Evidence of intrauterine device insertion by nurses in Primary Health Care: an integrative review

Oliveira, Lays Souza de; Hermida, Patrícia Madalena Vieira; Siqueira, Elizimara Ferreira; Arma, Juliana Cipriano Braga Silva de; Thomas, Larissa Scheeren; Dalmolin, Indiara Sartori

doi:10.1590/0034-7167-2023-0134

Lays Souza de Oliveira Corresponding author: Lays Souza de Oliveira, E-mail: enf.laysoliveira@gmail.com

conception or design of the study/research

analysis and/or interpretation of data

final review with critical

intellectual participation in the manuscript.

Prefeitura Municipal de Florianópolis. Florianópolis, Santa Catarina, Brazil

https://orcid.org/0000-0002-6882-7691

Patrícia Madalena Vieira Hermida

conception or design of the study/research

analysis and/or interpretation of data

final review with critical

intellectual participation in the manuscript.

Prefeitura Municipal de Florianópolis. Florianópolis, Santa Catarina, Brazil

https://orcid.org/0000-0002-7969-357X

Elizimara Ferreira Siqueira

final review with critical

intellectual participation in the manuscript.

Prefeitura Municipal de Florianópolis. Florianópolis, Santa Catarina, Brazil

https://orcid.org/0000-0002-9526-9939

Juliana Cipriano Braga Silva de Arma

final review with critical

intellectual participation in the manuscript.

Prefeitura Municipal de Florianópolis. Florianópolis, Santa Catarina, Brazil

https://orcid.org/0000-0002-2594-656X

Larissa Scheeren Thomas

analysis and/or interpretation of data

final review with critical

intellectual participation in the manuscript.

Prefeitura Municipal de Florianópolis. Florianópolis, Santa Catarina, Brazil

https://orcid.org/0000-0002-5890-8105

Indiara Sartori Dalmolin

final review with critical

intellectual participation in the manuscript.

