Info-NAS: A Computer Program for the Calculation of Intensive Care Unit Nurse Workload.

The purpose of this study was to design an algorithm that allows automatic calculation of nursing workload in intensive care units, based on the Nursing Activities Score scale, through a computer program. Three methodological steps were used: (1) Delphi method (group of experts); (2) identification of the correspondence: Nursing Activities Score items-variables in the EHR, namely, standardized terminology, laboratory values, and prescriptions; and (3) weighting of variables independently by a group of experts. Finally, the algorithm of the computer program was tested. The results showed an algorithm that calculates the nursing workload in an ICU. The calculation is objective and automatic through the EHRs. This study shows the feasibility of the algorithm as a rapid and objective strategy to quantify adequate nurse staffing in intensive care units. Moreover, it provides nurses with a practical resource for the correct completion of records and is thus an incentive to maintain or improve their quality.

Risk factors of catheter- associated bloodstream infection: Systematic review and meta-analysis.

INTRODUCTION: The prevalence of catheter-associated bloodstream infections (CLABSI) is high and is a severe health problem associated with an increase in mortality and elevated economic costs. There are discrepancies related to the risk factors of CLABSI since the results published are very heterogeneous and there is no synthesis in the description of all the predisposing factors. OBJECTIVE: We aimed to perform a systematic review and meta-analysis to synthesize and establish the risk factors predisposing to CLABSI reported in the literature. METHOD: This is a systematic review of observational studies following the PRISMA recommendations. MEDLINE and CINAHL databases were searched for primary studies from 2007 to 2021. The protocol was registered in PROSPERO CRD42018083564. RESULTS: A total of 654 studies were identified, 23 of which were included in this systematic review. The meta-analysis included 17 studies and 9 risk factors were analyzed (total parenteral nutrition (TPN), chemotherapy, monolumen and bilumen catheters, days of catheterization, immunosuppression, kidney disease and diabetes mellitus) due to the homogeneity of their definitions and measurements. The risk factors found to increase the probability of developing CLABSI were TPN, multilumen devices, chemotherapy treatment, immunosuppression and the number of days of catheterization. On the other hand, monolumen devices presented a lower likelihood of triggering this infection.

Efectividad de una intervención hospitalaria para disminuir interrupciones durante la preparación y administración de medicación / Effectiveness of a hospital intervention for reducing interruptions during medication preparation and administration

Objetivo: valorar la efectividad del uso de chaleco de alerta en la reducción de interrupciones durante las rondas de preparación y administración de medicación en el entorno hospitalario, y recoger las experiencias de los profesionales de Enfermería en relación con ellosMétodo: estudio cuasiexperimental pre y posintervención sin grupo control. La intervención consistió en dar información al equipo asistencial, pacientes y familiares de la importancia de no interrumpir el proceso de medicación, colocación de carteles informativos en las unidades e implementación de chalecos de un solo uso para visibilizar esa actividad. Los datos se recogieron mediante observación directa pre y posintervención en cuatro unidades de hospitalización durante la ronda de medicación. Adicionalmente se realizó una encuesta de opinión a los participantes.Resultados: en el periodo preintervención se observaron a 29 profesionales durante 29,2 horas. Se produjeron 516 interrupciones, una cada 3,23 (DE:1,18) minutos. En el periodo posintervención se observaron a 26 profesionales durante 19 horas y se produjeron 210 interrupciones, una cada 5,26 (DE: 3,44) minutos de media (p= 0,001). Un 58,8% creía que no era una medida efectiva para la reducción de las interrupciones, el 61,8% pensaba que los pacientes/familiares no entendían bien la medida, y el 11,5% sugería buscar medidas más ecológicas.Conclusiones: los chalecos disminuyeron el número de interrupciones aumentando el tiempo entre ellas, aunque seguía siendo considerable. Esto, sumado a la baja satisfacción de los profesionales y al impacto medioambiental, supuso la desestimación del chaleco de alerta como medida efectiva en la reducción de las interrupciones en el proceso de medicación.(AU)

Objective: to assess the effectiveness of the warning vest upon the reduction of interruptions during the medication preparation and administration rounds in the hospital setting, and to collect the experiences of Nursing professionals regarding this.Method: a quasi-experimental pre-and-post intervention study without control arm. The intervention consisted in giving information to the healthcare staff, patients and relatives, about the importance of not interrupting the medication process, as well as placing informative posters in the units, and implementing one-single-use vests to make this activity visible. Data were collected through direct observation pre-and-post intervention in four hospitalization units during medication rounds. Additionally, an opinion survey was conducted among participants.Results: in the pre-intervention period, 29 professionals were observed during 29.2 hours. There were 516 interruptions, one every 3.23 (SD:1.18) minutes. In the post-intervention period, 26 professionals were observed during 19 hours, and there were 210 interruptions, one every 5.26 (SD: 3.44) minutes as mean (p= 0.001). Of these professionals, 58.8% believed that this was not an effective measure for reducing interruptions, 61.8% thought that patients / relatives did not understand the measure well, and 11.5% suggested looking for measures which were more ecological.Conclusions: vests reduced the number of interruptions and increased the time between them, even though this continued being significant. Added on to the low satisfaction by professionals and its environmental impact, this entailed the rejection of warning vests as an effective measure for the reduction of interruptions during the medication process.(AU)

Nurse prescription start-up in a Spanish health organization: Nurses' preparedness and 6-month results.

