No / The Mid Staffordshire scandal is a salutary lesson that highlights unacceptable standards of poor care of patients by medical and nursing practitioners. The Francis report (2013) made 290 recommendations and a legal duty to enforce a duty of openness and transparencies has been prioritised. Fischer and Ferlie (2013) argue that rules-based regulation eroded values-based self-regulation, producing professional defensiveness and contradictions that undermine, rather than support, good patient care. The role of managers and clinical leaders will be crucial in achieving positive changes in practice; however, the return of autonomy to the practitioners remains central to re-establishing both public and professional confidence.

Yes / Reducing emergency admissions to hospital has been a cornerstone of health care policy. There is little evidence of systematic interventions which achieved this aim across a population. We report the impact on unplanned admissions to hospital through a complex intervention over a 44 month period in Frome, Somerset. A population health complex intervention of an enhanced model of primary care and compassionate communities to improve population health and reduce emergency admissions to hospital Design: A cohort retrospective study of a complex intervention on all emergency admissions in Frome compared to Somerset from April 2013 to December 2017. Setting: Frome Medical Practice, Somerset Methods: Patients were identified using broad criteria including anyone with cause for concern. Patient centred goal setting and care planning combined with a compassionate community social approach was implemented broadly across the population of Frome. Results: There was a progressive reduction, by 7.9 cases per quarter (95% CI: 2.8, 13.1; p=0.006) in unplanned hospital admissions across the whole population of Frome, over the study period from April 2014 to December 2017. At the same time, there was sharp increase in the number of admissions per quarter, within the Somerset, with an increase in the number of unplanned admissions of 236 per quarter (95% CI: 152, 320; p<0.001). Conclusion: The complex intervention in Frome was associated with highly significant reductions in unplanned admissions to hospital with reduction of healthcare costs across the whole population of Frome

Earlier studies show that when psychiatric out- and in-patient care units work together the risk for hospitalization decreases, leads to increased flexibility and shorter in-patient periods. At a psychiatric clinic in western Sweden there are routines in place regarding the transfer of patients from in-patient to out-patient care. The aim of this study was to describe nurses' experience of how out-and in-patient clinics collaborate during patients in-patient care. This is a qualitative study with an inductive approach. Ten nurses participated through semi structured interviews. The result ended up in two domains and eight subthemes and one theme, the diffuse responsibility – makes us not understand each other. Nurses in both out- and in-patient care experience uncertainty as to who has the responsibility for patients' treatment-plans and also uncertainty in how communication between the two parties works. Nurses in in-patient care experience that the out-patient care are uninterested, and nurses in out-patient care experience that in-patient care does not follow treatment-plans. In Conclusion both nurses in out- and in-patient care describe a need for an improved partnership. Some find that they are unsure of their role and their responsibility in the partnership. Structures for an improved partnership need to be implemented from the staff leadership, to be able to live up to the national guidelines and ensure that patients receive the treatment which serious psychiatric illness needs.

XXX Pharmacy is an independently-owned retail pharmacy in Johannesburg. Good Pharmacy Practice standards make it mandatory for pharmacists to provide “pharmaceutical care”, a highly patient-centred approach to providing pharmaceutical services. Since XXX Pharmacy has a high patient load, a shortage of dispensary staff and a strategic focus on operational efficiency, the question arose whether pharmacists comply fully with Good Pharmacy Practice standards for the provision of pharmaceutical care. Non-compliance poses operational risks that could undermine the business’s financial performance. The research statement was thus that the current performance management system undermines compliance with Good Pharmacy Practice standards for the provision of pharmaceutical care to patients. A triangulation approach was used. The quantitative research method, in which 200 patients completed a questionnaire, investigated two research objectives: (i) whether the pharmacy complies with Good Pharmacy Practice standards for pharmaceutical care; and (ii) whether there is a relationship between patients’ race or gender and their responses. The qualitative research method involved conducting individual semi-structured interviews with all four dispensary employees to achieve another two research objectives: (i) to determine whether the provision of pharmaceutical care is viewed as a key performance area by pharmacists; and (ii) to investigate what aspects of the implementation of the performance management system are viewed as enabling or undermining the provision of pharmaceutical care.

