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EXPERIENCE REPORT02-06-2023
Surgical counting: design of implementation and maintenance of a standardized evidence-based procedure
Revista Brasileira de Enfermagem. 2023;76(1):e20220144
Abstract
EXPERIENCE REPORTSurgical counting: design of implementation and maintenance of a standardized evidence-based procedure
Revista Brasileira de Enfermagem. 2023;76(1):e20220144
DOI 10.1590/0034-7167-2022-0144
Views0ABSTRACT
Objectives:
to report the implementation and maintenance of an evidence-based Standard Operating Procedure for surgical counting performed at a teaching hospital.
Methods:
a report of a project to implement evidence for surgical counting, carried out at a university hospital in December 2017, and the subsequent cycles for better performance of the implemented organizational document and maintenance of better results until March 2022.
Results:
the report is divided into implementation project presentation and four other cycles after implementation, related to maintenance of improvements. It was possible to prepare a Standard Operating Procedure for Surgical Count, train the nursing team, carry out educational intervention for surgical teams.
Final Considerations:
there was an improvement in complying with the standardized procedure at the first moment and worsening in the period related to the pandemic. New efforts began again, including a self-instructive online course combined with first-time strategies.
Keywords:Evidence-based NursingImplementation ScienceOutcome Assessment (Health Care)Patient SafetySurgicentersSee more -
ORIGINAL ARTICLE02-06-2023
Sexuality and its effects on older adults’ depressive symptoms and quality of life
Revista Brasileira de Enfermagem. 2023;76(1):e20210645
Abstract
ORIGINAL ARTICLESexuality and its effects on older adults’ depressive symptoms and quality of life
Revista Brasileira de Enfermagem. 2023;76(1):e20210645
DOI 10.1590/0034-7167-2021-0645
Views0See moreABSTRACT
Objectives:
to analyze the effects of sexuality on depressive symptoms and quality of life in older adults.
Methods:
a cross-sectional and analytical study, developed with 596 older adults, who completed four instruments for data collection. Data were analyzed using the Kruskal-Wallis test and Structural Equation Modeling, with a 95% Confidence Interval.
Results:
among the sexuality dimensions, only physical and social adversities exerted statistically significant effects on depressive symptoms (SC=-0.095; p=0.003), but with low magnitude. Moreover, all sexuality dimensions had statistically significant effects on quality of life, being of low magnitude for sexual act (SC=0.171; p=0.010) and for physical and social adversities (SC=0.228; p<0.001), and moderate magnitude for affective relationships (SC=0.474; p<0.001).
Conclusions:
effects of different magnitudes were observed between sexuality dimensions on participants’ depressive symptoms and quality of life.
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REVIEW02-06-2023
Nursing care management concepts: scoping review
Revista Brasileira de Enfermagem. 2023;76(1):e20220020
Abstract
REVIEWNursing care management concepts: scoping review
Revista Brasileira de Enfermagem. 2023;76(1):e20220020
DOI 10.1590/0034-7167-2022-0020
Views0ABSTRACT
Objectives:
to clarify the concepts of Nursing Care Management and Nursing Care Administration in the scientific literature, highlighting approximations and distances between the terms.
Methods:
scoping review as per Joanna Briggs Institute protocol and preferred reporting items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR). The searches were performed in LILACS, CINAHL, MEDLINE, and Scopus databases.
Results:
the qualitative analysis, through content analysis, counted 49 studies published between 2007 and 2020. Hospital care was the most evident level of care. It was identified that nursing care management aims at the macropolitical performance of nurses and mobilizes skills essentially strategic-cognitive, while Nursing Care Administration aims at the micropolitical performance of nurses, requiring essentially strategic-administrative skills.
Final Considerations:
the study allowed us to propose the conceptualization of the terms and identify the approximations and distances between them.
