Validation of an instrument to measure knowledge, attitudes and skills towards Evidence-Based Practice in nursing students in Colombia.

BACKGOUND: Evidence-Based Practice (EBP) is crucial for the nursing profession, as it helps professionals make informed clinical decisions based on the best available evidence. Most EBP competency assessment tools focus on specific technical knowledge or skill components, and most have been tested on medical students. The Evidence-Based Practice Competence Questionnaire (EBP-COQ-E) is an instrument that assesses the competence in EBP in nursing students. The objective of the article was to evaluate the psychometric properties of the EBP-COQ-E instrument in final year nursing students in Colombia. DESIGN: A validation study was conducted using a cross-sectional design. METHODS: The population included nursing students from 19 programs in Colombia, who were selected during the years 2020 and 2021 based on their university enrollment in the last year of training in nursing programs with current qualified registration by the Ministry of Education and who had attended the least one subject related to research. The data were collected through a virtual platform and the researchers consolidated it into a general database. The EBP-COQ-E instrument consists of 25 items grouped into three factors: attitude towards EBP, skills for EBP and knowledge about EBP. The items were answered on a Likert-type scale from 1 to 5. An exploratory factor analysis was performed and an internal consistency analysis of the instrument. RESULTS: A total of 1021 final year students from 19 university nursing programs participated, with a mean age of 23 years and where 83% identified themselves as female. The results showed good internal consistency and construct validity for the instrument, with a Cronbach's alpha of 0.89. In the exploratory factor analysis, 3 factors were found that explained 51% of the variance of the data. Together these three factors had statistically significant positive correlations. CONCLUSION: The study contributes to the validation of the Evidence-Based Practice Competence Questionnaire (EBP-COQ-E) which is a valid and reliable tool to assess knowledge, attitudes and skills in EBP in nursing students in the Colombian context. Training in EBP is crucial to guarantee the quality of performance of future professionals in care practice and the EBP-COQ-E can be useful and applicable where it is necessary to evaluate this competence in training processes.

Embarazo en la adolescencia: diseño y validación de un instrumento para medir el trabajo intersectorial / Pregnancy in adolescence: design and validation of an instrument for measuring intersectoral work / Gravidez na adolescência: desenho e validação dum instrumento para medir o trabalho intersetorial

Resumen El trabajo intersectorial en la promoción de la salud es ampliamente reconocido; sin embargo, la literatura consultada evidenció ausencia de instrumentos válidos y confiables en esta área. Objetivo: diseñar y validar un instrumento para medir el trabajo intersectorial en funcionarios públicos que participaron en una Estrategia Nacional de Prevención del Embarazo en la Adolescencia (EPEA). Metodología: 1. Diseño del instrumento a partir de revisión de literatura, antecedentes de trabajo intersectorial en Colombia y experiencia del equipo investigador; 2. Validación facial para medir precisión, pertinencia, claridad y comprensión de los ítems con muestra por conveniencia de 12 personas; 3. Validación del constructo mediante modelo Rasch, sobre muestra de 132 funcionarios públicos. Resultados: el instrumento final conformado por 21 ítems, presentó buenas propiedades de validez facial y de constructo. La consistencia interna fue de 0,92; en el análisis Rasch se excluyeron personas e ítems que no se ajustaron al modelo, logrando correlaciones positivas entre ítems y medidas mayores a 0,47, unidimensionalidad con una varianza explicada por las medidas de 44,6 %; la varianza explicada en el primer contraste de los residuales fue de 5,7 %, la separación de personas fue de 2,07 y de ítems de 4,51 y la dificultad de los ítems estuvo entre -3,14 y 3,69 lógitos. Ninguno de los ítems presentó funcionamiento diferencial. Conclusiones: se cuenta con un instrumento válido y confiable con 21 ítems para la evaluación de competencias en trabajo intersectorial de funcionarios públicos que trabajan en prevención del embarazo en la adolescencia.

Abstract Even though intersectoral work in health promotion is widely recognized, the literature consulted showed an absence of valid and reliable instruments in this area. Objective: to design and validate an instrument to measure intersectoral work in public officials who participated in a National Strategy for the Prevention of Pregnancy in Adolescence (EPEA in Spanish). Materials and methods: 1. Design of the instrument based on a literature review, history of intersectoral work in Colombia and experience of the research team; 2. Facial validation to measure precision, relevance, clarity and understanding of the items with a convenience sample of 12 people; 3. Validation of the construct using the Rasch model, on a sample of 132 public officials. Results: The final instrument, made up of 21 Items, presented good facial and construct validity properties. The internal consistency was 0.92. In the Rasch analysis, people and items that did not fit the model were excluded, achieving positive correlations between items and linearity measures greater than 0.47 with a variance explained by the measures of 44.6%. The variance explained in the first contrast of the residuals was 5.7%, the separation of people was 2.07 and of items was 4.51 and the difficulty of the items was between -3.14 and 3.69 logits. None of the items presented differential functioning. Conclusions: there is a valid and reliable instrument with 21 items, for the evaluation of competencies in intersectoral work of public officials who work in prevention of pregnancy in adolescence.

Resumo O trabalho intersetorial na promoção da saúde é amplamente reconhecido; porém, a literatura consultada evidenciou ausência de instrumentos válidos e confiáveis nesta área. Objetivo: desenhar e validar um instrumento para medir o trabalho intersetorial em funcionários públicos que participaram em uma Estratégia Nacional de Prevenção da Gravidez na Adolescência (EPEA). Metodologia: 1. Desenho do instrumento a partir de revisão de literatura, antecedentes de trabalho intersetorial na Colômbia e experiência da equipe investigador; 2. Validação facial para medir precisão, pertinência, claridade e compreensão dos itens com amostra por conveniência de 12 pessoas; 3. Validação do constructo mediante modelo Rasch, sobre amostra de 132 funcionários públicos. Resultados: o instrumento final conformado por 21 itens, apresentou boas propriedades de validez facial e de constructo. A consistência interna foi de 0,92; na análise Rasch se excluíram pessoas e itens que não se ajustaram ao modelo, logrando correlações positivas entre itens e medidas maiores a 0,47, unidimensionalidade com uma variância explicada pelas medidas de 44,6 %; a variância explicada no primer contraste dos residuais foi de 5,7 %, a separação de pessoas foi de 2,07 e de itens de 4,51 e a dificuldade dos itens esteve entre -3,14 e 3,69 lógitos. Nenhum dos itens apresentou funcionamento diferencial. Conclusões: conta-se com um instrumento válido e confiável com 21 itens para a avaliação de competências em trabalho intersetorial de funcionários públicos que trabalham em prevenção da gravidez na adolescência.

