[Operational planning of health services: How do we make it possible?] / Planificación operativa en servicios sanitarios: ¿cómo lo hacemos posible?

INTRODUCTION AND OBJECTIVE: The Catalan Health Service carries out the operational planning of service delivery and organization. The goal is to describe the methodology and procedure followed to perform these functions. METHODS: The process of operational planning in healthcare services (OPHS) is continuous, dynamic, participatory, objective, and adaptable. OPHS can be divided into three stages prior to implementation and evaluation: Service delivery planning, Organization of healthcare resources, and Procurement planning. RESULTS: Three examples of projects are presented following the POSS framework. It is essential to adapt the process to the characteristics of each project. CONCLUSIONS: The proposed framework is useful to achieve high quality and equity in access to services.

Las misiones médicas al Policlínico PAMS en Chincha: evolución del modelo de misión / The medical missions to the PAMS Polyclinic in Chincha: evolution of the mission's model

RESUMEN Presentamos la experiencia del Policlínico de la Peruvian American Medical Society (PAMS) en Chincha, en la ejecución de misiones médico-educativas en la región Chincha. El Policlínico PAMS presta atención médica general y especializada a la población de la zona, seis días a la semana. Además, recibe misiones médicas que vienen generalmente de los EE. UU. Desde 2011, se han recibido 43 misiones médicas. La composición y la naturaleza de las misiones han cambiado con el tiempo. Los primeros años se atraía a especialistas con el énfasis de traer equipos e insumos para mejorar la infraestructura del Policlínico. Ahora estamos limitados por la renuencia de voluntarios de venir al Perú en parte debido a que el gobierno americano considera que viajes al Perú son de alto riesgo. Esta limitación nos ha brindado la oportunidad de hacer misiones médicas juntamente con dos excelentes universidades peruanas. La experiencia ha sido positiva.

ABSTRACT We present the experience of the Polyclinic of the Peruvian American Medical Society (PAMS) in Chincha, in the execution of medical educational missions in the Chincha region. The PAMS Polyclinic provides general and specialized medical care to the population of the area, six days a week. In addition, the Polyclinic receives medical missions generally coming from the EE.UU. Since 2011, we have received 43 medical missions. The composition and nature of the missions have changed over time. The first years attracted specialists with the emphasis on bringing equipment and supplies to improve the infrastructure of the Polyclinic. We are now limited by the reluctance of volunteers to come to Peru in part because the U.S. government considers travel to Peru to be high-risk. This limitation has given us the opportunity to do medical missions together with two excellent Peruvian universities. This experience has been positive.

AEDV Expert Consensus Document on the Organization of a Multidisciplinary Unit for Patients With or at Risk of Venereal Infections. / Documento de expertos de la Academia Española de Dermatología y Venereología sobre la organización de una unidad multidisciplinar de atención a pacientes con o en riesgo de infecciones venéreas.

Over the past few years, venereal or sexually transmitted infections (STIs) have been on the rise worldwide requiring additional specialized monographic consultations to specifically treat STIs. Therefore, the Spanish Academy of Dermatology and Venereology (AEDV) Research Working Group on STIs and HIV has drafted this document with the necessary requirements in terms of infrastructure, personnel, technology, specific materials for sample collection, and needs for current therapeutic options. Strict emphasis is placed on the protection of patient privacy. A health care circuit model is outlined too. Additionally, a section has been included on contact tracking and reporting, key elements for the effective prevention and control of STIs. These clinical practice guidelines seek to establish a clinical action framework adapted to the current challenges posed by STIs and HIV in the dermatology, venereology, and multidisciplinary settings.

[Streamlining of patient discharge and intra-hospital transfer processes using Lean methodology]. / Resultados de la dinamización del proceso de alta y de traslados intrahospitalarios de los pacientes aplicando el método Lean.

INTRODUCTION: The application of Lean methodology in the hospital environment can help to improve interprofessional communication and reduce non-value adding activities (waste). OBJECTIVE: To determine the effectiveness of the implementation of a visual management tool, in the ability to reduce the number of trips, to determine the location of patients in real time in the process of intra-hospital transfers (ITH) and discharges in a hospital. MATERIAL AND METHODS: Before-after study in a hospital internal medicine unit. Several time wastes due to unnecessary transfers were detected. A multiprofessional group was formed to design a visual management tool for the resolution of these identified problems. The opinion of the professionals on the tool was evaluated and variables of staff displacement and completion of the tool were measured before and after its implementation. RESULTS: The personnel involved was trained. Completion of the tool improved over time, both in HIT and in discharges, reducing the number of trips. CONCLUSIONS: The application of a visual management tool in care processes, including all the personnel involved is effective and saves waste.

Organização da atenção primária à saúde de municípios de São Paulo, Brasil: modelo de atenção e coerência com as diretrizes do Sistema Único de Saúde / Organización de la atención primaria de salud de municipios de São Paulo, Brasil: modelo de atención y coherencia con las directrices del Sistema Único de Salud / Primary health care organization in municipalities of São Paulo, Brazil: a model of care aligned with the Brazilian Unified National Health System's guidelines

Resumo: Este trabalho tem como objetivo analisar os principais padrões de organização das redes municipais de serviços de atenção primária à saúde (APS) e avaliá-los segundo os indicadores de interface entre gestão e gerenciamento local. Trata-se de pesquisa avaliativa que analisou 461 municípios de São Paulo, Brasil, que participaram do Inquérito de Avaliação da Qualidade de Serviços de Atenção Básica (QualiAB) em 2017/2018, classificados segundo a composição dos arranjos organizacionais de 2.472 serviços de APS. Para avaliar os padrões identificados, foram selecionados oito indicadores de gestão e gerenciamento local. Os resultados apontam dois grupos de municípios: homogêneos, com serviços de um mesmo arranjo (43,6%); e heterogêneos, com diferentes arranjos (56,4%). Os grupos foram subdivididos em sete padrões que variaram entre homogêneo-tradicional, homogêneo-Estratégia Saúde da Família, homogêneo-misto e diferentes combinações no grupo heterogêneo. Todos os indicadores apontaram diferenças significativas entre os grupos (p < 0,001), com destaque para o grupo homogêneo-tradicional, com padrão organizacional distante do modelo desejado para uma APS abrangente e resolutiva, enquanto aqueles com unidades de saúde da família (USF), e com unidades básicas com agentes comunitários de saúde e/ou equipes de saúde da família (UBS/USF) demonstraram um padrão mais aproximado desse modelo - com ações de planejamento e avaliação comprometidos com a realidade local e com a qualificação do trabalho. Discute-se a importância das políticas implementadas pela gestão federal e estadual e seu poder de indução na definição do modelo de atenção à saúde na APS dos municípios.

