Nurses' perceptions of the performance of nurse managers and senior hospital management during the COVID-19 pandemic.

BACKGROUND: The first waves of the COVID-19 pandemic had a negative impact on health systems and health professionals, due to the high number of cases and a lack of preparation. The aim of this study was to understand how nurses working in hospital units and in intensive care perceived the performance of nurse managers and senior hospital management during the first two waves of the pandemic. METHODS: The phenomenological approach proposed by Giorgi was used to investigate perceptions of the performance of nurse managers and senior hospital management during the first two waves of the COVID-19 pandemic in Spain. Fourteen clinical nurses who worked on the front line in inpatient units or intensive care units of the Health Services of Extremadura and Madrid in the first (March-April 2020) and second (October-November 2020) waves of the COVID-19 pandemic participated in this study. The data was collected through semi-structured interviews, following a script of themes, in a theoretical sample of nurses who were worked during the pandemic. RESULTS: Two main themes emerged from the analysis of the data: (1) perceptions about the performance of nurse managers and senior hospital managers during the first and second waves of the pandemic (health system failure; belief that senior hospital management professionals could have managed the pandemic better; recognizing the efforts of middle management (nursing supervisors); insufficient institutional support) and (2) strategies employed by nurses to compensate for the weaknesses in pandemic management. CONCLUSIONS: The clinical nurses perceived that the nurse managers demonstrated better management of the pandemic than the hospital's senior management, which they attribute to their proximity, empathy, accessibility, and ability to mediate between them and the senior management. The nurses also believe that the senior management of the hospitals was to blame for organisational failures and the poor management of the pandemic.

Perspectives of women living with type 1 diabetes regarding preconception and antenatal care: A qualitative evidence synthesis.

INTRODUCTION: Pregnant women with type 1 diabetes may have an increased risk of complications for both the baby and themselves. Educational programmes, preconception planning, strict glycemic control and comprehensive medical care are some of the antenatal interventions that have been proposed to improve the outcomes of pregnant women with type 1 diabetes. While some evidence-based recommendations about antenatal care are included in clinical practice guidelines (CPGs), the views, and experiences of women with type 1 diabetes about these interventions are not well known. AIM: To understand and synthesize the perceptions of women with type 1 diabetes about the interventions before pregnancy. METHOD: A qualitative evidence synthesis (QES) was carried out with a framework analysis guided by the Cochrane Qualitative and Implementation Methods Group approach. Three online databases (Medline, Embase and Web of Science) were searched. We included qualitative articles that were published from 2011 to 2021 and which were available in English or Spanish. FINDINGS: Ten references met the inclusion criteria of the study and were included. Three main themes were identified: (a) acceptability of antenatal care, (b) feasibility and implementation consideration and (c) equity and accessibility difficulties. CONCLUSION: Continuity of care, coordination between health professionals and services, and a more holistic approach are the key aspects women say need to be considered for more acceptable, feasible and equitable preconception and antenatal care. PATIENT OR PUBLIC CONTRIBUTION: This QES was carried out as part of the CPGs on diabetes mellitus type 1, carried out as part of the Spanish Network of Health Technology Assessment Agencies. In this CPG, the representatives of the patient associations are Francisco Javier Darias Yanes, from the Association for Diabetes of Tenerife, who has participated in all the phases of the CPG; Aureliano Ruiz Salmón and Julián Antonio González Hernández (representatives of the Spanish Diabetes Federation (FEDE) who have participated as collaborator and external reviewer, respectively.

Efficacy of cognitive-behavioral therapy in improving the quality of life of people with compulsive gambling, a systematic review.

