Investigação e inovação em saúde: intervenções do enfermeiro de saúde comunitária e de saúde pública / Health research and innovation: community health and public health nurse interventions

Aim: To analyze the interventions of community and public health nurse in the context of health research and innovation. Method: A Systematic Review of Literature was conducted according to the Equator Network protocol, Systematic Reviews, CRD's guidance for undertaking reviews in health care, University of York. Results: A total of 23 articles were obtained, according to the inclusion criteria established. The qualitative analysis showed that references to interventions were reported together with others, although some articles focused only on interventions. We emphasize the qualification of the "leading nurse" in the approach to community health intervention, which is the driving force and responsible for taking initiative in future policies. A training program in public health nursing, prepared to be available on the internet that started in 2018, to establish new nurses in the area. The methodology of Item Response Theory in public health research to evaluate, validate and develop instruments, such as the Japanese version of a drowsiness scale. Conclusions: In terms of innovation / creativity, 2 articles specifically use the term. However, others, not mentioning any innovation, do in fact, as it is the case of the development of a new public health training program. As public health reform is taking place in Portugal, we believe that it is an opportunity for nursing to investigate, innovate and recreate, as the European Union recognizes that investing in research and innovation is investing in its own future

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Social Media Technology and Public Health in Ontario: Findings from a Planning Meeting Exploring Current Practices and Future Research Directions.

In the province of Ontario, many of the public health units (PHUs) now possess and use social media as part of their daily health promotion and communication operations. To explore this topic, a planning meeting was held to generate deeper insights toward the use of these forms of technology for preventative services delivery. The planning meeting was held with 50 participants, comprising representatives from 20 of the 36 PHUs in Ontario, interested academics, students and government representatives. A nominal group technique (NGT) was used to build consensus related to future research needs, as related to public health and social media. Participants generated a range of insights around the use of social media, including the need for: leadership buy-in and resource allocation; social media policy and governance structure; performance measurement and evaluation; practices related to engagement with program recipients and addressing the lack of resources faced by many health units. Future research priorities were also generated, related to evaluating the cost-benefit of social media activities and understanding behaviour change implications. Further research is needed to evaluate the functionality, leadership and competency requirements and impact(s) of these new forms of health communication technology within public health service delivery.

Competencias adquiridas en investigación y Salud Pública en la especialidad de Enfermería Familiar y Comunitaria en la Comunidad Valenciana / Skills acquired in research and public health in the specialty of family and community nursing in the Valencian Community

Objetivo: Valorar la adquisición de competencias en investigación y Salud Pública de los especialistas en Enfermería Familiar y Comunitaria. Método: Estudio descriptivo y analítico sobre población de enfermeros especialistas asociados a la Sociedad Enfermera Valenciana de Atención Primaria. Medido con cuestionario anónimo y autoadministrado sobre actividades implementadas y tiempo de rotación en el periodo de formación. Cuestionario realizado y revisado en base al programa formativo de la especialidad. Resultados: Responden 16 de los 41 especialistas. Existe representación de las cuatro promociones que han acabado su formación y siete unidades docentes nacionales. Los resultados muestran alta heterogeneidad en las actividades desarrolladas en la formación. La estancia media en Salud Pública es de 7,07 semanas, con rango de 0 a 16 semanas. El número de sesiones educativas medio es de 2,69 en los dos años. La media de proyectos de investigación es de 1,19. Conclusión: El resultado muestra un proceso de especialización con carencias formativas en las competencias de investigación y Salud Pública que podrían subsanarse. Algunos profesionales afirman que acaban la especialización sin desarrollar actividades de investigación y con rotatorios que no alcanzan los mínimos propuestos. No se observa proceso de mejora en las cuatro promociones estudiadas (AU)

Objective: To evaluate the acquisition of skills in research and public health specialists in family and community nursing. Method: Descriptive and analytical study on a population of specialist nurse members of with the Valencian Primary Nurse Society. Measured with anonymous self-administered questionnaire on activities implemented and turnaround time in the training period. The questionnaire was conducted and reviewed based on the training programme of the specialty. Results: Sixteen of the 41 specialists responded. The four year groups of nurses who had finished their training were represented as well as seven national teaching units. The results show high heterogeneity in the activities developed in the training. The average rotation in public health is 7.07 weeks, with range of 0 to 16 weeks. The mean number of educational sessions is 2.69 in the two years. The average number of research projects is 1.19. Conclusion: The result shows a specialisation process with training gaps in the skills of research and public health that could be remedied. Some practitioners claim that they finish their specialisation without undertaking research activities or completing the minimum proposed shifts. There is no process of improvement in the four year groups studied (AU)

Contributions of Public Health to nursing practice.

