Community Care Needs of Highly Complex Chronic Patients: An Epidemiological Study in a Healthcare Area.

One of the priorities in family and community care is the epidemiological surveillance of the care needs and dysfunctionality present in populations of highly complex chronic patients (HCCPs) using standardised nursing languages. The aim of this study is to establish the prevalence of care needs and dysfunctionality among HCCPs in a specific health area by municipalities and geographical areas (metropolitan, north, and south) while verifying correlations with sociodemographic, financial, and health characteristics. This is an epidemiological, observational, descriptive, cross-sectional study carried out with a sample of 51,374 HCCPs, whose data were grouped into 31 municipalities. Data were collected on the following variables: sociodemographic, financial, health, functional status (health patterns), and care needs (nursing diagnoses). The mean age of the HCCPs was 73.41 (1.45) years, of which 56.18 (2.86)% were women. The municipalities in the northern area have a significantly higher proportion of older patients, HCCPs, lower incomes, and higher unemployment rates. The southern area had higher proportions of non-Spanish nationals and professionals in the hotel and catering industry, and the metropolitan area had a higher proportion of employed individuals and higher levels of education. Northern municipalities had a higher prevalence of illnesses and anxiolytic and anti-psychotic treatments. Dysfunctionality frequencies did not differ significantly by area. However, a higher prevalence of 13 nursing diagnoses was observed in the north. A high number of correlations were observed between population characteristics, dysfunctionality, and prevalent diagnoses. Finally, the frequencies of dysfunctionality in the population and the most common care needs were mapped by municipality. This research sought to ascertain whether there was an unequal distribution of these two aspects among HCCPs in order to gain a deeper epidemiological understanding of them from a family and community perspective using standardised nursing languages. This study was not registered.

Continuing Bonds in grieving men: A comparative description of Costa Rica and Spain.

Continuing Bonds among grieving men from Costa Rica and Spain were compared, with the primary hypothesis that there would be significant differences between the two groups. A descriptive, comparative, and cross-sectional research study was conducted. Non-probability and convenience sampling was employed, involving 227 grieving men who completed an online questionnaire comprising sociodemographic data, mediators of mourning, and the Continuing Bonds Scale. The results did not reveal significant differences in Continuing Bonds expressions. However, upon controlling for the interaction between degree of kinship with the deceased person, notable differences emerged in Continuing Bonds and internalized and externalized Continuing Bonds (p < 0.05). The influence of sociocultural factors in each country on Continuing Bonds expressions is considered. The findings could support the development of strategies centered on grieving men, Continuing Bonds, and their specific needs.

Continuidad de vínculos, hombres y mujeres en duelo por un ser querido: un análisis secundario / Continuing bonds, men, and women in bereavement: A secondary analysis

Introducción: El duelo es una respuesta compleja ante la pérdida de un ser querido que exhibe diferentes rutas para su ajuste, la continuidad de vínculos forma parte de su naturaleza. Objetivo: Analizar la experiencia de duelo por un ser querido en hombres y mujeres relacionada a percepción de cercanía con la persona fallecida, continuidad de vínculos y diagnósticos de Enfermería. Materiales y Métodos: Análisis secundario. Muestra a conveniencia de 251 dolientes, adultos, residentes de Canarias, hispanohablantes. Recolección con encuesta en línea compuesta por características sociodemográficas y de salud, y relacionadas con la pérdida, Escala de inclusión del otro en el yo, Escala de Continuidad de Vínculos y diagnósticos de Enfermería. Se utilizó análisis descriptivo, U de Mann-Whitney, coeficiente de Spearman. Nivel de significancia p<0,05. Resultados: Edad media de 45,09 años ±10,38. Un 22,70% (57) fue hombre, 77,30% (194) mujer. Se identificaron diferencias significativas entre hombres y mujeres en percepción de cercanía con el fallecido (p<0,05), y relaciones significativas entre percepción de cercanía con el fallecido, continuidad de vínculos y diagnósticos de Enfermería (p=0,001). Discusión: Al confrontar los resultados con otros estudios se presentan algunas consistencias y diferencias en el comportamiento de las variables demostrando el dinamismo del fenómeno. Conclusiones: Para este grupo de participantes, la experiencia de duelo no estaría ligada a construcciones sociales de género si no que contesta a una respuesta de afrontamiento según sus necesidades. La comprensión del proceso de duelo permite a la Enfermería de Salud Mental implementar acciones fundamentadas en el Proceso de Enfermería.