Measurement of Practices-Knowledge-Attitudes of the Nursing Process: Systematic Review.

OBJECTIVES: To analyze the literature available on the psychometric properties of the instruments to measure knowledge, attitudes, and practices of the nursing care process. METHODS: This was a narrative-type review conducted by following the recommendations of the PRISMA declaration. The search strategy was executed in two stages; through the search in databases by two reviewers and - thereafter - three reviewers identified independently the studies and evaluated the methodological quality of the measurement instruments by using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) property checklist boxes. RESULTS: Of 71 studies identified for the full-text review, only seven complied with the inclusion criteria that represent four instruments (Q-DIO, D-CATCH, NP-CDSS, PNP). It was found that the instruments continue in their validation and appropriation processes to reality in health services. CONCLUSIONS: In spite of the evident evolution of the instruments to evaluate the implementation of the nursing care process, the need is still valid for an instrument that measures aspects of knowledge, attitudes, and practices in every stage of the process.

Measurement of Practices-Knowledge-Attitudes of the Nursing Process: Systematic Review / Medición de prácticas-conocimientos-actitudes del proceso de enfermería: Revisión sistemática / Medição das práticas, conhecimentos e atitudes do processo de enfermagem: revisão sistemática

Objective. To analyze the literature available on the psychometric properties of the instruments to measure knowledge, attitudes, and practices of the nursing care process. Methods. This was a narrative-type review conducted by following the recommendations of the PRISMA declaration. The search strategy was executed in two stages; through the search in databases by two reviewers and ­ thereafter ­ three reviewers identified independently the studies and evaluated the methodological quality of the measurement instruments by using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) property checklist boxes. Results. Of 71 studies identified for the full-text review, only seven complied with the inclusion criteria that represent four instruments (Q-DIO, D-CATCH, NP-CDSS, PNP). It was found that the instruments continue in their validation and appropriation processes to reality in health services. Conclusion. In spite of the evident evolution of the instruments to evaluate the implementation of the nursing care process, the need is still valid for an instrument that measures aspects of knowledge, attitudes, and practices in every stage of the process

Objetivo. Analizar la literatura disponible sobre las propiedades psicométricas de los instrumentos para medir Conocimientos, Actitudes y Prácticas del Proceso de Cuidado de Enfermería. Métodos. Revisión de tipo narrativa según las recomendaciones de la declaración PRISMA. La estrategia de búsqueda se realizó en dos etapas; a partir de la búsqueda en bases de datos por parte de 2 revisores y, posteriormente, tres revisores identificaron de forma independiente los estudios y evaluaron la calidad metodológica de los instrumentos de medición utilizando la COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). Resultados. De 71 estudios identificados para la revisión de texto completo, solo 7 cumplieron los criterios de inclusión que representan 4 instrumentos diferentes (Q-DIO, D-CATCH, NP-CDSS, PPE). Se encontró que los instrumentos continúan en procesos de validación y apropiación de los mismos a la realidad en los servicios de salud. Conclusión. A pesar de la evidente evolución de los instrumentos para evaluar la implementación del Proceso de Cuidado de Enfermería, aún sigue vigente la necesidad de un instrumento que mida los aspectos de Conocimientos, Actitudes y Prácticas en todas las etapas del proceso.

Objetivo. Analisar a literatura disponível sobre as propriedades psicométricas dos instrumentos de medida de Conhecimentos, Atitudes e Práticas do Processo de Cuidar de Enfermagem. Métodos. Revisão narrativa realizada de acordo com as recomendações da declaração PRISMA. A estratégia de busca foi realizada em duas etapas; por meio da busca nas bases de dados CINAHL, MEDLINE, BVS e Google Scholar por 2 revisores e, posteriormente, três revisores identificaram os estudos de forma independente e avaliaram a qualidade metodológica dos instrumentos de medição usando a COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). Resultados. Dos 71 estudos identificados para revisão de texto completo, apenas 7 preencheram os critérios de inclusão representando 4 instrumentos diferentes (Q-DIO, D-CATCH, NP-CDSS, PPE). Constatou-se que os instrumentos continuam em processos de validação e apropriação dos mesmos à realidade nos serviços de saúde. Conclusão. Apesar da evidente evolução dos instrumentos de avaliação da implementação do Processo de Cuidar em Enfermagem, persiste a necessidade de um instrumento que mensure os aspectos de Conhecimento, Atitudes e Práticas em todas as etapas do processo

Calidad del cuidado brindado por estudiantes de enfermería: experiencia y satisfacción del usuario / Qualidade dos cuidados oferecidos pelos estudantes de enfermagem: experiência e satisfação do usuário / Quality of care provided by nursing students: patient experience and satisfaction

Introducción: El estudiante de enfermería, es un recurso importante en la evaluación del cuidado y la satisfacción percibida por los usuarios en las instituciones de salud en las que desarrollan sus prácticas formativas. Objetivo: Determinar la experiencia y satisfacción de la atención brindada por el estudiante de enfermería de la Universidad Industrial de Santander, desde la percepción de los usuarios hospitalizados en una institución pública prestadora de servicios de salud. Materiales y Métodos: Estudio descriptivo, transversal, cuantitativo, con una muestra de 217 usuarios hospitalizados en una institución de salud, a quienes se les aplicó el Cuestionario de Calidad del Cuidado de Enfermería-CUCACE, versión en castellano. Se realizó un análisis descriptivo de la muestra y de los ítems del instrumento en las dimensiones satisfacción y experiencias con el cuidado, adicionalmente se evaluó la correlación entre los puntajes de las dimensiones. Resultados: La percepción de los usuarios en relación con la atención recibida por los estudiantes fue positiva en un 99.1%, con una puntuación de 92.3 en la dimensión de satisfacción y de 88.4 en la dimensión de experiencias con el cuidado. El 66.2% de los usuarios describió que la atención no requiere ser mejorada. Conclusiones: Los usuarios refieren una percepción positiva en las dimensiones de experiencias y satisfacción del cuidado brindado por los estudiantes de enfermería, al percibir un cuidado individualizado, orientado y supervisado, basado en habilidades en educación, comunicación, humanización y conocimiento; lo que puede servir como un indicador de calidad de la atención al interior de las instituciones de salud y de los programas de enfermería.

