Nursing practice environment and missed care at highly specialised hospitals in Mexico: A cross-sectional observational study.

BACKGROUND: The influence of the work environment on missed care and service quality has been well documented. However, available evidence concerning this relationship comes mostly from developed countries. Few studies have been conducted in low- or middle-income countries. We assessed the relationship between the work environment and missed nursing care in highly specialised hospitals in Mexico. METHODS: We conducted an observational cross-sectional study with data collected from January 2019 to February 2020 in 11 highly specialised hospitals (n = 510 nurses). We estimated missed nursing care utilising the MISSCARE questionnaire and used the Practice Environment Scale-Nursing Work Index instrument to assess the work environment. After describing the main attributes of the study sample according to the type of work environment, we constructed five adjusted fractional regression models, the first concerning the overall index of missed care, and the others pertaining to its various dimensions. RESULTS: The sample analysed was balanced as regards adjustment variables according to the type of work environment. The adjusted estimates confirmed an inverse relationship between the missed care index and enjoying an enhanced, or favourable, work environment. Overall, the difference was 9 percentage points (pp); however, by dimension of missed care, the major differences between enhanced and attenuated, or unfavourable, work environments were registered for basic care, followed by patient education and discharge planning (4pp) and individual needs (8pp). CONCLUSIONS: The work environment determines the frequency of missed nursing care, both overall and by dimension. Nursing managers need to create short- and mid-term strategies favouring positive work environments in order to improve working conditions for nursing professionals.

Gender-Specific Differences in Self-Care, Treatment-Related Symptoms, and Quality of Life in Hemodialysis Patients.

Gender and sex differences affect women with kidney failure (KF) negatively at all stages of the disease. This study assessed gender differences in self-care, hemodialysis symptoms, and quality of life in a sample of 102 adult KF patients treated with hemodialysis, from two clinical centers in Mexico. Self-care agency, quality of life, and the symptoms related to hemodialysis were evaluated through questionnaires, and sociodemographic and laboratory variables were obtained from the clinical records. Compared to male patients, female patients reported similar self-care, lower quality of life subscales (symptoms, physical functioning, pain, and overall health), and higher prevalence and intensity of hemodialysis symptoms. There were gender differences regarding the correlation between self-care and quality of life, symptoms intensity, and symptoms prevalence. In conclusion, women with KF treated with hemodialysis perceived a higher impact of hemodialysis and reported a lower quality of life than men. Despite having a similar self-care agency, the self-care correlations with quality of life and hemodialysis symptoms appeared different between men and women treated with chronic hemodialysis. Such differences may be important in future nursing interventions to improve self-care and quality of life among KF patients.

Autocuidado relacionado con la calidad de vida en pacientes con caudiopatía isquémica / Quality of life-related self-care in patients with ischemic cardiopathy

Introducción: el paciente que sufrió infarto agudo al miocardio (IAM) debe adherirse al tratamiento (AT), mejorar su autocuidado y realizar cambios de estilos de vida para restablecer su salud, de lo contrario puede haber repercusión en su calidad de vida relacionada con la salud (CVRS). Objetivo: analizar la relación que existe entre el autocuidado y la calidad de vida del paciente con cardiopatía isquémica. Material y métodos: estudio correlacional, prospectivo y transversal. Muestra no probabilística n=101 pacientes seleccionados por conveniencia; se incluyeron adultos de ambos sexos, pos IAM. Datos recolectados con cuestionario SF-36; Self-Care Agency Scale, parámetros bioquímicos y antropométricos. Análisis de datos con estadística descriptiva y prueba de Pearson, significancia p<0.05. Resultados: edad entre 34 y 86 años, predominaron los hombres (89.1%) y el 57.4% tenía educación básica. El 39% padecía hipertensión arterial y 44% diabetes mellitus II; el 51.5% mostró sobrepeso y el 18.8% obesidad. El 67.5% dependía de los cuidados de la esposa, hijos o ambos. El 93% tenía la percepción de mejor CVRS, el 69% mostró buena agencia de autocuidado y 30% regular. El autocuidado se correlaciona con la CVRS (r=0.447, p=0.000), principalmente con la capacidad de poder (r=0.443, p=0.000) y capacidad de operacionalizar (r=0.418, p=0.000). Conclusión: al mejorar la capacidad de autocuidado se modifica el estado de salud del paciente pos IAM y se refleja en su calidad de vida, pero deben reforzarse las áreas de oportunidad en materia de prevención secundaria y control de factores de riesgo, de lo contrario hay un riesgo de un nuevo IAM.