scholarly journals Diagnóstico, intervenção precoce e prevenção do Delirium no adulto

2021 ◽  
Vol 16 (43) ◽  
pp. 2366
Author(s):  
Luciana Almeida ◽  
Sónia Martins ◽  
Nivaldo Marins ◽  
Lia Fernandes
Keyword(s):  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Confusion Assessment ◽  
Primary Health

Introdução: O delirium é uma síndrome frequente, com morbimortalidade associada considerável mas potencialmente prevenível se instituídas medidas de prevenção e rastreio adequadas. No entanto, é ainda pouco conhecida e muitas vezes subdiagnosticada, principalmente na Atenção Primária à Saúde onde está muitas vezes associado a internamento recente e situações benignas facilmente corrigíveis se detetadas precocemente. O objetivo deste trabalho foi a realização de uma revisão sobre o delirium, assim como propor uma abordagem diagnóstica, terapêutica e preventiva na Atenção Primária à Saúde. Métodos: Foi feita uma pesquisa bibliográfica  de artigos publicados entre janeiro de 2008 e dezembro de 2020, na PubMed e Scielo com o descritor “delirium” combinado com “primary health care” ou “general practice”. Resultados: Na abordagem do delirium, importa primeiro identificar indíviduos de risco, tarefa que tem por base um modelo multifactorial que conjuga fatores predisponentes e precipitantes. Em termos de métodos de rastreio, o mais usado é o Confusion Assessment Method, mas testes de avaliação da atenção ou Escala de Agitação e Sedação de Richmond podem também ser usados, sempre em associação com o exame físico completo para confirmação diagnóstica. A abordagem terapêutica e preventiva assenta essencialmente em medidas não farmacológicas que visam corrigir fatores de risco. Considerações Finais: De uma forma geral, o desenvolvimento de programas sistemáticos de formação e rastreio que envolvam uma equipa multidisciplinar, incluindo elementos da Atenção Primária à Saúde e cuidadores, podem ser a chave para o sucesso na redução da incidência do delirium e das suas consequências.

Understanding the general practice nursing workforce in New Zealand: an overview of characteristics 2015–19

2021 ◽  
Vol 27 (1) ◽  
pp. 22
Author(s):  
Sarah L. Hewitt ◽  
Nicolette F. Sheridan ◽  
Karen Hoare ◽  
Jane E. Mills
Keyword(s):  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
New Zealand ◽  
Survey Data ◽  
Nursing Workforce ◽  
Roles And Responsibilities ◽  
Primary Health ◽  
Part Time ◽  
Role Confusion

Limited knowledge about the nursing workforce in New Zealand general practice inhibits the optimal use of nurses in this increasingly complex setting. Using workforce survey data published biennially by the Nursing Council of New Zealand, this study describes the characteristics of nurses in general practice and contrasts them with the greater nursing workforce, including consideration of changes in the profiles between 2015 and 2019. The findings suggest the general practice nursing workforce is older, less diverse, more predominately New Zealand trained and very much more likely to work part-time than other nurses. There is evidence that nurses in general practice are increasingly primary health care focused, as they take on expanded roles and responsibilities. However, ambiguity about terminology and the inability to track individuals in the data are limitations of this study. Therefore, it was not possible to identify and describe cohorts of nurses in general practice by important characteristics, such as prescribing authority, regionality and rurality. A greater national focus on defining and tracking this pivotal workforce is called for to overcome role confusion and better facilitate the use of nursing scopes of practice.

Community Health and General Practice: The Impact of Different Cultures on the Integration of Primary Care

2001 ◽  
Vol 7 (1) ◽  
pp. 65 ◽  
Author(s):  
Hal Swerissen ◽  
Jenny Macmillan ◽  
Catuscia Biuso ◽  
Linda Tilgner
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
Community Health ◽  
Community Health Centres ◽  
Care Services ◽  
Primary Health ◽  
Health Centres ◽  
The Relationship

This study examined the existing relationship between community health centres and General Practice Divisions in the State of Victoria, including the nature of joint working arrangements and the identification of barriers to greater collaboration. Improved integration of primary health care services has been advocated to improve consumer and population health outcomes and to reduce inappropriate use of acute and extended care services. General practitioners (GPs) and community health centres are two key providers of primary health care with potential for greater integration. The current study conducted telephone interviews with 20 community health centre CEOs and 18 Executive Officers of divisions, which were matched according to catchment boundaries. Results suggest, while some joint planning is occurring, especially on committees, working parties and projects, there is an overall low level of satisfaction with the relationship between community health centres and GPs and GP divisions. Major barriers to greater integration are the financial or business interests of GPs and misunderstanding and differences in perceived roles and ideology between GPs and community health centres. Improved communication, greater contact and referral and follow-up procedures are identified as a means of improving the relationship between GPs, GP divisions and community health centres. Community health centres and general practitioners (GPs) are key providers of primary care (Australian Community Health Association, 1990).

scholarly journals Why are there gaps in our management of those with high cardiovascular risk?