Resumen: El trabajo tiene el objetivo de analizar los principales patrones de organización de las redes municipales de servicios de atención primaria de salud (APS) y evaluarlos conforme los indicadores de interfaz entre la dirección y gestión local. Se trata de una investigación evaluativa que analizó 461 municipios de São Paulo, Brasil, que participaron de la Encuesta de Evaluación de la Calidad de los Servicios de Atención Primaria (QualiAB) en 2017/2018, clasificados según la composición de los arreglos organizativos de 2.472 servicios de APS. Para evaluar los patrones identificados, se seleccionaron ocho indicadores de dirección y gestión local. Los resultados indican dos grupos de municipios: homogéneos, con servicios de un mismo arreglo (43,6%) e heterogéneos, con arreglos diferentes (56,4%). Los grupos se subdividieron en siete patrones que iban desde homogéneo-tradicional, homogéneo-Estrategia de Salud de la Familia, homogéneo-mixto y diferentes combinaciones en el grupo heterogéneo. Todos los indicadores señalaron diferencias significativas entre los grupos (p < 0,001), con destaque para el grupo homogéneo-tradicional, con patrón organizativo alejado del modelo deseado para una APS completa y resolutiva, mientras aquellos con unidades de salud de la familia (USF), y con unidades básicas con agentes comunitarios de salud y/o equipos de salud de la familia (UBS/USF) demostraron un patrón más cercano a este modelo -con acciones de planificación y evaluación comprometidas con la realidad local y con la calificación del trabajo. Se discute la importancia de las políticas implementadas por la gestión federal y la gestión estatal y su poder de inducción para definir el modelo de atención a la salud en la APS de los municipios.

Abstract: This study analyzes the main organization patterns used by primary health care (PHC) services in municipal networks and evaluates them according to indicators of local management-administration interface. Evaluative research analyzed 461 municipalities in São Paulo, Brazil, that participated in the Primary Care Services Quality Assessment Survey (QualiAB) in 2017/2018, classified according to the organizational arrangements composition of 2,472 PHC services. Eight indicators of local management and administration were selected to evaluate the identified patterns. Results indicate two groups of municipalities: homogeneous, with services presenting the same arrangement (43.6%); and heterogeneous, with different arrangements (56.4%). These were subdivided into seven patterns that ranged from homogeneous-traditional, homogeneous-Family Health Strategy, homogeneous-mixed, and different combinations in the heterogeneous group. All indicators showed significant differences between groups (p < 0.001), especially the homogeneous-traditional group, which presented an organizational pattern far from the desired model of a comprehensive and problem-solving PHC. Those integrated with family health units (FHU) and basic health units with community health workers and/or family health teams (BHU/FHU) showed a pattern closer to a comprehensive model - with planning and evaluation actions committed to the local reality and qualification of care. Implementation of federal and state policies are essential for defining the PHC health care model adopted by municipalities.

Estructura conceptual de la competencia gestión de desechos radiactivos para tecnólogos de Medicina Nuclear / Conceptual structure of the radioactive waste management competency for Nuclear Medicine technologists

Introducción: la Medicina Nuclear es una especialidad médica que trata o diagnostica diferentes afecciones mediante imágenes de tipo funcional-molecular, a partir del empleo de fuentes no selladas. Un aspecto importante en el desempeño profesional es la adecuada gestión de sustancias que puedan resultar nocivas. Objetivo: fundamentar la estructura conceptual de la competencia gestión de desechos radiactivos. Métodos: se realizó una revisión bibliográfica con un análisis crítico reflexivo, se consideraron documentos normativos de la actividad en Medicina Nuclear, tesis, artículos y libros, publicados a partir del 2018 en español e inglés. La búsqueda fue realizada en las bases de datos SciELO durante el periodo comprendido de enero a mayo del 2023. Las palabras clave utilizadas fueron: competencias, gestión y desechos radiactivos. Fueron revisados 73 textos y se seleccionaron 20 para conformar el texto final. Resultados: se delimitaron cuatro núcleos temáticos: pertinencia de formar competencias profesionales, base teórico-metodológica, base legal y riesgos e implicaciones. Resulta evidente el insuficiente tratamiento teórico-metodológico a la gestión de desechos como actividad de los tecnólogos de Medicina Nuclear. Se propone la definición de la competencia, los problemas contextuales que aborda, ejes procesuales, criterio de desempeño y evidencias requeridas. Conclusiones: el estudio de las competencias profesionales en los tecnólogos de la salud es un campo de notable vigencia encaminado a desarrollar su profesionalización. La evidente relación establecida entre la competencia gestión de desechos radiactivos y la reducción de riesgos y accidentes, conlleva la responsabilidad de formar profesionales preparados para desempeñarse con éxito en la Medicina Nuclear.

Introduction: Nuclear Medicine is a medical specialty that treats or diagnoses different conditions through functional-molecular images, using unsealed sources. An important aspect in professional performance is the proper management of substances that may be harmful. Objective: to support the conceptual structure of the radioactive waste management competence. Methods: a bibliographic review was carried out with a reflective critical analysis, normative documents of the activity in Nuclear Medicine, theses, articles, and books, published since 2018 in Spanish and English, were considered. The search was carried out in the SciELO databases from January to May 2023. The keywords used were competencies, management and radioactive waste. 73 texts were reviewed and 20 were selected to make up the final text. Results: four topic cores were defined: relevance of training professional competencies, theoretical-methodological base, legal base and risks and implications. The insufficient theoretical-methodological treatment of waste management as an activity of Nuclear Medicine technologists is evident. The definition of the competence, the contextual problems it addresses, procedural axes, performance criteria and required evidence are proposed. Conclusions: the study of professional competencies in health technologists is a field of notable validity aimed at developing their professionalization. The evident relationship established between radioactive waste management competence and the reduction of risks and accidents entails the responsibility of training professionals prepared to perform successfully in Nuclear Medicine.