FUNDAMENTALS: Cognitive-behavioral therapy can reduce gambling behavior and other symptoms of pathological gambling. AIM: To synthesize and analyze the evidence on the efficacy of cognitive-behavioral interventions to improve the quality of life of people with pathological gambling. METHODOLOGY: Systematic review with a narrative synthesis of clinical trials published in English and Spanish in Medline, Scopus, Web of Science, CINAHL, The Cochrane Library Plus, PsycoInfo, and ProQuest of articles until January 2020 that will analyze this phenomenon. The PRISMA Declaration was followed and the quality of the articles was analyzed with the Jadad scale. RESULTS: 1233 articles were found, including nine in the review. Two studies confirmed the efficacy of cognitive behavioral therapy-based interventions for improving the quality of life in people with pathological gambling. In addition, these interventions improved depression, anxiety, the amount of money played, and reduced alcohol consumption and the gambling diagnosis score, which had an impact on improving the quality of life. Cognitive behavioral interventions were more effective when it was supported by a manual or when were combined with Mindfulness or Player Anonymous sessions. Having better long-term results in these cases. CONCLUSIONS: Cognitive behavioral-based interventions can improve the quality of life of people with pathological gambling and other psychological variables without being its immediate effect. Future research should analyze whether they are more efficacy online or in person, individually, or in groups, and the number of sessions required for their effects to last over time.

Individualised Care Scale-Nurse: Construct validity and internal consistency of the Spanish version.

BACKGROUND: Individualising the provided care is mandatory in nursing and is essential in clinical practice. Therefore, there is a need to develop accurate instruments to evaluate the quality of care. Moreover, there is no validated instrument to assess nurses' views of individualised care in Spanish-speaking countries. AIM: To assess the construct validity and internal consistency of the Spanish version of the Individualised Care Scale-Nurse. METHODS: A cross-sectional study including 108 nursing professionals (40.84 ± 9.51 years old, 86.1% female) was used to validate the Spanish Individualised Care Scale-Nurse version. A forward-back translation method with an expert panel and a cross-sectional study was used for transcultural adaptation and psychometric validation purposes. Psychometric properties of feasibility, reliability and validity were assessed. Construct validity was examined through a confirmatory factor analysis and fit indices of the overall model were computed. Internal consistency was explored through McDonald's omega and Cronbach's alpha coefficients among other correlation measures. RESULTS: The back-translation concluded both Spanish and English Individualised Care Scale-Nurse versions to be equivalent. The original structure of the Individualised Care Scale-Nurse was verified in the Spanish version through the confirmatory factor analysis (factor loadings >0.3; acceptable fit indices: SRMR ≈ 0.08, CFI ≈ 0.9, RMSEA ≈ 0.09 after posteriori modifications). McDonald's omega exceeded 0.7 for both subscales and complete scales revealing an adequate internal consistency. CONCLUSIONS: The Spanish version of the Individualised Care Scale-Nurse has exhibited good properties of homogeneity and construct validity for its use in practice and research in health care systems.

The psychological impact on frontline nurses in Spain of caring for people with COVID-19.

AIM: To understand the perceptions of National Health System nurses who have been working on the frontline of the psychological impact of caring for people with COVID-19 during the first and second waves. METHODS: A qualitative study, the design and analysis of which was based on phenomenology. For data collection, a semi-structured interview was administered to a sample of nurses who worked on the frontline in public hospitals in Extremadura and Madrid, Spain. The interviews, which followed a script including various topics, were conducted between May and November 2020 so as to include the experiences of the first and second waves of the pandemic. Sample collection continued until data saturation. The data were analysed following the phenomenological method of Giorgi with the help of the Atlas-Ti software. RESULTS: Two main themes emerged from the data analysis that explained the nurses' perceptions: (i) the main psychological repercussions of being frontline carers (anxiety, fear, stress, impotence, frustration, and an increase in obsessions and obsessive behaviours) and (ii) psychological coping strategies (collapse in the face of the situation, dissociative amnesia, leaning on colleagues and working as a team, resigning oneself, perceiving the situation as a war, and being aware of psychological repercussions). DISCUSSION: Caring as the first line causes great psychological repercussions for nurses. It is necessary to implement psychological and emotional support programmes to address the post-traumatic stress that nurses can suffer.

