Assessment of Health Indicators in Individuals with Intestinal Stoma using the Nursing Outcomes Classification: A Cross-Sectional Study.

Aim: To determine nursing outcomes in individuals with intestinal stoma and the relationships between them and sociodemographic and clinical variables. Design: Cross-sectional study performed with 102 subjects at the General Surgery Unit of a first-level hospital. Methods: Data on the presence of nursing outcomes were collected using the Nursing Outcomes Classification. Data on sociodemographic and clinical variables were also collected. Univariate and bivariate data analyses were performed. Results: Outcomes related to participation in making health decisions and knowledge of ostomy care were assessed across the study sample. Period of care (post-operative and follow-up) was the most common significant variable (p < 0.05) among the outcomes. The outcome scores ranged from 2 to 3, indicating a moderate level of impairment in the physical, psychological, and social spheres of these patients. The scores in the indicators on Participation in making health decisions and Knowledge of stoma care improved in the period of continuity of care compared to the postoperative period, being this difference statistically significant (p < 0.001). Conclusions: The care plan for individuals with intestinal stoma needs to include indicators measuring patient participation in making decisions related to their condition, as well as indicators related to their knowledge and self-care of their stoma. Relevance to clinical practice: This study aims to determine the nursing outcomes in individuals with intestinal stoma and the relationships between them and sociodemographic and clinical variables. It provides the opportunity to plan achievable objectives with patients using a system of indicators that facilitate their assessment and monitoring.

Leadership as a Facilitator of Evidence Implementation by Nurse Managers: A Metasynthesis.

Evidence-based practice is often not implemented in nursing for reasons relating to leadership. This article aims to cast light on the factors that facilitate nursing evidence implementation perceived by nurse managers in their practical experiences of this implementation. It is a qualitative, narrative metasynthesis of primary studies on nurse managers' leadership-related facilitation experiences, following the Joanna Briggs Institute meta-aggregative approach and the Promoting Action on Research Implementation in Health Services (PARiHS) model. Eleven primary studies were included and three general categories were identified as leadership-related factors facilitating evidence implementation: teamwork (communication between managers and staff nurses), organizational structures (strategic governance), and transformational leadership (influence on evidence application and readiness for change among leaders). Nurse managers act as facilitators of evidence-based practices by transforming contexts to motivate their staff and move toward a shared vision of change. Always providing support as managers and colleagues, sharing their experience in the clinic environment.

Psychometric Testing of the Spanish Modified Version of the Mini-Suffering State Examination.

BACKGROUND: The mini-suffering state examination is a valid and reliable measure that have been used to assess suffering in patients with advanced cancer. The aim of this study was to carry out a psychometric analysis of the Spanish version of the mini-suffering state examination. METHOD: A validation study was conducted. Seventy-two informal caregivers of deceased patients in palliative care were included in this study. A psychometric testing of content validity, internal consistency, and convergent validity with the Spanish version of the quality of dying and death questionnaire was performed. RESULTS: The original instrument was modified to be used by informal caregivers. The content validity was acceptable (0.96), and the internal consistency was moderate (α = 0.67). Convergent validity was demonstrated (r = -0.64). CONCLUSION: The Spanish modified version of the MSSE showed satisfactory measurement properties. The Spanish modified version of MSSE can be useful to facilitate screening, monitor progress, and guide treatment decisions in end-of-life cancer patients.

Young Nursing Student's Knowledge and Attitudes about Contraceptive Methods.

