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ORIGINAL ARTICLE11-22-2024
Safe practices for prevention and management of antineoplastic agent extravasation: development of an educational video
Revista Brasileira de Enfermagem. 2024;77(5):e20240172
Abstract
ORIGINAL ARTICLESafe practices for prevention and management of antineoplastic agent extravasation: development of an educational video
Revista Brasileira de Enfermagem. 2024;77(5):e20240172
DOI 10.1590/0034-7167-2024-0172
Views0ABSTRACT
Objectives:
to develop, validate, and evaluate an educational video on the prevention and management of antineoplastic agent extravasation, aimed at nursing professionals.
Methods:
this methodological study was developed according to Falkembach’s theoretical framework, which outlines five phases in the production of educational video materials: analysis and planning, modeling, implementation, evaluation, and distribution.
Results:
content validation demonstrated agreement above the minimum threshold stipulated. The overall Content Validity Index was 90.8%, and it was 94.2% among the content and technical evaluation judges, respectively. The target audience evaluated the video positively, highlighting the importance of the content, the clarity of the language used, and the understanding of the information pertinent to the topic.
Conclusions:
the video proved to be an appropriate strategy for instructing interventions on the prevention and management of extravasation, with the potential to improve educational practices among nursing professionals.
Keywords:Antineoplastic AgentsEducational TechnologyExtravasation of Diagnostic and Therapeutic MaterialsInstructional Film and VideoNursingSee more -
REVIEW11-22-2024
Telenursing contributions in Primary Health Care in the COVID-19 pandemic context: an integrative review
Revista Brasileira de Enfermagem. 2024;77(5):e20240093
Abstract
REVIEWTelenursing contributions in Primary Health Care in the COVID-19 pandemic context: an integrative review
Revista Brasileira de Enfermagem. 2024;77(5):e20240093
DOI 10.1590/0034-7167-2024-0093
Views1See moreABSTRACT
Objective:
to identify telenursing contributions in Primary Health Care during the COVID-19 pandemic.
Methods:
an integrative literature review, conducted between January and August 2022 in the PubMed, CINAHL, LILACS, BDENF, Scopus, WoS, EMBASE and SciELO databases. A total of 493 studies was found, 62 were read in full, and of these, 16 were selected. For analysis, a dynamic reading of the studies and synthesis of the main results were carried out.
Results:
the main results highlighted telenursing practice as a challenge for professionals and the population. Among the contributions and positive points and aspects that require improvement, practice showed promise when considered in a post-pandemic scenario.
Final considerations:
through telenursing, the population’s access to Primary Health Care was guaranteed in the face of the COVID-19 pandemic. However, a critical look at current technological advances in healthcare is necessary.
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Percepções de pessoas com deficiência física sobre acessibilidade e condições sociais: intervenções para enfermagem de reabilitação
Revista Brasileira de Enfermagem. 2024;77(5):e20240005
Abstract
Percepções de pessoas com deficiência física sobre acessibilidade e condições sociais: intervenções para enfermagem de reabilitação
Revista Brasileira de Enfermagem. 2024;77(5):e20240005
DOI 10.1590/0034-7167-2024-0005
Views0RESUMEN
Objetivos:
analizar las experiencias de personas con discapacidad física adquirida en cuanto a accesibilidad y condiciones sociales; identificar intervenciones de rehabilitación dirigidas por enfermeras para la accesibilidad y condiciones sociales; determinar indicadores sensibles a la enfermería para mejorar la accesibilidad y condiciones sociales.
Métodos:
estudio cualitativo descriptivo-exploratorio utilizó entrevistas semiestructuradas con personas con discapacidad física adquirida mediante muestreo intencionado en bola de nieve para cumplir con todos los objetivos. El análisis de datos siguió los principios del análisis de contenido de Bardin. Los objetivos 2 y 3 se lograron mediante un enfoque teórico reflexivo.
Resultados:
los 27 participantes informaron desafíos de accesibilidad, que impactan las actividades de la vida diaria y las condiciones sociales. Esto influye en la enfermería de rehabilitación, dando lugar a tres campos de intervención: Evaluar la capacidad para realizar actividades diarias y los factores que influyen; Desarrollar e implementar capacitación para la realización de actividades diarias; Promover la movilidad, la accesibilidad y la participación social.
