Complex management and descriptive cost analysis of kidney transplant candidates: a descriptive cross-sectional study.

BACKGROUND: The organisational care needs involved in accessing kidney transplant have not been described in the literature and therefore a detailed analysis thereof could help to establish a framework (including appropriate timing, investment, and costs) for the management of this population. The main objective of this study is to analyse the profile and care needs of kidney transplant candidates in a tertiary hospital and the direct costs of studying them. METHODS: A descriptive, cross-sectional study was conducted using data on a range of variables (sociodemographic and clinical characteristics, study duration, and investment in visits and supplementary tests) from 489 kidney transplant candidates evaluated in 2020. RESULTS: The comorbidity index was high (> 4 in 64.3%), with a mean of 5.6 ± 2.4. Part of the study population had certain characteristics that could hinder their access a kidney transplant: physical dependence (9.4%), emotional distress (33.5%), non-adherent behaviours (25.2%), or language barriers (9.4%). The median study duration was 6.6[3.4;14] months. The ratio of required visits to patients was 5.97:1, meaning an investment of €237.10 per patient, and the ratio of supplementary tests to patients was 3.5:1, meaning an investment of €402.96 per patient. CONCLUSIONS: The study population can be characterised as complex due to their profile and their investment in terms of time, visits, supplementary tests, and direct costs. Management based on our results involves designing work-adaptation strategies to the needs of the study population, which can lead to increased patient satisfaction, shorter waiting times, and reduced costs.

«I can't imagine it without my nurse¼: Experiences of people with chronic kidney disease in the evaluation process as kidney transplant candidates.

This qualitative study aimed to explore the experiences of 11 adults with chronic kidney disease (CKD) undergoing evaluation for kidney transplant (KT) and examine the role played by the nurse in the process. Employing a descriptive phenomenology approach, semi-structured interviews were conducted between October 2022 and July 2023. Thematic analysis, facilitated by Atlas. ti software, revealed a systemic management diagram with "The candidate for kidney transplant and their reality" at the center, followed by "The process of chronic kidney disease and kidney transplantation," and concluding with the most distal category centered on "The kidney transplant access nurse." This organizational framework provided insights into the layers of relationships between emerging themes. The findings underscored the complexity and multidimensionality of the CKD and KT process, emphasizing the nurse's pivotal role as a guide and protector throughout the evaluation process for accessing kidney transplantation. The convergence of results with existing literature highlighted the need to address challenges such as lack of time, resources, and emotional support to enhance the quality of care. Recognizing the nurse's crucial importance in this process, the study emphasizes the significance of addressing these challenges to improve patient care and calls for attention to the nurse's role in guiding individuals through the intricate journey of CKD and kidney transplantation.

The role of Advanced Practice Nurses in creating the Kidney Transplant candidate care map (APN-preKT): a convergent-parallel mixed methods research protocol.

BACKGROUND: Waiting time for kidney transplants (KT) is an important health determinant for patients with chronic kidney disease (CKD). During this time, ongoing evaluation and participation is necessary in order to guarantee the quality and suitability of the proposed treatment. There is no existing literature on the potential impact of inclusion of an Advanced Practice Nurse (APN) role in the hospital setting on care for CKD patients who are candidates for KT. The main objectives of this protocol are: to analyse outpatient nursing activity in the care of individuals with KT in Spain; to identify the needs of individuals who are KT candidates; and to measure the impact of the APN role through patient outcomes and experiences. These objectives are fulfilled through 5 specific related substudies. METHODS: A convergent parallel mixed methods approach will be conducted between July 2021 and April 2024. Quantitative and qualitative data will be collected and analysed separately to ascertain whether the findings confirm or contradict one another. Each of the 5 substudies of the project require a specific design, sampling method, and data collection procedure in order to meet the overall objectives for the project. DISCUSSION: The results of the project are expected to inform the design of future nursing roles and contribute to future improvements in the quality of care provided. The data that may be obtained from this protocol are limited to the specific context of the study facility and may be extrapolated but not compared to other settings due to the variability of care pathways for KT candidates internationally. TRIAL REGISTRATION: This project was approved by the Clinical Research Ethics Committee (no.2020/9418/I). The study was supported by the "Strategic Plan for Health Research and Innovation" from the Generalitat de Catalunya, registration number SLT017/20/000001, with a contribution of 57,239 euros.