Cuidado humanizado: Reto para el profesional de enfermería / Humanized Care: A Challenge for the Nursing Professional

Objetivo: El objetivo general de la investigación fue analizar el cuidado humanizado: Reto para el profesional de enfermería. Método: Se desarrolló desde un enfoque cuantitativo con una metodología descriptiva con diseño no experimental, la cual se apoya en el análisis documental­bibliográfico. Se organizó un proceso investigativo en donde la población de estudio, se basó primordialmente en documentos escritos como tesis, revistas arbitradas y artículos científicos. Resultados: Se planteó la idea de desconstruir el significado de humanizar y reconstruir el concepto de cuidad desde la humanización. En conclusión: Sin duda alguna el profesional de enfermería se enfrenta a grandes retos en la gestión de cuidado humanizado, en un mundo globalizado y en donde se están desarrollando tecnologías que buscan desplazar la acción del ser humano, sin embargo, la calidez y acompañamiento que ofrece este profesional a los pacientes y familiares no podrán ser sustituidos.

Objective: The general objective of the research was to analyze humanized care: Challenge for the nursing professional. Method: It was developed from a quantitative approach with a descriptive methodology with non-experimental design, which is supported by documentary-bibliographic analysis. A research process was organized in which the study population was based primarily on written documents such as theses, peer-reviewed journals and scientific articles. Results: The idea of deconstructing the meaning of humanizing and reconstructing the concept of care from humanization was proposed. In conclusion: Undoubtedly, the nursing professional faces great challenges in the management of humanized care, in a globalized world where technologies are being developed that seek to displace the action of the human being, however, the warmth and accompaniment offered by this professional to patients and family members cannot be replaced.

Consenso de recomendaciones para la mejora de la coordinación asistencial inter e intra-centros en el abordaje de la hemofilia / Consensus recommendations for the improvement of inter- and intra-centre care coordination in the management of hemophilia

Objetivo: definir las recomendaciones consensuadas para mejorar la coordinación asistencial entre Farmacia Hospitalaria, Hematología y Enfermería, inter e intra-centros, en la atención a los pacientes con hemofilia. Método: se identificaron y valoraron las recomendaciones para la mejora de la coordinación asistencial en el abordaje de los pacientes con hemofilia, por parte de un panel multidisciplinar de profesionales con experiencia en este campo (Farmacia Hospitalaria, Hematología y Enfermería) y apoyado en la evidencia científica. La valoración de las recomendaciones identificadas se realizó por metodología de consenso Rand/UCLA (Delphi-adaptado) con base en su adecuación y, posteriormente, a su necesidad. En ambos casos, se empleó la escala ordinal de Likert. Los datos se analizaron estadísticamente a través de diferentes métricas. Resultados: se identificaron 53 recomendaciones para la mejora de la coordinación asistencial entre Farmacia Hospitalaria, Hematología y Enfermería en el manejo del paciente con hemofilia, agrupadas en 8 ámbitos de actuación: i) Unidades de Hemofilia, centros de referencia y abordaje multidisciplinar; ii) papel de Hematología, Farmacia Hospitalaria y Enfermería en el recorrido asistencial de los pacientes con hemofilia; iii) telefarmacia y telemedicina; iv) monitorización farmacocinética; v) transición al régimen de paciente adulto; vi) educación sanitaria al paciente; vii) cirugía, urgencias e ingreso hospitalario; y viii) evaluación de los resultados. Todas las recomendaciones fueron valoradas por el panel de expertos externos como adecuadas y necesarias. Conclusiones: el recorrido asistencial del paciente con hemofilia es complejo y depende de diversas variables. Además, requiere la implicación de distintos profesionales sanitarios que deben actuar de manera coordinada e integrada en todas las etapas de la vida del paciente, de manera adaptada a sus necesidades individuales. ... (AU)

Objective: Define consensus recommendations to improve care coordination between Hospital Pharmacy, Haematology and Nursing, inter- and intra-center, in the care of haemophilia patients.Method: Recommendations for the improvement of care coordination in the management of haemophilia patients were identified and assessed by a multidisciplinary panel of professionals with experience in this field (Hospital Pharmacy, Haematology and Nursing) and supported by scientific evidence. The identified recommendations were assessed by Rand/UCLA consensus methodology (Delphi-adapted) based on their appropriateness and, subsequently, on their necessity. In both cases, it was used ordinal Likert scale. Data were statistically analysed through different metrics. Results: Fifty-three recommendations for the improvement of care coordination between Hospital Pharmacy, Haematology and Nursing in the management of haemophilia patients were identified, grouped into eight areas of action: i) Haemophilia units, reference centers and multidisciplinary care; ii) Role of Haematology, Hospital Pharmacy and Nursing in the patient journey of haemophilia patients; iii) Telepharmacy and telemedicine; iv) Pharmacokinetic monitoring; v) Transition to adult patient regimen; vi) Patient health education; vii) Surgery, emergency room and hospital admission; and viii) Outcome evaluation. All recommendations were assessed as appropriate and necessary by the external expert panel. Conclusions: Haemophilia patient journey is complex and depends on different variables. It also requires the involvement of different healthcare professionals who must act in a coordinated and integrated manner at all stages of the patient's life, adapted to their individual needs. ... (AU)

Modelo de gestión del cuidado de enfermería en servicios hospitalario / Nursing care management model in hospital services

RESUMEN Objetivo: Describir el modelo de gestión del cuidado de enfermería en servicios hospitalarios. Metodología: La metodología desarrollada en este estudio se basó en la perspectiva cuantitativa, utilizando tipologías documental-bibliográficas que ayudan a establecer el análisis del objeto de investigación. El material abordado se conformó por tesis de grado, investigaciones científicas, trabajos arbitrados y, con ello, descubrir características y relaciones entre los elementos. En conclusión: El rol de enfermería en el desarrollo de los modelos de gestión del cuidado en los servicios hospitalarios, es de gran importancia ya que establecen los mecanismos de comunicación para su implementación en conjunto con el resto del equipo de salud, que hace vida en los centros hospitalarios.

ABSTRACT Objective: To describe the nursing care management model in hospital services. Methodology: The methodology developed in this study is based on the quantitative perspective using documentary-bibliographic typologies that help to establish the analysis of the research object. The material approached consisted of degree theses, scientific research, refereed works and thus discovering characteristics and relationships between the elements. In conclusion: The role of nursing in the development of care management models in hospital services is of great importance since it is necessary to establish the communication mechanisms for its implementation together with the rest of the health team that works in the hospital centers.

[Translated article] Consensus recommendations for the improvement of inter- and intra-centre care coordination in the management of hemophilia.