OBJECTIVE:: Analyze the perceptions of undergraduate nursing students about the contributions of public health to nursing practice in the Unified Health System. METHOD:: Qualitative Descriptive Study. Data collection was carried out through semi-directed interviews with 15 students. The language material was analyzed according to content and thematic analysis. RESULTS:: Thematic categories were established, namely: "Perceptions about Public Health" and "Contribution of Public Health to nursing practice in the Unified Health System". FINAL CONSIDERATIONS:: Perceptions about Public Health are diversified, but converge to the recognition of this field as the basis for training nurses qualified to work in the SUS with technical competence, autonomy and focusing on the integrality in health care. OBJETIVO:: Analisar as percepções de alunos do curso de bacharelado em Enfermagem acerca das contribuições da Saúde Coletiva para o trabalho de enfermeiros no Sistema Único de Saúde. MÉTODO:: Estudo descritivo, com abordagem qualitativa. A coleta de dados foi realizada mediante a técnica da entrevista semidirigida com 15 alunos. O material de linguagem foi analisado segundo a técnica de análise de conteúdo temático-categorial. RESULTADOS:: Foram produzidas as categorias temáticas "Percepções acerca da Saúde Coletiva" e "Contribuição da Saúde Coletiva ao trabalho do enfermeiro no Sistema Único de Saúde". CONSIDERAÇÕES FINAIS:: As percepções sobre a Saúde Coletiva são plurais, mas convergem para o reconhecimento desse campo como base de sustentação da formação de enfermeiros habilitados a trabalhar no SUS com competência técnica, autonomia e com foco na integralidade do cuidado em saúde.

Contributions of Public Health to nursing practice / Las contribuciones de la Salud Pública para el trabajo de los enfermeros / Contribuições da Saúde Coletiva para o trabalho de enfermeiros

ABSTRACT Objective: Analyze the perceptions of undergraduate nursing students about the contributions of public health to nursing practice in the Unified Health System. Method: Qualitative Descriptive Study. Data collection was carried out through semi-directed interviews with 15 students. The language material was analyzed according to content and thematic analysis. Results: Thematic categories were established, namely: "Perceptions about Public Health" and "Contribution of Public Health to nursing practice in the Unified Health System". Final considerations: Perceptions about Public Health are diversified, but converge to the recognition of this field as the basis for training nurses qualified to work in the SUS with technical competence, autonomy and focusing on the integrality in health care.

RESUMEN Objetivo: Analizar las percepciones de los estudiantes de la educación superior en Enfermería acerca de las contribuciones de Salud Pública para el trabajo del personal de enfermería en el Sistema Único de Salud. Método: Investigación descriptiva con un enfoque cualitativo. La recolección de datos se realizó mediante la técnica de entrevistas semiestructuradas con 15 alumnos. El material lingüístico se analizó de acuerdo con la técnica del análisis de contenido categorial temático. Resultados: Los temas producidos fueron 'Las percepciones sobre la Salud Pública' y 'La contribución de Salud Pública para el trabajo de los enfermeros en el Sistema Único de Salud'. Consideraciones finales: Las percepciones sobre la salud pública son plurales, pero convergen en el reconocimiento de este campo como un apoyo para la formación de los enfermeros calificados para trabajar en el SUS con competencia técnica, autonomía y enfoque en la integralidad de la atención sanitaria.

RESUMO Objetivo: Analisar as percepções de alunos do curso de bacharelado em Enfermagem acerca das contribuições da Saúde Coletiva para o trabalho de enfermeiros no Sistema Único de Saúde. Método: Estudo descritivo, com abordagem qualitativa. A coleta de dados foi realizada mediante a técnica da entrevista semidirigida com 15 alunos. O material de linguagem foi analisado segundo a técnica de análise de conteúdo temático-categorial. Resultados: Foram produzidas as categorias temáticas "Percepções acerca da Saúde Coletiva" e "Contribuição da Saúde Coletiva ao trabalho do enfermeiro no Sistema Único de Saúde". Considerações finais: As percepções sobre a Saúde Coletiva são plurais, mas convergem para o reconhecimento desse campo como base de sustentação da formação de enfermeiros habilitados a trabalhar no SUS com competência técnica, autonomia e com foco na integralidade do cuidado em saúde.

