Nurses' perceived barriers and facilitators to the implementation of nurse prescribing: Delphi study and focus group.

AIM: To obtain consensus on barriers and facilitators to nurse prescribing following its recent introduction in Spain. DESIGN: A three round online Delphi survey and focus group. METHODS: An exploratory method was used with three consecutive rounds of questionnaires based on anonymity and feedback, and a focus group. The study was carried out with primary care, specialized care, socio-health care and manager nurses. RESULTS: On the basis of the Delphi study that was conducted, a list of 15 barriers and 18 facilitators of nurse prescribing was obtained. However, no general consensus was found with respect to the prioritization of these barriers/facilitators. The analysis of the results of the focus group confirmed the information obtained from the Delphi study. The main barriers highlighted were dependence on the figure of the physician, insufficient training in pharmacology, a lack of institutional support and the limited list of products that could be prescribed. The key facilitators were academic knowledge and ongoing training and education, independence in the functions and responsibilities of the nursing profession, adaptation to new roles and autonomy in the case of chronic care processes. CONCLUSION: Nurses were generally positive about the introduction of nurse prescribing. The commitment of nurses to training and their accreditation as prescribers (internal forces) and health policy and nursing management (external forces) play a fundamental role in supporting the basis of nurse prescribing and ensuring that it is developed with the identified support resources, such as staff training and the provision of the materials necessary for its proper implementation, all with the aim of guaranteeing quality healthcare. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Strong models of nurse prescribing are being considered globally to address population needs. The results can help the future implementation of non-medical independent prescribing and provide guidance to the government and society on the interventions that can be used to consolidate it. IMPACT: What problem did the study address? By 2027, the world's population will receive more than 4.5 trillion doses of medicine each year. However, the WHO estimates a projected shortfall of 10 million health workers by 2030. Inadequacies with traditional physician-led care systems mean that new approaches are imperative to maintain patient access to prescription medicines, with NP being a key element in this regard. In Catalonia (Spain), the accreditation process for nurses as prescribers was implemented in 2021. It is therefore of vital importance to question and consult the nurses themselves, the main promoters of the process, to find out their perceptions and thus be able to take them into consideration in the implementation process. What were the main findings? A total of 15 barriers and 17 facilitators were identified. The main perceived barriers are dependence on the figure of the physician, insufficient training in pharmacology during undergraduate studies and a lack of institutional support. The main perceived facilitators are academic knowledge and ongoing education and training, independence in nursing functions and responsibilities, and adaptation to new roles and tasks. Where and on whom will the research have an impact? These results can contribute to improving NP implementation in Spain and serve as a reference for other countries, especially where NP education and training have only recently been instigated or are in the planning process. REPORTING METHOD: Standards for reporting qualitative research: a synthesis of recommendations. SRQR. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Decision support-tools for early detection of infection in older people (aged> 65 years): a scoping review.

BACKGROUND: Infection is more frequent, and serious in people aged > 65 as they experience non-specific signs and symptoms delaying diagnosis and prompt treatment. Monitoring signs and symptoms using decision support tools (DST) is one approach that could help improve early detection ensuring timely treatment and effective care. OBJECTIVE: To identify and analyse decision support tools available to support detection of infection in older people (> 65 years). METHODS: A scoping review of the literature 2010-2021 following Arksey and O'Malley (2005) framework and PRISMA-ScR guidelines. A search of MEDLINE, Cochrane, EMBASE, PubMed, CINAHL, Scopus and PsycINFO using terms to identify decision support tools for detection of infection in people > 65 years was conducted, supplemented with manual searches. RESULTS: Seventeen papers, reporting varying stages of development of different DSTs were analysed. DSTs largely focussed on specific types of infection i.e. urine, respiratory, sepsis and were frequently hospital based (n = 9) for use by physicians. Four DSTs had been developed in nursing homes and one a care home, two of which explored detection of non- specific infection. CONCLUSIONS: DSTs provide an opportunity to ensure a consistent approach to early detection of infection supporting prompt action and treatment, thus avoiding emergency hospital admissions. A lack of consideration regarding their implementation in practice means that any attempt to create an optimal validated and tested DST for infection detection will be impeded. This absence may ultimately affect the ability of the workforce to provide more effective and timely care, particularly during the current covid-19 pandemic.

