[Primary care pathways and locations during the pandemic in a rural area of Alicante]. / Vías y lugares de atención primaria durante la pandemia en una zona rural de Alicante.

This paper describes the means of health care used in a primary health care centre (PHCC) in a rural area to care for patients during the COVID-19 pandemic. After conducting a cross-sectional study using health questionnaire with 243 patients (100 COVID-19 and 143 other pathologies), we observed that general medical care was 100% by telephone, and little use was made of the portal for citizen information and appointment requests of the Conselleria de Sanitat de la Comunidad Valenciana. Nursing attended 100% by telephone, as did the PHCC doctors and the PHCC emergencies; in the case of taking samples, blood samples and wound care it was face-to-face (men 91%, women 88%), and at home (9% and 12%). In conclusion, different care patterns are observed according to the PHCC professionals, and the need to improve the online pathway with care management.

[Urinary tract infections in older adults: Etiology and antimicrobial susceptibilities in a southern area of Spain]. / Infecciones del tracto urinario en personas mayores: etiología y susceptibilidades antimicrobianas en un área del sur de España.

INTRODUCTION: Urinary tract infection (UTI) is one of the most prevalent diseases in clinical practice and increases in patients older than 65years compared to middle-aged patients. In order to improve empirical treatment, the etiology and antibiotic sensitivity profile of the most frequent bacteria that produce UTIs in older people have been studied. MATERIAL AND METHODS: Cross-sectional, descriptive and retrospective study in which isolated micro-organisms with significant counts in urine samples from patients with UTI were included. The global etiology and according to sex were analyzed. Only one urine sample per patient and UTI episode was considered. RESULTS: Regarding the origin of the sample, the highest proportion was in primary care with 4853 urine cultures (51.6% of positive urine cultures), followed by hospital care with 3565 urine cultures (46.4% of positive urine cultures) and 94 urine cultures in nursing homes elderly (2% positive urine cultures). Escherichia coli was the most isolated micro-organism both in the population as a whole (54%) and in each of the analyzed groups. It was observed that E.coli isolated in women was significantly higher than in men (χ2, P=.044). Their sensitivity was: 80% fosfomycin and 75% amoxicillin-clavulanic acid. CONCLUSIONS: E.coli continues to be the most frequently isolated micro-organism in UTI. Empirical treatment of UTI in our environment should include fosfomycin or amoxicillin-clavulanic acid, regardless of the health care unit and gender.

[Effectiveness of the influenza vaccine in the prevention of influenza in people over 65 years of age]. / Efectividad de la vacuna antigripal en la prevención de la gripe en personas mayores de 65 años.

INTRODUCTION: Influenza is one of the diseases with the greatest epidemiological impact and of maximum relevance in the management of health services. The flu vaccine can have great variability each season, so our objective was to find out the effectiveness of the flu vaccine for the 2017/2018 season for the prevention of severe cases of flu in people over 65 years of age in a 385-bed acute general hospital. MATERIAL AND METHOD: Study of cases and controls. All hospitalized patients with laboratory-confirmed influenza older than 65 years during the 2017/2018 season were included. Those who met the criteria for a severe case of influenza were considered cases. Those who did not meet the severity criteria were considered controls. Factors associated with the development of severe influenza were calculated. RESULTS: The median age was 68 years (SD 91.87). The attack rate was 0.23 per hundred inhabitants and the vaccine effectiveness was 38%. The vaccinated and unvaccinated groups were different in terms of age (p < 0.0481). Vaccination status against severe influenza was found to be an independent protective factor (OR = 0.840; 0.746-0.913). CONCLUSIONS: The effectiveness of influenza vaccination provided greater protection against infection and reduced the severity of influenza in older hospitalized patients. These findings should be taken into account to improve vaccination strategies and achieve better vaccination coverage in the population at risk.

Percepción de los estudiantes de enfermería con las prácticas clínicas durante la pandemia covid-19

Objetivo: Conocer la percepción de los estudiantes de tercer grado de enfermería del ambiente de aprendizaje de prácticas clínicas durante el periodo de pandemia Covid-19. Material y Método: Estudio cualitativo fenomenológico que se llevó a cabo en un curso académico 2021-2022, de una universidad en Alicante, España. Participaron 15 estudiantes de tercer curso del grado de enfermería en el ambiente de aprendizaje de prácticas clínicas (5 módulos de prácticas, de 17 días cada uno) durante el periodo Covid-19 y en ámbitos de atención primaria y especializada. Se empleó un tipo de muestreo intencionado y se aplicaron las preguntas guía en entrevistas semiestructuradas hasta la saturación del objeto de estudio. Los datos fueron sometidos a análisis de contenido según Bardin. Resultados: Los participantes manifestaron preocupación ante la percepción con las prácticas clínicas durante la pandemia Covid-19, lo que permitió establecer una categoría principal denominada "Conocer". A partir de esta categoría principal se desarrollan las siguientes subcategorías: 1) Relación con los tutores, 2) Ambiente pedagógico en la sala de hospitalizados, 3) Rol de la enfermera docente, 4) Relación con la supervisora y el equipo clínico y 5) Documentación de enfermería. Conclusiones: Las percepciones de los estudiantes sobre el entorno de aprendizaje en las prácticas clínicas pueden considerarse aceptables, lo que refuerza la idea de que la práctica clínica en un entorno de apoyo podría motivar a los estudiantes y ayudarlos a adquirir conocimientos incluso en periodo de pandemia de Covid-19.