Keywords:Health ManagementNursingNursing CareOrganization and AdministrationProfessional Practice ManagementSee more -
EDITORIAL02-06-2023
Proyecto Termómetro Social COVID-19: articulaciones transnacionales para abordar poblaciones en situación de vulnerabilidad social
Revista Brasileira de Enfermagem. 2023;76:e76suppl201
Abstract
EDITORIALProyecto Termómetro Social COVID-19: articulaciones transnacionales para abordar poblaciones en situación de vulnerabilidad social
Revista Brasileira de Enfermagem. 2023;76:e76suppl201
DOI 10.1590/0034-7167.202376suppl201es
Views0El COVID-19 es una enfermedad infecciosa que ha impactado significativamente diferentes contextos alrededor del mundo, directa y/o indirectamente, y en mayor escala en países pobres y/o en vías de desarrollo(). No sabemos con certeza los efectos acumulativos del COVID-19 en las poblaciones (trastornos mentales, insomnio, ansiedad, trombosis, déficit cognitivo, problemas de memoria, etc.) tras la […]See more -
EDITORIAL02-06-2023
COVID-19 Social Thermometer Project: transnational articulations to approach populations in situations of social vulnerability
Revista Brasileira de Enfermagem. 2023;76:e76suppl201
Abstract
EDITORIALCOVID-19 Social Thermometer Project: transnational articulations to approach populations in situations of social vulnerability
Revista Brasileira de Enfermagem. 2023;76:e76suppl201
DOI 10.1590/0034-7167.202376suppl201
Views0COVID-19 is an infectious disease that has significantly impacted different contexts around the world, directly and/or indirectly, and on a larger scale in poor and/or developing countries(). We do not know for sure the cumulative effects of COVID-19 on populations (mental disorders, insomnia, anxiety, thrombosis, cognition deficit, memory problems, etc.) after exposure to infection by […]See more -
ORIGINAL ARTICLE02-03-2023
Quality of life and satisfaction of students with auriculotherapy in the covid-19 pandemic: a quasi-experimental study
Revista Brasileira de Enfermagem. 2023;76:e20220522
Abstract
ORIGINAL ARTICLEQuality of life and satisfaction of students with auriculotherapy in the covid-19 pandemic: a quasi-experimental study
Revista Brasileira de Enfermagem. 2023;76:e20220522
DOI 10.1590/0034-7167-2022-0522
Views0See moreABSTRACT
Objectives:
to evaluate the quality of life before and after the application of auriculotherapy and the satisfaction of university students with the treatment during the covid-19 pandemic.
Methods:
quasi-experimental study conducted with 44 students in a University Health Center. The intervention consisted of ten sessions of auriculotherapy focusing on emotional changes with quality of life assessment before and after treatment. The study also investigated the satisfaction concerning the intervention.
Results:
predominated among the students: women, from health courses, in use of psychotropic drugs and complaining of emotional changes. There was a statistically significant increase in all domains of quality of life, and students were satisfied with the treatment.
Conclusions:
auriculotherapy improved the quality of life of university students during the covid-19 pandemic, and the level of satisfaction with the treatment was high.
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ORIGINAL ARTICLE02-03-2023
Factors associated with the safety culture of patients under dialysis in the context of the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2023;76:e20220280
Abstract
ORIGINAL ARTICLEFactors associated with the safety culture of patients under dialysis in the context of the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2023;76:e20220280
DOI 10.1590/0034-7167-2022-0280
Views0See moreABSTRACT
Objectives:
to assess the factors associated with the safety culture of patients under dialysis in the context of the COVID-19 pandemic.
Methods:
a cross-sectional and analytical study, carried out in Minas Gerais, with 134 professionals from three dialysis services. The Hospital Survey on Patient Safety Culture, adapted for Brazil, was used.
Results:
only variable type of management was associated with the highest percentage of positive response in public and private services. Patient safety was rated as good by 55.7% of respondents. In dimension assessment, the public service presented one strength and five weaknesses, the private service did not present weak areas, and the philanthropic service presented a weakness. The priority areas for improvement actions are represented by dimensions “Nonpunitive response to error” and “Staffing”.
Conclusions:
interventions should consider the type of service management, as it is a factor associated with safety culture.
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EXPERIENCE REPORT08-19-2019
Hypothermia post-cardiopulmonary resuscitation with low inputs: an experience report
Revista Brasileira de Enfermagem. 2019;72(4):1114-1118
Abstract
EXPERIENCE REPORTHypothermia post-cardiopulmonary resuscitation with low inputs: an experience report
Revista Brasileira de Enfermagem. 2019;72(4):1114-1118
DOI 10.1590/0034-7167-2017-0771
Views1ABSTRACT
Objective:
to report the experience of conducting directed temperature control of a post-cardiopulmonary resuscitation patient, with reduced and basic inputs available at the institution.