Experiences and mediating factors in nurses' responses to electronic device alarms: A phenomenological study.

AIM: This study aims to explore the experiences and mediating factors of nurses' responses to electronic device alarms in critical care units (CCUs). BACKGROUND: Alarm fatigue occasionally has adverse consequences for patient safety. METHODS: This qualitative study was designed and analysed following Giorgi's descriptive phenomenological approach. Seventeen nurses were theoretically sampled, reaching information saturation. Semistructured interviews were used to collect the data. RESULTS: Three central themes explained nurses' experiences: general perceptions about alarms (basic equipment of the CCU), strategies to reduce false alarms (training in the configuration of monitors, customization of the alarms to fit he patient's condition. teamwork and taking advantage of the development of technology) and key elements of the response to alarms (information about patient's condition, nurses' clinical experience, type of CCU, 'cry-wolf' phenomenon and nurse/patient ratio). CONCLUSIONS: To reduce false alarms, nurses need further postgraduate training, training on monitors and customizing alarms to fit the patient's health status. The complex process of deciding to respond to an alarm includes environmental, professional variables and patient status. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should ensure that nurses have sufficient experience and training in the CCU, improve the nurse/patient ratio, promote teamwork and ensure that the devices are the latest generation.

Parents' and Teachers' Perceptions of Physical Activity in Schools: A Meta-Ethnography.

The aim of this meta-ethnographic study was to analyze parents' and teachers' perceptions of barriers and facilitators to physical activity in children. Facilitators were the benefits of physical activity, modeling, participation, children's preferences, and factors supporting active transport. Barriers were quantifying the physical activity, parents' lack of time, the cost of activities, bad weather, traffic, long distances, and the lack of facilities and safety. The level of physical activity does not depend exclusively on individual factors related to the child; rather, barriers and facilitators are influenced by the social and school context and the physical and built environment. It is important that school nurses understand these contextual factors, so that they can take these into consideration when designing their intervention programs.

Effectiveness of exercise-based interventions in reducing depressive symptoms in people without clinical depression: systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: In most trials and systematic reviews that evaluate exercise-based interventions in reducing depressive symptoms, it is difficult to separate treatment from prevention. AIMS: To evaluate the effectiveness of exercise-based interventions in reducing depressive symptoms in people without clinical depression. METHOD: We searched PubMed, PsycINFO, Embase, WOS, SPORTDiscus, CENTRAL, OpenGrey and other sources up to 25 May 2020. We selected randomised controlled trials (RCTs) that compared exclusively exercise-based interventions with control groups, enrolling participants without clinical depression, as measured using validated instruments, and whose outcome was reduction of depressive symptoms and/or incidence of new cases of people with depression. Pooled standardised mean differences (SMDs) were calculated using random-effect models (registration at PROSPERO: CRD42017055726). RESULTS: A total of 14 RCTs (18 comparisons) evaluated 1737 adults without clinical depression from eight countries and four continents. The pooled SMD was -0.34 (95% CI -0.51 to -0.17; P < 0.001) and sensitivity analyses confirmed the robustness of this result. We found no statistical evidence of publication bias and heterogeneity was moderate (I2 = 54%; 95% CI 22-73%). Only two RCTs had an overall low risk of bias and three had long-term follow-up. Multivariate meta-regression found that a larger sample size, country (Asia) and selective prevention (i.e. people exposed to risk factors for depression) were associated with lower effectiveness, although only sample size remained significant when adjustment for multiple tests was considered. According to the Grading of Recommendations Assessment, Development and Evaluation tool, the quality of evidence was low. CONCLUSIONS: Exercise-based interventions have a small effect on the reduction of depressive symptoms in people without clinical depression. It could be an alternative to or complement psychological programmes, although further higher-quality trials with larger samples and long-term follow-up are needed.

"Living with a fragmented body": a qualitative study on perceptions about body changes after a spinal cord injury.

