Entender el sentido de los cuidados en enfermería / Understand the meaning of care in nursing

El presente estudio tiene como objetivo dirigir a los profesionales de la enfermería a una reflexión crítica sobre la comprensión del sentido del cuidado en la profesión, en el escenario actual de la salud. Teniendo en cuenta la búsqueda del saber propio, a pesar de la práctica reiterada, heredada a lo largo de la historia, es importante que los profesionales de la enfermería direccionen su preocupación a descubrir el por qué y el cómo realizar en la práctica, armonizando el cuidado y la gerencia, siendo indispensable el hacer no solo desde el punto de vista de la acción y sí del cuidado, considerando el significado y profundidad, visto que el cuidado debe ser orientado por las teorías de una práctica no mecanicista, sino con un espíritu enfocado en la solidaridad y el respeto a la integralidad del ser humano(AU)

The present study aims to lead the nurses to uma critical reflection on understanding the meaning of care profession em, em the current scenario of the health. Teniendo into account the pursuit of knowledge itself, although the practice inherited repeated throughout history, it is important that nurses her lead! precocupación you to discover the why and the how to perform in practice amonizando care and management, being essential to do not only from the point of view of the action and yes, care, considering the meaning and depth, given that care should be guided by a non-mechanistic theories of practice, but in a spirit focused on solidarity and respect for the integrity of human beings(AU)

Managing acute asthma in primary care.

Asthma is a common inflammatory condition affecting the airways. Many people with it fail to achieve a satisfactory level of control and, consequently, have recurrent acute exacerbations. These can occur due to allergen exposure, viral infections or for no identifiable reason. Guidelines categorise exacerbations into three categories, from moderate to life threatening. Prompt assessment and treatment using bronchodilators and corticosteroids are essential, as is follow up to identify and manage factors that may have contributed to the exacerbation. This article discusses guidelines on the management and causes of acute exacerbations, and follow-up care that should be provided.

Specialized nursing practice for chronic disease management in the primary care setting: an evidence-based analysis.

BACKGROUND: In response to the increasing demand for better chronic disease management and improved health care efficiency in Ontario, nursing roles have expanded in the primary health care setting. OBJECTIVES: To determine the effectiveness of specialized nurses who have a clinical role in patient care in optimizing chronic disease management among adults in the primary health care setting. DATA SOURCES AND REVIEW METHODS: A literature search was performed using OVID MEDLINE, OVID MEDLINE In-Process and Other Non-Indexed Citations, OVID EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database. Results were limited to randomized controlled trials and systematic reviews and were divided into 2 models: Model 1 (nurse alone versus physician alone) and Model 2 (nurse and physician versus physician alone). Effectiveness was determined by comparable outcomes between groups in Model 1, or improved outcomes or efficiency in Model 2. RESULTS: Six studies were included. In Model 1, there were no significant differences in health resource use, disease-specific measures, quality of life, or patient satisfaction. In Model 2, there was a reduction in hospitalizations and improved management of blood pressure and lipids among patients with coronary artery disease. Among patients with diabetes, there was a reduction in hemoglobin A1c but no difference in other disease-specific measures. There was a trend toward improved process measures, including medication prescribing and clinical assessments. Results related to quality of life were inconsistent, but patient satisfaction with the nurse-physician team was improved. Overall, there were more and longer visits to the nurse, and physician workload did not change. LIMITATIONS: There was heterogeneity across patient populations, and in the titles, roles, and scope of practice of the specialized nurses. CONCLUSIONS: Specialized nurses with an autonomous role in patient care had comparable outcomes to physicians alone (Model 1) based on moderate quality evidence, with consistent results among a subgroup analysis of patients with diabetes based on low quality evidence. Model 2 showed an overall improvement in appropriate process measures, disease-specific measures, and patient satisfaction based on low to moderate quality evidence. There was low quality evidence that nurses working under Model 2 may reduce hospitalizations for patients with coronary artery disease. The specific role of the nurse in supplementing or substituting physician care was unclear, making it difficult to determine the impact on efficiency. PLAIN LANGUAGE SUMMARY: Nurses with additional skills, training, or scope of practice may help improve the primary care of patients with chronic diseases. This review found that specialized nurses working on their own could achieve health outcomes that were similar to those of doctors. It also found that specialized nurses who worked with doctors could reduce hospital visits and improve certain patient outcomes related to diabetes, coronary artery disease, or heart failure. Patients who had nurse-led care were more satisfied and tended to receive more tests and medications. It is unclear whether specialized nurses improve quality of life or doctor workload.

