Enferm Clin.

2017;27(2):65---67

www.elsevier.es/enfermeriaclinica

EDITORIAL

Nursing guaranteeing healthcare quality for people

and families in public health services: A view
from Latin America夽
Enfermería garantizando la calidad del cuidado a la salud de las personas y
familias en los sistemas públicos de salud: una mirada desde América Latina
María Angela Elías Marroquín

Enfermera, Maestra en Salud Pública, Directora Desarrollo de Recursos Humanos, Ministerio de Salud de El Salvador e
investigadora ad honorem, Observatorio de Políticas Públicas, Centro de Investigaciones y Estudios de la Salud, Universidad de El
Salvador, El Salvador

During the last 3 decades in Latin America health reform
processes have been implemented which have promoted the
human right to health and strengthened public health sys-
tems. Of mention are Brazil, Ecuador, Bolivia, El Salvador
and Venezuela. These processes have defined a strategy
for the creation of multidisciplinary work teams which
require general skills for promoting processes to guarantee
the quality of health care. Nursing staff form an essential
part of these teams. At present these reforming processes
are promoting universal access to health and universal
health coverage, approved by the Steering Committee of
the PAHO/WHO in 2014.1
The aim of all health systems is to improve the health
of the population, respond to peoples’ expectations and
provide financial protection against poor health costs. Qual-
ity of care is therefore an essential element within this
healthcare process, to avoid unexpected outcomes such as
adverse events which may be related to problems of clin-
夽 Please cite this article as: Elías Marroquín MA. Enfermería garan-
tizando la calidad del cuidado a la salud de las personas y familias
en los sistemas públicos de salud: una mirada desde América Latina.
Enferm Clin. 2017;27:65---67.
E-mail address: angelamery2002@gmail.com
ical practice, products, procedures or the system itself.
The improvement of patient safety therefore requires a
compound effort from the entire system to cover a range of
actions aimed at improving performance, the management
of safety and environmental risk, the control of infections,
the safe use of drugs and the safety of teams in clinical
practice and the healthcare setting.2 These management
processes lead to a shortening in hospital stay and the ensu-
ing lower health costs to both the health system and the
people using it. The financial burden entailed by healthcare
given without sufficient safety precautions is also extremely
high. Unsafe care leads to medical costs and hospitalisation,
infections associated with healthcare, loss of income, inca-
pacity and lawsuits which in several countries cost between
US$ 6000 million and US$ 29,000 million per year. The annual
cost from injections administered without safety precau-
tions is estimated to be US$ 535 million in direct medical
costs.
In 2004 the WHO created the World Alliance for Patient
Safety, aimed at coordinating, disseminating and expediting
improvements in patient safety areas worldwide, high-
lighting the international significance of the issue. In its
publication on research into patient safety the magnitude
of the problem was put into perspective on a worldwide
scale, citing that annually tens of millions of patients suf-

2445-1479/© 2017 Elsevier España, S.L.U. All rights reserved.

