Scopes of practice for advanced practice nursing and advanced practice midwifery in Kenya: A gap analysis.

BACKGROUND: There is increasing global evidence on the impact of advanced nursing and midwifery practitioners, and Kenya's healthcare system has an excellent opportunity to develop scopes of practice and other regulatory frameworks for the integration of these roles. OBJECTIVE: The primary purpose of this gap analysis was to explore the existing evidence on opportunities and threats toward the integration of the advanced practice nursing (APN) and advanced practice midwifery (APM) roles in Kenya's healthcare system. METHODS: The study team conducted a structured electronic database search of PubMed, CINAHL, Scopus, EBSCOhost Academic Search Complete, and PsycINFO to retrieve articles and credible websites for reports highlighting the opportunities and threats toward the integration of the APN and APM roles in Kenya's healthcare systems. The retrieved articles were screened for relevance and synthesized for reporting using the traditional literature review approach. RESULTS: The Kenya Health Policy Framework 2014-2030, growing population needs, and implementation of universal health coverage provide an opportunity to harness and leverage advanced practice roles in nursing and midwifery. There is also momentum to develop advanced practice because of strategic alliances and global evidence showing the contributions and quality of services offered by advanced practice nurses and advanced practice midwives. However, lack of financial support, structural challenges, and lack of national policies, regulations, and legislation continue to obstruct progress. CONCLUSION AND IMPLICATIONS FOR NURSING POLICY: Developing scopes of practice for APN and APM in Kenya will benefit the professions, the country's healthcare delivery system, and the population. Achieving universal health coverage depends on a health workforce trained and practicing at optimal levels in tandem with education and training to deliver quality care.

Nursing and midwifery education, regulation and workforce in Kenya: A scoping review.

AIM: To explore contextual literature on nursing and midwifery education, regulation and workforce in Kenya to develop an understanding of the current state and inform opportunities to strengthen the nursing and midwifery professions. INTRODUCTION: Kenya has yet to achieve the minimum nursing and midwifery workforce threshold, despite the exponential increase in population and epidemiologic disease transitions. BACKGROUND: There are glaring health gaps and inequities in sub-Saharan African countries. Health systems are evolving into complex and costly utilities, increasing the demand for nurses and midwives. It is, therefore, necessary to re-examine systems that educate, deploy and retain the nursing workforce, especially given the ongoing COVID-19 pandemic and increase in non-communicable diseases. METHODS: This scoping review was guided and reported following the PRISMA-ScR guidelines. Four electronic databases (PubMed, Scopus, CINAHL and Web of Science) were probed for relevant studies conducted in Kenya between 1963 and 2020. The search was supplemented using Google Scholar. Findings from selected studies were extracted and analysed thematically. RESULTS: Of the 238 retrieved studies, 37 were included in this review: 10 articles on nursing and midwifery education, 11 on regulation and 16 on the workforce. DISCUSSION: There have been changes in regulation and an increase in nursing and midwifery enrolment and graduates. However, maldistribution and shortage of nurses and midwives persist. CONCLUSIONS: Kenya's nursing and midwifery professions have undergone significant changes to meet the demand for a skilled workforce. However, the shortage of qualified and specialised nurses and midwives persists. Moreover, this shortage is exacerbated by underinvestment, outmigration and a need for more reforms to expand the nursing and midwifery workforce. IMPLICATION FOR NURSING AND MIDWIFERY POLICY: Investment in nurse and midwifery education, mentorship and legislation is needed to build the capacity of the profession to provide quality health services. Several nursing and midwifery policy changes utilising a multipronged approach involving stakeholders' collaboration are suggested to address the bottlenecks from education to deployment.

Tabela de procedimentos de enfermagem: análise do escopo e respaldo em resoluções do conselho federal / Table of nursing procedures: analysis of the scope and support in federal council resolutions / Tabla de procedimientos de enfermería: analizar el alcance y el respaldo de las resoluciones del consejo federal

RESUMO Objetivo: analisar o escopo e respaldo da tabela de procedimentos de enfermagem a partir de resoluções do Conselho Federal de Enfermagem de 2005 a 2021. Método: estudo documental quantitativo, realizado no site do Conselho Federal de Enfermagem a fim de identificar as resoluções publicadas entre 2005 e 2021. A análise, conduzida em três etapas de triagem, abrangeu resoluções situadas entre os números 301/2005 e 673/2021, relacionadas à tabela de procedimentos honorários mínimos da enfermagem. Resultados: em comparação, a resolução n. 673/2021 amplia a tabela de procedimentos de enfermagem da Resolução n. 301/2005 em quatro áreas de atividades e acresce-a em 34 procedimentos, totalizando 174 procedimentos de enfermagem, respaldados por 48 resoluções vigentes. Conclusão: a ampliação de procedimentos da enfermagem, respaldada por fundamentação legal, reforça a faceta empreendedora do enfermeiro. Este aspecto, ao ser indicado, pode instigar uma reflexão e reconhecimento por parte da categoria em expandir sua atuação.

ABSTRACT Objective: To analyze the scope and support of the nursing procedures table based on resolutions of the Federal Nursing Council from 2005 to 2021. Method: A quantitative documentary study was carried out on the Federal Nursing Council website to identify the resolutions published between 2005 and 2021. The analysis, conducted in three screening stages, covered resolutions between No. 301/2005 and 673/2021 related to the table of minimum fee procedures for nursing. Results: In comparison, resolution No. 673/2021 extends the table of nursing procedures in Resolution No. 301/2005 in four areas of activity and adds 34 procedures, totaling 174 nursing procedures, backed by 48 current resolutions. Conclusion: The expansion of nursing procedures, supported by legal grounds, reinforces the entrepreneurial side of nurses. This aspect, when pointed out, can instigate reflection and recognition on the part of the category to expand its activities.