PURPOSE: Adolescence is considered a period in which individuals are particularly at risk of negative consequences related to sexual health. Increased knowledge levels have traditionally been used as an indicator of the effectiveness of educational programs, but attitudes are not addressed and are a key element for the success of such programs. The aim of this study is to determine the level of knowledge and attitudes toward the use of contraceptive methods among nursing students. A multicenter cross-sectional study was carried out. In total, 2914 university students (aged 18-25 years) enrolled in the study. Participants completed two validated scales to measure knowledge level and attitudes toward contraceptive use. Nursing degree students who received training about contraceptives obtained a success rate of over 70%, compared to 15.3% among students who had not received such training (p < 0.001). The mean attitude score was 43.45 points (10-50), but there were no significant differences in terms of student training (p = 0.435), although they were significantly higher among students who used contraceptives at first or last sexual intercourse (p < 0.001). There was a significant weak correlation between the level of knowledge and attitudes toward the use of contraceptives. An adequate level of knowledge about sexuality and contraceptive methods does not correspond to positive attitudes toward their use, although having an excellent attitude toward contraceptive use is related to their use during youth and adolescence.

Umbilical cord separation time, predictors and healing complications in newborns with dry care.

OBJECTIVE: The objective of this study was to explore the umbilical cord separation time, predictors, and healing complications from birth until the newborn was one month old. DESIGN: A quantitative longitudinal observational analytical study by stratified random sample was adopted. SETTING: Public health system hospitals in southern Spain and at newborns' homes. PARTICIPANTS: Between April 2016 and December 2017, the study included 106 neonates born after 35-42 weeks of gestation whose umbilical cord was cured with water and soap and dried later as well as newborns without umbilical canalisation whose mothers enjoyed a low-risk pregnancy. METHODS: The data collection procedure comprised two blocks: from birth to the time of separation of the umbilical cord and from cord separation to the first month of life of the newborn. Umbilical cord separation time was measured in minutes; socio-demographic and clinical characteristics were measured by means of questionnaires, and the external diameter of the umbilical cord was measured using an electronic stainless-steel calliper and trailing roller. RESULTS: The mean umbilical separation time: 6.61 days (±2.33, IC 95%:6.16-7.05). Incidence of omphalitis was 3.7%; granuloma was 8.6%. Separation time predictors were wetting recurrence, birth weight, intrapartum antibiotics, birth season, and Apgar < 9 (R2 = 0.439 F: 15.361, p <0.01). CONCLUSION: The findings support the World Health Organization recommendations: dry umbilical cord cares is a safe practice that soon detaches the umbilical cord, taking into account the factors studied that will vary the length of time until the umbilical cord is separated.

Suffering measurement instruments in palliative care: protocol for a systematic psychometric review.

INTRODUCTION: The prevention and relief of suffering are regarded as a goal at the end of life; therefore, suffering assessment at the end of life is essential. In this regard, we need instruments that allow us to evaluate this construct for gathering more evidence, as the assessment of suffering is increasingly used in research and the clinical setting. Many measures have been designed to assess this construct, and the selection of the most appropriate instrument is crucial. The aims of this systematic review are to (1) identify the measures assessing suffering in patients with advanced disease and their psychometric properties and (2) evaluate the methodological quality of studies on measurement properties. METHODS AND ANALYSIS: The protocol of this systematic review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols Guidelines. A systematic psychometric review of measures assessing suffering in patients with advanced disease and their psychometric properties will be carried out according to the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN). The search strategy will be performed following the Peer Review of Electronic Search Strategies. Searches will be conducted in Cumulative Index to Nursing and Allied Health Literature, Medline, PsycINFO, Cochrane Library, SciELO, Open Grey, Scopus, Web of Science and COSMIN database of systematic reviews, and it will be limited by time (1980-2018) and language (only literature in English and Spanish). Literature will be evaluated by two independent reviewers according to the COSMIN checklist, and measurement properties data of each study that meet the inclusion criteria will be scored independently by two researchers according to COSMIN quality ratings. ETHICS AND DISSEMINATION: Ethical approval is not necessary for systematic review protocols. The results will be disseminated by publication in a peer-reviewed journal and presented at a relevant conference. PROSPERO REGISTRATION NUMBER: CRD42018106488.