OBJECTIVE: Define consensus recommendations to improve care coordination between Hospital Pharmacy, Hematology and Nursing, inter- and intra-center, in the care of hemophilia patients. METHOD: Recommendations for the improvement of care coordination in the management of hemophilia patients were identified and assessed by a multidisciplinary panel of professionals with experience in this field (Hospital Pharmacy, Hematology and Nursing) and supported by scientific evidence. The identified recommendations were assessed by Rand/UCLA consensus methodology (Delphi-adapted) based on their appropriateness and, subsequently, on their necessity. In both cases, it was used ordinal Likert scale. Data were statistically analyzed through different metrics. RESULTS: Fifty-three recommendations for the improvement of care coordination between Hospital Pharmacy, Hematology and Nursing in the management of hemophilia patients were identified, grouped into eight areas of action: i) Hemophilia units, reference centers and multidisciplinary care; ii) Role of Hematology, Hospital Pharmacy and Nursing in the patient journey of hemophilia patients; iii) Telepharmacy and telemedicine; iv) Pharmacokinetic monitoring; v) Transition to adult patient regimen; vi) Patient health education; vii) Surgery, emergency room and hospital admission; and viii) Outcome evaluation. All recommendations were assessed as appropriate and necessary by the external expert panel. CONCLUSIONS: Hemophilia patient journey is complex and depends on different variables. It also requires the involvement of different healthcare professionals who must act in a coordinated and integrated manner at all stages of the patient's life, adapted to their individual needs. On this matter, the identified and agreed recommendations may improve continuity and quality of care, as they facilitate the integration and coordination of the professionals involved in the management of this pathology, especially Hospital Pharmacy, Hematology and Nursing.

Biografía de la enfermera brasileña Edith de Magalhães Fraenkel y su iconografíafotográfica (1942-1955) / Biografia da enfermeira brasileira Edith de Magalhães Fraenkel e sua iconografia fotográfica (1942-1955) / Biography of the brazilian nurse Edith de Magalhães Fraenkel and her photographic iconography (1942-1955)

Introduction: The article presents the professional biography of a great leader in Braziliannursing, narrated from photographs and documents from the period. Objective: to describe thebiography of nurse Edith de Magalhães Fraenkel and analyze the content of her photographic iconography, covering the period from 1942 to 1955. Methodology: This is a qualitative, historicalsocial and biographical research, guided by the methodology of analysis and interpretation of photographic sources, by Boris Kossoy. Results: Edith de Magalhães Fraenkel was a leading figure inBrazilian and São Paulo nursing. She had a notable performance in care, teaching and managementof nursing schools and fought tirelessly to promote the development of the profession in Brazil andSouth America. The organization and curricular innovations implemented in the nursing courseduring her administration as the first director of the School of Nursing of the University of SãoPaulo are remarkable. She promoted the enrollment of men and women, white and black, fromdifferent social classes and of Brazilian and foreign nationality. Conclusion: Through Edith's direction, the School of Nursing of the University of São Paulo became a pioneer in promoting a cultureof gender equality and valuing sociocultural diversity among students.(AU)

Introducción: El artículo presenta la biografía profesional de un gran líder de la enfermería brasileña, narrada a partir de fotografías y documentos de la época. Objetivo: describir la biografía de la enfermera Edith de Magalhães Fraenkel y analizar el contenido de su iconografía fotográfica, de 1942 a 1955. Metodología: Se trata de una investigación cualitativa, histórico-social y biográfica, guiada por la metodología de análisis e interpretación de fuentes fotográficas de Boris Kossoy.Resultados: Edith de Magalhães Fraenkel fue una figura destacada de la enfermería brasileña y paulista. Tuvo un desempeño notable en la atención, docencia y gestión de escuela de enfermería yluchó incansablemente por promover el desarrollo de la profesión en Sudamérica. Son notables lasinnovaciones curriculares implementadas en el curso de enfermería durante su mandato como primera directora de la Escuela de Enfermería de la Universidad de São Paulo. Ella promovió la matrícula de hombres y mujeres, blancos y negros, de diferentes clases sociales y de nacionalidad brasileña y extranjera. Conclusión: A través de la dirección de Edith, la Escuela de Enfermería de la Universidad de São Paulo se convirtió en pionera en promover una cultura de igualdad de género yvalorar la diversidad sociocultural entre los estudiantes.(AU)

Introdução: O artigo apresenta a biografia profissional de uma grande líder da enfermagem brasileira, narrada a partir de fotografias e documentos de época. Objetivo: descrever a biografia da enfermeira Edith de Magalhães Fraenkel e analisar o conteúdo de sua iconografia fotográfica,referente ao período de 1942 a 1955. Metodologia: Trata-se de uma pesquisa de abordagem qualitativa, histórico-social e biográfica, guiada pela metodologia de análise e interpretação das fontes fotográficas, de Boris Kossoy. Resultados: Edith de Magalhães Fraenkel foi uma figura de revelo daenfermagem brasileira e paulista. Ela teve notória atuação na assistência, ensino e gestão de escolade enfermagem e lutou, incansavelmente, pela promoção do desenvolvimento da profissão, no Brasil e América do Sul. É notável a organização e as inovações curriculares implantadas no curso deEnfermagem, durante sua gestão como primeira diretora da Escola de Enfermagem da Universidade de São Paulo. Ela promoveu a matrícula de homens e mulheres, brancos e negros, de classessociais diversas e de nacionalidade brasileira e estrangeira. Conclusão: Através da direção de Editha Escola de Enfermagem da Universidade de São Paulo se tornou pioneira na promoção da culturada igualdade de gênero e de valorização da diversidade sociocultural entre o alunado.(AU)

O perfil acadêmico dos coordenadores dos cursos de Odontologia brasileiros: uma interface com a Bioética / El perfil académico de los coordinadores de cursos de Odontología brasileños: una interfaz con la Bioética / The academic profile of BrazilianDentistry course coordinators: an interface with Bioethics

