Laura Morán Peña

Advanced Practice Nursing: A Strategy for Achieving Universal Health Coverage and Universal Access to Health

ABSTRACT Objective: to examine advanced practice nursing (APN) roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health. Method: we examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and access to health. Results: given evidence of their effectiveness in many countries, APN roles are ideally suited as part of a primary health care workforce strategy in Latin America to enhance universal health coverage and access to health. Brazil, Chile, Colombia, and Mexico are well positioned to build this workforce. Role implementation barriers include lack of role clarity, legislation/regulation, education, funding, and physician resistance. Strong nursing leadership to align APN roles with policy priorities, and to work in partnership with primary care providers and policy makers is needed for successful role implementation. Conclusions: given the diversity of contexts across nations, it is important to systematically assess country and population health needs to introduce the most appropriate complement and mix of APN roles and inform implementation. Successful APN role introduction in Latin America and the Caribbean could provide a roadmap for similar roles in other low/middle income countries.Objetivo: examinar el rol de la enfermeria con practica avanzada (EPA) a nivel internacional para informar de su desarrollo en America Latina y el Caribe, en apoyo a la cobertura de salud universal y el acceso universal a la salud. Metodo: se analizo la literatura relacionada con los roles de la EPA, su despliegue en el mundo y la eficacia de EPA en relacion con la cobertura de salud universal y el acceso a la salud. Resultados: dada la evidencia de su eficacia en muchos paises, las funciones de la EPA son ideales como parte de una estrategia de recursos humanos de atencion primaria de salud en America Latina para mejorar la cobertura de salud universal y el acceso a la salud. Brasil, Chile, Colombia y Mexico estan bien posicionados para construir esta fuerza de trabajo. Las barreras a la implementacion de estas funciones incluyen: la falta de claridad de su rol, la legislacion/regulacion, educacion, financiamiento, y la resistencia de los medicos. Se necesita un liderazgo fuerte de enfermeria para alinear los roles de la EPA con las politicas prioritarias, y trabajar en colaboracion con los profesionales de atencion primaria y los responsables de las politicas para la implementacion exitosa de sus funciones. Conclusiones: teniendo en cuenta la diversidad de los contextos en diferentes naciones, es importante evaluar sistematicamente las necesidades de salud del pais y de la poblacion para introducir la combinacion mas adecuada y complementaria de los papeles de la EPA y dar un formato a su aplicacion. La introduccion con exito del papel de la EPA en America Latina y el Caribe podria proporcionar una hoja de ruta para funciones similares en otros paises de bajos/medios ingresos.

Assessment of an educational intervention based on constructivism in nursing students from a Mexican public university

OBJECTIVE This work sought to evaluate the effect of an educational intervention centered on the analysis of clinical cases to inquire on conceptual learning in students on the theme of nursing care of women with complicated puerperium. METHODOLOGY This was a quasi-experimental study with before and after evaluation. Two groups of students participated from the eighth semester of the nursing program, which professionalized individuals who were already nursing technicians: the study group (n = 33) was taught the theme of nursing care to women with complicated puerperium with the case analysis technique and the control group (n = 27) received traditional teaching. A self-applied question here was used related to the thematic unit, which included three clinical cases and the resolution of a total of 37 questions related to set cases. This questionnaire was the same applied before and after the intervention. RESULTS The pre-intervention mean score was similar in both groups (26 during the study and 27 during the intervention). Upon completing the educational intervention, the post-intervention scores were equal in both groups (27 points). The intra-group analysis showed that in the study group the intervention produced a slight change in conceptual learning, which was statistically significant. During the post-hoc analysis differences in scores were found in students who worked in hospitals with tier three level of care. CONCLUSION Educational intervention favored conceptual learning slightly in the study group. It is necessary to explore other intervening variables that propitiate this learning in the program.

The situation of nursing education in Latin America and the Caribbean towards universal health