RESUMEN Objetivo: analizar el alcance y el apoyo de la tabla de procedimientos de enfermería basada en las resoluciones del Consejo Federal de Enfermería de 2005 a 2021. Método: estudio documental cuantitativo realizado en la página web del Consejo Federal de Enfermería para identificar las resoluciones publicadas entre 2005 y 2021. El análisis, realizado en tres fases de cribado, abarcó las resoluciones comprendidas entre los números 301/2005 y 673/2021, relacionadas con la tabla de procedimientos de honorarios mínimos de enfermería. Resultados: en comparación, la resolución n. 673/2021 amplía la tabla de procedimientos de enfermería de la Resolución n. 301/2005 en cuatro áreas de actividad y añade 34 procedimientos, con un total de 174 procedimientos de enfermería, respaldados por 48 resoluciones vigentes. Conclusión: la expansión de los procedimientos de enfermería, respaldada por fundamentos jurídicos, refuerza la faceta empresarial del enfermero. Este aspecto, cuando se señala, puede suscitar la reflexión y el reconocimiento por parte de la categoría para ampliar sus actividades.

e-Consulta: desenvolvimento e avaliação de um guia digital interativo para a consulta de enfermagem / E-consultation: interactive guide for the nursing consultation

O aprimoramento profissional é essencial aos profissionais de enfermagem e dever legal previsto no Código de Ética da profissão, em especial, para a efetivação da consulta de enfermagem. Neste sentido o uso das tecnologias digitais de informação e comunicação representam forte aliado no processo formação profissional e de educação permanente em saúde, pois auxiliam na redução dos índices de erros clínicos, aumentam a eficiência no processo de capacitação, melhoram e qualificam os cuidados em saúde e a segurança da assistência ao paciente, ao permitir a aprendizagem virtual a qualquer momento e lugar. O presente estudo tem como objetivo desenvolver e avaliar um e-book sobre consulta de enfermagem para estudantes e profissionais de enfermagem. Trata-se de uma pesquisa aplicada, metodológica e descritiva, de produção tecnológica, envolvendo o desenvolvimento e avaliação de uma tecnologia educacional digital (e-book interativo), baseado na abordagem metodológica do Design Thinking. O e-book foi avaliado por 39 participantes, 07 especialistas e 33 representantes do público alvo, selecionados a partir da técnica de amostragem intencional ou por conveniência, denominada snowball, na qual um grupo de contatos iniciais (sementes) recomendam outros participantes. Os dados coletados foram coletados após aprovação do Comitê de Ética, em atendimento à Resolução 466 de 2012, e analisados conforme recomendações específicas. O e-book foi avaliado pelos especialistas com Indice de validade de Conteúdo (IVC) de 0,91 e Net Promoter Score (NPS) de 93,75% de clientes promotores e 6,25% de clientes neutros, não tivemos clientes detratores. A tecnologia educacional desenvolvida acerca da consulta de enfermagem reforça o papel cientifico e autônomo do enfermeiro, o que foi avaliado pelos participantes da pesquisa em seus comentários e sugestões. O e-book reforça subsídios para que a consulta de enfermagem seja realizada com rigor técnico-científico e responsabilidade ética-legal, com enfoque na individualidade e necessidades do nosso cliente, em busca de mais saúde para toda a sociedade. A tecnologia digital esta pautada nas recentes atualizações científicas e normativas brasileiras e nos princípios da aprendizagem multimídia, que reforçam a formação e o exercício profissional com autonomia, resolutividade, equidade e sustentabilidade. A autonomia e valorização profissional é conquistada por aqueles que assumem o papel na transformação da sua prática diária e contínua, a partir das suas ações na assistência, gerencia e docência de enfermagem e em prol do crescimento coletivo da profissão. Neste sentido, o e-book desenvolvido e avaliado contribui para a construção de competências necessárias ao protagonismo da consulta de enfermagem para o atendimento das demandas de saúde das pessoas

Professional improvement is essential for nursing professionals and a legal duty provided for in the profession's Code of Ethics. In this sense, the use of digital information and communication technologies represent a strong ally in the process of professional training and permanent education in health, as they help to reduce the rates of clinical errors, increase efficiency in the training process, improve and qualify health care and the safety of patient care by enabling virtual learning anytime, anywhere. The present study aims to develop and evaluate an e-book on nursing consultation for nursing students and professionals. This is an applied, methodological and descriptive research of technological production, involving the development and evaluation of a digital educational technology (interactive e-book), based on the methodological approach of Design Thinking. The e-book was evaluated by 39 participants, 07 specialists and 33 representatives of the target audience, selected from the intentional or convenience sampling technique, called snowball, in which a group of initial contacts (seeds) recommend other participants. The collected data were collected after approval by the Ethics Committee, in compliance with Resolution 466 of 2012, and analyzed according to specific recommendations. The e-book was evaluated by experts with a Content Validity Index (CVI) of 0,91 and a Net Promoter Score (NPS) of 93.75% of promoter customers and 6.25% of neutral customers, we had no detractor customers. The educational technology developed around the nursing consultation reinforces the scientific and autonomous role of the nurse, which was evaluated by the research participants in their comments and suggestions. The e-book reinforces subsidies so that the nursing consultation is carried out with technical-scientific rigor and ethical-legal responsibility, focusing on the individuality and needs of our client, in search of more health for the whole society. Digital technology is based on recent Brazilian scientific and normative updates and on the principles of multimedia learning, which reinforce training and professional practice with autonomy, resolution, equity and sustainability. Autonomy and professional appreciation is achieved by those who take on the role of transforming their daily and continuous practice, based on their actions in nursing care, management and teaching, and in favor of the collective growth of the profession. In this sense, the e-book developed and evaluated contributes to the construction of skills necessary for the protagonism of the nursing consultation to meet people's health demands

Leitos neonatais nas instituições públicas de saúde (2010-2019) / Neonatal beds in public health institutions (2010-2019) / Camas neonatales en instituciones de salud pública (2010-2019)

Objetivo: Identificar as instituições de saúde e distribuição dos leitos no município do Rio de Janeiro, destinados à assistência neonatal. Métodos: Estudo retrospectivo serial realizado com base nos processos administrativos do Conselho Regional de Enfermagem do Rio de Janeiro que teve como delimitação temporal o período de 2010 a 2019. Utilizou-se o programa computacional R para análise dos dados. Estudo aprovado pelo Comitê de Ética em Pesquisa. Resultados: Foram encontradas 19 instituições de saúde com Unidade de Terapia Intensiva Neonatal do tipo II e/ou III. A quantidade de leitos identificados pelos processos administrativos e pelo Cadastro Nacional dos Estabelecimentos de Saúde foram de 241 e 227, respectivamente. Os leitos foram distribuídos em 18 bairros do município do Rio de Janeiro. Conclusão: Os indicadores revelaram que há uma distribuição desproporcional dos leitos, associado a precarização das condições de trabalho e infraestrutura das unidades. (AU)

