Primary Health Care Environment Research Articles

Efficient Brain Cancer Classification Based on Advanced CNN and Transformer Technologies

Abstract. This study addresses the challenge faced by primary medical staff in accurately distinguishing different types of brain cancer by comparing the training accuracy and iteration speed of various classification models. Specifically, thesis evaluated a basic Convolutional Neural Network (CNN) alongside two transfer learning models: EfficientNetV2 and Vision Transformer. The analysis is based on publicly available data from Kaggle, which provided a robust dataset for evaluation. The results indicate that both EfficientNetV2 and Vision Transformer models achieve significantly higher iteration convergence speeds and classification accuracy compared to the basic CNN model trained solely on the database. These advanced models demonstrate a capacity for efficient and rapid brain cancer differentiation, making them suitable for settings with limited computing resources. The study highlights that the transfer learning models can effectively support outpatient doctors by providing fast and accurate etiological screening without requiring extensive hardware. Overall, the findings suggest that EfficientNetV2 and Vision Transformer models offer a practical solution for improving brain cancer classification in primary healthcare environments, where rapid and precise diagnosis is crucial. This research underscores the potential of transfer learning techniques to enhance diagnostic capabilities while accommodating resource constraints.

Telemedicine-Enabled Otoscopes as Catalysts for Accessible and Preventive Ear Health Care: Systematic Review and Meta-analysis

Background: Maintaining optimal hearing health and preventing ear infections is crucial across all life stages, spanning from before birth and infancy to middle age and beyond. The primary aim of the research was to evaluate and compare the effectiveness of the telemedicine-enabled otoscope (TEO) in diagnosing ear diseases with that of the conventional otoscope. Materials and Methods: The databases PubMed, Cochrane, and Embase were thoroughly searched to find original studies on TEO at the community as well as hospital levels along with meta-analysis for comparison with standard diagnostic methods using traditional otoscopes. Results: The telemedicine-equipped otoscope displays a sensitivity of 82% (confidence interval 0.78–0.95) and a specificity of 95% (confidence interval 0.93–0.96). When employed by physicians, the combined sensitivity and specificity become 84% (confidence interval 0.79–0.88) and 91% (confidence interval 0.87–0.94), respectively. Community Health Workers (CHWs) using telemedicine-enabled otoscopes exhibit a collective sensitivity of 80% (confidence interval 0.72–0.87) and a collective specificity of 97% (confidence interval 0.95–0.98). Snapping multiple photographs and removal of cerumen where necessary in increasing the quality of the photographs for diagnosis. Conclusions: The TEO holds the promise of substantially enhancing the accessibility of audiology services, encompassing evaluation, public outreach, and fundamental care. Its implementation has the potential to fortify primary health care environments, contributing to the prevention of ear diseases and assisting in mitigating the shortage of skilled ear care professionals.

The primary health care environment and the performance of advanced antenatal care trained nurse-midwives in South Africa.

Transfer of learning in the workplace depends on various factors, one of which is the work environment. The aim of this study was to describe the interplay between the primary healthcare work environment, the performance of advanced antenatal care trained nurse-midwives, and birth outcomes. A cross-sectional, quantitative study was conducted in two purposely selected districts in South Africa. Document analyses were also completed. Statistical Analysis Software version 9.4 was used for descriptive statistical data analysis. The participating clinics, in the TM and LJ districts, both achieved ideal clinic status. The scores for the management of low- and high-risk pregnancies ranged between 86-89% and 87%, respectively. Babies born had Apgar scores of between 7-9 and 8-10 in 1 minute and 5 minutes after birth, respectively. Nurse-midwives scored low on interpreting assessment findings. Contrary to the Transfer of Learning Theory, nurse-midwives performed better in poorer work environments. The study suggests that the performance of advanced antenatal care trained nurse-midwives may not solely depend on a well-equipped work environment. Further studies should highlight the broader determinants of advanced antenatal care nurse-midwives services output.

Reflecting on 12 years of training medical students in rural longitudinal integrated clerkships.

Longitudinal integrated clerkships (LICs) are effective in promoting careers in rural primary health care environments. This model of training medical professionals involves longer clinical placements of medical students and a different approach to learning which better prepares them for primary health care practice. Stellenbosch University created a LIC in 2011 for this purpose and has trained almost 100 doctors in their yearlong LIC since then. The past 12 years have brought about a lot of learning as this model of training was implemented, developed, and refined to suit the needs of students and the clinical environments.Contribution:Countries across the globe face challenges in recruiting and retaining doctors in rural primary health care environments. Longitudinal integrated clerkships have several educational benefits in addition to increase recruitment and retention of rural doctors, and 12 years of experience have led to a greater understanding regarding implementation and outcomes of an LIC in the South African context.