Prefeitura Municipal de Florianópolis. Florianópolis, Santa Catarina, Brazil

https://orcid.org/0000-0002-6611-4970

Corresponding author: Lays Souza de Oliveira, E-mail: enf.laysoliveira@gmail.com

EDITOR IN CHIEF: Dulce Barbosa

ASSOCIATE EDITOR: Ana Fátima Fernandes

Databases and search strategies
BDENF and LILACS (“Intrauterine Devices” OR “Contraceptive IUD” OR “Contraceptive IUDs” OR “Intrauterine Contraceptive Device” OR “Intrauterine Contraceptive Devices” OR “Intrauterine Device” OR “Unmedicated IUD” OR “Unmedicated IUDs” OR “Dispositivos Intrauterinos” OR “Anticoncepcionais Intrauterinos” OR “Dispositivo Intrauterino” OR “Anticonceptivos Intrauterinos” OR “Contraceptivos Intrauterinos”) AND (“Nursing Care” OR “Nursing” OR “Nursings” OR “Nurses” OR “Nurse” OR “Cuidados de Enfermagem” OR “Enfermagem” OR enfermeir^* OR “Atención de Enfermería” OR “enfermeria” OR enfermer^) AND (“Primary Health Care” OR “Primary Healthcare” OR “Primary Care” OR “basic health care” OR “basic care” OR “basic service” OR “Primary Care Nursing” OR “Atenção Primária à Saúde” OR “Atenção Básica” OR “Atenção Primária” OR “Atendimento Básico” OR “Atendimento Primário” OR “Cuidados de Saúde Primários” OR “Cuidado de Saúde Primário” OR “Cuidados Primários” OR “Cuidado Primário” OR “Cuidado de Saúde Básico” OR “Cuidados de Saúde Básicos” OR “Cuidado Básico” OR “Cuidados Básicos” OR “Enfermagem de Atenção Primária” OR “Atención Primaria de Salud” OR “Atención Primaria” OR “Atención Básica” OR “Cuidado de la Salud Primarios” OR “Cuidados Primarios” OR “servicios básicos de salud” OR “servicio básico” OR “servicios básicos” OR “cuidado básico de salud” OR “cuidados básicos de salud” OR “Enfermería de Atención Primaria*”)
CINAHL (“Intrauterine Devices” OR “Contraceptive IUD” OR “Contraceptive IUDs” OR “Intrauterine Contraceptive Device” OR “Intrauterine Contraceptive Devices” OR “Intrauterine Device” OR “Unmedicated IUD” OR “Unmedicated IUDs”) AND (“Nursing Care” OR “Nursing” OR “Nursings” OR “Nurses” OR “Nurse”) AND (“Primary Health Care” OR “Primary Healthcare” OR “Primary Care” OR “basic health care” OR “basic care” OR “basic service” OR “Primary Care Nursing”)
EMBASE (“Intrauterine Devices” OR “Contraceptive IUD” OR “Contraceptive IUDs” OR “Intrauterine Contraceptive Device” OR “Intrauterine Contraceptive Devices” OR “Intrauterine Device” OR “Unmedicated IUD” OR “Unmedicated IUDs”) AND (“Nursing Care” OR “Nursing” OR “Nursings” OR “Nurses” OR “Nurse”) AND (“Primary Health Care” OR “Primary Healthcare” OR “Primary Care” OR “basic health care” OR “basic care” OR “basic service” OR “Primary Care Nursing”