Objective: To identify the health institutions and bed distribution in the city of Rio de Janeiro, destined to neonatal care. Methods: A retrospective serial study carried out based on the administrative processes of the Regional Nursing Council of Rio de Janeiro, whose temporal delimitation was the period from 2010 to 2019. The computer program R was used for data analysis. Study approved by the Research Ethics Committee. Results: 19 health institutions with a Neonatal Intensive Care Unit of type II and / or III were found. The number of beds identified by administrative processes and by the National Register of Health Establishments was 241 and 227, respectively. The beds were distributed in 18 neighborhoods in the city of Rio de Janeiro. Conclusion: The indicators revealed that there is a disproportionate distribution of beds, associated with the precarious working conditions and infrastructure of the units. (AU)

Objetivo: Identificar las instituciones de salud y distribución de camas en la ciudad de Río de Janeiro, destinadas a la atención neonatal. Métodos: Estudio seriado retrospectivo realizado con base en los procesos administrativos del Consejo Regional de Enfermería de Río de Janeiro, cuya delimitación temporal fue el período de 2010 a 2019. Se utilizó el programa informático R para el análisis de los datos. Estudio aprobado por el Comité de Ética en Investigación. Resultados: Se encontraron 19 instituciones de salud con una Unidad de Cuidados Intensivos Neonatales de tipo II y / o III. El número de camas identificadas por procesos administrativos y por el Registro Nacional de Establecimientos de Salud fue de 241 y 227, respectivamente. Las camas se distribuyeron en 18 barrios de la ciudad de Río de Janeiro. Conclusión: Los indicadores revelaron que existe una distribución desproporcionada de las camas, asociada a las precarias condiciones de trabajo e infraestructura de las unidades. (AU)

The development of advanced practice nurses in Singapore.

The development of advanced practice nursing has evolved globally over the past decades and has become an important component in the contemporary healthcare system. The term 'advanced practice nurse' is used to refer to nurses practising at a higher level than traditional nurses and is defined as a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice. In 2003, Singapore embarked on the development of advanced practice nurses as an initiative to improve the nursing professional image, retain excellent clinical nurses and fill the gaps in the provision of healthcare services for the ageing population. This paper documents Singapore's journey of advanced practice nursing development and shares our unique learning experience in the aspects of education, certification, registration and scope of practice.

Caracterização dos processos éticos de enfermagem no estado de alagoas / Characterization of the ethical nursing processes in the state of alagoas / Caracterización de los procesos éticos de enfermería en el estado de alagoas

RESUMO Objetivo: analisar as infrações relacionadas à abertura de processos éticos disciplinares contra os profissionais de enfermagem no estado de Alagoas, Brasil. Método: trata-se de um estudo documental, exploratório, retrospectivo com análise quantitativa, realizado no Conselho Regional de Enfermagem de Alagoas, de novembro de 2020 a janeiro de 2021. Através da consulta ao processo físico, com auxílio de roteiro de coleta, os dados foram analisados por estatística descritiva. Resultados: foram analisados 68 processos éticos de 2009 a 2020. Destacam-se as infrações referente a relações interprofissionais (37,03%) e negligências (20,99%), a penalidade mais aplicada foi a advertência verbal (42,22%) e o denunciante principal foi o Conselho Regional de Enfermagem de Alagoas (27,94%). Conclusão: é necessário enfatizar as questões pertinentes às infrações pelos núcleos de educação permanente, para fortalecer a comunicação entre os profissionais. A pesquisa contribui para dar visibilidade aos processos éticos enfrentados pelos profissionais de enfermagem.

ABSTRACT Objective: to analyze the infringements related to the opening of disciplinary ethical processes against Nursing professionals in the state of Alagoas, Brazil. Method: this is a documentary, exploratory and retrospective study with quantitative analysis, carried out at the Regional Nursing Council of Alagoas, from November 2020 to January 2021. By consulting the physical process, with the aid of a collection script, the data were analyzed using descriptive statistics. Results: 68 ethical processes were analyzed from 2009 to 2020. The infringements referring to interprofessional relationships (37.03%) and negligence (20.99%) stand out; the most applied penalty was verbal warning (42.22%) and the main complainant was the Regional Nursing Council of Alagoas (27.94%). Conclusion: it is necessary to emphasize the issues related to the infringements by the permanent education centers, to strengthen communication between the professionals. The research contributes to giving visibility to the ethical processes faced by Nursing professionals.

RESUMEN Objetivo: analizar las infracciones relacionadas con la iniciación de procesos éticos disciplinarios contra profesionales de enfermería en el estado de Alagoas, Brasil. Método: se trata de un estudio documental, exploratorio, retrospectivo con análisis cuantitativo, realizado en el Consejo Regional de Enfermería de Alagoas, de noviembre de 2020 a enero de 2021. Mediante consulta del proceso físico, con la ayuda de una guía de recolección, los datos fueron analizados por estadística descriptiva. Resultados: Se analizaron 68 procesos éticos desde 2009 hasta 2020. Se destacan las infracciones vinculadas a las relaciones interprofesionales (37,03%) y la negligencia (20,99%), la sanción más aplicada fue la advertencia verbal (42,22%) y el principal denunciante fue el Consejo Regional de Enfermería de Alagoas (27,94%). Conclusión: es necesario enfatizar las cuestiones relacionadas con las infracciones de los centros de educación permanente, para fortalecer la comunicación entre los profesionales. La investigación contribuye a dar visibilidad a los procesos éticos que enfrentan los profesionales de enfermería.

Results of a National Survey: Ongoing Barriers to APRN Practice in the United States.

Limited information is available on the barriers to practice for advanced practice registered nurses (APRNs) among states with full, restricted, and reduced practice. The purpose of this study is to identify practice barriers in relationship to United States (U.S.) state practice authority, APRN type, area of practice (rural, suburban, urban), and nature of practice (outpatient, inpatient, and both). An electronic survey of a convenience sample of APRNs was conducted to assess barriers to practice. Identified barriers were examined based on state practice environment, APRN role, practice setting, and location. Data were analyzed using thematic analysis for qualitative data and descriptive analysis for quantitative data. Over 7,000 APRNs representing all 50 states participated. Themes that were identified and reported by respondents, included licensure and administrative barriers, therapy restrictions, physician signature requirements, a lack of collegiality, prescribing barriers, uneven reimbursement, physician only procedures, and telehealth issues. Barriers were identified in all states, regardless of the type of practice authority. All four APRN role types identified practice barriers, some of which were more frequent for some roles than others. Restrictions for home health approval and the requirement for a physician signature for durable medical supply orders were identified by over 40% of respondents practicing in rural areas. Barriers to APRN practice continue to restrict aspects of patient care and patient access to care, even in states with full practice authority. Continued efforts to reduce barriers to APRN practice are needed to ensure patient access to care, especially in rural areas.