Practical view of the topical treatment of peripheral venous catheter-related phlebitis: A scoping review.

OBJECTIVE: To identify and analyse topical treatments for peripheral venous catheter (PVC)-related phlebitis. DESIGN: The methodological framework used to make this scoping review was developed by Arksey and O'Malley (2005; (International Journal of Social Research Methodology, 8, 2005 and 19)). DATA SOURCES: A literature search was performed in various databases such as PubMed, Scopus, CINAHL, Cochrane, Cuiden, Web of Science, WorldWideScience and Joanna Briggs. Additionally, articles from informal sources were incorporated. REVIEW METHODS: A search and selection were made of experimental, quasi-experimental and pre-experimental studies published between January 2015 and September 2020 that consider the use of topical products for the treatment of hospital in-patients with PVC-related phlebitis. Appraisal of the methodological quality of the study was performed independently by pairs of reviewers on the basis of the Cochrane Collaboration tool. The review was based on the guidelines in the PRISMA-ScR statement. RESULTS: Twenty-two articles were selected (8 randomised controlled trials (RCTs), 12 quasi-RCTs and 2 pre-experimental studies) which considered treatments applied to a total of 2042 adult patients. The topical treatments described were classified into physical measures and phytotherapeutic and pharmacological treatments. The physical measures are easy to apply, but their effectiveness is limited. The main limitation of the phytotherapeutic treatments is their marketing and use in eastern culture. The best performing pharmacological treatment is the application of magnesium sulphate either with or without glycerine. These products can be presented in different pharmaceutical formulas: ointment, solution and oil. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE: The evidence currently available on this issue is limited and often of dubious methodological rigour. Further studies are required on the treatment and follow-up of intravenous therapy-related phlebitis in different national and international contexts.

Nursing interventions for perinatal bereavement care in neonatal intensive care units: A scoping review.

BACKGROUND: Despite technological advances and specialist training of neonatal teams, perinatal deaths still occur. Such events are traumatic experiences for the parents and increase the risk of pathological grieving. Nursing is one of the main sources of support. However, the important work of nurses in these situations is made more difficult by the lack of recognized strategies that can be implemented to assist parents and family members in the bereavement process. AIM: Identify nursing interventions to help parents of neonates admitted to neonatal intensive care units cope with perinatal loss. METHODS: A scoping review based on the methodological framework established by Arksey and O'Malley was used. A total of 327 relevant studies were identified through a bibliographic search in Pubmed, CINAHL Plus, APA PsycNET and Scopus between 2000 and 2019. The screening process included an initial analysis of the relevance of the abstract and, when required, an extensive review of the full paper. RESULTS: A total of 9 papers were finally selected which responded to the research question. All nine papers are from the USA and have different methodological characteristics. A number of effective interventions were identified, including legacy creation, support groups, family-centred accompaniment and follow-up, parental involvement in pre-mortem care, intergenerational bereavement programmes, and the use of technological and spiritual resources. CONCLUSION: In general, the scant evidence that is available about nursing interventions around perinatal bereavement care underlines the requirement to thoroughly assess the effectiveness of those that have already been designed and implemented. IMPLICATIONS FOR NURSING PRACTICE AND POLICY: This scoping review contributes to the potential implementation of effective interventions to deal with and help parents and family members cope with perinatal bereavement, with nursing staff as the main source of support and leading interventions which have family members in the care team. This review also makes a substantial contribution to the development of a practical and evidence-based clinical guide for nursing, with recommendations that can be adapted to effective quality care criteria. It is additionally intended to encourage visibility in health policies of care and attention to perinatal grief in neonatal intensive care units.

Educational interventions and identification of risk factors to prevent and reduce peritonitis in peritoneal dialysis: A scoping review.