INTRODUCTION: Nurse prescribing is well consolidated in many countries. In Spain, recent legislation has allowed nurse to prescribe under specific conditions, but the implementation process is complex. OBJECTIVES: First, to describe nurses' knowledge and expectations of nurse prescribing in a health institution in Spain. Second, to report the nurses' prescriptions in a pilot group at 6 months. METHODS: A descriptive, online survey design was used to identify nurses' knowledge and expectations of prescribing. The results were compared according to the nurses' professional position and training. We analyzed the number and type of prescriptions issued in the first 6 months. RESULTS: Training needs (overall score = 4.2/5) and lack of knowledge of the law (4.25/5) were scored lower by nurses with postgraduate training. Subjective assessment of preparedness among nurses was high (>4/5), and the highest-scoring expected impact was improvement in patients' experience (4.25/5). Years of nursing experience were negatively correlated with preparedness and the expectation of an increase in patient management errors. A total of 212 prescriptions were issued (2 drugs and 200 health devices). CONCLUSIONS: Nurses perceived good preparedness but also the need for more training in medicines and prescribing law. Expectations of prescribing were favourable. Most prescriptions were for health devices.

COVID-19 pandemic on health professionals in a third level hospital in Spain: job changes during the first wave, mental health at 4 months, and follow-up at 9 months.

OBJECTIVE: To determine the impact that the COVID-19 pandemic has had on health professionals, in terms of work changes and mental health. METHOD: 1) Cross-sectional study and 2) longitudinal prospective study on health professionals who worked directly with patients affected by COVID-19 pandemic during the period between March-June 2020 in a tertiary hospital in Barcelona. Baseline (July-November 2020) and follow-up (November 2020-March 2021) data were collected. Data related to the job and toxic habits were collected with ad hoc questionnaires, and data related to perceived stress, post-traumatic stress, depression, and anxiety using validated questionnaires. RESULTS: In the baseline group (cross-sectional study), 90 professionals participated, 76% nurses. More than a third were on sick leave or took drugs to manage stress. Half of smokers increased tobacco use, and one in 5 increased alcohol consumption. Habitual shift change is significantly associated with depression, professional profile with anxiety, and perceived stress with age. In the longitudinal prospective study, the follow-up group (n = 64) shows high levels of stress and anxiety, which are maintained or even significantly increased over time. CONCLUSIONS: The structural changes that occurred in the hospital during the first wave of the COVID-19 pandemic had a strong impact on professionals, many of them presenting an increase in toxic habits, as well as impaired mental health that is maintained over time.

Pandemia COVID-19 sobre profesionales sanitarios en un hospital de tercer nivel en España: cambios laborales durante la primera ola, salud mental a los 4 meses y seguimiento a los 9 meses / COVID-19 pandemic on health professionals in a third level hospital in Spain: job changes during the first wave, mental health at 4 months, and follow-up at 9 months

Objetivo: Determinar el impacto que ha tenido la pandemia COVID-19 en profesionales sanitarios, en términos de cambios laborales y de salud mental. Método: 1)Estudio transversal y 2) estudio longitudinal prospectivo sobre profesionales de la salud que trabajaron de forma directa con pacientes afectados por la pandemia COVID-19 durante el periodo comprendido entre marzo-junio de 2020 en un hospital de tercer nivel de Barcelona. Se recogieron datos basales (julio-noviembre de 2020) y de seguimiento (noviembre de 2020-marzo de 2021). Se recogieron datos relacionados con el puesto de trabajo y hábitos tóxicos con cuestionarios ad hoc, y de estrés percibido, estrés postraumático, depresión y ansiedad mediante cuestionarios validados. Resultados: En el grupo basal (estudio transversal) participaron 90 profesionales, 76% enfermeras. Más de un tercio estuvo de baja o tomó fármacos para gestionar el estrés. La mitad de los fumadores aumentó el consumo de tabaco, y uno de cada 5 aumentó el consumo de alcohol. Se asocia de forma significativa el cambio de turno habitual con la depresión, el perfil profesional con la ansiedad, y el estrés percibido con la edad. En el estudio longitudinal, el grupo de seguimiento (n=64) muestra niveles elevados de estrés y ansiedad, que se mantienen o incluso aumentan en el tiempo de forma significativa. Conclusiones: Los cambios estructurales acontecidos en el hospital durante la primera ola de la pandemia por la COVID-19 tuvieron un fuerte impacto en los profesionales, presentando muchos de ellos un aumento en los hábitos tóxicos, así como una salud mental alterada que se mantiene en el tiempo.(AU)

