Investigando el autocuidado en una muestra de pacientes con insuficiencia cardiaca descompensada: un estudio transversal / Investigating self-care in a sample of patients with decompensated heart failure: a cross-sectional study

Antecedentes: La información sobre el autocuidado en la insuficiencia cardiaca (IC) en España es escasa. En concreto, existe la necesidad de fijar el nivel de comprensión de los pacientes sobre la IC, así como su capacidad para reconocer los signos y los síntomas de la descompensación. Pacientes y métodos: Estudio transversal para determinar el nivel de autocuidado en una población de pacientes españoles ingresados en el hospital con un diagnóstico primario de IC descompensada. Para el estudio, se reclutó una muestra de conveniencia integrada por 108 pacientes (50 mujeres y 58 hombres) con una edad de 83+/-8 años. Resultados: Para cuantificar el autocuidado en nuestra muestra se empleó el Índice de Autocuidado en Insuficiencia Cardiaca versión 6.2. La media y la desviación estándar de la subescala de mantenimiento de autocuidado del Índice de Autocuidado en Insuficiencia Cardiaca fueron: a) «ejercicio durante 30 minutos», 1+/-1; b) «olvida tomar una de sus medicinas», 2+/-2; c) «pedir productos bajos en sal cuando sale a comer o de visita», 2+/-1. En el mes previo, el 67,6% experimentó dificultad para respirar o inflamación del tobillo. Sin embargo, era improbable que la gran mayoría de nuestros pacientes implementaran de forma independiente un remedio: a) reducir sal, 2+/-1; b) reducir la ingesta de líquidos, 1+/-1; c) tomar un diurético extra, 1+/-1. Más del 50% de los pacientes de nuestra muestra se sintieron confiados o muy confiados siguiendo los consejos profesionales (3+/-1), manteniéndose libres de síntomas (3+/-1), reconociendo los cambios en su enfermedad (3+/-1) y valorando la importancia de dichos cambios (3+/-1). Conclusiones: Al comparar a nuestros pacientes con IC con los de otros países el nivel de autocuidado es significativamente bajo, especialmente en lo que se refiere a la gestión de su enfermedad. La promoción del autocuidado debería ser una prioridad para todos los profesionales de la salud involucrados en la gestión de los pacientes con IC

Background: There is scarce evidence relating to self-care of heart failure (HF) in Spain. In particular, there is a need to establish patients' level of understanding of HF, as well as their ability to recognise signs and symptoms of decompensation. Patients and methods: Cross-sectional study to determine the level of self-care in a population of Spanish patients admitted to hospital with a primary diagnosis of decompensated HF. A convenience sample of 108 patients (50 women and 58 men) aged 83+/-8 were recruited to participate in this study. Results: The Self-Care of Heart Failure Index version 6.2 was used to quantify self-care in our sample. Mean and standard deviation from the Self-Care of Heart Failure Index self-care maintenance subscale were: a) "exercise for 30 minutes", 1+/-1; b) "forget to take one of your medicines", 2+/-2; c) "ask for low-salt items when eating out or visiting others", 2+/-1. A percentage of 67.6 had experienced shortness of breath or ankle swelling in the past month. However, the vast majority of our patients were unlikely to independently implement a remedy: a) reduce salt, 2+/-1; b) reduce fluid intake, 1+/-1; c) take an extra diuretic, 1+/-1. Over 50% of our sample felt confident or very confident at following professional advice (3+/-1), keeping themselves free of symptoms (3+/-1), recognizing changes in their condition (3+/-1) and evaluating the significance of such changes (3+/-1). Conclusions: HF patients have a significantly low level of self-care when compared with HF patients from other countries, especially when it comes to managing their condition. Self-care promotion should be a priority for all healthcare professionals involved in the care and management of HF patients

Percepción del entorno de práctica enfermera de Atención Primaria de la Comunidad Valenciana, en departamentos con gestión pública y privada / Perception of the professional nursing environment in Primary Care in the Valencian Community, in departments with public and private management

Fundamento: Los entornos para la práctica profesional enfermera (EPE) mejoran la calidad del cuidado, la satisfacción y los resultados en salud, no existiendo ninguna medición en Atención Primaria (AP) según su modelo de gestión. Pretendemos estimar y comparar la percepción de la calidad de dichos ERE en AP en tres departamentos de salud (DS) de la Comunidad Valenciana con modelos de gestión pública y privada (concesión administrativa). Material y métodos: Estudio transversal en profesionales de Enfermería de AP de tres DS, uno de gestión pública y dos de gestión privada. Se utilizó el cuestionario Practice Environment Scale-Nursing Work Index validado en España y se recogieron variables sociodemográficas y profesionales. Se determinaron las variables relacionadas con la puntuación mediante regresión lineal múltiple. Resultados: Se obtuvieron 269 respuestas (80,3%). Todos los DS percibieron la calidad de los EPE de forma positiva, tanto global como para las distintas dimensiones (excepto D4). La puntuación global fue más alta en los DS de gestión privada; la misma tendencia que se observó para D1 y D2, opuesta a la observada en D4. La puntuación global se relacionó con la edad, la experiencia profesional, ejercer un cargo de coordinación y el modelo de gestión, pero tan solo la edad y ejercer un cargo de coordinación mantuvo la relación en el modelo multivariante. Conclusiones: Los EPE de AP en la Comunidad Valenciana son positivos, y su calidad no se ve afectada por el modelo de gestión. Ejercer un cargo de coordinación y, especialmente, la edad son los factores que se relacionan de forma independiente con la puntuación obtenida