Gestión de cuidados con calidad desde la formación del profesional de Enfermería / Quality of care management from the training of Nursing professional

Se efectuó estudio analítico transversal con el objetivo de analizar cómo incide el proceso de formación del profesional de Enfermería en la gestión de los cuidados con calidad, en el periodo comprendido entre enero-abril 2008. El universo estuvo constituido por profesores y estudiantes, seleccionando una muestra. Las variables operacionalizadas fueron: asignaturas que enseñan a gestionar los cuidados, vínculos del sistema de conocimientos al desarrollo de habilidades profesionales, formas de organización de la enseñanza, influencia de las funciones de los profesionales de enfermería y consideraciones acerca de la calidad de los cuidados a brindar. Enseñan a gestionar cuidados con calidad técnica el 96,34 por ciento de los profesores, estableciendo el vínculo de sistemas de conocimientos con desarrollo de habilidades profesionales, gestión que se favorece con las formas de organización de la enseñanza. Las funciones asistenciales ocupan el primer lugar en la escala jerárquica, intervinieron con sus respuestas estudiantes de primer año del Nuevo Modelo Formativo, y expresan que todas las asignaturas los enseñan a gestionar cuidados con calidad mediante formas de organización de la enseñanza como conferencias, seminarios, presentación de casos y clase talleres. Profesores y estudiantes expresan desde sus ópticas cómo se percibe el proceso de gestión. El procesamiento de datos se realizó mediante el sistema SPSS. Se concluyó que el proceso de enseñanza influye de forma decisiva en la gestión de cuidados de enfermería con calidad que se brinda a los educandos(AU)

A cross-sectional and analytical study was conducted to analyze how to affect the process of training of Nursing on the quality care management from January to 'April, 2008. Universe included professors and students to select a sample. Operational variable included: subjects teaching to manage the cares, links of knowledge system to development of professional abilities, ways or teaching organization, influence of functions of nursing professionals and considerations on the quality of care to be supplied. To teach in management of care with a technical quality of the 96,34 percent of professors, establishing the link of knowledges systems with develop of professional abilities, management favored by teaching organization ways. Assistance functions are in the first place in hierarchical scale where the first year of the New Formative Form students gave their answers, expressing that all subjects teach them to manage the cars with quality be means of ways of organization of teaching as lectures, seminaries, cases presentation and workshop class. Professor and students express, from their point of view, how the management process is perceived. The data processing was carried out using the SPSS system. We conclude that the teaching process influences in a decisive way on the management of nursing care with quality offering to students(AU)

[Personalized nursing care and perceived quality of care in hospitals]. / Personalización enfermera y calidad percibida del cuidado en el ámbito hospitalario.

OBJECTIVE: To determine whether there is an association between the Primary Nursing Model and perceived quality of care. METHOD: An observational, descriptive, cross-sectional study in four hospital wards with Primary Nursing organization. Over a 12-month period, all the patients discharged from each ward were included in this study. The degree of development of Primary Nursing was measured by using the Personalization of Nursing Care Index and the perceived quality of care was measured with the LOPSS-12. Bivariate statistical analysis was carried out through ANOVA and Student's t-tests. Multivariate linear regression analysis was then applied to correlated variables (p < 0.05). RESULTS: 817 patients were included, 447 from two medical wards and 370 from two surgical wards. After a preliminary data analysis performed 6 months after the start of the study, four items were removed from the LOPSS-12 and each of the remaining items were analyzed separately. Scores for both patient satisfaction and the introduction of the Primary Nursing Model were higher in the surgical wards. Bivariate and multivariate regression analyses showed a statistically significant (p < 0.05) association between implantation of the model and all except one of the items included in the questionnaire. CONCLUSIONS: The introduction of the Primary Nursing Model in hospital wards allows the presence of a primary nurse for each patient and consequently improves the nurse-patient relationship, increasing perceived quality of care among patients.

Nontraditional or noncentralized models of diabetes care: models in which other HCPs take on a leading role in managing patients' diabetes.

