RESUMEN
AIM: to analyse the progress of implementing the process recommendations of the RNAO Assessment and Management of Pain guideline and health outcomes. METHOD: An observational, longitudinal, retrospective study conducted in 3tertiary-level hospitals in Spain. All patients discharged over the last 5 days of each month from the units selected in the implementation process were included. We evaluated structural data, mean hospital stay, implementation strategy and degree of implementation of the process recommendations of the RNAO guideline over the first 3 years of implementation, and outcomes. A descriptive analysis was performed by calculating means and absolute and relative frequencies in periods: baseline (T0), annual, over the 3first years of implementation (T1, T2 and T3 respectively), and inferential. RESULTS: 8128 patients were included in the study. Hypotheses were contrasted between the different periods. The initial pain assessment in the first 24h following admission or post-surgery increased after the baseline period in all the hospitals, especially those that did not meet the guidelines from the outset. It continued to rise progressively up to 3 years following implementation (reaching 94.6% in hospital 2). By contrast, implementation of the care plan did not exceed 37.5% and 38.5% in hospitals 1 and 3 respectively. With regard to the outcome indicators, the prevalence of pain at 24hours and intense pain generally decreased in the 3hospitals from T0 or T1 to T3, however no conclusive statistically significant differences were obtained. CONCLUSIONS: Implementation of the process recommendations improved from the outset, as did patient outcomes. A decrease in the prevalence and intensity of pain was achieved, although no conclusive data were obtained; all of which leads to better nursing practice with more recording, continuity of care and improved pain management for patients.
Asunto(s)
Manejo del Dolor , Dolor , Humanos , Dimensión del Dolor , Estudios Retrospectivos , EspañaRESUMEN
El programa de implantación de Guías de Buenas Prácticas, denominado en España Centros Comprometidos con la Excelencia en Cuidados®, se inició en 2010 tras un acuerdo de colaboración entre la Unidad de Investigación en Cuidados de Salud (Investén-isciii) de España, el Centro Colaborador Español del Instituto Joanna Briggs para los Cuidados de Salud basados en la Evidencia y la Registered Nurses' Association of Ontario (RNAO), siguiendo los mismos principios que el programa Best Practice Spotlight Organizations (BPSO®) iniciado por RNAO, en Canadá, en 1999. Objetivo: Describir la implantación de Guías de Buenas Prácticas de RNAO en el marco del programa de Centros Comprometidos con la Excelencia en Cuidados® (Best Practice Spotlight Organizations®) en España. El programa tiene como objetivo fomentar, facilitar y apoyar la implantación, evaluación y mantenimiento de buenas prácticas en cuidados, para el periodo 2012-2014. Metodología y Resultados: se han seleccionado 8 instituciones de salud y una universidad que implantan las guías de buenas prácticas de RNAO en función de sus necesidades. Tras los 24 primeros meses de implantación se ha formado a los profesionales de salud, constituido grupos estables de trabajo, desarrollado o actualizado protocolos de cuidados y registros correspondientes, también se han evaluado de forma sistemática los resultados de proceso y de salud de los pacientes. También se han difundido activamente los principales logros del programa. Conclusiones: Los candidatos a Centros Comprometidos con la Excelencia en Cuidados® están realizando un gran esfuerzo y los resultados empiezan a mostrar que son positivos, con una creciente cultura de cuidados basados en la evidencia, y el impulso de la investigación y el inicio de un trabajo colaborativo en red.
The Best Practice Guidelines Implementation Programme, called in Spain Centros Comprometidos con la Excelencia en Cuidados®, started in 2010 thanks to the collaboration between the Nursing and Healthcare Research Unit (Investén-isciii), in Spain, the Spanish Collaborating Centre of the Joanna Briggs Institute for evidence based healthcare, and the Registered Nurses Association of Ontario (RNAO), Canada. It is based on the same fundaments of Best Practice Spotlight Organizations (BPSO) Program, initiated by RNAO, in 1999, in Canada. Objective: To describe the implementation of Best Practice Guidelines developed by RNAO in the context of Centros Comprometidos con la Excelencia en Cuidados Program. The program aims to promote, facilitate and support the implementation, evaluation and sustainability of nursing best practices, for the period 2012-2014. Methodology and Results: Eight healthcare institutions and one university were selected to implement RNAO Best Practice Guidelines aligned with their needs. Twenty-four months into the implementation Programme healthcare professionals have been trained, work teams have been established, nursing care protocols and records have been developed or updated, and process and patient results have been systematically evaluated. Also, all main achievements of the Programme have been actively disseminated. Conclusions: Candidates centers committed to excellence in cuidados® are working hard and the results are starting to show positive, with a growing culture of evidence-based care, and the promotion of research and the start of work collaborative networking.
