[Ethical considerations during health crisis: about SARS-CoV-2 coronavirus pandemic.] / Consideraciones éticas durante las crisis sanitarias: a propósito de la pandemia por el coronavirus SARS-CoV-2.

In 2009, the H1N1 pandemic raised a series of ethical considerations that influenced the approach to the crisis. In the framework of the SARS-CoV-2 coronavirus pandemic, these issues have been repeated, and the analysis of what happened in 2009 can be seen as a warning. The principles of justice, solidarity, equity, transparency and reciprocity should be included in future pandemic response plans, including lessons learned.

En 2009 se vivió la pandemia del H1N1 con una serie de implicaciones éticas que influyeron en el abordaje de la crisis. En el marco de la pandemia por el coronavirus SARS-CoV-2 se han repetido estas cuestiones, y el análisis de lo sucedido en 2009 ha resultado premonitorio. Los principios de justicia, solidaridad, equidad, transparencia y reciprocidad deben ser incluidos en los futuros planes de respuesta ante pandemias, incluyendo las lecciones aprendidas.

The value of nursing care in the paradigm of chronicity and dependency. New roles and redesigns.

The future of Healthcare Systems not only faces financial troubles, but also--perhaps worse, the need to redesign its service offers. It is necessary to work for all the knowledge available to be placed at the service of patients and society, generating much more efficient services and opening to a redesign where nurses lead in new services supported on the strategy of effective care. Additionally, it is hoped that patients assume a responsibility and nurses another: that of accompanying patients during their disease process to become for them a support in their self-care efforts. The new role that must be assumed by community nurses is that of becoming the coaches of chronic patients and of their caregivers so they can reach a situation of equilibrium, between their desires and what they must do, to, thus, assume their responsibility in the self-provision of Basic Care.

El valor del cuidado de enfermería en el paradigma de la cronicidad y la dependencia. Nuevos roles y rediseños / O valor do cuidado da enfermagem no paradigma da cronicidade e a dependência. Novos papéis e redesenho / The value of nursing care in the paradigm of chronicity and dependency. New roles and redesigns

El futuro de los Sistemas Sanitarios no solo atraviesa por problemas de financiación, sino, tal vez mucho más, por la necesidad de rediseñar su oferta de servicios. Es necesario trabajar para que todo el conocimiento disponible se ponga al servicio de los pacientes y la sociedad, generando servicios mucho más eficientes y abriéndose a una rediseño en el cual las enfermeras lideren nuevos servicios que se apoyen en la estrategia de un cuidado eficaz. Además, se trata de que los pacientes asuman una responsabilidad y las enfermeras una más importante: la de acompañarlos en su proceso de enfermedad como apoyo en sus esfuerzos de autocuidado. El nuevo rol que deben asumir las enfermeras comunitarias es el de ser las entrenadoras de los pacientes crónicos y de sus cuidadores para que alcancen una situación de equilibrio entre sus deseos y lo que deben de hacer, para que así puedan asumir responsabilidad en la autoprovisión de Cuidados Básicos...

The future of Healthcare Systems not only faces financial troubles, but also – perhaps worse, the need to redesign its service offers. It is necessary to work for all the knowledge available to be placed at the service of patients and society, generating much more efficient services and opening to a redesign where nurses lead in new services supported on the strategy of effective care. Additionally, it is hoped that patients assume a responsibility and nurses another: that of accompanying patients during their disease process to become for them a support in their self-care efforts. The new role that must be assumed by community nurses is that of becoming the coaches of chronic patients and of their caregivers so they can reach a situation of equilibrium, between their desires and what they must do, to, thus, assume their responsibility in the self-provision of Basic Care...

O futuro dos Sistemas Sanitários não só atravessa por problemas de financiamento, senão talvez bem mais, pela necessidade de redesenhar sua oferta de serviços. É necessário trabalhar para que todo o conhecimento disponível se ponha ao serviço dos pacientes e a sociedade, gerando serviços bem mais eficientes e abrindo-se a um redesenho onde as enfermeiras liderem novos serviços que se apoiem na estratégia de um cuidado eficaz. Ademais se trata que os pacientes assumam uma responsabilidade e as enfermeiras outra: a de acompanhar aos pacientes em seu processo de doença a fim de ser para eles um apoio em seus esforços de autocuidado. O novo papel que deve ser assumido pelas enfermeiras comunitárias é o de ser as treinadoras dos pacientes crônicos e de seus cuidadores para que atinjam uma situação de equilíbrio, entre seus desejos e o que devem de fazer, para que assim possam assumir sua responsabilidade na auto-provisão de Cuidados Básicos...