[Nursing University Education in a New Healthcare Setting]. / La formación universitaria de las enfermeras en el nuevo contexto asistencial.

Nursing university education has to respond to the challenges of the 21st century. Health conditions are highly complex with associated social problems. The universities should train nurses with a transforming vision, by defining study plans, preventive approach and promoting health, in a context of community health. The information and communication technologies along with the nurse leadership are also essential elements of value for graduated nurses. An innovative response to social needs and transformation of society requires commitment in defining the study plans of degree and also in the master's degree and in the continuing education programs. Investigate is how to acquire the necessary skills to generate knowledge to help ensure the professional development of nurses and contribute to the persons health.

Exploring the factors influencing evidence-based approaches to advanced chronic kidney disease: a qualitative study involving nurses and physicians.

BACKGROUND: Advanced chronic kidney disease (ACKD) is associated with a high risk of adverse cardiovascular and renal events and has a significant impact on quality of life and life expectancy. Several studies have identified areas for improvement in their management in primary care. Some professional and environmental factors can act as key barriers to appropriate care. OBJECTIVE: To analyse attitudes, subjective norms, and perceived behavioural control among primary care professionals related to the implementation of an evidence-based approach for individuals with ACKD in primary care. METHODOLOGY: This was a qualitative study using an interpretative phenomenological approach based on the theory of planned behaviour. Two aspects of the evidence-based approach were explored: the implementation of clinical practice guidelines and the utilisation of electronic kidney disease records within the scope of this study. Primary care nurses and physicians participated in a previous pilot interview and five focus groups. Subsequently, a thematic analysis of the gathered data was conducted. FINDINGS: Thirty-three primary care professionals participated. The emerging themes included: experiences in the management of ACKD (highlighting a distinct profile of older, frail patients with comorbidities masking CKD and a CKD follow-up primarily focused on analytical monitoring and drug adjustment); factors in the professional environment influencing the use of scientific evidence (such as time constraints, excessive electronic health records, and unfamiliar reference guidelines); attitudes towards the application of recommendations on ACKD (recognising limitations of computer systems despite considering them as guidance); and capacities to implement evidence-based recommendations (acknowledging formative needs and challenges in coordinating care with nephrology services). CONCLUSIONS: Several psychological elements identified through the TBP hinder the adequate implementation of an evidence-based approach for individuals with CKD. Attitudes have been identified as factors modulating the use of standardised electronic records. Instead, subjective norms (influences from the professional environment) and perceived behavioral control (perception of capabilities) acted as barriers to the proper application of clinical practice guidelines and standardised records. IMPLICATIONS FOR PRACTICE: Strategies aimed at optimising the management of people with ACKD should focus not only on training but also on improving attitudes, organisational structures, IT systems and coordination between primary care and nephrology.

[Promotion of physical activity]. / Promoción de la actividad física.

AIM: To know the influence of the factors that determine physical exercise in adults and elderly by the analysis of the determinants categories of health-promoting behaviors in the health promotion nursing model (MPS) of Pender. METHODOLOGY: A descriptive review of the literature was conducted in order to identify the influencing factors in the adoption and maintenance of physical exercise as a health promotes behavior. The databases consulted were PubMed-MEDLINE via RefWorks bibliography manager, CUIDEN and CUIDATGE. The search was conducted in 2010 and 2011, including publications in English and Spanish. RESULTS: 18 articles were reviewed to assess the influence, in adult and elderly population, of the factors: prior related behavior; personal factors; perceived benefits of action; perceived barriers to action; perceived self-efficacy; activity-related affect; interpersonal influences; situational influences; immediate competing demands and preferences; commitment to a plan of action. DEVELOPMENT AND DISCUSSION: Many studies have demonstrated the validity and predictive ability of the model studied in this article (MPS). There are complex biopsychosocial processes that motivate individuals to engage in behaviors to promote health. The MPS variables and their relationship are relevant in the decision to adopt increased physical activity behaviors. CONCLUSIONS: The Health Promotion Model facilitates the evaluation of the elements that influence behavior and helps nurses to identify how willing a person to exercise, what are their difficulties and can decide what interventions are most seek to promote physical activity.