Consideraciones Finales:
a partir de las experiencias de los participantes, identificamos intervenciones de rehabilitación dirigidas por enfermeras para promover la accesibilidad y condiciones sociales.
Keywords:Acessibilidade ArquitetónicaCondições SociaisEnfermagem em ReabilitaçãoObjetivos de Desenvolvimento SustentávelPessoas com DeficiênciaSee more -
Rondas a beira leito no ambiente hospitalar na perspectiva de equipes multiprofissionais de saúde
Revista Brasileira de Enfermagem. 2024;77(5):e20230493
Abstract
Rondas a beira leito no ambiente hospitalar na perspectiva de equipes multiprofissionais de saúde
Revista Brasileira de Enfermagem. 2024;77(5):e20230493
DOI 10.1590/0034-7167-2023-0493
Views0RESUMEN
Objetivo:
Analizar la configuración de las relaciones de poder entre el equipo multiprofesional en el proceso de rondas de cabecera en el hospital.
Método:
Investigación cualitativa con datos analizados a través del análisis del discurso, basado en el marco teórico de Michel Foucault. De septiembre a diciembre de 2022, realizamos entrevistas y observaciones de campo con el equipo multiprofesional de un hospital de Belo Horizonte, Minas Gerais, Brasil, así como entrevistas cualitativas semiestructuradas con 37 profesionales.
Resultados:
Los participantes señalaron que las experiencias de los profesionales involucrados en las rondas de cabecera dependen de cómo el médico conduce el proceso, y el proceso centrado en el médico dificulta la participación de otros profesionales del equipo.
Consideraciones finales:
La forma en que los hospitales organizan las rondas de cabecera no promueve la articulación del conocimiento de sus profesionales. Además, dificulta la circulación del poder y perjudica el trabajo interdisciplinario en un proceso que mantiene al médico como actor principal de las decisiones clínicas.
Keywords:Conhecimentos, Atitudes e Prática em SaúdeEquipe de Assistência MultidisciplinarHospitaisPrática ProfissionalRelações InterprofissionaisSee more -
ORIGINAL ARTICLE11-22-2024
Bedside rounds in the hospital environment from the perspective of multiprofessional health teams
Revista Brasileira de Enfermagem. 2024;77(5):e20230493
Abstract
ORIGINAL ARTICLEBedside rounds in the hospital environment from the perspective of multiprofessional health teams
Revista Brasileira de Enfermagem. 2024;77(5):e20230493
DOI 10.1590/0034-7167-2023-0493
Views0ABSTRACT
Objective:
To analyze the configuration of power relations among the multiprofessional team in the bedside round process in the hospital.
Methods:
Qualitative research with data analyzed through discourse analysis, based on Michel Foucault’s theoretical framework. From September to December 2022, we conducted interviews and field observations with the multiprofessional team at a hospital in Belo Horizonte, Minas Gerais, Brazil, as well as qualitative, semi-structured interviews with 37 professionals.
Results:
The participants pointed out that the experiences of the professionals involved in bedside rounds depend on how the physician conducts the process, and the physician-centered process makes it difficult for other professionals in the team to participate.
Final considerations:
The way hospitals organize bedside rounds does not promote knowledge articulation for their professionals. It hinders the circulation of power and harms interdisciplinary work in a process that maintains the physician as the main actor in clinical decisions.
Keywords:Health Knowledge, Attitudes, PracticeHospitalsInterprofessional RelationsPatient Care TeamProfessional PracticeSee more -
REVIEW11-22-2024
Transition to family parenting in the face of the first child: a scoping review
Revista Brasileira de Enfermagem. 2024;77(5):e20230487
Abstract
REVIEWTransition to family parenting in the face of the first child: a scoping review
Revista Brasileira de Enfermagem. 2024;77(5):e20230487
DOI 10.1590/0034-7167-2023-0487
Views1See moreABSTRACT
Objectives:
to identify and summarize the elements that characterize the family transition process in relation to the first child.
Methods:
a scoping review was carried out based on JBI methodology, in six databases, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist.
Results:
ten articles were included with factors characterizing the transition, such as hindering/facilitating conditions that influence the process, important support structures in adaptation and strategies/responses used in the transition process.
Final Considerations:
elements characterizing the transition process in relation to the first child were identified. However, no theoretical explanation for this was identified. Further research should be carried out to obtain a deeper understanding of this process.