Class of 2010 Abstract / OBJECTIVES: To determine what information and clinical skill sets current student pharmacists, recent graduates, and current preceptors felt should be incorporated in designing the Advanced Patient Care course at The University of Arizona College of Pharmacy (UACOP). METHODS: This was a prospective, descriptive study using focus groups. Subjects included students in the fourth year of a four-year Doctor of Pharmacy program at the UACOP currently on rotations, recent UACOP graduates practicing in residency programs, and current preceptors for the UACOP who work closely with the students. Participants verbally consented and completed a demographic questionnaire. The three focus group sessions (each lasting 1.5 hours) were audiotaped, and the data was coded into categories and subcategories based on frequencies of topics that were discussed. RESULTS: A total of 14 subjects, separated into three focus groups of students, residents, and preceptors were held with 5, 4, and 5 subjects respectively. Both men and women were included in the study, with only females in the resident group. The student, resident, and preceptor groups had mean ages of 29±5.4, 28±3.7, and 47±12 years respectively. Overall the most commonly discussed topics included various learning techniques, specific drug or disease state focuses, and the importance of professionalism. CONCLUSIONS: Many insightful ideas for the Advanced Patient Care course soon to be implemented at the UACOP were generated by the three focus groups. Focus groups including pharmacy students, residents and preceptors are a useful tool for designing new courses and determining information and skill sets to be added to college of pharmacy curriculums.

The problem of this study was the development of a theoretical construct based on a survey of current practices and consistent with accepted theories of touch as they related to nursing.

O propósito deste estudo foi desenvolver um software-protótipo, que possibilite aos enfermeiros atender ao planejamento da assistência de enfermagem, prescrição de intervenções de enfermagem e toda sua documentação de forma informatizada.A equipe multiprofissional envolvida no desenvolvimento deste software-protótipo foi constituída pela pesquisadora, um analista de sistema e um programador. A metodologia utilizada fundamentou-se no ciclo de vida de desenvolvimento de sistema, baseando-se no conceito de prototipação. Sedimentou-se em duas fases: a fase de definição e a de desenvolvimento. A fase de definição iniciou-se com a etapa de planejamento, seguido pela definição e análise dos requisitos necessários para sua construção e culminou com a produção da especificação de requisitos do software. A fase de desenvolvimento traduziu o conjunto de requisitos em um modelo informatizado, estruturado em 10 módulos, referentes ao processo de sistematização da assistência de enfermagem. Os módulos denominados: Ficha de Identificação, Dados Clínicos, Internações, Informações adicionais e Entrevista armazenam dados relativos às necessidades humanas básicas e abrangem: o índice de massa corpórea, situação clínica, resumo de admissão, internações anteriores e os dados para identificação do paciente. O módulo para Coleta de Dados foi desenhado para cadastrar informações diferenciadas sobre os sinais e sintomas e gerar, automaticamente, o módulo Lista de Problemas. Este viabiliza a elaboração da prescrição de enfermagem específica para cada paciente por meio da utilização de uma base de dados previamente estabelecida pelo sistema. Para propiciar maior comodidade e agilidade nas atividades de documentação, o módulo sobre Sinais Vitais permite transformar, eletronicamente, os valores atribuídos à pressão arterial, pulso, respiração e temperatura em gráficos individualizados. O ambiente Balanço Hidroeletrolítico permite implementar, automaticamente, o balanço parcial e total oferecendo aos enfermeiros simplicidade na execução desta tarefa, bem como realizar seu acompanhamento posterior. A avaliação deste recurso inovador na performance da Sistematização da Assistência de Enfermagem nos diferentes estágios do seu processo será objeto de um estudo posterior. / The purpose of this study is to develop a software-prototype to help the nurses to plan the nursing care, to make nursing interventions and all documentation in a computerized way. The multi- professional team is involved in the development of this software-prototype and constituted by the researcher, a system analyst and a programmer. The methodology is based in the life cycle of system development, basing on the prototype concept. It is following up into two phases: the definition and the development one. The definition phase began with the planning stage, following for the definition and analysis of the requirements for the construction and it culminated with the specification of the software requirements.The development phase translated the group of requirements in a computerized model, structured in 10 modules, regarding the process of nursing care system. The Identification, Clinical Data, Interview and additional Information modules store data related to the basic human needs and they include: the index of corporal mass, clinical situation, admission summary, and the patient's identification. The Data Collection module was design to register information related to the signs and symptoms and to generate, automatically, the List of Problems module. This makes possible the elaboration of the nursing prescription of each patient using the data base established previously by the system. To make better the documentation activities, the Vital Signs module allows to transform, electronically, the values attributed to the blood pressure, pulse, breathing and temperature in individualized graphs.The fluid and electrolyte metabolism balance module allows to implement, automatically, the partial and total response helping the nurses in the execution of this task, as well as to accomplish the subsequent attendance. The evaluation of this innovative resource in the performance of Nursing Care System will be object of a subsequent study.

