Impact of advanced practice nurses in hospital units on compliance with clinical practice guidelines: a quasi-experimental study.

BACKGROUND: Incorporating the best available evidence into clinical practice is a determining challenge for healthcare professionals and organisations. The role of advanced practice nurses is viewed as a facilitator to adapt guideline recommendations to suit specific contexts and to overcome barriers to implementation. In this study, we evaluate the impact of advanced practice nurses on clinical indicators of hospitalised patients and on adherence to recommendations derived from two clinical practice guidelines (pressure ulcer prevention and treatment and vascular access device management). METHODS: Quasi-experimental study in five intervention (IU) and five control (CU) hospital units at three hospitals in Spain (period 2018-19). Five advanced practice nurses were incorporated into IU, with the intention that would produce attitudinal changes and enhance the skills and knowledge of the nursing team regarding 18 clinical practice recommendations. In this study, 41 indicators were evaluated through direct observation of all patients admitted, at monthly intervals for 1 year. Outcomes were assessed by means of a descriptive, multi-line regression and association analysis. RESULTS: The study population was composed of 3742 inpatients admitted for pressure ulcer assessment and 2631 fitted with vascular access devices. By the end of the study period, all variables had improved in the IU, where average compliance with recommendations was statistically significantly higher (pressure ulcer guidance 7.9 ± 1.9 vs 6.0 ± 1.7. OR 1.86, 95% CI 1.67-2.05; vascular access devices guidance 5.4 ± 1.4 vs 4.4 ± 1,6. OR 1.06, 95% CI 0.95-1.17). The prevalence of pressure lesions and catheter-related adverse events decreased statistically significantly in the IU compared to the CU. The prevalence of pressure ulcers decreases (5.7% in IU vs 8.7% in CU p < 0.005) as well as the prevalence of adverse events related to the catheter (14% In IU vs 21.6% in CU p < 0.005). The unnecessary catheters decressed in IU 10.9% VS CU 15.8% (p < 0.005). CONCLUSIONS: The incorporation of an advanced practice nurse statistically significantly improves clinical indicators related to the prevention and treatment of pressure ulcers and to the management of vascular access devices. TRIAL REGISTRATION: ISRCTN18259923 retrospectively registered on 11/02/2022.

Moving Evidence into Practice by Advanced Practice Nurses in Hospitalization Wards. Protocol for a Multicentre Quasi-Experimental Study in Three Hospitals in Spain.

Evidence-based practice (EBP) combined with quality of care improves patient outcomes. However, there are still difficulties for its implementation in daily clinical practice. This project aims to evaluate the impact of the incorporation of the Advanced Practice Nurse (APN) role on the implementation of EBP at three levels: context, nurses' perceptions, and clinical outcomes. Mixed-methods study in two phases is proposed. Phase 1: a quasi-experimental design where five APNs are included in five hospitalization wards that are compared with another five similar wards without APNs. Variables from Practice-Environment-Scale-Nursing-Work-Index, Health-Science-Evidence-Based-Practice-Questionnaire, and Advanced-Practice-Nursing-Competency-Assessment-Instrument are used. Clinical outcomes are followed-up with monthly. A descriptive and exploratory analysis is performed. Phase 2: an exploratory qualitative design through focus groups at the intervention wards after one year of APNs implementation. Explicative data are gathered to explain the progression of change and how actors perceive and attribute triggers, barriers, and facilitators for change. An inductive thematic analysis is performed. The inclusion of APN in hospitalization context is insufficiently studied. It is hoped that these figures provide solutions to the multiple barriers in the development of EBP in these sceneries and contribute to resolve the gap between research results and healthcare practice.

[Nursing treatments in Majorca]. / Los cuidados enfermeros en Mallorca.

In this article, the authors analyze the role the "Sant Vicente de Paül" Sisters of Charity had in treating the ill in Majorca during the 19th Century. The authors carried out their research on two primary resources: The Rules of Life and a record of members of the order called the Book of the Curia. The authors tried to identify the methods the sisters followed in their work inside the Rules, searching for those aspects indicating their possible influence on the health of the population to whom they served as well as searching for references to their dedication as teachers, nurses and/or managers. In the Book of the Curia, the authors analyze the social data registered for the first 320 members of the order; evaluating their age upon entrance, their length of stay in the order, their job, and the cause of their death in order to compare these according to whether a sister was a teacher or a nurse.

Y a pesar de todo seguimos ahumando a los demás / And in spite of it all we carry on smoking out everyone else

Objetivos: Un edificio universitario en Palma de Mallorca (España) fue declarado 'libre de humo de tabaco' en octubre de 2002. En este estudio se ha entrevistado una muestra de usuarios hallados fumando en zonas prohibidas, evaluándose el conocimiento de la prohibición de fumar, la consciencia de estar perjudicando y molestando a las personas que comparten el mismo espacio y qué justificación daban a su conducta tabáquica. Métodos: Estudio descriptivo transversal, mediante encuesta verbal con un cuestionario que consta de 6 preguntas cerradas y una abierta. Se ha tomado una muestra de 50 sujetos que han sido hallados fumando en zonas prohibidas. Resultados y Conclusiones: Casi la totalidad de los encuestados (98 por ciento) tienen conocimiento de la prohibición de fumar donde lo hacen. El 80 por ciento conoce la existencia de zonas para fumadores. Una amplia mayoría cree que el tabaco perjudica y molesta a los fumadores pasivos (98 por ciento y 94 por ciento). Uno de cada cinco opina que no deben restringirse las zonas donde se pueda fumar. Los sujetos que fuman en los lugares no permitidos son perfectamente conscientes de la prohibición, conocen los espacios destinados a fumadores y reconocen perjudicar y molestar a los fumadores involuntarios. De estos conocimientos no se desprende una conducta respetuosa sino que incluso se reclama el derecho a fumar en los espacios compartidos. Ningún encuestado afronta su responsabilidad personal ni reconoce su adicción como motivo de su conducta (AU)

Aims: An university building in Palma de Mallorca (Spain) was declared “smoke free” in October 2002. In this study we interviewed a sample of users found smoking in prohibited areas, evaluating their knowledge of the prohibition on smoking, the awareness of harming and disturbing the people who share the same space and what justification they gave for their smoking behaviour. Methods: Transversal descriptive study, by a verbal survey with a questionnaire consisting of 6 closed questions and one open one. A sample of comprised 50 subjects found smoking in prohibited areas. Results and Conclusions: Practically all (98%) were aware of the prohibition on smoking in the area where they did so. 80% of those surveyed knew of the existence of designated smoking areas. A large majority believe smoking harms and disturbs passive smokers (98% and 94%). One in five is of the opinion that smoking should not be restricted to certain areas. The subjects who smoke in the areas where it is not allowed are perfectly aware of the prohibition, they know the areas designated for smoking and acknowledge harming and disturbing involuntary smokers. The outcome of this knowledge is not respectful behaviour, but rather a claim to the right to smoke in shared area. Not one of those surveyed accepts his or her personal responsibility or recognises their addiction as a motive for their behaviour (AU)