Effectiveness of the best practice spotlight organizations program to reduce the prevalence of pressure injuries in acute care settings for hospitalized patients in Spain: A quasi-experimental study.

BACKGROUND: Pressure injuries are a major public health problem because of their impact on morbidity and mortality, quality of life, and increased healthcare costs. The Centros Comprometidos con la Excelencia en Cuidados/Best Practice Spotlight Organization (CCEC/BPSO®) program provides guidelines that can improve these outcomes. AIMS: This study aimed to assess the effectiveness of the CCEC/BPSO® program in improving the care of patients at risk of pressure injury (PI) at an acute care hospital in Spain. METHODS: A quasi-experimental regression discontinuity design in three periods was used: (1) baseline (2014), (2) implementation (2015-2017), and (3) sustainability (2018-2019). The study population was comprised of 6377 patients discharged from 22 units of an acute care hospital. The performance of the PI risk assessment and reassessment, the application of special pressure management surfaces, and the presence of PIs were all monitored. RESULTS: Forty-four percent of patients (n = 2086) met the inclusion criteria. After implementing the program, the number of patients assessed (53.9%-79.5%), reassessed (4.9%-37.5%), the application of preventive measures (19.6%-79.7%), and the number of people identified with a PI in implementation (1.47%-8.44%) and sustainability (1.47%-8.8%) all increased. LINKING EVIDENCE TO ACTION: The implementation of the CCEC/BPSO® program achieved improved patient safety. Risk assessment monitoring, risk reassessment, and special pressure management surfaces were practices that increased during the study period and were incorporated by professionals to prevent PIs. The training of professionals was instrumental to this process. Incorporating these programs is a strategic line to improve clinical safety and the quality of care. The implementation of the program has been effective in terms of improving the identification of patients at risk and the application of surfaces.

Insomnia Symptoms and Associated Factors in Caregivers of Adult Hospitalized Patients.

Caregivers experience high levels of emotional stress and must cope with several clinical and hospital-related environmental factors that seriously impact their night's rest. The purpose of this study was to establish the prevalence of insomnia symptoms in a sample of caregivers of adult hospitalized patients and to examine the relationships between insomnia symptoms and patient and caregiver-associated factors. A total of 152 caregivers were enrolled from the two main hospitals in Granada, Spain. Sociodemographic, economic, and care-related data were collected. Insomnia symptoms, burden, anxiety and depression, social support, and resilience were assessed. Information on patients' hospital admission, dependence, and neuropsychiatric symptoms was also obtained. Most caregivers were middle-aged women caring for their spouses. Self-reported insomnia prevalence was set at 45.4%. Comparison analyses between caregivers suffering from insomnia symptoms and non-insomniacs showed significantly higher burden, anxiety and depression and patients' neuropsychiatric symptoms (p < 0.05) and lower resilience and social support in the former (p < 0.01). A regression analysis showed that anxiety (ORa = 1.15; p < 0.05) and higher caregiver education level (ORa = 5.50; p < 0.05) were factors significantly associated with insomnia symptoms. Patients' neuropsychiatric symptoms showed a trend toward statistical significance as well (ORa = 1.09; p = 0.06). There is an acute need to address, prevent and treat insomnia problems in caregivers.

Hospital Environmental Disruptors and Caregiver Sleep During Hospitalization.

PURPOSE: Caregivers must cope with a poor sleep environment when caring for someone admitted to the hospital. The aim was to study the environmental factors associated with a sleep disruption pattern in caregivers during hospitalization and to test their association with caregivers' insomnia symptoms. DESIGN: This was a cross-sectional study. METHODS: One hundred twenty-three caregivers completed the study. The effect of environmental stimuli on sleep disruption was measured on a scale from 1 to 10 (1 = no disruption, 10 = significant disruption). Type of room (single vs shared), insomnia symptoms, anxiety and depression, and patients' dependence (Barthel Index) were assessed as well. Caregiver and patient characteristics as well as identified hospital disruptors were compared with Student t test, χ2 test, and Fisher exact test according to the caregivers' type of room. A linear regression model using main caregiver and patient sociodemographic variables, questionnaires, and the sum of all hospital disruptors determined the factors associated with caregivers' insomnia symptoms. RESULTS: Of the caregivers and their care recipients, 51.2% shared a room with 1 to 2 other patients. Higher self-reported levels of sleep disruption due to environmental stimuli were found in shared rooms when compared with single rooms (eg, nursing care, noise, and light) (P < .05). Hospital sleep disruptors (adjusted regression coefficient, 0.15; 95% confidence interval, 0.06-0.24) and caregiver anxiety (adjusted regression coefficient, 0.57; 95% confidence interval, 0.33-0.81) were predictors for insomnia (P < .01). However, caregivers' type of room was not associated with insomnia severity symptoms (P > .05). CONCLUSIONS: Interventions are urgent to implement, such as relieving caregivers from patient needs during the night, providing them with single rooms, and conducting multiple nursing tasks in 1 visit to minimize night hospital noise.

