Article 21 of Law 44/2003, of 21 November, of management of the health professions and Article 7 of the Royal Decree 450/2005 of 22 April on Nursing specialties, respectively, the the procedure for approving the training programs of the health specialties in general and the nursing specialties in particular, in both cases providing for their publication in the Official Gazette of the State for general knowledge.

The National Commission for the Speciality of Family and Community Nursing, has developed the first training program of this specialty in the framework of the current lines of the same.

The program has been ratified by the National Council of Specialties in Health Sciences, an advisory body of the Ministries of Health and Social Policy and Education in the field of specialized health training. It has been studied, analyzed and informed by the Human Resources Commission of the National Health System, among others, the health advisers of the various autonomous communities and the Director General of Politics University of the Ministry of Education.

In its virtue, in accordance with the provisions of Article 21 of Law 44/2003, of 21 November, and in Article 7 of Royal Decree 450/2005 of 22 April, previous reports of the Commission on Human Resources of the National System Health and the Ministry of Education, I have:

First. -Approve the training program of the Family and Community Nursing Specialty, the content of which is published as an annex to this Order.

Second. -This training program will apply to the residents of the Family and Community Nursing Speciality who obtain a place in training in the Teaching Units of that specialty, starting from the annual call of selective testing for access to specialised health training places where places of this specialty are to be included.

Final disposition.

This Order shall enter into force on the day following that of its publication in the "Official State Gazette".

Madrid, June 17, 2010. -Minister of Health and Social Policy, Trinidad Jiménez García-Herrera.

ANNEX

OFFICIAL FAMILY AND COMMUNITY NURSING SPECIALTY PROGRAM

Denomination: Family and Community Nursing. Duration: 2 years. Prior qualification: Diplomacy/Graduate U. in Nursing

1. Introduction, historical reference, and current framework of the craft

Since the first District Nurses appeared in Liverpool in the second half of the 19th century, from the Public Health nurses created by Lillian Wald years later in the United States, or more closely in our country, of the first visiting nurses in the early twentieth century, many have been the vicissitudes and transformations of both the formation and the development of what we know today as Family and Community Nursing.

The primitive naming of Public Health Nursing continued to be used until the 1970s, at which time the World Health Organization (WHO) and the Pan American Health Organization (PAHO) were the need to clarify the nurse's contribution to improving the health of the communities and the need for essential changes, both in the conception and in the reform of the curricula. The designation of "Community Nursing" begins to be used in 1974 by the WHO in convening the first seminar called "Community Nursing", which was carried out to outline a community approach to nursing care. Therefore, it is not by chance the conceptual evolution and denomination of "nursing of public health" to "nursing of community care".

The WHO considers that the nurse Specialist in Family and Community Nursing " has to have in-depth knowledge about the complexity of both individuals, families and groups and the interactions that occur. between them. The community in which it offers services, the resources available, the different ways of interacting among its members, etc., must be known. " She also foresaw that this specialist is " ready to intervene in public health bodies, since she can identify elements in the neighborhood or in the community that influence in a positive or negative way the health of the family and the persons who compose it, so it must be an active participant of the community as regards health programs, including local schools, non-governmental organizations, community groups, cultural, social, religious, etc., developing a Community action as an essential element of Primary Health Care. "

While each country is at a different stage in the process of developing Community Nursing, the basic ideas that define it are shared around the world. In Spain, despite the absence of a training program on the basis of the specialty of Family and Community Nursing, a specific community nursing care has been developed coincident with the implementation of the new model of Primary Health Care initiated in the 1980s and emanating from the Declaration of Alma Ata. The approval of subsequent regulations that established the nursing modality in Primary Health Care, the regulation of this model by Royal Decree 137/1984, of January 11, on basic health structures, the publication of the General Law of Health, the incorporation of nursing studies into the university field and the inclusion of subjects such as Public Health and Community Nursing in the curriculum of the study plans, have been the factors that have contributed to to lay the current foundations for Family and Community Nursing.

This changing situation of the old sanitary structures was seen as an opportunity for a bet for modernity and for equating with the health practices of the most advanced countries. It was a question of compensating for the hospital-centric health concept based on the disease and the techniques accepted at each moment and was based on a model of professional practice closer to the citizen, participative, multidisciplinary, preventive and focused on health.

After the illusionant years of the twentieth century, the process of evolution of nursing specialties has been slow due to the fact that, on the one hand, the sanitary and academic structures were not adapted, initially, to the new realities and opportunities opened up by the Health Reform of 1986, and on the other hand, by the very dynamic of the health reform that was embodied in a complex process of transferring competences in the field of health to the different Autonomous communities, which are now considered to be completed.

After the first step taken by Royal Decree 992/1987, of July 3, on obtaining the title of Specialist Nurse, the new Royal Decree 450/2005, of 22 April, on nursing specialties has finally enabled the development of the Family and Community Nursing specialty program, which will allow an optimal response to the needs arising from the demographic, social and economic changes that have been produced and which have generated new ways of adapting to the environment and a process of changing the health problems that need to be planning, management and delivery of effective and efficient care for individuals, families and communities.

The purpose of this program of the specialty in Family and Community Nursing is to develop an active learning process that allows to contextualize knowledge and integrate it into the daily dynamics of nurses. training, while at the same time exercising a wide range of cross-sectional competences so that, at the end of their training period, they have the necessary levels of competence for the independent exercise of the craft and are capable of to develop continuous training throughout your professional life.

This program is an important step in the development model of the nursing profession designed by Law 44/2003, of 21 November, of management of the health professions and by the Royal Decree 450/2005, of 22 April, on nursing specialties. The implementation of this model must necessarily be progressive and take into account the guidelines contained in the additional provision third of the Royal Decree, the characteristics of each Health Service as well as the competencies that correspond to the autonomous communities in the area of planning, organization and management of human resources.

It is not, therefore, to mimic or repeat the model implemented in other professional groups of specialists, or to generalize the category of nurse specialist in the field of Primary Care, but to combine the the role of these professionals who have advanced training, with the needs and possibilities of the Health System, reconciling the role of the specialist nurse with a key, flexible and useful figure for the Health System, such as the General care nurse.

2. Family and Community Nurse values

The current society presents health demands resulting from specific circumstances: demographic and economic factors, prevalent pathologies, information technologies, population movements, health habits, rights of the citizen, etc. The specialist in Family and Community Nursing, through quality care will ensure a professional exercise based on the professional values that legitimize it in the society, giving a response to the health demands arising from the Factors cited above.

The mission of the Family and Community Nurse is the professional participation in the shared care of the health of the people, the families and the communities, in the "continuum" of their life cycle and in the different aspects of promotion of health, disease prevention, recovery and rehabilitation, in their environment and socio-cultural context.

The action of the Family and Community Nurse is guided by scientific, humanistic and ethical principles and foundations of respect for life and human dignity. Their practice requires interdisciplinary thinking, a multi-professional and team-based approach, and an active participation of the people they serve, with a holistic view of the human being in their relationship with the family context, social and environmental.

For the proper performance of their mission, the values mentioned below should guide the training process of nurses who are specialists in Family and Community Nursing:

a) Commitment and guidance to people, families and communities: People in their holistic acceptance, throughout their lives and in their natural environment, together with their families and communities with their interactions, their culture and Also in their midst, they are the active protagonists of the care provided by the Family and Community Nurse. Their actions are aimed at the shared improvement and maintenance of their health and well-being, not reducing the clinical intervention in the presence of disease.

b) Commitment to society, equity and efficient management of resources: The Family and Community Nurse when developing its activity in the field of primary health care is the first contact and gateway to the healthcare system. It has a high social responsibility for the efficient use of health resources, since its inadequate use not only poses a risk to people, but also an unnecessary expense that deprives society as a whole. resources.

The Family and Community Nurse as a professional who works in the first level of care should facilitate access to the healthcare system, eliminating any physical, structural or organizational barriers that make it difficult. It will also facilitate and enhance active and responsible citizen participation in the search for responses to their health problems and in the planning of health services.

The Family and Community Nurse acquires a special commitment to the most disadvantaged social sectors for reasons of social class, gender, ethnicity, age, disability, disease, etc. with the aim of maintaining a of equity in access to care. To this end, it plans, directs, and implements specific health programs to meet the needs of these and other at-risk groups in their daily activities.

The Family and Community Nurse cooperates and actively participates with community organizations and networks, non-governmental organizations, mutual aid associations, and other public or private institutions that have aim to improve the health of people as a whole.

c) Commitment to the continuous improvement of quality: The Family and Community Nurse makes their decisions based on up-to-date scientific evidence and keeps their knowledge, skills and attitudes up to date. professionals, while also making people involved in making decisions that affect their health.

In addition to knowing the basic tools of the quality of care, it applies them both in the self-assessment of the quality of the care provided and in the study of the needs and expectations of the people.