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ORIGINAL ARTICLE12-13-2024
Nurses’ experience regarding patient safety in mobile pre-hospital care
Revista Brasileira de Enfermagem. 2024;77(5):e20230529
Abstract
ORIGINAL ARTICLENurses’ experience regarding patient safety in mobile pre-hospital care
Revista Brasileira de Enfermagem. 2024;77(5):e20230529
DOI 10.1590/0034-7167-2023-0529
Views0See moreABSTRACT
Objectives:
to understand nurses’ experience regarding patient safety in mobile pre-hospital care.
Method:
a qualitative, exploratory and descriptive study, conducted with nurses active in mobile pre-hospital care services. Semi-structured interviews were conducted, audio-graved and submitted to Bardin’s content analysis.
Results:
from four thematic categories established, nurses reported the care and management skills necessary to work in this service. They demonstrated a commitment to ensuring safe care for patients, staff and spectators. They highlighted the actions taken to prevent and mitigate incidents. However, they based their experiences on practice protocols and individual actions, expressing the need to improve knowledge about patient safety.
Final Considerations:
mobile pre-hospital care nurses’ experience in relation to patient safety was limited, suggesting the need for training on the subject, alignment of work processes and implementation of strategies, aiming to guarantee safe care.
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ORIGINAL ARTICLE12-13-2024
Repercussions of the pandemic on tuberculosis control actions from the perspective of health professionals
Revista Brasileira de Enfermagem. 2024;77(5):e20230477
Abstract
ORIGINAL ARTICLERepercussions of the pandemic on tuberculosis control actions from the perspective of health professionals
Revista Brasileira de Enfermagem. 2024;77(5):e20230477
DOI 10.1590/0034-7167-2023-0477
Views0See moreABSTRACT
Objectives:
to analyze the repercussions of the COVID-19 pandemic on tuberculosis control actions from the perspective of primary health care professionals.
Methods:
this descriptive study with a qualitative approach was conducted from November 2022 to April 2023, using semi-structured interviews with 11 key informant professionals from primary health care units in a Brazilian capital. Data were organized using Atlas.ti 22.0 software and subjected to thematic-categorical content analysis.
Results:
the pandemic scenario caused alterations in the work process, necessitating abrupt adaptations, and led to detrimental impacts on the health of professionals and tuberculosis control actions, which were reduced or discontinued.
Final Considerations:
there was evident unpreparedness and a lack of resources from various governmental levels and health services to handle the public health emergency situation without severe harm to the provision of essential services.
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Training of Brazilian indigenous nurses: between human rights, valuing diversity and inclusion
Revista Brasileira de Enfermagem. 2024;77(5):e20230430
Abstract
Training of Brazilian indigenous nurses: between human rights, valuing diversity and inclusion
Revista Brasileira de Enfermagem. 2024;77(5):e20230430
DOI 10.1590/0034-7167-2023-0430
Views0See moreABSTRACT
Objectives:
to analyze the possibilities and potential of training indigenous nurses, given the Brazilian Health System (SUS), understanding the relationships between education and health.
Methods:
theoretical-reflective study, based on scientific literature, aligned with the experience, critical thinking of its authors and the Sustainable Development Goals in Brazil.
Results:
this text articulates three axes: Potential for including indigenous students in nursing training; Paths to achieving equity through inclusion and retention policies for indigenous students at different levels; and Implications of this for the SUS and global health.
Final Considerations:
indigenous students, beneficiaries of affirmative actions, face challenges of inclusion and retention in public universities that directly impact their academic training. Added to this are the difficulties identified in basic education, professor training and implementation of permanence policies, with consequences for services and training at other levels.
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ORIGINAL ARTICLE12-13-2024
Interobserver agreement in Reception and Risk Stratification in Obstetrics implementation
Revista Brasileira de Enfermagem. 2024;77(5):e20230361
Abstract
ORIGINAL ARTICLEInterobserver agreement in Reception and Risk Stratification in Obstetrics implementation
Revista Brasileira de Enfermagem. 2024;77(5):e20230361
DOI 10.1590/0034-7167-2023-0361
Views0See moreABSTRACT
Objectives:
to analyze interobserver agreement in the Reception and Risk Stratification in Obstetrics protocol implementation.