Creating the nursing care map in the evaluation of kidney transplant candidates: A scoping review and narrative synthesis.

AIMS: To analyse the aspects involved in the care of individuals assessed as kidney transplant candidates and to identify the role of nurses in providing specialised care for this population. DESIGN: Scoping review. The results were summarised using a narrative synthesis technique. DATA SOURCES: A review of the literature published between 2001 and 2021 was conducted between October and November 2021 using PubMed, CINAHL and SciELO. REVIEW METHODS: The research team agreed on a search strategy based on clinical practice guidelines for assessing kidney transplantation candidates. Quantitative, qualitative and mixed methods studies published in peer-reviewed journals in English, Spanish, French and Portuguese were included. RESULTS: A total of 377 studies were identified, and 49 articles were included after the inclusion and exclusion criteria were applied. The narrative synthesis was structured into four themes: Physical needs; Psychological and quality of life needs; Education and adherence needs; and Nurses' role. CONCLUSION: Nursing assessment of kidney transplantation candidates should encompass physical, psychosocial and adherence aspects. A variety of methodologies and resources are available for this assessment. Nurses contribute to coordinating access to kidney transplantation, aiming to improve adherence to an appropriate lifestyle to prevent patients from being excluded from kidney transplantation or suffering from kidney transplantation-related complications. IMPACT: Based on our findings, we managed to design a nursing care map for kidney transplantation candidates combining the main elements of nursing care that should be incorporated into this process. Advanced practice nursing professionals play a crucial role in accessing renal transplant care.

[Perceptions and external factors of physical activity in adolescents using mixed methods]. / Percepciones y factores externos de la actividad física en adolescentes mediante métodos mixtos.

OBJECTIVE: Analyze the levels of physical activity in adolescents and their relationship with perceptions of physical activity and external factors. METHOD: Cross-sectional descriptive observational study. The participants were adolescents between the ages of 11 and 18. They were recruited in secondary schools in the municipality of Esplugues de Llobregat, Barcelona, Spain. The measurements were amount of physical activity (IPAQ-A questionnaire) and the relationship between level of physical activity and the perceptions of physical activity and external factors proposed by the health promotion model. RESULTS: Of the total sample, 60.34% participants were insufficiently active. The factors positively associated with physical activity were male gender (p<0.01), engaging in extracurricular sports (p<0.01), perceiving benefits (p<0.01), perceiving self-efficacy (p<0.01), interpersonal influences (p<0.01), having parents who engage in sports (p<0.01), social support (p<0.01) and social norms supporting exercise (p<0.01). The factors negatively associated with physical activity were female gender (p<0.01), body mass index (p=0.048) and perceiving obstacles (p<0.01). There was no relationship with social class (p=0.164). Situational influences were a conditioning factor for boys (p<0.01), but not girls (p=0.561). CONCLUSIONS: This study identifies factors that determinate the practice of physical activity in adolescents. Taking these factors into account in the design of health promotion interventions and policies could help increase levels of physical activity in this population. Even so, there are some variables, such as gender and socioeconomic status, that should be explored in depth through research that is more exploratory and discursive.

Nurse-led clinical activity in kidney transplantation care in Spain: A cross-sectional observational study.

OBJECTIVES: To explore the presence of specialist outpatient nursing activity in care for kidney transplant recipients in Spain and to determine the level of competence development of this activity according to the Advanced Practice Nurse model. DESIGN: Descriptive, cross-sectional study. PARTICIPANTS AND MEASUREMENTS: All outpatient nurses specialising in renal transplantation in the 39 transplant hospitals in Spain were included. To fulfil the study objectives, an ad hoc questionnaire and the 'Advanced Practice Nurse Role Definition Instrument (IDREPA)' were administered to assess the nurses' level of competence development. RESULTS: Of the facilities included in the study, 25 (64.1%) had posttransplant nursing activity, 13 (33.3%) had pretransplant nursing activity and 11 (28.2%) had nursing activity involving kidney donor candidates. Twenty-seven specialist nurse's offices were identified. The results of the IDREPA reflect the presence of advanced practice in the domains of 'expert care planning' and 'comprehensive care'. Three (11.1%) nurses met all criteria for advanced nursing practice. CONCLUSION: The results on specialised outpatient nursing activity at the 39 transplantation facilities in Spain indicate a low presence of this type of activity, with an even lower presence of advanced practice nurses. IMPLICATIONS FOR CLINICAL PRACTICE: Management teams should consider investing in the quality of care provided by advanced nurse practice to ensure that suitable treatment is provided and better clinical outcomes are obtained.

