Care Management Processes Research Articles

Nursing process for patients with chronic wounds: A series of successful cases

The care of patients with chronic wounds represents a significant challenge for nursing. Recently, healing protocols have been developed that employ extracellular matrices (ECM), achieving complete wound regeneration. These protocols require an individualized care plan led by nurses, who work in multidisciplinary teams and provide a holistic view of the patient, thus improving care management processes. The nursing process, which includes research, logical analysis and interpersonal techniques, has been shown to improve the quality of care. In this study, evidence was presented on the successful management of chronic wounds through a comprehensive protocol in a first level hospital in Girón, Colombia. Three patients with venous insufficiency who had received conventional management without success were selected. The assessment was performed using the NANDA domains, with a diagnosis of impaired skin integrity. The protocol included disinfection, application of Regenesis® matrix and appropriate dressings, with daily photographic follow-up. The first patient, a 74-year-old woman with a 22-year-old venous ulcer, showed complete wound closure in six weeks. The second patient, a 53-year-old woman with a five-year-old venous ulcer, achieved closure in five weeks. The third patient, a 47-year-old man with a three-year-old venous ulcer, experienced complete closure in eight weeks. All patients showed significant improvements in their wound characteristics and had no adverse events. The study concluded that the healing protocol, which integrates the nursing process, is effective in closing chronic wounds in a short period, even in patients who have not responded to conventional treatments. These results underscore the importance of strict adherence to standardized protocols and nurse-patient interaction for successful treatment

Assessing Patient Readiness for Hospital Discharge, Discharge Communication, and Transitional Care Management.

Discharge communication between hospitalists and primary care clinicians is essential to improve care coordination, minimize adverse events, and decrease unplanned health services use. Health-related social needs are key drivers of health, and hospitalists and primary care clinicians value communicating social needs at discharge. To 1) characterize the current state of discharge communications between an academic medical center hospital and primary care clinicians at associated clinics; 2) seek feedback about the potential usefulness of discharge readiness information to primary care clinicians. Exploratory, convergent mixed methods. Primary care clinicians from Family Medicine and General Internal Medicine of an academic medical center in the US Intermountain West. Literature-informed REDCap survey. Semistructured interview guide developed with key informants, grounded in current literature. Survey data were descriptively summarized; interview data were deductively and inductively coded, organized by topics. Two key topics emerged: 1) discharge communication, with interrelated topics of transitional care management and follow-up appointment challenges, and recommendations for improving discharge communication; and 2) usefulness of the discharge readiness information, included interrelated topics related to lack of shared understanding about roles and responsibilities across settings and ethical concerns related to identifying problems that may not have solutions. While reiterating perennial discharge communication and transitional care management challenges, this study reveals new evidence about how these issues are interrelated with assessing and responding to patients' lack of readiness for discharge and unmet social needs during care transitions. Primary care clinicians had mixed views on the usefulness of discharge readiness information. We offer recommendations for improving discharge communication and transitional care management (TCM) processes, which may be applicable in other care settings.

‘Letting it be’: a grounded theory about dementia care in Fiji

Objectives This research study aimed to discover how dementia affecting older people was perceived, experienced, and managed by stakeholders in the Pacific Island country of Fiji. Method A transformational grounded theory approach was used. Semi-structured interviews and focus groups with key stakeholders in the major towns of Suva, Lautoka, and Nadi were carried out. Transcripts were analysed in line with transformational grounded theory methods. Results A total of 50 participants (40 service providers, eight family caregivers, one person with dementia, and one village elder) shared their views and experiences about dementia. A grounded theory about dementia care management was constructed. ‘Letting it be’ is the grounding socio-cultural construct that interweaves and binds together the processes of dementia care management. It expresses a compassionate approach to caring for older people with dementia that involves searching for knowledge and support, and application of traditional care practices within the strength of family and community networks. Conclusion In Fiji, support for dementia centres on the integration of community understandings, and promotion of cultural values of wellbeing and care, with service provision. It also focuses on support for families and communities through social welfare, community networks, and education.