Differentiated nursing practice as a catalyst for transformations in nursing: A multiphase qualitative interview study.

AIM: To identify and follow-up on the transition towards differentiated nursing practice among bachelor trained and vocationally trained nurses in Dutch hospitals. DESIGN: A multiphase general qualitative interview study. METHODS: Fifty semi-structured interviews with project managers in charge of introducing differentiated nursing practice to their hospital were conducted. Purposive sampling was used, and data were collected in 2017, 2019 and 2020. A meta-analysis was conducted after independent primary thematic analysis of each data collection. RESULTS: The introduction of differentiated nursing practice to Dutch hospitals was perceived as uncertain and ambiguous. Three themes were identified during the transition towards differentiated nursing practice: (1) call to action; (2) sitting and waiting; and (3) new beginnings and open ends. The change to differentiated nursing practice is not straightforward and these findings highlight the emerging awareness among project managers of the nature and complexity of the transition. During the study period, professionalization of the nursing profession was recognized as fundamental in hospital organizations. CONCLUSION: Nursing cannot be separated from differentiated nursing practice. Visible leadership is important at all organizational levels and nurses' opinions must be considered as nurses are essential to such changes in healthcare. IMPACT: Differentiated nursing practice based on nursing education allows nurses to make the best use of their experience, skills and competencies, and could promote the provision of effective and high-quality patient care. However, in many cases, a nurse's practice role is based on their nursing licensure instead of their educational background. The change to differentiated nursing practice in hospitals is not straightforward and the nature and complexity of the transition needs to be acknowledged. Nurses have an important role in healthcare transformation and need to be active in developing and formulating rather than just implementing the changes.

Desafíos ético-legales en el cuidado al paciente en el servicio de urgencia: perspectiva de las enfermeras

RESUMEN Objetivo: Describir, analizar y discutir los desafíos éticos-legales en el cuidado al paciente en un servicio de urgencia desde la perspectiva de las enfermeras de un hospital público de Chiclayo, Perú. Material y Método: Investigación cualitativa, descriptiva; participaron 12 enfermeras que laboran en un servicio de emergencia. La muestra fue no probabilística, determinada por saturación y redundancia. Los datos fueron recolectados usando la entrevista semiestructurada validada por juicio de expertos, grabada y procesada para análisis de contenido, previa aprobación de un Comité de Ética en Investigación y consentimiento informado. Resultados: Emergieron cuatro categorías: a) Conflictos éticos en el trato personal con omisión de respeto a colegas y pacientes; b) Infraestructura que propicia enfrentamientos, falta de recursos humanos, materiales y privacidad; c) Enfrentando problemas de salud y término de la vida con riesgo a denuncias fiscales y d) Necesidad de protocolos y respaldo ético-legal por consecuencias laborales. Conclusión: Infraestructura genera enfrentamientos entre colegas, equipo de trabajo y familiares; presentan problemas en la comunicación y el trato entre colegas y con familiares de pacientes, quienes insultan, agreden físicamente y acusan ante fiscalía; ante situaciones críticas priorizan según ley de emergencia, pero no tienen gestión adecuada de protocolos y guías de atención, reflexionan sobre desconocer leyes de salud y código de ética de enfermería. Es necesario tener mayores destrezas para control emocional frente al estrés laboral y que las autoridades gestionen mejoras en infraestructura, insumos y dotación de personal.

ABSTRACT Objective: To describe, analyze and discuss the ethical-legal challenges regarding patient care in an emergency department from the nurses' perspective in a public hospital in Chiclayo, Peru. Material and Method: Qualitative, descriptive research; 12 nurses working in an emergency department participated. The sample was non-probabilistic, determined by the saturation and redundancy technique. Data were collected using a semi-structured interview validated by expert judgment, recorded and then processed for content analysis, after approval by a Research Ethics Committee and prior informed consent. Results: Four categories emerged: a) Ethical conflicts in interpersonal relationships: lack of respect to colleagues and patients, b) Infrastructure that promotes confrontations, lack of human and material resources and privacy protection, c) Facing health and end-of-life problems with possible legal accusations, and d) Need for protocols and ethical-legal support due to work-related consequences. Conclusion: Nurses who work in the emergency department face various problems: infrastructure generates confrontations between colleagues, work team and relatives; there are problems in communication and interpersonal relationships between colleagues and with patients' relatives, who may insult, physically attack and present accusations. When dealing with critical situations nurses act according to emergency legislation, but they cannot adequately handle protocols and care guidelines and are not fully aware of health-related laws or nursing code of ethics. It is necessary to have better skills for emotional control in the face of work-related stress and encourage authorities to make improvements in infrastructure, resources and personnel.

RESUMO Objetivo: Descrever, analisar e discutir os desafios ético-legais relativos à atenção ao paciente no departamento de emergência segundo a perspectiva das enfermeiras de um hospital público de Chiclayo, Peru. Material e Método: Pesquisa qualitativa e descritiva, na qual participaram 12 enfermeiras que trabalham no departamento de emergência. A amostra foi não probabilística, determinada pela técnica de saturação e redundância. Os dados foram coletados por meio de entrevista semiestruturada validada por julgamento de especialista, registrados e processados para análise de conteúdo, após aprovação do Comitê de Ética em Pesquisa e consentimento informado. Resultados: Emergiram quatro categorias: a) Conflitos éticos no relacionamento interpessoal, incluindo falta de respeito aos colegas e pacientes, b) Infraestrutura que promove confrontos, falta de recursos humanos e materiais e proteção da privacidade, c) Enfrentar problemas de saúde e de fim de vida com risco de possíveis acusações legais, e d) Necessidade de protocolos e apoio ético-legal devido a consequências relacionadas ao trabalho. Conclusão: As enfermeiras que trabalham no departamento de emergência enfrentam diversos problemas: a infraestrutura que gera confrontos entre colegas, o equipe de trabalho e familiares; problemas de comunicação e relacionamento interpessoal entre colegas e os familiares dos pacientes, os que podem insultar, atacar fisicamente e apresentar acusações. Em situações críticas, as enfermeiras atuam de acordo com a legislação de emergência, mas não podem lidar adequadamente com protocolos e diretrizes de cuidados, têm desconhecimento das leis relacionadas à saúde ou do código de ética de enfermagem. Por tanto, é necessário ter melhores habilidades para o controle emocional diante do estresse relacionado ao trabalho e que as autoridades façam melhorias na infraestrutura, nos recursos e no pessoal.

