Healthcare Readiness and Primary Care Nursing Using the Theory of Bureaucratic Caring: Turning Never Into Now

The global COVID-19 pandemic of 2020 challenged primary care nursing as never before. Attention focused mainly on care within the inpatient realm, and guidance for these areas was predicated on existing plans for contingency response. In the primary care realm, few clinics plan for or practice readiness responses; thus patients and staff faced a daunting mission of ensuring continuation of services using nontraditional platforms. This article describes bureaucratic caring theory guidance for readiness activities, basic planning, and resources required for primary care clinics in contingency and crisis responses.

Atuação de enfermeiros da Estratégia Saúde da Família na prevenção e controle do HIV e sífilis durante o pré-natal

Este trabalho teve como objetivo avaliar as práticas dos enfermeiros das equipes de saúde da família durante as consultas de pré-natal, na prevenção e controle do HIV e sífilis gestacional. Estudo transversal, descritivo e exploratório, com aplicação de questionário estruturado a 27 enfermeiros atuantes em unidades de saúde da zona urbana do município de Aracaju, Sergipe, entre setembro e outubro de 2019. A distribuição das variáveis foi analisada por meio do teste de qui-quadrado de Pearson. Constatou-se que 85,2% dos enfermeiros conheciam o manual do ministério da saúde para consulta de pré-natal e 96,3% o utilizavam, porém, 25,9% solicitavam os testes rápidos no período inadequado e 18,5% conduziam erroneamente o tratamento para gestantes com teste para HIV. Houve maior proporção de conduta assertiva dos profissionais que fizeram capacitação há menos de um ano quanto aos testes rápidos de HIV (p=0,001) e sífilis (p=0,046), testes não treponêmicos solicitados no pré-natal (p=0,003), mês que devem ser solicitados o exame de VDRL e o HIV (p=0,046) e trimestre da gestação que oferece o teste de HIV (p=0,046). Evidenciou-se a importância de capacitações sobre à temática para a proporção de atuação condizente com os manuais preconizados pelos Ministério da Saúde na Estratégia de Saúde da Família. ABSTRACTThis study aimed to evaluate the practices of nurses in family health teams, during prenatal consultations, in the prevention and control of HIV and gestational syphilis. Crosssectional study, descriptive and exploratory study, with the application of a structured questionnaire, to 27 nurses working in health units in the urban area of the municipality of Aracaju, Sergipe, between September and October 2019. The distribution of variables was analyzed using Pearson’s chi-square test. It was found that 85.2% of nurses knew the Ministry of Health for prenatal consultation and 96.3% used it, however, 25.9% requested rapid tests in the wrong period and 18.5% conducted erroneously treatment for pregnant women with an HIV test. There was a greater proportion of assertive conduct among professionals who had been trained less than a year ago regarding rapid tests for HIV (p = 0.001) and syphilis (p = 0.046), non treponemal tests requested in prenatal care (p = 0.003), month that the VDRL and HIV test (p = 0.046) and trimester of pregnancy that offers the HIV test (p = 0.046) should be requested. The importance of training on the theme was evidenced for the proportion of performance consistent with the manuals recommended by the Ministry of Health in the Family Health Strategy.Keywords: HIV; Gestational syphilis; Primary care nursing; Prenatal. RESUMENEste estudio tuvo como objetivo evaluar las prácticas de los enfermeros en los equipos de salud de la familia durante las consultas prenatales, en la prevención y control del VIH y la sífilis gestacional. Estudio transversal, descriptivo y exploratorio, con la aplicación de un cuestionario estructurado a 27 enfermeros que laboran en unidades de salud del área urbana del municipio de Aracaju, Sergipe, entre septiembre y octubre de 2019. La distribución de variables se analizó mediante la prueba de Chi Cuadrado de Pearson. Se encontró que el 85,2% de las enfermeras conocía el manual del Ministerio de Salud para la consulta prenatal y el 96,3% lo usaba, sin embargo, el 25,9% solicitó pruebas rápidas en el período inadecuado y el 18,5% realizó erróneamente tratamiento a gestantes con prueba de VIH. Hubo una mayor proporción de conducta asertiva por parte de profesionales que se habían formado hace menos de un año en cuanto a pruebas rápidas de VIH (p = 0,001) y sífilis (p = 0,046), pruebas no treponémicas solicitadas en atención prenatal (p = 0,003), mes en que se debe solicitar la prueba VDRL y VIH (p = 0,046) y trimestre de embarazo que ofrece la prueba VIH (p = 0,046). Se resaltó la importancia de la capacitación en el tema por la proporción de desempeño acorde con los manuales recomendados por el Ministerio de Salud en la Estrategia Salud de la Familia.Palabras clave: Sífilis gestacional; Enfermería de atención primaria; Prenatal.