2012 ◽  
Vol 4 (1) ◽  
pp. 21 ◽  
Author(s):  
Fiona Doolan-Noble ◽  
Jocelyn Tracey ◽  
Stewart Mann
Keyword(s):  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
Cardiovascular Risk ◽  
New Zealand ◽  
Barriers And Facilitators ◽  
Care Providers ◽  
High Cardiovascular Risk ◽  
Text Data ◽  
Primary Health

INTRODUCTION: Multiple New Zealand and other international studies have identified gaps in the management of those identified at high risk of a future cardiovascular (CV) event. This study sought to explore the views of health professionals about the barriers and facilitators present within the current primary health care system to the optimal management of those at high CV risk. METHODS: This qualitative study utilised a focus group methodology to examine the barriers and facilitators within primary health care (PHC), and employed a general inductive approach to analyse the text data. FINDINGS: The analysis of text data resulted in the emergence of interrelated themes, underpinned by subthemes. The patient, their circumstances and their characteristics and perceptions provided the first key theme and subthemes. The next key theme was primary health care providers, with subthemes of communication and values and beliefs. The general practice was the third theme and included multiple subthemes: implementation planning and pathway development, time and workload and roles and responsibilities. The final main theme was the health system with the subthemes linking to funding and leadership. CONCLUSION: This study determined the factors that act as barriers and facilitators to the effective management of those at high CV risk within the New Zealand PHC sector. General practice has a pivotal role in preventive health care, but to succeed there needs to be a refocusing of the PHC sector, requiring support from policy makers, District Health Boards and Primary Health Organisations, as well as those working in the sector. KEYWORDS: Primary health care; high cardiovascular risk management; general practitioners; practice nurses; barriers; facilitators

scholarly journals Caring for refugees in general practice: perspectives from the coalface

2014 ◽  
Vol 20 (1) ◽  
pp. 85 ◽  
Author(s):  
Rebecca Farley ◽  
Deborah Askew ◽  
Margaret Kay
Keyword(s):  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
Health Care Providers ◽  
Minority Groups ◽  
Health Care Systems ◽  
Refugee Health ◽  
Care Providers ◽  
Structured Interviews ◽  
Primary Health

This qualitative research project explored the experiences of primary health care providers working with newly arrived refugees in Brisbane. Data from 36 participants (20 general practitioners, five practice nurses and 11 administrative staff) involved in five focus groups and four semi-structured interviews were analysed. The results indicated that despite difficulties, providers are committed and enthusiastic about working with refugees. The flexibility of the general practice setting enables innovative approaches. The establishment of a specialised refugee health service in Brisbane has improved providers’ capacity to deliver refugee health care. However, most practices continue to feel isolated as they search for solutions, and the need for greater supports and a more coordinated approach to care were emphasised. The themes of communication, knowledge and practice and health care systems encapsulated the factors that influence health care providers’ ability to care for refugees and provide a framework for improving available supports. Australian primary health care is currently undergoing great change, which provides an opportunity to make significant gains in the provision of care for refugees and other minority groups within our community. As health care reforms are implemented it is essential that they are responsive to the expressed needs of health care providers working in these areas.

scholarly journals The Nursing Presence in General Practice: Revealing Dimensions of Day-to-day Experience of Practice Nurses in New Zealand

2021 ◽  
Author(s):  
◽  
Katrina Fyers
Keyword(s):  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
New Zealand ◽  
Models Of Care ◽  
Complex Nature ◽  
Practice Nurses ◽  
Nursing Leaders ◽  
Primary Health ◽  
General Practices

<p>This study makes visible and gives value to the day-to-day experience of practice nurses who work in New Zealand general practices. Nursing leaders internationally and locally have highlighted the importance of the Primary Health Care nurse to improving health outcomes, addressing inequalities and implementing new models of care. As one of the largest groups of Primary Health Care nurses, practice nurses have a significant part to play. There is however, no consensus and limited research related to the day-to-day experience of practice nurses. Therefore, the nature, extent, and contribution of nursing in general practice may be overlooked or misunderstood. Furthermore as an autonomous self-regulating profession, nursing has a responsibility to the public to provide understanding of nursing in the present and in the future, particularly when this relates to the care of families and the structure of health systems. Located within the qualitative research paradigm and utilising a narrative inquiry methodology, this study applies a 'supportive voice' to highlight the experience of five practice nurses, and in the process makes visible the dimensions of nursing work in New Zealand general practices. The five constructed narratives particularly draw attention to the complex nature of nursing work that practice nurses engage in daily, the importance of nurse-patient relationships and continuity of care and the significance of autonomous and specialty aspects of nursing practice. Ultimately, the value of the practice nurse in the day-to-day operation of general practice is brought to the fore.</p>