STUDY DESIGN: A qualitative study analyzed using Grounded Theory. OBJECTIVES: To explore perceived bodily changes in people with acquired spinal cord injury of both genders and with different levels of injury. SETTING: The National Paraplegic Hospital in Toledo, Spain, a national reference center for the treatment of spinal cord injury. METHODS: A qualitative study designed and analyzed from the perspective of Grounded Theory. Semi-structured interviews were conducted in a triangulated sample of 32 people with acquired spinal cord injury. The analysis was based on the constant comparative method and an open, axial, and selective coding process. RESULTS: The perceptions regarding bodily changes in people with spinal cord injury were grouped into two broad categories: changes in body schema (a fragmented body, a blurred body, body as a burden, non-muscular body, the wheelchair as an extension of the body, and body normalization) and increased bodily awareness (an uncontrollable body and retraining the body). The amount of time since the injury, positive life behaviors and attitudes, youth, male gender, and having flexible beliefs, values, and habits were considered facilitators for coping with body changes after a spinal cord injury. CONCLUSIONS: Suffering a spinal cord injury implies a new body schema and a change in body awareness. When healthcare professionals are aware of the changes affecting the body after a spinal cord injury, they display more favorable attitudes and are more involved in promoting the patients' adaptation to their new body schema.

Factors associated with the provision of individualized care during hospitalization: A systematic review.

AIM: To analyse and integrate the existing literature on nurses' perceptions regarding factors associated with the provision of individualized care in hospital contexts. BACKGROUND: Individualized care considers the personal characteristics of patients and promotes their participation in decision-making. The application of individualized care is not standardized among professionals. METHODS: A systematic literature search was performed in Scopus, Web of Science, MEDLINE, Índice Médico Español, CUIDEN, ProQuest, PsycoINFO, CINAHL and the Cochrane Library, for studies published in English or Spanish analysing nurses' perceptions on factors associated with the provision of individualized care. RESULTS: A total of 6,330 articles were retrieved, of which 13 fulfilled the inclusion criteria. The provision of individualized care was influenced by the nurses' personal characteristics (academic training, being a specialist, age, professional experience, personal motivation, empathy and culture) and by organisational factors (staff ratio, routinization and standardization of care, autonomous professional practice, leadership and positive work environment). CONCLUSIONS: Nurses' perceptions on the provision of individualized care are influenced by their personal characteristics and organisational factors. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers may optimize personalization of care by encouraging positive work environments; ensuring adequate staffing; avoiding routinization or standardization of care; and promoting training, leadership and autonomy of nursing professionals.

Factors influencing general practitioners decisions to refer Paediatric patients to the emergency department: a systematic review and narrative synthesis.

BACKGROUND: Clinical guidelines are integral to a general practitioner's decision to refer a paediatric patient to emergency care. The influence of non-clinical factors must also be considered. This review explores the non-clinical factors that may influence general practitioners (GPs) when deciding whether or not to refer a paediatric patient to the Emergency Department (ED). METHODS: A systematic review of peer-reviewed literature published from August 1980 to July 2019 was conducted to explore the non-clinical factors that influence GPs' decision-making in referring paediatric patients to the emergency department. The results were synthesised using a narrative approach. RESULTS: Seven studies met the inclusion criteria. Non-clinical factors relating to patients, GPs and health systems influence GPs decision to refer children to the ED. GPs reported parents/ caregivers influence, including their perception of severity of child's illness, parent's request for onward referral and GPs' appraisal of parents' ability to cope. Socio-economic status, GPs' aversion to risk and system level factors such as access to diagnostics and specialist services also influenced referral decisions. CONCLUSIONS: A myriad of non-clinical factors influence GP referrals of children to the ED. Further research on the impact of non-clinical factors on clinical decision-making can help to elucidate patterns and trends of paediatric healthcare and identify areas for intervention to utilise resources efficiently and improve healthcare delivery.

Behavior of Parents Seeking Care From Emergency Services Due to Fever in Children.