Method:
an experience report of directed temperature control in patient (age 15 years), after four hours of cardiopulmonary resuscitation in an Intensive Care Unit of a hospital in São Paulo State countryside in 2016, according to the protocol suggested by the American Heart Association, in 2015. There were applications of cold compresses, plastic bags with crushed ice and rectal temperature control.
Results:
after eight hours, temperature had reached 93.2 ºF. Body cooling was maintained for 24 hours. However, bags with crushed ice were used in the first 6 hours.
Conclusion:
conduct of nurses to obtain the body cooling with reduced and basic inputs was effective during the stay at the Intensive Care Unit.
Keywords:Body Temperature RegulationCardiopulmonary ResuscitationHeart ArrestHypothermia InducedIntensive Care UnitsSee more -
ORIGINAL ARTICLE09-16-2019
Spatial analysis on tuberculosis and the network of primary health care
Revista Brasileira de Enfermagem. 2019;72(5):1197-1202
Abstract
ORIGINAL ARTICLESpatial analysis on tuberculosis and the network of primary health care
Revista Brasileira de Enfermagem. 2019;72(5):1197-1202
DOI 10.1590/0034-7167-2017-0897
Views1See moreABSTRACT
Objective:
to analyze the spatial distribution of new cases of tuberculosis compared to the location of the Primary Healthcare Units that performed the compulsory notification.
Method:
ecological study conducted in Belém, Pará, with 5,294 new cases of tuberculosis notified to Sistema de Informação de Agravos de Notificação for the period from 2010 to 2014. The cases were georeferenced using the software applications ArcGis 10.2 and TerraView 4.2.2. The techniques of Kernel density and global Moran geostatistics were used.
Results:
the incidence of tuberculosis cases did not vary significantly between the years studied, however there was a variation in incidence between neighborhoods. Health units that exhibited higher number of notifications can suffer great influence of migration from nearby neighborhoods.
Conclusion:
the spatial dynamics of tuberculosis associated with health services allows to know the areas with increased risk of tuberculosis and the density of notifications of health units.
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ORIGINAL ARTICLE10-21-2019
Nurses defending the autonomy of the elderly at the end of life
Revista Brasileira de Enfermagem. 2019;72(6):1639-1645
Abstract
ORIGINAL ARTICLENurses defending the autonomy of the elderly at the end of life
Revista Brasileira de Enfermagem. 2019;72(6):1639-1645
DOI 10.1590/0034-7167-2018-0768
Views1See moreABSTRACT
Objective:
to understand how nurses deal with the elderly’s autonomy at the end of life.
Method:
qualitative, exploratory study, guided by the Grounded Theory. Ten nurses, eight doctors and 15 nursing technicians were interviewed between November 2016 and May 2017 at a university hospital in Rio de Janeiro/Brazil.
Results:
nurses deal with the elderly’s autonomy in compliance with the code of ethics and exercise leadership in actions and interactions to defend this right, evaluating, guiding and listening to the preferences of the elderly; interacting with the family; and sharing information with the health team.
Final considerations:
the elderly’s autonomy must be ensured in care planning, based on patient-centered communication and developed in the interaction among agents involved in care. The discussion on “Living Wills” Health Care Directives and principles of palliative care must be encouraged.
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ORIGINAL ARTICLE12-05-2019
Care complexity in hospitalized elderly according to cognitive performance
Revista Brasileira de Enfermagem. 2019;72:134-139
Abstract
ORIGINAL ARTICLECare complexity in hospitalized elderly according to cognitive performance
Revista Brasileira de Enfermagem. 2019;72:134-139
DOI 10.1590/0034-7167-2018-0357
Views1See moreABSTRACT
Objective:
to investigate possible differences in care complexity, functional performance and biopsychosocial and health system aspects among hospitalized elderly with or without cognitive decline.
Method:
quantitative, cross-sectional and analytical study in which was used the INTERMED method and cognitive and functional screening scales. We investigated 384 elderly patients admitted to a medical and surgical clinic of a University Hospital located in São Paulo/SP.
Results:
cognitive decline was present in 40.1% of the sample, most of them were longer-lived elderly individuals with less schooling and income, more dependent in activities of daily living and had greater vulnerability in different domains of INTERMED. After adjustments, the elderly with cognitive decline presented greater vulnerability in the psychological domain.
