RESUMO

Objective. To describe the Factors to Effective Clinical Experience and Willingness to pursue Career in Rural Health Facilities among Nursing Students on Clinical Placement in southeast Nigeria. Methods. The study was conducted among 48 rural health centres and general hospitals with 528 respondents from different higher institutions of learning serving in these health facilities for their clinical experience. The study applied survey design and utilized questionnaire instrument for data collection. Results. Majority of the students (60%) agreed that their school lacked functional practical demonstration laboratory for students' clinical practice, 66.7% agreed that their school lab lacked large space for all the students to observe what is being taught, 79.9% that their school lab lacked enough equipment that can enable many students to practice procedures; majority of the students (79.9%) answered that the hospitals where they are on clinical placement lacked enough equipment needed for the students on each shift of practice, 59.9% agreed that student/client ratio in each ward during clinical experience periods was not enough for students' practice under supervision, while 73.3% indicated that their school lacked library with current nursing texts for references. Personal, socioeconomic and institutional factors explain the 76% of the variance of effective clinical experience and the 52% of the variance of the willingness to work in rural health facilities in the future if offered employment. Conclusion. The factors surrounding effective clinical experience in rural healthcare facilities in southeastern Nigeria are unfavorable and could discourage future nurses from working there. It is necessary to implement strategies to improve the management of these centers in order to promote the perspective of improving sustainable rural health in this region.

Objetivo. Describir la experiencia clínica efectiva entre los estudiantes de enfermería en prácticas clínicas en las instalaciones sanitarias rurales en el sudeste de Nigeria. Métodos. Este estudio descriptivo se llevó a cabo entre 48 centros de salud rurales y hospitales generales con 528 encuestados de diferentes instituciones de enseñanza superior que prestaban servicio en estas instalaciones sanitarias para su experiencia clínica. Resultados. 60% de los estudiantes comentaron que su centro carecía de un laboratorio de simulación para las prácticas clínicas de los estudiantes, el 66.7% indicó que el laboratorio de su centro carecía de un espacio para que todos los estudiantes pudieran observar lo que se enseñaba. Un 79.9% indicó que el laboratorio de su centro no disponía de equipos suficientes para practicar los procedimientos, y otro porcentaje igual (79.9%) manifestaron que los hospitales carecían del equipo necesario para realizar adecuadamente las prácticas clínicas. El 59.9% indicaron que la razón de estudiantes por paciente en cada sala durante los periodos de experiencia clínica era insuficiente para que los estudiantes realizaran prácticas bajo supervisión, y el 73.3% indicaron que los recursos de la biblioteca en textos de enfermería eran insuficientes para sus necesidades. Los factores personales, socioeconómicos e institucionales explican el 76% de la varianza en la experiencia clínica efectiva y el 52% en la disposición a trabajar en centros sanitarios rurales en el futuro. Conclusión. Los factores que rodean la experiencia clínica efectiva en los centros sanitarios rurales del sudeste de Nigeria son desfavorables y podrían desanimar a los futuros enfermeros a trabajar en ellos. Es necesario implementar estrategias de mejoramiento de la gestión de estos centros con el fin de impulsar la perspectiva de mejorar la salud rural sostenible en esta región.

Objetivo. Descrever a experiência clínica eficaz entre estudantes de enfermagem em estágios clínicos em unidades de saúde rurais no sudeste da Nigéria (África). Métodos. Este estudo descritivo foi realizado em 48 centros de saúde rurais e hospitais gerais com 528 entrevistados de diferentes instituições de ensino superior que atendem essas unidades de saúde pela sua experiência clínica. Resultados. 60% dos alunos comentaram que seu centro não possuía laboratório de simulação para as práticas clínicas dos alunos, 66.7% indicaram que o laboratório de seu centro carecia de espaço para que todos os alunos pudessem observar o que estava sendo ensinado. 79.9% indicaram que o laboratório do seu centro não possuía equipamentos suficientes para a realização dos procedimentos e outro percentual igual (79.9%) afirmou que os hospitais não possuíam os equipamentos necessários para a realização adequada das práticas clínicas. 59.9% indicaram que a proporção de estudantes por pacientes em cada sala durante os períodos de experiência clínica era insuficiente para que os estudantes realizassem as práticas sob supervisão e 73.3% indicaram que os recursos da biblioteca em textos de enfermagem eram insuficientes para suas necessidades. Fatores pessoais, socioeconómicos e institucionais explicam 76% da variação na experiência clínica efetiva e 52% na vontade de trabalhar em centros de saúde rurais no futuro. Conclusão. Os fatores que rodeiam a experiência clínica eficaz em unidades de saúde rurais no sudeste da Nigéria são desfavoráveis e podem desencorajar futuros enfermeiros de trabalhar lá. É necessário implementar estratégias para melhorar a gestão destes centros, a fim de promover a perspectiva de melhorar a saúde rural sustentável nesta região.