Caracterização dos processos éticos de enfermagem no estado de alagoas / Characterization of the ethical nursing processes in the state of alagoas / Caracterización de los procesos éticos de enfermería en el estado de alagoas

RESUMO Objetivo: analisar as infrações relacionadas à abertura de processos éticos disciplinares contra os profissionais de enfermagem no estado de Alagoas, Brasil. Método: trata-se de um estudo documental, exploratório, retrospectivo com análise quantitativa, realizado no Conselho Regional de Enfermagem de Alagoas, de novembro de 2020 a janeiro de 2021. Através da consulta ao processo físico, com auxílio de roteiro de coleta, os dados foram analisados por estatística descritiva. Resultados: foram analisados 68 processos éticos de 2009 a 2020. Destacam-se as infrações referente a relações interprofissionais (37,03%) e negligências (20,99%), a penalidade mais aplicada foi a advertência verbal (42,22%) e o denunciante principal foi o Conselho Regional de Enfermagem de Alagoas (27,94%). Conclusão: é necessário enfatizar as questões pertinentes às infrações pelos núcleos de educação permanente, para fortalecer a comunicação entre os profissionais. A pesquisa contribui para dar visibilidade aos processos éticos enfrentados pelos profissionais de enfermagem.

ABSTRACT Objective: to analyze the infringements related to the opening of disciplinary ethical processes against Nursing professionals in the state of Alagoas, Brazil. Method: this is a documentary, exploratory and retrospective study with quantitative analysis, carried out at the Regional Nursing Council of Alagoas, from November 2020 to January 2021. By consulting the physical process, with the aid of a collection script, the data were analyzed using descriptive statistics. Results: 68 ethical processes were analyzed from 2009 to 2020. The infringements referring to interprofessional relationships (37.03%) and negligence (20.99%) stand out; the most applied penalty was verbal warning (42.22%) and the main complainant was the Regional Nursing Council of Alagoas (27.94%). Conclusion: it is necessary to emphasize the issues related to the infringements by the permanent education centers, to strengthen communication between the professionals. The research contributes to giving visibility to the ethical processes faced by Nursing professionals.

RESUMEN Objetivo: analizar las infracciones relacionadas con la iniciación de procesos éticos disciplinarios contra profesionales de enfermería en el estado de Alagoas, Brasil. Método: se trata de un estudio documental, exploratorio, retrospectivo con análisis cuantitativo, realizado en el Consejo Regional de Enfermería de Alagoas, de noviembre de 2020 a enero de 2021. Mediante consulta del proceso físico, con la ayuda de una guía de recolección, los datos fueron analizados por estadística descriptiva. Resultados: Se analizaron 68 procesos éticos desde 2009 hasta 2020. Se destacan las infracciones vinculadas a las relaciones interprofesionales (37,03%) y la negligencia (20,99%), la sanción más aplicada fue la advertencia verbal (42,22%) y el principal denunciante fue el Consejo Regional de Enfermería de Alagoas (27,94%). Conclusión: es necesario enfatizar las cuestiones relacionadas con las infracciones de los centros de educación permanente, para fortalecer la comunicación entre los profesionales. La investigación contribuye a dar visibilidad a los procesos éticos que enfrentan los profesionales de enfermería.

Ethics in nursing: categorization of legal processes / Ética en enfermería: caracterización de procesos legales / Ética em enfermagem: categorização de processos legais

ABSTRACT Objectives: to categorize factual elements of ethical-disciplinary nursing lawsuits in the state of Goiás. Methods: cross-sectional, retrospective study, based on secondary data obtained from ethical-disciplinary lawsuits filed at the Regional Nursing Council of Goiás (Coren-Goiás) between the years 2010 and 2019. Results: the highest number of lawsuits filed was in 2013 and 2014, with a greater frequency in the state capital. The majority came from the Nursing Ethics Committees and ex-officio complaints. The professional with most complaints was the nursing technician, aged between 31 and 40 years old, at the beginning of their career. The most common type of complaints referred to performing attributions that were not within the nursing competences. Conclusions: as a highlight are the contributions of this study to professional ethics in nursing and the clear need to consolidate these skills in nurses who are in training and in the continuous education for those already in the profession.

RESUMEN Objetivos: categorizar elementos fácticos de los procesos ético-disciplinarios de enfermería en Goiás. Métodos: estudio transversal, retrospectivo, basado en datos secundarios obtenidos de procesos ético-disciplinarios denunciados en el Consejo Regional de Enfermería de Goiás (CorenGoiás) entre 2010 y 2019. Resultados: el mayor número de procesos instaurados fue en 2013 y 2014, con mayor frecuencia en la capital del estado. La mayoría advino de las Comisiones de Ética de Enfermería y denuncias de oficio. El profesional más denunciado fue el técnico de enfermería, en la franja etaria entre 31 y 40 años, en inicio de carrera. El tipo de denuncia más común se referió a ejercer atribuciones que no son competencias de enfermería. Conclusiones: destacada la contribución de este estudio para la ética profesional en enfermería y necesidad clara de consolidación de esas competencias en el profesional en formación y educación permanente para aquellos que se encuentran en ejercicio de la profesión.

RESUMO Objetivos: categorizar elementos fáticos dos processos ético-disciplinares de enfermagem no estado de Goiás. Métodos: estudo transversal, retrospectivo, com base em dados secundários obtidos de processos ético-disciplinares autuados no Conselho Regional de Enfermagem de Goiás (CorenGoiás) entre os anos de 2010 e 2019. Resultados: o maior número de processos instaurados foi nos anos 2013 e 2014, com maior frequência na capital do estado. A maioria adveio das Comissões de Ética de Enfermagem e das denúncias de ofício. O profissional mais denunciado foi o técnico de enfermagem, na faixa etária entre 31 e 40 anos, no início da carreira. O tipo de denúncia mais comum referiu-se a exercer atribuições que não são competências da enfermagem. Conclusões: destaca-se a contribuição deste estudo para a ética profissional em enfermagem e a necessidade clara de consolidação dessas competências no profissional em formação e de educação permanente para aqueles que se encontram em exercício da profissão.

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

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.

Impact of COVID-19 pandemic on APRN practice: Results from a national survey.