The Family and Community Nurse recognizes as a prerequisite of quality care the value of teamwork and the participation and co-responsibility of the people to whom it provides care.

d) Commitment to ethics: The Family and Community Nurse is demanding with itself, with the health administration itself and with the other actors involved in it, to fulfill its mission.

The Family and Community Nurse bases its commitment on people in the principles of bioethics and especially, given the idiosyncrasies of its scope of action, in the principle of autonomy (self-care and responsibility). Ensures respect for each of the rights of users and patients of the health system as established in the Law on the Management of Health Professions and in the Basic Law on the Autonomy of the Patient and Rights and obligations for information and clinical documentation.

It will maintain rigor and ethics in the performance of its teaching and research functions.

e) Commitment to the safety of users and patients: The Family and Community Nurse will promote and develop the knowledge and safety culture of the people it serves. Collaborate and participate in projects that drive and evaluate safe practices.

f) Commitment to professional development: The Family and Community Nurse is committed to the general development of her profession and particularly to her main work, the nursing that intervenes with families, communities and in public health.

The polyvalence of the work of the Family and Community Nurse is a characteristic of the specialty and an incentive to participate actively in the research, development, consolidation and updating of its own body. of knowledge and framework of action.

3. Nursing Specialist Family and Community Nursing Skills

3.1 General characteristics. This program focuses on the development of the specific competencies to be acquired by the Family and Community Nursing Specialist, ensuring that the resident has acquired the knowledge, skills, attitudes and values that make up these skills that will have been acquired in the training of the degree and will be expanded, in depth and specificity, in specialized training.

The advanced skills that make up the professional profile of this specialist are developed in the family and the community, which in no case means the creation of exclusive areas of action, since these The Commission has been responsible for the implementation of the Directive on the protection of the health and safety of workers, and on the protection of the health and safety of workers

the field of health.

3.2 Pool of advanced competencies in the field of Family and Community Nursing. -In the context of the health system, the advanced competencies of these professionals can be grouped into the following paragraphs:

a) Competencies linked to the provision of advanced care in direct clinical care in the field of family and community care to people throughout their life cycle and to families at all stages, both as regards its management, such as planning and development, in accordance with the needs of the population and the requirements of the health services. (Section 5 of this program).

b) Competences linked to public and community health, related to the design of health education programs, to epidemiological and environmental surveillance, and to emergency and disaster situations. (Paragraph 6 of this program).

c) Skills linked to teaching, aimed at both individuals and families, as well as students and other professionals. (Section 7 of this program).

d) Competences linked to the management of care and services at the family and community level, with the aim of applying them according to the principles of equity, effectiveness and efficiency and developing strategies for improving the quality of care in the care of the community. (Paragraph 8 of this program).

e) Competences linked to research, whose purposes are: to use the best available scientific evidence, to generate knowledge and to disseminate the existing one. (Paragraph 9 of this program).

3.3 Priority skills. -Priority skills are considered to be targeted at:

a) Identify the health needs of the population and provide the correct care response of the health services to the citizens in any area (care center, home, school, place of work ...).

b) Establish and direct sentinel networks of care epidemiology.

c) Develop indicators of activity and quality criteria for family and community care.

d) Increase follow-up and longitudinal attention when assessing the individual and the family from the perspective of the need for care, in their environment and in all stages of life, with special attention to those who should be served at your address.

e) To respond effectively to the needs of the population with chronic diseases prevalent, to the situations of disability, to the risk of being sick and of frailty.

f) Design and develop strategies for community intervention and participation, focusing on health promotion and disease prevention.

g) Ensuring continuity of care and care, through effective management and coordination of human and material resources available.

(h) To promote the functioning of the multi-professional teams, through participation, reflection, analysis and consensus, and from the respect of their own competences and the rest of the specialists and professionals of the community and public health.

i) To improve the practice of nurses in the family and the community through research in nursing care and participation in multi-professional lines of research.

4. General characteristics of the teaching program and methodology

4.1 Legal framework for training.

4.1.1 Our country's specialized health training system has included Family and Community Nursing, as one of the specialties related to Article 2 of Royal Decree 450/2005, of 22 April, on Nursing specialties.

In this respect and as set out in Article 15 of Law 44/2003, of 21 November, of ordination of the health professions, the specialized training in Health Sciences, is a regulated and character formation The aim is to provide specialists with the knowledge, techniques, skills and attitudes of the relevant specialist at the same time as the progressive assumption by the person concerned of the inherent responsibility of the self-exercise of the same.

4.1.2 To obtain the title of the specialty of Family and Community Nursing, the resident nurses will fulfill the training program of the same in multi-professional teaching units of Family and Community Care, accredited for the training that meets the general accreditation requirements approved for the purpose, for a period of two years at full time.

4.1.3 Access to training, organisation, supervision, evaluation and accreditation of multi-professional Family and Family Care teaching units will be carried out in accordance with the provisions of Royal Decree 183/2008, February 8, which determines and classifies specialties in Health Sciences and develops certain aspects of specialized health training.

The monitoring and qualification of the training process for the acquisition of professional skills during the period of residence will be carried out through continuous, annual and final evaluation, as indicated by the Royal Decree 183/2008, cited above.

4.1.4 The legal regime that regulates the employment relationship that unites the nurse specialist with the head of the teaching unit where it is being formed, will follow the provisions of Royal Decree 1146/2006, of 6 October, regulating the special employment relationship of residence for the training of specialists in health sciences.

4.2 General objective of the programme: acquisition of skills. The general objective of this programme is that, at the end of the training period, the resident nurse has acquired the professional skills associated with the programme. paragraph 3, by means of the development of the specific powers referred to in paragraphs 5, 6, 7, 8 and 9, the minimum activities of which are specified in paragraphs 10 and 11 of paragraphs 10 and 11 of this Article. program.

This practical-clinical training is the central axis of this program because the residence system consists, fundamentally, in learning by doing so.

4.3 Teaching Methodology. -Educational techniques, both in-person and semi-face-to-face, will be used, with a teaching methodology that gives priority to tutoring active learning, to the use of creative educational methods that ensure the weighting and coordination with clinical training, through an experiential learning that implies a working relationship between the resident and the titular entity of the teaching unit where it is being formed.

For the acquisition of the competencies mentioned in this program, the training leaders will carry out teaching strategies that favor critical thinking and allow the integration of theoretical training with the clinical and research training to be carried out on the various devices that make up the teaching unit.

In the training process of these specialists, it is necessary for them to internalize that the scientific advances are outdated, promptly, so it is necessary to awaken in the residents the concern to learn and assume that the commitment to the training process remains throughout its active life, acquiring a professional attitude appropriate to the present times. With this objective, the most significant legal and bibliographic references, related to the training of the nurse specialist in Family and Community Nursing, are included as Annex II to this program for the teaching units where These specialists are trained. These bibliographic references may be updated periodically on a proposal from the National Commission of the Specialty.

The theoretical training and clinical practice of this program will be carried out during the working day, without prejudice to the hours that will be provided in the concept of continued attention and the personal hours of study outside the program. day.

The common training with other specialties in Health Sciences (bioethics, research methodology, radiation protection, clinical management, etc.) will be carried out, as far as possible, together with the residents of the various specialties attached to the appropriate Unit/Health Care Commission.

The following methods are considered to be conducive to learning:

a) Tutorialized self-learning: active learning-centered methodologies in which the resident acquires responsibility for the process under the guidance and guidance of the tutor. It can be done in different ways:

Use of learning tools by the resident: teacher portfolio and resident's book.

Directed learning: Recommended readings or visualizations (books, videos, articles of interest, Web pages, etc.), problem-solving-based learning, and case discussion and practical problems.

Performing interactive courses at a distance.

Assistance to courses, symposiums, congresses and workshops related to the areas of knowledge of Family and Community Nursing.

Preparing and exposing training sessions.

b) Self-learning in the field: training in real situations in the care practice, in which the resident lives critically and reflexively the real situation in which his self-learning takes place. It can be done in different ways:

Direct observation: The resident sees what the tutor does.

Tutored Intervention: The resident performs his or her activities in the presence of the guardian, while the resident has not yet acquired the competence that allows him to assume full responsibility for the activity.

Direct intervention, not directly supervised by the tutor when the tutor has already checked the acquisition of the competence of the activity that the resident will perform autonomously.

Obtaining information by other indirect means: Audit of stories, opinion of patients, opinion of other teammates, etc.

Video-recordings of resident interventions and further analysis with the tutor.

Field jobs.

c) Information transmission sessions: the tutor transmits complex information on a specific subject, in order to promote the creation of a conceptual framework. You can use the visual or demonstration support material you deem necessary to favor understanding. Sessions can be:

Classic master lesson.

Participatory class.

d) Discussion sessions: Learning is based on the discussion of issues or issues between residents and the person responsible for training. Can be celebrated:

Seminars.

Case resolution sessions, clinical sessions.

Workshops.

e) Practical sessions: The resident rehearses and learns the task that he will have to perform afterwards. They can be:

Actual situations.

