Legal issues of Brazilian hyperbaric nursing: why regulate? I Marinha do Brasil. Rio de Janeiro, RJ. Escola de Enfermagem Anna Nery. This study aimed to show the needs to standardize nursing care related to hyperbaric oxygenation and regulate working conditions for nursing staff that works on this area. They approach the legislation at the Brazilian Society of Hyperbaric Medicine, on Brazilian Chapter of the Undersea and Hyperbaric Medical Society, on Regulating Rules of the Ministry of Labor and on the Code of Ethics of Nursing Professionals, as instruments still insufficient to legalize the Hyperbaric Nurse, its procedures in hyperbaric conditions and pressurized environments.

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Eloita Pereira Neves, Ph. Citation: Neves, E. Dec 20, Available www. Until the 19 th century, family members, healers, and practical midwives were the primary sources of health and illness care in the home in Brazil and other Latin American countries, while religious, custodial, and philanthropic organizations delivered health care in the major cities.

Early efforts to prepare personnel to care for the sick in a systematic manner were undertaken by the National Hospital for the Mentally Ill in , and by the Brazilian Red Cross in , , and In the early 20 th century, the growing coffee export business created a need for disease control in ports that traded with foreign countries. Carlos Chagas, a prominent public health physician, requested assistance from the Rockefeller Foundation.

This agency established a technical mission for the development of nursing in Brazil, directed by Ethel Parsons, a nurse of The International Health Service.

The mission consisted of 31 North American nurses who analyzed the health care system and made recommendations regarding the organization of modern nursing in Brazil. Twenty of the North American nurses served as faculty for the nursing school, which was founded in and later named School of Nursing Anna Nery. Ethel Parsons served during ten years in the mission, from to She published an article in the American Journal of Nursing in June , documenting the efforts of the technical cooperation mission to implement modern nursing in Brazil Germano, ; Paiva et al.

This model was based on the Nightingale paradigm of scientific principles of hygiene and public health and a feminist perspective, and addressed political, regulatory, and economic concerns of the profession Paiva et al. The first Brazilian nursing journal, the Revista Brasileira de Enfermagem , premiered in as the official publication of the nurses association. Parsons also influenced the passage of the Decree no.

The subsequent Decree no. After , a social security system of medical care shifted the focus of health care toward individualized hospital medical care, resulting in changes in nursing roles and organization. Growing hospital care needs, increasing patient complexity, and a shortage of nurses led to the creation of different categories of nursing personnel in addition to practical nurses and nurses of the armed forces. Nursing auxiliaries, who had five years of general education equivalent to elementary school , received a one year training program from nurses before entering the nursing work force.

The curriculum was primarily disease-oriented, based on the medical model, with hospital-based clinical experiences. Social sciences, administration, and teaching methods for training nurse auxiliaries was included. Community nursing received little emphasis. The 36 month course of study took 3 to 4 years to complete. Physicians and other health care professionals taught the basic and clinical courses.

Nurses taught the technical portion and the nursing care in each course. After the s, candidates for admission to undergraduate nursing education were required to have a 12 th grade education.

This elevated nursing to the status of a liberal profession, and the nursing faculty assumed major roles in nursing education. Candidates were admitted to an official school after eight years of general education and received nursing education in addition to basic education at senior high school level. Due to university reform in the s, applicants for admission were required to pass an admissions examination, and were placed in their professional studies according to the mean scores obtained.

Candidates who did not qualify for admission to other professions such as medicine or dentistry and had indicated nursing as a lower priority would be admitted to nursing, because nursing had fewer applicants. Fortunately, this situation has changed. University reform increased the number of nursing students and resulted in a division of the program of study into two sections, the basic and the professional components.

Physicians and other health care professionals, including nurses, were hired to teach the basic courses for students. Nurse faculty taught all the professional courses. Students earned credits for courses, and were allowed flexibility in choosing courses. The Brazilian university system established a new curriculum in that was followed for 23 years. The plan of study consisted of three sections: basic, professional and pre-specialization in areas such as community, maternal-child, medical -surgical, and pedagogical nursing.

Courses in community health nursing were given each semester along with the clinical courses. Graduate education at the master, doctoral, and clinical specialization levels expanded in the s, resulting in an increase in nursing research.

A nursing practice law was passed in the s to regulate the activities of nurses, technical nurses, nursing auxiliaries, and midwives Brasil, ; According to this law, nurses perform all activities in nursing care and participate actively in the health care team.

Only nurses can perform activities related to direction, organization, planning and evaluation of nursing services, nursing consultation, prescription of nursing care, and activities that are complex and require scientific knowledge and immediate actions. Nursing auxiliaries perform those activities related to nursing care that are simple such as those related to signs and symptoms, hygiene and comfort.

A new minimum curriculum was established in after 14 years of nursing lobbying for government approval. Because of this delay, the curriculum was already outdated, and is failing to attend the societal demands of the nursing profession. Therefore, discussions are again in progress to implement changes. The minimum curriculum eliminated pre-nursing courses, absorbing their content into the professional courses, and established an internship in the last year of study.