Methods:
a cross-sectional study carried out during Reception and Risk Stratification in Obstetrics implementation, conducted in a tertiary hospital in southern Brazil with 891 participants in January 2020. Descriptive and interobserver agreement analysis was carried out using the Kappa coefficient in the risk stratification assigned by the triage nurse and reviewed by the researcher.
Results:
around half of the calls (55.6%) were stratified as not very urgent (green), followed by urgent (yellow) (31.8%), very urgent (orange) (9.3%), not urgent (blue) (3.4%) and no emerging stratification (red). Agreement analysis of revised stratification found Kappa values of 0.20 (blue), 0.54 (green), 0.77 (yellow) and 0.80 (orange).
Conclusions:
most appointments were non-urgent. The agreement analysis between the revised and assigned risk stratification revealed greater interobserver agreement as the priority level increased.
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ORIGINAL ARTICLE12-13-2024
Adaptation and implementation of a Nursing care protocol for children in the Amazon Region
Revista Brasileira de Enfermagem. 2024;77(5):e20230245
Abstract
ORIGINAL ARTICLEAdaptation and implementation of a Nursing care protocol for children in the Amazon Region
Revista Brasileira de Enfermagem. 2024;77(5):e20230245
DOI 10.1590/0034-7167-2023-0245
Views0See moreABSTRACT
Objectives:
to describe the process of implementing an adapted protocol for pediatric nursing care in a health unit located in a municipality in the Amazon Region.
Methods:
methodological research conducted in a basic health unit with four family health teams in the state of Rondônia, involving seven nursing professionals. Data collection occurred between October 2020 and April 2022, following the research phases: situational diagnosis, exploratory phase, protocol definition, implementation, and evaluation.
Results:
the outcome was the adaptation and implementation of a nursing care protocol for children.
Final Considerations:
the adaptation and implementation process can be an effective approach to improving care, strengthening nursing as a profession with a solid foundation in scientific and clinical evidence. This facilitates early problem identification and appropriate guidance, leading to better health outcomes for children.
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ORIGINAL ARTICLE12-13-2024
Nurses’ experiences in caring for people with mental health problems hospitalized due to clinical comorbidities
Revista Brasileira de Enfermagem. 2024;77(5):e20230136
Abstract
ORIGINAL ARTICLENurses’ experiences in caring for people with mental health problems hospitalized due to clinical comorbidities
Revista Brasileira de Enfermagem. 2024;77(5):e20230136
DOI 10.1590/0034-7167-2023-0136
Views0See moreABSTRACT
Objectives:
to understand nurses’ experiences in caring for people with mental health problems hospitalized due to clinical comorbidities in non-psychiatric Inpatient Units.
Methods:
qualitative study, guided by Alfred Schutz’s social phenomenology. Sixteen phenomenological interviews were conducted. The content was analyzed and discussed based on the literature, through the composition of three categories of analysis.
Results:
three categories emerged in the study: Challenges in care faced by nurses; Fragmented care action; and Ideal care. The disarticulation of the clinic was revealed, as described by nurses, showing care as an action far removed from the comprehensiveness of a person. Nurses’ performance is guided predominantly by biomedical reference, disregarding appreciation of subjectivity.
Final Considerations:
it was observed that nurses attribute the responsibility for patient care to factors external to their life-world, when, in fact, these aspects should be components that help them in comprehensive care construction.
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REVIEW11-29-2024
Assessment of knowledge in oncology about care for transgender people: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20230532
Abstract
REVIEWAssessment of knowledge in oncology about care for transgender people: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20230532
DOI 10.1590/0034-7167-2023-0532
Views0ABSTRACT
Objective:
to identify evidence available in the literature on instruments and methodologies used to assess healthcare professionals’ knowledge about cancer care for the transgender population.
Methods:
a scoping review was conducted in seven databases, including studies that answered the question: what is the healthcare professionals’ level of knowledge about cancer care for the transgender population?
Results:
forty-one articles were selected that dealt specifically with healthcare professionals’knowledge in relation to care for the LGBTQIAPN+ population, especially the transgender population. Eighteen studies assessed patients’ perceptions of professionals’knowledge, whereas other studies used their own assessment tools, considering the global context of LGBTQIAPN+ health.
