Table 4 Convergent matrix of the research results
Components | Results | Inferences | Recommendations |
|---|---|---|---|
Regulation Objective: to identify legally authorized practices Method: document analysis | a) Curricular guidelines: comprehensive, indicate skills and abilities for primary care practices b) Normative documents of the Legislative and Executive branches and the professional council: regulate advanced practices in the context of primary healthcare (PHC) (nosological diagnoses of common and non-serious diseases, drug prescriptions, requests and interpretations for diagnostic tests, referrals) but are dependent on clinical protocols established by local administrators | a) The Professional Practice Law is outdated (it was created before the Brazilian Unified Health System (SUS)) and does not fully detail the activities that nurses can perform. The gaps in the legislation focus on the appropriation of tasks by other professions; excessive publications of regulations by professional councils that revoke, include, or ratify tasks; legal disputes with other categories, especially with physicians; insecurity in the professionals who provide care; limited social perception of the nurse’s scope of practice b) The practices performed by the nurse respond to the main healthcare demands of PHC c) The advanced practices prescribed in the legislation and performed by PHC nurses correspond to those defined by other countries d) The nurse’s autonomy is limited in places where there are no established clinical protocols, which points to nurses’ underutilization e) Exclusive medical acts are performed by nurses in places where there are no doctors f) Advanced practices have already been implemented in the context of Brazilian PHC, so it is not necessary to introduce the APN as a new professional category | a) Implement clinical protocols in all municipalities based on local needs b) In-service training for advanced practices c) Reforms in the training/education model that ensure the acquisition of skills for advanced practices d) Update the Professional Practice Law so that it considers incorporating the premises of the SUS, the content of the different normative acts issued by the professional council, and the details of the set of authorized activities for nurses |
Practices Objective: to identify the practices performed in the context of PHC Method: systematic review | a) Managerial, educational, clinical, and health surveillance practices b) Advanced practices based on clinical protocols: nosological diagnoses of common and non-serious diseases, drug prescriptions, requests and interpretations for diagnostic tests, referrals c) Exclusive medical practices: sutures, abscess drainage, application of local anesthesia | ||
Education Objective: to identify the practices taught in undergraduate nursing programs Method: exploratory research | a) The program prepares students for practices legally and historically recognized as nurses’ activities b) Partly prepares for advanced practices c) Does not prepare for exclusive medical practices d) Education administrators do not recognize advanced practices as part of the nurse's scope of practice |