Background: Nursing practice environments (NPE) improve the quality of care, satisfaction and heath results; there are no studies that compare the Primary Health Care (PHC) environments according to their management model. Our aim is to estimate and compare the perception of the quality of the NPE in the PHC in Health Departments (HD) of the Valencian Community (Spain) with management model public or indirect-private (Administrative concession). Method: Transversal study on PHC nurses from three HD, one with direct public management and two with indirect-private management. The Practice Environment Scale-Nursing Work Index questionnaire, validated in Spain, was administered. Sociodemographic and professional variables were recorded. Variables related to test score were analyzed by multiple linear regression. Results: Two hundred and sixty-nine answers (80.3%). All HD perceived NPE quality in a positive way, both globally and for the different dimensions (except D4). Indirect private management model HD obtained higher global scores, the same tendency was observed for D1 and D2, and the opposite for D4. Global score was related to age, professional experience, being a coordinator and management model; only the age of the nurses and being a coordinator showed a significant relationship with the score in the multivariate regression model. Conclusions: The NPE of the PHC of the Valencian Community are of good quality, without significant differences according to different management models of the HD. Being a coordinator and, particularly, the age of the nurses are variables that are independently related to the global score obtained

[Perception of the professional nursing environment in Primary Care in the Valencian Community, in departments with public and private management]. / Percepción del entorno de práctica enfermera de Atención Primaria de la Comunidad Valenciana, en departamentos con gestión pública y privada.

BACKGROUND: Nursing practice environments (NPE) improve the quality of care, satisfaction and heath results; there are no studies that compare the Primary Health Care (PHC) environments according to their management model. Our aim is to estimate and compare the perception of the quality of the NPE in the PHC in Health Departments (HD) of the Valencian Community (Spain) with management model public or indirect-private (Administrative concession). METHOD: Transversal study on PHC nurses from three HD, one with direct public management and two with indirect-private management. The Practice Environment Scale-Nursing Work Index questionnaire, validated in Spain, was administered. Sociodemographic and professional variables were recorded. Variables related to test score were analyzed by multiple linear regression. RESULTS: Two hundred and sixty-nine answers (80.3%). All HD perceived NPE quality in a positive way, both globally and for the different dimensions (except D4). Indirect private management model HD obtained higher global scores, the same tendency was observed for D1 and D2, and the opposite for D4. Global score was related to age, professional experience, being a coordinator and management model; only the age of the nurses and being a coordinator showed a significant relationship with the score in the multivariate regression model. CONCLUSIONS: The NPE of the PHC of the Valencian Community are of good quality, without significant differences according to different management models of the HD. Being a coordinator and, particularly, the age of the nurses are variables that are independently related to the global score obtained.

Investigating self-care in a sample of patients with decompensated heart failure: A cross-sectional study. / Investigando el autocuidado en una muestra de pacientes con insuficiencia cardiaca descompensada: un estudio transversal.

BACKGROUND: There is scarce evidence relating to self-care of heart failure (HF) in Spain. In particular, there is a need to establish patients' level of understanding of HF, as well as their ability to recognise signs and symptoms of decompensation. PATIENTS AND METHODS: Cross-sectional study to determine the level of self-care in a population of Spanish patients admitted to hospital with a primary diagnosis of decompensated HF. A convenience sample of 108 patients (50 women and 58 men) aged 83±8 were recruited to participate in this study. RESULTS: The Self-Care of Heart Failure Index version 6.2 was used to quantify self-care in our sample. Mean and standard deviation from the Self-Care of Heart Failure Index self-care maintenance subscale were: a) "exercise for 30 minutes", 1±1; b) "forget to take one of your medicines", 2±2; c) "ask for low-salt items when eating out or visiting others", 2±1. A percentage of 67.6 had experienced shortness of breath or ankle swelling in the past month. However, the vast majority of our patients were unlikely to independently implement a remedy: a) reduce salt, 2±1; b) reduce fluid intake, 1±1; c) take an extra diuretic, 1±1. Over 50% of our sample felt confident or very confident at following professional advice (3±1), keeping themselves free of symptoms (3±1), recognizing changes in their condition (3±1) and evaluating the significance of such changes (3±1). CONCLUSIONS: HF patients have a significantly low level of self-care when compared with HF patients from other countries, especially when it comes to managing their condition. Self-care promotion should be a priority for all healthcare professionals involved in the care and management of HF patients.