66
fered disabling injuries or died as a consequence of unsafe
medical practices or healthcare,3 and establishing that one
out of every 104 patients suffered from some sort of dam-
age having received healthcare in hospitals which were
well financed and technologically advanced. Much less is
known regarding unsafe healthcare in the different hos-
pitals where most of the worldwide healthcare services
are offered. In Latin American the Project ‘‘Latin Amer-
ican study on adverse events’’ (IDEAS from its initials in
Spanish) analyses the magnitude of the problems which
may arise in hospitals as a result of care. Studies were
conducted in 58 centres with teams of researchers from
Argentina, Costa Rica, Colombia, Mexico and Peru, led by
leading teams from the Health Ministries. They demon-
strated that the lack of patient safety had become a public
health problem; that being aware of its magnitude through
research was an opportunity for improvement in health-
care with the central element being recognition of this5 ;
that one in every 10 patients who were hospitalised, at
the time of the study, had suffered the consequences of a
healthcare incident; that the exposure factors were asso-
ciated with the state in which they were hospitalised;
that the longer the stay, the greater the risk and num-
ber of problems; that there were also risk factors such
as catheterisation and other entry pathways with 2 pri-
mary lesions also being associated with pneumonia and
surgical wound infections, resulting in death and disabling
injuries.
A study in Brazil which used photography, showed that
the quality of nursing care reflects the quality of treatment
and safety of care to the patient and that photographic
research methods may help to highlight risks at work aris-
ing from the administration of drugs. Using research may
help to shorten hospital stay, reduce temporary or perma-
nent disabilities and even prevent unnecessary deaths.6 One
study at a tertiary level hospital in Bogota showed that
the level of satisfaction found was 53.3% in the patients
studied, with the main effect being the lack of physical
expression by the nurses when establishing an interpersonal
relationship with the patient (slapping their shoulder, tak-
ing their hand) (20%); lack of information about how the
service worked, about the nursing care that would be pro-
vided and their health situation (11% and 8% respectively);
lack of help requested when in pain, discomfort and/or
anxiety because help was received after 5 min of having
requested it (38%); and lack of information regarding their
state of health when requested (26.6%). Only 26% of patients
responded that they had always been able to consult doubts
and eliminate fears whilst undergoing this procedure.7 These
effects demonstrated that previous studies are also related
to the characteristics of the health system of each coun-
try and its financing. There is thus a policy in Latin America
to strengthen the public health systems, where financing
comes from the state. An example of a fortified public health
system is that of El Salvador, which since June 2009 has pro-
moted an intense process of transformation of its national
health system. It is based on guaranteeing universal access
to health and the coverage of health concerns, the main cor-
nerstone of which is primary healthcare. This includes its
principal pillars of community organisation, social partici-
pation, social inclusion and quality.8 Moreover, the reform
sustains social determination of health, which also covers
M.A. Elías Marroquín
the living conditions of people in their social setting. In this
sense, the major key to public health system strengthening
has been the implementation of processes which improve
the quality of healthcare, develop services dedicated to
quality and provide offices for health rights through a ser-
vice which deals with complaints and social control of the
national health forum. Nursing forms an integral part of
the processes of change, improving teaching and distribu-
tion of professional staff, including a professional nurse in
family healthcare and a technician in nursing, increasing
the percentage of professionals from 3.84/10,000 inhabi-
tants in 2010 to 7.85 in 2016.9 This increase in staff has led
to the development of better care management of nursing
both in health centres and in the community. The Nursing
Care Policy (MINSAL 2016) establishes the focal points of
human rights, the universality of care, integral and inte-
grated health care, gender, ethics, intersectionality, social
co-existence, co-operation and peaceful resolution of con-
flict. Nursing care is therefore based on scientific evidence,
in the strengthening of university training, in the devel-
opment of specific skills for patient safety as an essential
element of care quality and the consideration of patient
safety as an essential principle of healthcare. During patient
care constant changes occur to clinical conditions and the
care environment. Both the complexity of each clinical or
surgical procedure and human factors need to be consid-
ered. Moreover, it should be noted that in any clinical setting
where there is a patient, adverse events may present from
the actual act of caring and nurses must be aware to iden-
tify and to act accordingly to minimise them. Another major
tool for guaranteeing quality care and the safety of its
users is the definition of regulations, procedures and stan-
dards in care, as patterns of behaviour to define the roles
of nursing in care and particularly those relating to pro-
fessional self governance. New employment profiles with
academic requirements which promote continuous profes-
sional development and certify their skills have been put
into practice. In this context several nursing discussion
groups have been formed for advanced practice that develop
highly complex care plans. The current law on patients
has also been adhered to. Finally, patient safety has been
strengthened with continuous improvement of senior nursing
management in their difference organisational structures
and their training, regulation of processional practice, and
the accreditation of continuous professional development.
Gaps in training and care practices still exist, which require
the tightening of co-operation between the different enti-
ties and the fortifying of synergies and communication
between Universities and health institutions. This approach
towards patient safety and the quality of care from Latin
American shows that both are the result of multiple factors
in health systems, often associated with health personnel
skills, to the combination of multidisciplinary teams, their
work load, work setting, staff and organisation of the work
itself. These conditions may be overcome with manage-
ment of quality, where the health professionals have the
right methodological tools and instruments to allow them to
intervene with minimal risk to users. One example of this
was the campaign inspired by the World Alliance for Patient
Safety ‘‘save lives, wash your hands’’ and the improvement
in professional nurse staffing markers in highly complex
services.
Nursing guaranteeing healthcare quality for people and families
Conflict of interests
The authors have no conflict of interests to declare.
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