Introduction: Practicing nursing students are an essential resource in assessing patients' quality of care and satisfaction provided in healthcare institutions during their clinical practice. Objective: To determine patients' experience and satisfaction of care provided by practicing nursing students at the Industrial University of Santander from the perspective of patients who have been hospitalized in a healthcare center. Materials and Methods: A quantitative descriptive cross-sectional study was conducted with a sample of 217 patients who have been hospitalized in a healthcare center. Data were collected using the Nursing Care Quality Questionnaire (Spanish version). A descriptive analysis of the sample and instrument items was conducted in the patients' care satisfaction and experience dimensions. Results: Patients' perception of the care provided by nursing students was positive by 99.1%, rating 92.3% in the care satisfaction dimension and 88.4% in the care experience dimension. 66.2% of patients reported that there was no need to improve care provision. Conclusions: Patients report having a positive perception of care experience and satisfaction provided by practicing nursing students as they perceive that individualized, guided and supervised care is provided on the basis of skills in education, communication, humanization and knowledge. The above can serve as a health care quality indicator in healthcare institutions and nursing programs.

Introdução: O estudante de enfermagem é um recurso importante na avaliação do cuidado e da satisfação percebida pelos usuários nas instituições de saúde onde eles desenvolvem suas práticas de formação. Objetivo: Determinar a experiência e satisfação do atendimento prestado pelo estudante de enfermagem da Universidade Industrial de Santander, com base na percepção dos usuários internados em uma instituição pública prestadora de serviços de saúde. Materiais e Métodos: Estudo descritivo, transversal, quantitativo, com uma amostra de 217 usuários internados em uma instituição de saúde, aos quais lhes foi aplicado o Questionário de Qualidade do Cuidado de Enfermagem-CUCACE, versão em espanhol. Foi feita uma análise descritiva da amostra e dos itens do instrumento nas dimensões satisfação e experiências com o cuidado, além disso, foi avaliada a correlação entre as pontuações das dimensões. Resultados: A percepção dos usuários sobre o atendimento recebido pelos estudantes foi positiva em 99,1%, com uma pontuação de 92,3 na dimensão satisfação e 88,4 na dimensão experiência com o cuidado. 66,2% dos usuários descreveram que o atendimento não precisa ser melhorado. Conclusões: Os usuários relatam uma percepção positiva nas dimensões de experiências e satisfação do atendimento prestado pelos estudantes de enfermagem, pois percebem um cuidado individualizado, orientado e supervisionado, baseado em habilidades em educação, comunicação, humanização e conhecimento; o que pode servir como um indicador da qualidade do atendimento dentro das instituições de saúde e dos programas de enfermagem.

La estrategia de vivienda saludable, una intervención en la población rural / The healthy housing strategy, an intervention in the rural population

Introducción: La estrategia de vivienda saludable fue aplicada en diversas comunidades con resultados positivos en el logro de entornos saludables. La estrategia, aplicada a través de una metodología educativa, favorece el empoderamiento y la toma de decisiones relacionadas con los conocimientos, actitudes y prácticas de las familias. Las localidades en el sector rural cuentan con viviendas de construcción precaria, en las que no se han tenido en cuenta para su edificación los factores internos y externos que influyen directamente en la salud de las familias. Objetivo: Determinar el efecto de una intervención educativa, que está enmarcada en la estrategia de vivienda saludable, en los conocimientos, actitudes y prácticas de las familias de una localidad rural de la ciudad de Bucaramanga. Métodos: Se efectuó un estudio cuasi-experimental a través de una intervención educativa, casa a casa. Se evaluaron al principio y al final de su aplicación los conocimientos, actitudes y prácticas de las familias. La muestra estuvo conformada por 31 viviendas rurales. Se tuvo como base metodológica el contenido teórico propuesto en la estrategia de vivienda saludable de la Organización Panamericana de la Salud. Resultados: De los 6 componentes de la estrategia, se lograron cambios significativos en 5 de los 31 ítems evaluados. Conclusión: La estrategia de vivienda saludable, desarrollada a través de la intervención educativa, demuestra ser una herramienta útil en la mejora de prácticas y costumbres sanitarias en la población(AU)

Introduction: The healthy housing strategy was applied in different communities with positive results in the achievement of healthy environments. The strategy, applied through an educational methodology, favors the empowerment and decision-making related to the knowledge, attitudes and family practices. The towns in the rural sector have houses with precarious constructions, in which have not been taken into account for their building the internal and external factors that directly affect the health of families. Objective: To determine the effect of an educational intervention that is framed in the healthy housing strategy, in the knowledge, attitudes and practices of families in a rural town of Bucaramanga city. Methods: It was performed a quasi-experimental study through an educational intervention house to house. Knowledge, attitudes and practices of families were evaluated at the beginning and at the end of the application. The sample consisted of 31 rural homes. It had as a methodological basis the theoretical content proposed in the healthy housing strategy of the Pan American Health Organization. Results: Of the 6 components of the strategy, there were significant changes in 5 of the 31 items evaluated. Conclusion: The healthy housing strategy developed through the educational intervention proves to be a useful tool in improving health practices and customs in the population(AU)

Motivación y logros en procesos de educación para la sexualidad con docentes / Motivation and achievement in education processes for teaching sexuality / Motivação e logros em processos de educação para a sexualidade com docentes

Resumen Objetivo: Evaluar la motivación como elemento esencial en el proceso de capacitación sobre educación para la sexualidad de un grupo docente de educación básica y media y apreciar los cambios alcanzados por el colectivo. Materiales y métodos: Estudio con diseño mixto secuencial explicativo-cuantitativocualitativo con 81 docentes de dos instituciones públicas de Oiba y Simacota (Santander), quienes participaron de manera voluntaria en la investigación durante 2016. La etapa cuantitativa, diseño de corte transversal y enfoque empírico analítico no experimental, evaluó la motivación del colectivo antes de iniciar la capacitación. Se utilizó instrumento construido y validado previamente por el equipo investigador; se analizó mediante el modelo de Rasch y se establecieron relaciones significativas entre variables sociodemográficas y tipos de motivación. En la etapa cualitativa se utilizó el enfoque fenomenológico y la técnica del conversatorio para recabar lo esencial de la experiencia del colectivo y logros alcanzados. Resultados: Más de la mitad del grupo mostró motivación interna alta; la motivación externa se distribuyó en baja, media y alta y hubo un grupo desmotivado en nivel bajo. La confiabilidad de las personas en los tres grupos fue muy baja, lo cual puede sugerir que la muestra no fue la mejor para medir el constructo, aunque el instrumento (ítems) mostró buenas propiedades para evaluarlo. La etapa cualitativa corroboró motivación interna alta en el grupo, amplió la comprensión de los resultados cuantitativos e identificó cambios importantes en el colectivo. Conclusiones: Los testimonios que aportaron muchos de los asistentes evidenciaron cambios en relación con la educación para la sexualidad, lo cual era el objetivo a lograr.