Simulated situations: Role games, group jobs, simulators, computer programs, etc.

4.4 Continuous care. -Services provided in the concept of continuing care are of a formative nature, will be carried out during the two years of training in the specialty and will be programmed subject to the Day and rest periods established by the legislation in force.

The guards will be performed on any device of the teaching unit and will be planned taking into account the fulfillment of the objectives of the training program.

It is advisable to perform between two and four monthly guards.

4.5 Radiation protection training. -During the delivery of the program, the resident nurse will be trained in radiation protection with the aim of acquiring basic knowledge in this field, which will be adjusted to the expected in the European Guide 'Radiological Protection 116', in the terms set out in Annex I to this programme. To this end, nurses in the field of Family and Community Nursing will acquire the training in radiation protection provided for in the Joint Resolution of 21 April 2006 from the Directorates General de Salud Public and Human Resources and Economic and Budgetary Services of the then Ministry of Health and Consumer Affairs, through which it is agreed to incorporate in certain training programs of specialties in Health Sciences training in protection radiological.

5. Advanced clinical competencies at the family and community level

5.1 Clinical and Advanced Methodology.

Capacity for:

a) Apply conceptual models for nursing practice in the field of family and community care.

b) Use the nursing process of assessing the health status, identification of health problems/diagnoses nurses and user objectives (family or group), planning of interventions of nurse treatment and assessment of the results.

c) Establish effective communication and therapeutic relationship with patients, families, and social groups in the field of specialty.

d) Perform diagnostic and therapeutic techniques especially related to the prevention and control of more prevalent chronic diseases.

e) Plan, direct, develop and evaluate, together with other specialists and professionals, programs of care for the chronic diseases present at the family and community level.

f) Use and indicate the use of drugs and other health products linked to nursing care in the field of family and community care, in accordance with current legislation, with special attention to the processes of chronicity and dependency situations.

g) Integrate and indicate other non-pharmacological therapeutic measures such as diet, relaxation techniques or physical exercise in the most frequent health changes in the field of the specialty with special attention to the processes of chronicity and dependency situations.

h) Plan, direct, develop and evaluate, together with other specialists and professionals, minor surgery programs in the areas of family and community nursing intervention.

i) Detect situations that require coordination or referral to other professionals, specialists, or levels of care.

j) Working as a team, in family and community care.

k) Documenting and recording the process of attention using new information and communication technologies in the field of specialty performance.

l) To manage the ethical and legal conflicts that arise as a consequence of the practice of family and community nursing, to solve them or in their case to refer them to other instances.

m) Manage, lead and develop family and community care from the perspective of patient safety.

n) Lead, design and apply health care and family and community nursing care based on case management.

Learning Results:

Uses conceptual nurses as a guide to the process of care in clinical practice.

accurately obtains the relevant objective and subjective data in the state assessment or health situation.

Organizes, synthesizes, analyzes and interprets data from the various sources to make judgments about health problems/nursing diagnoses.

Evaluates the accuracy of the nurse diagnosis in family and community care and the results of the nurse treatment.

Knows and performs the nurses interventions related to the most prevalent chronic diseases based on current evidence, with special attention to those that develop in the home of the patients who require.

Meet and perform nursing interventions in situations of dependency and frailty, with special attention to those that develop in the home of patients who need it.

Know the regulations regarding the use, indication, and authorization of drugs and medical devices.

Know the drugs and healthcare products linked to nursing care that are developed in the field of the specialty to achieve its effective and efficient management and utilization.

Performs the precise clinical reasoning procedure to perform the prescriptions.

Knows and uses non-pharmacological therapeutic measures such as diet, relaxation techniques, or physical exercise in the most frequent health changes in the field of the specialty as part of the nurse treatment.

Analyzes the knowledge and beliefs of individuals, families, and communities about drugs, non-pharmacological therapeutic measures, and medical devices.

Implies, coordinates and executes minor surgery programs and other diagnostic and therapeutic techniques, with both technical and legal patient safety.

Promotes the full participation of patients in the decision-making process on their health.

Identifies and acts in conflicting situations.

Detects situations of ethical or legal conflict in the practice of family and community care and is capable of applying the principles of bioethics or current legality.

Meet and apply the concepts and regulations of confidentiality, professional secrecy, informed consent, patient autonomy, and rational use of resources at the family and community level.

Recognizes diversity and multiculturalism.

Handles persuasive communication.

Meet and activate the required shunt channels.

Uses nurse-language taxonomies.

Identifies and uses new technology tools applicable to care and communication.

Handles basic concepts related to patient safety.

You design and use adverse drug and other health product notification systems.

Elaborates notification and learning systems to facilitate analysis of the causes that caused errors and prevent them.

Leads, in its field of work, the dissemination and acquisition of a patient safety culture.

Meet and apply the False and Errors Modal Analysis (AMFE) methodology for security problem analysis.

Rotations and training activities:

Clinical rotations in the health center and other clinical-care devices.

Workshops or theoretical sessions with active methodology.

Brief description of content, attitudes and skills:

A holistic approach to health problems. Advanced management of the methodology and taxonomies of nursing language in EFYC. Therapeutic communication. Empathy. Advanced techniques in patient-safe and evidence-based EFyCs. Techniques for the execution of diagnostic and therapeutic interventions. Use of drugs, medical devices and other therapeutic approaches in the EFYC. Different models and tools for coordination and continuity of care among the different levels of health care. Efficient economic impact for the healthcare system. Responsibility for optimizing healthcare resources.

5.2 Childhood care.

Capacity for:

a) To systematically value, within the family and community context, child development in its physical, psychological, cultural, environmental and social aspects.

b) Promote the health of children in the family and in the community, with special attention to the school.

c) Prevent children's and girls ' disease in the family and community context.

d) To provide specialized care at Community level, together with other specialists and other professionals when necessary, in situations of: changes in child development, acute health problems, disabilities and chronic health problems.

Learning Results:

Detects the precocious situations of abnormality in child development and health.

Implements programs in which healthy habits and behaviors are encouraged at school and in the community, identifying and coordinating different health agents.

Facilitates and encourages parental autonomy in the care of their children.

Contributes to adequate sexual development in children.

Power the self-responsibility of children in their individual and group and environmental health.

Works with the education system and with other professionals and specialists.

Prevents, detects and intervenes in situations of child abuse and marginalisation.

Prevents child accidents and their possible sequelae, along with families and school.

Designs, directs, executes, and evaluates related health programs: Child Health, School Health, others.

Provides family and community care in a coordinated way with other team members.

Promotes the necessary adaptive processes of both the environment and people, in case of illness or disability.

Facilitates the adaptation of the family environment for the continuity of care in the home.

Rotations and training activities:

Clinical rotations at the health center. Interventions at school. Workshops or theoretical sessions with active methodology.

Brief description of content, attitudes and skills:

Child development processes and assessment tools (scales, exploration, methods and systems). Family dynamics and adaptations in relation to the child and his/her health status. Health education methods adapted to the school environment. Vaccination programmes.

Comprehensive approach to the health of the child in his/her environment/sociofamiliar unit. Respect for the rights of children.

Application of scales and valuation systems. Children's health education techniques. Implementation and adaptation of vaccination guidelines.

5.3 Attention in adolescence:

Capacity for:

a) To value the development of the adolescent in its biological, psychological and social aspects.

b) Promote the health of adolescents in their aspects, biological, psychological and social, both individual and group.

c) Prevent adolescent disease in its aspects, biological, psychological and social.

d) Prevent teen accidents and their aftermath.

e) To provide specialized care for adolescents with health problems at the community level, along with other specialists and other professionals when necessary.

f) Foster sexual development and gender identity, detecting potential difficulties.

g) Contribute to families effectively addressing the crisis of adolescence.

Learning Results:

Identifies health problems related to the psycho-affective, biological, and social development of adolescents.

Encourages self-care, self-esteem, social skills and healthy life in general (physical activity, food, affective-sexual health, interpersonal relationships ...).

Promotes responsible behaviors regarding activities that involve risk.

Detects early health risk behaviors related to eating disorders, self-harm ...

Directs, collaborates or participates in EPS programs aimed at adolescents.

Encourages effective family coping in situations of risk (pregnancy, drug addiction, violence, etc.).

Work with adolescents with health problems with special attention to: Disorders of food behavior and body image, antisocial behavior, violence and abuse, drug dependency and addictions, among others.

Help and support the teen in making decisions about health problems.

Encourages effective family coping in the face of disease situations.

Contributes to the promotion of affective-sexual health.

Favors the acceptance of the adolescent's sexual condition.

Capacity for the use of problem-solving, decision-making and social skills methodologies.

Detects early gender-related identity issues.

Contributes to the adoption of healthy reproductive behaviors.

Collaborates with parents in addressing issues related to adolescence, their negotiation, and problem and conflict resolution.

