y Web of Science y en la biblioteca electrónica SciELO. Resultados: se incluyeron 15 artículos, que se restringieron a las fases de captación (en las dimensiones estructural, particular y singular) e interpretación de la realidad objetiva, lo que evidenció una laguna de conocimientos en cuanto a la efectividad de la teoría en relación con la intervención en la realidad objetiva. Consideraciones finales: el análisis de las evidencias científicas ratificó, a pesar de la utilización discreta y puntual de la Teoría de Intervención Práxica de la Enfermería en Salud Colectiva, su potencial para el direccionamiento de las prácticas de los enfermeros en la atención primaria a la salud.

Objective: analyzing the scientific evidence about the use of the Theory of Praxis Intervention of Public Health Nursing in primary health care through studies of primary sources. Method: this is an integrative review, without delimitation of time and languages, with searches in the databases LILACS, MEDLINE/PubMED, CINAHL, SCOPUS, EMBASE and Web of Science and the electronic library SciELO. Results: fifteen articles were included, which were restricted to the phases of capture (in the structural and singular dimensions) and interpretation of the objective reality, which showed a lack of knowledge about the effectiveness of theory in relation to intervention in objective reality. Final considerations: the analysis of scientific evidence confirmed, despite the discrete and punctual use of the Theory of Praxis Intervention of Nursing in Collective Health, its potential for the direction of nurses' practices in primary health care.

Percepciones de las enfermeras sobre el cuidado de pacientes con lesiones cutáneas relacionadas con la dependencia y otras heridas crónicas en la comunidad / Perceptions of nurses regarding the care of patients with dependency-related skin injuries and other chronic wounds in the community

Objetivos: Explorar las percepciones de las enfermeras de atención primaria en relación con los cuidados de los pacientes con lesiones cutáneas relacionadas con la dependencia y otras heridas crónicas en el ámbito comunitario. Metodología: Diseño cualitativo que empleó la técnica de grupo focal con una muestra de 8 participantes seleccionados mediante muestreo teórico. Para el análisis de los datos se utilizaron técnicas de análisis de contenido cualitativo. Resultados: Emergen 15 categorías que se presentan bajo los 4 conceptos del metaparadigma enfermero. Destacan la intervención de las enfermeras en el cuidado de heridas, los conocimientos profesionales insuficientes, la meta de los cuidados enfermeros, la vivencia única de cada paciente y la gran influencia del entorno. Conclusiones: El cuidado de pacientes con heridas en la comunidad es complejo e incluye un gran número de actividades de enfermería que, a menudo, se basan en la experiencia y no en la evidencia. Las heridas impactan profundamente en la calidad de vida de las personas provocando experiencias únicas y multifactoriales. El entorno que rodea a la persona, tanto la familia, los cuidadores, el domicilio como el nivel socioeconómico, político y cultural, influye enormemente en los cuidados.(AU)

Objectives: Exploring primary care nurses’ perceptions of caring for patients with dependency-related skin injuries and other chronic wounds in the community setting. Methodology: Qualitative design that employed the focus group technique with a sample of 8 participants selected through theoretical sampling. Qualitative content analysis techniques were used for data analysis. Results: A total of 15 categories emerge that are presented under the 4 concepts of the nursing metaparadigm. They highlight the intervention of nurses in wound care, insufficient professional knowledge, the goal of nursing care, the unique experience of each patient, and the great influence of the environment. Conclusions: The care of patients with wounds in the community is complex and involves a large number of nursing activities that often rely on experience rather than evidence. Wounds profoundly impact the quality of life of individuals, leading to unique and multifactorial experiences. The environment surrounding the individual, including family, caregivers, home, as well as socioeconomic, political, and cultural factors, greatly influences care.(AU)