Dry care versus chlorhexidine cord care for prevention of omphalitis. Systematic review with meta-analysis / Cura a seco versus cura com clorexidina para prevenção da onfalite. Revisão sistemática com metanálise / Cura seca frente a cura con clorhexidina para prevención de onfalitis. Revisión sistemática con metaanálisis

ABSTRACT Objective: to compare the effect of dry care and the application of chlorhexidine to the umbilical cord of newborns at risk of developing omphalitis. Method: systematic review with meta-analysis. Clinical trials comparing dry care with the application of clorexidine to evaluate omphalitis were selected. Methodological quality was evaluated using the Consolidated Standards of Reporting Trials. Results: the joint analysis of the studies shows a significant decrease in the risk of omphalitis in the chlorhexidine group compared to the dry care group (RR=0.58, CI: 0.53-0.64). However, in the analysis by subgroups, chlorhexidine umbilical cord care did not reduce the risk of omphalitis in hospital births (RR=0.82, CI: 0.64-1.05), in countries with a low infant mortality rate (RR=0.8, CI: 0.5-1.28), or at chlorhexidine concentrations below 4% (RR=0.55, CI: 0.31-1). Chlorhexidine acted as a protective factor at a concentration of 4% (RR=0.58, CI: 0.53-0.64), when applied in cases of home births (RR=0.57, CI: 0.51-0.62), in countries with a high infant mortality rate (RR=0.57, CI: 0.52-0.63). Conclusion: dry cord care is effective in countries with low infant mortality rate and in hospital births. However, 4% chlorhexidine for umbilical cord care protects against omphalitis in home births, in countries with a high infant mortality rate.

RESUMO Objetivo: comparar o efeito da cura a seco e da aplicação de clorexidina no cordão umbilical de recém-nascidos em risco de desenvolver onfalite. Método: revisão sistemática com metanálise. Foram selecionados os ensaios clínicos que comparavam a cura a seco com a aplicação de clorexidina para avaliar a onfalite. A qualidade metodológica foi avaliada com Consolidated Standards of Reporting Trials. Resultados: a análise conjunta dos estudos mostra uma redução significativa do risco de onfalite no grupo da clorexidina em comparação com a cura a seco (RR=0,58; IC 0,53-0,64). Entretanto, na análise por subgrupos, a cura com clorexidina não reduziu o risco de onfalite em nascimentos hospitalares (RR=0,82; IC: 0,64-1,05), nos países com baixa taxa de mortalidade infantil (RR=0,8; IC: 0,5-1,28), ou com concentrações de clorexidina abaixo de 4% (RR=0,55; IC: 0,31-1). A clorexidina atuou como fator de proteção na concentração de 4% (RR=0,58; IC: 0,53-0,64), aplicada em nascimentos no domicílio (RR=0,57; IC: 0,51-0,62), em países com taxas de mortalidade infantil elevadas (RR=0,57; IC: 0,52-0,63). Conclusão: a cura a seco é eficaz em países com baixa taxa de mortalidade infantil e em nascimentos no contexto hospitalar. No entanto, a cura com clorexidina 4% protege contra a onfalite nos nascimentos domiciliares, em países com elevada mortalidade infantil.

RESUMEN Objetivo: comparar el efecto de la cura seca y de la aplicación de clorhexidina en el cordón umbilical de los recién nacidos en el riesgo de desarrollo de onfalitis. Método: revisión sistemática con metaanálisis. Se seleccionaron ensayos clínicos que compararan la cura seca con la aplicación de clorhexidina evaluando la onfalitis. Calidad metodológica evaluada con Consolidated Standards of Reporting Trials. Resultados: el análisis conjunto de los estudios muestra una reducción significativa del riesgo de onfalitis en el grupo de clorhexidina en comparación con cura seca (RR=0,58; IC: 0,53-0,64). Sin embargo, en el análisis por subgrupos, la cura con clorhexidina no aportó reducción del riesgo de onfalitis en nacimientos hospitalarios (RR=0,82; IC: 0,64-1,05) en países con baja tasa de mortalidad infantil (RR=0,8; IC: 0,5-1,28), ni a concentraciones de clorhexidina inferiores al 4% (RR=0,55; IC: 0,31-1). La clorhexidina actuó como factor protector a concentraciones del 4% (RR=0,58; IC: 0,53-0,64), aplicada en nacimientos en el hogar (RR=0,57; IC: 0,51-0,62), en países con elevada mortalidad infantil (RR=0,57; IC: 0,52-0,63). Conclusión: la cura seca es eficaz en países con baja tasa de mortalidad infantil y nacimientos en ámbito hospitalario. Sin embargo, la cura con clorhexidina al 4% protege de onfalitis en nacimientos en el hogar, en países con elevada mortalidad infantil.