Rotations and training activities:

Clinical rotations in the health center and in young consultation. Interventions in educational, cultural and youth leisure centres. Infant-youth mental health units.

Workshops or theoretical sessions with active methodology.

Brief description of content, attitudes and skills:

Global development processes for adolescents, instruments and assessment strategies. Education for the health of adolescents, with special attention to sexual health and risk management. Family dynamics and adaptations in relation to the adolescent.

Integrality of the health of adolescents and their families. Empathy and therapeutic relationship towards this age group.

Effective communication with adolescents. Relationship of trust and help. Negotiation. Handling the Problem Resolution Method.

5.4 General health care in the adult stage.

Capacity for:

a) Plan, develop, execute and evaluate programs to promote the health and prevention of adult disease in its biological, psychological and social aspects prevalent in adulthood, both individual and grub.

b) Plan, execute and evaluate care management programs for people with disease or dependency in terms of equality, developing them, both in healthcare devices and in the family environment or home and community.

c) Identify and act in situations of violence, especially in the face of gender-based violence.

d) Plan, execute and evaluate programs in relation to chronicity or disability by developing them both in healthcare devices and in the family or home and community environment.

Learning Results:

Advisor on responsible health decision making.

Encourages personal autonomy and prevents dependency.

Encourages mental health.

Advisor on the use of accident protection measures.

Prevents complications from an altered health situation.

Encourages effective coping with altered health situations.

Evaluates the quality of life of people attending biological, psychological and social spheres.

Identifies the existence of health risk factors, with particular attention to healthy lifestyles and the specific health problems prevalent in the community.

Identifies, values and controls the evolution of chronic health problems and the specific health problems prevalent in the community.

Encourages self-care and healthy lifestyles, both individual and group, or in community settings.

Identifies and intervenes with signs and symptoms of gender-based violence, labor, etc.

Mobilizes the resources needed to address health problems, with special attention on disability or dependency problems in the family environment.

Know the methodology of home care in the field of family and community nursing.

Rotations and training activities:

Clinical rotations at the health center and other devices. Physical exercise and health centers. Education units to chronically ill. Assessment and home care devices. Workshops or theoretical sessions with active methodology.

Brief description of content, attitudes and skills:

Physical, chemical, biological and social risks related to health disturbance in the adult person. Measures to prevent specific health problems prevalent in the community. Specialized care and specific therapy.

Comprehensive approach, biopsychosocial, of health. Risk approach in health assessment and intervention. Respect to the decisions of the person.

Handling of standardized clinimetric assessment scales and test scales. Clinical skills required to provide specialized care. Techniques of cognitive reconversion and behavioral reinforcement. Effective communication techniques. Home care methodology.

5.5 Sexual, reproductive and gender health care:

Capacity for:

a) Promote sexual and reproductive health in men and women.

b) Intervening sexual and reproductive health care programs in populations with special needs such as the disabled, people at risk of social exclusion, etc.

c) Promote health during pregnancy, childbirth and puerperium in the family and community environment and participate with other team members and/or specialists in planning, directing, coordinating and evaluating activities specific.

d) Promote the health of women and men in their climactic stages.

e) To promote the prevention and early detection of male and female genital and breast cancer.

f) Detect and act in situations of gender-based violence.

g) Prevent, detect and intervene in the health problems of women and men linked to gender at the community level.

Learning Results:

Relates gender and gender to health processes in men and women.

Encourages sexual health.

Integrates into specialized nursing care, sexuality, and the partner relationship as aspects that are involved in health.

Reports, advises, and partners people and partners about pleasant and healthy affective-sexual behaviors.

Train people for informed choice and responsible for contraceptive methods.

Collaborates in the follow-up of contraceptive methods, including emergency contraception, following guidelines that are determined by specialists in the field of gynecology and obstetrics.

Participates in the development of education and counseling programs for sexual and reproductive health.

Orients to the demand for IVE and derives the specialists who in each case correspond.

It addresses the influence of the most frequent chronic diseases and their treatments in sexual response.

Detects early difficulties in the perception of gender identity and guides or derives other professionals as needed.

Detects early sexual dysfunctions in people and partners, and advises or derives other professionals as needed.

Meet and use existing resources to address the needs related to sexuality and the reproduction of populations of special characteristics such as the disabled, people at risk of social exclusion, etc.

Power the self-care of the pregnant woman.

Identifies social risk factors in pregnancy.

Captures the pregnant woman early and contributes to her health monitoring.

Advisor for effective pregnancy coping and the adequacy of the environment.

Collaborates to adapt the family, home and community environment to promote breastfeeding.

Collaborates in the proper recovery and adequacy of the family, home, and community environment after delivery.

Provides emergency delivery assistance in the area of emergency care.

Strengthens the self-esteem and self-knowledge of people in the climate.

Encourages knowledge, coping and self-care in the face of the most frequent changes in the climate, both physical and emotional and social.

Encourages the adaptation of sexual relationships to be enjoyable and safe.

Plans and participates in programs to promote the health of women and men in the climate.

It disseminates male and female genital cancer screening programs, and of breast and implements community-wide actions.

Awareness to men and women for the acceptance of diagnostic tests for genital and breast cancer.

Potency healthy life habits preventive breast and genital cancer.

Collaborates in the education of men and women in respect and coexistence between genders.

Prevents and detects precociously situations of risk of gender-based violence.

Caters to victims of gender-based violence.

Recognizes the discomfort of women as a response to social conditions of gender.

Attends to the first level of care, the bio-psycho-social discomfort of women and men with an integral approach that includes conditions of gender and subjectivity.

Rotations and training activities:

Clinical rotations in the health center, contraception and family orientation, and in the corresponding hospital units, as a delivery room, puerperium units ... Workshops or theoretical sessions with active methodology.

Brief description of content, attitudes and skills:

Sexual health: education and counselling. Contraception in the community environment. Adaptations of women and the environment to pregnancy and the puerperium. Emergency delivery to the hospital. Techniques and resources for the prevention and early detection of female and male genital cancer, and breast cancer. Effective coping with climate change. Condition of gender in health. Health problems in relation to gender-based violence.

Health vision from a gender perspective. Holistic conception of sexuality. Respect for the own decisions related to sexuality and reproduction. Empathy with victims of gender-based violence.

Education for health. Trust, confidentiality and therapeutic communication.

5.6 Attention to the elderly:

Capacity for:

a) Plan, develop, execute and evaluate programs to promote the health of elderly people in their family and community environment.

b) Plan, develop, execute, and evaluate, along with other professionals and specialists, prevention programs for the most frequent complications and health problems in the elderly in their family and community environment.

c) Detect and intervene early on health problems prevalent in the elderly in their family and community environment.

d) Detect and intervene early in situations of fragility or social isolation of elderly people.

e) Develop health programs for care in dependency situations.

f) Manage the training of family caregivers for the care of the elderly in the family.

g) Manage care for family caregivers in the family environment.

h) Identify and mobilize resources (own, social and/or community network) that best fit the needs of the elderly and their caregivers.

i) Identify needs and promote the appropriate use of materials and instruments of help and adaptation needed to perform the basic activities of everyday life.

j) Care in your environment to the patient and your family at the end of life, respecting your decisions.

Learning Results:

Stimulates the autonomy of the elderly in the performance of the activities of daily life in their family and community environment.

Encourages the physical, psychological, social, cultural, environmental, sexual and spiritual health of the elderly with the greatest possible autonomy.

Promotes home care as a preferential treatment for older dependents or with serious health problems.

Stimulates the creation and maintenance of self-help networks and groups.

Identifies and intervenes early in cases of abuse of the older.

Prevents accidents and falls by taking care of the security of their environments, especially homes.

Encourages and empowers mobility and balance through physical exercise.

Prevents complications in the elderly associated with restricted mobility in the home.

Prevents complications to the elderly from their health disorders and therapeutic guidelines.

Values capabilities for stand-alone performance.

Help in adapting to the role changes due to age and supports elderly people at the loss of their partner and other loved ones.

Detects the cognitive, functional, physical, and relational deterioration of the older person precociously.

Provides specialized care to compensate for functional dependencies and limitations.

Recognizes critical signs of poor prognosis.

Identifies caregivers as primary care subjects.

Supports caregivers in decision making regarding care.

Collaborates for caregivers to deliver quality care, preventing negative impacts on their health.

Efficiently knows and uses the socio-healthcare resources to support the patient and his family.

Knows and advises materials and instruments of help and adaptation needed to perform the basic activities of everyday life.

Cares and accompanies the person in the end of life.

Caters to the grieving of the person and their family by preventing and addressing dysfunctional grief reactions.

Plans, implements, and coordinates with other professionals and specialists in palliative care programs.

Rotations and training activities:

Clinical rotations by the health center and other social-health devices.

Workshops or theoretical sessions with active methodology.