Nurse practitioners (NPs) are advanced practice nurses who have increased responsibility,such as prescribing authority. In the NP-led model, the NP is the primary care provider for clinic patients and takes on an autonomous role in patient management. In some states, NP-led clinics are required to have a supervising or collaborating physician. There is evidence that NP-led and physician-led primary care is comparable for multiple health outcomes. The NP-led model emphasizes the strong interaction between health care provider and patient. Challenges of NP-led care include physician resistance, legal restrictions, inaccessibility and cost of malpractice insurance, and limited payouts from insurance companies

[Instrument to assess nursing care delivery stystems "IzEP". Making nursing care systematically visible for practice, management and science]. / Instrument zur Erfassung von Pflegesystemen "IzEP". Pflegerische Organisation für Praxis, Management und Wissenschaft sichtbar machen.

Network activities and publications show a rising interest in nursing care delivery systems like primary nursing. There are aspects in quality and outcomes attributed to primary nursing to answer the changes in health care. To assign outcomes in nursing to different kinds of nursing care delivery systems and for systematic developing of primary nursing in a unit one needs a special assessment instrument. IzEP, the instrument to assess nursing care delivery systems, relates the nursing care delivery system of a unit to primary nursing. This article describes the development of the instrument, testing of reliability, validity and possibilities for using.

The effect of interrupted 5-day training on Integrated Management of Neonatal and Childhood Illness on the knowledge and skills of primary health care workers.

The conventional 8-day Integrated Management of Neonatal and Childhood Illness (IMNCI) training package poses several operational constraints, particularly due to its long duration. A 5-day training package was developed and administered in an interrupted mode of 3 days and 2 days duration with a break of 4 days in-between, in a district of Haryana state in northern India. Improvement in the knowledge and skills of 50 primary health care workers following the interrupted 5-day training was compared with that of 35 primary health care workers after the conventional 8-day IMNCI training package. The average score increased significantly (P < 0.05) from 46.3 to 74.6 in 8-day training and from 40.0 to 73.2 in 5-day training. Knowledge score improved for all health conditions, like anaemia, diarrhoea, immunization, malnutrition, malaria, meningitis and possible severe bacterial infection, and for breastfeeding in 8-day as well as in 5-day training. Average skills score for respiratory problems increased from 38 to 57 in 8-day training and from 41 to 91 in 5-day training. Corresponding increases in skill scores for diarrhoea assessment were from 28 to 67 and 48 to 75, and for breastfeeding assessment from 33 to 84 and 42 to 86 in 8-day and 5-day training, respectively. Average counselling skill score also rose from 42 to 89 in 8-day and from 37 to 70 in 5-day training. A direct cost saving of US$813 for a batch of 25 trainees and an indirect cost saving of 3 days per trainee and resource person makes the interrupted 5-day IMNCI training more cost-effective.

Effects of payment for performance in primary care: qualitative interview study.

OBJECTIVES: To understand the effects of a large scale 'payment for performance' scheme (the Quality and Outcomes Framework [QOF]) on professional roles and the delivery of primary care in the English National Health Service. METHODS: Qualitative semi-structured interview study. Twenty-four clinicians were interviewed during 2006: one general practitioner and one practice nurse in 12 general practices in eastern England with a broad range of sociodemographic and organizational characteristics. RESULTS: Participants reported substantial improvements in teamwork and in the organization, consistency and recording of care for conditions incentivized in the scheme, but not for non-incentivized conditions. The need to carry out and record specific clinical activities was felt to have changed the emphasis from 'patient led' consultations and listening to patients' concerns. Loss of continuity of care and of patient choice were described. Nurses experienced increased workload but enjoyed more autonomy and job satisfaction. Doctors acknowledged improved disease management and teamwork but expressed unease about 'box-ticking' and increased demands of team supervision, despite better terms and conditions. Doctors were less motivated to achieve performance indicators where they disputed the evidence on which they were based. Participants expressed little engagement with results of patient surveys or patient involvement initiatives. Some participants described data manipulation to maximize practice income. Many felt overwhelmed by the flow of policy initiatives. CONCLUSIONS: Payment for performance is driving major changes in the roles and organization of English primary health care teams. Non-incentivized activities and patients' concerns may receive less clinical attention. Practitioners would benefit from improved dissemination of the evidence justifying the inclusion of new performance indicators in the QOF.

Physician perspectives of nurse care management located in primary care clinics.

Care management has been suggested as a method to improve management of chronic disease, but its success can depend on the involvement of primary care physicians, especially with referral to care management. Our objective was to identify and characterize physicians' perspectives of care management in order to gain insight into the rationale for referral to care management. The study took place in primary care clinics within an integrated delivery system. Nineteen primary care physicians with varying levels of involvement with care management participated in the study. We performed a qualitative and quantitative analysis ofsemistructured interviews. Four referral patterns emerged that were related to physicians' recognition of care managers' abilities and how care managers were connected to their practice. Results from this study can be used to more effectively implement similar models of chronic disease management, where physician participation is a critical component for successful implementation.