Práctica basada en evidencia en estudiantes de enfermería colombianos / Practice based on evidence from Colombian nursing students / Prática baseada na evidencia de estudantes colombianos de enfermagem

Objetivo. Determinar el nivel de competencias sobre Práctica Basada en Evidencia en estudiantes de un programa de Enfermería de Colombia. Materiales y métodos. Mediante un diseño cuantitativo, descriptivo y correlacional, el estudio se desarrolló en 2 fases. La primera fase consistió en la adaptación cultural y validación de contenido del cuestionario de Competencias en Práctica Basada en la Evidencia (CACH-PBE) al contexto Colombiano; este instrumento valora tres factores: Actitudes, Habilidades y Conocimientos. En la segunda fase se aplicó el cuestionario a una muestra de 291 estudiantes del Programa de Enfermería de una Universidad de Cúcuta, Colombia, durante el primer semestre del 2016. Resultados. Se encontró un promedio de edad de 20 años, de género femenino en su mayoría, el 57,4 % de ellos no tenía ninguna formación previa sobre PBE y el 57.1 % la había recibido en metodología de investigación. La puntuación global de competencia en PBE fue de 3,58 sobre un máximo de 5, destacando la dimensión Actitudes hacia la PBE con mayor puntuación y la dimensión Conocimientos con menor; encontrándose diferencias estadísticamente significativas a mayor medida en que los estudiantes se encontraban en un semestre superior. Conclusiones. Los estudiantes obtuvieron un nivel medio en competencias para la PBE, asociándose un impacto positivo de la formación académica recibida, ya que en los últimos semestres se evidenció mayor puntuación con respecto a los primeros.

Objective: To determine the level of competence regarding Practice Based on Evidence in students of a nursing program in Colombia. Materials and methods: Through a quantitative, descriptive, and correlational design, the study was developed in two phases. The first phase, consisted on the cultural adaptation and validation of the content of the questionnaire of Competitions in Practice Based on Evidence (CACH-PBE) to the Colombian context; this instrument evaluates 3 factors: attitudes, skills, and understanding. In the second phase, the questionnaire was applied to a sample of 291 students of the nursing program of a university in Cucuta­ Colombia during the first semester of 2016. Results: An average age of 20 years was found, mostly females, 57.4% did not have previous training about PBE and 57.1% had received training of PBE in methodology of research. The global score in PBE competence was of 3.58 out of a maximum of 5; highlighting the Attitude dimension toward the PBE with the highest score and the Knowledge dimension with the lowest score; encountering statistically significant differences to a greater extent as the students moved ahead to a higher semester. Conclusions: The students received an average level in competences for the PBE, associating a positive impact with the academic training received, considering that in the last semesters a higher score was evidenced compared to the first ones.