Cuidados de enfermagem para prevenção e manejo da Hipertensão Arterial em gestantes na Atenção Primária

O objetivo do estudo é identificar os cuidados de enfermagem para prevenção e manejo da Hipertensão Arterial em gestantes na atenção primária. Revisão integrativa. A busca foi realizada nas bases de dados LILACS, MEDLINE, SCIELO, via portal de periódicos capes com os Mesh “Hypertension, pregnancy-induced" OR "prenatal care" OR "primary care nursing". Na amostra inicial tem-se um total de 52.595 artigos, após utilização dos critérios de inclusão e exclusão, obteve-se um total de 39.997 estudos e após a leitura dos títulos e resumos, obteve-se uma amostra final de 1.345 estudos que foram lidos com rigor e em sua íntegra, a amostra final foi composta de 16 estudos que foram analisados, interpretados e discutidos. Após análise das publicações constatou-se a importância da assistência de enfermagem no pré-natal, bem como da qualificação dos profissionais no manejo adequado das gestantes hipertensas e, portanto, na prevenção das possíveis complicações, que deve repercutir de maneira positiva na redução das taxas de mortalidade materno- infantil. Evidenciou-se no estudo o significativo percentual de mulheres jovens com hipertensão durante a gestação assim como a existência de fatores de risco entre estas mulheres. Faz-se necessário as intervenções de enfermagem envolvendo o controle da hipertensão arterial, acolhimento, suporte emocional e espiritual para as gestantes e seus familiares, e no desenvolvimento de estratégias que possam contribuir para a redução da ansiedade e estresse, e incentivo à prática de atividade física, orientação quanto o uso das medicações, controle e acompanhamento do peso corporal e controle nutricional.

Drug–Drug Interactions in Elderly Patients with Potentially Inappropriate Medications in Primary Care, Nursing Home and Hospital Settings: A Systematic Review and a Preliminary Study

Drug–drug interactions (DDI) occurring with potentially inappropriate medications (PIM) are additional risk factors that may increase the inappropriate character of PIM. The aim of this study was (1) to describe the prevalence and severity of DDI in patients with PIM and (2) to evaluate the DDI specifically regarding PIM. This systematic review is based on a search carried out on PubMed and Web-of-Science from inception to June 30, 2020. We extracted data of original studies that assessed the prevalence of both DDI and PIM in elderly patients in primary care, nursing home and hospital settings. Four hundred and forty unique studies were identified: 91 were included in the qualitative analysis and 66 were included in the quantitative analysis. The prevalence of PIM in primary care, nursing home and hospital were 19.1% (95% confidence intervals (CI): 15.1–23.0%), 29.7% (95% CI: 27.8–31.6%) and 44.6% (95% CI: 28.3–60.9%), respectively. Clinically significant severe risk-rated DDI averaged 28.9% (95% CI: 17.2–40.6), in a hospital setting; and were approximately 7-to-9 lower in primary care and nursing home, respectively. Surprisingly, only four of these studies investigated DDI involving specifically PIM. Hence, given the high prevalence of severe DDI in patients with PIM, further investigations should be carried out on DDI involving specifically PIM which may increase their inappropriate character, and the risk of adverse drug reactions.