Objective: to assess the situation of nursing education and to analyze the extent to which baccalaureate level nursing education programs in Latin America and the Caribbean are preparing graduates to contribute to the achievement of Universal Health. Method: quantitative, descriptive/exploratory, cross-sectional study carried out in 25 countries. Results: a total of 246 nursing schools participated in the study. Faculty with doctoral level degrees totaled 31.3%, without Brazil this is reduced to 8.3%. The ratio of clinical experiences in primary health care services to hospital-based services was 0.63, indicating that students receive more clinical experiences in hospital settings. The results suggested a need for improvement in internet access; information technology; accessibility for the disabled; program, faculty and student evaluation; and teaching/learning methods. Conclusion: there is heterogeneity in nursing education in Latin America and the Caribbean. The nursing curricula generally includes the principles and values of Universal Health and primary health care, as well as those principles underpinning transformative education modalities such as critical and complex thinking development, problem-solving, evidence-based clinical decision-making, and lifelong learning. However, there is a need to promote a paradigm shift in nursing education to include more training in primary health care.Objective: to assess the situation of nursing education and to analyze the extent to which baccalaureate level nursing education programs in Latin America and the Caribbean are preparing graduates to contribute to the achievement of Universal Health. Method: quantitative, descriptive/exploratory, cross-sectional study carried out in 25 countries. Results: a total of 246 nursing schools participated in the study. Faculty with doctoral level degrees totaled 31.3%, without Brazil this is reduced to 8.3%. The ratio of clinical experiences in primary health care services to hospital-based services was 0.63, indicating that students receive more clinical experiences in hospital settings. The results suggested a need for improvement in internet access; information technology; accessibility for the disabled; program, faculty and student evaluation; and teaching/learning methods. Conclusion: there is heterogeneity in nursing education in Latin America and the Caribbean. The nursing curricula generally includes the principles and values of Universal Health and primary health care, as well as those principles underpinning transformative education modalities such as critical and complex thinking development, problem-solving, evidence-based clinical decision-making, and lifelong learning. However, there is a need to promote a paradigm shift in nursing education to include more training in primary health care.Objetivo: evaluar la situacion de la educacion en enfermeria y analizar en que grado los programas de educacion de enfermeria a nivel de grado en America Latina y el Caribe estan preparando a los graduados para contribuir al logro de la Salud Universal. Metodo: se llevo a cabo un estudio transversal, cuantitativo, descriptivo y exploratorio en 25 paises. Resultados: participaron en el estudio 246 escuelas de enfermeria. El porcentaje de profesores con titulos de doctorado fue de 31,3%; pero, si se excluye a Brasil esta cifra se reduce a 8,3%. La proporcion de la experiencia clinica adquirida en los servicios de atencion primaria de salud en relacion con la adquirida en servicios hospitalarios fue de 0,63, lo que indica que los estudiantes adquieren la mayor parte de su experiencia clinica en entornos hospitalarios. Los resultados mostraron una necesidad de mejorar el acceso a internet; la tecnologia de la informacion; la accesibilidad para las personas discapacitadas; la evaluacion de los programas, de los profesores y de los estudiantes; y los metodos de ensenanza y aprendizaje. Conclusiones: hay heterogeneidad en la educacion en enfermeria en America Latina y el Caribe. En general, los programas de estudios de enfermeria han adoptado los principios y los valores de la Salud Universal y la atencion primaria de salud, asi como los principios que sustentan las modalidades de educacion transformadora, como son el desarrollo del pensamiento critico y complejo, la solucion de problemas, la toma de decisiones clinicas basadas en la evidencia y el aprendizaje a lo largo de toda la vida. Sin embargo, hay necesidad de promover un cambio en el paradigma de la educacion en enfermeria, a fin de que abarque mas capacitacion en la atencion primaria de salud.

A Situação da Educação em Enfermagem na América Latina e no Caribe Rumo à Saúde Universal