As diferentes dimensões do cuidado na prática realizada por enfermeiros no âmbito da atenção básica / Las diferentes dimensiones del cuidado en la práctica hecha por enfermeras en la atención primaria / The different dimensions of care in practice held by nurses in primary care

Objective: to understand the practices developed in the care provided by nurses in the National Health Programs in a unit of the basic health network in the city of Rio de Janeiro. Methods: The design was a formof case study. The scenario set up in a health center in the municipality of Rio de Janeiro and the research participants, eight nurses. Data were collected through semi-structured and subjected to thematic analysis systematic observation and interview. Results: One may observe the following practices most frequently associated programmatic activities performed by nurses: the nursing consultation, educational practice and the organization of the input stream. Conclusion: Knowing the different practices and care developed by nurses in different areas of expertise and professional linkages in different programs within the Primary Care, it was possible to understand the elements complexity and the multifaceted nature of the nursing profession.

Objetivo: compreender as práticas desenvolvidas no cuidado realizado por enfermeiros nos Programas Nacionais de Saúde em uma unidade da rede básica de saúde no município do Rio de Janeiro. Métodos: A modalidade de delineamento foi o estudo de caso. O cenário configurou-se em um Centro Municipal de Saúde no município do Rio de Janeiro e os participantes da pesquisa, oito enfermeiros. Os dados foram coletados por meio de observação sistemática e entrevista semi-estruturada e submetidos a análise temática. Resultados: Pôde-se constatar, as seguintes práticas mais frequentes associadas às atividades programáticas, realizadas pelos enfermeiros: a consulta de enfermagem, a prática educativa e a organização do fluxo de entrada. Conclusão: Conhecer as diferentes práticas e o cuidado desenvolvido por enfermeiros, nos diferentes espaços de atuação e de articulação profissional em distintos programas, no âmbito da Atenção Básica, possibilitou compreender a complexidade de elementos e o caráter multifacetário da profissão.

Objetivo: comprender las prácticas desarrolladas en la atención proporcionada por enfermeras en los Programas Nacionales de Salud en una unidad de la red básica de salud en la ciudad de Río de Janeiro. Métodos: El diseño en forma de estudio de caso. El escenario instalado en un centro de salud en el municipio de Río de Janeiro y los participantes de la investigación, ocho enfermeras. Los datos fueron recolectados a través de entrevista semi-estructurada y observación sistemática y se sometieron a análisis temático. Resultados: Se pudo observar las siguientes prácticas más frecuentemente asociadas actividades programáticas realizadas por las enfermeras: la consulta de enfermería, la práctica educativa y la organización del flujo de entrada. Conclusión: Conocer las diferentes prácticas y el cuidar desarrollados por las enfermeras en diferentes áreas de conocimiento y en diferentes programas dentro de la Atención Primaria, nos ha permitido comprender la complejidad de los elementos y la naturaleza multifacética de la profesión.

The Dialogue Continues: The Future of Public Health Nursing.

This editorial reflects upon the current discussion among nursing academics and educators about the division between individual level care and population health and its implications for the subdiscipline of public health nursing, from the perspective of a current practitioner in the field.

Reshaping Public Health Nursing in the Republic of Ireland.

Across the world, there are concerns about how nursing and midwifery services are delivered in community settings. In the Republic of Ireland (ROI), significant economic contraction since 2009 has resulted in a decrease in the number of personnel available at a time when the older and younger population has been increasing. The purpose of this article is to outline a change initiative made in one public health nursing service in the ROI. In this change process, public health nursing staff moved from generalist to specialist roles. Distinct teams were created to deal with clinical care and child health, welfare, and protection. A key feature of the clinical team was the utilisation of a corporate caseload approach. The change was prompted by a reduction in staffing numbers, vacant caseloads, and increasing clinical risks and activity. Initial response to the change from frontline staff, management, and patients has been positive. The main effects of the change were noted in caseload management, risk management, and increased focus on clinical supervision. An external evaluation of the change initiative was carried out in 2014.

Factors explaining variability in health literacy outcomes of public health nursing clients.