O programa para implementar Manuais de Boas Práticas, chamados na Espanha de Centros Comprometidos com a Excelência no atendimento®, teve início em 2010 depois de um acordo de colaboração entre a Unidade de Investigação em Atendimento de Saúde (Investén-ISCIII), na Espanha, o Centro Colaborador espanhol do Instituto Joanna Briggs de Atenção à Saúde baseada em evidências e a Registered Nurses' Association of Ontario (RNAO), seguindo os mesmos princípios do programa de Best Practice Spotlight Organizations (BPSO®) iniciado por RNAO no Canadá em 1999. Objetivo: Descrever a implementação de manuais de boas práticas no âmbito do programa RNAO de Centros Comprometidos com a Excelência no Atendimento® (Best Practice Spotlight Organizations®) na Espanha. O programa tem como objetivo estimular, facilitar e apoiar a implementação, avaliação e manutenção de boas práticas nos cuidados no período de 2012-2014. Metodologia e Resultados: Foram selecionadas oito instituições de saúde e uma universidade que implementam as diretrizes de boas práticas RNAO de acordo com suas necessidades. Após os primeiros 24 meses de implantação, foram treinados profissionais de saúde, formados grupos estáveis de trabalho, desenvolvidos ou atualizados protocolos de atendimento e registros correspondentes, também foram avaliados sistematicamente os resultados do processo e de saúde dos pacientes. Também se difundiram amplamente as principais realizações do programa. Conclusões: Os candidatos aos Centros Comprometidos com a Excelência no Atendimento® têm feito um esforço e os resultados são positivos, com uma cultura crescente dos cuidados baseados em evidências, a promoção da investigação e do início do trabalho colaborativo em rede.
Asunto(s)
Enfermería , Enfermería Basada en la Evidencia , Guías de Práctica Clínica como Asunto , Guías como Asunto , Práctica Clínica Basada en la EvidenciaRESUMEN
OBJECTIVE: To analyze the relationship between burden of disease during 2007-2009 and public funding of research in health in Spain during 2008-2010. METHOD: Descriptive cross-sectional study of burden of disease and funding allocated for research in diseases in the Spanish National Health System. RESULTS: A review was made of a total of 6,573 project titles funded for the years 2008, 2009 and 2010. During this period, a total of 472.7 million Euros were assigned as grants for research projects. Malignant tumors and neuropsychiatric diseases were the illnesses with greatest funding support. During the study period, it was estimated that there was a total of 15,253,331.3 disability-adjusted life years (DALYs) in Spain, with neuropsychiatric diseases being the category representing most DALYs with 4,396,900 (28.8%). The relationship between funding and DALYs was obtained with a Pearson r equal to 0.759 (p<0.001). The study of congenital diseases had higher funding per DALY than any other disease with an investment of 290.4/DALY. Among these, the study of cleft palate and esophageal atresia, with ratios of 3,432.7/DALY and 3,387.6/DALY respectively, obtained the greatest funding. CONCLUSIONS: The study shows that the relative distribution of economic resources in the study period is consistent with the burden suffered by the Spanish population. This relationship is altered by the funding of the study of congenital anomalies, because of the low number of projects in this area.
Asunto(s)
Investigación Biomédica/economía , Costo de Enfermedad , Estudios Transversales , Humanos , Años de Vida Ajustados por Calidad de Vida , España , Factores de TiempoRESUMEN
BACKGROUND: Little is known of the extent to which nursing-care tasks are left undone as an international phenomenon. AIM: The aim of this study is to describe the prevalence and patterns of nursing care left undone across European hospitals and explore its associations with nurse-related organisational factors. METHODS: Data were collected from 33 659 nurses in 488 hospitals across 12 European countries for a large multicountry cross-sectional study. RESULTS: Across European hospitals, the most frequent nursing care activities left undone included 'Comfort/talk with patients' (53%), 'Developing or updating nursing care plans/care pathways' (42%) and 'Educating patients and families' (41%). In hospitals with more favourable work environments (B=-2.19; p<0.0001), lower patient to nurse ratios (B=0.09; p<0.0001), and lower proportions of nurses carrying out non-nursing tasks frequently (B=2.18; p<0.0001), fewer nurses reported leaving nursing care undone. CONCLUSIONS: Nursing care left undone was prevalent across all European countries and was associated with nurse-related organisational factors. We discovered similar patterns of nursing care left undone across a cross-section of European hospitals, suggesting that nurses develop informal task hierarchies to facilitate important patient-care decisions. Further research on the impact of nursing care left undone for patient outcomes and nurse well-being is required.