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INTRODUCTION: Nurses comprise the largest group of health workers globally and are essential to the provision of care necessary for delivering curative therapy to children with cancer. In high-income countries, previous studies of the nurse workforce have shown an association between patient morbidity and mortality and nursing-related factors such as staffing, education and the nursing practice environment. There is currently limited evidence available to define the scope of essential core competencies for paediatric oncology nursing (PON) practice internationally and specifically in Latin America. Clearly defined essential core competencies contribute to establishing nurses' scope of practice within clinical practice, education and research settings. Here, we aimed to map and synthesise the available evidence on the scope of PON practices in the context of clinical practice, educational training and research settings in Latin America. METHODS: A scoping review (ScR) protocol is reported, adhering to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement and guided by The Joanna Briggs Institute. MEDLINE/PubMed, Cochrane Library, Embase, CINAHL, Web of Science, Scopus, Science Direct and Latin American and Caribbean Health Sciences Literature, plus additional sources: The ProQuest Dissertation & Theses Global, The British Library, Google Scholar, medRXiv, ClinicalTrials.gov and WHO-ICTRP will be searched. No date or language restrictions will be employed. Two independent researchers will conduct all the steps of this ScR. The findings will be presented through tables, charts, narrative summaries and assessed based on the outcomes. The search strategy will be updated in May 2022. The expected completion date for this ScR is November 2022. ETHICS/DISSEMINATION: This protocol does not require ethical approval. The dissemination plans comprise peer-reviewed publication and conference presentations, to be shared with International Oncology Societies/International Nursing Societies and advisory groups to inform discussions on future research. We expect that our results will be of interest to nurse professionals, especially, PON and nurse scholars concerned with this particular issue.

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This study aimed to identify differences in the scope of practice of primary care physicians and find the main factors associated with expanded practice in rural and urban areas of Brazil. Data from an online survey with 2,277 primary care physicians, conducted between January and March 2016, were used. Differences regarding activities and procedures performed by physicians per area were verified using Kruskal-Wallis/Dunn's post hoc and chi-square tests. Multivariate linear regression analyses were done using a bootstrap technique to identify the main factors associated with an expanded scope of practice. Regardless of the location, the results showed that the practices of the primary care physicians are below their competences. Rural physicians performed a higher number of procedures and activities compared with their peers from intermediate and urban municipalities. Within the overall sample, the variables related to a broader scope of practice included: male gender, work in rural municipalities, participation in training and continuing education programs and consultation of clinical protocols, articles and books. This study contributes with evidence that the medical scope of practice varies according to location. Recognizing and understanding the differences and associated factors for an expanded scope of practice is necessary to determine the skills and resources required for practice in rural and urban areas, collaborating in proposals of strategies to improve quality and access of health care services.

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Resumo: Introdução: A Prática Avançada de Enfermagem no processo de trabalho da enfermagem na Atenção Primária à Saúde consiste na integração das áreas do conhecimento e a formação profissional, experiência prática, pesquisa, gestão, habilidades clínicas complexas e tomada de decisão com autonomia. Essa função é regulamentada em mais de 50 países, sendo necessária a formulação de políticas de saúde para sua implementação, além de infraestrutura que apoie o ensino e a pesquisa para os enfermeiros que a desenvolvem. A Atenção Primária à Saúde configura um grande potencial para o desenvolvimento da Prática Avançada de Enfermagem, por ser considerada primeiro contato entre o profissional da saúde e o indivíduo, ofertando essencialmente serviços de atenção integral, que vão desde a promoção em saúde até a reabilitação. Objetivo: Analisar as competências necessárias para a prática avançada de enfermagem na atenção primária à saúde. Método: Estudo exploratório do tipo survey, de corte-transversal, com abordagem quantitativa e amostragem não probabilística intencional com desfecho em proporções. Os participantes da pesquisa foram os enfermeiros que declararam exercer a função na atenção primária à saúde, inscritos e ativos no Conselho Regional de Enfermagem do Paraná, que responderam um formulário eletrônico com 64 itens, divididos em sete domínios. A análise estatística descritiva com frequência simples e relativa das variáveis de cada domínio foi verificada com o teste de qui-quadrado. Resultados: Participaram da pesquisa 178 enfermeiros, sendo 156 (87,6%) do sexo feminino, com tempo de experiência na profissão entre 6 e 10 anos 45 (25,3%), e entre 11 a 20 anos de atuação 46 (25,8%). Os participantes estão distribuídos geograficamente em cidades consideradas de pequeno porte 66 (37,1%), de médio porte 46 (25,8%), e de grande porte 66 (37,1%). Foi identificado que 123 (69,10%) possuem especialização Lato sensu e 94 (52,8%) possui alguma formação em saúde pública ou coletiva. A competência comunica-se de maneira efetiva, abordando os achados clínicos, o diagnóstico e as intervenções terapêuticas foi respondida por 80,89%, sendo o maior percentual encontrado no domínio gestão do cuidado. No domínio ética, dentre as quatro competências, a que incorpora princípios éticos na tomada de decisões atingiu 87,64% das respostas. Do domínio colaboração interprofissional, composto por seis competências, obteve o maior percentual a competência colabora com o resto da equipe de saúde para promover o cuidado interprofissional centrado no cliente, com 87,64%. Duas competências do domínio promoção e prevenção atingiram 71,34%, dentre as nove competências que compõe o domínio. No domínio enfermagem baseada em evidências, a competência busca as melhores evidências para melhorar os resultados de saúde alcançou 70,22%. Já o domínio liderança, com 14 competências, apresentou três acima do ponto de corte. O domínio pesquisa não apresentou resultados acima do recomendado para este estudo. Conclusão: As competências descritas nesta pesquisa demonstram que os enfermeiros da Atenção Primária à Saúde desenvolvem parcialmente ou incompletamente as atividades que se aproximam das práticas avançadas de enfermagem.

Abstract: Introduction: Advanced Nursing Practice in the nursing work process in Primary Health Care consists of the integration of the areas of knowledge and professional training, practical experience, research, management, complex clinical skills and decision-making with autonomy. This function is regulated in more than 50 countries, making it necessary to formulate health policies for its implementation, in addition to infrastructure that supports teaching and research for nurses who develop it. Primary Health Care represents a great potential for the development of Advanced Nursing Practice, as it is considered the first contact between the health professional and the individual, essentially offering comprehensive care services, ranging from health promotion to rehabilitation. Objective: To analyze the skills needed for advanced nursing practice in primary health care. Method: Exploratory survey, cross-sectional study, with a quantitative approach and intentional non-probabilistic sampling with an outcome in proportions. The research participants were nurses who declared to exercise their function in primary health care, enrolled and active in the Regional Nursing Council of Paraná, who answered an electronic form with 64 items, divided into seven domains. The descriptive statistical analysis with simple and relative frequency of the variables of each domain was verified with the chi-square test. Results: 178 nurses participated in the survey, 156 (87.6%) of whom were female, with experience in the profession between 6 and 10 years 45 (25.3%), and between 11 and 20 years of experience 46 (25.8 %). Participants are distributed geographically in cities considered to be small 66 (37.1%), medium sized 46 (25.8%), and large sized 66 (37.1%). It was identified that 123 (69.10%) have a Lato sensu specialization and 94 (52.8%) have some training in public or collective health. Competence communicates effectively, addressing clinical findings, diagnosis and therapeutic interventions, accounted for 80.89%, with the highest percentage found in the care management domain. In the ethics domain, among the four competencies, the one that incorporates ethical principles in decision making reached 87.64% of the answers. In the domain of interprofessional collaboration, composed of six competences, the highest percentage obtained was the competence that collaborates with the rest of the health team to promote client-centered interprofessional care, with 87.64%. Two competences in the promotion and prevention domain reached 71.34%, among the nine competencies that make up the domain. In the evidence-based nursing domain, competence seeks the best evidence to improve health outcomes reached 70.22%. The leadership domain, with 14 competencies, presented three above the cutoff point. The research domain did not present results above the recommended for this study. Conclusion: The competencies described in this research demonstrate that Primary Health Care nurses develop partially or incompletely the activities that approach advanced nursing practices.

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This study aimed to identify differences in the scope of practice of primary care physicians and find the main factors associated with expanded practice in rural and urban areas of Brazil. Data from an online survey with 2,277 primary care physicians, conducted between January and March 2016, were used. Differences regarding activities and procedures performed by physicians per area were verified using Kruskal-Wallis/Dunn's post hoc and chi-square tests. Multivariate linear regression analyses were done using a bootstrap technique to identify the main factors associated with an expanded scope of practice. Regardless of the location, the results showed that the practices of the primary care physicians are below their competences. Rural physicians performed a higher number of procedures and activities compared with their peers from intermediate and urban municipalities. Within the overall sample, the variables related to a broader scope of practice included: male gender, work in rural municipalities, participation in training and continuing education programs and consultation of clinical protocols, articles and books. This study contributes with evidence that the medical scope of practice varies according to location. Recognizing and understanding the differences and associated factors for an expanded scope of practice is necessary to determine the skills and resources required for practice in rural and urban areas, collaborating in proposals of strategies to improve quality and access of health care services.

O estudo buscou identificar diferenças no escopo da prática de médicos na atenção primária e os principais fatores associados com a ampliação dessa prática nas áreas rural e urbana do Brasil. Foram usados dados de um inquérito online com 2.277 médicos de atenção primária, realizado entre janeiro e março de 2016. Foram utilizados os testes de Kruskal-Wallis/post hoc de Dunn e qui-quadrado para verificar as diferenças em relação às atividades e procedimentos realizados pelos médicos, de acordo com o local. Foram realizadas análises de regressão linear multivariada, usando a técnica bootstrap para identificar os principais fatores associados com o escopo ampliado da prática. Independente de localização, os resultados mostraram que os médicos de atenção primária estão praticando abaixo de seus níveis de competências. Os médicos rurais realizavam mais procedimentos e atividades quando comparados aos colegas de municípios intermediários e urbanos. Na amostra total, as variáveis relacionadas ao escopo ampliado incluíam: sexo masculino, trabalho em municípios rurais, participação em programas de capacitação e de educação continuada, além de consultas a protocolos clínicos, artigos e livros. O estudo corrobora evidências de que o escopo da prática médica varia de acordo com a localização. O reconhecimento e compreensão das diferenças e fatores associados à ampliação do escopo de prática são relevantes para determinar as competências e recursos necessários para a prática médica nas áreas rural e urbana, contribuindo para propostas de estratégias para melhorar a qualidade e acesso a serviços de saúde.

El objetivo de este estudio fue identificar las diferencias en el alcance de las consultas médicas en atención primaria, así como averiguar los principales factores asociados con las consultas practicadas en áreas rurales y urbanas de Brasil. Los datos que se usaron provenían de una encuesta en línea a 2.277 médicos de asistencia primaria, llevada a cabo entre enero y marzo de 2016. Las diferencias, respecto a las actividades y procedimientos realizados por médicos según su localización, fueron verificadas por los test post hoc de Kruskal-Wallis/Dunn y chi-cuadrados. Los análisis de regresión lineal multivariada se realizaron usando una técnica de bootstrap para identificar los factores principales, asociados con un alcance extendido de la consulta. Independientemente de la localización, los resultados mostraron que los médicos de atención primaria están realizando su trabajo por debajo de sus competencias. Los médicos rurales realizaron un número más alto de procedimientos y actividades, comparado con sus pares en municipios de tamaño medio y urbanos. En la muestra global, las variables relacionadas con un alcance más amplio de las consultas incluyeron: género masculino, trabajo en municipalidades rurales, participar en el entrenamiento y programas de educación continua y protocolos de consulta clínica, artículos, y libros. Este estudio corrobora con evidencias que el alcance de las consultas médicas varía según la localización. Reconocer y comprender las diferencias y factores asociados para un alcance extendido de las consultas, son relevantes para determinar las habilidades y recursos requeridos para realizar consultas en áreas rurales y urbanas, así como para colaborar con propuestas de estrategias en la mejora de la calidad y acceso a los servicios de salud.