The Effect of Hepatitis B Vaccine on Health Workers in Medina

This study aimed to assess hepatitis B virus (HBV) vaccination rates among healthcare professionals and understand their knowledge about HBV transmission. Conducted in a healthcare setting, the research employed survey methods to collect data on vaccination status and awareness levels. Alarmingly, only 25% of healthcare workers were found to be vaccinated against HBV, highlighting a significant gap in protection. Additionally, a considerable lack of awareness regarding HBV transmission was observed among the participants. These findings underscore the urgent need for targeted vaccination campaigns and educational initiatives within primary healthcare environments. The study advocates for mandatory HBV vaccination as a condition of employment for healthcare workers, coupled with ongoing infection prevention and control training. Further research is recommended to explore the prevalence of HBV infection among healthcare professionals in primary care settings and to assess the broader implications for public health. This study serves as a critical call to action for healthcare systems to prioritize HBV vaccination and education, thereby safeguarding both healthcare providers and patients from HBV infection risks. Highlights : Low Vaccination Rates: Only 25% of healthcare workers are vaccinated against HBV, indicating a critical need for improved vaccination coverage in healthcare settings. Knowledge Deficit: There is a significant lack of awareness among healthcare professionals about HBV transmission, necessitating educational programs. Policy Implications: The study advocates for mandatory HBV vaccination for healthcare workers, emphasizing the importance of infection control measures for public health safety. Keywords : Hepatitis B Vaccination, Healthcare Workers, Infection Prevention, Public Health, Vaccination Awareness

Risk of depression during pregnancy in usual risk antenatal care.

to identify the risk of depression during pregnancy among pregnant women receiving routine prenatal care and the associated factors. a cross-sectional study, carried out with 201 pregnant women, in a routine prenatal clinic of a university maternity hospital. Data were collected using an electronic form containing a characterization instrument and the Escala de Risco de Depressão na Gravidez (Depression during Pregnancy Scale). The dependent variable was the risk of depression during pregnancy. Statistical analysis was performed by calculating the Odds Ratio and using the Chi-square and Fischer's Exact tests. among the participants, 68.2% had a higher risk of depression during pregnancy. There was a statistically significant association between a higher risk of depression during pregnancy and occupation (p=0.04), that is, unemployment (OR=2.00) doubled the risk of depression. the high prevalence of the risk of depression during pregnancy indicates the necessity of planning, prioritizing, and integrating mental health into prenatal health services, especially in the primary healthcare environment, by health managers and policymakers.

Design strategies and health planning to improve the primary health care environment: a case study in Brazil

PurposeThe research outlined in this paper highlights the importance of certain factors related to primary health care buildings’ physical environment, such as the facility size, the functional efficiency, and the health planning of public areas in the health centers to improve the architectural space of health facilities.Design/methodology/approachThis study was performed using a mixed method. Data collection was carried out through observational research and descriptive analysis in six primary health care facilities in Salvador and Lauro de Freitas, Brazil.FindingsBased on this study’s results, facility capacity, functional efficiency and space accessibility have been considered the facilities’ main problems in the investigated context. The impact of the users’ perspective on healthcare facilities was assessed for each of these three criteria to verify the results obtained. Furthermore, most of the parameters were not satisfied, as the buildings analyzed had defects in their physical environment. Therefore, it is necessary to review and pay more attention to the architecture of these cities’ primary health care units.Originality/valueThe present study addresses the architectural environment design in Brazil’s healthcare facilities, which still have gaps. Improving the physical space of a health center ensures that the approach used in this research also applies to other health centers in similar contexts. The awareness that space’s activities and configurations will change according to each territory examined will open up so many investigation worlds.

Qualitative analysis of the barriers and facilitators influencing uptake of direct-acting antiviral therapy for hepatitis C in a primary healthcare environment.

Historical interferon and ribavirin therapies for hepatitis C virus have been replaced by modern treatments with improved efficacy and tolerability. Despite the availability of direct-acting antiviral therapy, evidence demonstrates poor uptake in Australia. Presently, the barriers and facilitators influencing uptake of direct-acting antiviral therapy are not fully understood, especially in a primary healthcare environment. Our study aimed to discover methods of improving uptake of treatment in the community. We conducted 15 semi-structured, face-to-face interviews in a metropolitan, primary healthcare clinic in Australia. Interviews were recorded, transcribed and subsequently analysed using thematic content analysis. We identified patient-related and healthcare system-related barriers and facilitators to commencing treatment. This included established themes from current literature, and novel themes unique to direct-acting antiviral therapy and primary care. Overall, our study reinforces the importance of public health campaigns to promote community awareness and emphasises the concomitant role of mental health in fostering treatment uptake. Informed by our findings, we suggest further research on an integrated model of care, focused on the domains of disease awareness, patient engagement and treatment adherence. Hence, a community-oriented approach, driven by primary healthcare, ultimately underpins a successful public strategy to improve outcomes for patients affected by hepatitis C.

The primary health care environment and the impact on motivation and stress in nurses

Objective: The focus of this study was to investigate the possible occupational stress the nurses perceived that in Basic Health Units (BHUs) and assess the major factors that motivate these employees’ inside these primary healthcare centers. Methodology: Data was collected from 70 nurses working in 61 BHUs distributed in the South of Brazil. The stress was measured with the Nurses' Stress Inventory (NSI), and the determination of motivation was performed using Maslow's Hierarchy of Needs. The research has been taken up with special reference to administrative/assistance nurses. Results: The investigation showed that nurses are predominantly female (89.5%) and 80.0% work equally in assistant care and administrative functions. Moreover, the data showed that 89.4% of nurses present moderate to higher stress scores as a consequence of the intrinsic work factors. Investigating the motivation, the higher level in the Maslow hierarchy was belonging, this could be related to the fact BHUs are inserted in communities with strong social connections and relationships with the population. Conclusion: Knowing the main factors responsible for stress in nurses at the BHUs are essential for future strategies to improve working conditions.

Point-of-care ultrasound at Role 1: is it time for a rethink?

IntroductionThe past 20 years have seen a rapid increase in point-of-care ultrasound (POCUS) use in the prehospital sphere. However, in the British Army there is no POCUS capability in the...

A Literature Review on People-Centered Care and Nursing Practice in Primary Health Care Setting

BACKGROUND: With increased research, the concept of people-centered care is advancing, and it remains an important concept in the health sector. Despite reported evidence of significant benefits, this concept is poorly utilized by professional nurses. The principle has not been demonstrated and absorbed at primary health care levels.
 
 AIM: The aim of this study is to present review of literature on people-centered care (PCC) in nursing and its practice in primary health care setting. 
 
 METHODS: Searching for this study is conducted through electronic databases in which the following databases were searched: PubMed, Google Scholar, Science Direct, EMBASE, and CINAHL, MEDLINE, Health sources: Nursing/Academic edition, PsycINFO, Education source, Academic search complete, and psychARTICLE from EBSCOhost platform. The Joanna Briggs Institute Reviewers’ Manual 2015 methodology framework was used as a guide to conduct the search strategy. Furthermore, in this review study, both peer reviewed articles and grey studies on people centered care were reviewed.
 
 RESULT: The findings of this research review outlined the evidence, practicability and acceptability of nursing care with people-centered care concept in the primary health care centers. Considering that nurses play a vital role in the health sector, it is possible to use people-centered care in Primary Health Care settings. However, there are many difficulties and obstacles identified such as: absence of nursing fraternity training and growth, absence of clear educational advancement resulting from change in accreditation, small number of nurses at the organizational level of health care organizations, and reduced global health care organization assistance.
 
 DISCUSSION: The results from this review highlighted evidence of the relationship between quality healthcare deliveries of nurses with people-centered care concept in primary healthcare centers. Nurses' role in delivering PCC and gauging their knowledge and understanding is becoming imperative and crucial. In primary health care environments, nurses play a significant role in understanding a patient's culture of quality and efficient health care.

Perception of the professional nursing environment in Primary Care in the Valencian Community, in departments with public and private management

Nursing practice environments (NPE) improve the quality of care, satisfaction and heath results; there are no studies that compare the Primary Health Care (PHC) environments according to their management model. Our aim is to estimate and compare the perception of the quality of the NPE in the PHC in Health Departments (HD) of the Valencian Community (Spain) with management model public or indirect-private (Administrative concession). Transversal study on PHC nurses from three HD, one with direct public management and two with indirect-private management. The Practice Environment Scale-Nursing Work Index questionnaire, validated in Spain, was administered. Sociodemographic and professional variables were recorded. Variables related to test score were analyzed by multiple linear regression. Two hundred and sixty-nine answers (80.3%). All HD perceived NPE quality in a positive way, both globally and for the different dimensions (except D4). Indirect private management model HD obtained higher global scores, the same tendency was observed for D1 and D2, and the opposite for D4. Global score was related to age, professional experience, being a coordinator and management model; only the age of the nurses and being a coordinator showed a significant relationship with the score in the multivariate regression model. The NPE of the PHC of the Valencian Community are of good quality, without significant differences according to different management models of the HD. Being a coordinator and, particularly, the age of the nurses are variables that are independently related to the global score obtained.