SciELO (“Intrauterine Devices” OR “Contraceptive IUD” OR “Contraceptive IUDs” OR “Intrauterine Contraceptive Device” OR “Intrauterine Contraceptive Devices” OR “Intrauterine Device” OR “Unmedicated IUD” OR “Unmedicated IUDs” OR “Dispositivos Intrauterinos” OR “Anticoncepcionais Intrauterinos” OR “Dispositivo Intrauterino” OR “Anticonceptivos Intrauterinos” OR “Contraceptivos Intrauterinos”) AND (“Nursing Care” OR “Nursing” OR “Nursings” OR “Nurses” OR “Nurse” OR “Cuidados de Enfermagem” OR “Enfermagem” OR enfermeir^* OR “Atención de Enfermería” OR “enfermeria” OR enfermer^) AND (“Primary Health Care” OR “Primary Healthcare” OR “Primary Care” OR “basic health care” OR “basic care” OR “basic service” OR “Primary Care Nursing” OR “Atenção Primária à Saúde” OR “Atenção Básica” OR “Atenção Primária” OR “Atendimento Básico” OR “Atendimento Primário” OR “Cuidados de Saúde Primários” OR “Cuidado de Saúde Primário” OR “Cuidados Primários” OR “Cuidado Primário” OR “Cuidado de Saúde Básico” OR “Cuidados de Saúde Básicos” OR “Cuidado Básico” OR “Cuidados Básicos” OR “Enfermagem de Atenção Primária” OR “Atención Primaria de Salud” OR “Atención Primaria” OR “Atención Básica” OR “Cuidado de la Salud Primarios” OR “Cuidados Primarios” OR “servicios básicos de salud” OR “servicio básico” OR “servicios básicos” OR “cuidado básico de salud” OR “cuidados básicos de salud” OR “Enfermería de Atención Primaria*”)
Scopus (“Intrauterine Devices” OR “Contraceptive IUD” OR “Contraceptive IUDs” OR “Intrauterine Contraceptive Device” OR “Intrauterine Contraceptive Devices” OR “Intrauterine Device” OR “Unmedicated IUD” OR “Unmedicated IUDs”) AND (“Nursing Care” OR “Nursing” OR “Nursings” OR “Nurses” OR “Nurse”) AND (“Primary Health Care” OR “Primary Healthcare” OR “Primary Care” OR “basic health care” OR “basic care” OR “basic service” OR “Primary Care Nursing”)
PubMed (“Intrauterine Devices”[Mesh] OR “Intrauterine Devices” OR “Contraceptive IUD” OR “Contraceptive IUDs” OR “Intrauterine Contraceptive Device” OR “Intrauterine Contraceptive Devices” OR “Intrauterine Device” OR “Unmedicated IUD” OR “Unmedicated IUDs” OR “Intrauterine Devices, Copper”[Mesh]) AND (“Nursing Care”[Mesh] OR “Nursing Care” OR “Nursing”[Mesh] OR “Nursing” OR “Nursings” OR “Nurses”[Mesh] OR “Nurses” OR “Nurse”) AND (“Primary Health Care”[Mesh] OR “Primary Health Care” OR “Primary Healthcare” OR “Primary Care” OR “basic health care” OR “basic care” OR “basic service” OR “Primary Care Nursing” OR “Primary Care Nursing”[Mesh])
Web of Science (“Intrauterine Devices” OR “Contraceptive IUD” OR “Contraceptive IUDs” OR “Intrauterine Contraceptive Device” OR “Intrauterine Contraceptive Devices” OR “Intrauterine Device” OR “Unmedicated IUD” OR “Unmedicated IUDs”) AND (“Nursing Care” OR “Nursing” OR “Nursings” OR “Nurses” OR “Nurse”) AND (“Primary Health Care” OR “Primary Healthcare” OR “Primary Care” OR “basic health care” OR “basic care” OR “basic service” OR “Primary Care Nursing”)

