Challenges for hospital management in supporting nurses to deliver humanized care.

Hospitals are paying increasing attention to the delivery of humanized care. The purpose of this study was to explore from the nursing perspective what hospital managers might do to facilitate this. A secondary analysis from a primary ethnographic study regarding dignity in nursing practice was conducted. Twenty interviews of internal medicine nurses from four hospitals were analyzed, and three main themes were identified: Management of nursing teams, Management of ethical values, and Management of the context. It is important for institutional values to be closely aligned with those of the nursing profession, and nurse managers play a key role in ensuring that the latter are applied in practice. The proposed actions offer a cost-effective framework through which nurses and managers may promote the delivery of humanized care.

Determinants associated with activation in patients with oral anticoagulant treatment: A cross-sectional study.

AIMS: The terms "patient activation" and "patient empowerment" are used to describe the extent to which individuals are able to manage their own healthcare. Health outcomes and quality of life improve in patients who are more active in health care. The aim of this study was to identify sociodemographic, clinical, sociological and psychological determinants associated with activation in a group of chronically anticoagulated patients. METHODS: Cross-sectional study of patients treated with oral antivitamin-k drugs attended at a specialized outpatient anticoagulant unit between November 2021 and June 2022. The main dependent variable was the level of patient activation according to the 13-item Patient Activation Measure (PAM-13). Simple and multiple linear regression models were conducted to identify the determinants associated with PAM-13 score. RESULTS: A total of 137 patients who met all the inclusion criteria were recruited for the study. The mean age was 59.6 years (SD 13.8; range 22-86) and 60.6% were male. Sixty per cent presented a level IV of activation according to the PAM-13 scale. Mean patient activation score was 73.9 (SD 15.4). The factors independently associated with significantly lower activation were: emergency department visits in the past 12 months, intermediate social risk, anxiety symptoms, stress symptoms and low self-efficacy. CONCLUSIONS: Five determinants were found to be associated with activation. Knowing the factors that modify the level of activation can help to identify subgroups of chronic anticoagulated patients who are less likely to engage in self-management and are therefore candidates for tailored educational interventions.

Effectiveness of an educational intervention to reduce the burden on home care workers and facilitating factors: A pre-post study.

AIMS: To determine if a training program, aimed at home care workers, for caring for the elderly and for providing their own self-care is effective for reducing workers burden in the short and long terms and to identify the associated variables that can influence burden across 12 months. BACKGROUND: An increasing number of older adults rely on home care workers as a complement to the care received from family caregivers. However, these workers do not usually have any formal training in nursing care and occasionally suffer burden. DESIGN: A pre- and post-intervention study with a follow-up at 12 months including 86 participants. METHODS: An 85-hour training course, which included a practical module lasting 35 h, was offered on five separate occasions between 2014 and 2017 in Barcelona (Spain). The care burden was measured according the Zarit Burden Interview and care knowledge and perceived difficulty performing care tasks were assessed. We also gathered data on the physical and psychological status of the care recipients. RESULTS: The educational intervention was effective after training (-7.45% p = .020) and although the initial burden on caregivers did not worsen significantly despite spending 12 months caring for people with moderate physical and psychological dependence, the decrease in the burden was not maintained over time. Associated variables that can influence the burden over 6 months were the caregivers' baseline perception of lacking knowledge and/or having no difficulty with care tasks. The variable that could influence overburden in caregivers at 12 months was becoming ill before the intervention. CONCLUSIONS: For the first time, the effectiveness of home workers-specific training has been demonstrated: a reduction in the perceived burden was observed immediately following training completion, but this reduction was not sustained at 6/12 months. The practical interpretation is that a remedial/follow-up training course may be needed. Whether difficulty in providing care or having sufficient knowledge and having an illness influence self-care maintenance requires further verification.

Enhancing perceived leadership of nursing students through a student-led dedicated education unit in a community setting: A feasibility study.

BACKGROUND: Leadership competence is important to ensure the provision of safe and high-quality care in hospitals. PURPOSE: The aim was to demonstrate the feasibility of enhancing the perceived leadership competence of nursing students through an innovative health education strategy, consisting of a student-led dedicated education unit (DEU) informed by a service-learning approach in a community setting. DESIGN: Feasibility study in a three-phase process: I: Design; II: Acceptability and implementation; III: Expansion to a different setting. In phase II the DEU was piloted with 62 students using a pretest/post-test with control group design. In phase III it was piloted with 20 students in the expansion setting. METHODS: The DEU was implemented and tested in Barcelona (Spain) between 2014 and 2019. To assess acceptability and implementation, students' perceived leadership competence was measured using the Self-Assessment Leadership Instrument. We also obtained satisfaction ratings using an ad hoc questionnaire. RESULTS: Satisfaction was high among students, as well as among service users who received health education. In phase II, students' post-test self-ratings of their leadership competence were higher in both the intervention and control groups, but the increase was significantly greater among students who participated in the DEU (25.84 % vs. 16.72 %, p = .012). Similar results were obtained in the expansion phase, with students in the intervention group once again showing a significant increase in perceived leadership skills (12.89 %, p = .005). CONCLUSIONS: Student-led DEUs appear to be an effective way of enhancing perceived leadership competence among senior nursing students.