Introduction: Grief is a complex response to the loss of a loved one with different ways of adjustment, and Continuing Bonds are part of its nature. Objective: To analyze men's and women's experiences of grief in terms of perception of closeness to the deceased, Continuing Bonds, and Nursing diagnoses. Materials and Methods: Secondary analysis. A convenience sample of 251 Spanish-speaking adult mourners, residents of the Canary Islands, was used. Data was collected via an online survey consisting of socio-demographic, health, and loss-related characteristics, the Inclusion of Other in the Self scale, the Continuing Bonds Scale, and Nursing diagnoses. Descriptive analysis, Mann-Whitney U test, and Spearman's coefficient were used. Level of significance p<0.05. Results: The mean age was 45.09 years ±10.38 years; 22.70% (57) were male, and 77.30% (194) were female. Significant differences were found between men and women in the perception of closeness to the deceased (p<0.05), and significant relationships were found between the perception of closeness to the deceased, Continuing Bonds, and Nursing diagnoses (p=0.001). Discussion: A comparison of the results with other studies shows some consistencies and differences in the behavior of the variables, demonstrating the dynamism of the phenomenon. Conclusions: For this group of participants, the experience of grief would not be linked to social constructions of gender but instead respond to a coping response according to their needs. Understanding the grieving process allows Mental Health Nursing to implement interventions based on the Nursing Process.

Introdução: O luto é uma resposta complexa à perda de um ente querido que apresenta diferentes caminhos de ajustamento, a continuidade dos laços faz parte da sua natureza. Objetivo: Analisar a vivência do luto por um ente querido em homens e mulheres relacionada à percepção de proximidade com a pessoa falecida, continuidade de vínculos e diagnósticos de Enfermagem. Materiais e Métodos: Análise secundária. Amostra para conveniência de 251 enlutados, adultos, residentes nas Ilhas Canárias, falantes de espanhol. Coleção com inquérito online composto por características sociodemográficas e de saúde, e relacionadas à perda, Escala de inclusão do outro no eu, Escala de Continuidade de Vínculos e diagnósticos de Enfermagem. Foram utilizadas análise descritiva, U de Mann-Whitney, coeficiente de Spearman. Nível de significância p<0,05. Resultados: Idade média de 45,09 anos ±10,38. 22,70% (57) eram homens, 77,30% (194) eram mulheres. Foram identificadas diferenças significativas entre homens e mulheres na percepção de proximidade com o falecido (p<0,05), e relações significativas entre percepção de proximidade com o falecido, continuidade de vínculos e diagnósticos de Enfermagem (p=0,001). Discussão: Ao comparar os resultados com outros estudos, apresentam-se algumas consistências e diferenças no comportamento das variáveis, demonstrando o dinamismo do fenômeno. Conclusões: Para este grupo de participantes, a vivência do luto não estaria ligada a construções sociais de género, mas responde a uma resposta de enfrentamento de acordo com as suas necessidades. A compreensão do processo de luto permite à Enfermagem em Saúde Mental implementar ações pautadas no Processo de Enfermagem.

Knowledge of Diabetic Retinopathy among Primary Care Nurses Performing Fundus Photography and Agreement with Ophthalmologists on Screening.

Diabetic retinopathy (DR) is one of the complications of diabetes mellitus (DM), with macular oedema being one of the leading causes of avoidable blindness among individuals with DM worldwide. Fundus screening is the only method for early detection and treatment. High-quality training programmes for professionals performing primary care screening are essential to produce high-quality images that facilitate accurate lesion identification. This is a two-phase observational, descriptive, and cross-sectional study. The first phase analysed DR knowledge in a sample of nurses. The second phase explored agreement on DR screening between referral ophthalmologists in image assessment (gold standard) and a small group of nurses involved in the previous phase. In phase 1, the agreement rate for screening results was 90%. In phase 2, the overall raw agreement on the screening of fundus photography results between nurses and ophthalmologists was 75% (Cohen's kappa = 0.477; p < 0.001). Agreement on screening with ophthalmologists was moderate, suggesting that implementing a specific training programme for nurse-led imaging screening would help develop this competence among nurses, ensuring a good level of agreement and patient safety and adding value for users, and also for the sustainability of the healthcare system. This study was not registered.

Psychosocial Care Needs, Personality Styles, and Coping Strategies of Mourners in a Rural Municipality in Spain: An Observational Study.

Grieving is a natural, self-limiting process of adaptation to a new reality following a significant loss, either real or perceived, with a wide range of manifestations that have an impact on the health of the grieving individual. This study aims to analyse the relationships between interpersonal styles, coping strategies, and psychosocial care needs in a sample of mourners in a rural municipality. Initial hypothesis: there are associations between types of grief and psychosocial needs, as well as between types of grief and interpersonal styles or coping strategies. An observational, descriptive, analytical, cross-sectional study was carried out with a sample of 123 people. Female participants represented 64.2% of all participants. The mean age was 42.7 (±13.2) years, and 86.2% of participants reported continuing to suffer from the loss, with a 10.5% prevalence of maladaptive grieving. Regarding the associations identified between coping strategies and the interpersonal characteristics of the mourners, we found that those with the best coping scores described themselves as self-confident, boastful, jovial, forceful, gentle-hearted, self-assured, outgoing, and/or neighbourly. By contrast, mourners who obtained poorer coping scores self-identified as shy, unsparkling, timid, unsociable, unbold, and/or bashful. This provides a clinical profile linked to maladaptive grieving in which emotional, self-perception, and social problems are prevalent.