Brief description of content, attitudes and skills:

Risk factors for the overall health of the elderly, techniques and scales for their assessment. Effective coping strategies. Attention to the "frail" old man. Sexuality and affectivity in the elderly person. Socio-health resources supporting the care of the dependent person and their family. The home care in the old man. The caregiver as a care recipient. The process of end-of-life at Community level. Management of bereavement situations. Situations of violence against elderly people.

I respect people's personal, cultural and religious choices. Empathy for loss situations (bereavement).

Usage of rating scales. Working with groups. Physical and sensory stimulation.

5.7 Care for Families:

Capacity for:

a) Plan, direct, develop and evaluate comprehensive care programs aimed at promoting health and preventing problems in families, in health contexts, and with particular attention to those at risk of disease.

b) Relating the influence that the health problems have on the family, in the cognitive plane, in the emotions, in the daily activities and in the plane of interpersonal relationships. As well as the influence of family dynamics on health problems.

c) Making interventions that promote health and prevent family problems, with particular attention to problematic and crisis situations.

d) Prevent and detect intra-family violence.

e) Managing community and family programs for crisis prevention and detection and intra-family violence.

Learning Results:

Uses an appropriate analysis methodology to work with families, using systemic strategies to formulate hypotheses, intervene, and evaluate.

Understands the extent of family dynamics in the health and disease process of their members.

Understand the scope of phenomena such as: the protection and dependence of family members affected by health problems.

Understands and analyzes power relationships in the family, roles, communication systems, and analyzes their relationship to the existence and management of health problems.

Understands the isolation of sick people and their families and intervenes to cushion the effects.

Consider patient care in their family context.

Meet and value the health needs of families in their different stages of development.

Identifies the different stages of the development of families and helps their effective coping.

Train families in decision making.

Capacity and support the family in coping with crises or problematic situations such as illness or death of a member, arrival of a new component, parental separations, etc.).

Detects psychosocial problems and at-risk families, and provides anticipatory family counseling.

Develops the role of the family as a health promoter.

Values housing as a health context and recognizes the importance it has on family health.

Facilitates access to family adaptation resources in health-disease processes and crisis situations.

Meet and encourage family support systems and networks.

Manages group dynamics for intra-family conflict management in health-disease contexts.

Detects and intervenes early in situations of risk and/or domestic violence.

Identifies risk and family crisis situations and elaborates intervention plans.

Rotations and training activities:

Rotations in the health center. Workshops or theoretical sessions with active methodology.

Brief description of content, attitudes and skills:

Family, structure, dynamics, types, and family life cycle.

The relationships of power in the family, the roles and the rules, the expression of feelings. Marital relationships.

The concepts of the systemic family intervention strategy.

Family care instruments: genogram, specific questionnaires (family APGAR, social support, stressful life events ...). The anticipated family orientation. Intervention with families with prevailing crises: duels, members with addictive behaviors, mental illness, in the end of life, arrival of new children ... Housing as a space for coexistence and conditioning of health. The family perspective on individual health problems. The role of the family caregiver. Intra-family violence. Group dynamics.

Perception of the family as a health manager. Acceptance and assessment of the family's ability to promote their health. Respect for family decisions.

Negotiation. Interview with couples and families. Management of family boarding instruments.

Working with groups. Work with families on equal terms (the paternariat).

5.8 Attention to emergencies, emergencies and catastrophes:

Capacity for:

a) Actuate individually and/or in equipment in situations of urgency.

b) Collaborate on prevention and intervention in emergency and disaster situations.

Learning Results:

Efficiently handles vital support resources and care techniques in the community scope.

Ensures patient safety and the environment to prevent potential complications arising from the emergency situation at the community level.

Caters to the family and environment in emergency situations.

Identifies available resources for emergency situations, your organization, and responsibilities.

Collaborates on performance devices for emergencies and catastrophes.

Rotations and training activities:

Clinical rotations in health centers, urgent care points, emergency and emergency centers, and urgent health care. Workshops or theoretical sessions with active methodology.

Brief description of content, attitudes and skills:

Urgent action protocols. Advanced life support techniques. Mobilisation and transport of patients in a situation of urgency. Problem prioritization techniques.

Leadership and coordination capacity. Serenity in decision making.

Managing crisis and stress situations. Decision making capacity. Application of the techniques of life support, mobilization and transport of patients.

5.9 Health care in situations of fragility or socio-health risk

Capacity for:

a) Promoting the health and integration of excluded groups or at risk of social exclusion (immigrants, ethnic minorities and other groups).

b) Manage interventions linked to problems: Immigration, ethnic minorities. disability, underdevelopment, marginalisation and others.

c) Detect and intervene early in situations of social-health fragility of people at all vital stages.

Learning Results:

Identifies specific needs of minority groups, excluded or at risk at Community level.

Collaborates in the planning, coordination, execution and evaluation of programs of care for minority groups, excluded or at risk, at the community level (individual and group).

Prevents and detects situations of social-health exclusion, fragility, and social isolation.

Power the development of social networks.

Collaborates in the health management of socially excluded groups.

Works with intercultural groups.

Rotations and training activities:

Rotations in health center. Collaboration with NGOs. Socio-health devices. Workshops or theoretical sessions with active methodology.

Brief description of content, attitudes and skills:

Risk factors related to situations of marginalization and social isolation. More frequent social and health problems in this type of population. Existing resources.

Proactive in the search for social risk conditions. Empathy, Tolerance and understanding of different attitudes. Respect for others.

Strategies for addressing and coping with situations of social marginalization. Risk approach in the assessment of individuals and families. Expression and Communication in other languages (sign language, other languages, etc.) Dynamisation of groups and communities to promote inter-group solidarity.

6. Competencies in public and community health

Capacity for:

a) Analyze the community health situation and plan and develop community health promotion programs.

b) Plan and develop health education programs in the community.

c) Design, execute and evaluate epidemiological surveillance programs.

d) Encourage and manage community participation.

e) Establish effective communication with institutions, community services, and with the different levels of health care services.

f) Plan and develop actions on environmental health.

g) Collaborate with other specialists and professionals in the health programs in the community settings.

h) Know the information system, monitoring and control of occupational accidents and occupational diseases.

Learning Results:

Investigates, analyzes and interprets community responses to health-disease problems, taking into account, among others, the gender perspective.

Collaborates with the community in detecting the factors that affect their health.

Performs research related to health promotion.

Identifies health education needs (EPS) in the community.

Plans, develops, and evaluates EPS programs with the community.

Leads and perform intersectoral programs of social and health intervention in prevention, advocacy, and EpS.

Identifies and uses economics concepts in health promotion program management.

Designs and evaluates informational and educational materials.

Involves the media in the EpS.

Handles epidemiological and sociocultural information systems.

Develops and manages care epidemiology surveillance networks.

Identifies early health risk situations and activates the corresponding alarm mechanisms.

Elaborates reports on emerging or relevant health problems.

Collaborates in the management of health inspection and registration activities for food, public establishments and the environment.

Identifies and values community resources to meet health needs.

Drives community participation.

Encourages and coordinates social networks, self-help groups, non-governmental organizations, social volunteering, and other resources.

Manages care planning and coverage of demands and needs in the community with other public and/or private community sectors.

Recognizes and favors the relationship between the environment and health.

Collaborates in identifying and preventing community-based environmental risk hotspots.

Identifies and collaborates in the management of processes that are carried out in a public health laboratory.

Participates in the design and development of the health programs of the community's working environments through collaboration with the health and safety committees at work and/or with other health professionals in the community.

Uses and interprets data from the information, tracking, and control system for accidents and occupational diseases.

Rotations and training activities:

Rotations in health center, epidemiological unit and programs, inspection, food control and environmental health and other public health and health administration units, health NGOs. Workshops or theoretical sessions with active methodology.

Brief description of content, attitudes and skills:

Programs for health promotion and education. Methods and techniques of social research. Basic legal framework and measures on environmental protection and control and food security. Information and surveillance systems on health and epidemiology. The Management of Community Resources. A multicultural approach to health.

Fostering community participation. Respect for the environment and sustainable development. Respect for other cultures and ways of life. Community recognition as a core of care action.

Leadership in the promotion and monitoring of health in the Community. Development of intervention strategies in the community that encourage community participation. Planning, designing and implementing measures for the protection and prevention of health risks. Communication and working with groups.

7. Teaching skills

Capacity for:

a) Identify and assess the training needs and the factors that influence the learning of care in the family and the community, enabling an effective and efficient response.

b) Develop learning goals.

c) Determine the teaching plan that best suits the needs/demands identified.

d) Deciding the pedagogical formulas to be used and what is best suited to each individual case.

e) Manage and facilitate the proper preparation and use of the teaching material needed to teach teaching.

f) Manage the application of the teaching plan.

g) Evaluate the achievement of people's learning and teaching by people.

h) Designing disclosure texts: brochures, protocols, opinion pieces.

Learning Results:

Determines the level of knowledge of the group to which the training is directed.

Determines people's motivation for learning.