BACKGROUND: The impact of the COVID-19 pandemic on Advanced Practice Registered Nurse (APRN) practice is not well known. PURPOSE: This study aimed to describe state practice barriers and explore the effects of the COVID-19 pandemic on APRN practice. METHODS: A descriptive study design used a 20-item web-based survey open from June 1 through September 23, 2020. FINDINGS: A total of 7,467 APRNs responded from all 50 states, including nurse practitioners (n = 6,478, 86.8%), certified registered nurse anesthetists (n = 592, 7.9%), certified nurse-midwives (n = 278, 3.7%), and clinical nurse specialists (n = 242, 3.2%). A number of barriers to practice prior to the pandemic were identified. Most respondents (n = 6334, 84.8%) identified that practice barriers limited the ability of APRNs to provide care during the pandemic. DISCUSSION: Barriers to APRN practice continue to restrict aspects of patient care and patient access to care, even in states with Full Practice Authority (FPA), during the COVID-19 pandemic and with state executive orders waiving practice restrictions. The study findings can be used to advocate for policy changes to support APRN practice authority.

O que facilita e dificulta a Sistematização da Assistência de Enfermagem na percepção dos enfermeiros das Unidades de Saúde da Família? / What facilitates and hinders the Systematization of Nursing Care in the perception of nurses in family health units? / ¿Qué facilita y dificulta la Sistematización de la Atención de Enfermería en la percepción de los enfermeros en las Unidades de Salud de la Familia?

Objetivo: analisar os elementos facilitadores e dificultadores na realização da Sistematização da Assistência de Enfermagem e Processo de enfermagem a partir da percepção dos enfermeiros das Unidades de Estratégia Saúde da Família. Método: Estudo descritivo-exploratório, de corte transversal e abordagem quantitativa, por meio da aplicação de um questionário auto aplicado. Resultados: perfil de profissionais predominantemente do sexo feminino com idade prevalente entre 30-40 anos e um equilíbrio entre tempo de atuação profissional (média 10,7 anos) entre 2- 10 anos e maior do que 10 anos, além de uma média de atuação na APS de 8,8 anos, demonstrando uma equipe com boa experiência, o que facilitou a interpretação dos resultados. Elementos facilitadores: reconhecimento da importância da realização do Processo de enfermagem sobre o desenvolvimento do raciocínio clínico do enfermeiro, o benefício para o paciente e para a equipe de saúde. Elementos dificultadores: falta de linguagem universal padronizada; despreparo do profissional para realização da Sistematização da Assistência de Enfermagem na APS; sobrecarga de atendimentos ao longo do dia; falta de colaboração da equipe durante a consulta, com muitas interrupções; baixa oferta de capacitação sobre Sistematização da Assistência de Enfermagem/Processo de enfermagem pela instituição; baixa valorização da consulta de enfermagem tanto pela equipe, quanto pela população em geral; falta de impressos com diagnósticos e prescrição de enfermagem. Conclusão: Para facilitar a implementação da Sistematização da Assistência de Enfermagem/Processo de enfermagem, os enfermeiros referiram que: há a necessidade do conhecimento de Sistematização da Assistência de Enfermagem/Processo de enfermagem pelo enfermeiro, a necessidade de capacitação da equipe pela unidade de saúde, a adoção de linguagem padronizada e a adoção de protocolos.

Objective: to analyze the elements that facilitate and hinder the accomplishment of the Systematization of Nursing Care and Nursing Process from the perception of nurses from the Family Health Strategy Units. Method: Descriptiveexploratory study, cross-sectional and quantitative approach, through the application of a self-processed questionnaire. Results: profile of predominantly female professionals with a prevalent age between 30-40 years and a balance between professional experience (average 10.7 years) between 2-10 years and greater than 10 years, in addition to an average performance in the PHC of 8.8 years, showing a team with good experience, which facilitated the interpretation of the results. Facilitating elements: recognition of the importance of carrying out the Nursing Process on the development of the nurse's clinical reasoning, the benefit for the patient and the health team. Difficult elements: lack of standardized universal language; unpreparedness of the professional to carry out the Systematization of Nursing Care in PHC; overload of assistance throughout the day; lack of team collaboration during the consultation, with many interruptions; low training offer on Nursing Care Systematization / Nursing process by the institution; low valuation of the nursing consultation by both the team and the population in general; lack of printed forms with nursing diagnoses and prescription. Conclusion: To facilitate the implementation of the Systematization of Nursing Assistance / Nursing Process, nurses reported that: there is a need for knowledge of Systematization of Nursing Assistance / Nursing Process by nurses, the need for staff training by the health unit , an adoption of standardized language and an adoption of protocols.

Objetivo: analizar los elementos facilitadores y obstaculizadores en la realización del Proceso de Sistematización de la Atención y Enfermería desde la percepción de los enfermeros de las Unidades de Estrategia de Salud de la Familia. Método: Estudio descriptivo-exploratorio, de abordaje transversal y cuantitativo, mediante la aplicación de un cuestionario autoprocesado. Resultados: perfil de profesionales predominantemente mujeres con una edad prevalente entre 30-40 años y un balance entre tiempo de experiencia profesional (promedio 10,7 años) entre 2-10 años y mayor de 10 años, además de un desempeño promedio en la APS de 8.8 años, mostrando un equipo con buena experiencia, lo que facilitó la interpretación de los resultados. Elementos facilitadores: reconocimiento de la importancia de la realización del Proceso de Enfermería en el desarrollo del razonamiento clínico del enfermero, el beneficio para el paciente y el equipo de salud. Elementos difíciles: falta de lenguaje universal estandarizado; falta de preparación del profesional para realizar la Sistematización de la Atención de Enfermería en la APS; sobrecarga de asistencia a lo largo del día; falta de colaboración en equipo durante la consulta, con muchas interrupciones; baja oferta formativa en Sistematización de la Atención de Enfermería / Proceso de Enfermería por parte de la institución; baja valoración de la consulta de enfermería tanto por parte del equipo como de la población en general; falta de formularios impresos con diagnósticos de enfermería y prescripción. Conclusión: Para facilitar la implementación de la Sistematización de la Asistencia / Proceso de Enfermería, las enfermeras informaron que: existe la necesidad de conocimiento de la Sistematización de la Asistencia / Proceso de Enfermería por parte de las enfermeras, la necesidad de capacitación del personal por parte de la unidad de salud, una adopción de lenguaje estandarizado y adopción de protocolos.