Assuntos

RESUMO

Objective: To describe the Factors to Effective Clinical Experience and Willingness to pursue Career in Rural Health Facilities among Nursing Students on Clinical Placement in southeast Nigeria. Methods: The study was conducted among 48 rural health centres and general hospitals with 528 respondents from different higher institutions of learning serving in these health facilities for their clinical experience. The study applied survey design and utilized questionnaire instrument for data collection. Results: Majority of the students (60%) agreed that their school lacked functional practical demonstration laboratory for students' clinical practice, 66.7% agreed that their school lab lacked large space for all the students to observe what is being taught, 79.9% that their school lab lacked enough equipment that can enable many students to practice procedures; majority of the students (79.9%) answered that the hospitals where they are on clinical placement lacked enough equipment needed for the students on each shift of practice, 59.9% agreed that student/client ratio in each ward during clinical experience periods was not enough for students' practice under supervision, while 73.3% indicated that their school lacked library with current nursing texts for references. Personal, socioeconomic and institutional factors explain the 76% of the variance of effective clinical experience and the 52% of the variance of the willingness to work in rural health facilities in the future if offered employment. Conclusion: The factors surrounding effective clinical experience in rural healthcare facilities in southeastern Nigeria are unfavorable and could discourage future nurses from working there. It is necessary to implement strategies to improve the management of these centers in order to promote the perspective of improving sustainable rural health in this region.

Assuntos

RESUMO

En la actualidad, la oferta de cuidados paliativos especializados ha sido superada por la demanda, por lo cual la atención a pacientes con enfermedades en estado terminal o en fase final de la vida suele estar a cargo del médico del nivel primario de asistencia. En ese sentido, los cuidados paliativos primarios incluyen el diagnóstico, el tratamiento paliativo, la planificación anticipada, la gestión y coordinación de intervenciones multidisciplinarias y la transferencia a cuidados especializados cuando sea necesario y haya disponibilidad para ello. Al respecto, en este artículo se exponen brevemente algunos elementos sobre el tema y se propone, además, un algoritmo práctico y fácil de aplicar en la atención primaria, que permitirá identificar a la población aquejada por dolencias en esas etapas, con diferenciación en cuanto a afecciones neoplásicas o no neoplásicas.

Nowadays, the offer of specialized palliative care has been overcome by the demand, reason why care to patients with terminal illness or in end-of-life period is usually in charge of the doctor from primary care level. In that sense, primary palliative care includes the diagnosis, palliative treatment, early planning, administration and coordination of multidisciplinary interventions and referring to specialized care when it is necessary and the service is available. In this respect, some elements on the topic are shortly exposed in this work and, also, a practical and easy implementation algorithm in primary care is proposed that will allow identifying population suffering from pain in those stages, with differentiation as for neoplastic or non neoplastic affections.