CuidaCare: effectiveness of a nursing intervention on the quality of life's caregiver: cluster-randomized clinical trial.

BACKGROUND: In Spain, family is the main source of care for dependent people. Numerous studies suggest that providing informal (unpaid) care during a prolonged period of time results in a morbidity-generating burden. Caregivers constitute a high-risk group that experiences elevated stress levels, which reduce their quality of life.Different strategies have been proposed to improve management of this phenomenon in order to minimize its impact, but definitive conclusions regarding their effectiveness are lacking. METHODS/DESIGN: A community clinical trial is proposed, with a 1-year follow-up period, that is multicentric, controlled, parallel, and with randomized allocation of clusters in 20 health care centers within the Community of Madrid. The study's objective is to evaluate the effectiveness of a standard care intervention in primary health care (intervention CuidaCare) to improve the quality of life of the caregivers, measured at 0, 6, and 12 months after the intervention.One hundred and forty two subjects (71 from each group) ≥65 years, identified by the nurse as the main caregivers, and who provide consent to participate in the study will be included.The main outcome variable will be perceived quality of life as measured by the Visual Analogue Scale (VAS) of EuroQol-5D (EQ-5D). The secondary outcome variables will be EQ-5D Dimensions, EQ-5D Index, nursing diagnosis, and Zarit's test. Prognostic variables will be recorded for the dependent patient and the caregiver.The principle analysis will be done by comparing the average change in EQ-5D VAS value before and after intervention between the two groups. All statistical tests will be performed as intention-to-treat. Prognostic factors' estimates will be adjusted by mixed-effects regression models. Possible confounding or effect-modifying factors will be taken into account. DISCUSSION: Assistance for the caregiver should be integrated into primary care services. In order to do so, incorporating standard, effective interventions with relevant outcome variables such as quality of life is necessary. Community care nurses are at a privileged position to develop interventions like the proposed one. TRIAL REGISTRATION: This trial has been registered in ClinicalTrials.gov under code number NCT 01478295.

[The family and community nurse: Health agent and model for the chronic patient within the community]. / La enfermera familiar y comunitaria: referente del paciente crónico en la comunidad.

It is estimated that the chronic, fragile and complex patient represents 5% of the general population, but uses up to 65% of the total amount of health care resources. Older people who are dependent, with chronic illnesses and comorbidities need professional care that promotes self-care and self-management of their illnesses. Thus, new strategies need to be considered to channel those professional care services to focus on this group. Nurse practicioners are professionals who could lead this change to improve the sustainability of the health care system, since they are in a position to respond in an effective way to the demands of patients with chronic illnesses, dependency or fragility. For the nurse working force to provide an efficient and cost-effective response to the health needs of chronically ill and disabled persons, an analysis needs to be made of the factors that restrict professional growth, as well as those nursing services where nurses do not take part in the decision making, as well as how to correct them. The lack of goals or quality care indicators, the measurement of the problem, the lack of patients assigned to a nurse practicioners, lack of training, the disparity of the profession in Spain, and the inability of the system to lead a self-sufficient care system project, should also be taken into consideration.

Influence of socio-demographic, labour and professional factors on nursing perception concerning practice environment in Primary Health Care.

AIM: To analyze the perception of nursing professionals of the Madrid Primary Health Care environment in which they practice, as well as its relationship with socio-demographic, work-related and professional factors. DESIGN: Cross-sectional, analytical, observational study. PARTICIPANTS AND CONTEXT: Questionnaire sent to a total of 475 nurses in Primary Health Care in Madrid (former Health Care Areas 6 and 9), in 2010. MAIN MEASUREMENTS: Perception of the practice environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI) questionnaire, as well as; age; sex; years of professional experience; professional category; Health Care Area; employment status and education level. RESULTS: There was a response rate of 69.7% (331). The raw score for the PES-NWI was: 81.04 [95%CI: 79.18-82.91]. The factor with the highest score was "Support from Managers" (2.9 [95%CI: 2.8-3]) and the lowest "Workforce adequacy" (2.3 [95%CI: 2.2-2.4]). In the regression model (dependent variable: raw score in PES-NWI), adjusted by age, sex, employment status, professional category (coefficient B=6.586), and years worked at the centre (coefficient B=2.139, for a time of 0-2 years; coefficient B=7.482, for 3-10 years; coefficient B=7.867, for over 20 years) remained at p≤0.05. CONCLUSIONS: The support provided by nurse managers is the most highly valued factor in this practice environment, while workforce adequacy is perceived as the lowest. Nurses in posts of responsibility and those possessing a higher degree of training perceive their practice environment more favourably. Knowledge of the factors in the practice environment is a key element for health care organizations to optimize provision of care and to improve health care results.