Objective: To know the perception of third year students of the nursing program in the learning environment of clinical practice during the period of the Covid-19 pandemic. Material and Methods: A qualitative phenomenological study was conducted in the academic year 2021-2022, from a university of Alicante, Spain. 15 third-year nursing students participated in the clinical practice-learning environment (5 practice modules of 17 days each) during the Covid-19 period and in primary and specialized care settings. An intentional sampling technique was used and the guiding questions were applied in semi-structured interviews until reaching saturation. The data were subjected to Bardin's content analysis. Results: Participants expressed concerns about the perception of clinical practices during the Covid-19 pandemic, which allowed the establishment of a main category called "to know". From this main category, the following subcategories were developed: 1) Relationship with instructors, 2) Educational environment in the inpatient treatment room, 3) Role of the nurse educator, 4) Relationship with the supervisor and the clinical team, and 5) Nursing documentation. Conclusions: Students' perceptions of the learning environment in the clinical practice can be considered acceptable, which reinforces the idea that clinical practice in a supportive environment can motivate students and help them acquire knowledge even in the period of the Covid-19 pandemic.

Objetivo: Conhecer a percepção dos estudantes do terceiro ano do programa de enfermagem sobre o ambiente de aprendizagem da prática clínica durante o período da pandemia da Covid-19. Material e Método: Estudo fenomenológico qualitativo realizado no ano académico 2021-2022 na uma universidade de Alicante, Espanha. 15 estudantes de enfermagem do terceiro ano participaram do ambiente de aprendizagem de prática clínica (5 módulos de prática de 17 dias cada) durante o período da Covid-19 em ambientes de atendimento primário e especializado. Utilizou-se uma técnica de amostragem intencional e as perguntas orientadoras foram aplicadas em entrevistas semiestruturadas até atingir a saturação. Os dados foram submetidos à análise de conteúdo de Bardin. Resultados: Os participantes manifestaram preocupação com a percepção das práticas clínicas durante a pandemia de Covid-19, o que permitiu estabelecer uma categoria principal denominada "conhecer". A partir desta categoria principal desenvolvem-se as seguintes subcategorias: 1) Relacionamento com os tutores, 2) Ambiente pedagógico na enfermaria do hospital, 3) Papel do enfermeiro docente, 4) Relacionamento com o supervisor e a equipe clínica e 5) Documentação de enfermagem. Conclusões: As percepções dos estudantes sobre o ambiente de aprendizagem nas práticas clínicas podem ser consideradas aceitáveis, o que reforça a ideia de que a prática clínica num ambiente de apoio pode motivar os estudantes e ajudá-los a adquirir conhecimento, mesmo no período de pandemia da Covid-19.

[Medication safety during the COVID-19 pandemic in primary care nurses]. / Seguridad de medicamentos durante la pandemia COVID-19 en las enfermeras de atención primaria.

OBJECTIVE: To know the perception of nurses about the factors that influence the safe administration of medications during the COVID-19 period, in the work context in a primary care health department of the Spanish national health system. DESIGN: This is a qualitative phenomenological study. SITE: Carried out in the Department of Health 21 (Alicante, Spain) between the months of September 2021 and November 2021. PARTICIPANTS: Fifteen nurses chosen by intentional sampling. METHODS: A semi-structured interview lasting between 30 and 60min was used, recorded and transcribed verbatim by the research team. A main category called "know" is established, which encompasses all the reflections about the nurse's performance during the medication administration process. RESULTS: The participants expressed concern about the performance of medication administration procedures, which made it possible to perceive safety as the greatest concern in the study unit. From this main category, the following subcategories are developed: work overload, insufficient training, distractions and communication and information failures. CONCLUSION: Knowing the perception of nurses about the factors that influence the safe administration of medications could facilitate the use of instruments to standardize and reduce variability in the safe administration of medications. As well as improving conditions in work environments at the community level, and not favoring social, personal and professional stigmatization due to care error.

[Perception of the safe administration of medications in primary care]. / Percepción de la administración segura de medicamentos en atención primaria.

The purpose of this study was to know the perception of nurses about safety in the preparation and administration of medications in a primary care health department of the Spanish national health system. Cross-sectional descriptive study. Carried out in the Health Department 21 (Alicante, Spain) in the months of September to November 2021. 66 nurses, with a predominance of women (88.9%). A semi-structured interview with ten questions was used. The inclusion criterion took into account nurses with more than two years of experience working in the health center. The perception of nurses about the degree of safety in the preparation and administration of medications was evaluated. 81.9% of the sample did not report adverse events. The steps for secure administration were varied. A significant association was observed in the correct time of medication (p < 0.031) and antisepsis (p < 0.026) according to the number of nurses in the basic health areas. Our results indicate the perceptions of nurses about improvements in the degree of implementation of standards or tools for the safe administration of medications, with special attention to lack of knowledge, care overload (high patient/nurse ratio) and associated dilemmas with the notification.

Nurses' Perceptions on the Implementation of a Safe Drug Administration Protocol and Its Effect on Error Notification.

Patient safety and quality of care are fundamental pillars in the health policies of various governments and international organizations. The purpose of this study is to evaluate nurses' perceptions on the degree of implementation of a protocol for the standardization of care and to measure its influence on notification of adverse events related to the administration of medications. This comparative study used data obtained from questionnaires completed by 180 nurses from medical and surgical units. Our analyses included analysis of variance and regression models. We observe that the responses changed unevenly over time in each group, finding significant differences in all comparisons. The mean response rating was increased at 6 months in the intervention group, and this level was maintained at 12 months. With the new protocol, a total of 246 adverse events and 481 incidents without harm was reported. Thus, actions such as the use of protocols and event notification systems should be implemented to improve quality of care and patient safety.