Assuntos

RESUMO

INTRODUCTION: Rural riverside populations of Brazil face several difficulties to access health services. The Brazilian National Primary Care Policy implemented the Fluvial Family Health Teams (FFHT), which is a specific primary care team arrangement for these territories. The aim of the study was to assess the use of dental services by adults living in rural riverside areas covered by a FFHT. METHODS: A household-based cross-sectional survey was carried out with a rural riverside population of 38 localities on the left bank of the Rio Negro, Manaus, Amazonas, representative of the area covered by the FFHT. Stratified random sampling was calculated based on the number of adults and households in each riverside locality. An electronic questionnaire was used to obtain information on sociodemographic and oral health conditions, and the utilization of dental services. After descriptive analysis, logistic regression analyses were performed to estimate the odds ratios for the outcome 'use of dental health services over the past 12 months'. RESULTS: A total of 492 individuals, aged 18 years or more, from 38 rural riverside areas were assessed. The mean age of participants was 43.5 years (standard deviation 17.0), ranging from 18.0 to 90.7 years. Of these participants, 3.1% had never been to a dentist and 21.9% had been to a dentist more than 3 years ago. Among those who attended the dental service, 77.4% of appointments occurred in public health services. Dental pain over the previous 6 months (odds ratio (OR)=2.44; 95% confidence interval (CI) 1.51-3.96), higher education (OR=2.62; 95%CI 1.23-5.56), most recent appointment in public health services (OR=1.86; 95%CI 1.19-2.93), edentulism (OR=0.38; 95%CI 0.17-0.85) and dissatisfaction with oral health (OR=0.59; 95%CI 0.38-0.93) were associated with the dental services utilization. CONCLUSION: The study results revealed that approximately a quarter of the individuals did not use dental services over the previous 3 years or have never used them. Despite the increase in access provided by the FFHT, edentulous individuals, individuals dissatisfied with their oral health, and those with lower levels of education were less likely to use dental services, while individuals who experienced dental pain sought dental services more frequently. These findings suggest that the healthcare model offered to this population must be rearranged.

Assuntos

RESUMO

ABSTRACT BACKGROUND: Specific types of violence such as intimate partner sexual violence and intimate partner homicide occur more frequently in rural areas. OBJECTIVE: This study aimed to systematically review the literature on the knowledge and attitudes of rural healthcare providers regarding cases of domestic violence against women. DESIGN AND SETTING: Systematic review developed at Universidade Federal de Uberlândia. METHODS: We conducted an electronic search of six databases, which only included observational studies, regardless of the year, language, or country of publication, except for studies that used secondary data and were exclusively qualitative. Two reviewers performed the selection, data extraction, and risk of bias assessment using a specific Joanna Briggs Institute tool. RESULTS: Six studies met the inclusion criteria. All the studies had a low risk of bias. Approximately 38% of these professionals identified injuries caused by violence in patients. When asked about knowing the correct attitude to take in cases of confirmed violence, between 12% and 64% of rural healthcare providers answered positively; most of them would refer to specialized institutions and promote victim empowerment and counseling. The number of professionals with an educational background in the field ranged from 16% to 98%. CONCLUSIONS: The evident disparity across studies shows that some professionals have suboptimal knowledge and require training to adopt the correct attitude when identifying female victims of domestic violence in clinical practice. SYSTEMATIC REVIEW REGISTRATION: This systematic review was registered in the Open Science Framework Database under the registration http://doi.org/10.17605/OSF.IO/B7Q6S.