Determines people's ability to learn, assessing the pace of learning, and skills to understand and retain based on their level of education and age.

Meet and apply the incentives for learning.

Pedagogical objectives related to training needs.

Identifies the required competencies to be acquired.

Elaborates and schedules a training strategy.

Select and use the supporting media and supplemental material best suited to the end of the program.

Effectively transmits the specified contents.

Evaluates the impact of the training program.

Elaborates texts and brochures for information and disclosure.

Know the different means of disclosure.

Considers the gender perspective and the non-sexist language in the elaboration of informational materials.

Rotations and training activities:

Rotations in health center and teaching centers. Health education activities with different groups. Elaboration of divulgative texts. Workshops or theoretical sessions with active methodology.

Brief description of content, attitudes and skills:

Educational planning. Educational strategies. Design and evaluation of educational materials. Learning evaluation techniques.

Accessibility and suppression of barriers to communication.

Respect for individual learning options and processes. Empathy. Listen active.

Communication. Use of ICT. Self-learning self-learning (learning to learn).

8. Skills in care management and services at the family and community level

Capacity for:

a) Lead, coordinate and lead clinical care management processes. patients, families and social groups in the field of specialty.

b) Manage, lead and coordinate work groups and work in nursing and multidisciplinary teams.

c) Manage, lead and coordinate the continuity of individual, family and community care and health services.

d) Manage information systems related to professional practice and propose improvements in the development of clinical documentation in the field of specialty performance.

e) Manage, lead and coordinate the continuous improvement of care quality.

Learning Results:

Applies basic process management tools to clinical management.

Applies Scientific Evidence Based Health Care (ASBE) as an instrument for clinical management.

Applies patient-oriented management models.

In clinical practice, the various assessment instruments are used.

Work as a team, in the different scopes of work.

Leads, coordinates and energizes team activity.

Directs any type of work group appropriately.

Resolves and properly manages conflicts that arise on the team or workgroup.

Meet and describe the structure of the healthcare system.

Meet the different organizational models of the AP teams.

Handles the different management and organization models of the activity in the query, at home, in the community, and in the urgent activity.

Adequately handles tools that facilitate care continuity.

Know the features of Health Information Systems.

Handles the different logging systems that are used in Primary Care and knows its practical utility.

Handles and interprets the most common activity indicators in Primary Care.

Know the Primary Care Information System.

Efficiently handles software and software applications used in Primary Care.

Know the theoretical bases and methodology of electronic medical history.

Identifies gaps and makes proposals for the development of the nurse documentation software.

Applies the principles of calls 5s in all areas where it is necessary to ensure patient safety.

Ensures the integrality, integration and globality of care, minimizing the fragmentation of care.

Ensures the continuity and consistency of the work of the different professionals and establishments of the National Health System.

Agizes the interventions of the professionals who integrate the healthcare system and the social care system.

Optimizes and streamlines the consumption and utilization of services and resources.

Avoids duplication or lack of services or capabilities.

Manages comprehensive healthcare in highly complex patients.

Know the concept of quality, continuous improvement of quality, and the various components that integrate it.

Know and apply the steps in the quality improvement cycle.

Meet and use the various instruments that are used in each phase of the cycle.

Meet and manage the measurement tools of perceived quality.

Handles basic concepts about quality monitoring.

Participates in the design and development of a clinical practice guide.

Meet the European Model of Excellence.

Rotations and training activities:

Rotations in the health center and in management units. Workshops or theoretical sessions with active methodology.

Brief description of content, attitudes and skills:

Methodological bases of clinical management: management by processes and management models. ASBE as an instrument for clinical management: decision making, clinical practice variability, clinical practice guidelines and practice evaluation. Utility of the efficiency and cost-effectiveness studies. The leadership and its influence as the coordinating element and dynamizer of equipment. Structure and organisation of the health system at all levels. Models of organisation of the EAP. Continuous improvement of quality. Overall and systematic evaluation of the organization.

Positive attitude towards evaluation and knowledge of error as a method of improvement. Recognition of the value of teamwork.

Resolution of conflicts. Interpretation of indicators of most frequent use in Primary Care. Use of computer programs used in AP.

Elaboration of quality criteria or standards based on scientific evidence. Identification and documentation of the care processes, developing clinical practice guidelines based on the evidence.

9. Competence in research

Capacity for:

a) Basing your clinical practice and that of the teams you lead in the best available evidence.

b) Generate scientific knowledge.

c) Spread scientific knowledge.

Learning Results:

Understand and apply the core concepts of the scientific method including hypothesis formulation, statistical errors, and calculation of sample sizes and statistical methods linked to hypothesis contrast.

Bases your daily clinical practice on scientific bases.

Search for and select specific clinical documentation for your craft.

Lee and interprets critically, with an application vision, the scientific documentation.

Elaborates procedures, protocols, and clinical practice guidelines.

Applies the ethical principles of scientific research.

Design, development and development of research projects, especially those related to the specialty.

Identifies research needs from your clinical practice.

Innovates in the field of the definition of diagnoses, interventions and outcomes in family and community nursing, especially in the care of chronic and dependent patients, and individuals and communities in situations of frailty or risk to your health.

Write scientific work of your own.

Exposes and effectively defends scientific work of its own.

Transmits the findings of scientific knowledge to the citizens or the population, in an adapted and intelligible way.

Rotations and training activities:

All rotations. Workshops or theoretical sessions with active methodology. Design of a research project.

Brief description of content, attitudes and skills:

Search for relevant information. Protocols, procedures and clinical practice guidelines. The ethics of the investigation. The logic of the research process. Qualitative and quantitative research strategies. Statistics and qualitative data analysis. Knowledge of priority lines of research in family and community nursing. Standards for oral and written scientific communications exposures in the most used media in family and community nursing.

Reflexive attitude to clinical practice and scientific concern. Concern to consider and respond to questions arising from the practice. Interest for the citizen to receive the highest quality nursing care. Sensitivity to share knowledge and nurse discipline to advance.

Managing the main sources of clinical guidelines. Carrying out a critical reading of scientific publications. Development of research questions in the field of their specialty. Coordination and work in research teams. Communication for public exposure. Scientific writing.

10. Minimum rotations and activities

The comprehensive and personalized care provided by the community nurse requires multiple interventions aimed at different groups and with different objectives and methodologies throughout their working day. Therefore, a resident who shares a day with a nurse who is a specialist in the tutor, will perform in the same rotation, objectives of various headings of his training program.

Rotations will be planned for each resident subject to their individual training plan which will be in accordance with the training guide or itinerary to be approved by the Teaching Commission on the proposal of the tutor.

At least 60% of the training time will be developed in the health center, in which the resident will carry out activities, both in consultation and in the patients ' homes, as well as in other devices, organizations and existing institutions in the community.

During the first year, a rotation of at least four months will take place in the health center where the tutor will serve and the second year will be finished in the same way. The rest of the time will be distributed between time in the health center and rotations by other devices, according to resources and needs.

The resident may perform external rotations not provided for in this training program in national or foreign centers in accordance with Article 21 of RD 183/2008.

Competencies	Minimum Activity	Rotation Device
Childcare.	100 healthy child visits.	Health Center
	50 acute/chronic queries	School.
	Participates in the development and execution of at least one health intervention program In all stages.	Youth-youth mental health center
in adolescence.	Group Intervention in one of the following thematic units: Sexual affective education, prevention unwanted pregnancy, STIs, violence, drug addiction, etc.	Health center
	25 queries Teens individual.	High School Institute
		Young query.
		Community: Youth associations, youth centers of recreation culture or sport
		Youth-youth mental health center.
health care at the stage adult.	300 demand/scheduled nursing consultations in adults with deficits acute and chronic health.	Health Center
	50 home visits programmed.	Mental Health Center
	Participate in Planning and Development and evaluation, at least in an adult group health education intervention with chronic pathology.
Minor Surgery Interventions: 20.
		Hospital-table_izq"> Hospital: Diabolical education unit or other chronic pathologies
	Intervention in the Existing diagnostic and/or therapeutic techniques in the health center (anticoagulation control, hospitalization home etc.)	Adult sports center
	Participate at least one community intervention and/or community involvement.
	Program Intervention physical exercise for health.
	200 urgencies in C. Health.
care sexual, reproductive and gender.	Guidance for family planning: 15 couples.	Health Center
	Valuation and Advice on ITS to 5 Men and 5	Family Orientation Center
	Urgency and Intervention Anticonception educational: 10.	Delivery preparation and pregnancy monitoring device in primary care
	Attention and Follow Up to Pregnant Woman: 10.	Hospital: Obstetrics and ward deliveries, menopause unit, gynaecological cancer prevention unit
	Collaborating on assistance to 5 deliveries (I potentiate the use of simulators.)
	Port visits: 10.
	Breastfeeding Promotion: 10.
	Education for sexual health and gender coexistence: intervention in two groups.
	Attention to the woman and man in her climactic stage: 10.
to elderly people.	300 demand/scheduled nursing consultations.	Health Center.
	Workshops for caregivers: 2.	Sports center for the third age.
	Intervention in program physical exercise for health.	Mental health center
	Care for patients with Cognitive impairment at home: 25.	Unit assessment unit.
	Valuation functional and cognitive at home: 25.	Community Care Centers elderly (day centers, geriatric etc.)
	Interventions for the functional, social, and cognitive maintenance of the elderly in the address: 25.	Sociosanitary coordination unit
	Coordination of resources sociosanitarios: 5.	Palliative care device or unit (addresses, hospitals, etc.)
	Care for patients in the end of life at home: 10.
to families.	Family-intervention in the various stages of the family cycle:	Health Center
	with newborn children: 2.
	with school: 2.
	with adolescents: 2.
	with nest syndrome empty ": 2.
	risk unipersonnel: 2.
	with immobilized family members: 4.
	with seniors with health problems: 25.
	with people in the end of life: 10.
to emergencies and emergencies.	100 child hospital urgent care demands.	Health Center (Urgences and Continuous Care)
	100 demands for urgent hospital care.	Hospital pediatric emergencies
	250 demands for urgent care at the health and/or home center.	Hospital urgent care service
	10 in-situation interventions emergency.	Urgent Healthcare Transport Service
Public and Community Health.	2 Epidemiological surveillance activities (food establishments, food handlers, school dining, markets, sampling, etc.).	Health Center
	Management activities in the minus 3 health programs.	Epidemiology unit (Counselor or health service)
		Program Unit (Counselor or Health Service)
		Inspection.
		Food Control and Food Handler Devices
		Environmental Health
		NGOs.