Interventions to improve medication adherence in adults with mental-physical multimorbidity in primary care: a systematic review.

Medication non-adherence is a notable contributor to healthcare inefficiency, resulting in poor medication management, impaired patient outcomes, and ineffective symptom control. To summarise interventions targeting medication adherence for adults with mental-physical multimorbidity in primary healthcare settings. A systematic review of the literature - published in any language and with any country of origin - was conducted. MEDLINE, EMBASE, PsycInfo, Web of Science, Cochrane Library, and the Cumulated Index to Nursing and Allied Health Literature - more commonly known as CINAHL - were searched for relevant studies. Data were extracted and synthesised using narrative synthesis. The Effective Practice and Organisation of Care (EPOC) taxonomy was used to classify intervention types. Risk of bias was assessed using the National Heart, Lung, and Blood Institute's quality assessment tool for controlled intervention studies. Eleven studies, representing 2279 patients, were included. All interventions examined were classified into one EPOC domain, namely 'delivery arrangements'. All included studies examined patients who had a physical condition and depression. Seven studies examining interventions focused on coordination of care and management of care processes reported statistically significant improvements in medication adherence that were attributed to the intervention. Four studies considering the use of information and communication technology observed no changes in medication adherence. Interventions that coordinate and manage healthcare processes may help improve patients' adherence to medication regimes in those with mental-physical multimorbidity. However, it is still necessary to better understand how digital health technology can support patients in following their medication regimes. As the growing challenges of treating multimorbidity are faced, everyone involved in health services - from providers to policymakers - must be receptive to a more integrated approach to healthcare delivery.

Assessment of Patient Matters in Healthcare Facilities

Background and Objectives: Ensuring the sustainability of healthcare facilities requires the evaluation of patient matters with appropriate methods and tools. The objective of this research is to develop a new tool for assessing patient matters as a component of social responsibility requirements that contribute to the sustainability of healthcare facilities. Materials and Methods: We carried out an analytical observational study in which, starting from the domains of the reference framework for the sustainability of health facilities (economic, environmental, social, provision of sustainable medical care services and management processes), we designed indicators that describe patient matters. To achieve this, we extracted from the scientific literature the most recent data and aspects related to patient matters that have been reported by representative hospitals from all over the world. These were organized into the four sequences of the quality cycle. We designed the method of evaluating the indicators based on the information couple achievement degree-importance of the indicator. In the experimental part of the study, we validated the indicators for the evaluation of patient matters and the evaluation method at an emergency hospital with an orthopedic profile. Results: We developed the patient matters indicator matrix, the content of the 8 indicators that make it up, questions for the evaluation of the indicators, and the evaluation grids of the indicators. They describe five levels for each variable of the achievement degree-importance couple. The practical testing of the indicators at the emergency hospital allowed the calculation of sustainability indicators and the development of a prioritization matrix for improvement measures. Conclusions: Indicators designed in this research cover social responsibility requirements that describe patient matters. They are compatible and can be used by health facilities along with other implemented national and international requirements. Their added value consists in promoting social responsibility and sustainable development of healthcare facilities.

Interventions and Hospital Characteristics Associated With Patient Experience: An Update of the Evidence.

Patient experience is a key hospital quality measure. We review and characterize the literature on interventions, care and management processes, and structural characteristics associated with better inpatient experiences as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Prior reviews identified several promising interventions. We update these previous efforts by including more recent peer-reviewed literature and expanding the review's scope to include observational studies of HCAHPS measures with process measures and structural characteristics. We used PubMed to identify U.S. English-language peer-reviewed articles published in 2017 to 2020 and focused on hospital patient experience. The two HCAHPS domains for which we found the fewest potential quality improvement interventions were Communication with Doctors and Quietness. We identified several modifiable processes that could be rigorously evaluated in the future, including electronic health record patient engagement functionality, care management processes, and nurse-to-patient ratios. We describe implications for future policy, practice, and research.