Dificuldades para a atuação autônoma do enfermeiro obstetra no Brasil / Difficulties for the obstetric nurse autonomous performance in Brazil / Dificultades para el desempeño autónomo de la enfermera obstétrica en Brasil

Compreender as limitações da atuação autônoma do enfermeiro obstetra no Brasil. Método: Trata-se de uma revisão integrativa da literatura, a partir de publicações científicas de enfermagem, a partir da BVS, indexadas nas bases de dados BDENF e LILACS, publicadas em periódicos nacionais, sem recorte temporal. Seguindo os critérios de inclusão e exclusão, 10 estudos primários compuseram a amostra. Resultados: Foram encontrados como fatores que limitam a autonomia do enfermeiro obstetra: a dicotomia entre a prática profissional e a legislação, a resistência do profissional médico frente a atuação do enfermeiro obstetra e o déficit na formação e capacitação do enfermeiro obstetra. Considerações Finais: Constatase que, a compreensão dessas dificuldades pode subsidiar possível mudança na realidade atual, assim como a ampliação dos estudos referentes a este tema, uma vez que, a falta de autonomia do enfermeiro obstetra constitui um fenômeno que atinge profissionais e pacientes, debilitando o sistema de saúde do país.

To understand the limitations of autonomous performance of obstetric nurses in Brazil. Method: This is an integrative literature review, based on scientific nursing publications, based on the VHL, indexed in the BDENF and LILACS databases, published in national journals, with no time frame. Following the inclusion and exclusion criteria, 10 primary studies comprised the sample. Results: The following factors were found to limit the autonomy of the obstetric nurse: the dichotomy between professional practice and legislation, the resistance of the medical professional to the performance of the obstetric nurse and the deficit in the training and qualification of the obstetric nurse. Final Considerations: It appears that the understanding of these difficulties can support a possible change in the current reality, as well as the expansion of studies related to this topic, since the lack of autonomy of obstetric nurses is a phenomenon that affects professionals and patients , weakening the country's health system.

Comprender las limitaciones del desempeño autónomo de las enfermeras obstétricas en Brasil. Método: Esta es una revisión bibliográfica integradora, basada en publicaciones científicas de enfermería, basada en la BVS, indexada en las bases de datos BDENF y LILACS, publicada en revistas nacionales, sin marco de tiempo. Siguiendo los criterios de inclusión y exclusión, 10 estudios primarios comprendieron la muestra. Resultados: Se encontró que los siguientes factores limitan la autonomía de la enfermera obstétrica: la dicotomía entre la práctica profesional y la legislación, la resistencia del profesional médico al desempeño de la enfermera obstétrica y el déficit en la capacitación y calificación de la enfermera obstétrica. Consideraciones finales: Parece que la comprensión de estas dificultades puede apoyar un posible cambio en la realidad actual, así como la expansión de los estudios relacionados con este tema, ya que la falta de autonomía de la enfermera obstétrica es un fenómeno que afecta a profesionales y pacientes. , debilitando el sistema de salud del país.

Representaciones de enfermeras comunitarias sobre aspectos éticos y legales en el cuidado con plantas medicinales / Representations of community nurses about ethical and legal aspects in the care with medicinal plants / Representações de enfermeiros comunitários sobre aspectos éticos e legais no cuidado com plantas medicinais

RESUMEN Objetivo: Describir las representaciones sociales de las enfermeras comunitarias sobre los aspectos éticos y legales en el uso terapéutico de plantas medicinales, como parte de los cuidados. Material y Métodos: Estudio cualitativo, descriptivo, hermenéutico, delineado por medio de las Representaciones Sociales en su enfoque procesual. Los métodos de producción de información fueron la entrevista enfocada y dos grupos focales. Se realizó triangulación de fuentes y de datos y se utilizó el análisis de contenido cualitativo inductivo. Resultados: Se presentan seis categorías: Políticas públicas, Prescripción de plantas medicinales, Calidad de los fitofármacos, Cuidado complementario, Cuidado con evidencia y Educación a la comunidad. Conclusión: Emergen dos aspectos centrales: El primero es el desarrollo de políticas públicas que apunten hacia el respaldo del accionar de la profesión y el avance de la prescripción enfermera, que permita la autonomía de la profesión respecto al cuidado con plantas medicinales en la comunidad.

ABSTRACT Objective: Describe the social representations of community nurses about ethical and legal aspects of the therapeutic use of medicinal plants. Material and Methods: Qualitative, descriptive and hermeneutical study, guided by the Social Representations in their procedural approach. Methods of information gathering consisted of focused interview and two focus groups. Data and source triangulation were conducted, using inductive qualitative content analysis. Results: Six categories were established: public policies, prescription of medicinal plants, quality of phytopharmaceuticals, complementary care, evidence-based health care and community education. Conclusion: Two central aspects emerged: the development of public policies to support the practice of the profession, and the advancement of the nurse prescribing, contributing to autonomy with respect to health care provision with medicinal plants in the community.

RESUMO Objetivo: Descrever as representações sociais dos enfermeiros da comunidade sobre aspectos éticos e legais no uso terapêutico de plantas medicinais como parte do cuidado. Material e Métodos: Estudo qualitativo, descritivo, hermenêutico, delineado pelas Representações Sociais em sua abordagem processual. Os métodos de produção da informação foram a entrevista focalizada e dois grupos focais. Foi realizada a triangulação de fontes e dados e a análise qualitativa indutiva de conteúdo. Resultados: Foram apresentadas seis categorias: Políticas públicas, Prescrição de plantas medicinais, Qualidade dos fitofarmacêuticos, Cuidados complementares, Cuidados com evidências e Educação à comunidade. Conclusão: Dois aspectos centrais emergem: O desenvolvimento de políticas públicas que apontem para o apoio à atividade da profissão e o avanço da prescrição do enfermeiro, o que permite a autonomia da profissão em relação ao cuidado com plantas medicinais na comunidade.

"Guarding their practice": a descriptive study of Canadian nursing policies and education related to medical cannabis.

