Exercise of essential competencies for midwifery care by nurses in Sao Paulo, Brazil

General objective: to analyse the exercise of essential competencies for midwifery care by nurses and/or midwives in the public health system of Sao Paulo (eastern zone), Brazil. Specific objectives: to develop a profile of the public health institutions and of the nurses and/or midwives who care for women before, during and following child birth; to identify the activities performed in providing such care, as well as their frequency; and to specify the possible obstacles or difficulties encountered by them when exercising their competencies. Design: a descriptive and exploratory research design , using a quantitative approach. Setting: the study was conducted in all public health services of Sao Paulo (eastern zone), Brazil, namely 59 basic health-care units and six hospitals, during the period of October 2006-December 2007. Participants: the study population consisted of 272 nurses and/or midwives who provide care for pregnant women and newborns at the primary health-care units and maternity hospitals of the public health system. Participants comprised 100% of hospital nurse coordinators (n = 6), 61% of hospital maternity nursing and/or midwifery staff (n = 62) and 64% (n = 204) of nursing and/or midwifery staff working at primary health-care units. Methods and findings: the data collection was based on a single form given to the coordinators and two questionnaires, one handed out to antenatal and postnatal nursing and/or midwifery staff and another handed out to labour and birth nursing and/or midwifery staff. The results showed that nurses and/or midwives providing care for women during pregnancy, labour, birth and the postnatal period did not put the essential competencies for midwifery care into practice, because they encountered institutional barriers and personal resistance, and lacked protocols based on best practice and on the exercise of essential competencies needed for effective midwifery care. Key conclusions: the model of care in the public health services of Sao Paulo (eastern zone) is based much more on hierarchical positions than on professional competencies or on there commendations of the scientific community. As a result, health authorities need to review their midwifery policies to improve maternal-infant care by nurses and/or midwives in order to ensure the implementation of best midwifery practice. Practical implications: the results of this study support actions to improve the quality of care delivered to women and their families, while integrating nursing and midwifery care in Sao Paulo, Brazil. (C) 2009 Elsevier Ltd. All rights reserved.

Identification of nurses` competencies in primary health care through a Delphi study in southern Brazil

Objective: This investigation aimed to identify and analyze the general and specific competencies of nurses in the primary health care practice of Brazil. Design: The Delphi Technique was used as the method of study. Sample: 2 groups of participants were selected: One contained primary health care nurses (n=52) and the other specialists (n=57), including public health nurses and public or community health faculty. Measurements: 3 questionnaires were developed for the study. The first asked participants to indicate general and specific competencies, which were compiled into a list for each group. A Likert scale of 1-5 was added to these 2 lists in the second and third questionnaires. A consensus criterion of 75% for score 4 or 5 was adopted. Results: In the nurses` group, 17 general and 8 specific competencies reached the consensus criterion; 19 general and 9 specific competencies reached the criterion in the specialists` group. These competencies were classified into 10 domains: professional values, communication, teamwork, management, community-oriented, health promotion, problem solving, health care, and education and basic public health sciences. Conclusions: These competencies reflect Brazilian health policy and constitute a reference for health professional practice and education.

Primary immunodeficiency diseases in Latin America: Proceedings of the Second Latin American Society for Immunodeficiencies (LASID) Advisory Board

Early diagnosis and appropriate therapy are essential for the best prognosis and quality of life in patients with primary immunodeficiency diseases (PIDDs). Experts from several Latin American countries have been meeting on a regular basis as part of an ongoing effort to improve the diagnosis and treatment of PIDD in this region. Three programmes are in development that will expand education and training and improve access to testing facilities throughout Latin America. These programmes are: an educational outreach programme (The L-Project); an immunology fellowship programme; and the establishment of a laboratory network to expand access to testing facilities. This report provides the status of these programmes based on the most recent discussions and describes the next steps toward full implementation of these programmes. (C) 2010 SEICAP. Published by Elsevier Espana, S.L. All rights reserved.