Code	Title	Year/country of origin	Study design/LoE	Participants
S1(24Saniel FL. The Bohol IUD program. Stud Fam Plann [Internet]. 1979 [cited 2023 May 25];10(6-7):211-2. Available from: https://pubmed.ncbi.nlm.nih.gov/483349/ https://pubmed.ncbi.nlm.nih.gov/483349/... )	The Bohol IUD program	1979/Philippines	Experience report/VII	Nurses^* * preserved the nomenclature of participants used in the studies, whose operating scenario was Primary Health Care. (n=40) and midwives (n=40)
S2(25Bibb BN. The effectiveness of non-physicians as providers of family planning services. J Obstet Gynecol Neonatal Nurs. 1979;8(3):137-43. https://doi.org/10.1111/j.1552-6909.1979.tb00819.x https://doi.org/10.1111/j.1552-6909.1979... )	The effectiveness of non-physicians as providers of family planning services	1979/United States	Literature review/VII	Not applicable
S3(26Elton J. Managing change in primary care: part 1. Pract Nurs[Internet]. 2008 [cited 2023 May 25];36(10):42-4. Available from: https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=105616450⟨=pt-br&site=ehost-live https://search.ebscohost.com/login.aspx?... )	Managing change in primary care: part 1	2008/England	Experience report/VII	Nurse^* * preserved the nomenclature of participants used in the studies, whose operating scenario was Primary Health Care. (n=1)
S4(27Elton J. Managing change in primary care: part 2. Pract Nurs[Internet]. 2009 [cited 2023 May 25];37(1):28-33. Available from: https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=105450851⟨=pt-br&site=ehost-live https://search.ebscohost.com/login.aspx?... )	Managing change in primary care: part 2	2009/England	Experience report/VII	Nurse^* * preserved the nomenclature of participants used in the studies, whose operating scenario was Primary Health Care. (n=1)
S5(28Elton J. Managing change in primary care: part 3. Pract Nurs [Internet]. 2009 [cited 2023 May 25];37(2):38-40. Available from: https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=105450881⟨=pt-br&site=ehost-live https://search.ebscohost.com/login.aspx?... )	Managing change in primary care: part 3	2009/England	Experience report/VII	Nurse^* * preserved the nomenclature of participants used in the studies, whose operating scenario was Primary Health Care. (n=1)
S6(29Harper CC, Stratton L, Raine TR, Thompson K, Henderson JT, Blum M, et al. Counseling and provision of long-acting reversible contraception in the US: national survey of nurse practitioners. Prev Med. 2013;57(6):883-8. https://doi.org/10.1016/j.ypmed.2013.10.005 https://doi.org/10.1016/j.ypmed.2013.10.... )	Counseling and provision of long-acting reversible contraception in the US: National survey of nurse practitioners	2013/United States	Probability survey/VI	PHC (n=224) and women’s health (n=360) nurses
S7(30Atkin K, Beal MW, Long-Middleton E, Roncari D. Long-acting reversible contraceptives for teenagers: primary care recommendations. Nurse Pract. 2015;40(3):38-46. https://www.doi.org/10.1097/01.NPR.0000460853.60234.c2 https://www.doi.org/10.1097/01.NPR.00004... )	Long-acting reversible contraceptives for teenagers: Primary care recommendations	2015/United States	Literature review/VII	Not applicable
S8(31Rubin SE, Maldonado L, Fox K, Rosenberg R, Wall J, Prine L. Establishing and conducting a regional, hands-on long-acting reversible contraception training Center in Primary Care. Womens Health Issues. 2018;28(5):375-8. https://www.doi.org/10.1016/j.whi.2018.04.010 https://www.doi.org/10.1016/j.whi.2018.0... )	Establishing and conducting a regional, hands-on long-acting reversible contraception training Center in primary care	2018/United States	Experience report/VII	Family^* * preserved the nomenclature of participants used in the studies, whose operating scenario was Primary Health Care. and pediatric nurses (n=28)
S9(32Chin-Quee DS, Ridgeway K, Onadja Y, Guiella G, Bai GM, Brennan C, et al. Evaluation of a pilot program for task sharing short and long-acting contraceptive methods in Burkina Faso. Gates Open Res. 2020;3:1499. https://doi.org/10.12688/gatesopenres.13009.2 https://doi.org/10.12688/gatesopenres.13... )	Evaluation of a pilot program for task sharing short and long-acting contraceptive methods in Burkina Faso	2020/Burkina Faso	Descriptive study of mixed methods/VI	Nurses^* * preserved the nomenclature of participants used in the studies, whose operating scenario was Primary Health Care. (n=16) and registered midwives (n=8), assistant midwives (n=29), mobile health professionals (n=26), totaling 79 primary care professionals.
S10(15Lacerda LDRC, Arma JC, Paes LG, Siqueira EF, Ferreira LBB, Fetzner RRT, et al. Inserção de dispositivo intrauterino por enfermeiros da atenção primária à saúde. Enferm Foco. 2021;12(suppl 1):99-104. https://doi.org/10.21675/2357-707X.2021.v12.n7.SUPL.1.5209 https://doi.org/10.21675/2357-707X.2021.... )	Inserção de DIU por enfermeiros da Atenção Primária à Saúde	2021/Brazil	Experience report/VII	PHC nurses (n=115)