Ten years of the Citizen's Electronic Health Record e-SUS Primary Healthcare: in search of an electronic Unified Health System.

Contextualize the adherence to the Prontuário Eletrônico do Cidadão (PEC - Citizen's Electronic Health Record) by Brazilian municipalities and the evolution of the electronic strategy of the Unified Health System (e-SUS) for Primary Healthcare (PHC) during its 10 years. This descriptive study added information on adherence to the use of medical records extracted from the database of the Secretaria de Atenção Primária à Saúde (SAPS- Primary Healthcare Secretary) of the Federal Government between 2017 and 2022. We analized the number of computerized basic healthcare units that used some electronic medical records, the number of those that used simplified data collection (SDC), and those that implemented the citizen's electronic health record (PEC) in the same period. A descriptive synthesis of the functionalities and modules implemented in the system during its 10 years of development was also carried out. The adherence of Brazilian municipalities to the PEC has grown exponentially in the last five years, going from 8,930 healthcare units in 2017 to 26,091 in 2022. As expected, while the main functionalities and improvements developed in this decade sought to implement new flows and modules of administrative, clinical care, and care management processes and health service administration, improving aspects of usability and technological infrastructure of the application architecture was also crucial for the success of the system. In 2023, the milestone of a decade will be celebrated since the beginning of health records implementation by Brazilian municipalities, marked by technological and infrastructure challenges and improvements and new functionalities that highlight the technological evolution of the e-SUS PHC system and strategy. Despite many other tools, the PEC is arguably Brazil's leading electronic medical record today, as it has always invested in evolution, updating itself in technological and usability opportunities.

Quality indicators for the diagnosis and treatment of breast cancer integrated assistance: A critical appraisal

IntroductionQuality indicators (QIs) are essential for adequate control of the health care management process, recognizing areas of improvement and providing solutions. We aimed to evaluate the Integrated Breast Cancer (BC) Care Process QIs. MethodsWe studied 487 consecutive BC cases diagnosed from November 1st, 2013, to November 30th, 2019, in a Spanish healthcare area, and we estimated the associated QIs. ResultsFour indicators did not meet the standards and were analysed based on related sociodemographic and clinical variables. The surgical delay after a multidisciplinary team discussion (mean 64%, IQR 59.6–68.5) was lower in elder people (p=0.027), and early histological grades (p=0.019) and stages (p=0.008). The adjuvant treatment delay (mean 55.7%, IQR 51.1–60.3) was lower in advance stages (p=0.002) and when there was no reoperation (p=0.001). The surgical delay after inclusion (mean 83.2%, IQR 79.3–87.2) was lower in early histological grades (p=0.048). The immediate reconstruction (mean 42.3%, IQR 34.0–50.5) reached 72.3% in young women compared to 11.8% in older than 70 years (p=0.001) and it was higher in early stages (45.3% vs 36.2%; p=0.049). ConclusionThe study of QIs evaluated their compliance and analysed the variables influencing them to propose improvement measures. Not all the indicators were equally valuable. Some depended on the available resources, and others on the mix of patients or complementary treatments. It would be essential to identify the specific target populations to estimate the indicators or provide standards stratified by the related variables.

Trabalho e riscos de adoecimento na Atenção Psicossocial Territorial: implicações para a gestão do cuidado em saúde mental

ABSTRACT The study aims to analyze precarious work due to working conditions that influence the management of mental health care and occupational health. This single case mixed study was conducted in six Psychosocial Care Centers (CAPS) in a Decentralized Health Sector. The Work and Illness Risks Inventory was applied to a total purposeful sample of 35 workers, 15 of whom participated in the projective interview. Data were processed in SPSS 26.0.0.0 as measures of central tendency and dispersion. The interviews were categorized based on the evaluation axes proposed by the inventory, contextualized, and discussed from Edgar Morin’s Complex Thought. The result is critical for most predictors that evaluated the context, human cost, pleasure, distress, and harm related to work in the CAPS. Data illustrated by the workers’ narratives describe the precarious work conditions. Local Unified Health System managers quickly incorporated neoliberalism’s productivist principles, perpetuating substandard work conditions. Mental health care management processes, funding, and legal occupational and contractual conditions must be reviewed to align with Territorial Psychosocial Care (APT).