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El presente trabajo busca caracterizar las prácticas fonoaudiológicas en dos contextos de atención de la salud pública chilena (hospitalario y atención primaria -centros comunitarios de rehabilitación). Es un estudio cualitativo con enfoque micro-sociológico, que implicó la realización de entrevistas en profundidad y observaciones no participantes a dos fonoaudiólogos/as insertos en Centros Comunitarios de Rehabilitación (CCR) y dos fonoaudiólogos/as insertos en hospitales públicos. Los datos obtenidos se analizaron con herramientas de la Teoría Fundamentada y se propuso una conceptualización basada en semejanzas y diferencias de las prácticas fonoaudiológicas utilizando el software computacional ATLAS-ti. Del análisis surgen las siguientes categorías: rol del profesional, sujeto de atención, relación terapeuta-usuario/a, espacio físico y organización de la sesión, los/las participantes. Además, el principal hallazgo refiere a que todos/as los/las profesionales mencionan la relevancia de incorporar matices psicosociales en el abordaje que realizan. Sin embargo, en la práctica de todos/as los/las fonoaudiólogos/as durante la observación participante no se evidencia dicha incorporación. Los resultados permiten concluir que la conceptualización del quehacer fonoaudiológico se construye mayormente a partir del contexto laboral. Asimismo, los modelos de atención a la base (biomédico-biopsicosocial) se encuentran actualmente en un proceso de hibridación, siendo la práctica de los/las fonoaudiólogos/as situada y también influida por el contexto laboral.

The present work seeks to characterize speech therapy practices in two Chilean public health care contexts (hospital and primary care -community rehabilitation centers). It is a qualitative study with a micro-sociological approach, which involved conducting in-depth interviews and non-participant observations with two speech therapists inserted in Community Rehabilitation Centers (CCR) and two speech therapists enrolled in public hospitals. The data obtained were analyzed with Grounded Theory tools and a conceptualization based on similarities and differences of speech therapy practices was proposed using ATLAS-ti computational software. The following categories emerge from the analysis: role of the professional, subject of care, therapist-user relationship, physical space and organization of the session, the participants. In addition, the main finding refers to the fact that all the professionals mention the relevance of incorporating psychosocial nuances in the approach they carry out. However, in the practice of all speech therapists during participant observation, such incorporation is not evidenced. The results allow us to conclude that the conceptualization of speech therapy is built mostly from the work context. Likewise, the models of care at the base (biomedical-biopsychosocial) are currently in a process of hybridization, the practice of speech therapists being situated and also influenced by the work context.

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OBJECTIVES: to analyze the normative bases that guide the nurse technician's practice, clarifying how the performance of this category happens. METHODS: this is a qualitative study of exploratory and descriptive nature and of documentary type, held on the basis of the resolutions of the Brazilian Federal Nursing Council (Cofen). From a total of 364 resolutions published from 1975 to 2018, 15 accounted for the objective of the study and were therefore selected. RESULTS: this study systematized two analytical categories: areas of practice of the nurse technician, according to Cofen resolutions; and description of the professional's activities based on the resolutions. FINAL CONSIDERATIONS: the analysis of the normative bases that guide the nurse technician's practice leads to the conclusion of a possible frailty of theoretical and normative content to justify the practice of these professionals.

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PURPOSE: Critics argue that the American Board of Internal Medicine's medical oncology Maintenance of Certification examination requires medical oncologists with a narrow scope of practice to spend time studying material that is no longer relevant to their practice. However, no data are available describing the scope of practice for medical oncologists. METHODS: Using Medicare claims, we examined the scope of practice for 9,985 medical oncologists who saw 8.6 million oncology conditions in 2016, each of which was assigned to 1 of 23 different condition groups. Scope of practice was then measured as the percentage of oncology conditions within each of the 23 groups. We grouped physicians with similar scopes of practice by applying K-means clustering to the percentage of conditions seen. The scope of practice for each physician cluster was determined from the cancers that encompassed the majority of average oncology conditions seen among physicians composing the cluster. RESULTS: We found 20 distinct scope-of-practice clusters. The largest (n = 6,479 [65.5%]) had a general oncology scope of practice. The remaining physicians focused on a narrow scope of cancers, including 22.6% focused on ≥ 1 solid tumors and 11.9% focused on hematologic malignancies. The largest focused cluster accounted for 7.7% of physicians focused on breast cancer. CONCLUSION: A single American Board of Internal Medicine Maintenance of Certification assessment in medical oncology is most appropriate for approximately 65% of certified medical oncologists' practices. However, the addition of assessments focused on breast cancer and hematologic malignancies could increase this figure to upwards of 85% of certified medical oncologists.

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