Objective: to assess the situation of nursing education and to analyze the extent to which baccalaureate level nursing education programs in Latin America and the Caribbean are preparing graduates to contribute to the achievement of Universal Health. Method: quantitative, descriptive/exploratory, cross-sectional study carried out in 25 countries. Results: a total of 246 nursing schools participated in the study. Faculty with doctoral level degrees totaled 31.3%, without Brazil this is reduced to 8.3%. The ratio of clinical experiences in primary health care services to hospital-based services was 0.63, indicating that students receive more clinical experiences in hospital settings. The results suggested a need for improvement in internet access; information technology; accessibility for the disabled; program, faculty and student evaluation; and teaching/learning methods. Conclusion: there is heterogeneity in nursing education in Latin America and the Caribbean. The nursing curricula generally includes the principles and values of Universal Health and primary health care, as well as those principles underpinning transformative education modalities such as critical and complex thinking development, problem-solving, evidence-based clinical decision-making, and lifelong learning. However, there is a need to promote a paradigm shift in nursing education to include more training in primary health care.Objective: to assess the situation of nursing education and to analyze the extent to which baccalaureate level nursing education programs in Latin America and the Caribbean are preparing graduates to contribute to the achievement of Universal Health. Method: quantitative, descriptive/exploratory, cross-sectional study carried out in 25 countries. Results: a total of 246 nursing schools participated in the study. Faculty with doctoral level degrees totaled 31.3%, without Brazil this is reduced to 8.3%. The ratio of clinical experiences in primary health care services to hospital-based services was 0.63, indicating that students receive more clinical experiences in hospital settings. The results suggested a need for improvement in internet access; information technology; accessibility for the disabled; program, faculty and student evaluation; and teaching/learning methods. Conclusion: there is heterogeneity in nursing education in Latin America and the Caribbean. The nursing curricula generally includes the principles and values of Universal Health and primary health care, as well as those principles underpinning transformative education modalities such as critical and complex thinking development, problem-solving, evidence-based clinical decision-making, and lifelong learning. However, there is a need to promote a paradigm shift in nursing education to include more training in primary health care.Objetivo: evaluar la situacion de la educacion en enfermeria y analizar en que grado los programas de educacion de enfermeria a nivel de grado en America Latina y el Caribe estan preparando a los graduados para contribuir al logro de la Salud Universal. Metodo: se llevo a cabo un estudio transversal, cuantitativo, descriptivo y exploratorio en 25 paises. Resultados: participaron en el estudio 246 escuelas de enfermeria. El porcentaje de profesores con titulos de doctorado fue de 31,3%; pero, si se excluye a Brasil esta cifra se reduce a 8,3%. La proporcion de la experiencia clinica adquirida en los servicios de atencion primaria de salud en relacion con la adquirida en servicios hospitalarios fue de 0,63, lo que indica que los estudiantes adquieren la mayor parte de su experiencia clinica en entornos hospitalarios. Los resultados mostraron una necesidad de mejorar el acceso a internet; la tecnologia de la informacion; la accesibilidad para las personas discapacitadas; la evaluacion de los programas, de los profesores y de los estudiantes; y los metodos de ensenanza y aprendizaje. Conclusiones: hay heterogeneidad en la educacion en enfermeria en America Latina y el Caribe. En general, los programas de estudios de enfermeria han adoptado los principios y los valores de la Salud Universal y la atencion primaria de salud, asi como los principios que sustentan las modalidades de educacion transformadora, como son el desarrollo del pensamiento critico y complejo, la solucion de problemas, la toma de decisiones clinicas basadas en la evidencia y el aprendizaje a lo largo de toda la vida. Sin embargo, hay necesidad de promover un cambio en el paradigma de la educacion en enfermeria, a fin de que abarque mas capacitacion en la atencion primaria de salud.

La situación de la educación en enfermería en América Latina y el Caribe hacia el logro de la salud universal

Objective: to assess the situation of nursing education and to analyze the extent to which baccalaureate level nursing education programs in Latin America and the Caribbean are preparing graduates to contribute to the achievement of Universal Health. Method: quantitative, descriptive/exploratory, cross-sectional study carried out in 25 countries. Results: a total of 246 nursing schools participated in the study. Faculty with doctoral level degrees totaled 31.3%, without Brazil this is reduced to 8.3%. The ratio of clinical experiences in primary health care services to hospital-based services was 0.63, indicating that students receive more clinical experiences in hospital settings. The results suggested a need for improvement in internet access; information technology; accessibility for the disabled; program, faculty and student evaluation; and teaching/learning methods. Conclusion: there is heterogeneity in nursing education in Latin America and the Caribbean. The nursing curricula generally includes the principles and values of Universal Health and primary health care, as well as those principles underpinning transformative education modalities such as critical and complex thinking development, problem-solving, evidence-based clinical decision-making, and lifelong learning. However, there is a need to promote a paradigm shift in nursing education to include more training in primary health care.Objective: to assess the situation of nursing education and to analyze the extent to which baccalaureate level nursing education programs in Latin America and the Caribbean are preparing graduates to contribute to the achievement of Universal Health. Method: quantitative, descriptive/exploratory, cross-sectional study carried out in 25 countries. Results: a total of 246 nursing schools participated in the study. Faculty with doctoral level degrees totaled 31.3%, without Brazil this is reduced to 8.3%. The ratio of clinical experiences in primary health care services to hospital-based services was 0.63, indicating that students receive more clinical experiences in hospital settings. The results suggested a need for improvement in internet access; information technology; accessibility for the disabled; program, faculty and student evaluation; and teaching/learning methods. Conclusion: there is heterogeneity in nursing education in Latin America and the Caribbean. The nursing curricula generally includes the principles and values of Universal Health and primary health care, as well as those principles underpinning transformative education modalities such as critical and complex thinking development, problem-solving, evidence-based clinical decision-making, and lifelong learning. However, there is a need to promote a paradigm shift in nursing education to include more training in primary health care.Objetivo: evaluar la situacion de la educacion en enfermeria y analizar en que grado los programas de educacion de enfermeria a nivel de grado en America Latina y el Caribe estan preparando a los graduados para contribuir al logro de la Salud Universal. Metodo: se llevo a cabo un estudio transversal, cuantitativo, descriptivo y exploratorio en 25 paises. Resultados: participaron en el estudio 246 escuelas de enfermeria. El porcentaje de profesores con titulos de doctorado fue de 31,3%; pero, si se excluye a Brasil esta cifra se reduce a 8,3%. La proporcion de la experiencia clinica adquirida en los servicios de atencion primaria de salud en relacion con la adquirida en servicios hospitalarios fue de 0,63, lo que indica que los estudiantes adquieren la mayor parte de su experiencia clinica en entornos hospitalarios. Los resultados mostraron una necesidad de mejorar el acceso a internet; la tecnologia de la informacion; la accesibilidad para las personas discapacitadas; la evaluacion de los programas, de los profesores y de los estudiantes; y los metodos de ensenanza y aprendizaje. Conclusiones: hay heterogeneidad en la educacion en enfermeria en America Latina y el Caribe. En general, los programas de estudios de enfermeria han adoptado los principios y los valores de la Salud Universal y la atencion primaria de salud, asi como los principios que sustentan las modalidades de educacion transformadora, como son el desarrollo del pensamiento critico y complejo, la solucion de problemas, la toma de decisiones clinicas basadas en la evidencia y el aprendizaje a lo largo de toda la vida. Sin embargo, hay necesidad de promover un cambio en el paradigma de la educacion en enfermeria, a fin de que abarque mas capacitacion en la atencion primaria de salud.