Обеспеченность службы медицинской статистики квалифицированными кадрами

The implementation of the tasks of the medical statistics service is an integral part of the health care management process, as well as methodological support of the management vertical in the system [2, 3]. The quality of medical statistical and analytical data depends primarily on the personnel component of the medical statistics service. Currently, medical statistics are developing in the context of significant organizational changes in the healthcare system [1], which determines the priority of providing the service with qualified personnel [5]. The purpose of the study: to study the availability of qualified personnel engaged in professional activities in medical statistics. Materials and methods. The data of the Federal statistical observation form No. 30 “Information about a medical organization” were used for the study. Statistical and analytical methods were used in the study. Results. The Medical Statistics Service performs one of the key roles in the management of a medical organization and the healthcare industry as a whole. In medical organizations, statistical document management is carried out by specialists of departments (offices) of medical statistics, which make up the medical statistics service as a whole. The key specialists of the service are statisticians and medical statisticians. The analysis of the indicator of the availability of qualified personnel of the medical statistics service shows its stable decline. Thus, in the dynamics of the total indicator of the provision of statisticians and medical statisticians per 10 000 population in the Russian Federation from 2015 to 2021, there is a decrease in its level by 18,6% or from 0,86 0/000 to 0,700/000, including in outpatient settings by 24,4% or from 0,450/000 to 0,34 0/000, in stationary by 11,8% or from 0,34 0/000 to 0,30 0/000. By the end of 2021, the shortage of qualified specialists of the medical statistics service amounted to 44,3% of their total needs. A similar situation is observed in medical organizations for outpatient and inpatient medical care (45% and 42,6%, respectively). Simultaneously with the decrease in the staffing of the medical statistics service, an increase in the load on the specialist was revealed. Thus, in medical organizations providing medical care in outpatient and inpatient settings, the average load on a statistician and medical statistician is almost 1,5–2 times higher than the average standard. Conclusions. The analysis of personnel changes in the medical statistics service indicates the need to improve approaches to the training and use of qualified personnel engaged in professional activities in medical statistics.

Care Management Processes Important for High-Quality Diabetes Care.

Identify the improvement in diabetes performance measures and population-based clinical outcomes resulting from changes in care management processes (CMP) in primary care practices over 3 years. This repeated cross-sectional study tracked clinical performance measures for all diabetes patients seen in a cohort of 330 primary care practices in 2017 and 2019. Unit of analysis was patient-year with practice-level CMP exposures. Causal inference is based on dynamic changes in individual CMPs between years by practice. We used the Bayesian method to simultaneously estimate a five-outcome model: A1c, systolic and diastolic blood pressure, guideline-based statin use, and Optimal Diabetes Care (ODC). We control for unobserved time-invariant practice characteristics and secular change. We modeled correlation of errors across outcomes. Statistical significance was identified using 99% Bayesian credible intervals (analogous to P < 0.01). Implementation of 18 of 62 CMPs was associated with statistically significant improvements in patient outcomes. Together, these resulted in 12.1% more patients meeting ODC performance measures. Different CMPs affected different outcomes. Three CMPs accounted for 47% of the total ODC improvement, 68% of A1c decrease, 21% of SBP reduction, and 55% of statin use increase: 1) systems for identifying and reminding patients due for testing, 2) after-visit follow-up by a nonclinician, and 3) guideline-based clinician reminders for preventive services during a clinic visit. Effective quality improvement in primary care focuses on practice redesign that clearly improves diabetes outcomes. Tailoring CMP adoption in primary care provides effective improvement in ODC performance through focused changes in diabetes outcomes.