Development and External Validity of a Short-Form Version of the INICIARE Scale to Classify Nursing Care Dependency Level in Acute Hospitals.

Background: The increasing dependence care in patients hospitalized in acute hospitals around the world entails classification systems heeding the wide range of care dependency levels generated by the many different types of dependent patients. This article is a report of a study assessing the validity and reliability of a short-from version of the instrument (Inventario del NIvel de Cuidados mediante Indicadores de Resultados de Enfermería (INICIARE)) used to classify inpatients according to their care dependency level. Methods: The validation, carried out in a multicenter longitudinal study, included three different samples: the first sample of 1800 patients to evaluate the reliability and validity, a second of 762 patients for confirmatory factor analysis, and a third of 762 to test the short-form version. Patients over 16 years of age, admitted to medical or surgical units at 11 public hospitals, were included. Results: The final sample included 3605 patients. Patients had a mean age of 64.5 years, 60% were admitted to medical units, with severe dependency. The validation process yielded two versions of the instrument: a 40-item version, with eight factors with 83.6% of total variance explained and Cronbach's alpha values between 0.98 and 0.92, and a short-form with 26 items, with five factors and Cronbach's alpha values between 0.96 and 0.90. The Confirmatory Factor Analysis yielded a good fit model to the 40-item version (Chi Square on Degrees of Freedom CMIN/DF) = 1.335; Normed Fit Index (NFI); Tucker-Lewis Index (TLI); Comparative Fit Index (CFI) > 0.90; Standardized Residual Root Mean Square (RMSEA) = 0.02; and Standardized Residual Root Mean Square (SRMR) = 0.027) and 26-item version (Chi Square on Degrees of Freedom CMIN/DF = 1.385; NFI = 0.998; CFI = 0.999; RMSEA = 0.02; and SRMR 0.02). Both INICIARE versions obtained a high correlation between them (r = 0.96; p < 0.001). Conclusion: INICIARE has proved to be a valid and reliable instrument for the assessment of the level of care dependency of acutely hospitalized patients.

Implementation of the best practice guideline for pressure ulcer prevention: Development, results and sustainability. / Implantación de la Guía de buenas prácticas en prevención de lesiones por presión: desarrollo, resultados y sostenibilidad.

AIM: To assess the impact of implementing the "Risk Assessment and Prevention of Pressure Injuries (PI)" guideline on adherence to its recommendations, the prevalence of PI and the sustainability of results, and to analyse the implementation strategies, sustainability and barriers detected. METHODS: A retrospective observational study (June 2015 to December 2018). Two periods were studied (P1: Preparation and P2: Sustainability). The programme reports and data from the medical records of patients discharged from the 4participating hospitals were analysed with regard to adherence to preventive recommendations and health outcomes in terms of the presence of pressure injuries per centre. RESULTS: A total of 13,515 patients were included, of whom 4,523 were at risk for PI and 722 had PI. Of the patients, 82.9% underwent a risk assessment for PI on admission. A decrease in this assessment on admission was observed between P1:89.1% vs. P2: 81% P<.001. Of the patients at risk, 42.1% were reassessed during their admission and a significant increase was observed between the periods P1: 30.7% vs. P2:46%; P<.001. 63.2% had a special pressure management surface, with a significant increase between P1:55.3% vs. P2: 65%; P<.001. The overall prevalence of PI was 5.5% and a significant decrease was observed on comparing P1: 6.6% vs. P2:5.1%; P=.003. The prevalence of nosocomial PI remained constant at 2.1%, P1:2% and P2:2.1%; P=.708. Institutional commitment, the appointment of leaders, drawing up of action plans, and training are outstanding strategies in all the centres. CONCLUSIONS: This study shows that there is adequate adherence to the main recommendations of the guideline. A statistically significant improvement was observed in adherence to 2 out of the 3 recommendations assessed. The implantation and sustainability strategies implemented have been contributed to maintenance and/or improving results over time.

Implementation of the assessment and care of adults at risk for suicidal ideation and behaviour: A guideline of the Registered Nurses' Association of Ontario (RNAO). / Implantación de la valoración y el cuidado de los adultos en riesgo de ideación y comportamiento suicida: una Guía de la Registered Nurses' Association of Ontario (RNAO).