PURPOSE: To explore the behavior of parents, with and without health training, seeking care from emergency services due to their child's fever. DESIGN AND SETTING: A qualitative study based on Grounded Theory using a triangulated sample (theoretical sampling and snowball sampling) of parents of children 0 to 12 years old who received care for fever in the emergency primary care services of two Spanish municipalities. METHODS: Data saturation was achieved after eight focus groups segmented by gender, place of residence, and education (57 participants). Data analysis followed the constant comparative method and coding process. FINDINGS: The parents attended the emergency department when fever was high or persistent and to determine the cause. The reasons for avoiding the emergency department differed; whereas the health professional parents avoided consulting other colleagues as they felt questioned, for parents who were not healthcare professionals, there was a fear of acquiring an infection. CONCLUSIONS: Parents' search for healthcare differs according to their background and education. CLINICAL RELEVANCE: These results provide key information for the design of care plans to improve health care and patient satisfaction.

Pilot testing the effectiveness of the Healthy Ageing Supported by Internet and Community programme for promoting healthy lifestyles for people over 65 years of age.

Active ageing is associated with physical, social and mental wellbeing, as well as the participation and integration of older people in society. Currently, demographic changes represent a major challenge while reinforcing the need to improve our current understanding of active ageing and promote appropriate interventions suitable for older people. The aim of this pilot study was to evaluate the impact of the Healthy Ageing Supported by Internet and Community training programme for acquiring the knowledge and skills necessary for adopting a healthy lifestyle in community-dwelling adults over 65 years of age. This study was conducted between 2015 and 2016 and was based on a convenience sample of individuals who responded to questionnaires. The study participants comprised all those who were included in the training programme (n = 71, 47 mentors and 24 participants in peer groups). The statistical analysis demonstrated the effectiveness of the programme regarding feasibility and expected results (p < 0.05 for most items, individually, as well as for the total scores of each test dimension). The programme was based on peer group training and the use of information and communication technologies and proved to be effective for acquiring the knowledge and skills necessary for adopting a healthy lifestyle. Furthermore, increased health scores were obtained in the physical, mental and social domains. It could also be beneficial for other groups of older people in order to support their integration into society, enhance their social skills and decrease any feelings of loneliness and rejection.

Parents' and primary caregivers' conceptualizations of fever in children: A systematic review of qualitative studies.

This study was a systematic review and thematic synthesis of qualitative studies. The aim was to explore parents' and primary caregivers' knowledge and conceptualizations of fever in children aged between 0 and 12 years. A systematic literature search of the Medline, CINAHL, SCOPUS, Web of Science, Cochrane Library, BIREME, CUIDEN, ProQuest, and PsycINFO databases was undertaken for qualitative studies published in English or Spanish up to December 2018. Ten studies were included in the thematic synthesis. Parents' perceptions of their children's fever were classified according to three criteria: fever as a pathology, care for the febrile child, and the search for understandable and reliable information on this topic. Fever was perceived as being harmful to children's health and as a pathology that requires health care. Further studies are necessary to gather key information for improving health action plans and satisfaction with the care received. This information might help us to understand the management of fever and the related fears experienced by caregivers. These perceptions can be influenced by parents' knowledge, attitudes, and beliefs on fever and their previous experiences.

Conceptualisations on home care for pressure ulcers in Spain: perspectives of patients and their caregivers.