Conclusions:
there is no tested and validated instrument that assesses the knowledge about the transgender population’s oncological health, highlighting the need to construct and validate an instrument focused on this population’s needs.
Keywords:Health Services for Transgender PeopleNeoplasmsOncologyProfessional TrainingTransgender PeopleSee more
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Ineffective health management in hemodialysis patients: content analysis
Revista Brasileira de Enfermagem. 2018;71(4):1825-1831
Abstract
Ineffective health management in hemodialysis patients: content analysis
Revista Brasileira de Enfermagem. 2018;71(4):1825-1831
DOI 10.1590/0034-7167-2016-0682
Views1See moreABSTRACT
Objective:
To analyze the content of the nursing diagnosis Ineffective Health Management in hemodialysis patients.
Method:
The Nursing Diagnoses Validation Model by Lopes, Silva and Auraújo was used in this research. A semi-structured questionnaire and evaluated the definition, location, defining characteristics, and related factors of the diagnosis Ineffective Health Management was answered by 22 experts in nursing diagnosis. The analysis was conducted from August 2014 to January 2015.
Results:
Experts considered the proposed definition and the current location in the taxonomy II by the NANDA-I, Domain 1 Health Promotion, Class 2 Health Control, adequate to the diagnosis. The adequacy level adopted at 85% or p > 0.05 were above 10 defining characteristics and 24 related factors. Experts also suggested that one defining characteristic should become a related factor and that three factors should turn into defining characteristics.
Conclusion:
A new proposal was developed for the diagnosis under study after the analysis of experts.
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Myocardial revascularization: factors intervening in the reference and counter-reference in the hospital setting
Revista Brasileira de Enfermagem. 2018;71(4):1817-1824
Abstract
Myocardial revascularization: factors intervening in the reference and counter-reference in the hospital setting
Revista Brasileira de Enfermagem. 2018;71(4):1817-1824
DOI 10.1590/0034-7167-2017-0218
Views0ABSTRACT
Objective:
To understand the intervening factors in the process of reference and counter-reference of the individual with heart disease in the scenario of high complexity in the health care network.
Method:
Research anchored in the Grounded Theory (Teoria Fundamentada nos Dados). It totaled 21 participants. The data collection scenario was a cardiovascular reference hospital in the south of Brazil and occurred between March and June 2014.
Results:
The intervening factors in the reference process were the difficulty to access the points of the network and telemedicine and the central to manage the flow of patients in the network. In the counter-reference, there was a link with the hospital and the lack of communication among network professionals.
Conclusion:
It reveals the need to reorganize the service flow in HCN, enhancing PHC, expanding the performance of medium complexity and increasing the capacity of high complexity in order to carry out the process of reference and counter-reference.
Keywords:Access to Health ServicesHealth ManagementIntegrality in HealthMyocardial RevascularizationNursingSee more -
Importância da prática clínica sustentada por instrumentos de avaliação em saúde
Revista Brasileira de Enfermagem. 2018;71(4):1815-1816
Abstract
Importância da prática clínica sustentada por instrumentos de avaliação em saúde
Revista Brasileira de Enfermagem. 2018;71(4):1815-1816
DOI 10.1590/0034-7167-2018710401
Views0Instrumentos de avaliação na prática clínica são recursos com capacidade de identificar, de maneira objetiva, importantes alterações físico-psíquico e espirituais, de aferir fenômenos subjetivos, de acompanhar de forma regular a progressão, retrocesso ou estagnação de um estado de saúde-doença além de criar um mecanismo de direção ao examinador e à equipe assistencial.Esses instrumentos ainda são […]See more -
The importance of clinical practice supported by health assessment tools
Revista Brasileira de Enfermagem. 2018;71(4):1815-1816
Abstract
The importance of clinical practice supported by health assessment tools
Revista Brasileira de Enfermagem. 2018;71(4):1815-1816
DOI 10.1590/0034-7167-2018710401
Views0The tools of assessment in clinical practice are tools capable of objectively identifying important physical and psychic and spiritual changes, examining subjective phenomena and regularly monitoring the progression, regression or stagnation of a health-disease state. Moreover, of creating a steering mechanism for the examiner and the care team. These tools are still capable of standardizing […]See more -
EXPERIENCE REPORT01-01-2018
Constructing a logical model in school health: experience on the Lower Amazon region
Revista Brasileira de Enfermagem. 2018;71(3):1198-1202
Abstract
EXPERIENCE REPORTConstructing a logical model in school health: experience on the Lower Amazon region
Revista Brasileira de Enfermagem. 2018;71(3):1198-1202
DOI 10.1590/0034-7167-2016-0389
Views0See moreABSTRACT
Objective:
This experience report presents the construction of the theoretical and logic model for intervention to promote physical activity and healthy eating habits of the public schools students in the city of Parintins, Amazonas, Brazil.