BACKGROUND: Peritonitis is a common and serious complication of peritoneal dialysis and is one of the main causes of peritoneal dialysis technique failure and long-term hemodialysis conversion. OBJECTIVES: The aim of the review was to identify and clarify peritonitis risk factors and learn about strategies employed at international level to prevent and reduce the occurrence of peritoneal dialysis associated infections and their complications. DESIGN: A scoping review. PARTICIPANTS: Adults in pertitoneal dialysis. MEASUREMENTS: The methodology framework of Arksey and O'Malley and PRISMA for Scoping Reviews guidelines were applied. A search was conducted of PubMed, Scopus and CINAHL using terms to identify peritoneal dialysis -associated risk factors and interventions carried out for the prevention and reduction of peritonitis in adult persons living at home. RESULTS: The 17 studies selected were based on work carried out in nine different countries. Eleven articles analysed modifiable risk factors (low educational level, being a foreigner and low adherence to aseptic technique) and non-modifiable risk factors (age and comorbidities) that predispose to peritonitis in peritoneal dialysis. The other six studies applied an intervention to improve the prevalence of peritonitis considering educational practices adapted to patient characteristics and the application of retraining. CONCLUSIONS: Personalised patient training and the identification of risk factors for peritonitis are key to reducing complications and enhancing the survival of peritoneal dialysis patients and the effectiveness of the technique.

Knowledge, attitudes, and practices about COVID-19 pandemic: a bibliometric analysis.

Background: In order to avoid high rates of COVID-19 infection, one of the main tasks that must be performed is to improve the knowledge, attitudes, and practices (KAP) about the virus. In this sense, Health Education is an essential tool for dealing with the virus. The aim of health education is to educate individuals through educational, motivational, skill development, and awareness techniques, and an understanding of the main needs of KAP is essential for this. Many KAP studies were published during the COVID-19 pandemic, and the aim of the present study was to analyze these publications through a bibliometric study. Methods: A bibliometric analysis of the publications on KAP and COVID-19 was conducted in the Web of Science Core Collection database. The RStudio Bibliometrix and VOSviewer packages were utilized to analyze the scientific production, authors, citations, countries, publishers, journals, research areas, and keywords. Results: Of the 1,129 articles published, 777 were included in the study. The year with the most publications and citations was 2021. Three authors were underlined (all from Ethiopia), due to the number of articles published, the number of citations, and the collaboration networks established. As for the countries, most of the publications came from Saudi Arabia, while China obtained the most citations. PLOS One and Frontiers in Public Health published the most articles on the subject. The most frequent keywords were knowledge, attitudes, practices, and COVID-19. At the same time, others were identified based on the population group analyzed. Conclusion: This is the first bibliometric study on KAP and COVID-19. The significant number of publications identified on KAP and its relationship to the COVID-19 pandemic, in the span of only 3 years, indicates the increased interest in this area. The study provides relevant information to researchers who are approaching this subject for the first time. It is a useful tool that can stimulate new studies and collaborations between researchers from different countries, areas and approaches. At the methodological level, a step-by-step guide is provided for future authors who wish to perform a bibliometric analysis.

Diagnostic Concordance between the Visual Analogue Anxiety Scale (VAS-A) and the State-Trait Anxiety Inventory (STAI) in Nursing Students during the COVID-19 Pandemic.

Anxiety is one of the most common problems among nursing students. The State-Trait Anxiety Inventory (STAI) is used to detect anxiety in this population; however, its length hinders speedy detection. For this reason, a faster and more efficient instrument is needed for early detection. This study aimed to determine the relationship between the anxiety measurement scales State-Trait Anxiety Inventory (STAI) and the Visual Analogue Scale for Anxiety (VAS-A) by establishing a discrimination threshold through the contrast of true positive rates (VPR) and false positive rates (FPR). To this end, a cross-sectional quantitative observational and analytical study was carried out on 185 fourth-year nursing students. The data collected were anxiety (STAI and VAS-A) and socio-demographic variables during the COVID-19 pandemic. The results showed a correlation between the two scales (VAS-A and STAI). The VAS-A is a useful instrument for assessing students in a crisis that could potentially generate anxiety. The study established a reasonably safe error probability range (>5%), allowing the VAS-A scale to be used as a rapid diagnostic or pre-diagnostic tool, depending on the scores. The study shows that speedy detection of anxiety using the VAS-A and an in-depth approach with the STAI by teaching staff in crises is possible.