Code	Objectives	Main results	Conclusion
S1(24Saniel FL. The Bohol IUD program. Stud Fam Plann [Internet]. 1979 [cited 2023 May 25];10(6-7):211-2. Available from: https://pubmed.ncbi.nlm.nih.gov/483349/ https://pubmed.ncbi.nlm.nih.gov/483349/... )	To report the proposal for an IUD program that used midwives and nurses to perform the insertions.	The six-week IUD trainings involved ten nurses and ten midwives in each class. They formed four classes in 1977 and 1978, totaling 80 participants, who learned everything from contraindications to IUD insertion and removal. Each professional needed to insert 20 IUD to be considered qualified. Of the total insertions, 63% occurred in the women’s homes. More than 2,000 IUD were inserted, and there were no serious complications related to the insertions.	Nurses and midwives can safely insert IUD. Device insertion by these trained professionals increased the acceptability of the method, due to women’s bond and trust, in addition to the availability of professionals to perform the procedure at home.
S2(25Bibb BN. The effectiveness of non-physicians as providers of family planning services. J Obstet Gynecol Neonatal Nurs. 1979;8(3):137-43. https://doi.org/10.1111/j.1552-6909.1979.tb00819.x https://doi.org/10.1111/j.1552-6909.1979... )	To review the literature on the role of non-medical professionals as primary care providers in family planning.	In the USA, since the National Family Planning Act in 1970, nurses have received training to work in planning and women’s health. In 1967, removal, expulsion, retention, and pregnancy rates after IUD insertion in 210 women showed lower rates of expulsion and removals and higher retention rates among women who had IUD inserted by nurses (n=150) when compared to insertions by physicians (n=60). Regarding IUD insertion by physicians, obstetric nurses and rural midwives, there were no complications and significant differences between professionals. Countries such as Korea, Nigeria and Pakistan have been encouraging the training of non-physicians to insert IUD, aiming to reduce birth rates and improve access to contraception in rural areas.	Non-physicians’ ability to safely insert IUD is advocated, as they have greater acceptability and accessibility by vulnerable populations when compared to physicians. The literature reveals that there was no apparent difference in relation to IUD complications and maintenance between physicians and non-physicians. It is recommended that public services train and expand the role of nurses in family planning.
S3(26Elton J. Managing change in primary care: part 1. Pract Nurs[Internet]. 2008 [cited 2023 May 25];36(10):42-4. Available from: https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=105616450⟨=pt-br&site=ehost-live https://search.ebscohost.com/login.aspx?... )	To describe the rationale for the strategies used to introduce a nurse-led service to improve LARC access and discuss the effectiveness, cost-effectiveness and training for IUD insertion.	To provide a more comprehensive and accessible family planning service, the project relies on clear evidence that nurses are competent to acquire IUD insertion skills as well as reducing costs to the practice. The Royal College of Nursing recommends that nurses insert at least five IUD and remove two IUD per year to maintain their competency.	Guidance on training and practices for IUD insertion is based on comprehensive evidence and provides a clear framework for ongoing training and practice. There is disparity in access to training, however training nurses is more economical, and they are competent in the procedure when compared to physicians.
S4(27Elton J. Managing change in primary care: part 2. Pract Nurs[Internet]. 2009 [cited 2023 May 25];37(1):28-33. Available from: https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=105450851⟨=pt-br&site=ehost-live https://search.ebscohost.com/login.aspx?... )	To describe the project presentation to physician partners to introduce a nurse-led service for IUD and IUS insertion into practice and the steps required to have the clinic up and running.	A practical nurse with criteria for the role of trainer was trained by a physician to insert IUD and IUS. Practically, there was no difference between counseling and IUD insertion between physicians and nurses, except that nurses have a trained assistant. Three consultations were scheduled: the first, lasting 10 minutes, for advice, assessment and decision on the device to be inserted; in the second, lasting 20 minutes, the IUD or IUS was inserted; and after 6 weeks, a new consultation took place to check the device wires, assess bleeding and satisfaction with the method.	The success of project implementation depended in part on its application in practice, related to patients’ needs within the multidisciplinary environment.
S5(28Elton J. Managing change in primary care: part 3. Pract Nurs [Internet]. 2009 [cited 2023 May 25];37(2):38-40. Available from: https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=105450881⟨=pt-br&site=ehost-live https://search.ebscohost.com/login.aspx?... )	To report the successful introduction of a nurse-led service to improve contraceptive choice, reflecting problems encountered, what was achieved and aspects of leadership in action.	The plan to develop a skill historically dominated by the medical profession was initially met with opposition. Different leadership styles were used to facilitate service implementation, and culture was identified as an important facilitator in this process. A satisfaction survey was used which revealed that patients did not attribute IUD insertion exclusively to physicians, but understood that all nurses trained in family planning already performed this procedure.	Obtaining competency in IUD/IUS insertion improved family planning skills, in addition to enabling the training of other nurses. Publication of the experience and lectures at events increased interest in the subject and inspired many nurses to train on their own.