As Diretrizes Curriculares Nacionais para o Curso de Graduação em Odontologia orientam para uma formação humanista, crítica, reflexiva, e pautada em princípios éticos/bioéticos. Considerando que os coordenadores dos cursos de graduação são fundamentais no processo de formação, foi realizada uma pesquisa nacional, objetivando analisar o perfil acadêmico desses atores. Trata-se de pesquisa transversal, documental, exploratória e analítica. A coleta de dados ocorreu entre junho e julho de 2020, a partir da consulta aos currículos na Plataforma Lattes. Realizaram-se análises descritivas e univariada. Foram analisados os currículos dos coordenadores dos 446 cursos de Odontologia em atividade no Brasil. Destes, 53,0% eram do sexo masculino; 94,2% formados em Odontologia; 81,2% possuíam pelo menos uma especialização, 89,5% mestrado e 52,0% doutorado; 0,4% possuíam especialização em bioética e 0,7% em odontologia legal; 0,7% possuíam mestrado em odontologia legal; 11,7% já haviam lecionado disciplinas nas áreas de ética (deontológica e bioética); 3,8% participavam de projetos de pesquisa e 2,0% de projetos de extensão relacionados à ética; e 6,1% tinham publicações relacionadas à deontologia, ética e/ou bioética. Conclui-se que a maioria dos coordenadores possui cursos de especialização e mestrado, e pouco mais da metade possui doutorado. No entanto, poucos têm alguma formação nas áreas de ética e/ou bioética, ou apresentam projetos de extensão e pesquisa nesses campos do conhecimento (AU).

Las Directrices Curriculares Nacionales para los Cursos de Pregrado en Odontología prevén una formación humanística, crítica, y reflexiva basada en principios éticos/bioéticos. Considerando que los coordinadores de los cursos de pregrado son fundamentales en el proceso de formación, se realizó una pesquisa nacional para analizar el perfil académico de esos profesionales. Se trata de una investigación transversal, documental, exploratoria, y analítica. La colecta de datos se realizó entre junio y julio de 2020, a partir de la consulta de planes de estudio en la Plataforma Lattes. Se realizaron análisis descriptivos y univariados. Fueron analizados los currículos de los coordinadores de los 446 cursos de Odontología activos en Brasil. De los mismos, 53,0% eranhombres; 94,2% eran graduados en Odontología; 81,2% tenían por lo menos una especialización, 89,5% maestría y 52,0% doctorado; 0,4% tenían especialización en Bioética, y 0,7% en Odontología Legal; 11,7% ya había impartido asignaturas en las áreas de ética(deontológica y bioética); 3,8% participaba en proyectos de investigación, y 2,0% en proyectos de extensión relacionados con la ética; 6,1% tenía publicaciones relacionadas con la deontología, la ética y/o la bioética. Se concluye que la mayoría de los coordinadores tienen títulos de especialización y maestría, y poco más de la mitad tienen un doctorado. No obstante, pocos tienen formación en las áreas de ética y/o bioética, o presentan proyectos de extensión e investigación en estos campos del conocimiento (AU).

The National Curriculum Guidelines for the Undergraduate Course in Dentistry guide towards for humanistic, critical, and reflective education, with activities based on ethical/bioethical principles. Considering that undergraduate course coordinators are essential in conducting the education process, a nationwide study was carried out with the objective of evaluating the academic profile of these actors. This is a cross-sectional, documentary, exploratory, and analytical study. The data collection was carried out between June and July 2020, from the consultation of curricula on the Lattes Platform. Descriptive and univariate analyses were performed. The curricula of the coordinators from 446 Dentistry courses in activity in Brazil were analyzed. Of these, 53.0% were male; 94.2% graduated in Dentistry; 81.2% had at least one specialization, 89.5% had a master's degree, and 52.0% had a doctorate; 0.4% had a specialization in bioethics and 0.7% in legal dentistry; 11.7% had already lectured subjects in ethics (deontology and bioethics); 3.8% had participated in research projects, and 2.0% in extension projects related to ethics; while 6.1% had publications related to deontology, ethics, and/or bioethics. It is concluded that most coordinators have specialization and master's degrees, and just over half have a doctorate. However, few have some training in the areas of ethics and/or bioethics, or have extension and research projects in these fields of knowledge (AU).

Consensus recommendations for the improvement of inter- and intra-centre care coordination in the management of hemophilia. / Consenso de recomendaciones para la mejora de la coordinación asistencial inter e intra-centros en el abordaje de la hemofilia.

OBJECTIVE: Define consensus recommendations to improve care coordination between Hospital Pharmacy, Haematology and Nursing, inter- and intra-center, in the care of haemophilia patients. METHOD: Recommendations for the improvement of care coordination in the management of haemophilia patients were identified and assessed by a multidisciplinary panel of professionals with experience in this field (Hospital Pharmacy, Haematology and Nursing) and supported by scientific evidence. The identified recommendations were assessed by Rand/UCLA consensus methodology (Delphi-adapted) based on their appropriateness and, subsequently, on their necessity. In both cases, it was used ordinal Likert scale. Data were statistically analysed through different metrics. RESULTS: Fifty-three recommendations for the improvement of care coordination between Hospital Pharmacy, Haematology and Nursing in the management of haemophilia patients were identified, grouped into eight areas of action: i) Haemophilia units, reference centers and multidisciplinary care; ii) Role of Haematology, Hospital Pharmacy and Nursing in the patient journey of haemophilia patients; iii) Telepharmacy and telemedicine; iv) Pharmacokinetic monitoring; v) Transition to adult patient regimen; vi) Patient health education; vii) Surgery, emergency room and hospital admission; and viii) Outcome evaluation. All recommendations were assessed as appropriate and necessary by the external expert panel. CONCLUSIONS: Haemophilia patient journey is complex and depends on different variables. It also requires the involvement of different healthcare professionals who must act in a coordinated and integrated manner at all stages of the patient's life, adapted to their individual needs. On this matter, the identified and agreed recommendations may improve continuity and quality of care, as they facilitate the integration and coordination of the professionals involved in the management of this pathology, especially Hospital Pharmacy, Haematology and Nursing.

Modelo de gestión del cuidado de enfermería en servicios hospitalario / Nursing care management model in hospital services

Describir el modelo de gestión del cuidado de enfermería en servicios hospitalario. Metodología: La metodología desarrollada en este estudio se basó en la perspectiva cuantitativa utilizando tipologías documental-bibliográficos que ayudan a establecer el análisis del objeto de investigación. El material abordado se conformó por tesis de grado, investigaciones científicas, trabajos arbitrados y con ello descubrir características y relaciones entre los elementos. En conclusión: El rol de enfermería en el desarrollo de los modelos de gestión del cuidado en los servicios hospitalarios, es de gran importancia ya que establecen los mecanismos de comunicación para su implementación en conjunto con el resto del equipo de salud, que hace vida en los centros hospitalarios.