Enfermería con práctica avanzada: una estrategia para lograr la cobertura universal de salud y el acceso universal a la salud

ABSTRACT Objective: to examine advanced practice nursing (APN) roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health. Method: we examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and access to health. Results: given evidence of their effectiveness in many countries, APN roles are ideally suited as part of a primary health care workforce strategy in Latin America to enhance universal health coverage and access to health. Brazil, Chile, Colombia, and Mexico are well positioned to build this workforce. Role implementation barriers include lack of role clarity, legislation/regulation, education, funding, and physician resistance. Strong nursing leadership to align APN roles with policy priorities, and to work in partnership with primary care providers and policy makers is needed for successful role implementation. Conclusions: given the diversity of contexts across nations, it is important to systematically assess country and population health needs to introduce the most appropriate complement and mix of APN roles and inform implementation. Successful APN role introduction in Latin America and the Caribbean could provide a roadmap for similar roles in other low/middle income countries.Objetivo: examinar el rol de la enfermeria con practica avanzada (EPA) a nivel internacional para informar de su desarrollo en America Latina y el Caribe, en apoyo a la cobertura de salud universal y el acceso universal a la salud. Metodo: se analizo la literatura relacionada con los roles de la EPA, su despliegue en el mundo y la eficacia de EPA en relacion con la cobertura de salud universal y el acceso a la salud. Resultados: dada la evidencia de su eficacia en muchos paises, las funciones de la EPA son ideales como parte de una estrategia de recursos humanos de atencion primaria de salud en America Latina para mejorar la cobertura de salud universal y el acceso a la salud. Brasil, Chile, Colombia y Mexico estan bien posicionados para construir esta fuerza de trabajo. Las barreras a la implementacion de estas funciones incluyen: la falta de claridad de su rol, la legislacion/regulacion, educacion, financiamiento, y la resistencia de los medicos. Se necesita un liderazgo fuerte de enfermeria para alinear los roles de la EPA con las politicas prioritarias, y trabajar en colaboracion con los profesionales de atencion primaria y los responsables de las politicas para la implementacion exitosa de sus funciones. Conclusiones: teniendo en cuenta la diversidad de los contextos en diferentes naciones, es importante evaluar sistematicamente las necesidades de salud del pais y de la poblacion para introducir la combinacion mas adecuada y complementaria de los papeles de la EPA y dar un formato a su aplicacion. La introduccion con exito del papel de la EPA en America Latina y el Caribe podria proporcionar una hoja de ruta para funciones similares en otros paises de bajos/medios ingresos.