Method:
We carried out a theoretical research and also a documentary research on the School Health Program (PSE – Programa Saúde na Escola) on the national and local level, in addition to meetings with the PSE management committee for strategic planning of the actions.
Result:
The municipality had no systematic structure of health practices at school. A theoretical and logical model that involved prerogatives of practice from the management of the municipality in PSE was developed. Actions to promote physical activity and healthy nutrition of primary and secondary school students were planned and promoted in schools of the PSE.
Final considerations:
Thus, the collective construction of this proposal contributed to the research of multi-sectoral practices related to the PSE principles and strategies, considering the particularities of the Lower Amazon context.
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EXPERIENCE REPORT01-01-2018
Multiple case study applied in nursing research: a case report
Revista Brasileira de Enfermagem. 2018;71(3):1194-1197
Abstract
EXPERIENCE REPORTMultiple case study applied in nursing research: a case report
Revista Brasileira de Enfermagem. 2018;71(3):1194-1197
DOI 10.1590/0034-7167-2017-0066
Views0See moreABSTRACT
Objective:
To report the experience of using the method of multiple case study.
Method:
We used the method of multiple case study, conducted with children and adolescents assisted in the pediatric oncology inpatient unit.
Results:
The steps used for the development of a multiple case study were: Step 1 – Define and design; Step 2 – Prepare, collect and analyze; Step 3 – Analyze and complete. The steps included the development of a research project with the definition of its components, preparation of protocol for the case study, data collection, individual report of cases, data analysis and final report with data cross-referencing.
Conclusion:
The case study method can be used by nurses and contribute to the advancement in knowledge of nursing as a science and therefore contribute to a full care practice in the context in which the phenomenon happens.
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REVIEW01-01-2018
Hand hygiene: nurses’ adherence after training
Revista Brasileira de Enfermagem. 2018;71(3):1189-1193
Abstract
REVIEWHand hygiene: nurses’ adherence after training
Revista Brasileira de Enfermagem. 2018;71(3):1189-1193
DOI 10.1590/0034-7167-2017-0239
Views0See moreABSTRACT
Objective:
Hand hygiene plays a key role in the prevention of healthcare-associated infections. Therefore, this study aims to analyze nurses’ adherence to hand hygiene and identify intervention strategies to improve this procedure.
Method:
Integrative literature review, using the Cochrane methodology, to answer the following question: “What is the level of effectiveness of training in improving nurses’ adherence to hand hygiene?”.
Results:
Studies show that nurses’ adherence to hand hygiene has increased from 42.9% to 61.4% (p<0.001), or even from 63% to 76% (p<0.005) after a specific training intervention.
Conclusion:
After training, nurses’ adherence to hand hygiene improved, particularly when compared to the other professionals involved. Despite its simplicity, the implementation of a training program and its subsequent follow-up have a positive on nurses’ attitudes and adherence to hand hygiene.
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REVIEW01-01-2018
Integrative literature review: access to primary healthcare services
Revista Brasileira de Enfermagem. 2018;71(3):1178-1188
Abstract
REVIEWIntegrative literature review: access to primary healthcare services
Revista Brasileira de Enfermagem. 2018;71(3):1178-1188
DOI 10.1590/0034-7167-2017-0441
Views0See moreABSTRACT
Objective:
Analyze the scientific production that describes the type of access to primary healthcare services and identify specific populations that have differentiated access to health services.
Method:
An integrative review. For study selection, the following databases were used: PubMed, Scopus, Bireme, and Cinahl. The sample included 22 national and international articles.
Results:
The results describe the access of specific populations to health services, the access to primary care through health plans and proposed improvements to the access to primary care.
Conclusion:
The access to services is a challenge in many countries and some strategies and policies are implemented to solve and improve primary health care.
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