OBJECTIVES: To evaluate variability in health literacy outcomes due to home visiting (HV) program components including PHN, Intervention, and Client. DESIGN AND SAMPLE: A comparative, correlational study evaluated PHN home visiting program data that included PHNs (N = 16); Interventions (N = 21,634); and Clients (N = 141). Client age ranged from 14 to 46 (median = 21, mean = 22.8, SD = 6.65). Clients were predominately White (75.9%), not married (84.4%), and female (99.3%). PHNS documented care using electronic health records (EHR) and the Omaha System. MEASURES: The outcome of interest was health literacy benchmark attainment (adequate knowledge) operationalized by Omaha System Problem Rating Scale for Outcomes Knowledge scores averaged across problems. INTERVENTION: Program of individually tailored, evidence-based HV interventions provided by PHNs. RESULTS: There were 233 different interventions for 22 problems. Knowledge benchmark was attained by 16.3% of clients. Four factors explained variance in reaching the knowledge benchmark: Client (51%), Problem (17%), Intervention (16%), and PHN (16%). CONCLUSIONS: The PHN and intervention tailoring are actionable components of HV programs that explain variability in health literacy outcomes. Further research should examine effects of training on PHN relationship skills and intervention tailoring to optimize outcomes of evidence-based PHN HV programs, and to evaluate whether improving health literacy may subsequently improve client problems.

Community/public health nursing: is there a future for the specialty?

Graduate nursing education in the United States has undergone significant changes over the last decade with institution of the doctorate in nursing practice (2006) and the revised Essentials of Master's Education in Nursing (2011). An overview of the status of community/public health nursing (C/PHN) education and practice during the past 100 years provides a historic context for understanding the current situation of the specialty. An analysis of U.S. graduate nursing programs in C/PHN is used to foreground a discussion of the factors that may significantly affect community/public health nurses' interest in graduate education and the ability to sustain a master's-prepared C/PHN workforce. Questions are raised about how the potential loss of this particular specialty may influence the practice of C/PHN and the role of nursing in general in ensuring the public's health. Recommendations are offered for strengthening the specialty long-term, with a particular focus on C/PHN education and practice.

Lean in to our profession.

Nurses play a critical role in the delivery of high-quality, evidence-based health care. Nurses can "lean in" to our professional by voicing our opinions, contributing to decisions affecting health care practice and policy, and assuming leadership roles.

Trends in geographic distribution of nursing staff in Japan from 2000 to 2010: a multilevel analysis.

The aim of this study was to examine trends in the geographic distribution of nursing staff in Japan from 2000 to 2010. We examined time trends in the rates of nursing staff per 100,000 population across 349 secondary health service areas. Using the Gini coefficient as a measure of inequality, we separately analyzed the data of 4 nursing staff types:public health nurses (PHN), midwives (MW), nurses (NS), and associate nurses (AN). Then, using multilevel Poisson regression models, we calculated the rate ratios (RRs) and their 95% confidence intervals (CIs) for each type of nursing staff per 1-year change. Overall, the distribution of PHN, MW, and NS improved slightly in terms of the Gini coefficient. After adjusting for prefectural capital and population density, PHN, MW, and NS significantly increased;the RRs per 1-year increment were 1.022 (95% CI:1.020-1.023), 1.021 (95% CI:1.019-1.022), and 1.037 (95% CI:1.037-1.038), respectively. In contrast, AN significantly decreased;the RR per 1-year increment was 0.993 (95% CI:0.993-0.994). Despite the considerable increase in the absolute number of nursing staff in Japan (excluding AN), this increase did not lead to a sufficient improvement in distribution over the last decade.

Changes in the organizational structure of public health nurse service in the Republic of Croatia 1995 to 2012.

Since 1996, after the privatization of primary health care, public health nurse (PHN) in Croatia remained employed within the health center, mainly responsible for the preventive care of the inhabitants from defined catchment's area. Before that time they were part of general practice teams. The main aim of the study was to investigate what are the trends in the organizational structure of PHN service in Croatia, from 1995-2012. The main source was the Croatian Health Service Yearbooks. The obtained results shows that they are college educated and mostly in full-time jobs. The important findings are the lack of nurses and theirs regional differences. In highly demanding societies, with growing numbers of elderly, mental, social and economic problems, it will be worthy to consider the lower standard then 5 100 inhabitants per one PHN. Also, it should be taken into account to invest into the lowering of regional disparities.

Did the structure of work in the public health nurse service of the Republic of Croatia change in the period 1995-2012?

In Croatia, public health nurses (PHN) have been members of family doctor (FD) teams for decades, conducting a multifunctional and polyvalent scope of activities, including health promotion, prevention, as well as part of the treatment for the inhabitants of a defined catchment area. The main aim of the study was to investigate the trends in the number and structure of PHN visits in the period from 1996 to 2012. The main sources of data were Croatian Health Service Yearbooks. The results strongly indicate that PHN's are overloaded by a high number of visits, especially to chronic patients. While mothers and new-born children are in the PHN care, pregnant women and small children are rather neglected. Considering different working conditions and differences in population needs, a review of the standard is recommendable.