Mapping of advanced practice nursing actions in the Family Health Strategy

cross-sectional exploratory study carried out with Family Health Strategy nurses. Data obtained in the mapping were compared to the characteristics that define advanced practice nurses and are adopted internationally by using a checklist based on the International Council of Nurses Guidelines.

Results:

the mapping allowed to identify advanced practice nursing actions, such as advanced assessment, judgement, decision-making, and diagnostic reasoning skills and authority to diagnose and prescribe medications, diagnostic testing, and therapeutic treatments. However, evidence found in the educational preparation domain indicated evident fragility, expressed as the low percentage of nurses credentialed with a professional master’s degree.

Conclusions:

the present study showed that nurses in the Family Health Strategy carry out advanced practice nursing actions without the professional master’s degree recommended for credentialing, with pertinent legislation, which requires initiatives to be taken by nursing leaders to overcome this deficiency.

Descriptors:
Advanced Practice Nursing; Primary Health Care; Family Health Strategy; Nursing; Nursing Education

Characteristics of the domains	n	%
Educational preparation	1	4.8
1. Educational preparation beyond that of a generalist or specialized nurse education at a minimum requirement of a full master's degree programme (master's level modules taken as detached courses do not meet this requirement)^* * It is recognized that, for some countries, the requirement of a master's degree may be an aspirational target while they make efforts to reach this standard. Intermediate programs and courses can be defined that may evolve into this standard;	Yes
2. Formal recognition of educational programmes preparing nurses specifically for advanced practice nursing (e.g. accreditation, approval, or authorization by governmental or nongovernmental agencies)^ Although some countries require clinical experience for nurses to enter an advanced practice nursing educational program, no evidence supporting this requirement was found.	No
3. A formal system of credentialing linked to defined educational qualifications	No
Nature of practice	6	28.6
4. A designated role or level of nursing that has its focus on the provision of care, illness prevention and cure based on direct and indirect healthcare services at an advanced level, including rehabilitative care and chronic disease management. This is beyond the scope of practice of a generalist or specialized nurse.	Yes
5. The capability to manage full episodes of care and complex healthcare problems including hard to reach, vulnerable and at-risk populations	No
6. The ability to integrate research (evidence informed practice), education, leadership, and clinical management	Yes
7. Extended and broader range of autonomy (varies by country context and clinical setting)	No
8. Case-management (manages own case load at an advanced level)	Yes
9. Advanced assessment, judgement, decision-making and diagnostic reasoning skills	Yes
10. Recognized advanced clinical competencies, beyond the competencies of a generalist or specialized nurse	No
11. The ability to provide support and/or consultant services to other healthcare professionals emphasizing professional collaboration	No
12. Plans, coordinates, implements and evaluates actions to enhance healthcare services at an advanced level	Yes
13. Recognized first point of contact for clients and families (commonly, but not exclusively, in primary healthcare settings)	Yes
Advanced practice nursing practice	4	19.0
14. Authority to diagnose	Yes
15. Authority to prescribe medications	Yes
16. Authority to order diagnostic testing and therapeutic treatments	Yes
17. Authority to refer clients/patients to other services and/or professionals	Yes
18. Authority to admit and discharge clients/patients to hospital and other services	No
19. Officially recognized title(s) for nurses working as advanced practice nurses	No
20. Legislation to confer and protect the title(s) (e.g. clinical nurse specialist, nurse practitioner)	No
21. Legislation and policies from an authoritative entity or some form of regulatory mechanism explicit to advanced practice nurses (e.g. certification, credentialing or authorization specific to country context)	No

Level of education/type	n	%
Professional master's degree	2	5.1
Academic master's degree	2	5.1
Residence	5	12.8
Lato Sensu specialization
Family health	28	70
Urgency and emergency	8	17.5
Occupational nursing	1	2.5
Public health	2	5

