# Mental health nursing consultations in Brazilian primary care: analysis of proposed competencies for advanced practice nurses

## TL;DR

This study examines the competencies of nurses in mental health consultations in Brazil's primary care and finds they lack skills needed for advanced practice roles.

## Contribution

The study identifies gaps in care management competencies among nurses in mental health consultations within Brazilian primary care.

## Key findings

- Only 39.68% of consultations showed care focus, and 47.62% showed provision of care.
- Nurses displayed few competencies in care management as proposed for Advanced Practice Nurses.
- Seven out of 49 consultations met the 50% compliance threshold for the nursing process.

## Abstract

Primary Health Care (PHC) is a key strategy to identify, manage, and coordinate mental health cases. Considering that nurses are essential to integrating mental health care into PHC, initiatives to broaden the discussion and incorporate the role of Advanced Practice Nurses in this setting can help reduce disparities in mental health care. Thus, this study aimed to analyze mental health nursing consultations in PHC and investigate whether nurses have the care management skills proposed for Advanced Practice Nurses.

A multicenter study, with a quantitative and qualitative approach, was conducted in 17 Primary Care Health Units distributed in three regions of Brazil from May to July 2022. Data collection was carried out twice during the nurse’s professional practice: nursing consultation (recorded using film, with direct and non-participatory observation) and nursing record. From a quantitative perspective and during the first research stage, consultations that had ≥ 50% compliance with the nursing process were selected so that, in the second qualitative stage, the competencies proposed for Advanced Practice Nurses in PHC were identified through content analysis.

A total of 49 mental health nursing consultations were performed by 21 nurses. Of these, seven were selected with a score greater than 50% compliance with the nursing process, carried out by three nurses. The consultations presented few competencies in the care management dimension proposed for the Advanced Practice Nurses; nevertheless, nursing consultation presented 39.68% in the care focus, 38.78% in evaluation and diagnosis, and 47.62% in the provision of care.

Nurses who conduct mental health nursing consultations in PHC present, in a scarce and partial way, the competencies proposed for the Advanced Practice Nurses for the care management domain. Hence, the results of this study highlight the need for specific training and policy initiatives to enhance the integration of Advanced Practice Nurses in mental health care within PHC, address existing gaps in care management competencies, and improve the quality of mental health services provided to the population.