To describe the nursing care management model in hospital services. Methodology: The methodology developed in this study is based on the quantitative perspective using documentary-bibliographic typologies that help to establish the analysis of the research object. The material approached consisted of degree theses, scientific research, refereed works and thus discovering characteristics and relationships between the elements. In conclusion: The role of nursing in the development of care management models in hospital services is of great importance since it is necessary to establish the communication mechanisms for its implementation together with the rest of the health team that works in the hospital centers.

[Analysis of pediatric «short stays¼ in a second-level hospital throughout 25 years]. / Análisis de las «estancias cero¼ pediátricas en un hospital de nivel 2 a lo largo de 25 años.

INTRODUCTION: It is essential to admit patients to hospital in an efficient way in order to use resources rationally. Short hospitalary stays are hospitalizations which does not include 00:00h and are considered avoidable. This study describes trends and characteristics of short stays throughout 25 years in our hospital. PATIENTS AND METHODS: We analyzed hospital pediatric discharges in a second-level hospital through the registration system «conjunto mínimo básico de datos¼. We categorized pediatric patients and newborn patients in two groups according to length of hospital stay: «short stays¼ and «prolonged stays¼. We analyzed and compared the following variables: gender, age, type of admission, month, diagnosis-related groups (DRG) and admission service. Binary logistic regression analysis and assessment of trends through joinpoint regression analysis were performed. RESULTS: From 1993 to 2017, 45710 children were admitted to our hospital, of which 7.3% were short stays. The trend analysis showed a point of change upwards-downwards at the beginning of the millennium. Pediatric short stays: the most important variables were emergency admissions (89%), urgent transfers (9%), month December (11%) and main diagnosis category: nervous system (18%). Mean diagnosis-related groups cost was 2432±1115€ in short stays group and 2549±1065€ in prolonged stays. CONCLUSIONS: Short stays and prolonged stays show a falling trend in our hospital. Short stays percentage in our environment is similar to other neighbor countries. Some of our short stays are urgent transfers and admissions for clinical observation. We did not find clinical significance in weight or cost of pediatric patients' DRG comparing to prolonged stays.

Gestão compartilhada em serviços de pronto atendimento: estudo de métodos mistos / Gestión compartida en servicios de emergencias: estudio de métodos mixtos / Shared management in emergency care services: mixed methods study

Resumo Objetivo Analisar o modelo de gestão adotado nos Prontos Atendimentos dos municípios que integram um Departamento Regional de Saúde. Métodos Estudo de métodos mistos, com desenho incorporado concomitante, realizado em 2017, com seis gestores e 223 trabalhadores de saúde (médicos, enfermeiros e técnicos/auxiliares de enfermagem) de dez Prontos Atendimentos de oito municípios do Departamento Regional de Saúde XIII, São Paulo. Foi entregue o instrumento de coleta de dados composto por seis questões fechadas e quatro questões abertas. Os dados quantitativos foram analisados por meio de estatística descritiva; os dados qualitativos, desenvolvidos por meio da técnica do Discurso do Sujeito Coletivo, foram analisados com o apoio do software DSCSoft®. Resultados Predominaram profissionais do sexo feminino 173 (75,2%) e que ocupavam o cargo de auxiliar de enfermagem 78 (33,9%). Enquanto os gestores avaliaram o modelo de gestão da instituição como contemporâneo e participativo, possibilitando que os trabalhadores participassem da tomada de decisão e dando autonomia aos mesmos para decidirem sobre questões do dia a dia, os trabalhadores avaliaram como gestão tradicional, destacando-se por sua estrutura formal. Conclusão Foi possível observar que gestores e trabalhadores têm visão destoante sobre o modelo de gestão das instituições de saúde. Os pressupostos do modelo de gestão compartilhada englobam concepções valiosas, como comunicação dialógica, descentralização do poder e maior autonomia para a tomada de decisões. Contudo, ao analisar a opinião da maior parte dos trabalhadores que participaram deste estudo, observa-se que o modelo hierarquizado ainda é muito utilizado nas instituições.

Resumen Objetivo Analizar el modelo de gestión adoptado en los servicios de emergencias de los municipios que integran un Departamento Regional de Salud. Métodos Estudio de métodos mixtos, con diseño incorporado simultáneo, realizado en 2017, con seis gerentes y 223 trabajadores de la salud (médicos, enfermeros y técnicos/auxiliares de enfermería) de diez servicios de emergencias de ocho municipios del Departamento Regional de Salud XIII, São Paulo. Se entregó el instrumento de recopilación de datos, compuesto por seis preguntas cerradas y cuatro preguntas abiertas. Los datos cuantitativos se analizaron mediante estadística descriptiva. Los datos cualitativos, elaborados mediante la técnica del discurso del sujeto colectivo, se analizaron con ayuda del software DSCSoft®. Resultados Predominaron profesionales de sexo femenino 173 (75,2 %), que ocupaban el cargo de auxiliar de enfermería 78 (33,9 %). Mientras los gerentes evaluaron el modelo de gestión de la institución como contemporáneo y participativo, que permite a los trabajadores participar de la toma de decisiones y les da autonomía para decidir sobre cuestiones del día a día, los trabajadores la evaluaron como una gestión tradicional, con énfasis en su estructura formal. Conclusión Se pudo observar que los gerentes y los trabajadores tienen visiones discordantes sobre el modelo de gestión de las instituciones de salud. Las premisas del modelo de gestión compartida engloban concepciones valiosas, como comunicación dialógica, descentralización del poder y mayor autonomía para la toma de decisiones. Sin embargo, al analizar la opinión de la mayoría de los trabajadores que participaron en este estudio, se observa que el modelo jerárquico aún es muy utilizado en las instituciones.

Abstract Objective To analyze the management model adopted in Emergency Services in municipalities that are part of a Regional Health Department. Methods Mixed methods study with a concomitantly incorporated design. It was conducted in 2017 with six managers and 223 health workers (physicians, nurses and nursing technicians/assistants) from ten Emergency Care Units in eight municipalities of the Regional Health Department XIII, São Paulo. The data collection instrument composed of six closed questions and four open questions was delivered to participants. Quantitative data were analyzed using descriptive statistics; qualitative data were developed using the Collective Subject Discourse technique and analyzed using the DSCSoft® software. Results There was a predominance of female professionals, 173 (75.2%), in the position of nursing assistants, 78 (33.9%). Managers evaluated the institution's management model as contemporary and participatory, enabling workers to participate in decision making and giving them autonomy to decide on day-to-day issues, while workers evaluated it as traditional management, highlighting its formal structure. Conclusion It was observed that managers and workers have a different view of the management model of health institutions. The assumptions of the shared management model encompass valuable concepts, such as dialogic communication, decentralization of power and greater autonomy for decision making. However, when analyzing the opinion of most workers who participated in this study, the wide use of a hierarchical model in institutions is still observed.