BACKGROUND: In Canada, federal regulations allow Nurse Practitioners (NPs) to authorize medical cannabis. Nursing regulatory bodies, however, have been hesitant to include medical cannabis within NPs' scope of practice. As the interest in cannabis increases, NPs have the potential to play a pivotal role in promoting the safe and appropriate use of cannabis. This study aimed to: summarize nursing policies in Canada related to medical cannabis; explore the perspective of nursing regulatory bodies regarding practice and policy issues related to medical cannabis; and examine the inclusion of medical cannabis content within Canadian NP curricula. METHODS: A descriptive study was conducted that comprised three phases. The first phase reviewed nursing regulatory bodies' existing policies related to medical cannabis. In the second phase, practice consultants from nursing regulatory bodies were interviewed regarding policies and practices issues related to medical cannabis. The interviews were analyzed using thematic analysis. The third phase was a national survey of NP program coordinators regarding inclusion of cannabis in curricula. Descriptive statistics summarized survey responses. RESULTS: Of the 12 nursing regulatory bodies in Canada, only 7 had policies or statements related to cannabis, with only Ontario allowing NPs to authorize medical cannabis. There was confusion among practice consultants regarding the role of nurses in the administration of medical cannabis and several barriers were identified regarding nursing engagement in care related to medical cannabis, including lack of knowledge and clinical guidelines. 60% of NP programs included cannabis in their curricula, however, less than half addressed the risks and benefits of medical cannabis and dosing and administration protocols. Limited faculty expertise was a barrier to including cannabis content in NP curricula. CONCLUSION: Nursing regulatory bodies must be proactive in developing policies and educational resources that will support nurses in providing safe and informed care related to cannabis. To ensure patients using medical cannabis receive consistent and safe care from nurses, harmonized regulations and policies are needed across all jurisdictions. Education programs must also provide updated knowledge and training for both registered nurses and NPs that will support them in providing non-judgemental and evidence-based care to the growing number of individuals using cannabis.

Conhecimento dos profissionais de enfermagem sobre a sistematização da assistência de enfermagem / The nursing professionals' knowledge with regards to the nursing care systematization / Conocimiento de los profesionales de enfermería sobre la sistematización de la asistencia de enfermería

Objetivo: Avaliar o conhecimento dos profissionais de enfermagem sobre Sistematização da Assistência de Enfermagem (SAE). Métodos: Pesquisa exploratória, quantitativa, descritiva e analítica, realizada com 105 profissionais de enfermagem assistenciais em Hospital Universitário no período de janeiro a maio de 2017. Foi aplicado questionário semiestruturado cujos dados foram apresentados por estatística descritiva e analítica adotando-se 5% de significância e 95% de confiança. Foram utilizados os testes de Mann-Whitney, Exato de Fisher e Qui-quadrado de Person para associação bivariada. Pesquisa aprovada pelo Comitê de Ética em Pesquisa, CAAE 57875216.2.0000.5207. Resultados: Amostra constituída de 74,3% Técnicos de Enfermagem e 25,7% Enfermeiros, prevalência do sexo feminino, solteiros, que não realizaram aperfeiçoamento sobre SAE. Conclusão: Existem lacunas no conhecimento sobre SAE, sendo necessário aprimorar o ensino nas instituições de formação técnica e superior e estimular a qualificação profissional e treinamento da equipe para utilização dos instrumentos relacionados ao Processo de enfermagem

Objective: Objective: To evaluate the knowledge of Nursing professionals about Nursing Care Systematization (SAE). Methods: Exploratory, quantitative, descriptive and analytical study was carried out with 105 nursing care professionals in a university hospital from January to May 2017. A semi-structured questionnaire was applied, with data presented by descriptive and analytical statistics, adopting 5% significance and 95% confidence. The Mann-Whitney, Fisher's Exact and Chi-square of Person tests were used for bivariate association. Research approved by the Research Ethics Committee, CAAE 57875216.2.0000.5207. Results: Sample comprised of 74.3% Nursing Technicians and 25.7% Nurses, female prevalence, single, who did not perform improvement on SAE. Conclusion: There are gaps in the knowledge about SAE, it is necessary to improve teaching in institutions of technical and higher education, to stimulate the professional qualification and training of the team to use the instruments related to the Nursing Process

Objetivo: Evaluar el conocimiento de los profesionales de Enfermería sobre Sistematización de la Asistencia de Enfermería (SAE). Métodos: Investigación exploratoria, cuantitativa, descriptiva y analítica, realizada con 105 profesionales de Enfermería asistenciales en el Hospital Universitario en el período de enero a mayo de 2017. Se aplicó un cuestionario semiestructurado cuyos datos fueron presentados por estadística descriptiva y analítica adoptando el 5% de significancia Y el 95% de confianza. Se utilizaron las pruebas de Mann-Whitney, Exacto de Fisher y Qui-cuadrado de Person para asociación bivariada. Investigación aprobada por el Comité de Ética en Investigación, CAAE 57875216.2.0000.5207. Resultados: Muestra constituida de 74,3% Técnicos de Enfermería y 25,7% Enfermeros, prevalencia del sexo femenino, solteros, que no realizaron perfeccionamiento sobre SAE. Conclusión: Existen lagunas en el conocimiento sobre SAE, siendo necesario mejorar la enseñanza en las instituciones de formación técnica y superior, estimular la cualificación profesional y entrenamiento del equipo para la utilización de los instrumentos relacionados al Proceso de Enfermerí

Shaping nursing profession regulation through history - a systematic review.

AIM: The aim of this systematic review was to provide a critical synthesis of the factors that historically shaped the advancements of nursing regulators worldwide. BACKGROUND: An in-depth examination of the different factors that moulded regulatory changes over time is pivotal to comprehend current issues in nursing. INTRODUCTION: In the light of global health scenarios, the researchers explored the factors that historically influenced the socio-contextual circumstances upon which governments made regulatory changes. METHODS: A systematic search was performed on the following databases: PubMed, CINAHL, Scopus, OpenGrey and ScienceDirect. The review included papers from January 2000 to October 2016 published in English. The authors used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and an inductive thematic approach for synthesis. RESULTS: Two main themes were identified: factors underpinning current challenges and historical and contextual triggers of regulation. The first theme was composed of three aspects: education, migration and internationalization, and policy and regulation; the second theme consisted of four attributes: demographics, economics, history of registration and wars, and historical changes in nursing practice. DISCUSSION: Factors that shaped nursing regulation were linked to changing demographics and economics, education, history of nursing registration, shifting patterns of migration and internationalization, nursing practice, policy and regulation and significant societal turns often prompted by wars. CONCLUSION: A deeper understanding of the developments of the nursing regulatory institutions provides the foundation for portable standards that can be applied across an array of jurisdictions to guarantee a better public safety. IMPLICATION FOR NURSING AND HEALTH POLICY: Understanding factors that socially, legislatively and politically have influenced the development of regulatory bodies over time helps to mould local, national and international policies that have a stronger impact on health worldwide. To achieve this, there must be effective cooperation among systems of nursing regulations globally.