The perception of training and professional development according to nursing students as health workers during COVID-19: A qualitative study.

AIM: To explore the perception of education and professional development of final-year nursing students who carried out health relief tasks during the COVID-19 pandemic. BACKGROUND: The COVID-19 pandemic has led to a global health emergency. This situation has exacerbated the need for additional healthcare employees, forcing the Spanish government to incorporate volunteer nursing students as auxiliary health staff. DESIGN: A qualitative study framed in the constructivist paradigm. METHODS: Twenty-two students of nursing were recruited. A purposeful sampling was implemented until reaching saturation. A semi-structured interview as a conversational technique was used to collect information based on three dimensions: academic curriculum, disciplinary professional development, and patient care. Subsequently, a content analysis of the information was carried out. Three phases were followed in the data analysis process: theoretical, descriptive-analytical, and interpretive. The COREQ checklist was used to evaluate the study. RESULTS: The most important results are linked to the students' professional and academic preparation, how the nurses handled the pandemic situation and the characteristics of the COVID-19 patients. CONCLUSIONS: Students require training in order to offer holistic care to patients, adapted to the context. Participants highlight the importance of professional values and recognise a high level of competence and autonomy in nurses.

Evidence of learning on the insertion and care of peripheral venous catheters in nursing students: A mixed study.

OBJECTIVES: 1) To assess nursing students' evidence-based knowledge on the use of PVCs, and 2) to examine the perception of learning and teaching strategies aimed at this skill. BACKGROUND: Insertion and care of Peripheral Venous Catheters (PVCs) are essential skills in undergraduate nursing education. Appropriate knowledge of this skill is crucial to improve clinical practice and patient safety. Therefore, training becomes an enabler for safe practice. DESIGN: A multi-centre convergent parallel mixed-methods. SETTING AND PARTICIPANTS: A total of 675 second-, third- and fourth-year nursing students from 3 nursing schools took part in the study. METHODS: Quantitative data collection used a validated 15-question survey on knowledge of PVC management, and a descriptive and inferential analysis was carried out. Qualitative data were collected via a questionnaire consisting of 4 open-ended questions assessing knowledge, teaching methodologies and scenarios, and points for improvement. RESULTS: Most participants were female (74.04%), with a mean age of 22.45 (SD = 4.65), who had no experience in the health field (61.8%). They obtained a mean knowledge score of 7.27 (SD = 2.64) out of 15. The students who obtained higher scores had a mean professional experience of 7.96, SD = 2.66 (p 0.000) and were in their final year, with a mean of 8.59, SD = 2.56, (p 0.000). On the other hand, the students assessed their knowledge as basic but improving year by year. They also identified a need to apply more active and experiential methodologies that would allow for reflection. CONCLUSION: Level of educational level and experience is associated with increased knowledge. In order to improve knowledge, changes must be made in the training process to incorporate methodologies such as simulation and online training. There is a need to develop programmes that favour the alignment of theory with clinical practice.

[Analysis of dehydration in older people in a nursing home in Spain: prevalence and associated factors]. / Análisis de la deshidratación de adultos mayores en una residencia geriátrica de España: prevalencia y factores asociados.