Abstract Objective: To evaluate motivation as an essential element to the training process on education for the sexuality of an elementary and middle school group of teachers and to appreciate the changes achieved by the group. Materials and methods: Explanatory-quantitative-qualitative sequential mixed design study with 81 teachers from two public educational institutions of Oiba and Simacota, Department of Santander, who participated voluntarily in the research project during 2016. The quantitative stage, a cross-sectional design and non-experimental analytical empirical approach, evaluated the motivation of the group before starting the training. An instrument built and validated previously by the research team was used and it was analyzed using the Rasch model, establishing significant relationships between sociodemographic variables and types of motivation. In the qualitative stage, the phenomenological approach and the conversational technique were used to gather the essential of the experience lived by the group and achievements. Results: More than half of the group showed high internal motivation; the external motivation was distributed in low, medium and high and a demotivated group in a low-level was identified. The reliability of the individuals in the three groups was very low which may suggest that the sample was not the best to measure the construct, although the instrument (items) showed good properties to evaluate it. The qualitative stage corroborated high internal motivation in the group, expanded the understanding of quantitative results and identified important changes in the group. Conclusions: The testimonies contributed by many of the attendees evidenced changes in relation to the education for the sexuality, which was the objective to be achieved.

Resumo Objetivo: Avaliar a motivação como elemento essencial no processo de capacitação sobre educação para a sexualidade de um grupo de professores de ensino fundamental e médio e apreciar os câmbios alcançados pelo coletivo. Materiais e métodos: Estudo com desenho misto seqüencial explicativo-quantitativo - qualitativo com 81 professores de duas instituições públicas de Oiba e Simacota em Santander- Colômbia, quem participaram de maneira voluntaria na pesquisa durante 2016. A etapa quantitativa, desenho de corte transversal e enfoque empírico analítico não experimental, avaliaram a motivação do coletivo antes de iniciar a capacitação. Utilizou se instrumento construído e validado previamente pela equipe pesquisador; analisou se mediante o modelo de Rasch e se estabeleceram relações significativas entre variáveis sóciodemográficas e tipos de motivação. Na etapa qualitativa se utilizou o enfoque fenomenológico e a técnica do dialogo para conseguir o essencial da experiência do coletivo e logros alcançados. Resultados: Mais da metade do grupo mostrou motivação interna alta; a motivação externa se distribuiu em baixa, media e alta e houve um grupo desmotivado no nível baixo. A confiabilidade das pessoas nos três grupos foi muito baixa, o qual pode sugerir que a amostra não foi à melhor para medir o constructo, porém o instrumento (itens) mostrou boas propriedades para avaliar-lo. A etapa qualitativa corroborou motivação interna alta no grupo, ampliou a compreensão dos resultados quantitativos e identificou câmbios importantes no coletivo. Conclusões: As testemunhas que aportaram muitos dos assistentes evidenciaram câmbios em relação com a educação para a sexualidade, o qual era o objetivo a lograr.

The Contribution of the Rasch Model to the Clinical Validation of Nursing Diagnoses: Integrative Literature Review.

PURPOSE: To analyze the knowledge related to the use of the Rasch model in validation of nursing diagnoses. METHODS: Integrative literature review with search in LILACS, PUBMED, CINAHL, and SCOPUS. FINDINGS: Five studies comprised the sample, which analyzed unidimensionality, local independence, item calibration, item reliability, separation of items and people, and differential item functioning for analyzing nursing diagnoses. CONCLUSIONS: The Rasch model seems to be a useful method to validate nursing diagnoses and probably also for the validation of nursing outcomes in the Nursing Outcomes Classification. The use of this model is promising, considering the advantages that it can be used in studies with several methodological designs. IMPLICATIONS FOR NURSING: Methods that are able to provide more robust evidence of nursing diagnosis validity are needed to support highly accurate diagnostic findings in clinical practice.

Soporte social percibido en cuidadores familiares de personas con enfermedad crónica / Social support perceived in family caregivers of people with chronic disease

Resumen Introducción: El aumento de las enfermedades crónicas ha puesto en evidencia la problemática entre la oferta y demanda de los servicios de salud, generando el desplazamiento de cuidados al hogar y sobrecarga a los cuidadores familiares. Objetivo: determinar el soporte social percibido por los cuidadores familiares de personas con enfermedad crónica. Materiales y Métodos: Se realizó un estudio de corte trasversal, se aplicó el instrumento: Inventario de Soporte Social en Enfermedad Crónica de Hilbert a 129 cuidadores de personas con enfermedad crónica atendidos en un hospital de tercer nivel de atención. Resultados: Los cuidadores continúan siendo principalmente mujeres (89,9%). El puntaje promedio de la escala fue de 110,7, desviación estándar = 38,1, observándose diferencias significativas en la escolaridad (p=0,030), el estrato socioeconómico (p=0,013) y el alojamiento conjunto al paciente (p=0,010). Conclusión: Los cuidadores reportaron estar poco satisfechos con el soporte social percibido y esta percepción estuvo relacionada con las condiciones socioeconómicas de las personas.

Abstract Introduction: The increase in chronic diseases has put in evidence the problem between the supply and demand for health services, generating the displacement of care to home and the overload to family caregivers. Objective: To determine the social support perceived by family caregivers of people with chronic disease. Materials and methods: A transversal study was conducted and the Inventory of Social Support on Chronic Disease of Hilbert instrument was used with 129 family caregivers of people with chronic disease seen in a hospital of third level of attention. Results: The caregivers are primarily women (89.9%). The average score of the scale was of $110.7, standard deviation = 38.1. Significant differences were found in the schooling (p=0.030), socioeconomic status (p=0.013) and the housing to the patient (p=0.010). Conclusion: The caregivers reported to be unhappy with perceived social support and this perception was related to the socio-economic conditions of the people.