Differences in family caregiver experiences and expectations of end-of-life heart failure care across providers and settings: a systematic literature review

Heart failure impacts patients’ quality of life and life expectancy and significantly affects the daily behaviours and feelings of family caregivers. At the end-of-life, the burden for family caregivers depends on their emotional and sentimental involvement, as well as social costs.Objectives: The aim of this work is to determine whether and how family caregivers’ experiences and expectations vary in relation to the places of care and teams involved in heart failure management. Methods: A systematic literature review was conducted, by screening manuscripts dealing with the experience of Family Care Givers’ (FCGs) of patients with Advanced Heart failure. Methods and results were reported following the PRISMA rules. Papers were searched through three databases (PubMed, Scopus and Web of Science). Seven topics were used to synthetize results by reporting qualitative information and quantitative evidence about the experience of FCGs in places of care and with care teams.Results: Thirty-one papers, dealing with the experience of 814 FCGs, were selected for this systematic review. Most manuscripts came from the USA (N = 14) and European countries (N = 13) and were based on qualitative methods. The most common care setting and provider profile combination at the end of life was home care (N = 22) and multiprofessional teams (N = 27). Family caregivers experienced “psychological issues” (48.4%), impact of patients’ condition on their life (38,7%) and “worries for the future” (22.6%). Usually, when family caregivers were unprepared for the future, the care setting was the home, and there was a lack of palliative physicians on the team.Discussion: At the end-of-life, the major needs of chronic patients and their relatives are not health related. And, as we observed, non-health needs can be satisfied by improving some key components of the care management process that could be related to care team and setting of care. Our findings can support the design of new policies and strategies.

Multilevel influences on patient engagement and chronic care management.

Physician practices are increasingly owned by health systems, which may support or hinder adoption of innovative care processes for adults with chronic conditions. We examined health system- and physician practice-level capabilities associated with adoption of (1) patient engagement strategies and (2) chronic care management processes for adult patients with diabetes and/or cardiovascular disease. We analyzed data collected from the National Survey of Healthcare Organizations and Systems, a nationally representative survey of physician practices (n = 796) and health systems (n = 247) (2017-2018). Multivariable multilevel linear regression models estimated system- and practice-level characteristics associated with practice adoption of patient engagement strategies and chronic care management processes. Health systems with processes to assess clinical evidence (β = 6.54 points on a 0-100 scale; P = .004) and with more advanced health information technology (HIT) functionality (β = 2.77 points per SD increase on a 0-100 scale; P = .03) adopted more practice-level chronic care management processes, but not patient engagement strategies, compared with systems lacking these capabilities. Physician practices with cultures oriented to innovation, more advanced HIT functionality, and with a process to assess clinical evidence adopted more patient engagement strategies and chronic care management processes. Health systems may be better able to support the adoption of practice-level chronic care management processes, which have a strong evidence base for implementation, compared with patient engagement strategies, which have less evidence to guide effective implementation. Health systems have an opportunity to advance patient-centered care by expanding practice-level HIT functionality and developing processes to appraise clinical evidence for practices.

Clinical Nurse Specialist Tracheostomy Management Improves Patient Outcomes.

Patients with a tracheostomy are a low-volume, high-risk population with long lengths of hospital stay and high health care costs. Because of the complex nature of caring for patients with a tracheostomy, it is essential to provide a standardized care approach with ongoing monitoring to optimize outcomes. A pre/postimplementation design was used. A formal tracheostomy care management process using clinical nurse specialists (CNSs) was implemented. Between April 2019 and December 2020, this process resulted in a significant reduction in time between tracheostomy placement and discharge, from 16 to 12.9 days ( P = .02). Reductions were also seen in length of stay and incidence of tracheostomy-related pressure injuries. This project shows that a CNS-led care management process can improve patient outcomes. These improvements in patient outcomes resulted in a significant cost savings to the organization.