Enfermagem com prática avançada : uma estratégia para atingir cobertura universal de saúde e acesso universal à saúde

ABSTRACT Objective: to examine advanced practice nursing (APN) roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health. Method: we examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and access to health. Results: given evidence of their effectiveness in many countries, APN roles are ideally suited as part of a primary health care workforce strategy in Latin America to enhance universal health coverage and access to health. Brazil, Chile, Colombia, and Mexico are well positioned to build this workforce. Role implementation barriers include lack of role clarity, legislation/regulation, education, funding, and physician resistance. Strong nursing leadership to align APN roles with policy priorities, and to work in partnership with primary care providers and policy makers is needed for successful role implementation. Conclusions: given the diversity of contexts across nations, it is important to systematically assess country and population health needs to introduce the most appropriate complement and mix of APN roles and inform implementation. Successful APN role introduction in Latin America and the Caribbean could provide a roadmap for similar roles in other low/middle income countries.Objetivo: examinar el rol de la enfermeria con practica avanzada (EPA) a nivel internacional para informar de su desarrollo en America Latina y el Caribe, en apoyo a la cobertura de salud universal y el acceso universal a la salud. Metodo: se analizo la literatura relacionada con los roles de la EPA, su despliegue en el mundo y la eficacia de EPA en relacion con la cobertura de salud universal y el acceso a la salud. Resultados: dada la evidencia de su eficacia en muchos paises, las funciones de la EPA son ideales como parte de una estrategia de recursos humanos de atencion primaria de salud en America Latina para mejorar la cobertura de salud universal y el acceso a la salud. Brasil, Chile, Colombia y Mexico estan bien posicionados para construir esta fuerza de trabajo. Las barreras a la implementacion de estas funciones incluyen: la falta de claridad de su rol, la legislacion/regulacion, educacion, financiamiento, y la resistencia de los medicos. Se necesita un liderazgo fuerte de enfermeria para alinear los roles de la EPA con las politicas prioritarias, y trabajar en colaboracion con los profesionales de atencion primaria y los responsables de las politicas para la implementacion exitosa de sus funciones. Conclusiones: teniendo en cuenta la diversidad de los contextos en diferentes naciones, es importante evaluar sistematicamente las necesidades de salud del pais y de la poblacion para introducir la combinacion mas adecuada y complementaria de los papeles de la EPA y dar un formato a su aplicacion. La introduccion con exito del papel de la EPA en America Latina y el Caribe podria proporcionar una hoja de ruta para funciones similares en otros paises de bajos/medios ingresos.

Avaliação de uma intervenção educativa baseada no construtivismo em alunas de enfermagem de uma universidade pública mexicana

OBJECTIVE This work sought to evaluate the effect of an educational intervention centered on the analysis of clinical cases to inquire on conceptual learning in students on the theme of nursing care of women with complicated puerperium. METHODOLOGY This was a quasi-experimental study with before and after evaluation. Two groups of students participated from the eighth semester of the nursing program, which professionalized individuals who were already nursing technicians: the study group (n = 33) was taught the theme of nursing care to women with complicated puerperium with the case analysis technique and the control group (n = 27) received traditional teaching. A self-applied question here was used related to the thematic unit, which included three clinical cases and the resolution of a total of 37 questions related to set cases. This questionnaire was the same applied before and after the intervention. RESULTS The pre-intervention mean score was similar in both groups (26 during the study and 27 during the intervention). Upon completing the educational intervention, the post-intervention scores were equal in both groups (27 points). The intra-group analysis showed that in the study group the intervention produced a slight change in conceptual learning, which was statistically significant. During the post-hoc analysis differences in scores were found in students who worked in hospitals with tier three level of care. CONCLUSION Educational intervention favored conceptual learning slightly in the study group. It is necessary to explore other intervening variables that propitiate this learning in the program.

Evaluación de una intervención educativa basada en el constructivismo en alumnas de enfermería de una universidad pública mexicana

OBJECTIVE This work sought to evaluate the effect of an educational intervention centered on the analysis of clinical cases to inquire on conceptual learning in students on the theme of nursing care of women with complicated puerperium. METHODOLOGY This was a quasi-experimental study with before and after evaluation. Two groups of students participated from the eighth semester of the nursing program, which professionalized individuals who were already nursing technicians: the study group (n = 33) was taught the theme of nursing care to women with complicated puerperium with the case analysis technique and the control group (n = 27) received traditional teaching. A self-applied question here was used related to the thematic unit, which included three clinical cases and the resolution of a total of 37 questions related to set cases. This questionnaire was the same applied before and after the intervention. RESULTS The pre-intervention mean score was similar in both groups (26 during the study and 27 during the intervention). Upon completing the educational intervention, the post-intervention scores were equal in both groups (27 points). The intra-group analysis showed that in the study group the intervention produced a slight change in conceptual learning, which was statistically significant. During the post-hoc analysis differences in scores were found in students who worked in hospitals with tier three level of care. CONCLUSION Educational intervention favored conceptual learning slightly in the study group. It is necessary to explore other intervening variables that propitiate this learning in the program.