Diagnósticos de enfermería al alta hospitalaria en personas con Síndrome Coronario Agudo / Nursing Diagnoses to Hospital Discharge in People with Acute Coronary Syndrome

Introducción: Enfermería juega un rol fundamental en las diferentes etapas de la atención de las personas con síndrome coronario agudo, entre ellas el egreso hospitalario. Brindar cuidado acorde a las necesidades propias de estas personas, requiere de la identificación de los principales diagnósticos de enfermería. Objetivo: Determinar la prevalencia de diagnósticos de Enfermería de las personas con síndrome coronario agudo al momento del alta hospitalaria. Metodología: Estudio de corte transversal en 196 personas hospitalizadas por el evento de interés, se utilizó instrumento de valoración focalizada que evaluaba las características definitorias de los diagnósticos de enfermería: ansiedad, afrontamiento ineficaz, disposición para mejorar la religiosidad, disposición para mejorar los conocimientos, intolerancia a la actividad; los cuales fueron identificados como prioritarios según la literatura científica y por consenso de expertos. Para determinar la prevalencia de los diagnósticos se realizó análisis de definición y características definitorias. Resultados: Se evidenció como principal problema de la población de estudio los conocimientos deficientes, seguido de la intolerancia a la actividad y la ansiedad. De igual forma se logró identificar diagnósticos positivos como la disposición para mejorar los conocimientos y la religiosidad. Conclusiones: El presente trabajo nos permitió identificar necesidades reales y reconocer factores protectores al momento del alta hospitalaria en personas que han vivido un evento coronario agudo, lo cual constituye un punto de partida para el diseño de planes de cuidado y la puesta en marcha de intervenciones que conduzcan a mejorar la situación de salud de este grupo de personas...(AU)

Introduction: Nursing plays a crucial role during the different stages of care of people with acute coronary syndrome, including hospital discharge. Providing care to these patients, according to their needs, requires the identification of the main nursing diagnoses. Objective: To determine the prevalence of nursing diagnoses of people with Acute Coronary Syndrome at the time of hospital discharge. Methodology: This is a cross-sectional study of 196 hospitalized people for this event; a focused assessment instrument was used to evaluate the defining characteristics of the nursing diagnoses: anxiety, ineffective coping of the problem, willingness to improve religiosity, readiness to improve knowledge, and intolerance to activity. These characteristics were identified as priorities according to the scientific literature and by the consensus of experts. A definition analysis and defining characteristics of the problem were performed to determine the prevalence of the diagnoses. Results: The main problem of the population studied was evidenced a deficient knowledge about the problem, followed by intolerance to activity and anxiety. Likewise, it was possible to identify some positive diagnoses such as the willingness to improve their knowledge about the problem and religiosity. Conclusions: The current study allowed identifying real needs and recognizing protective factors at the time of hospital discharge in people who have experienced an acute coronary event, which is a starting point for the design of care plans and the implementation of interventions that lead to improve the health situation of this group of people...(AU)

Introdução: a enfermagem desempenha um papel fundamental nas diferentes etapas do atendimento de pessoas com síndrome coronariana aguda, incluindo alta hospitalar. Prestar cuidados de acordo com as necessidades dessas pessoas requer a identificação dos principais diagnósticos de enfermagem. Objetivo: Determinar a prevalência de diagnósticos de enfermagem de pessoas com síndrome coronariana aguda no momento da alta hospitalar. Metodologia: Foi feito um estudo de corte transversal, com 196 pessoas hospitalizadas com a síndrome coronariana e se utilizou um instrumento de avaliação enfocado nas características que definem os diagnósticos da enfermagem. ansiedade, enfrentamento ineficaz, disposição para melhorar a religiosidade, disposição para melhorar o conhecimento, intolerância à atividade; que foram identificados como prioritários de acordo com a literatura científica e por consenso de especialistas. Para determinar a prevalência dos diagnósticos, realizamos a análise da definição e das características definidoras. Resultados: O principal problema da população estudada foi o conhecimento precário, seguido da intolerância à atividade e à ansiedade. Da mesma forma, foi possível identificar diagnósticos positivos, como a vontade de melhorar o conhecimento e a religiosidade. Conclusões: o presente estudo nos permitiu identificar necessidades reais e reconhecer fatores de proteção no momento da alta hospitalar, em pessoas que sofreram um evento coronariano agudo, que é um ponto de partida para o planeação de planos de cuidados e a implementação de intervenções que levaram a melhorar a situação de saúde desse grupo de pessoas...(AU)

Multimorbidity in adults from a southern Brazilian city: occurrence and patterns.

OBJECTIVES: The aim of this study was to evaluate occurrences and patterns of multimorbidity in adults from a southern Brazilian city. METHODS: A population-based cross-sectional study was carried out in 2012 through face-to-face interviews with adults (20 or more years) living in Pelotas, southern Brazil. Multimorbidity was evaluated by a list of 11 morbidities (based on medical diagnosis; Patient Health Questionnaire 9 for depression; and Anatomical Therapeutic Chemical index) and operationalized according to two cutoff points: ≥2 and ≥3 morbidities. Descriptive analysis and factor analysis (FA) were performed. RESULTS: The sample was made up of 2927 adults. Multimorbidity reached 29.1 % (95 % CI: 27.1; 31.1) for ≥2, and 14.3 % (95 % CI: 12.8; 15.8) for ≥3 morbidities and was greater in females, older people, those with less schooling and those from lower economic classes. Four pairs (frequency ≥5 %) and four triplets (frequency ≥2 %) were observed. Two patterns of morbidities (cardiometabolic and joint problems; and respiratory diseases) explained 93 % of total variance. CONCLUSIONS: Multimorbidity was common in the studied population. The observed patterns may be used to generate and improve Brazilian diseases guidelines.