INTRODUCTION: Background: dehydration in institutionalized elderly people has not been extensively studied. There are not clear data on the Spanish context. Aim: to estimate the prevalence of dehydration and to identify the associated factors in institutionalized older people in a nursing home. Methods: a cross-sectional study was carried out. Dehydration was measured through the colour of urine. For the identification of the associated factors, sociodemographic, clinical, functional, and mental variables were selected. Results: the total sample studied was comprised of 96 individuals with a mean age of 86.6 years (± 7.1), of whom 80.2 % were women. The prevalence of dehydration was 31.3% (95 % CI, 22.0 to 40.6). The factors that were independently associated with dehydration were the presence of sunken eyes (OR = 8.67; p = 0.004), low fluid intake (OR = 3.96; p = 0.041), and both functional (OR = 0.97; p = 0.012) and cognitive (OR = 1.10; p = 0.009) impairment. Conclusions: this study highlights the problem of dehydration in institutionalized older people in Spain. An urine colour table may be used routinely, non-invasively, and cheaply. So, it may well be the best simple method for detecting dehydration in this population. Taking into account that chronic dehydration is most prevalent in elderly people, the identification of associated factors is a key factor for a successful approach.

INTRODUCCIÓN: Introducción: la deshidratación en las personas mayores institucionalizadas es un problema poco explorado, no habiéndose encontrado evidencia al respecto en relación con las personas mayores del contexto residencial español. Objetivos: estimar la prevalencia de la deshidratación e identificar los factores asociados a la misma en las personas mayores institucionalizadas en una residencia geriátrica. Métodos: estudio descriptivo y transversal. La deshidratación se midió a través del color de la orina. Para la identificación de los factores se seleccionaron variables sociodemográficas, clínicas, funcionales y mentales. Resultados: la muestra total estudiada fue de 96 individuos con una media de edad de 86,6 años (± 7,1), de los cuales el 80,2 % eran mujeres. La prevalencia de la deshidratación fue del 31,3 % (IC 95 %: 22,0 a 40,6). Los factores que se asociaron independientemente a la deshidratación fueron la presencia de ojos hundidos (OR = 8,67; p = 0,004), la baja ingesta hídrica (OR = 3,96; p = 0,041) y el deterioro funcional (OR = 0,97; p = 0,012) y cognitivo (OR = 1,10; p = 0,009). Conclusiones: este estudio permite visibilizar el problema de la deshidratación en las personas mayores institucionalizadas en España. La tabla de colores de la orina puede emplearse de forma rutinaria, no invasiva y con bajo coste, por lo que podría ser el método de elección para la detección de la deshidratación en esta población. Teniendo en cuenta que la deshidratación crónica es la más prevalente en las personas mayores, la identificación de los factores asociados es clave para mejorar su hidratación.

Experiences, emotional responses, and coping skills of nursing students as auxiliary health workers during the peak COVID-19 pandemic: A qualitative study.

The COVID-19 crisis in Spain has exacerbated the shortage of nursing staff to respond to increasing healthcare demands. For this reason, nursing students were requested to collaborate voluntarily as auxiliary health staff. This emergency has led to mental health problems in health professionals, hence the relevance of coping techniques. The objectives of this study were to explore the experiences and emotional responses of final-year nursing students who volunteered to carry out healthcare relief tasks during the peak of the COVID-19 pandemic, and to identify the coping strategies they adopted to deal with this situation. A qualitative study was conducted in the constructivist paradigm. Purposive sampling was used, and twenty-two students participated in semi-structured interviews, which were then content-analysed. The study is reported using the COREQ checklist. Five themes emerged in the 'Experiences and emotional response' dimension (context, patients, emotions and feelings, risk of contagion, and personal satisfaction), and three themes emerged in the 'Coping strategies' dimension strategies in the work environment, in daily life and personal life. Although the students expressed negative emotions due to the highly complex context and lack of professional experience, they evaluated the experience positively in terms of learning and usefulness. Most notably, the students employed adaptive coping strategies to deal with the pandemic.

The influence of COVID-19 on the mental health of final-year nursing students: comparing the situation before and during the pandemic.