RESUMO

INTRODUCTION: The COVID-19 pandemic has emerged as one of the greatest challenges to societies, world health systems and science in the past century, making it imperative to restructure care networks. Therefore, it is essential to discuss the role and initiatives of primary health care (PHC) to deal with it. However, regarding the response to the pandemic, including the current global effort against COVID-19, the nuances of the rural/remote PHC context in the pandemic is barely visible. Rural and remote communities have differentiated health risks, such as socioeconomic disadvantages, difficulties in mobility and access to health services, in addition to linguistic and cultural barriers. This scoping review aimed to analyze the set of individual and collective initiatives and innovations developed to face the COVID-19 pandemic, within the PHC scope, in rural and remote areas. METHODS: A scoping review methodology was applied to peer-reviewed articles. Eight databases were searched to identify scientific articles published in English, Spanish and Portuguese, initially from January 2020 to July 2021, complemented by a rapid review of articles published from January 2022 to April 2023. The main focus sought in the literature was the set of initiatives and innovations carried out within the PHC scope in rural and remote locations during the pandemic, as well as the comparison with pre-pandemic situations and between different countries. The bibliographic information of each search result was imported into Rayyan (Intelligent Systematic Review), followed by the screening and eligibility stages, performed independently by two reviewers, with a third reviewer being accessed in case of conflicts. RESULTS: This review included 54 studies, with publications mostly from Australia, Canada, the US and India. The main PHC initiatives were related to access; to the roles of community health workers and health surveillance; and to the importance of placing, retaining and valuing human resources in health. Cultural, equity and vulnerability issues occupy a major place among the initiatives. Regarding the innovations, telehealth and customized communication are highlighted. From an organizational point of view, rural and remote locations showed enormous flexibility to deal with the pandemic and to improve intersectoral activities at the local level. The description of rurality and remoteness is practically coincident with that of the specific populations, present in geographic areas of difficult sociospatial and cultural access. Rarely, there is an index to measure rurality, or its description deals with the need to overcome distances and obstacles. CONCLUSION: The findings highlight and summarize knowledge about initiatives and innovations developed to face the COVID-19 pandemic, within the PHC scope in rural and remote areas in the world. This review has identified collective, clinical, intersectoral and, mainly, organizational health initiatives. An articulation between different government levels would be paramount in evaluating the implementation of policies and protocols in rural and remote locations for future sanitary crises. Innovations and lessons learned are equally relevant in strengthening health services and systems. This issue calls for considerable further exploration by new reviews and empirical research that seek evidence to assess the sustainability and effectiveness of the implemented measures to face post-pandemic difficulties and other adversities.

Assuntos

RESUMO

INTRODUCTION: Job satisfaction has been shown to have important effects at the organizational level. In various corners of the world, physicians are obliged to perform a period of social service, generally at the first level of care in rural or remote areas. OBJECTIVE: To describe the level of job satisfaction and perceptions of Ecuadorian rural physicians regarding compulsory social service. METHODOLOGY: A descriptive, cross-sectional study was conducted based on a self-administered online questionnaire from February to March 2022, in Ecuadorian rural physicians who were performing their compulsory social service. Participants were invited through official outreach groups. A total of 247 surveys were included in this study. We assessed job satisfaction by means of the S20/23 job satisfaction questionnaire and compared these results with sociodemographic variables and job characteristics of the participants. We performed the reliability test (Cronbach's alpha) to find the validity of the S20/23 questionnaire in physicians performing compulsory social service. RESULTS: The majority of participants were women (61.0%), and overall job satisfaction was 4.1/7.0 pts. "indifferent." The only satisfaction factor in which a predominance of dissatisfaction was found related to benefits/remuneration (43.3%). Participants' perceptions of wrong academic guidance during training, insufficient induction, and negative experiences during work were related to higher levels of dissatisfaction (P < .05). CONCLUSION: The level of job satisfaction of Ecuadorian rural physicians during their compulsory social service was low and graduates indicated a neutral attitude toward job satisfaction in general. Negative perceptions with respect to training and expectation formation prior to and during the mandatory social service generated greater dissatisfaction. The Ministry of Health of Ecuador, as an organizational entity, should implement improvements to increase the job satisfaction of recently graduated physicians, given the implications that this experience may have for their professional future.

Assuntos

RESUMO

Resumo Introdução: A integração ensino-serviço com vivências que incluam ambientes rurais na prática clínica é fundamental para o ensino de uma realidade mais próxima ao Sistema Único de Saúde. Objetivo: Este estudo teve como objetivo analisar a visão dos usuários, estudantes de Medicina e profissionais de saúde de uma unidade de saúde sobre a integração ensino-serviço-comunidade no âmbito rural. Método: Trata-se de um estudo qualitativo realizado com esse público, sendo 15 entrevistas ao todo, em que se utilizou o referencial teórico fenomenológico-hermenêutico para construção das categorias de análise. Resultado: Os estudantes e profissionais identificaram como vantagens da Estratégia Saúde da Família na área rural o menor número de pessoas adscritas e o melhor acesso ao serviço. Tal fato contribui para a longitudinalidade do cuidado e a adesão dos usuários às propostas terapêuticas. Conclusão: O estudo aponta questões relevantes para fomentarmos o estágio rural nos currículos de escolas médicas, como a possibilidade de vínculos mais estruturados com a comunidade e com a equipe de saúde.