Início da vida sexual entre adolescentes (10 a 14 anos) e comportamentos em saúde / Sexual initiation among adolescents (10 to 14 years old) and health behaviors

OBJETIVO: Avaliar a prevalência de início da vida sexual até os 14 anos de idade e fatores sociodemográficos e comportamentais relacionados à sua ocorrência. MÉTODOS: Em 2008, 4.325 adolescentes dos 5.249 pertencentes ao estudo de coorte de nascimentos de Pelotas, Rio Grande do Sul (1993) foram entrevistados. O início da vida sexual foi definido como primeira relação sexual ocorrida até os 14 anos. As informações foram obtidas através de questionários durante o acompanhamento de 2008, com entrevistas realizadas nos domicílios. As varáveis analisadas foram: cor da pele, índice de bens, escolaridade materna e do adolescente, uso experimental de cigarro e de álcool, episódio de embriaguez, uso de alguma droga ilícita pelo adolescente ou pelos amigos e envolvimento em brigas no último ano. Além dessas, foram analisados o uso de preservativos e contraceptivos, número de parceiros(as) e idade de iniciação sexual. RESULTADOS: A prevalência de iniciação sexual foi de 18,6%, sendo maior no sexo masculino, nos adolescentes com menor escolaridade, de baixo nível econômico e naqueles cujas mães tinham baixa escolaridade e tiveram filhos na adolescência. A prática sexual esteve relacionada às variáveis comportamentais analisadas. Na última relação sexual, 30% das entrevistadas não haviam usado métodos contraceptivos e 18% não usaram preservativos. Meninos referiram maior número de parceiros(as) sexuais do que meninas. CONCLUSÃO: Resultados apontam uma relação entre iniciação sexual (≤ 14 anos) e comportamentos vulneráveis à saúde. O não uso de preservativos e contraceptivos pode torná-los vulneráveis a experimentarem situações não desejadas. Estratégias educativas e socioculturais em saúde devem ser praticadas desde o início da adolescência. .

OBJECTIVE: To assess the prevalence of sexual initiation until the age of 14 years old, as well as sociodemographic and behavioral factors. METHODS: In 2008, 4,325 from the 5,249 adolescents of the 1993 birth cohort in Pelotas, Rio Grande do Sul, were interviewed. Sexual initiation was defined as the first intercourse up to the age of 14 years old. The information was obtained by interviewing adolescents in their houses, during the 2008 follow-up. The analyzed variables were: skin color, asset index, maternal and adolescents' schooling, experimental use of tobacco and alcohol, drunkenness episode, use of any illicit drug, illegal drug use by friends and involvement in fights during the past year. Use of condoms and contraceptive methods, number of partners and the age of sexual initiation were also analyzed. RESULTS: The prevalence of sexual initiation by the age of 14 was of 18.6%. Lower schooling, asset index and maternal education were related to higher prevalence of sexual initiation until the age of 14, as well as being male or being born to adolescent mothers. Sexual intercourse was also related to the behavioral variables analyzed. Among adolescent girls who had intercourse up to the age of 14, 30% did not use contraception and 18% did not use condoms in the last sexual intercourse. Boys reported a higher number of sexual partners than girls. CONCLUSION: The results suggest a relationship between sexual intercourse (≤ 14 years) and some health-risk behaviors. The non-use of condoms and contraceptives may make them vulnerable to experiencing unwanted situations. Education and sociocultural strategies for health should be implemented from the beginning of adolescence. .

Sexual initiation among adolescents (10 to 14 years old) and health behaviors.

OBJECTIVE: To assess the prevalence of sexual initiation until the age of 14 years old, as well as sociodemographic and behavioral factors. METHODS: In 2008, 4,325 from the 5,249 adolescents of the 1993 birth cohort in Pelotas, Rio Grande do Sul, were interviewed. Sexual initiation was defined as the first intercourse up to the age of 14 years old. The information was obtained by interviewing adolescents in their houses, during the 2008 follow-up. The analyzed variables were: skin color, asset index, maternal and adolescents' schooling, experimental use of tobacco and alcohol, drunkenness episode, use of any illicit drug, illegal drug use by friends and involvement in fights during the past year. Use of condoms and contraceptive methods, number of partners and the age of sexual initiation were also analyzed. RESULTS: The prevalence of sexual initiation by the age of 14 was of 18.6%. Lower schooling, asset index and maternal education were related to higher prevalence of sexual initiation until the age of 14, as well as being male or being born to adolescent mothers. Sexual intercourse was also related to the behavioral variables analyzed. Among adolescent girls who had intercourse up to the age of 14, 30% did not use contraception and 18% did not use condoms in the last sexual intercourse. Boys reported a higher number of sexual partners than girls. CONCLUSION: The results suggest a relationship between sexual intercourse (≤ 14 years) and some health-risk behaviors. The non-use of condoms and contraceptives may make them vulnerable to experiencing unwanted situations. Education and sociocultural strategies for health should be implemented from the beginning of adolescence.

Early life determinants of low IQ at age 6 in children from the 2004 Pelotas Birth Cohort: a predictive approach.

BACKGROUND: Childhood intelligence is an important determinant of health outcomes in adulthood. The first years of life are critical to child development. This study aimed to identify early life (perinatal and during the first year of life) predictors of low cognitive performance at age 6. METHODS: A birth cohort study started in the city of Pelotas, southern Brazil, in 2004 and children were followed from birth to age six. Information on a broad set of biological and social predictors was collected. Cognitive ability-the study outcome-was assessed using the Wechsler Intelligence Scale for Children (WISC). IQ scores were standardized into z-scores and low IQ defined as z < -1. We applied bootstrapping methods for internal validation with a multivariate logistic regression model and carried out external validation using a second study from the 1993 Pelotas Birth Cohort. RESULTS: The proportion of children with IQ z-score < -1 was 16.9% (95% CI 15.6-18.1). The final model included the following early life variables: child's gender; parents' skin color; number of siblings; father's and mother's employment status; household income; maternal education; number of persons per room; duration of breastfeeding; height-for-age deficit; head circumference-for-age deficit; parental smoking during pregnancy; and maternal perception of the child's health status. The area under the ROC curve for our final model was 0.8, with sensitivity of 72% and specificity of 74%. Similar results were found when testing external validation by using data from the 1993 Pelotas Birth Cohort. CONCLUSIONS: The study results suggest that a child's and her/his family's social conditions are strong predictors of cognitive ability in childhood. Interventions for promoting a healthy early childhood development are needed targeting children at risk of low IQ so that they can reach their full cognitive potential.