The COVID-19 pandemic has had an important impact on the academic world. It is known that university studies can influence the mental health of students, and especially those studying health sciences. In this study, we therefore sought to analyse whether the current pandemic has affected the mental well-being of final-year nursing students. This was a multi-centre study, with a descriptive, longitudinal, and prospective design. Mental well-being was evaluated using the General Health Questionnaire. A total of 305 participants were included in the study, of whom 52.1% had experienced the COVID-19 pandemic. Statistically significant differences were found between the two groups analysed in terms of age, access to university, average marks, mental well-being self-esteem, emotional exhaustion, and sense of coherence. In the case of mental well-being, a direct association was found with both the pandemic situation (OR = 2.32, P = 0.010) and emotional exhaustion scores (OR = 1.20, P < 0.001), while an inverse association was found with sense of coherence scores (OR = 0.45, P < 0.001). This study shows that the mental health of students is a significant factor and one that must be taken into consideration when training nursing staff at university. There is a need to promote healthy habits and provide appropriate coping strategies. It is also important to train and prepare students for pandemic situations as these can have an important impact on the mental health of both the members of the public who will be treated by these future nursing professionals and the students themselves.

Psychological Well-Being in Nursing Students: A Multicentric, Cross-Sectional Study.

In addition to complying with strict academic standards, nursing students must acquire relevant knowledge and skills, and learn how to carry themselves in different and often stressful professional settings. These obligations could severely affect their mental health. The purpose of this study was to examine the mental health status of undergraduate nursing students and related factors. A total of 1368 nursing students from different universities in Spain and Chile were included in this study, which took place over the 2018-2019 academic year. We assessed their levels of stress related to specific learning methodologies and determined their mental health status using the General Health Questionnaire (GHQ-28). The results revealed that the more advanced the course was, the lower the total GHQ-28 score. The stress generated by different types of training activities had a significant effect on the total GHQ-28 score. These results suggest that nursing education could act as a protective factor against mental health disorders. Although a heavy academic workload could lead to higher levels of stress, overall, it seems that mental health is better in more advanced courses than in initial academic years.

High rates of malnutrition in older adults receiving different levels of health care in Lleida, Catalonia: an assessment of contributory factors.

The aim of this study was to define the factors associated with the presence or risk of malnutrition in older adults (>65 years of age) attending health care centers in Lleida, Catalonia, using a cross-sectional study approach. Nutritional parameters assessed included the Mini Nutritional Assessment Scale, sociodemographic and psychosocial factors, functional and cognitive status, swallowing and oral problems, texture and route of administration of the diet, changes in dietary intake, and presence of digestive disorders. A total of 398 individuals (184 men) with an average age of 77 years were included in the assessment. Poor nutritional status was recorded in 58% of the individuals. Factors independently associated with unsatisfactory nutritional status included weight loss, functional dependence, cognitive impairment, loneliness, living without a partner, history of heart disease, lung disease, and the presence of acute vomiting.

Fluid Intake Recommendation Considering the Physiological Adaptations of Adults Over 65 Years: A Critical Review.

The aim of this critical review was to clarify recommended fluid intake for older people. A literature search of published articles and guidelines on fluid intake recommendations until April 2020 was carried out using PUBMED, Scopus, Cochrane, and Google Scholar. In this review, we focused on people over 65 years old at different care levels. The results show that the mean fluid intake ranges between 311 and 2390 mL/day. However, it is difficult to know whether this corresponds to the real pattern of fluid intake, due to the variability of data collection methods. With respect to the recommendations, most international organizations do not take into consideration the physiology of ageing or the health problems associated with an older population. In conclusions, we recommend to follow the guideline of the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Food Safety Authority (EFSA). ESPEN is the only guideline which takes into account age. It is also based on EFSA recommendations. This authority takes into consideration all fluids consumed (ranging from food to fluids). If it is known that around 20% of all fluids consumed come from food, the result would effectively be that the EFSA recommends the same as the ESPEN guidelines: 1.6 L/day for females and 2.0 L/day for males. The findings could help raise the awareness of professionals in the sector with respect to the required fluid intake of the elderly and, in this way, contribute to avoiding the consequences of dehydration.