Adaptation and validation of an adult patient classification instrument with emphasis on the family dimension / Adaptación y validación de instrumento de clasificación de paciente adulto con énfasis en la dimensión familiar / Adaptação e validação de instrumento de classificação de paciente adulto com ênfase na dimensão familiar

ABSTRACT Objectives: to adapt and validate an instrument for classifying adult patients that emphasizes the family support network in the demand for nursing care. Methods: methodological study, carried out in three phases: adaptation of an instrument considering the reality of adult patients; content validation with seven experts and assessment of measurement properties (construct validity and internal consistency) with 781 hospitalized patients. Results: in content validation, the indicators reached the values established for the Content Validity Index (0.85-1.00). In the confirmatory factor analysis, the 11 indicators were distributed in three domains and presented average variance extracted and factor loading greater than 0.5. Composite reliability was greater than 0.7. Conclusions: the present study adapted and made available, with evidence of validity and reliability, an instrument for classifying adult patients that considers the family support network in the demand for nursing care.

RESUMEN Objetivos: adaptar y validar un instrumento para clasificación de pacientes adultos que enfatiza la red de apoyo familiar en la demanda de cuidados de enfermería. Métodos: estudio metodológico, realizado en tres fases: adaptación de un instrumento considerando la realidad de pacientes adultos; validez de contenido con siete especialistas y evaluación de las propiedades de medida (validez de constructo y consistencia interna) con 781 pacientes internados. Resultados: en la validez de contenido, los indicadores alcanzaron los valores establecidos para el Índice de Validez de Contenido (0,85-1,00). En el análisis factorial confirmatorio, los 11 indicadores fueron distribuidos en tres dominios y presentaron desviación mediana extraída y carga factorial superiores a 0,5. La confiabilidad compuesta fue superior a 0,7. Conclusiones: el presente estudio adaptó y proveyó, con evidencias de validez y confiabilidad, un instrumento para clasificación de pacientes adultos que considera la red de apoyo familiar en la demanda de cuidados de enfermería.

RESUMO Objetivos: adaptar e validar um instrumento para classificação de pacientes adultos que enfatiza a rede de suporte familiar na demanda de cuidados de enfermagem. Métodos: estudo metodológico, realizado em três fases: adaptação de um instrumento considerando a realidade de pacientes adultos; validação de conteúdo com sete especialistas e avaliação das propriedades de medida (validade de construto e consistência interna) com 781 pacientes internados. Resultados: na validação de conteúdo, os indicadores alcançaram os valores estabelecidos para o Índice de Validade de Conteúdo (0,85-1,00). Na análise fatorial confirmatória, os 11 indicadores foram distribuídos em três domínios e apresentaram variância média extraída e carga fatorial superiores a 0,5. A confiabilidade composta foi superior a 0,7. Conclusões: o presente estudo adaptou e disponibilizou, com evidências de validade e confiabilidade, um instrumento para classificação de pacientes adultos que considera a rede de suporte familiar na demanda de cuidados de enfermagem.

Adaptation and validation of an adult patient classification instrument with emphasis on the family dimension / Adaptación y validación de instrumento de clasificación de paciente adulto con énfasis en la dimensión familiar / Adaptação e validação de instrumento de classificação de paciente adulto com ênfase na dimensão familiar

ABSTRACT Objectives: to adapt and validate an instrument for classifying adult patients that emphasizes the family support network in the demand for nursing care. Methods: methodological study, carried out in three phases: adaptation of an instrument considering the reality of adult patients; content validation with seven experts and assessment of measurement properties (construct validity and internal consistency) with 781 hospitalized patients. Results: in content validation, the indicators reached the values established for the Content Validity Index (0.85-1.00). In the confirmatory factor analysis, the 11 indicators were distributed in three domains and presented average variance extracted and factor loading greater than 0.5. Composite reliability was greater than 0.7. Conclusions: the present study adapted and made available, with evidence of validity and reliability, an instrument for classifying adult patients that considers the family support network in the demand for nursing care.

RESUMEN Objetivos: adaptar y validar un instrumento para clasificación de pacientes adultos que enfatiza la red de apoyo familiar en la demanda de cuidados de enfermería. Métodos: estudio metodológico, realizado en tres fases: adaptación de un instrumento considerando la realidad de pacientes adultos; validez de contenido con siete especialistas y evaluación de las propiedades de medida (validez de constructo y consistencia interna) con 781 pacientes internados. Resultados: en la validez de contenido, los indicadores alcanzaron los valores establecidos para el Índice de Validez de Contenido (0,85-1,00). En el análisis factorial confirmatorio, los 11 indicadores fueron distribuidos en tres dominios y presentaron desviación mediana extraída y carga factorial superiores a 0,5. La confiabilidad compuesta fue superior a 0,7. Conclusiones: el presente estudio adaptó y proveyó, con evidencias de validez y confiabilidad, un instrumento para clasificación de pacientes adultos que considera la red de apoyo familiar en la demanda de cuidados de enfermería.

RESUMO Objetivos: adaptar e validar um instrumento para classificação de pacientes adultos que enfatiza a rede de suporte familiar na demanda de cuidados de enfermagem. Métodos: estudo metodológico, realizado em três fases: adaptação de um instrumento considerando a realidade de pacientes adultos; validação de conteúdo com sete especialistas e avaliação das propriedades de medida (validade de construto e consistência interna) com 781 pacientes internados. Resultados: na validação de conteúdo, os indicadores alcançaram os valores estabelecidos para o Índice de Validade de Conteúdo (0,85-1,00). Na análise fatorial confirmatória, os 11 indicadores foram distribuídos em três domínios e apresentaram variância média extraída e carga fatorial superiores a 0,5. A confiabilidade composta foi superior a 0,7. Conclusões: o presente estudo adaptou e disponibilizou, com evidências de validade e confiabilidade, um instrumento para classificação de pacientes adultos que considera a rede de suporte familiar na demanda de cuidados de enfermagem.