Objetivo. Determinar o nível de competências sobre Prática Baseada na Evidencia (PBE) de estudantes de um curso de Enfermagem na Colômbia. Materiais e métodos. O estudo se desenvolveu em duas fases, através um delineamento quantitativo, descritivo e correlacional, A primeira fase, consistiu na adaptação cultural e validação de conteúdo do questionário de Competências em Prática Baseada na Evidencia (CACH-PBE) no contexto Colombiano; este instrumento valora três fatores: Atitudes, Habilidades e Conhecimentos. Na segunda fase, aplicou-se o questionário a uma amostra de 291 estudantes do Programa de Enfermagem de uma Universidade localizada na cidade de Cúcuta ­ Colômbia, durante o primeiro semestre de 2016. Resultados. Encontrou-se uma média de idade de 20 anos, de género feminino em sua maioria, o 57,4% deles não tinham nenhuma formação previa sobre PBE e o 57,1% a receberam em metodologia da pesquisa. A pontuação global de competência em PBE foi de 3,58 sobre um máximo de 5; destacando a dimensão Atitudes para a PBE com maior pontuação e a dimensão Conhecimentos com menor; encontrando-se diferenças estatisticamente significativas a maior medida em que os estudantes se encontravam num semestre superior. Conclusões. Os estudantes obtiveram um nível médio em competências para a PBE, associando-se um impacto positivo da formação académica recebida, já que nos últimos semestres se evidenciou maior pontuação respeito dos primeiros.

[Cultural adaptation and content validation of the «Pain level¼ outcome of the Nursing Outcomes Classification]. / Adaptación cultural y validación de contenido del resultado «Nivel del dolor¼ de la Clasificación de Resultados de Enfermería.

AIMS: To translate and culturally adapt the Pain Level outcome to the Spanish context to validate the contents of the Spanish version of the «Pain level¼ outcome. METHOD: The original English version of the «Pain level¼ outcome was translated into Spanish (twice); then back-translated into English, and all the discrepancies were resolved after consulting with NOC authors. A panel consisting of 21 experts in pain care assessed this culturally adapted Spanish version, in order to score the content validity. In the first step, the experts scored the adequacy of each indicator to the concept «Pain level¼. In the second round, three new indicators were scored. The Statistical analysis included content validity index (CVI), probability of agreement by chance, and modified kappa statistic. RESULTS: A Spanish version was developed including label, definition, two groups of indicators, and two measurement scales. This version is fully adapted to the Spanish context and language. A set of 21 indicators (19 translated and two new) was selected, and 4 were deleted (three translated and one new). The CVI-average score was 0.83 and the CVI-universal agreement was 0.05. CONCLUSION: The Spanish-version of the outcome «Pain level¼ is semantically and culturally to adapted to a Spanish context and preserves equivalency with the original. Content validation has identified indicators useful for practice. The clinimetric properties (validity and reliability) of the adapted version could be tested in a clinical study with people suffering from acute pain.

Pressure ulcer care in Spain: nurses' knowledge and clinical practice.

AIM: This paper is a report of a study to determine: (a) Spanish nurses' level of knowledge of existing guidelines for pressure ulcer prevention and treatment, (b) the level of implementation of this knowledge in clinical practice and (c) the professional and educational factors that influence knowledge and practice. BACKGROUND: Improvement in pressure ulcer care depends both on the dissemination of knowledge and on its implementation in clinical practice. Studies carried out in several countries have demonstrated gaps in knowledge about recommendations for pressure ulcer care and deficiencies in their implementation. METHODS: A survey was carried out between September 2001 and June 2002, targeting a cluster randomized sample of 2006 Registered Nurses and Licensed Practice Nurses working at hospitals, primary healthcare centres and elder care centres in Andalusia (Spain). RESULTS: The response rate was 36.9% (n = 740). The level of knowledge of prevention interventions was 79.1%, while that of treatment interventions was 75.9%. The levels of implementation in clinical practice were notably lower: 68.1% for prevention, and 65.3% for treatment. Nurses holding a university degree obtained higher scores, and those who had received specific education in pressure ulcer care obtained higher scores both for knowledge and clinical practice. Taking part in research projects also improved knowledge implementation. CONCLUSION: Although most of the recommendations on pressure ulcer care found in guidelines are well known by nurses, there is a group of interventions about which they have insufficient knowledge and low implementation rates.