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

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Abstract

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.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12960-021-00632-w.

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PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation

Adrian Aldcroft, Chantelle Garritty, Simon Lewin … (2018)

Scoping reviews, a type of knowledge synthesis, follow a systematic approach to map evidence on a topic and identify main concepts, theories, sources, and knowledge gaps. Although more scoping reviews are being done, their methodological and reporting quality need improvement. This document presents the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and explanation. The checklist was developed by a 24-member expert panel and 2 research leads following published guidance from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network. The final checklist contains 20 essential reporting items and 2 optional items. The authors provide a rationale and an example of good reporting for each item. The intent of the PRISMA-ScR is to help readers (including researchers, publishers, commissioners, policymakers, health care providers, guideline developers, and patients or consumers) develop a greater understanding of relevant terminology, core concepts, and key items to report for scoping reviews.

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The Brazilian health system: history, advances, and challenges.

Jairnilson Paim, Claudia Travassos, Celia Almeida … (2011)

Brazil is a country of continental dimensions with widespread regional and social inequalities. In this report, we examine the historical development and components of the Brazilian health system, focusing on the reform process during the past 40 years, including the creation of the Unified Health System. A defining characteristic of the contemporary health sector reform in Brazil is that it was driven by civil society rather than by governments, political parties, or international organisations. The advent of the Unified Health System increased access to health care for a substantial proportion of the Brazilian population, at a time when the system was becoming increasingly privatised. Much is still to be done if universal health care is to be achieved. Over the past 20 years, there have been other advances, including investments in human resources, science and technology, and primary care, and a substantial decentralisation process, widespread social participation, and growing public awareness of a right to health care. If the Brazilian health system is to overcome the challenges with which it is presently faced, strengthened political support is needed so that financing can be restructured and the roles of both the public and private sector can be redefined. Copyright © 2011 Elsevier Ltd. All rights reserved.

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Is Open Access

Modelo assistencial em saúde: conceitos e desafios para a atenção básica brasileira

Hosanna Pattrig Fertonani, Denise Elvira Pires de Pires, Daiane Biff … (2015)

Trata de uma reflexão teórica com objetivo de resgatar o debate conceitual sobre modelo assistencial em saúde e os desafios para a atenção básica no Brasil. O estudo caracteriza diferentes conceitos e terminologias relativas à expressão modelo assistencial e mostra que a saúde da família promoveu ampliação do acesso e incorporação do acolhimento e humanização das práticas. No entanto, verifica-se a persistência da centralidade do tratamento de patologias e dos cuidados ao corpo biológico, as dificuldades na implantação da integralidade e déficits na formação das equipes e nas condições e relações de trabalho. Concluiu que o termo modelo assistencial é polissêmico e que, embora existam propostas e políticas estruturantes de um modelo que avance em relação ao paradigma biomédico, as dificuldades para sua implementação são significativas.

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Author and article information

Contributors

Carinne Magnago:

ORCID: http://orcid.org/0000-0001-8799-3225

carinne@usp.br

Journal

Journal ID (nlm-ta): Hum Resour Health

Journal ID (iso-abbrev): Hum Resour Health

Title: Human Resources for Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1478-4491

Publication date (Electronic): 22 July 2021

Publication date PMC-release: 22 July 2021

Publication date Collection: 2021

Volume: 19

Electronic Location Identifier: 90

Affiliations

[1 ]GRID grid.11899.38, ISNI 0000 0004 1937 0722, Department of Policy, Management and Health, School of Public Health, , University of São Paulo (FSP/USP), ; Av. Dr. Arnaldo, 715, São Paulo, SP 01246-904 Brazil

[2 ]GRID grid.412211.5, Institute of Social Medicine, , Rio de Janeiro State University (IMS/Uerj), ; Rio de Janeiro, Brazil

Author information

Carinne Magnago http://orcid.org/0000-0001-8799-3225

Article

Publisher ID: 632

DOI: 10.1186/s12960-021-00632-w

PMC ID: 8296671

PubMed ID: 34294088

SO-VID: a983ead0-64b6-4ba1-bb9f-cc62b97d5150

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 4 May 2021

Date accepted : 9 July 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100011893, Pan American Health Organization;

Award ID: Letter Agreement BR / LOA / 1400070.001

Award Recipient : Celia Regina Pierantoni

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: advanced practice nursing,primary health care,scope of practice,nurse's role,baccalaureate nursing education,nursing legislation,brazil

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ScienceOpen disciplines: Health & Social care

Keywords: advanced practice nursing, primary health care, scope of practice, nurse's role, baccalaureate nursing education, nursing legislation, brazil

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

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Most cited references 48

PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation

The Brazilian health system: history, advances, and challenges.

Modelo assistencial em saúde: conceitos e desafios para a atenção básica brasileira

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