Nursing care management concepts: scoping review / Conceptos de gestión y administración de la atención de enfermería: revisión de ámbito / Conceitos de gestão e gerência do cuidado de enfermagem: revisão de escopo

ABSTRACT Objectives: to clarify the concepts of Nursing Care Management and Nursing Care Administration in the scientific literature, highlighting approximations and distances between the terms. Methods: scoping review as per Joanna Briggs Institute protocol and preferred reporting items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR). The searches were performed in LILACS, CINAHL, MEDLINE, and Scopus databases. Results: the qualitative analysis, through content analysis, counted 49 studies published between 2007 and 2020. Hospital care was the most evident level of care. It was identified that nursing care management aims at the macropolitical performance of nurses and mobilizes skills essentially strategic-cognitive, while Nursing Care Administration aims at the micropolitical performance of nurses, requiring essentially strategic-administrative skills. Final Considerations: the study allowed us to propose the conceptualization of the terms and identify the approximations and distances between them.

RESUMEN Objetivos: aclarar conceptos de Gestión de Atención de Enfermería y Administración de Atención de Enfermería en la literatura científica, destacando aproximaciones y alejamientos entre los términos. Métodos: revisión de ámbito conforme protocolo del Joanna Briggs Institute e Items de Informes Preferenciales para Revisiones Sistemáticas y extensión de Meta-Análisis para Revisiones de Ámbito (PRISMA-ScR). Las búsquedas ocurrieron en las bases LILACS, CINAHL, MEDLINE y Scopus. Resultados: el análisis cualitativo, mediante el análisis de contenido, cuenta con 49 estudios, publicados entre 2007 y 2020. La Atención Hospitalaria fue el nivel de atención más evidenciado. Identificado que la Gestión de la Atención de Enfermería objetiva la actuación macropolítica del enfermem y moviliza competencias esencialmente estratégico-cognitivas, mientras la Administración de la Atención de Enfermería objetiva a la actuación micropolítica del enfermera, demandando competencias esencialmente estratégico-administrativas. Consideraciones Finales: el estudio posibilitó proponer la conceptuación de los términos e identificar las aproximaciones y alejamientos entre esos.

RESUMO Objetivos: esclarecer os conceitos de Gestão do Cuidado de Enfermagem e Gerência do Cuidado de Enfermagem na literatura científica, destacando aproximações e distanciamentos entre os termos. Métodos: revisão de escopo conforme protocolo do Joanna Briggs Institute e Itens de Relatórios Preferenciais para Revisões Sistemáticas e extensão de Meta-Análises para Revisões de Escopo (PRISMA-ScR). As buscas ocorreram nas bases LILACS, CINAHL, MEDLINE e Scopus. Resultados: a análise qualitativa, mediante a análise de conteúdo, contou com 49 estudos, publicados entre 2007 e 2020. A Atenção Hospitalar foi o nível de atenção mais evidenciado. Identificou-se que a Gestão do Cuidado de Enfermagem objetiva a atuação macropolítica do enfermeiro e mobiliza competências essencialmente estratégico-cognitivas, enquanto a Gerência do Cuidado de Enfermagem visa à atuação micropolítica do enfermeiro, requisitando competências essencialmente estratégico-administrativas. Considerações Finais: o estudo possibilitou propor a conceituação dos termos e identificar as aproximações e distanciamentos entre eles.

Gerencia de Enfermería durante la pandemia de COVID-19 en un hospital público de Honduras / Nursing Management at a Honduran Public Hospital during the COVID-19 Pandemic

Introducción: El modelo de gestión hospitalaria es el conjunto de políticas y procesos que permiten tomar decisiones asertivas. Durante la pandemia de COVID-19, los sistemas de salud a nivel global necesitaron reorganización para responder a las necesidades presentadas. Sin embargo, no se tiene registro de dicho proceso en Honduras. Objetivo: Explorar las experiencias de profesionales de Enfermería relacionadas con la gerencia de servicios del Hospital "Mario Catarino Rivas" durante la pandemia de COVID-19. Métodos: Se realizó un estudio fenomenológico interpretativo sobre las experiencias de profesionales de Enfermería relacionadas con la gerencia de servicios del Hospital "Mario Catarino Rivas", durante la pandemia de COVID-19. La colecta de datos fue mediante entrevistas semiestructuradas a 20 profesionales de Enfermería en cargos de jefatura, como resultado de un muestreo deliberado. Los datos se analizaron con el método temático, con agrupación de las narraciones, se siguieron los siete pasos de la perspectiva de Colaizzi. Resultados: Se hallaron tres temas, siete subtemas y 30 conceptos, se encontró la calidad total el modelo gerencial utilizado para dar respuestas a las dificultades presentadas durante la pandemia COVID-19. Dentro de los principales desafíos se encontró "falta de recursos humanos" para dar respuesta a la demanda de pacientes. Conclusiones: Durante la COVID-19, se evidencia el importante rol del profesional de Enfermería en cargos gerenciales para mitigar el impacto económico en el sistema de salud hondureño, y garantizar la calidad de vida de los pacientes. Es necesario la apertura de espacios con mayor responsabilidad, con respaldo legal que fortalezca la práctica avanzada(AU)

Introduction: A hospital management model is the set of policies and processes that allow assertive decision making. During the COVID-19 pandemic, health systems worldwide required reorganization to respond to the emerging needs. However, there is no record of such process in Honduras. Objective: To explore the experiences of nursing professionals concerning the management of services at Hospital Mario Catarino Rivas during the COVID-19 pandemic. Methods: An interpretative phenomenological study was conducted on the experiences of nursing professionals concerning the management of services at Hospital Mario Catarino Rivas during the COVID-19 pandemic. The data were collected using semistructured interviews with 20 nursing professionals in head positions, as a result of a deliberate sampling. The data were analyzed using the thematic method, with clustering of narratives and following the seven steps of Colaizzi's perspective. Results: Three themes, 7 subthemes and 30 concepts were found. In addition, the overall quality of the management model used to respond to the difficulties presented during the COVID-19 pandemic was found. Among the main challenges, "lack of human resources" to respond to patient demand was found. Conclusions: During COVID-19, the important role of the nursing professional in managerial positions to mitigate the economic impact on the Honduran health system and to guarantee the quality of life of patients is evident. It is necessary to open spaces with greater responsibility, with legal support to strengthen advanced practice(AU)