Cohort profile update: 2004 Pelotas (Brazil) Birth Cohort Study. Body composition, mental health and genetic assessment at the 6 years follow-up.

This is an update of the 2004 Pelotas Birth Cohort profile, originally published in 2011. In view of the high prevalence of overweight and mental health problems among Brazilian children, together with the availability of state-of-the-art equipment to assess body composition and diagnostic tests for mental health in childhood, the main outcomes measured in the fifth follow-up (mean age 6.8 years) included child body composition, mental health and cognitive ability. A total of 3722 (90.2%) of the original mothers/carers were interviewed and their children examined in a clinic where they underwent whole-body dual X-ray absorptiometry (DXA), air displacement plethysmography and a 3D photonic scan. Saliva samples for DNA were obtained. Clinical psychologists applied the Development and Well-Being Assessment questionnaire and the Wechsler Intelligence Scale for Children to all children. Results are being compared with those of the two earlier cohorts to assess the health effects of economic growth and full implementation of public policies aimed at reducing social inequalities in the past 30 years. For further information visit the programme website at [http://www.epidemio-ufpel.org.br/site/content/coorte_2004/questionarios.php]. Applications to use the data should be made by contacting 2004 cohort researchers and filling in the application form available at [http://www.epidemio-ufpel.org.br/site/content/estudos/formularios.php].

Eventos adversos relacionados con el cuidado de enfermería / Adverse events related to nursing care

Introducción: la seguridad en la atención en salud se ha convertido en una prioridad mundial, por lo cual es importantecaracterizar los eventos adversos con elfin de tomar las medidas pertinentes para prevenirlos. Objetivo: caracterizar la población que presentó los eventos adversos, describiendo las características relacionadas con el paciente, el ambiente yel personal de enfermería. Métodos: análisis descriptivo de una cohorte hospitalariapiloto sobre los eventos adversos relacionados con el cuidado de enfermería, en Bucaramanga, Colombia. Fueron incluidos 198 pacientes, a quienes se les aplicó en las primeras horas de hospitalización un formato que evaluaba posibles factores de riesgo para la ocurrencia de eventos adversos: úlceras por presión, caídas, flebitis y retiros de dispositivos terapéuticos. Resultados: las características que prevalecieron con respecto al pacientefueron: lasalteraciones en el estado de ánimo, el confinamiento a la camay la dieta especial; en cuanto al ambiente, la falta de insumos para la prevención de UPP y timbres. El promedio de pacientes por enfermera profesional fue de 27,3 y en personal auxiliar de enfermería de 9,1. Conclusiones: el conocer las características que estuvieron presentes en los pacientes que desarrollaron un evento adverso, es una primera aproximación sobre la problemática y un elemento importante para que las organizaciones de salud tengan mayores argumentos e inviertan en prácticas más seguras(AU)

Introduction: safety in health care has become a priority in many countries. It is important to inquire about those fact involved in its occurrence for the organizations to respond appropriately to prevent them. Objective: To characterize the population who presented adverse events, describing the characteristics related to the patient, the environment and the nursing staff. Methodology: descriptive analysis of a cohort pilot hospital about adverse events related to nursing care, in Bucaramanga, Colombia. Results: Prevalent events found in patients were alterations in mood, confinement to bed and need for special diet; in the environment events were: lack of inputs for pressure ulcers prevention and lack of nurse call buttons. The average number of patients per nurse practitioner was 27.3 and auxiliary nurses of 9.1. Conclusions: The knowledge about the characteristics that were present in the patients who developed an adverse event, is a first approximation of the problem and an important element for health organizations have more arguments for investing in safer practices(AU)

Percepción del rol de la enfermera en un programa de rehabilitación cardíaca / Perception of the role of the nurse in a cardiac rehabilitation program

Objetivo: indagar acerca de la percepción que tienen tanto usuarios como funcionarios ante el rol de la enfermera en los programas de rehabilitación cardiaca. Métodos: estudio cualitativo de tipo etnográfico, llevado a cabo en el programa de rehabilitación cardiaca de una institución de salud privada de tercer nivel, del departamento de Santander, Colombia. La muestra estuvo conformada por personal interdisciplinario de salud, usuarios del servicio y familiares. Resultados: para las personas, las actividades asistenciales son el papel esencial de la enfermera desconociendo la heterogeneidad de su rol, el cual unido a un equipo interdisciplinario favorece al cuidado holístico. Conclusiones: las intervenciones de enfermería dependen en gran medida de la calidad del cuidado y empoderamiento de su profesión, así como la percepción de los usuarios con respecto a dicho cuidado(AU)

Objective: investigate about perceptions both users and staff to the role of the nurse in cardiac rehabilitation programs. Methods: qualitative ethnographic study conducted in the cardiac rehabilitation program of a private health institution of tertiary and quaternary care, from Santander, Colombia. The sample consisted of interdisciplinary health staff, service users and family. Results: for people health care activities are the essential role of the nurse ignoring the heterogeneity of their role, which together with an interdisciplinary team promotes holistic care. Conclusions: the nursing interventions depends largely on the quality of care and empowerment of their profession and the perception of users regarding such care(AU)

Prevalencia y factores asociados al resultado anormal de la citología vaginal en estudiantes universitarias en Bucaramanga, Colombia / Prevalence and factors associated with abnormal cytology result in female College Students in Bucaramanga, Colombia

Objetivo: Identificar la frecuencia de anormalidad en el reporte de la citología y sus factores asociados en estudiantes atendidas en los Servicios de Salud de Bienestar Universitario de la Universidad Industrial de Santander. Métodos: Estudio de corte transversal, incluyó 1 549 registros de estudiantes que se tomaron la citología en el Servicio de Salud de la División de Bienestar Universitario de la Universidad Industrial de Santander en el periodo de Enero de 2009 a Diciembre de 2011 y cuyo resultado y variables de estudio estuviesen almacenados en el sistema de información de los Servicios de Salud de Bienestar Universitario. Fue determinada la prevalencia de anormalidad en los resultados de la citología y por medio de análisis multivariados fueron explorados los factores asociados a dicho reporte citológico. Resultados: La prevalencia de anormalidad fue de 17,8 %. La anormalidad fue más frecuente en mujeres con antecedentes de embarazo, sexarquia temprana y con dos o más compañeros sexuales. Permanecieron asociadas al reporte de anormalidad después de ajustar: el número de compañeros sexuales y la sexarquia. Discusión: Existe un aumento de la prevalencia de anormalidad en los resultados citológicos de la población universitaria. Son necesarias estrategias de prevención sobre el cáncer de cuello uterino haciendo énfasis en sus principales factores de riesgo y en la citología como medio de tamizaje para la detección temprana.