Conclusion:
the relationship between cognitive decline and psychological vulnerability highlights the need to adopt long-term care based on involvement of the family, health team and different services, thereby maximizing the quality of care.
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ORIGINAL ARTICLE03-09-2020
Quality of life at work in a central sterile processing department
Revista Brasileira de Enfermagem. 2020;73(2):e20180792
Abstract
ORIGINAL ARTICLEQuality of life at work in a central sterile processing department
Revista Brasileira de Enfermagem. 2020;73(2):e20180792
DOI 10.1590/0034-7167-2018-0792
Views1See moreABSTRACT
Objectives:
to evaluate the quality of life of nursing professionals who work in a central sterile processing department.
Methods:
a descriptive, quantitative, exploratory study, conducted with 82 nursing professionals working in the Central Sterile Processing Department of a University Hospital, from September to November 2017. A semi-structured instrument and the questionnaire “Medical Outcomes Study Short-Form 36” were used. Results: most of the participants were female, married, aged 31-40 years; 47.6% with 6-10 years of profession, and 82.9% reported working in CSPD for 1-5 years. The most affected quality of life domains were Pain, Vitality, General Health Status and Social Aspects.
Conclusions:
This study showed a need for rethinking and re-creating the labor dynamics in CSPD to improve the quality of life of these nursing professionals.
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ORIGINAL ARTICLE07-06-2020
Nurses’ work process in an emergency hospital service
Revista Brasileira de Enfermagem. 2020;73(5):e20180923
Abstract
ORIGINAL ARTICLENurses’ work process in an emergency hospital service
Revista Brasileira de Enfermagem. 2020;73(5):e20180923
DOI 10.1590/0034-7167-2018-0923
Views1ABSTRACT
Objectives:
to analyze the nurses’ work process in an Emergency Hospital Service.
Methods:
a qualitative, exploratory and descriptive research conducted with 17 nurses from the emergency service of a high complexity hospital in southern Brazil. Data were collected through interviews, focus group and document analysis. Data analysis followed the thematic content analysis framework.
Results:
four categories emerged: Work environment characteristics; Assistance dimension; Management dimension; Care management.
Final Considerations:
the nurses’ work process in Emergency Hospital Service is characterized by the peculiarities of the setting, with centrality in care and care management aiming at quality care and safety to patients.
Keywords:Emergency NursingEmergency Service, HospitalHealth ManagementNurse's RoleProfessional PracticeSee more -
REVIEW07-13-2020
The quality of life of family health professionals: a systematic review and meta-synthesis
Revista Brasileira de Enfermagem. 2020;73(5):e20190645
Abstract
REVIEWThe quality of life of family health professionals: a systematic review and meta-synthesis
Revista Brasileira de Enfermagem. 2020;73(5):e20190645
DOI 10.1590/0034-7167-2019-0645
Views1See moreABSTRACT
Objectives:
to perform a systematic review and meta-synthesis of qualitative studies about the work-related quality of life of Family Health Strategy professionals.
Methods:
this systematic review was developed to answer the following PVO question: “Which factors (variables) are associated with the work-related quality of life (outcome) of Family Health Strategy professionals (population)?” The PubMed, Scopus, Embase, SciELO, Web of Science, LILACS, Science Direct, OpenThesis, OpenGrey, and OATD databases were selected. The meta-synthesis analyzed the main codes and secondary codes of all included studies.
Results:
the database search resulted in 1,744 reports; six were considered eligible for the meta-synthesis. Four factors were considered for the quality of work life: working conditions; work processes; interpersonal relationships; and personal aspects.
Conclusions:
although this study confirms the adequacy of aspects commonly related to the quality of work life, other factors are important in the case of FHS professionals, especially work context.
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REVIEW11-06-2020
Transitional care to caregivers of dependent older people: an integrative literature review
Revista Brasileira de Enfermagem. 2020;73:e20200394
Abstract
REVIEWTransitional care to caregivers of dependent older people: an integrative literature review
Revista Brasileira de Enfermagem. 2020;73:e20200394
DOI 10.1590/0034-7167-2020-0394
Views1See moreABSTRACT
Objective:
To identify the needs of caregivers of dependent older people related to self-care in the transition from hospital to home.