BACKGROUND: Pressure ulcers represent an important worldwide public health problem, which substantially decrease the quality of life of those affected. Yet, few studies to date have analysed the perceptions regarding home care for pressure ulcers. AIMS: To explore the conceptualisations regarding home care of pressure ulcers from the perspective of affected patients and their caregivers. METHODS: A qualitative study design based on Grounded Theory. In-depth interviews were conducted on a theoretical sample of 10 people currently suffering from a pressure ulcer, or who had experienced one in the past, and 15 caregivers of patients who had suffered from this pathology, all of whom came from the four health districts of Puertollano (Ciudad Real, Spain). FINDINGS: Two categories emerged to explain the conceptualisations regarding pressure ulcers: (a) Cause of the pressure ulcer with three subcategories (unavoidable injuries, caregiver's lack of knowledge and painful wounds) and (b) Preferences regarding caring for pressure ulcers with two subcategories (home care as the best approach to treatment and noninstitutionalisation). CONCLUSIONS: This research provides a novel perspective on the specific problems surrounding home care for pressure ulcers, including the perceptions of both patients and their caregivers. It is important to give a voice to patients and their caregivers as this will help understand their needs and improve the care provided. Further studies are required to improve current treatment protocols and clinical practice guidelines for the prevention and treatment of this pathology.

Individualized Care Scale-patient: A Spanish validation study.

BACKGROUND: I suggest this individualized care is a fundamental principle closely linked to nursing ethics and has important benefits for the patients, however, nurses do not always take into consideration the principles of individualized care. Moreover, there is no validated instrument to assess patients' views of individualized care in Spanish-speaking countries. OBJECTIVES: To assess the validity and reliability of the Spanish version of the Individualized Care Scale-patient. DESIGN: A cross-sectional study design was conducted. A questionnaire survey, including the Individualized Care Scale-patient, was used for data collection. Psychometric properties of reliability and validity were assessed. Fit indices of the overall model were computed. PARTICIPANTS AND RESEARCH CONTEXT: Survey data were collected from a sample of 118 inpatients at a public hospital in Spain. ETHICAL CONSIDERATIONS: Informed consent from participants and ethical approval was obtained from a regional Clinical Research Ethics Committee. FINDINGS: Ordinal Cronbach's alphas were 0.966 for Individualized Care Scale-patient subscale A and 0.969 for Individualized Care Scale-patient subscale B. The polychoric correlation between each item and the subscale ranged between 0.653-0.874 and 0.604-0.916, respectively. The exploratory factor analysis revealed a three-factor solution. Personal life situation explained relatively large amounts of the variance. Goodness of fit index showed a good fit for the model. DISCUSSION: This study confirms three factors underlining the individualized care concept, but some differences were found in the load of the factors, such as the relevance of "personal life situation" subscale, that need further research. CONCLUSION: The Spanish version of the Individualized Care Scale-patient is reliable, valid, user-friendly, and suitable to be used in Spanish-speaking countries showing satisfactory properties. This instrument may help managers better understand and develop areas in which patients perceive lower individualized care received and the factors influencing it. Such key information will help ensure the right of the patient to be respected as an individual.

Resilience as a mediator between cardiorespiratory fitness and mental health-related quality of life: A cross-sectional study.

In this cross-sectional study, we analyzed the relationship between resilience, cardiorespiratory fitness, and mental health-related quality of life, and examined whether resilience acts as a mediator between the latter two. The study included 770 university students, aged 18-30 years, from Cuenca, Spain. Anthropometric, sociodemographic, cardiorespiratory fitness (20 m shuttle run test), biochemical parameters, resilience, and mental health-related quality of life measurements were analyzed. The results showed that mental health-related quality-of-life values were significantly higher in students who had good cardiorespiratory fitness and a high level of resilience. Moreover, resilience acted as a partial mediator between cardiorespiratory fitness and mental health-related quality of life at 33.79%. Therefore, in young adults, resilience mediates the relationship between cardiorespiratory fitness and mental health-related quality of life. These findings should be taken into account by nurses and other public health professionals, because in addition to the development of physical activity interventions to improve mental health-related quality of life, it is necessary to implement measures that increase resilience to achieve mental wellness.

Nurses' characteristics and organisational factors associated with their assessments of individualised care in care institutions for older people.