S6(29Harper CC, Stratton L, Raine TR, Thompson K, Henderson JT, Blum M, et al. Counseling and provision of long-acting reversible contraception in the US: national survey of nurse practitioners. Prev Med. 2013;57(6):883-8. https://doi.org/10.1016/j.ypmed.2013.10.005 https://doi.org/10.1016/j.ypmed.2013.10.... )	To assess practice and training needs to prepare nurses to provide highly effective contraceptives such as IUD and implants.	Of the nurses participating in the study, 86% were trained in family planning, almost all of them working in the area of women’s health (97%). PHC nurses had greater limitations in their IUD insertion skills, with 12% of them and 72% of women’s health nurses feeling comfortable performing the procedure. IUD were most often offered by women’s health nurses, and 72% of them and 30% of PHC nurses reported including IUD in discussions with patients. The desire for training on IUD insertion was expressed by 35% of PHC nurses and 20% of women’s health nurses. The latter had more knowledge about the contraindications of the method.	Nurses provide care to vulnerable women of reproductive age in PHC settings, such as health centers as well as community family planning clinics. To address the persistent problem of unwanted pregnancy, it is essential to train nurses who provide contraceptive care to offer the most effective methods.
S7(30Atkin K, Beal MW, Long-Middleton E, Roncari D. Long-acting reversible contraceptives for teenagers: primary care recommendations. Nurse Pract. 2015;40(3):38-46. https://www.doi.org/10.1097/01.NPR.0000460853.60234.c2 https://www.doi.org/10.1097/01.NPR.00004... )	To discuss barriers to underuse of long-acting reversible contraceptive methods (LARC) and present an evidence-based approach to the use of these methods among adolescents in PHC.	Barriers to IUD acceptance are identified, such as lack of professional training, pain during insertion and procedure costs. Contraception is considered an essential preventive care service, and this increases the need for PHC nurses to adequately provide this service. Skills-based training in LARC methods in advanced practice nursing and continuing education programs is critical to increasing access, delivery, and utilization by adolescents in primary care.	PHC nurses are responsible for meeting the contraceptive needs of adolescents, incorporating counseling and increasing access to IUD. Furthermore, they have the potential to impact the reproductive health outcomes of adolescents. It is important to increase training in LARC methods for professionals.
S8(31Rubin SE, Maldonado L, Fox K, Rosenberg R, Wall J, Prine L. Establishing and conducting a regional, hands-on long-acting reversible contraception training Center in Primary Care. Womens Health Issues. 2018;28(5):375-8. https://www.doi.org/10.1016/j.whi.2018.04.010 https://www.doi.org/10.1016/j.whi.2018.0... )	To describe the experience and lessons learned developing and conducting training of PHC professionals in contraception, including LARC insertion through the Hands-on Reproductive Health Training (HaRT) Center.	A total of 28 pediatric and family nurses, 13 physicians and four physician assistants were trained. Most entered training with few speculum handling skills and limited LARC knowledge and advice. During training, professionals inserted an average of eight IUD and removed an average of two. Everyone inserted at least one IUD and 80% of them removed the device. Only 41% of trainees consider themselves competent in inserting a copper IUD and 50% in inserting a hormonal IUD. However, more than 75% of them were considered competent by the coaches. After training, 32% of participants reported that they are providing IUD insertion and 35% of them are providing device removal.	Those who entered training with basic knowledge of gynecological examination procedures and skills developed their LARC skills more quickly. It was found that family nurses have more training in speculum and gynecological examination than pediatric nurses. Services need professionals trained to provide LARC.
S9(32Chin-Quee DS, Ridgeway K, Onadja Y, Guiella G, Bai GM, Brennan C, et al. Evaluation of a pilot program for task sharing short and long-acting contraceptive methods in Burkina Faso. Gates Open Res. 2020;3:1499. https://doi.org/10.12688/gatesopenres.13009.2 https://doi.org/10.12688/gatesopenres.13... )	To assess the pilot project that aimed to share long-term family planning service tasks with the primary care team and short-term with CHW.	A total of 79 primary care providers from 26 health centers received training to provide family planning services, including IUD insertion and removal. Around 78.6% of women who had an IUD inserted were very satisfied with the method and 17.1% were satisfied. Only 12% of undesirable effects and no reports of complications after IUD insertion were revealed. Some PHC services may have been overloaded with increased access to LARC, increasing waiting times for care or the need to seek another service to obtain IUD.	The results indicate that task sharing is viable and acceptable to increase access to family planning. Before expanding the task sharing intervention, IUD insertion training is recommended for a larger number of professionals. Furthermore, attention should be paid to establishments with insufficient resources to offer LARC.
S10(15Lacerda LDRC, Arma JC, Paes LG, Siqueira EF, Ferreira LBB, Fetzner RRT, et al. Inserção de dispositivo intrauterino por enfermeiros da atenção primária à saúde. Enferm Foco. 2021;12(suppl 1):99-104. https://doi.org/10.21675/2357-707X.2021.v12.n7.SUPL.1.5209 https://doi.org/10.21675/2357-707X.2021.... )	To describe the experience of nurses implementing the copper IUD insertion service in PHC in Florianópolis, Santa Catarina.	A total of 115 nurses were qualified, including permanent professionals and residents. 2,024 IUD insertions by nurses were recorded in just over three years since the service was implemented. There was a 60% increase in access and offering the method to women. In the period analyzed, nurses were responsible for the majority of IUD insertions in the city, corresponding to 58.3% of the total procedures performed.	In PHC, IUD insertion by nurses has contributed to access to the method. In this context, nurse training positively influences the qualification of care. Furthermore, the reported practice has demonstrated efficacy and safety, and goes beyond hegemonic and medical-centered models.

[1] Corresponding author: Lays Souza de Oliveira, E-mail: enf.laysoliveira@gmail.com

Brasil

Brasil

Evidence of intrauterine device insertion by nurses in Primary Health Care: an integrative review

Evidencias de inserción de dispositivos intrauterinos por parte de enfermeros en Atención Primaria de Salud: revisión integradora

ABSTRACT

Objectives:

Methods:

Results:

Conclusions: