Background Health systems are often fragmented in low- and middle-income countries (LMICs). This can increase inefficiencies and restrict progress towards universal health coverage. The objective of the systematic review described in this protocol will be to evaluate and synthesize the evidence concerning the impacts of health systems financing fragmentation in LMICs. Methods Literature searches will be conducted in multiple electronic databases, from their inception onwards, including MEDLINE, EMBASE, LILACS, CINAHL, Scopus, ScienceDirect, Scielo, Cochrane Library, EconLit, and JSTOR. Gray literature will be also targeted through searching OpenSIGLE, Google Scholar, and institutional websites (e.g., HMIC, The World Bank, WHO, PAHO, OECD). The search strings will include keywords related to LMICs, health system financing fragmentation, and health system goals. Experimental, quasi-experimental, and observational studies conducted in LMICs and examining health financing fragmentation across any relevant metric (e.g., the presence of different health funders/insurers, risk pooling mechanisms, eligibility categories, benefits packages, premiums) will be included. Studies will be eligible if they compare financing fragmentation in alternative settings or at least two-time points. The primary outcomes will be health system-related goals such as health outcomes (e.g., mortality, morbidity, patient-reported outcome measures) and indicators of access, services utilization, equity, and financial risk protection. Additional outcomes will include intermediate health system objectives (e.g., indicators of efficiency and quality). Two reviewers will independently screen all citations, abstract data, and full-text articles. Potential conflicts will be resolved through discussion and, when necessary, resolved by a third reviewer. The methodological quality (or risk of bias) of selected studies will be appraised using established checklists. Data extraction categories will include the studies’ objective and design, the fragmentation measurement and domains, and health outcomes linked to the fragmentation. A narrative synthesis will be used to describe the results and characteristics of all included studies and to explore relationships and findings both within and between the studies. Discussion Evidence on the impacts of health system fragmentation in LMICs is key for identifying evidence gaps and priority areas for intervention. This knowledge will be valuable to health system policymakers aiming to strengthen health systems in LMICs. Systematic review registration PROSPERO CRD42020201467

Objetivo: Determinar a efetividade da intervenção entrevista motivacional no autocuidado dos pacientes com insuficiênciacardíaca. Método: Trata-se de uma revisão sistemática, atualizada em julho de 2018, realizada nas bases MEDLINE, CINAHL,Cochrane Library, Joanna Briggs Institute Library, PubMed, LILACS e Scopus com os descritores: heart failure/insuficiênciacardíaca, motivational interviewing/entrevista motivacional, self care/autocuidado e patient compliance/cooperação dopaciente. Principais resultados: Foram identificados, inicialmente, 25 estudos em potencial para inclusão nesta revisão, noentanto, após serem aplicados os critérios de elegibilidade, 14 estudos foram encaminhados a dois revisores para avaliação metodológica, diante disso, três estudos foram selecionados após alcançarem rigor suficiente para inclusão e síntese.Conclusão: Percebe-se nos estudos, que é o impacto da comunicação na relação paciente x profissional de saúde, o quepromove um elo fundamental e diretamente relacionado ao sucesso do tratamento. A síntese dos estudos evidenciou aefetividade da intervenção Entrevista Motivacional na adesão e no autocuidado dos pacientes com insuficiência cardíaca.Palavras-chave: Insuficiência Cardíaca; Entrevista Motivacional; Autocuidado e Cooperação do Paciente. ABSTRACTObjective: To determine the effectiveness of the motivational interview intervention in the self-care of patients with heartfailure. METHODS: This is a systematic review, updated in July 2018, based on the MEDLINE, CINAHL, Cochrane Library,Joanna Briggs Institute Library, PubMed, LILACS and Scopus databases, with the descriptors: heart failure/motivationalinterviewing/interview motivational, selfcare and patient compliance. MAIN RESULTS: We initially identified 25 potentialstudies for inclusion in this review; however, after eligibility criteria were applied, 14 studies were referred to two reviewersfor methodological evaluation; three studies were selected after reaching enough accuracy for inclusion and synthesis.Conclusion: It is perceived in the studies, which is the impact of communication in the relation between patient and healthprofessional, which promotes a fundamental link directly related to the success of the treatment. The synthesis of thestudies evidenced the effectiveness of the Motivational Interview intervention in the adherence and self-care of patientswith heart failure.Keywords: Heart failure; Motivational Interview: Self-Care and Patient Compliance.

Objetivo: Apresentar os cuidados de enfermagem na assistência ao paciente crí­tico com COVID-19 e discutir a importância da atuação de uma equipe multiprofissional. Método: Trata-se de um estudo observacional, descritivo, retrospectivo, na modalidade relato de caso, com coleta de dados de prontuário, realizado no perí­odo de 17 de abril a 14 de maio de 2020. Resultado: Paciente atendido no pronto atendimento, com necessidade de intubação orotraqueal e transferência imediata para unidade de terapia intensiva. Evoluiu com agravamento do caso, instabilidade hemodinâmica, diálise contí­nua, necessidade de cuidados intensivos de enfermagem para controle de lesão de pele, drogas vasoativas, manutenção hemodinâmica e manobra de decúbito prona. Apresentou melhora e alta em 28 dias. Conclusão: A complexidade do caso associada a uma patologia de tratamento pouco conhecido e de alta infectividade é desafiadora para a assistência multidisciplinar na terapia intensiva e encontra-se relacionada a uma alta demanda de cuidados diretos e indiretos.

Aim: to identify educational strategies used in the training of nurses regarding the process of nursing involving standardized language systems. Method:  this is  an  integrative  review  of  the  relevant  literature,  performed  using the  following databases:  MEDLINE,  via  PUBMED;  CINAHL; SCOPUS;  and  LILACS.  Results: six  papers were  selected.  The  main  features  of  such  papers  were:  the  use  of  a  practical  guide, workshops,  study  groups,  recording  using  standardized  instruments,  discussion  of studies  based  on  fictitious  and  real  cases,  theoretical-practical  classes  using  clinical cases, and guided clinical reasoning. Discussion: the knowledge produced regarding the strategies used to train nurses about the nursing process – with or without standardized language  systems –  reinforced  the  importance  of  such  strategies  to  produce  clearer recorded  information,  as  seen  in  four  clinical  studies  and  two  descriptive  ones. Conclusion:  educational  strategies  involving  standardized  language  systems  in  the training of nurses promote development in the implementation of nursing processes.