Recording of Social Determinants in Computerized Medical Records in Primary Care Consultations: Quasi-Experimental Study.

BACKGROUND:  Social determinants of health may be more important than medical or lifestyle choices in influencing people's health. Even so, there is a deficit in recording these in patients' computerized medical histories. The Spanish administration and the World Health Organization are promoting the recording of diagnoses in computerized clinical histories with the aim of benefiting the individual, the professional, and the community. In most cases, professionals tend to record only clinical diagnoses despite evidence in the literature documenting that addressing the social determinants of health can lead to improvements in health and reductions in social disparities in disease. OBJECTIVE:  This study aims to develop and evaluate the effectiveness of a mixed intervention (face-to-face-digital) aimed at improving the quantity and quality of the records of the social determinants of health in computerized medical records at primary care clinics. METHODS:  A quasi-experimental, nonrandomized, controlled, multicenter study with 2 parallel study arms was conducted in the area of Central Catalonia (Spain) with primary care professionals of the Institut Català de la Salut (ICS), working from September 23, 2019, to March 31, 2020. All interested professionals were accepted. In total, 22 basic health areas were involved in the study. In Spain and Catalonia, the International Classification of Diseases is used, in which there is a coding of the social determinants of health. Five social determinants were selected by a physician, a nurse, and a social worker; these professionals had experience in primary care and were experts in community health. The choice was made taking into account the ease of use, benefit, and existing terminology. The intervention, based on the integration of a checklist, was integrated as part of the usual multidisciplinary clinical workflow in primary care consultations to influence the recording of these determinants in the patient's computerized medical record. RESULTS:  After 6 months of implementing the intervention, the volume and quantity of records of 5 social determinants of health were compared, and a significant increase in the median number of pre- and postintervention diagnoses was observed (P≤.001). There was also an increase in the diversity of selected social determinants. Using the linear regression model, the significant mean increase of the experimental group with respect to the control group was estimated with a coefficient of 8.18 (95% CI 5.11-11.26). CONCLUSIONS:  The intervention described in this study is an effective tool for coding the social determinants of health designed by a multidisciplinary team to be incorporated into the workflow of primary care practices. The effectiveness of its usability and the description of the intervention described here should be generalizable to any environment. TRIAL REGISTRATION: ClinicalTrials.gov NCT04151056; https://clinicaltrials.gov/ct2/show/NCT04151056.

The usefulness and acceptance of the OSCE in nursing schools.

This qualitative study explores the usefulness and acceptance attributed by students and faculty members to an Objective Structured Clinical Evaluation (OSCE) administered to nursing undergraduates in Catalonia (Spain) for 10 years. Seventy undergraduate nursing students and twelve faculty members participated in the study. The data collection techniques included an open-ended questionnaire, a student focus group, and individualized faculty interviews. The students experienced the OSCE positively as a learning event that offered an opportunity for feedback that could help them master the required competencies. The OSCE increased students' responsibility by presenting them with a set of challenges that they had to tackle individually. Moreover, it reaffirmed their confidence in situations that closely resembled professional practice. Faculty members valued the ability of the OSCE to integrate and assess competencies, its objectivity, and the indirect information it provided on the effectiveness of the curriculum. The educational impact attributed to the OSCE and its acceptance among faculty and students suggest that it would be useful to re-implement it in the Bachelor's of Nursing in Catalan universities. Our findings may be of use to other nursing programs considering how to assess competency-based education, especially in the context of the European Higher Education Area.

Adherence to Antituberculosis Drugs in Children and Adolescents in A Low-Endemic Setting: A Retrospective Series.

Adherence to antituberculosis drug regimens is critical for the prevention and treatment of tuberculosis in pediatrics. In a large retrospective series of children and adolescents in Barcelona, Spain, completion of treatment was worse among patients treated for latent infection, compared with those treated for active tuberculosis or receiving primary chemoprophylaxis. Toxicity and cultural and language barriers were identified as predictors of nonadherence.