RATIONALE: Individualised care is considered a key attribute of the quality in clinical care. Despite the environment in which the care is delivered and the care providers can influence in this concept, perceptions of individuality in the care settings for older people are rarely studied. AIM: To identify nurses' characteristics and organisational factors associated with nurses' views about the provision of individualised care in care settings for older people. STUDY DESIGN: A cross-sectional multisite survey design. METHODS: A multisite survey of nursing staff (N = 1513, n = 874, response rate 58%) working in 62 different units for older people in southwest Finland was carried out using self-administered questionnaires (The Individualised Care Scale-Nurse-B and a questionnaire gathering socio-demographic and organisational variables). Data were analysed using descriptive statistics, Spearman's correlation coefficients, paired-sample t-tests and one-way analyses of variance. RESULTS: Participants' perceptions about the level of individualised care provided to older people were generally positive (Mean 3.92, SD 0.56). In this regard, taking into account the patients' clinical situation (Mean 4.31, SD 0.53) and the support of older patients' decisional control (Mean 3.80, SD 0.71) obtained the highest scores. Regarding nurses' socio-demographic variables, a positive correlation between age and type of organisation with the assessments of individualised care provision was found. CONCLUSIONS: The findings of this study show that nurses' age and the type of organisation where the care is delivered have an impact on the perceptions of individualised care of nurses working in institutions for older people. The participants' assessments about individualised care delivery have practical utility as it may help managers better understand and develop areas that obtained the lowest scores. This information may lead to the reduction of barriers (structures and processes) that hinder individualised care delivery and facilitate programs aimed at developing professional environments that improve the delivery of older people's care.

Effectiveness of brief interventions in primary health care settings to decrease alcohol consumption by adult non-dependent drinkers: a systematic review of systematic reviews.

OBJECTIVE: To evaluate the effectiveness of brief interventions in the primary health care setting to decrease alcohol consumption in non-alcoholic adult drinkers. METHOD: Systematic review of systematic reviews and meta-analyses of randomized clinical trials published in English and Spanish and indexed in EMBASE, MEDLINE (PubMed), Web of Science, Scopus, and The Cochrane Library, from their inception to January 2014. The quality of the studies was evaluated with the AMSTAR instrument. RESULTS: Seven studies, published from 1999 to 2011, were included in the review (six meta-analyses, one systematic review). These studies were heterogeneous in terms of design, type and length of interventions analyzed, participants, responsible professionals, and results. Five studies reported a moderate decrease in alcohol consumption and four showed a decrease in the number of participants who consumed alcohol above the established risk level. CONCLUSION: Brief interventions have a moderate effect on reducing alcohol consumption among excessive drinkers or people who consume excessive amounts of alcohol and as a consequence these interventions increased the number of people drinking alcohol below established limits of risk. Brief interventions with multiple contacts or follow-up sessions are the most effective.

Perception of quality of care among residents of public nursing-homes in Spain: a grounded theory study.

BACKGROUND: The quality of care in nursing homes is weakly defined, and has traditionally focused on quantify nursing homes outputs and on comparison of nursing homes' resources. Rarely the point of view of clients has been taken into account. The aim of this study was to ascertain what means "quality of care" for residents of nursing homes. METHODS: Grounded theory was used to design and analyze a qualitative study based on in-depth interviews with a theoretical sampling including 20 persons aged over 65 years with no cognitive impairment and eight proxy informants of residents with cognitive impairment, institutionalized at a public nursing home in Spain. RESULTS: Our analysis revealed that participants perceived the quality of care in two ways, as aspects related to the persons providing care and as institutional aspects of the care's process. All participants agreed that aspects related to the persons providing care was a pillar of quality, something that, in turn, embodied a series of emotional and technical professional competences. Regarding the institutional aspects of the care's process, participants laid emphasis on round-the-clock access to health care services and on professional's job stability. CONCLUSIONS: This paper includes perspectives of the nursing homes residents, which are largely absent. Incorporating residents' standpoints as a complement to traditional institutional criteria would furnish health providers and funding agencies with key information when it came to designing action plans and interventions aimed at achieving excellence in health care.