Youth Mental Health Services Utilization Rates After a Large-Scale Social Media Campaign: Population-Based Interrupted Time-Series Analysis.

BackgroundDespite the uptake of mass media campaigns, their overall impact remains unclear. Since 2011, a Canadian telecommunications company has operated an annual, large-scale mental health advocacy campaign (Bell Let’s Talk) focused on mental health awareness and stigma reduction. In February 2012, the campaign began to explicitly leverage the social media platform Twitter and incented participation from the public by promising donations of Can $0.05 for each interaction with a campaign-specific username (@Bell_LetsTalk).ObjectiveThe intent of the study was to examine the impact of this 2012 campaign on youth outpatient mental health services in the province of Ontario, Canada.MethodsMonthly outpatient mental health visits (primary health care and psychiatric services) were obtained for the Ontario youth aged 10 to 24 years (approximately 5.66 million visits) from January 1, 2006 to December 31, 2015. Interrupted time series, autoregressive integrated moving average modeling was implemented to evaluate the impact of the campaign on rates of monthly outpatient mental health visits. A lagged intervention date of April 1, 2012 was selected to account for the delay required for a patient to schedule and attend a mental health–related physician visit.ResultsThe inclusion of Twitter into the 2012 Bell Let’s Talk campaign was temporally associated with an increase in outpatient mental health utilization for both males and females. Within primary health care environments, female adolescents aged 10 to 17 years experienced a monthly increase in the mental health visit rate from 10.2/1000 in April 2006 to 14.1/1000 in April 2015 (slope change of 0.094 following campaign, P<.001), whereas males of the same age cohort experienced a monthly increase from 9.7/1000 to 9.8/1000 (slope change of 0.052 following campaign, P<.001). Outpatient psychiatric services visit rates also increased for both male and female adolescents aged 10 to 17 years post campaign (slope change of 0.005, P=.02; slope change of 0.003, P=.005, respectively). For young adults aged 18 to 24 years, females who used primary health care experienced the most significant increases in mental health visit rates from 26.5/1000 in April 2006 to 29.2/1000 in April 2015 (slope change of 0.17 following campaign, P<.001).ConclusionsThe 2012 Bell Let’s Talk campaign was temporally associated with an increase in the rate of mental health visits among Ontarian youth. Furthermore, there appears to be an upward trend of youth mental health utilization in the province of Ontario, especially noticeable in females who accessed primary health care services.

Improving patient outcomes by coaching primary health general practitioners and practice nurses in evidence based wound management at on-site wound clinics

BackgroundWound management is frequently performed in the community and forms a large part of daily activities of General Practice health professionals. However, previous research has acknowledged a need for further education and training on evidence based wound management for these health professionals. AimThe aim of this project was to develop and trial a Cooperative Wound Clinic model of care in General Practices, using a nurse led, interdisciplinary, holistic approach; including training and coaching to increase the wound management expertise and capacity of health professionals working in the primary healthcare environment. MethodsA longitudinal, pre-post design was used. Four Cooperative Wound Clinic pilot sites and nine wound clinics were established in General Practices across three Australian states with the intervention of the study being the model care and incorporating a local wound expert employed to provide the training and coaching. Pre and post survey data were collected on wound management practices, health professional confidence in evidence based wound management, patient health, wellbeing and healing outcomes. Longitudinal patient data were collected for 24 weeks. FindingsResults included an increase in the confidence of health professionals to manage wounds. Utilisation of a repetitive coaching model over a six month period empowered the decision making process and assessment knowledge for a variety of wound types. A positive impact on patient outcomes for a variety of wound types was also observed. ConclusionThe potential for expanding this model will bring many benefits including: empowerment of nurses’ confidence in managing wounds, promoting the role of nurse led clinics; improved wound related capability and confidence of health professionals; improved wound management, patient knowledge and better patient satisfaction and outcomes.