Variables	Yes n (%)	No n (%)	No answer n (%)
Reception of patients without an appointment in FHS	38 (97.4)	-	1 (2.6)
Chronic disease risk stratification	37 (94.9)	1 (2.6)	1 (2.6)
Health education activities	37 (94.9)	1 (2.6)	1 (2.6)
Care plan formulation	34 (87.2)	2 (5.1)	3 (7.7)
Home visit	38 (97.4)	-	1 (2.6)
Visit to community spaces	35 (89.7)	2 (5.1)	2 (5.1)
Care plan development	31 (79.5)	7 (17.9)	1 (2.6)
Nursing process development	32 (82.1)	6 (15.4)	1 (2.6)
Nursing history	35 (89.7)	3 (7.7)	1 (2.6)
Nursing care plan and prescription	34 (87.2)	4 (10.3)	1 (2.6)
Nursing evolution	38 (97.4)	-	1 (2.6)
Knows the mobile technologies of the Ministry of Health	24 (61.5)	14 (35.9)	1 (2.6)
Uses technology to facilitate communication with FHS users	9 (23.1%)	29 (74.4)	1 (2.6)

Variables	Yes n (%)	No n (%)	No answer n (%)
Executes nursing appointments^# # prevention, appointments for children, elderly people, people with diabetes, people with hypertension, appointments to address problems related to mental health, tuberculosis, sexually transmitted infections, leprosy, appointments for pregnant women, postpartum women, adolescents, and to offer prenatal care, appointments to address questions related to sexual orientation, preventive cervical screening, family planning, evaluation of pressure injuries, integrated management of childhood illnesses, encouragement to reduction of harm caused by tobacco (all authorized by the municipality protocol);	37 (94.9)	1 (2.6)	1 (2.6)
Executes nursing procedures^* * blood pressure measurement, dressings, capillary glycemia measurements, collection of material for preventive cervical screening, indwelling urinary catheter insertion, medication administration, newborn blood spot test, stitch removal, anthropometry, rapid molecular test for tuberculosis, foreign body removal, change of indwelling and intermittent urinary catheter, monofilament testing (diabetic foot), auriculotherapy, rehydration, inhalation, administration of vitamin A, change of colostomy bag, vaccination, ear cleaning, neonatal screening, rapid test for sexually transmitted infections (all authorized by the municipality protocol);	37 (94.9)	-	2 (5.1)
Requests tests^ cytopathological clinical analysis, screening mammography, prenatal specific tests, women's health, 1st and 3rd pregnancy trimester testing, systemic arterial hypertension, blood count, fasting glycemia, glycemia 2 hours after administration of 75 g of dextrose, venereal disease research laboratory, HIV testing, HBsAg testing, urine culture, antibiogram, toxoplasmosis serology, laboratory and imaging testing, blood, stool, and urine testing, and obstetric ultrasound (all authorized by the municipality protocol);	38 (97.4)	-	1 (2.6)
Prescribes medications according to municipal decree^* ***** folic acid, ferrous sulfate, nystatin, miconazole, fluconazole, paracetamol, antibiotics, painkillers, vaginal ointments, anti-inflamatories, syrups, contraceptive medications, dipyrone, scopolamine, metoclopramide, Noripurum, betamethasone, ceftriaxone, diclofenac-dexamethasone, Citoneurin, vermifuges, medications to treat sexually transmitted infections and tuberculosis, antihypertensives, hypoglycemics, supplements, and medications listed in the municipality nursing protocol.	38 (97.4)	-	1 (2.6)
Fulfills therapeutic guidelines according to municipal protocol	36 (92.3)	2 (5.1)	1 (2.6)
Refers to other services	37 (94.9)	1 (2.6)	1 (2.6)
Carries out nursing prognosis	27 (69.2)	11 (28.2)	1 (2.6)
Carries out nursing diagnosis	28 (71.8)	10 (25.6)	1 (2.6)

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Isabel Amélia Costa Mendes E-mail: iamendes@usp.br