XXX Pharmacy is an independently-owned retail pharmacy in Johannesburg. Good Pharmacy Practice standards make it mandatory for pharmacists to provide “pharmaceutical care”, a highly patient-centred approach to providing pharmaceutical services. Since XXX Pharmacy has a high patient load, a shortage of dispensary staff and a strategic focus on operational efficiency, the question arose whether pharmacists comply fully with Good Pharmacy Practice standards for the provision of pharmaceutical care. Non-compliance poses operational risks that could undermine the business’s financial performance. The research statement was thus that the current performance management system undermines compliance with Good Pharmacy Practice standards for the provision of pharmaceutical care to patients. A triangulation approach was used. The quantitative research method, in which 200 patients completed a questionnaire, investigated two research objectives: (i) whether the pharmacy complies with Good Pharmacy Practice standards for pharmaceutical care; and (ii) whether there is a relationship between patients’ race or gender and their responses. The qualitative research method involved conducting individual semi-structured interviews with all four dispensary employees to achieve another two research objectives: (i) to determine whether the provision of pharmaceutical care is viewed as a key performance area by pharmacists; and (ii) to investigate what aspects of the implementation of the performance management system are viewed as enabling or undermining the provision of pharmaceutical care.

O propósito deste estudo foi desenvolver um software-protótipo, que possibilite aos enfermeiros atender ao planejamento da assistência de enfermagem, prescrição de intervenções de enfermagem e toda sua documentação de forma informatizada.A equipe multiprofissional envolvida no desenvolvimento deste software-protótipo foi constituída pela pesquisadora, um analista de sistema e um programador. A metodologia utilizada fundamentou-se no ciclo de vida de desenvolvimento de sistema, baseando-se no conceito de prototipação. Sedimentou-se em duas fases: a fase de definição e a de desenvolvimento. A fase de definição iniciou-se com a etapa de planejamento, seguido pela definição e análise dos requisitos necessários para sua construção e culminou com a produção da especificação de requisitos do software. A fase de desenvolvimento traduziu o conjunto de requisitos em um modelo informatizado, estruturado em 10 módulos, referentes ao processo de sistematização da assistência de enfermagem. Os módulos denominados: Ficha de Identificação, Dados Clínicos, Internações, Informações adicionais e Entrevista armazenam dados relativos às necessidades humanas básicas e abrangem: o índice de massa corpórea, situação clínica, resumo de admissão, internações anteriores e os dados para identificação do paciente. O módulo para Coleta de Dados foi desenhado para cadastrar informações diferenciadas sobre os sinais e sintomas e gerar, automaticamente, o módulo Lista de Problemas. Este viabiliza a elaboração da prescrição de enfermagem específica para cada paciente por meio da utilização de uma base de dados previamente estabelecida pelo sistema. Para propiciar maior comodidade e agilidade nas atividades de documentação, o módulo sobre Sinais Vitais permite transformar, eletronicamente, os valores atribuídos à pressão arterial, pulso, respiração e temperatura em gráficos individualizados. O ambiente Balanço Hidroeletrolítico permite implementar, automaticamente, o balanço parcial e total oferecendo aos enfermeiros simplicidade na execução desta tarefa, bem como realizar seu acompanhamento posterior. A avaliação deste recurso inovador na performance da Sistematização da Assistência de Enfermagem nos diferentes estágios do seu processo será objeto de um estudo posterior. / The purpose of this study is to develop a software-prototype to help the nurses to plan the nursing care, to make nursing interventions and all documentation in a computerized way. The multi- professional team is involved in the development of this software-prototype and constituted by the researcher, a system analyst and a programmer. The methodology is based in the life cycle of system development, basing on the prototype concept. It is following up into two phases: the definition and the development one. The definition phase began with the planning stage, following for the definition and analysis of the requirements for the construction and it culminated with the specification of the software requirements.The development phase translated the group of requirements in a computerized model, structured in 10 modules, regarding the process of nursing care system. The Identification, Clinical Data, Interview and additional Information modules store data related to the basic human needs and they include: the index of corporal mass, clinical situation, admission summary, and the patient's identification. The Data Collection module was design to register information related to the signs and symptoms and to generate, automatically, the List of Problems module. This makes possible the elaboration of the nursing prescription of each patient using the data base established previously by the system. To make better the documentation activities, the Vital Signs module allows to transform, electronically, the values attributed to the blood pressure, pulse, breathing and temperature in individualized graphs.The fluid and electrolyte metabolism balance module allows to implement, automatically, the partial and total response helping the nurses in the execution of this task, as well as to accomplish the subsequent attendance. The evaluation of this innovative resource in the performance of Nursing Care System will be object of a subsequent study.

FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / O princÃpio da interprofissionalidade à critÃrio fundamental que orienta equipes multiprofissionais na EstratÃgia SaÃde da FamÃlia. A aÃÃo profissional, no entanto, parece ser marcada por uma lÃgica caracterizada pela delimitaÃÃo estreita de territÃrios de cada categoria, conformando um quadro de disputa entre as lÃgicas contraditÃrias da profissionalizaÃÃo e da interprofissionalidade. Esta à compreendida como a sÃntese de um processo de integraÃÃo de saberes e de colaboraÃÃo interprofissional, processos estes mediados pelos afetos. Considerando haver obstÃculos diversos para a efetivaÃÃo da interprofissionalidade, a pesquisa objetiva compreender a dinÃmica das relaÃÃes interprofissionais na produÃÃo do cuidado na EstratÃgia SaÃde da FamÃla, explorando a existÃncia de condiÃÃes de possibilidade para a construÃÃo da interprofissionalidade na AtenÃÃo PrimÃria à SaÃde no Brasil. Trata-se de estudo de caso, de natureza qualitativa, inspirado na HermenÃutica. O cenÃrio de estudo à um Centro de SaÃde da FamÃlia, numa capital brasileira. A recolha das informaÃÃes foi procedida no perÃodo de marÃo a agosto de 2011, com realizaÃÃo de entrevistas abertas, observaÃÃo das atividades desenvolvidas pelas equipes e realizaÃÃo de oficinas de produÃÃo de conhecimento, envolvendo 23 profissionais da ESF, NÃcleos de Apoio à SaÃde da Familia e residentes de Medicina e de SaÃde da FamÃlia e Comunidade. Foram identificadas condiÃÃes de possibilidades da interprofissionalidade na ESF, sintetizadas em trÃs dimensÃes: organizacional, coletiva e subjetiva. Incluem-se na dimensÃo organizacional dispositivos e arranjos institucionais, suportes para as atividades interprofissionais, quais sejam: a estruturaÃÃo de uma âRede de SaÃde â Escolaâ, transformando todas as unidades de saÃde de um municÃpio em espaÃos de ensino, pesquisa e assistÃncia; a âEducaÃÃo Permanente Interprofissionalâ que contribua para ultrapassar a lÃgica da profissionalizaÃÃo ainda hegemÃnica na formaÃÃo dos trabalhadores da saÃde; bem como a âAbordagem Centrada na FamÃliaâ, em contraposiÃÃo à tendÃncia de organizar os serviÃos de saÃde com base em interesses corporativos. A segunda dimensÃo enfoca aspectos relacionados à organizaÃÃo dos profissionais como grupo de trabalho, ou seja, a organizaÃÃo do coletivo em comunidade de prÃtica, caracterizada pela pactuaÃÃo de um projeto em comum, engajamento mÃtuo e repertÃrios compartilhados. Mesmo tendo sido os profissionais da saÃde formados hegemonicamente para a lÃgica da profissionalizaÃÃo, envolvendo luta por status e reserva de mercado de trabalho, a participaÃÃo numa equipe da ESF, constituida como comunidade de prÃtica, possibilita a aprendizagem de outros valores, favorecendo a integraÃÃo de saberes e a colaboraÃÃo interprofissional, embora nÃo livre de conflitos. A terceira dimensÃo privilegia aspectos subjetivos, como a identificaÃÃo dos profissionais com o modelo assistencial da ESF, saber lidar com frustraÃÃes e a afetividade. Consideramos ser possÃvel a interprofissionalidade, desde que sejam disponibilizadas condiÃÃes organizacionais e coletivas, mobilizadoras de aspectos subjetivos dos profissionais. A oferta das condiÃÃes de possibilidade, no plano organizacional, à indispensÃvel, mas nÃo suficiente para a integraÃÃo de saberes e a colaboraÃÃo interprofissional. Sem