Objective: To determine the impact that the COVID-19 pandemic has had on health professionals, in terms of work changes and mental health. Method: 1) Cross-sectional study and 2) longitudinal prospective study on health professionals who worked directly with patients affected by COVID-19 pandemic during the period between March-June 2020 in a tertiary hospital in Barcelona. Baseline (July-November 2020) and follow-up (November 2020-March 2021) data were collected. Data related to the job and toxic habits were collected with ad hoc questionnaires, and data related to perceived stress, post-traumatic stress, depression, and anxiety using validated questionnaires. Results: In the baseline group (cross-sectional study), 90 professionals participated, 76% nurses. More than a third were on sick leave or took drugs to manage stress. Half of smokers increased tobacco use, and one in 5 increased alcohol consumption. Habitual shift change is significantly associated with depression, professional profile with anxiety, and perceived stress with age. In the longitudinal prospective study, the follow-up group (n=64) shows high levels of stress and anxiety, which are maintained or even significantly increased over time. Conclusions: The structural changes that occurred in the hospital during the first wave of the COVID-19 pandemic had a strong impact on professionals, many of them presenting an increase in toxic habits, as well as impaired mental health that is maintained over time.(AU)

[COVID-19 pandemic on health professionals in a third level hospital in Spain: job changes during the first wave, mental health at 4 months, and follow-up at 9 months]. / Pandemia COVID-19 sobre profesionales sanitarios en un hospital de tercer nivel en España: cambios laborales durante la primera ola, salud mental a los 4 meses y seguimiento a los 9 meses.

Objective: To determine the impact that the COVID-19 pandemic has had on health professionals, in terms of work changes and mental health. Method: 1) Cross-sectional study and 2) longitudinal prospective study on health professionals who worked directly with patients affected by COVID-19 pandemic during the period between March-June 2020 in a tertiary hospital in Barcelona. Baseline (July-November 2020) and follow-up (November 2020-March 2021) data were collected. Data related to the job and toxic habits were collected with ad hoc questionnaires, and data related to perceived stress, post-traumatic stress, depression, and anxiety using validated questionnaires. Results: In the baseline group (cross-sectional study), 90 professionals participated, 76% nurses. More than a third were on sick leave or took drugs to manage stress. Half of smokers increased tobacco use, and one in 5 increased alcohol consumption. Habitual shift change is significantly associated with depression, professional profile with anxiety, and perceived stress with age. In the longitudinal prospective study, the follow-up group (n = 64) shows high levels of stress and anxiety, which are maintained or even significantly increased over time. Conclusions: The structural changes that occurred in the hospital during the first wave of the COVID-19 pandemic had a strong impact on professionals, many of them presenting an increase in toxic habits, as well as impaired mental health that is maintained over time.

Impact of the implementation of best practice guidelines on nurse's evidence-based practice and on nurses' work environment: Research protocol.

AIM: To determine the impact of the Best Practice Spotlight Organization® initiative on nurses' perception of their work environment and their attitudes to evidence-based practice. DESIGN: Quasi-experimental, multicentre study. The intervention is the participation in Best Prectice Spotilight Organizations to implement Best Practice Guidelines. METHODS: The study will include seven centres in the interventional group and 10 in the non-equivalent control group, all of them belonging to the Spanish national health system. The Practice Environment Scale of the Nursing Work Index, and the Health Sciences Evidence-Based Practice Questionnaire will be administered to a sample of 1,572 nurses at the beginning of the programme and at 1 year. This 3-year study started in April 2018 and will continue until December 2021. Statistical analyses will be carried out using the SPSS 25.0. This project was approved by the Drug Research Ethics Committee of the Parc de Salut Mar and registered in Clinical Trials. DISCUSSION: The study findings will show the current state of nurses' perception of their work environment and attitudes to evidence-based practice, and possible changes in these parameters due to the programme. IMPACT: The findings could provide a strong argument for health policymakers to scale up the Best Practice Spotlight Organization® initiative in the Spanish national health system.

Knowledge expectations of orthopaedic patients.