The motivational needs of primary health care nurses to acquire power as leaders in a mine clinic setting

Motivation is a process that influences and directs behaviour in order to satisfy a need. It links with goal 3 of the sustainable development goals that focus on ensuring healthy lives and promoting well-being at all ages. Motivation of nurses is important in the primary health care environment of, for instance, mine settings; since low levels of motivation among Primary Health Care (PHC) nurses could have a negative effect on the achievement of high standards in health service delivery. The study was conducted within the theoretical framework of McClelland's Acquired Motivation Theory which consists of three basic needs, – the need for achievement, the need for power, and the need for affiliation. One of the research questions posed was “What are the motivational needs of PHC nurses to acquire power in the workplace at mine clinic settings?” A quantitative, explorative, descriptive design was followed. The accessible population in this study was PHC nurses (N = 30) working at 13 mine clinics, that also served as the total sample. A 7 point Likert scale was used in a self-administered structured questionnaire that was developed from a literature review. Ethical considerations were adhered to and respondents gave written informed consent. Data was analysed by using descriptive and inferential statistics. TheManne Whitney test compared the mean ranks and a p-value of p &lt; 0.05 was indicative of a significant difference between male and female groups. Validity and reliability principles were applied during the entire research process. The results indicated that PHC nurses needed acknowledgement, organisational responsibility, strategic planning and promotion, as well as support. Significant differences between gender were not found in relation to the need to acquire power.

The motivational needs of primary health care nurses to acquire power as leaders in a mine clinic setting

Motivation is a process that influences and directs behaviour in order to satisfy a need. It links with goal 3 of the sustainable development goals that focus on ensuring healthy lives and promoting well-being at all ages. Motivation of nurses is important in the primary health care environment of, for instance, mine settings; since low levels of motivation among Primary Health Care (PHC) nurses could have a negative effect on the achievement of high standards in health service delivery. The study was conducted within the theoretical framework of McClelland's Acquired Motivation Theory which consists of three basic needs, – the need for achievement, the need for power, and the need for affiliation. One of the research questions posed was “What are the motivational needs of PHC nurses to acquire power in the workplace at mine clinic settings?” A quantitative, explorative, descriptive design was followed. The accessible population in this study was PHC nurses (N = 30) working at 13 mine clinics, that also served as the total sample. A 7 point Likert scale was used in a self-administered structured questionnaire that was developed from a literature review. Ethical considerations were adhered to and respondents gave written informed consent. Data was analysed by using descriptive and inferential statistics. The Mann–Whitney test compared the mean ranks and a p-value of p < 0.05 was indicative of a significant difference between male and female groups. Validity and reliability principles were applied during the entire research process. The results indicated that PHC nurses needed acknowledgement, organisational responsibility, strategic planning and promotion, as well as support. Significant differences between gender were not found in relation to the need to acquire power.

Australian primary health care nurses most and least satisfying aspects of work.

To identify the aspects of working in Australian primary health care that nurses rate as the most and least satisfying. The nursing workforce in Australian primary health care has grown exponentially to meet the growing demand for health care. To maintain and further growth requires the recruitment and retention of nurses to this setting. Understanding the factors that nurses' rate as the most and least satisfying about their job will inform strategies to enhance nurse retention. A cross-sectional online survey. Nurses employed in primary health care settings across Australia were recruited (n=1166) to participate in a survey which combined items related to the respondent, their job, type of work, clinical activities, job satisfaction and future intention, with two open-ended items about the most and least satisfying aspects of their work. Patient interactions, respect, teamwork, collegiality and autonomy were identified as the most satisfying professional aspects of their role. Personal considerations such as family friendly work arrangements and a satisfactory work-life balance were also important, overriding negative components of the role. The least satisfying aspects were poor financial support and remuneration, lack of a career path, physical work environment and time constraints. National restructuring of the primary health care environment was seen as a barrier to role stability and ability to work to a full scope of practice. This study has identified a range of positive and negative professional and personal aspects of the primary health care nursing role, which may impact on staff recruitment and retention. Findings from the study should be considered by employers seeking to retain and maximise the skills of their primary health care workforce. Understanding the factors that nurses perceive as being the most and least satisfying aspects of the work is can open up dialogue about how to improve the working experience of nurses in primary health care.