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ANNEX I

To the Family and Community Nursing program

Developing section 4.5

The resident nurses must acquire, in accordance with the provisions of the current legislation, basic knowledge in radiation protection as provided for in the European Guide "Radiological Protection 116", in the Following subjects:

a) Atomic structure, production and interaction of radiation.

b) Nuclear structure and radioactivity.

c) magnitudes and radiological units.

d) Physical characteristics of the X-ray equipment or radioactive sources.

e) Fundamentals of radiation detection.

f) Fundamentals of radiobiology. Biological effects of radiation.

g) Radiological protection. General principles.

h) Quality assurance and quality assurance.

(i) National legislation and European legislation applicable to the use of ionising radiation.

j) Operational radiological protection.

k) Specific radiation protection aspects of patients.

l) Specific radiological protection aspects of exposed workers.

The teaching of the above headings will focus on the actual risks of exposure to ionising radiation and its biological and clinical effects.

Duration of training: The training contents of points (a), (b), (c), (d), (e), (f), (g), (h), (i), shall be provided during the first year of specialisation. Its duration shall be between six and ten hours, fractionable in modules, which shall be provided in accordance with the training plan to be determined.

The learning content of points (j), (k) and (l): they will be progressively imparted in each of the successive years of training and their duration will be between two and four hours, highlighting the practical aspects.

Place of performance: The training contents of points (a), (b), (c), (d), (e), (f) (g), (h), (i), shall be provided by the members of a Service of Hospital Radiophysical/Radiological Protection/Medical Physics. The training contents of points (j), (k) and (l): are to be taught in a Health Institution with Hospital Physical Radio/Radiological Protection/Medical Physics, in coordination with the care units of that institution specifically related to ionising radiation.

Effects of training: Training in Radiological Protection in the period of residence mentioned above, is in line with the requirements of the legislation applicable during the training of specialists in health sciences, without no case, such training involves the acquisition of the second additional level in Radiological Protection, as referred to in Article 6.2 of Royal Decree 1976/1999 of 23 December 1999 laying down the quality criteria for radiodiagnostic, for interventional procedures guided by fluoroscopy. (Order SCO/3276/2007 of 23 October 2007-BOE of 13 November 2007).

Organization of training: When advised by the number of residents, specialties and services of Radiophysical/Radiological Protection/Medical Physics involved, the competent bodies in the field of health training In connection with the Teaching Commissions concerned, the specialized authorities of the various Autonomous Communities may take the necessary measures to coordinate their implementation with a view to the rational use of training resources.

ANNEX II

Legal and bibliographic references of an orientation related to the training of the Nurse Specialist in Family and Community Nursing.

1. More significant legal references:

Law 14/1986 of 25 April, General of Health.

Royal Decree 183/2008 of 8 November 2008 incorporating into the Spanish legal order Directive 2005 /36/EC of the European Parliament and of the Council of 7 September 2005 and Directive 2006 /100/EC of the European Parliament and of the Council on 20 November 2006, concerning the recognition of professional qualifications, as well as certain aspects of the exercise of the profession of lawyer.

Law 41/2002, of 14 November, basic law regulating the autonomy of the patient and of rights and obligations regarding information and clinical documentation.

Law 16/2003, of 28 May, of cohesion and quality of the National Health System.

Law 44/2003, of 21 November, of management of the health professions.

Law 55/2003, of 16 December, of the Framework Staff Regulations of the statutory staff of health services.

Royal Decree 450/2005 of 22 April on Nursing specialties.

Law 29/2006 of July 26 on the guarantees and rational use of medicines and medical devices.

Royal Decree 1030/2006 of 15 September establishing the portfolio of services of the National Health System.

Royal Decree 1146/2006, of 6 October, which regulates the special employment relationship of residence for the training of specialists in Health Sciences.

Law 39/2006 of 14 December on the Promotion of Personal Autonomy and Care for Persons in a Situation of Dependence.

Law 14/2007, of July 3, of biomedical research.

Royal Decree 1393/2007 of 29 October establishing the ordination of official university teaching.

Royal Decree 183/2008 of 8 February 2008 determining and classifying specialties in Health Sciences and developing certain aspects of the specialized health training system.

2. Books:

2.1 Community Nursing, Primary Care, Public Health.

Ashton, J. Seymour, H. The new Public Health. Masson. 1990.

Benitez del Rosario, MA. Salinas Martín, A. Palliative care and Primary Care. Springer-Verlag Ibérica. 2000.

Bernabeu Mestre, J. Gascón Pérez, E. History of Nursing in Public Health in Spain (1860-1977). Universidad de Alicante. 1999.

Colomer Revolt, C. Promotion of health and social change. Masson. 2000.

Count, JC. Gene, J. Pii, M. Home Care. Organisation and practice. Springer-Verlag Ibérica. 1999.

Duarte Climents, G. Gomez Salgado, J. Sanchez Gomez, MB. Public Health-Community Nursing. Focus-Editions. 2008.

Franco Agudelo, S. La Salud Pública Hoy. Universidad Nacional de Colombia. 2002.

Frias Osun, A. Community Nursing. Masson. 2000.

Frias Osun, A. Public Health and Education for Health. Ed. Masson, S.A. Barcelona, 2004.

Girbau Garcia, MR. Community Nursing. Masson. 2004.

Jaffe, M. Skidmore-Roth, L. Nursing in Home Care. Harcourt Brace. 1998.

Lopez Imedio, E. Nursing in palliative care. Pan-American Medical Editorial. 1998.

Martin Zurro, A. Cano Perez, JF. Primary Care. Concepts, organization and clinical practice (2 volumes). Elsevier. 2008.

Martinez Riera, JR. Del Pino Casado, R. Nursing in Primary Care (2 volumes). DAE. 2006.

Mazarrasa, L. German, C. Sánchez, A. Sánchez, AM. Merelles, T. Aparicio, V. Public Health and Community Nursing (3 volumes). McGraw-Hill-Inter-American. 1996.

Piedrola Gil. Public Health and Preventive Medicine. Masson. 2008.

Ramos Calero, E. Community Nursing, methods and techniques. DAE. 2000.

Sánchez, A. Aparicio, V. German, C. Mazarrasa, L. Merelles, A. Sánchez, A. Nursing Comunitaria (2 volumes). McGraw-Hill-Inter-American. 2000.

Universitas-Miguel Hernández. Palliative medicine courses in Primary Care (2 volumes). AstraZeneca. 2000.

2.2. Health Planning, Education for Health, Participation and Community Intervention:

Calvo Bruzos, S. Education for Health at the School, Diaz de Santos. 1992.

Donati, P. Manual of Sociology of Health. Díaz de Santos. 1994.

Garcia Calvente, MM. Mateo Rodríguez, I. Gutiérrez Cuadra, P. Care and Carers in the Health Information System. Andalusian Institute of Women. 1999.

García Ferrer, J. The new social sustainability. Ariel Sociology. 2000.

García, M. Saez, J. Escarbajal, A. Education for Health. The bet for quality of life. Arán. 2000.

Gavidia Catalán, V. Health, education and quality of life. Magisterio editorial cooperative. 1998.

Gomez Ocana, C. Rius Lozano, M. Education for Health. A curricular transversal. Conselleria de Sanitat IVESP. 1998.