Association of human papillomavirus (HPV) infection and potentially pathogenic vaginal microorganisms in women attending at primary care nursing gynecological consultation

To identify the incidence of human papillomavirus (HPV) with the presence of other microorganisms. This is a cross-sectional study composed of 128 women who were attended in the basic health units, between 2014 and 2018, to perform the Pap smear. The presence of papillomavirus was investigated using conventional PCR with primers MY09/11 and GP5 +/6+ (echo and endocervix cells) and the smear bacterioscopy of vaginal secretions was performed to identify the microorganisms. Statistical was performed using the square test, including a risk ratio or 95% confidence interval. HPV infection was identified in 48.4% (n = 62) women. Corynebacterium sp (39.8%) was the most prevalent microorganism, followed by Escherichia coli (21.1%), Staphylococcus aureus (14.0%), Gardnerella vaginalis (13.2%) and Candida albicans (7%), respectively. According to statistical analysis or HPV and the group of potentially pathogenic microorganisms had a significant association p <0.02. Corynebacterium sp showed an effective protection (0.356 [0.170-0.744] <0.05) in relation to sociodemographic, gynecological and obstetric factors. Only vaginal discharge and pH had p <0.05 when comparing the presence of infection. The other variables showed no statistical differences. This study revealed an association between the presence of pathogenic microorganisms with HPV virus infection, confirming a need for a better understanding of the female genitals’ microbiota. Thus, research involving the vaginal infectious agents, methods of protection and rapid diagnosis to contribute to the reduction of the number of lesions in the cervix and cervical cancer are needed.

Enhancing Lactation Support in the NICU During the COVID-19 Pandemic by Implementing a Primary Care Model

ObjectiveMeet the needs for additional lactation support in the NICU during the Covid-19 pandemic due to restriction in visitors, hours, and other stressors impacting the Mother and infant dyad.MethodDuring the Covid-19 pandemic, a large southeast U.S. research hospital implemented a new model of providing Lactation Consultation in a Level IV NICU. The Primary Care nursing model utilized in the NICU focuses on the infant and mother's individual needs and assists in the development of a caring and supportive environment.ResultsThe response to the Primary Care Lactation Consultant has well received and has resulted in the early identification of any Lactation concerns. Parents are reassured, knowing whom to contact with questions. The Lactation Consultant can set mutually agreed upon goals with the mother and include input from the other family members and the healthcare team.ConclusionsIn the future, the model and outcomes of Primary Care by Lactation Consultants in the NICU will focus on additional study and evaluation. In the interim, the parents at this facility have benefited from the family-centered care that focuses on the infant and parents.

Transcultural Adaptation and Piloting of the “Regarding Blood-Sampling Practices at Primary Health Care Centres” Questionnaire

Preanalytical errors account for up to 70% of the total potentially detectable errors in the laboratory. The main problems detected are related with procedures associated with Primary Care nursing practices that are directly involved in the preanalytical phase. The objective of this study is to carry out a transcultural adaptation and piloting of the “Regarding Blood-Sampling Practices at Primary Health Care Centres” questionnaire as regards blood sampling in Primary Care. For this, a cross-sectional descriptive study has been developed within the Primary Care area of the Andalusian Public Health System. The venous blood sampling questionnaire was translated into and adapted to Spanish by qualified professionals and expert translators. The questionnaires were then delivered to all staff nurses from the health districts involved. The total sample consisted of 224 primary care nursing professionals. The factors that showed statistically significant relationships were identification and sample collection, management with information search, storage and labelling of samples, and reporting of errors. A lack of global relationship between factors makes it impossible to find a global quality factor in the sampling process. The process of translation, adaptation, and piloting of the questionnaire from its original version to the Spanish one has proven to be understandable by professionals in its entirety and to offer data similar to the original version.