This curriculum also proposed better integration of course content, however it maintained similarities with the previous curriculum. The profession of nursing advanced in Brazil in the s. The number of nursing journals increased from 2 in to 11 in , master's programs from 8 to 15, and doctoral programs, from 3 to 8.

The quality of the Brazilian publications has steadily improved and meets the criteria for nursing journals and proceedings established by the Capes Nursing Evaluation Committee The criteria for evaluating proceedings include geographical range, scope of the themes, and regularity. The conference proceedings published by ABEn reflect a significant number of books, manuals and research articles published by nurses in the s, due at least in part to the increase in nursing graduate education.

ABEn established a center for nursing research, the Centro de Estudos e Pesquisas em Enfermagem CEPEN , which has published the Brazilian directory of nursing research and researchers since , and indexes graduate dissertations and theses.

The Brazilian public health care system includes government funded hospitals, clinics, and community health care agencies that provide no cost care. SUS was developed as a universal system to provide access to health care services for all the Brazilian population.

Antunes noted that, while nursing has a political interest in the implementation of the SUS, reorganizing nursing practice according to this delivery system is difficult. Nursing practice is still based on providing acute care to individuals according to a disease orientation. The SUS guidelines incorporate acute care needs, but stress population-based initiatives as well. This broader concept of health proposed by the health care reformists focuses on health determinants and conditioning factors, such as food, housing, environment, work, waste control, income, education, transportation, leisure, and access to goods and services Antunes, ; Brasil, Such costs are covered, totally or partially, by SUS money whenever agreements are established, or by private health care plans provided by insurance companies.

However, even those plans require a co-payment from the health care consumer. The private system has become one of the major options offered to a large contingent of people due to the difficult access to public services.

Unfortunately, a large contingent of the population do not have the economic resources to support the costs of the private sector, and remain unassisted. Current commentary on the Brazilian health care system points out that the principle of universality should be associated with the principle of equity, that is the right to access should be related to the availability of resources.

Instead, the SUS health care according to the resources within each district, rather than the population. The Brazilian territory is very large with million inhabitants. Educational, economical, and sanitary conditions vary among the districts, further complicating delivery of care. Issues related to nursing education are addressed by ABEn. ABEn is is a voluntary organization composed of nurses and technical nurses. Nursing undergraduate students and nursing auxiliaries are accepted as special members.

It is organized nationally through 23 state and 21 regional sections. Every section has an elected board of directors. However, all are under the direction of a national board and regulated according to the bylaws the latest version was approved in ABEn collaborates with other Brazilian nursing organizations to advance the nursing profession.

As the only nursing organization in Brazil from to , ABEn faced many challenges in pioneering nursing's causes and establishing nursing as a profession.

Therefore, professionals from different categories must register in the CORENs' state and regional councils to practice as established in the nursing practice act Brasil, COFEN is composed of nine nurse counselors and an equal number of substitutes elected by a national assembly of regional delegates.

The members are elected by their peers in a secret and mandatory voting process according to norms established by COFEN. All nursing personnel registered at the councils are required to vote. Fees are charged in cases of no show for voting. The counselor's term is three years Brasil, COFEN establishes resolutions to regulate professional practice. Nursing unions started in Today there are 12 nursing unions in the country The organizations are encouraged to affiliate with ABEn as institutional members in order to avoid the fragmentation of the profession.

Societies affiliated to ABEn are those related to stoma therapy, continuing education, midwives and obstetrical nurses, trauma and orthopaedic nursing ABEn, Those are related to nursing scientific societies in the following areas: pediatrics, nephrology, operating room, oncology, intensive care, management, natural therapies, endoscopy, psychiatric and mental health, auditors, informatics, hemodynamics, home care, cardiovascular, image diagnostic, dermatology, parenteral and enteral nutrition, and occupational health.

ABEn state sections provide physical space and logistic support to these organizations. In , nursing schools awarded baccalaureate degrees to 3, nurses. Even though nursing school enrollment and the number of nursing schools have increased, the number of nurses is still insufficient. Brazil has 4 nurses and 13 physicians per 10, inhabitants. However, there is a shortage of job opportunities for new graduates, with disproportionate distribution in bigger cities.

The growth of jobs in the health care sector has decreased in recent years. In the s and 80s Brazil had an annual 10 percent increase in jobs; now the increase in jobs is only 2 percent Paiva et al, The distribution of nursing schools in the country are as follows: 48 percent the Southeast, 21 percent in the South, 19 percent in the Northeast, 7 percent in the North, and 5 percent in the Midwest Paiva et al, , p. All schools are required to follow a basic curriculum established by the Ministry of Education; however, they are allowed to include other courses to meet regional needs.

In addition to curriculum guidelines, the Ministry of Education developed guidelines for opening programs and for accreditation; it also developed criteria for external evaluation according to performance indicators that are widely publish by the media.

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Nursing in Brazil: Trajectory, Conquests and Challenges








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