Gracia Fuster, E. Social support in community intervention. Paid Social Work 1. 1998.

Heierle Valero, C. Taking care of caregivers. Exchange of family support. Foundation Index. 2004.

Juarez, F. Educate in the classroom. Activities to work in Health Education. Enedias Eneida Health. 2001.

Justamante, M. Diez, MT. Education for Health. Didactic Guide. Universidad de Alicante. 1999.

Mayan Santos, JM. Nursing and social and health care. DAE. 2005.

Perdero, E. Comelles, JM. Medicine and culture. Studies between anthropology and medicine. Editions Bellaterra. 2000.

Pérez, R. Saez, S. The group on health promotion and education. Editorial Milenio. 2005.

Pineaul, R. Daveluy, C. Health Planning. Concepts, methods, strategies. Masson. 2002.

Restrepo. Malaga. Health Promotion: How to build healthy living. Pan-American. 2002.

Saez, S. Font, P. Pérez, R. Marques, F. Promotion and Education for Health. Editorial Milenio. 2001.

Saez, S. Marques, F. Colell, R. Education for Health. Techniques for working with small groups. Pages. 1998.

Sanchez Alonso, M. The participation. Methodology and practice. Editorial Popular. 2004.

Sánchez Moreno, A. et al. Education for Health in the School: Experience and Participation. Universidad de Murcia. 1997.

Sánchez Vidal, A. Programs for Community Prevention and Intervention. PPU. 1993.

Serrano Gonzalez, MI. Education for the Health of the 21st Century. Díaz de Santos. 1997.

Turabian, JL. Community Participation in Health. Díaz de Santos. 1992.

2.3 Communication and Family Care:

Carwath, T. Miller, D. Behavioral psychotherapy in primary care. Martínez Roca. 1986.

Cibanal, L. Introduction to systemic and family therapy. ECU. 2006.

Cibanal, L. Arce, MC. Nurse/patient relationship. Universidad de Alicante. 1991.

Cibanal, L. Arce, MC. Carballal, MC. Communication techniques and aid relationship in Health Sciences. Elsevier España. 2003.

Cibanal, L. Martínez Riera, JR. Basic concepts of family nursing. Enfo editions. 2008.

Gimeno, A. The family has the challenge of diversity. Ariel Psychology. 1999.

Gomez Sancho, M. How to give bad news in medicine. Medical Classroom Group. 1996.

Minuchin, S. Fishman HC. Family therapy techniques. Paid Family Therapy. 2004.

Minuchin, S. Fishman HC. Families and Family Therapy. Gedisa. 2003.

Valverde Gefaell, C. Therapeutic Communication in Nursing. DAE. 2007.

2.4 Teaching-nursing learning:

Foucault, M. Watch and punish. Twenty-first century of Spain. 1998.

Bimbela Pedrola, JL. Navarro Matillas, B. Taking care of the trainer. Emotional and communication skills. EASP. 2005.

Medina, JL. The pedagogy of care: Saberes and Internship in Univ. Nursing. Laertes. 1998.

Medina, JL. Desire to care and will to power. The teaching of nursing. Universitat de Barcelona. 2005.

Schon, DA. The training of thoughtful professionals. Paidos. 1992.

Villar Angle, LM. Cheerful of the Rose, OM. Manual for excellence in higher education. McGraw Hill. 2004.

2.5 Research:

Alvarez Caceres, R. multivariate and non-parametric statistics with SPSS. Application CC SS. Díaz de Santos. 1994.

Armijo Rojas, R. Basic Epidemiology in Primary Health Care. Díaz de Santos. 1993.

Badia, X. Salamero, M. Alonso, J. The health measure. EDITAC. 2002.

Bobenriieth Astete, MA. The original scientific article. Writing, style and critical reading. 1993.

Burns, N. Grove, SK. Nursing research. Saunders. 2004.

Coffey, A. Atkinson, P. Find the sense of qualitative data. Universidad de Antioquia. 2003.

Gerrish, K. Lacey, A. Nursing Research. McGraw Hill. 2008.

Huth, EJ. How to write and publish jobs in health sciences. Masson-Salvat medicine. 1992.

Market, FJ. Gastaldo, D. Calderón, C. Paradigm or designs of qualitative health research. Service Vasco de Salud. 2002.

Market, FJ. Gastaldo, D. Calderón, C. Qualitative health research in Latin America. Methods, analysis and ethics. Service Vasco de Salud. 2002.

Pearson, A. Field, J. Jordan, Z. Clinical practice based on evidence in nursing and health care. McGraw Hill. 2008.

Polit DF. Scientific research in health sciences. Inter-American McGraw Hill. 1991.

Richart, M. et al. Bibliographic search in nursing and other health sciences. Universidad de Alicante. 2001.

Sandoval Casilimas, C. Qualitative research. ICFES. 1996.

Silva Aycaguer, LC. Sampling for research in Health Sciences. Díaz de Santos. 1993.

Wolcott, H. Improve the writing of qualitative research. Universidad de Antioquia. 2003.

2.6 Nursing Management:

Baudouin Meunier. Management of Non-Commercial Organizations. MAP. 1993.

Beckhard, R. Pritchard, W. Strategy for Change. Management in the business organization. Parramón. 1992.

Blankenship Pugh, J. Woodward-Smith, MA. Practical guide for the Nursing Staff Directorate. DOYMA. 1992.

EUE Santa Madrona. The exercise of management from the perspective of caring. Social Work Foundation "La Caixa". 2005.

La Monica, EL. Management and Administration in Nursing. Mosby/Doyma Books. 1994.

Lamata, F. et al. Healthcare Marketing. Díaz de Santos. 1994.

Llano Senaris, J. et al. Health Management. Innovations and challenges. MASSON. 1999.

Marriner-Tomey, A. Administration and leadership in nursing. Mosby. 1996.

Muir Gray, JA. Evidence-based Health Care. Churchill Livingstone. 1997.

Salvadores Fuentes, P. Sanchez Lozano, FM. Jiménez Fernández, R. Manual of administration of nursing services. Ariel Medical Sciences. 2002.

Varo, J. Strategic Quality Management in Healthcare Services. Díaz de Santos. 1993.

Vuori, HV. Quality control of health services. MASSON. 1991.

3. Journals:

Doyma.

Evidence. Evidence-Based Nursing Journal.

	Editorial	Web
Nursing Role Journal.	ROL Editions.	http://www.e-rol.es/
Paradigm.	Paradigm.	Paradigm.	http://www.enfermeria21.com/
Doyma.	http://www.elsevier.es/home/ctl_servlet?_f=110
Index.	http://www.index-f.com/evidentia/inicio.php
Index of Nursing.	Index.	http://www.index-f.com/index-enfermeria/revista.php
Community Nursing.	Paradigm.	http://www.enfermeria21.com/
Nursing. International family and community health care journal.	Index.	http://www.index-f.com/comunitaria/revista.php
Health Gazette.	Elsevier.	http://www.elsevier.es/home/ctl_servlet?_f=110
21st Century Health Administration.	http://www.elsevier.es/home/ctl_servlet?_f=110
Health 2000.	Health 2000.	http://www.fadsp.org/html/saud2000.htm Journal of the Federation of Associations for Public Health Advocacy.	http://www.fadsp.org/html/saud2000.htm
Doyma.	Doyma.		http://www.elsevier.es/home/ctl_servlet?_f=110
Culture.	CECOVA.
American Journal of Health Promotion.
Notebook.	Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz.
Health Education Research.		http://her.oxfordjournals.org/
Journal of Public Health.		http://jpubhealth.oxfordjournals.org/
Public Health Nursing.		http://www.wiley.com/bw/journal.asp?ref=0737-1209
				Saude Magazine.
Spanish Journal of Public Health.		http://scielo.isciii.es/scielo.php/script_sci_serial/pid_1135-5727/lng_es/nrm_iso
American Journal of Enfermagem.
Ibero-American Journal of Community Nursing.	Community Nursing Association.	http://revista.enfermeriacomunitaria.org/

4. Web pages of interest:

Community Nursing Association:

http://www.enfermeriacomunitaria.org/

Bandolier:

http://www.infodoctor.org/bandolera/

Cochrane plus library:

http://www.update-software.com/Clibplus/ClibPlus.asp

Federation of Community Nursing and Primary Care Associations:

http://www.faecap.com/

Fisterra:

http://www.fisterra.com/

Guiding:

http://www.guiasalud.es/home.asp

Nursing Index:

http://www.index-f.com/

Joanna Briggs Institute:

http://es.jbiconnect.org/

Invest (Carlos III Health Institute):

http://www.isciii.es/htdocs/redes/investen/investen_presentacion.jsp

Medline:

http://www.ncbi.nlm.nih.gov/sites/entrez?db=PubMed

Ministry of Health and Consumer Affairs:

http://www.msc.es/

WHO:

http://www.who.int/es/

Pan American Health Organization:

http://new.paho.org/