a mobilizaÃÃo dos afetos, dos desejos e dos micropoderes de cada sujeito, nÃo hà interprofissionalidade possÃvel. / The principle of interprofessional learning and practice is a fundamental criterion that guides multidisciplinary teams in the Family Health Strategy (FHS).The professional action however, seems to be marked by a logic characterized by the narrow boundaries of the territories of each category as a scene of contention between the contradictory logics of professionalization and interprofessional practice. This is understood as the synthesis of a process of integration of knowledge and interprofessional collaboration (COLET, 2002). These processes are mediated by affects. Considering that there are several obstacles to the realization of the interprofessional learning and practice, the research aims to understand the dynamics of inter-relationships in the production of care in the familyÂs health strategy, exploiting the existence of conditions of possibility for the construction of interprofessional learning and practice. This is a qualitative case study inspired by hermeneutics. The scenario is a study of the Family Health Center, in a Brazilian capital. The gathering of the information was provided from March to August 20122, with open interviews, observation of activities in the FHS and workshops for knowledge production, involving 23 professionals. Conditions were identified in the possibilities of interprofessional FHS, combined in the following groups: Organizational, collective, and subjective. Included in the organizational dimension are devices and institutional arrangements, cross-media activities for the structuring of a âHealth-Education systemsâ, transforming all health facilities of a municipality into areas of teaching, research, and assistance. The âinterprofessional continuing educationâ helps to overcome the hegemonic logic of professionalism, sill found in the training of healthcare workers and user-centered approach, in contrast to the trend of organizing health service base on corporate interests. The second dimension focuses on aspects related to the organization of professionals working as a group, or the organizations of the collective community practice, characterized by agreeing on a common project, mutual engagement and shared repertoire. Even though health professionals trained to the hegemonic logic of professionalization, involving a struggle to preserve status and labor market participation in the ESF team, the way they are formed as a community of practice, enables the learning of other values, knowledge and practice, favoring the integration of interprofessional collaboration and knowledge, though not free of conflict. The third dimension includes subjective aspects such as the identification of professionals of the ESF health care model, dealing with frustration and affection. We consider that the interprofessional learning and practice is possible, if subjected to the organizational and collective conditions, mobilizing subjective aspects of professionals. The offering conditions of possibility in the organizational level are essential but not sufficient for integration of knowledge and interprofessional collaboration. Without the mobilization of emotions, desires and micro powers of each subject, inter-professional learning and practice is not possible.