Prevalence and Risk Factors Associated With Low Fluid Intake in Institutionalized Older Residents.

OBJECTIVE: The aim of this study was to determine the prevalence of low fluid intake in institutionalized older residents and the associated factors. DESIGN: This was a cross-sectional study. SETTING AND PARTICIPANTS: The study was carried out at a nursing home with a capacity for 156 residents, all of whom were older than 65 years. MEASURES: Data were collected on the fluids consumed by each resident over a period of 1 week. Information relating to sociodemographic variables and to residents' health, nutrition, and hydration status was also collected. RESULTS: Of 53 residents, 34% ingested less than 1500 mL/d. The factors with the greatest correlation associated with low fluid intake were cognitive and functional impairment, the risk of suffering pressure ulcers, being undernourished, a texture-modified diet, dysphagia, impaired swallowing safety, and BUN:creatinine ratio. CONCLUSIONS/IMPLICATIONS: The results obtained highlight the scale of low fluid intake in nursing homes and also aid to identify and understand the factors associated with this problem. The findings could help us to develop specific strategies to promote the intake of liquids and thereby reduce the incidence of dehydration in nursing homes.

[How to improve hydration and fluid intake in institutionalized older people? A scientific literature review]. / ¿Cómo mejorar la hidratación y la ingesta hídrica en las personas mayores institucionalizadas? Una revisión de la literatura científica.

BACKGROUND: residents are vulnerable to suffer of dehydration due to physiological changes and the physical and cognitive limitations. AIM: to handle this situation, it has been decided to evaluate the interventions which are carried out for the management of dehydration and low fluid intake in older people living in nursing homes. METHODS: the revised scientific literature review methodology of PRISMA was applied. An electronic database search was performed in PubMed, Scopus, CINAHL and other sources databases. The literature search was carried out between October 2016 and January 2017. Out of a total of 3,379 articles extracted, eleven studies were selected for analysis. In addition, their quality was assessed through Cochrane and the Newcastle-Ottawa Scale. RESULTS: the risk of bias in the studies was mostly medium. Regarding the results, the interventions were classified according to whether they were invasive or non-invasive. Invasive interventions were intravenous and/or subcutaneous fluid therapy. Their effectiveness was related to the clinical improvement of dehydration. However, local reactions appeared. Non-invasive interventions focused on the individualized assistance, the stimulation to drink more and the consideration of the preferences of each resident, producing an increase in fluid intake and an improvement in analytical parameters. CONCLUSIONS: given the peculiarities of the institutionalized elderly population, both types of intervention have been shown to have a positive effect on improving hydration. Nonetheless, non-invasive interventions have confirmed to be more efficient given their simplicity of application and cause fewer adverse effects.

INTRODUCCIÓN: los residentes son vulnerables a sufrir deshidratación por los cambios fisiológicos y las limitaciones físicas y cognitivas que padecen. OBJETIVO: para manejar esta situación, se ha decidido evaluar las intervenciones que se llevan a cabo para el manejo de la deshidratación y la baja ingesta hídrica en las personas mayores institucionalizadas en residencias geriátricas. MÉTODOS: se realizó una revisión de la literatura científica siguiendo la metodología PRISMA mediante búsquedas sistemáticas en las bases de datos PubMed, Scopus, CINAHL y otras fuentes. De un total de 3.379 artículos extraídos, se seleccionaron once estudios para su análisis. Además, se avaluó su calidad a través de Cochrane y la Newcastle-Ottawa Scale. RESULTADOS: el riesgo de sesgo de los estudios fue medio en su mayoría. En cuanto a los resultados, las intervenciones se clasificaron según fuesen invasivas o no invasivas. Las intervenciones invasivas fueron la sueroterapia intravenosa y/o subcutánea y su efectividad estuvo relacionada con la mejora clínica de la deshidratación. No obstante, aparecieron reacciones locales. Las no invasivas se centraron en la asistencia individualizada, la estimulación para beber más y tener en cuenta las preferencias de cada residente, produciendo un aumento de la ingesta y una mejora en los parámetros analíticos. CONCLUSIONES: dadas las peculiaridades de la población mayor institucionalizada, ambos tipos de intervención han demostrado tener un efecto positivo en la mejora de la hidratación. No obstante, las intervenciones no invasivas han confirmado ser más eficientes dada su sencillez de aplicación y provocar menos efectos Adversos.