scholarly journals Community engagement in general practice: a qualitative study

2019 ◽  
Vol 11 (2) ◽  
pp. 146 ◽  
Author(s):  
N. Rowe ◽  
R. Keenan ◽  
L. Lack ◽  
N. Malloy ◽  
R. Strasser ◽  
...  
Keyword(s):  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
Qualitative Study ◽  
Conceptual Framework ◽  
Community Engagement ◽  
Perceived Benefits ◽  
Primary Health ◽  
General Practices ◽  
Systematic Framework

ABSTRACT BACKGROUNDCommunity engagement is believed to be an important component of quality primary health care. We aimed to capture specific examples of community engagement by general practices, and to understand the barriers that prevent engagement. METHODSWe conducted 20 distinct interviews with 31 key informants from general practice and the wider community. The interviews were semi-structured around key relevant topics and were analysed thematically. RESULTSKey themes identified from the interview transcripts included an understanding of ‘community’, examples of community engagement and the perceived benefits and barriers to community-engaged general practice. We particularly explored aspects of community engagement with Māori. CONCLUSIONSGeneral practices in the study do not think in terms of communities, and they do not have a systematic framework for engagement. Although local champions have generated some great initiatives, most practices seemed to lack a conceptual framework for engagement: who to engage with, how to engage with them, and how to evaluate the results of the engagement.

scholarly journals Role Identification: an Impediment to Effective Core Primary Health Care Teamwork?

2021 ◽  
Author(s):  
◽  
Jean Ross
Keyword(s):  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
General Practitioners ◽  
Team Work ◽  
Role Clarity ◽  
Practice Nurses ◽  
Attitudinal Differences ◽  
Primary Health ◽  
The Future

<p>This study, which is methodologically grounded in qualitative research and philosophically informed by critical social science, explores important aspects of the socio-political context in which practice nurses and general practitioners (core primary health care team) work within a team environment. It is indicated in the literature that there are benefits for improved health care through the development of collaborative teamwork. However, there have been many barriers identified which prevent collaborative teamwork. Amongst the many barriers, is the lack of role clarity and attitudinal differences. Role clarity and attitudinal differences are the topic of this thesis. This thesis explored and highlighted whether the lack of role clarity and attitudinal differences do indeed impede the team's success, and are barriers to teamwork. The views and opinions of practice nurses and general practitioners understanding of their own and each other's current roles within the general practice setting were explored. The participants had the opportunity to discuss together, in focus group meetings, their thoughts on the topic. This raised their awareness of their taken for granted ideas on role and teamwork. Focus groups offered the participants the added opportunity to question each other which allowed for a deeper and more fulfilling understanding of role. New understandings that emerged could lead to alternative models of health care and influence the future delivery and planning of general practice. The thesis concludes by offering a potentially suitable model/framework which has been developed to further the understanding of teamwork in the future.</p>

A complexity perspective on health care improvement and reform in general practice and primary health care

2010 ◽  
Vol 16 (1) ◽  
pp. 29 ◽  
Author(s):  
Barbara J. Booth ◽  
Nicholas Zwar ◽  
Mark Harris
Keyword(s):  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
Organisational Change ◽  
Alternative View ◽  
Policy Makers ◽  
Complex Processes ◽  
Primary Health ◽  
Health Care Improvement ◽  
Care Improvement

Health care improvement is always on the planning agenda but can prove frustrating when ‘the system’ seems to have a life of its own and responds in unpredictable ways to reform initiatives. Looking back over 20 years of general practice and primary health care in Australia, there has been plenty of planning and plenty of change, but not always a direct cause and effect relationship between the two. This article explores in detail an alternative view to the current orthodoxy of design, control and predictability in organisational change. The language of complexity is increasingly fashionable in talking about the dynamics of organisational behaviour and health care improvement, but its popular use often ignores challenging implications. However, when interpreted through human sociology and psychology, a complexity perspective offers a better match with everyday human experience of change. As such, it offers some suggestions for leaders, policy makers and managers in health care: that uncertainty and paradox are inherent in organisational change; that health care reform must pay attention to the constraints and politics of the everyday; and that change in health systems results from the complex processes of relating among those involved and that neither ‘the system’ nor a few individuals can be accountable for overall performance and outcomes.

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