New ways of seeing: Nursing students' experiences of a pilot service learning program in Australia

The objective of this paper was to evaluate pre-registration nursing students' experiences of a pilot program that placed them in community based non-government organisations for clinical placement as part of a core mental health subject.Clinical placements that adopt a Service Learning model in primary health care environments are valuable to nursing students but are not commonly available in Australia. In order to enhance student exposure to primary health care models and support experiential learning about the social determinants of health, a pilot Service Learning program was designed to provide clinical placements in non-government organisations.Qualitative data were collected through one focus group with program participants. The focus group was audio-recorded and transcribed verbatim. Thematic analysis of transcribed data was undertaken.The overarching theme identified was ‘new ways of seeing’. Three sub-themes – ‘learning outside the box’, ‘confronting the real world’ and ‘transformative experiences’ – were also identified.The authors have concluded that nursing students in community organisations for clinical practicum facilitated valuable learning and generated professional and personal insight leading to increased understanding of the social determinants of health and increased awareness of mental health nursing in the community.

Is integration an add-on or a new way of working for health professionals in co-located medical practices?

Introduction: Characteristically health services within the community are not separated based on illness/condition but rather on profession for example, GP services, physiotherapy clinics. In the primary health sector government policy at federal and state levels has established integrated health services. Functional and operationalised integration does not spontaneously arise from colocating health professionals. Despite primary health reforms there is no prescriptive method whereby services are integrated. For those health professionals working in a co-located primary health care environment how integrated is ‘integrated’? Practice and context: Our study examines integration at the point of service delivery, within colocated community medical practices in Australia: five different case study practices in areas of high population need. These are a purposeful mix of the state government model, Commonwealth government model (university linked Superclinic), a hybrid of state and Commonwealth model, and private for profit models. Change implemented: These practices commenced delivering co-located health services with an underlying philosphy of service integration to better address patient health outcomes (between 3 and 10 years). Objective of the change: We examine health professionals’ experience of health service integration. Targeted population: Health professionals in an integrated service delivery environment. Stakeholders engaged: Health professionals in the case study clinics. World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116679– http://www.ijic.org/ Timeline: These are practices offering a range of services for between 3 and 10 years. The questionnaire was completed over a 3 week period (July 2014) and focus groups were conducted from July – September 2014. Theory/method: Our research method plan is a multiple case study (mixed methods design) of contemporary co-location service models. The case study approach incorporates close interaction with practitioners and deals with real management situations. Our data collection method was twofold; individual questionnaires designed for our research questions, and focus groups. Highlights (innovation/impact/outcomes): This is timely research with the increasing emphasis on patient centred care and recognition that more than one discipline can contribute to patient wellbeing. Health professionals varied in their expectations of integration. There was variability across the models on different components of health professional experience. Integration was described as lacking direct leadership and overt expectations of health professionals. Some infrastructure supported integration at an operational level but integration regarding patient care was relatively informal. Co-location may be the only form of health professional interface. Sustainability: Co-located services can be sustained without health professional integration because patients can continue to receive services but health professional retention and patient services can arguably be impacted by dealing with patients with multiple and chronic conditions on a longer term basis. Transferability: Outcomes of this research can be transferred and adapted across co-located health services to improve levels of integration. Conclusions: Integration as it impacts health professionals has been under-researched in colocated health services. The case study environments were not obstructive but were not making optimal use of co-located services. Discussions: Co-location is a start towards integration but health professionals see greater potential in higher levels of integration. Lessons learned: Health professionals favour integration and there are key factors that feature in their expectations of integrated health service delivery.

The environment of professional practice and Burnout in nurses in primary healthcare

OBJECTIVES: to assess how nurses perceive autonomy, control over the environment, the professional relationship between nurses and physicians and the organizational support and correlate them with burnout, satisfaction at work, quality of work and the intention to quit work in primary healthcare. METHOD: cross-sectional and correlation study, using a sample of 198 nurses. The tools used were the Nursing Work Index Revised, Maslach Burnout Inventory and a form to characterize the nurses. To analyze the data, descriptive statistics were applied and Spearman's correlation coefficient was used. RESULTS: the nurses assessed that the environment is partially favorable for: autonomy, professional relationship and organizational support and that the control over this environment is limited. Significant correlations were evidenced between the Nursing Work Index Revised, Maslach Burnout Inventory and the variables: satisfaction at work, quality of care and the intent to quit the job. CONCLUSION: the nurses' perceptions regarding the environment of practice are correlated with burnout, satisfaction at work, quality of care and the intent to quit the job. This study provides support for the restructuring of work processes in the primary health care environment and for communication among the health service management, human resources and occupational health areas.