Objective: To identify the frequency of abnormal cytology reports and associated factors in students that attended the Health Service University Welfare Divisionof the Universidad Industrial de Santander. Methods: Cross-sectional study that included 1 549 records of students who had a cytology in the Health Service University Welfare Division of the Universidad Industrial de Santander during the period extending from January 2009 to December 2011 and whose results and variables of study were stored in the information system at the Health Services University Welfare. The prevalence of abnormal cytology results was determined and through multivariate analysis the factors associated with this cytological report were explored. Results: The prevalence of abnormality was 17,8 %. The abnormality was more frequent in women with a history of pregnancy, early first sexual intercourse and with two or more sexual partners. After adjusting, the number of sexual partners and age of first sexual intercourse remained associated to the report of abnormality. Discussion: There is an increased prevalence of abnormal cytology results in the university population. Prevention strategies are needed for cervical cancer with emphasis on its main risk factors and cytology as a means of screening for early detection.

Validación de un formato para algunos diagnósticos de enfermería de interés en la familia / Validation of a format for some nursing diagnosis of interest in the family

Objetivo: determinar la validez de criterio de un formato de valoración de tamizaje para algunos diagnósticos de enfermería de interés en la familia. Métodos: el diseño utilizado fue la Evaluación de Tecnologías o Pruebas Diagnósticas. Fueron estudiadas 204 familias de la ciudad de Bucaramanga, Colombia. Entre septiembre y octubre de 2008 se realizó valoración de las familias, primero a través de un formato de valoración de tamizaje para sospechar la presencia de algunos diagnósticos de enfermería, seguido de, y aplicado independientemente, un formato de valoración focalizada para la confirmación de la presencia de los diagnósticos de enfermería aplicables a la familia. Con dichos formatos se evaluaron 10 etiquetas diagnósticas NANDA-I. Para determinar la validez del formato de tamizaje se calcularon las características psicométricas que indicaban su validez de criterio. Resultados: se obtuvo los altos valores operativos del formato de tamizaje, presentado en altas sensibilidades, especificidades, áreas bajo la curva, valores predictivos y likelihood ratio's. A partir de la valoración focalizada se obtuvo la prevalencia de los diagnósticos de enfermería evaluados en la familia, los más prevalentes fueron las conductas generadoras de salud, manejo inefectivo del régimen terapéutico familiar, y los menos frecuentes fueron conflicto del rol parental, riesgo de deterioro de la vinculación entre los padres y el lactante niño. Conclusiones: el instrumento de tamizaje resulto ser un instrumento válido para las etiquetas diagnósticas de NANDA-I incluidas en el presente estudio, alcanzando una buena validez de criterio(AU)

Objective: to determine the validity of criteria of a screening assessment format for some nursing diagnoses of interest in the family. Methods: the design used was Evaluation of Technologies or Diagnostic Tests. Two hundred and four families from Bucaramanga city in Colombia were studied. The assessment of families occurred from September to October, 2008. Firstly, a format of screening assessment was used to detect the presence of some nursing diagnoses, and then, a focalized assessment format for confirmation of nursing diagnoses applicable to the family was made. With these formats, ten diagnostic labels NANDA-1 were evaluated. The psychometric characteristics indicating criterion validity were estimated to determine the validity of the screening format. Results: high operational values of the screening format were achieved, in terms of high sensitivity, specificity, areas under the curve, predictive values and likelihood ratios. Based on focalized assessment, the most prevalent nursing diagnoses evaluated in the family were health-generating behaviors, ineffective management of family therapeutic regimes whereas the least frequent were conflicts with the parent role, risk of deterioration of the linking between parents and the breast-fed child. Conclusions: the screening instrument proved to be a valid instrument for the diagnostic labels of NANDA-1 included in the present study. The validity of criteria was good(AU)

Validación de un formato para algunos diagnósticos de enfermería de interés en la familia / Validation of a format for some nursing diagnosis of interest in the family

El objetivo fue determinar la validez de criterio de un formato de valoración de tamizaje para algunos diagnósticos de enfermería de interés en la familia. El diseño utilizado la Evaluación de Tecnologías o Pruebas Diagnósticas. Fueron estudiadas 204 familias de la ciudad de Bucaramanga, Colombia entre septiembre y octubre de 2008. Se realizó valoración de las familias, primero para sospechar la presencia de algunos diagnósticos de enfermería, seguido para la confirmación de la presencia de los diagnósticos de enfermería aplicables a la familia. Con dichos formatos se evaluaron 10 etiquetas diagnósticas NANDA-I. Para determinar la validez del formato de tamizaje se calcularon las características psicométricas que indicaban su validez de criterio. Como resultados principales se obtuvo la prevalencia de los diagnósticos de enfermería evaluados en la familia como conductas generadoras de salud, manejo inefectivo del régimen terapéutico familiar, y los menos frecuentes fueron conflicto del rol parental, riesgo de deterioro de la vinculación entre los padres y el lactante niño. El instrumento de tamizaje resulto ser un instrumento válido para las etiquetas diagnósticas de NANDA-I incluidas en el estudio. Se alcanzó una buena validez de criterio(AU)

The objective was to determine the validity of criteria about a screening assessment format for some nursing diagnoses of interest in the family setting. The design followed the Evaluation of Technologies or Diagnostic Tests model. Two hundred four families from Bucaramanga city, Colombia were studied from September to October, 2008. The families were firstly assessed to verify the presence of some nursing diagnoses and then to confirm those diagnoses applicable to the family. With these formats, 10 diagnostic labels NANDA-I were evaluated. With the objective of determining the validity of screening formats, the psychometric characteristics indicating the validity of criteria were estimated. The main results were the prevalence of nursing diagnoses evaluated in the family setting such as health-generating behaviors, ineffective management of the family therapeutic regime, whereas the less common ones were controversy about the parent's role, risk of deteriorated link between the parents and the breast-fed child. The screening instrument proved to be valid for NANDA-I diagnostic labels included in the study since good validity of criteria was achieved(AU)