AIM: To describe and compare knowledge expectations and received knowledge in elective orthopaedic surgery patients. BACKGROUND: Population aging, increasing incidence of osteoarthritis, the growing number of surgical procedures, and reduced clinical stays underline the need for a new approach to patient education. DESIGN: This study has a descriptive, comparative design. METHODS: Data were collected from 263 patients who had total hip and knee replacement elective surgery during 3 years (2009-2012) in 5 public hospitals in Spain. The Knowledge Expectation of Hospital Patients and the Received Knowledge of Hospital Patients Scales were used to collect data. The questionnaires were filled before hospital admission, at discharge and at follow-up 6 to 7 months later. RESULTS: Surgical patients received less knowledge than they expected. Patients' expectations were only met in the functional dimension. At follow-up, patients reported that they perceived having acquired more knowledge during their hospital stay than they reported at the time of discharge. Knowledge expectations and knowledge received were related to employment status, gender, and previous contact experience with the hospital. CONCLUSION: Knowledge expectations were not met, and results showed the need to improve education for orthopaedic patients throughout the perioperative process, not only during hospitalization.

Validación de la versión española: Expectativas y conocimiento recibido del paciente hospitalizado / Validation of the Spanish Version: Expectations and Knowledge Received in the Hospitalized Patient / Validação da versão española do instrumento Expectativa e Conhecimento Recebido do Paciente Hospitalizado

RESUMEN Objetivo: evaluar la validez y la fiabilidad de la versión española del instrumento Expectativas y conocimiento recibido del paciente hospitalizado (ECPH/CRPH) en pacientes con osteoartritis intervenidos de artroplastia total de rodilla. Material y métodos: el proceso de validación siguió las recomendaciones internacionales: validez de contenido, validez de constructo, validez de criterio y fiabilidad. Un total de 248 pacientes que debían intervenirse de artroplastia total de rodilla en 5 hospitales públicos españoles contestaron la ECPH antes de ser hospitalizados y 220 pacientes contestaron el CRPH al darles el alta hospitalaria. Resultados: el análisis factorial confirmó las dimensiones de la escala original para el conocimiento recibido, pero no en la escala para las expectativas. La correlación de las dimensiones de la ECPH con la Escala de Opinión de la Salud de Krantz (KHOS) y la correlación de las dimensiones de la CRPH con la Escala de Acceso a la Información (AKS) indicaron la validez de criterio mostrando unas relaciones positivas. Los resultados señalaron buena fiabilidad con valores de alfa Cronbach elevados. Conclusión: el proceso de validación indica que la versión española del ECPH/CRPH es un instrumento válido y fiable para medir las expectativas y el conocimiento recibido en pacientes quirúrgicos en el contexto español.

ABSTRACT Objective: The objective of the study was to assess the validity and reliability of the Spanish version of Expectations and Received Knowledge in the Hospitalized Patient (ECPH / CRPH), specifically among patients with osteoarthritis who are undergoing total knee arthroplasty. Material and methods: The validation process followed international recommendations in terms of content validity, construct validity, criterion validity and reliability. A total of 248 patients who were about to undergo total knee arthroplasty at five (5) Spanish public hospitals answered the ECPH before being hospitalized and 220 patients answered the CRPH when they were discharged. Results: Factor analysis confirmed the dimensions of the original scale for the knowledge received, but not with respect to the scale for expectations. The correlation of the ECPH dimensions with the Krantz Health Opinion Scale (KHOS) and the correlation of the CRPH dimensions with the Information Access Scale (AKS) indicated criterion validity, showing positive relationships. The results suggested good reliability with high Cronbach alpha values. Conclusion: The validation process showed the Spanish version of ECPH / CRPH is a valid and reliable instrument to measure the expectations and knowledge received in surgical patients in the Spanish context.

RESUMO Objetivo: avaliar a validade e a confiabilidade da versão espanhola do instrumento Expectativa e Conhecimento Recebido do Paciente Hospitalizado (ECPH/CRPH) em pacientes com osteoartrite submetidos à artroplastia total de joelho. Métodos: o processo de validação seguiu as recomendações internacionais: validade de conteúdo, validade de construto, validade de critério e confiabilidade. 248 pacientes que devem ser submetidos à artroplastia total de joelho em cinco hospitais públicos espanhóis responderam ao ECPH antes de serem hospitalizados, e 220 pacientes responderam ao CRPH ao ganharem alta. Resultados: a análise fatorial confirmou as dimensões da escala original para o conhecimento recebido, mas não na escala para as expectativas. A correlação das dimensões do ECPH com a Escala de Opinião da Saúde de Krantz (KHOS) e a correlação das dimensões do CRPH com a Escala de Acesso à Informação (AKS) indicaram a validade de critério e mostraram umas relações positivas. Os resultados indicam boa confiabilidade com valores de alfa Cronbach elevados. Conclusões: o processo de validação indica que a versão espanhola do ECPH/CRPH é um instrumento válido e confiável para medir as expectativas e o conhecimento recebido em pacientes em regime de internamento no contexto espanhol.