COVID-19 Impacts on Primary Care Clinic Care Management Processes.

To learn whether the COVID-19 pandemic's disruptions and associated reduced health outcomes for people with chronic conditions might have been caused by a decrease in care management processes (CMPs) in primary care clinics METHODS: Longitudinal cohort design with repeated survey-based measures of CMPs from 2017, 2019, and 2021 in 269 primary care clinics in Minnesota. There were only small differences in organizational characteristics and no differences in overall CMPs between the 269 clinics analyzed and the 287 that only completed surveys in 1 or 2 years. Overall CMP scores rose by similar amounts (1.6% and 2.1%) from 2017 to 2019 and from 2019 to 2021. In 2021, CMP scores were lower in small medical groups than in large medical groups in 2017 (66.1% vs 78.5%, P <.001), a similar difference to that in 2017. Care management process scores were also lower in clinics in urban areas compared with rural areas (73.9% vs 79.0%, P <.001), but overall scores in all subgroups were higher in 2021 than in 2017. This improvement occurred despite reports from 55% of clinic leaders that the pandemic had been very or extremely disruptive. Although quite disrupted by the pandemic, care management processes for chronic disease care in these resilient primary care clinics actually increased from 2019 to 2021, at least in clinics that were part of large organizations. However, that was not true for clinics from smaller groups and perhaps for other areas of care.

DESAFIOS DE ENFERMEIROS GESTORES NO TRABALHO EM HOSPITAIS BRASILEIROS E PORTUGUESES: ESTUDO DE MÉTODOS MISTOS

ABSTRACT Objective: to analyze the challenges found in nurse-managers' work in the Brazilian and Portuguese hospital contexts. Method: a mixed-methods research study with a sequential explanatory approach, carried out between March 2019 and March 2020 with nurse-managers from four hospitals. The study was initiated with the quantitative stage, applying a survey to 143 participants and analyzing the data by means of analytical and inferential statistics. The qualitative stage was carried out with 71 of these participants using interviews, in order to understand the challenges inherent to this job, and the data were submitted to content analysis. Integration of the findings was performed through data connection. Results: in the quantitative stage, the results evidenced that the managerial activities carried out by nurses by scenario included planning, people management, management of care processes, management of materials, quality management and leadership, with higher mean values for the first four. The qualitative stage allowed deepening the previous findings, contrasting invisibility of the planning, confirming people management as the common challenge to the realities, explaining the mean values in the national and Portuguese scopes. Integration of the findings detailed the relevance of the conflicts and the deficit of professionals in people management and leadership. Conclusion: managing people, care processes and materials are challenges for nurses in hospital management in both countries. Nurses lack structural support and ongoing training for better management and improvement of planning and leadership.

Grasping the structure of the care management process evaluation items that are related to care management skills with regard to individual users: conducting verification through self-assessment by care managers.

Objective: This study aimed to understand the structure of a self-assessment for evaluating the care management skills of individuals in the care management process. Materials and Methods: A survey was distributed to 964 care managers in home care management hailing from each committee in Japanese municipalities in Ibaraki, Chiba, Saitama, Kanagawa, and Tokyo. The process implementation degree of care management in 46 care management process evaluation items was assessed using a five-point method. Cronbach's alpha coefficients were derived for the items, and an exploratory factor analysis was conducted to ascertain the factor structure. We also verified the relationship between the factor scores, presence or absence of a chief care manager, and years of experience. Results: We received 385 responses (response rate: 39.9%), of which 372 were included in the analysis (valid response rate: 96.6%). Six factors were extracted, and 29 items were retained because of the exploratory factor analysis. Three of the six factors did not exist in the existing scales and had a unique structure. The cumulative contribution rate of the six factors was 64.9%, and Cronbach's alpha coefficient for all items was α=0.95, with Factor 1 being 0.88; Factor 2 being 0.83; Factor 3 being 0.86; Factor 4 being 0.85; Factor 5 being 0.80; and Factor 6 being 0.87. The total score for Factors 1, 2, 4, and 5 was significantly higher among chief care managers. Pearson's correlation coefficients were calculated to determine the correlation between scale scores and years of experience. Factor 1 (r=0.22) and Factor 2 (r=0.21) showed a modest positive correlation between the scale scores and years of experience. Conclusion: We retained 29 items and extracted six factors for the care manager self-assessment items that had a unique factor structure while following existing scales' factor structure.