Fear of falling in community-dwelling older adults: A cause of falls, a consequence, or both?

BACKGROUND: Despite the number of studies that have tried to demonstrate that there is an association between previous falls and the fear of falling, the relationship between these two variables remains a matter of controversy. OBJECTIVES: Our objective was to investigate whether the fear of falling is a cause of falls, a consequence, or both in community-dwelling adults aged ≥ 75 years old. METHODS: A descriptive, longitudinal, prospective study was performed. A total of 640 individuals were interviewed between 2009 and 2011. Sociodemographic data, health status, history of falls and fear of falling were assessed at baseline and at 24 months. RESULTS: The prevalence of falls at baseline was 25% as opposed to 35.2% at 24 months. The prevalence of the fear of falling was 41.5% at baseline. Logistic regression analysis showed a significant association between a history of falls and the fear of falling. Other factors associated with the fear of falling were female gender, comorbidity, depressive symptoms, and disability. In total, 41.7% of the subjects who had reported a fear of falling at baseline had suffered at least one fall 24 months later. Unadjusted Cox regression analysis revealed that the fear of falling was a risk factor for falls. According to the final model adjusted for other covariates, the only reliable predictor was female gender. The Cox model stratified by gender failed to show a crude association between fear of falling and falls. CONCLUSION: A previous history of falls in the previous year was a good predictor of the fear of falling; but the fear of falling was a predictor of falls during follow-up only in the unadjusted model, pointing to strong gender turns out as an effect modifier of the association of FOF and subsequent falls. Nursing staff working in elderly care should not only routinely assess patients' previous history of falls, but also evaluate their fear of falling and its associated factors.

Risk factors associated with dehydration in older people living in nursing homes: Scoping review.

BACKGROUND: Dehydration in the older people is a prevalent problem that is often associated with physiological changes, physical limitations and environmental conditions. OBJECTIVES: The scoping review was carried out to identify risk factors associated with dehydration in older people living in nursing homes. DESIGN: The revised scoping methodology framework of Arksey and O'Malley (2005) was applied. Study selection was carried out in accordance with Davis et al. (2009) and focused on the inclusion criteria (people over 65 years old and living in nursing homes). Risk factors were classified using the geriatric assessment. DATA SOURCES: An electronic database search was performed in PubMed, Scopus and CINAHL. The literature search was carried out between October 2016 and January 2017. REVIEW METHODS: Thematic reporting was performed and study findings were validated through interdisciplinary meetings of experts. The quality of the papers consulted was also evaluated using the Newcastle-Ottawa Scale adapted for cross-sectional, cohort and case-control studies. RESULTS: In all, 16 papers were analysed, all of which were observational studies. The risk of bias ranged from very low (n = 1), to medium (n = 13) and high (n = 2). The risk factors were classified in line with the different components of the geriatric assessment. In the socio-demographic characteristics age and gender were identified. In the clinical component, infections, renal and cardiovascular diseases and end-of-life situations were the most common factors highlighted in the papers analysed. With reference to the functional component, its limitation was associated with dehydration, while for factors of mental origin, it was related to dementia and behavioural disorders. Finally, the factors relating to the social component were institutionalisation, requiring a skilled level of care and it being winter. CONCLUSIONS: The most commonly repeated factors highlighted in the review were age, gender, infections, end of life and dementia, with it being important to highlight the large number of factors in the clinical component. Even so, the great majority of the factors were unmodifiable conditions associated typically associated with the physiology of ageing.

Correction: Fear of falling in community-dwelling older adults: A cause of falls, a consequence, or both?

[This corrects the article DOI: 10.1371/journal.pone.0194967.].