Methods:
Integrative literature review that followed a predefined protocol, carried out from March to May 2019 in the platforms EBSCO, B-On, Scopus, Web of Science, and Joanna Briggs Institute. Descriptors and eligibility criteria were defined for the bibliographic sample, which was ten articles. The search was limited to articles published between 2015 and 2019 to guarantee evidence topicality.
Results:
The needs of caregivers related to transitional care can be grouped into five categories: needs in the transition into the role of caregiver; needs related to self-care of caregivers themselves; health needs; economic needs; and social and collective needs.
Final considerations:
The work developed by nurses regarding transitional care of caregivers must have two focuses: managing care provided to dependent older people and managing the needs of caregivers and the care offered to them.
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EXPERIENCE REPORT04-09-2020
Implementation of an Artificial Intelligence Algorithm for sepsis detection
Revista Brasileira de Enfermagem. 2020;73(3):e20180421
Abstract
EXPERIENCE REPORTImplementation of an Artificial Intelligence Algorithm for sepsis detection
Revista Brasileira de Enfermagem. 2020;73(3):e20180421
DOI 10.1590/0034-7167-2018-0421
Views0See moreABSTRACT
Objectives:
to present the nurses’ experience with technological tools to support the early identification of sepsis.
Methods:
experience report before and after the implementation of artificial intelligence algorithms in the clinical practice of a philanthropic hospital, in the first half of 2018.
Results:
describe the motivation for the creation and use of the algorithm; the role of the nurse in the development and implementation of this technology and its effects on the nursing work process.
Final Considerations:
technological innovations need to contribute to the improvement of professional practices in health. Thus, nurses must recognize their role in all stages of this process, in order to guarantee safe, effective and patient-centered care. In the case presented, the participation of the nurses in the technology incorporation process enables a rapid decision-making in the early identification of sepsis.
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ORIGINAL ARTICLE06-27-2019
Caring for the carer: quality of life and burden of female caregivers
Revista Brasileira de Enfermagem. 2019;72(3):728-736
Abstract
ORIGINAL ARTICLECaring for the carer: quality of life and burden of female caregivers
Revista Brasileira de Enfermagem. 2019;72(3):728-736
DOI 10.1590/0034-7167-2018-0334
Views0See moreABSTRACT
Objective:
To assess the quality of life and the burden of female caregivers.
Method:
Descriptive, cross-sectional, quantitative study carried out with 224 informal caregivers from March to July 2016. Three instruments were used: a characterization form for the caregiver, the WHOQOL-Bref questionnaire and the Zarit Burden Interview. The following tests were used: Cronbach’s Alpha, Kolmogorov-Smirnov, Kruskal-Wallis, Spearman and Mann-Whitney.
Results:
The mean age of caregivers was 51.8 years with a standard deviation of 13.7. They were predominantly married, had a low income and low level of education, were first-degree relatives, had been providing care for one to five years and presented some pathology. The associations of quality of life that presented statistical significance were: income, marital status, number of people living with the caregiver and time of care.
Conclusion:
The burden was negatively correlated with QOL, that is, the greater the burden, the more impaired will be the life of these caregivers.
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REVIEW03-24-2021
Development of clinical competence in nursing in simulation: the perspective of Bloom’s taxonomy
Revista Brasileira de Enfermagem. 2021;74(1):e20200135
Abstract
REVIEWDevelopment of clinical competence in nursing in simulation: the perspective of Bloom’s taxonomy
Revista Brasileira de Enfermagem. 2021;74(1):e20200135
DOI 10.1590/0034-7167-2020-0135
Views0See moreABSTRACT
Objectives:
to investigate the scientific evidence on the use of Bloom’s taxonomy for developing competence in nursing professionals and students in clinical simulation.
Methods:
integrative review of the National Library of Medicine (NLM), National Institutes of Health (NIH), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Latin American and Caribbean Literature in Health Sciences (LILACS), Web of Science and SCOPUS databases, using the Rayyan application.
Results:
a total of 871 studies were identified; four composed the sample. The development of clinical competence occurred through the coordination of knowledge, skills, and attitudes. To develop the cognitive domain, the objectives of knowledge and comprehension of the Bloom’s taxonomy were mobilized. The psychomotor domain required development of the skills demanded by the proposed clinical care. The affective domain was developed through will and motivation to learn.
Conclusions:
it is possible to develop clinical competence in nursing by adopting Bloom’s taxonomy in each phase of clinical simulation.