Effectiveness of a rehabilitation professional's advice and suggestions on a care manager's self-assessment scores of their care management.

[Purpose] To verify how advice or suggestions from rehabilitation professionals affect self-assessment by care managers. [Participants and Methods] This was a cross-sectional study in which a survey was administered to care managers from in-home care support offices in nine randomly selected municipalities. The survey was used to self-assess how the advice and suggestions from rehabilitation professionals affected the participant's care management process. [Results] Responses were received from 419 participants (response rate 11.3%). Of these responses, 388 (92.6% valid response rate) were analyzed, which revealed that 349 (89.9%) participants had received support from a rehabilitation professional, while 39 (10.1%) had not. Participants who had received support from a rehabilitation professional had significantly higher self-assessment scores than those who had not. Univariate and multiple regression analyses revealed that the factors affecting the self-assessment score were as follows: community care conferences as a support system was a negative factor and years of experience as a care manager was a positive factor. [Conclusion] Advice and suggestions from rehabilitation professionals affect improved care managers' self-assessment scores.

Didactic Sequences as an Educational Product to Facilitate Teaching-Learning Processes in Lato Sensu Graduate Courses in the Area of Health Management in Primary Care

Teaching strategies can be considered as techniques that are constructed to be used with the objective of promoting teaching and learning in the classroom, so that the teacher is considered a mentor, as he is the one who selects, analyzes, studies, organizes, builds and proposes the most classic tools to facilitate the learning process [1]. This study is an experience report related to the construction of an educational product that consists of the elaboration of pedagogical strategies, characterized by five didactic sequences in the perspective of collaborating with teaching-learning processes in lato sensu graduate courses. The themes that are part of the didactic sequences were built based on the results obtained in scientific research carried out during the development of the strict sensu postgraduate course in Teaching in Health and Technology, which involved: the work of coordinators who work in the field of health management in Primary Care, situations that challenge the management of Primary Care and the potentialities of work in the management of Primary Care. The didactic sequences have fun teaching strategies that provide meaningful learning for a future qualified professional performance. These sequences involve the use of active methodologies and the use of digital tools. The educational product developed seeks to promote benefits that can collaborate with the improvement of Primary Care Management and teaching-learning processes in the training of health professionals. Therefore, the pedagogical strategies, as well as its entire construction process, were developed through the collaboration of professors of the Health and Society discipline at the State University of Health Sciences of Alagoas (UNCISAL), seeking to make it qualify for effective construction of knowledge and that promote its wide use in the academic environment.

Nursing perception regarding the care of patients with chronic renal failure

Chronic Renal Failure (CRF) is a disease that affects the functionality of the kidneys, and can cause irreversible organ failure over time. The rate of patients requiring renal replacement therapies, such as hemodialysis, is growing in the country. The main treatment used for chronic kidney disease is hemodialysis, which acts as a blood filter, excluding all toxins and excess fluid by means of a machine that has its activity presented as an artificial type of kidney, where a dialysis compound is applied, which its main component is water. To describe the role of the nursing team during the treatment of the patient. A literature review, of the integrative type, which searched articles in secondary databases, Lilacs, SciELO, in the period between 2007 and 2017. A total of 30 articles were found and after the exclusion criterion, 05 articles were analyzed. The nursing team is very important in the development of quality of life, treatment, care management, and coping process with chronic kidney disease (CKD). Conclusion: the nursing team has a primary role for quality of life, survival and treatment success.