Assessment of childhood allergy for the primary care practitioner.

PURPOSE: To update the primary care practitioner on the assessment of common childhood allergic illnesses. DATA SOURCES: Relevant scientific literature and published clinical practice guidelines. CONCLUSIONS: Atopic children often develop symptoms that occur in a predictable progression from atopic dermatitis to gastrointestinal disturbances, chronic serous otitis media, rhinitis, and asthma. Evaluation of allergic symptoms should be based on their chronicity, family history of atopy, and knowledge of how the information will change patient management. Both skin and blood testing are accurate and useful tools in establishing a diagnosis of allergic disease. Management includes avoidance/environmental control, medications, and, when necessary, referral to specialists. IMPLICATIONS FOR PRACTICE: As the incidence of allergic disease increases, the human and monetary costs associated with allergies place a major burden on our healthcare system. Early identification of allergies and appropriate intervention are important to prevent progression to more significant disease. The use of objective diagnostic testing aids in implementing appropriate evidence-based medical management.

La diversidad como variable en la gestión del cuidado: una problemática a tratar desde la formación del recurso humano enfermero / Diversity and nursing care

En el momento histórico social y cultural que se vive hoy en día, es de mucha importancia e implica una gran responsabilidad que desde la Formación del Recurso Humano Enfermero se comiencen a trabajar de manera intensa los impactos y las percepciones que cada uno le represente ser diferente de quien tiene a su lado. La habilidad para identificar diferencias contribuirá a que cada uno pueda conocerse y comprender a los demás para luego efectuar abstracciones de las realidades que se puedan presentar. De este modo, con los datos valorados se podrá trazar una gestión de cuidados "diferente" de las habituales, de las clásicas, por la que quien se encuentra en instancias de formación adquiera y demuestre habilidades con una perspectiva de cuidado integral, en la que lo diverso se considere un valor, una igualdad, una inclusión, para fomentar así el respeto, la comprensión y la empatía interpersonal en los diferentes ámbitos y contextos donde se desarrolle el Proceso de Enseñanza-Aprendizaje

The outcomes of an intervention study to reduce the barriers experienced by people with intellectual disabilities accessing primary health care services.

BACKGROUND: People with intellectual disabilities (IDs) experience significant health inequalities compared with the general population. The barriers people with IDs experience in accessing services contribute to these health inequalities. Professionals' significant unmet training needs are an important barrier to people with IDs accessing appropriate services to meet their health needs. METHOD: A three group, pre- and post-intervention design was used to test the hypothesis that a training intervention for primary health care professionals would increase the knowledge and self-efficacy of participants. The intervention had two components - a written training pack and a 3-hour face-to-face training event. One group received the training pack and attended the training event, a second group received the training pack only, and a third group did not participate in the training intervention. Research measures were taken prior to the intervention and 3 months after the intervention. Statistical comparisons were made between the three groups. RESULTS: The participants in the training intervention reported that it had a positive impact upon their knowledge, skills and clinical practice. As a result of the intervention, 35 (81.4%) respondents agreed that they were more able to meet the needs of their clients with IDs, and 33 (66.6%) reported that they had made changes to their clinical practice. The research demonstrated that the intervention produced a statistically significant increase in the knowledge of participants (F = 5.6, P = 0.005), compared with the group that did not participate in the intervention. The self-efficacy of the participants that received both components of the intervention was significantly greater than the group that did not participate in the training (t = 2.079, P = 0.04). Participation in the two components of the training intervention was associated with significantly greater change in knowledge and self-efficacy than those receiving the training pack alone. CONCLUSION: This intervention was effective in addressing the measured training needs of primary health care professionals. Future research should directly evaluate the positive benefits of interventions on the lives of people with IDs.

[A study to improve the quality of visiting nursing care at Isehara City].

As for Isehara City Visiting Nursing Liaison Congress, we investigated and analyzed the actual conditions of visiting nursing care development at Isehara city by using the NADA nursing diagnosis. It is desirable that a visiting nurse should have skills in evacuation, suction of the respiratory tract, rehabilitation, prevention of complications and an early detection of a poor condition of the patient. In addition, we found that it is also desirable that a visiting nurse fulfill a leadership function in coordinating to support home-care, have a communication skill to anticipate potential problems of patients and counsel his or her family concerns in a short period of time.