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ORIGINAL ARTICLE06-27-2019
Package of menthol measures for thirst relief: a randomized clinical study
Revista Brasileira de Enfermagem. 2019;72(3):600-608
Abstract
ORIGINAL ARTICLEPackage of menthol measures for thirst relief: a randomized clinical study
Revista Brasileira de Enfermagem. 2019;72(3):600-608
DOI 10.1590/0034-7167-2018-0057
Views0See moreABSTRACT
Objective:
To evaluate the effectiveness of the menthol package (lip hydration and ice popsicles) compared to a package of non-menthol measures (lip hydration and ice popsicles) as a way to relieve thirst in patients in the Anesthetic Recovery Room.
Method:
Randomized and parallel trial study, with 120 patients randomized patients in an experimental group – menthol measurements (n=59) and control group – measures without menthol (n = 61).
Results:
There was a significant (p<0.05) decrease in intensity, hydration, dryness and taste in the oral cavity between the three moments of assessment/intervention in the two groups. The difference was significant in the experimental group for thirst intensity at the second assessment/intervention point (p<0.05) after a single administration of the menthol package.
Conclusion:
There was a reduction in thirst intensity in both groups. Patients who received menthol packages showed a significant decrease in intensity after a single evaluation/intervention time. NCT: 02869139.
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EDITORIAL03-27-2020
Coronavirus 2020
Revista Brasileira de Enfermagem. 2020;73(2):e2020n2
Abstract
EDITORIALCoronavirus 2020
Revista Brasileira de Enfermagem. 2020;73(2):e2020n2
DOI 10.1590/0034-7167-2020730201
Views0Emerging and reemerging infectious diseases are constant challenges for public health worldwide. Recent cases of pneumonia of unknown cause in Wuhan, China, have led to the discovery of a new type of Coronavirus (2019-nCoV), which are enveloped RNA viruses, commonly found in humans, other mammals and birds, capable of causing respiratory, enteric, hepatic, and neurological […]See more -
ORIGINAL ARTICLE12-04-2020
Pressure injury related to the use of personal protective equipment in COVID-19 pandemic
Revista Brasileira de Enfermagem. 2020;73:e20200670
Abstract
ORIGINAL ARTICLEPressure injury related to the use of personal protective equipment in COVID-19 pandemic
Revista Brasileira de Enfermagem. 2020;73:e20200670
DOI 10.1590/0034-7167-2020-0670
Views0See moreABSTRACT
Objective:
To describe the prevalence and factors associated with pressure injuries related to the use of personal protective equipment during the COVID-19 pandemic.
Methods:
Cross-sectional study conducted using an instrument made available in social networks with 1,106 health professionals. The data were analyzed using descriptive statistics and compared, considering pvalue < 0.05.
Results:
There was a prevalence of 69.4% for pressure injuries related to the use of personal protective equipment, with an average of 2.4 injuries per professional. The significant factors were: under 35 years of age, working and wearing personal protective equipment for more than six hours a day, in hospital units, and without the use of inputs for protection.
Conclusion:
Pressure injuries related to the use of medical devices showed a high prevalence in this population. The recognition of the damage in these professionals makes it possible to advance in prevention strategies.
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ORIGINAL ARTICLE12-13-2019
Accessibility of children with special health needs to the health care network
Revista Brasileira de Enfermagem. 2019;72:65-71
Abstract
ORIGINAL ARTICLEAccessibility of children with special health needs to the health care network
Revista Brasileira de Enfermagem. 2019;72:65-71
DOI 10.1590/0034-7167-2017-0899
Views0See moreABSTRACT
Objective:
To know how children with special health needs access the health care network.
Method:
This is a qualitative research of descriptive-exploratory type, developed using semi-structured interviews mediated by the Talking Map design. Participants were 19 family caregivers of these children in two Brazilian municipalities. Data were submitted to inductive thematic analysis.
Results:
Difficulties were mentioned from the diagnosis moment to the specialized follow-up, something represented by the itinerary of the c hild and his/her family in the search for the definition of the medical diagnosis and the access to a specialized professional; a gap between the children’s needs and the care offered was observed in primary health care.
Conclusion:
The access of children with special health needs is filled with obstacles such as slowness in the process of defining the child’s diagnosis and referral to a specialist. Primary health care services were replaced by care in emergency care units.
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