Abstract Introduction: Teaching-service integration with experiences that include rural environments is fundamental for teaching the reality of clinical practice that is closer to the Brazilian Unified Health System. Objective: To analyse the views of users, medical students and health professionals of a health unit, on teaching-service-community integration in rural areas. Method: Qualitative study with the target public, involving fifteen interviews in all, using the phenomenological-hermeneutic theoretical framework to construct the categories of analysis. Results: Students and professionals identified the advantages of the Family Health Strategy in the rural area as being the smaller number people enrolled and better access to the service. This fact contributes to longitudinal care and user adherence to proposed treatments. Conclusion: The study points to relevant issues for promoting rural internships in the curricula of medical schools, such as the possibility of closer ties with the community and the health team.

RESUMO

This case study analyses the challenges to providing specialized care in Brazilian remote rural municipalities (RRM). Interviews were conducted with managers from two Brazilian states (Piauí and Bahia). We identified that the distance between municipalities is a limiting factor for access and that significant care gaps contribute to different organizational arrangements for providing and accessing specialized care. Physicians in all the RRMs offer specialized care by direct disbursement to users or sale of procedures to managers periodically, compromising municipal and household budgets. Health regions do not meet the demand for specialized care and exacerbate the need for extensive travel. RRM managers face additional challenges for the provision of specialized care regarding the financing, implementation of cooperative arrangements, and the provision of care articulated in networks to achieve comprehensive care, seeking solutions to the locoregional specificities.

Assuntos

RESUMO

INTRODUCTION: Health studies of the Amazon often focus on diseases and infections prevalent in the region, and few studies address health organizations and services. In this sense, this study fills a gap by reviewing the studies aimed at primary healthcare (PHC) implementation in the nine Amazonian countries. This review addresses a need to explore the forms in which PHC is implemented in the Amazon areas outside the urban centers and its potential to reduce health inequities. This study contributes to improvements in the practices of managers and health professionals and research on the topic. METHODS: Scoping review methodology was applied to peer-reviewed articles. The databases searched were PubMed, Scopus, Lilacs, Embase and Web of Science. Selected studies included peer-reviewed publications, published between January 2000 and November 2019, that focused on PHC or one of its components in the Amazon, and were published in English, Spanish and Portuguese. The study used Arksey and O'Malley's scoping review guidelines, supported by Levac, and included five steps: (i) identification phase, where search queries were applied to the databases followed by the removal of duplicates; (ii) screening phase, where titles and abstracts of articles were screened to exclude irrelevant articles; (iii) eligibility phase, where the full texts of articles were read to assess their relevancy to this study; (iv) data extraction, using a spreadsheet designed to capture relevant information required in this review, using an iterative process; (v) summarizing and classification of each article according to content. The second and third phases were conducted independently by two reviewers. If a disagreement arose between the reviewers, a third reviewer was consulted to help decide whether to include or exclude a study. RESULTS: This review included 25 studies. Of these, 11 presented promising results regarding PHC functioning in the Amazon region, and 14 presented challenges and difficulties in its functioning. Some PHC strategies implemented in the Amazon showed the potential to reduce inequities, mostly when they involved actions that increased access to PHC in the region when they developed a culturally adapted role and engaged community members in the decision-making and in the collaborative construction of health services. Actions that exposed challenges and difficulties were related to ill-prepared healthcare professionals, inadequate service approach and the inability to adapt to cultural issues. CONCLUSION: The findings reveal information about PHC implementations that have had promising results in the Amazon region and, at the same time, show the challenges and difficulties of the PHC actions. The findings also highlight and synthesize knowledge about the potential that PHC strategies have to affect existing inequities in the Amazon region and gaps in the studies that have been undertaken, or at least published, including a lack of studies of PHC implementation and examination of strategies aimed at health determinants.

Assuntos