Nursing Diagnoses, Planned Outcomes and Associated Interventions with Highly Complex Chronic Patients in Primary Care Settings: An Observational Study.

The information logged by nurses on electronic health records (EHRs) using standardised nursing languages can help us identify the characteristics of highly complex chronic patients (HCCP) by focusing on care in terms of patients' health needs. The aim of this study was to describe the profile of HCCPs using EHRs from primary care (PC) facilities, presenting patients' characteristics, functional status based on health patterns, NANDA-I nursing diagnoses, health goals based on Nursing Outcomes Classification (NOC), and care interventions using Nursing Interventions Classification (NIC). With an observational, descriptive, cross-sectional, epidemiological study design, this study was carried out with a sample of 51,374 individuals. The variables were grouped into sociodemographic variables, clinical variables, resources, functional status (health patterns), nursing diagnoses, outcomes, and interventions. A total of 57.4% of the participants were women, with a mean age of 73.3 (12.2), and 51% were frail or dependent. Prevalent conditions included high blood pressure (87.2%), hyperlipidaemia (80%), osteoarthritis (67.8%), and diabetes (56.1%). The participants were frequent users of healthcare services, with 12.1% admitted to hospital in the past year. Some 49.2% had one to four health patterns assessed, with more information on biological and functional aspects than on psychosocial aspects. The mean number of nursing diagnoses was 7.3 (5.2), NOC outcomes 5.1 (4.1), and NIC interventions 8.1 (6.9). Moderately and highly significant differences were observed between dysfunction in physical activity/exercise health pattern and age group, and between dysfunction in other health patterns and classification as a frail or dependent elderly person. Regarding the presence of certain nursing diagnoses, significant differences were observed by age group, classification of elderly person status, and presence of diseases. A total of 20 NIC interventions showed moderately or relatively strong associations for older age groups, higher levels of dependency, and chronic health conditions.

Use of the Nursing Interventions Classification and Nurses' Workloads: A Scoping Review.

BACKGROUND: The Nursing Interventions Classification allows the systematic organisation of care treatments performed by nurses, and an estimation of the time taken to carry out the intervention is included in its characteristics. The aim of this study is to explore the evidence related to the use of the Nursing Interventions Classification in identifying and measure nurses' workloads. METHODS: A scoping review was conducted through a search of the databases Ovid Medline, PubMed, Web of Science, CINAHL, Scopus, LILACS and Cuiden. The DeCS/MeSH descriptors were: "Standardized Nursing terminology" and "Workload". The search was limited to articles in Spanish, English and Portuguese. No limits were established regarding year of publication or type of study. RESULTS: Few reports were identified (n = 8) and these had methodological designs that contributed low levels of evidence. Research was focused on identifying specific interventions, types of activities, the prevalence of interventions and the time required to perform them. CONCLUSIONS: The evidence found on determination of nurses' workloads using the Nursing Interventions Classification was inconclusive. It is essential to increase the number of reports, as well as the settings and clinical context in which the Nursing Interventions Classification is used, with greater quality and methodological rigour.

Care Needs of Highly Complex Chronic Patients in the Canary Islands: An Observational Study.

In the last few decades, the impact of chronic health conditions on health systems, as well as on the quality of life, frailty, and dependence of those affected, has been brought to light. The objective of this study was to describe the population care needs of highly complex chronic patients (HCCPs). METHODS: An epidemiological observational study was conducted. RESULTS: A total of 13,262 patients were identified, 51% of which were elderly women. Among all patients, 84.4% had received a nursing assessment related to health patterns. Three diagnoses were established in 25% of the sample: readiness for enhanced health management, impaired skin integrity, and risk for falls. There were significant differences according to age, most importantly in terms of impaired skin integrity (39% of patients under 80 years old). Risk for falls, social isolation, situational low self-esteem, chronic low self-esteem, impaired home maintenance, anxiety, ineffective health management, ineffective coping, impaired memory, insomnia, and self-care deficits were more common in those living alone. A total of 37 diagnoses featured differences according to frailty/dependence. Approximately 23% of HCCPs suffered from frail elderly syndrome. CONCLUSIONS: This study presents the most common care needs of HCCPs, describing the sociodemographic profile of this part of the population. The planning of HCCP care varies in nature. Factors such as the dependence level and frailty of these people should be taken into consideration.

A New Instrument for Measuring Dietary Knowledge in Patients With Diabetes: Psychometric Testing of the CoNOCidiet-Diabetes.