OBJECTIVE: To establish the evolution of the care process after the implementation of the Best Practices Guideline «Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour¼. METHOD: A descriptive longitudinal study was carried out at the Mental Health Hospitalization Unit in Hospital Universitario Virgen de las Nieves, Granada. All patients admitted to the Unit between 2016 and 2018, 1471 in total, were included. Compliance of care process indicators and suicidal risk were evaluated; in addition, suicide rates per 100,000 inhabitants were obtained. Absolute and relative frequencies of the indicators were calculated, as well as the change during the study period by the chi-square Pearson test, for P<.05. RESULTS: We observed a statistically significant increase in the entire care process. The percentage of patients with suicidal risk assessment improved from 16% in 2016 to 45.25% in 2018. The application of safety measures grew reaching 100% in 2018, and community services referral went from 70.31% to 90.50%. The percentage of patients at risk of suicidal ideation remains stable. Suicide rates per 100,000 inhabitants in Granada decreased by 24.50%. CONCLUSIONS: Improvement in the care process and the decrease in the suicide rate in Granada since the implementation of the guideline are consistent with the results of other research and offer a hopeful vision. Comprehensive strategies for suicide prevention must be promoted, and the evaluation of initiatives undertaken must continue.

[Nursing mothers satisfaction with the promotion of breastfeeding and professionals adherence to the recommendations. Multi-center study.] / Satisfacción de madres lactantes con la promoción de la lactancia materna y adherencia de los profesionales a las recomendaciones. Estudio multicéntrico.

OBJECTIVE: The Baby-friendly Hospital Initiative or clinical practice guideline implementation programs have a positive impact on the promotion of breastfeeding (BF). There are knowledge gaps regarding the perceptions of new mothers towards these initiatives, and their degree of satisfaction. Our objective was to describe the satisfaction of BF mothers and adherence to the recommendations of the "Breastfeeding" guide from the Registered Nurses' Association of Ontario (RNAO). METHODS: Between 2018-2019, in 9 Spanish hospitals that implemented the guide, 2,397 nursing mothers were surveyed who met inclusion criteria. A self-administered survey was designed with sociodemographic data, mother-child, BF promotion interventions carried out and degree of satisfaction. Descriptive and bivariate analysis was performed. RESULTS: The recommendations for skin-to-skin contact, help in breastfeeding, observation of a breastfeeding session and resolution of doubts presented adhesions >84%. Information about support groups, rooming-in and recognize signs of baby satisfaction obtained adhesions <40%. The exclusive BF rate at discharge was 77.5%. The mean satisfaction with skin-to-skin contact and the percentage of satisfaction at discharge were 5.8 and 96.8% respectively. The differences were significant between the degree of satisfaction and the educational level, age, work situation, type of delivery and type of hospital (p<0.05). CONCLUSIONS: According to puerperal women, adherence to the recommendations of the Clinical Practice Guide is good for most interventions and the degree of satisfaction is high.

OBJETIVO: La Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia (IHAN) o programas de implantación de Guías de Práctica Clínica tienen impacto positivo en la promoción de la lactancia materna (LM). Existen lagunas respecto a percepciones de las puérperas hacia estas iniciativas y el grado de satisfacción. Nuestro objetivo fue describir la satisfacción de las madres lactantes y la adherencia a las recomendaciones de la guía "Lactancia Materna" de la Registered Nurses´Association of Ontario (RNAO). METODOS: Entre 2018-2019, en 9 hospitales españoles que implantaban la guía se encuestaron 2.397 madres lactantes que cumplieron criterios de inclusión. Se diseñó una encuesta autoadministrada con datos sociodemográficos madre-hijo, intervenciones de promoción de LM realizadas y grado de satisfacción. Se realizó análisis descriptivo y bivariado. RESULTADOS: Las recomendaciones de contacto piel-con-piel, ayuda en el amamantamiento, observación de la toma y resolución de dudas presentaron adherencias >84%. La información sobre grupos de apoyo, alojamiento conjunto y reconocer signos de satisfacción del bebé obtuvieron adherencias <40%. La tasa de LM exclusiva al alta fue 77,5%. La satisfacción media con el contacto piel con piel y el porcentaje de satisfacción al alta fueron 5,8 y 96,8% respectivamente. Las diferencias fueron significativas entre el grado de satisfacción y el nivel de estudios, la edad, la situación laboral, tipo de parto y tipo de hospital (p<0,05). CONCLUSIONES: Según las puérperas, la adherencia a las recomendaciones de la Guía de Práctica Clínica es buena para la mayoría de intervenciones y el grado de satisfacción elevado.