PURPOSE: To determine the psychometric properties of the CoNOCidiet-Diabetes, a new instrument based on nursing outcome "Knowledge: prescribed diet." METHODS: Methodological design. The participant were 359 patients diagnosed with diabetes visiting 27 primary healthcare centers in Spain. Reliability (internal consistency and test-retest), validity (convergent criterion validity, concurrent content validity and known-groups validity), and sensitivity to change was tested. FINDINGS: CoNOCidiet-Diabetes has shown evidence of acceptable psychometric properties as instrument but some items should be revised. CONCLUSIONS: This research provides a new instrument developed to specifically measure dietary knowledge in individuals with diabetes. IMPLICATIONS: For nursing practice: The literalness of the CoNOCidiet-Diabetes with the nursing outcome "Knowledge: prescribed diet" facilitate its measurement using the patient's statements.

OBJETIVO: Determinar las propiedades psicométricas del CoNOCidiet-Diabetes, un nuevo instrumento basado en el resultado enfermero "Conocimiento: dieta prescrita". MÉTODOS: Diseño metodológico. Los participantes fueron 359 pacientes diagnosticados de diabetes que acudieron a 27 centros de atención primaria de salud en España. Se comprobó la fiabilidad (consistencia interna y test-retest), la validez (validez de criterio convergente, validez de contenido concurrente y validez de grupos conocidos) y la sensibilidad al cambio. RESULTADOS: El CoNOCidiet-Diabetes ha mostrado evidencias de tener unas propiedades psicométricas aceptables como instrumento, pero algunos ítems deben ser revisados. CONCLUSIONES: Esta investigación proporciona un nuevo instrumento desarrollado para medir específicamente el conocimiento sobre dieta en personas con diabetes. IMPLICACIONES PARA LA PRÉCTICA ENFERMERA: La literalidad del CoNOCidiet-Diabetes con el resultado enfermero "Conocimiento: dieta prescrita" facilita la medición de este último utilizando las declaraciones del paciente.

Bereavement care interventions and outcome criteria planned by community nurses in the Canary Islands. / Intervenciones y criterios de resultado planificados por las enfermeras comunitarias en la atención al duelo en Canarias.

Nursing care in bereavement is complex. Primary health care is the ideal setting to support the bereaved, but we do not know much about the care plans designed by primary health care nurses in the treatment of grief. OBJECTIVE: To identify the outcomes criteria and interventions planned by nurses for mourners with and without complications in the Canary Islands. METHOD: Retrospective longitudinal study, using the electronic health records of the Canary Islands health service of people with a diagnosis of grieving, risk of complicated grieving and complicated grieving, in the period 2009-2014. RESULTS: NOC outcomes criteria were recorded in 67% of the mourners, and up to 24 different outcomes were identified. The main outcomes measures were Grief resolution; Psychosocial adjustment, Life change; Coping; Family coping; Family social climate and Caregiver emotional health. The remaining outcomes were present in less than 1% of the mourners. Although the outcomes criteria proposed by nurses in the mourners with and without complications were quite homogeneous, differences in interventions were found. In 67% of the cases, NIC interventions were reported. Ninety-nine different interventions were identified in the mourners; the most frequent were Emotional support; Grief work facilitation; Active listening; Coping enhancement and counselling. The remaining identified interventions were present in less than 5% of patients. The main interventions in the mourners with complications were Grief work facilitation; Coping enhancement; Active listening; Counselling and Family integrity promotion. CONCLUSION: Nurses state that there are more interventions and outcomes in mourners with complications. Given the few methodologically reliable studies that prove their effectiveness, continued research in this area is recommended.

Blogged nursing: analysis of the phenomenon and contextualization in the Spanish setting.

Blogging within the health profession has grown in the recent past. This article aims to perform an analysis of the theoretical aspects of blogging, the use by professional nurses and students, benefits for patients, and, finally, an approach to the activities of Spanish nursing blogs. Blogs have great advantages as social communication tools. Immediacy in content update, closeness to information consumers, and compatibility with other Web 2.0 tools are points to be highlighted. Nurses use blogs for education and communication with other health professionals, students, and patients. For patients, therapeutic effects have been demonstrated in using blogging to share their health problems and express their experiential viewpoints. There are about 80 blogs written by Spanish nurses; most of them originated in the period between 2010 and 2012. These blogs are targeted to professionals (59%), patients (20%), or mixed (13%). There is a great heterogeneity in content: informative style (20%), opinion (28%), narrative (9%), experiential (2%), or humorous (2%). Nursing language is present in 15%, research and evidence-based practice in 13%, and protocols, guidelines, and procedures in 11% of them. We propose the need to plan institutional strategies for effective use of Web 2.0 resources as well as the need to unify criteria to provide quality content.