Positive Psychology: Supervisor Leadership in Organizational Citizenship Behaviors in Nurses.

INTRODUCTION: In nursing, identifying factors encouraging positive work attitudes is extremely important since a nurse's performance directly impacts the quality of the care they provide, and, therefore, their patients' health. OBJECTIVE: The main objective of this research is to analyze whether the supervisor-nurse relationship is positively correlated with a nurse's organizational citizenship behaviors. Thus, we established a main hypothesis as follows: the quality of the supervisor-nurse interpersonal relationship is positively related to the job satisfaction of the nurse, controlled by moderating the effects of psychological empowerment, the perceived organizational support, and leader-leader exchange. METHODOLOGY: This is a cross-sectional descriptive study with individuals as the units of analysis. The population studied comprised all the nurses and supervisors working in nine public hospitals in the autonomous community of Aragon (Spain). The sample consisted of 2541 nurses, 192 supervisors, and 2500 paired dyads. Self-report questionnaires were used to ensure workers' anonymity. The dependent variable was the nurse's organizational citizenship behaviors; the main independent variable was the supervisor's leadership; the moderating variables were the nurse's empowerment, the organizational support the nurse perceived, and the quality of the supervisor-superior relationship. RESULTS: Empirical evidence demonstrates that the quality of the supervisor-nurse relationship is positively correlated with organizational citizenship behaviors. The results also confirm the moderating effect of nurses' empowerment and of the organizational support they perceive. DISCUSSION: Our research shows how important it is for organizations to establish management practices promoting high-quality nurse-supervisor relationships; thus, hospital management should monitor both the supervisors' performance and leadership. CONCLUSIONS: The quality of the relationship the supervisor establishes with their nurses is vitally important since it is a necessary requirement for beneficial results for the organization as a result of citizenship behavior practice.

Cocaine Allergy in Drug-Dependent Patients and Allergic People.

BACKGROUND: Adverse reactions to local anesthetics (LAs), especially esters, are not uncommon, but true allergy is rarely diagnosed. To our knowledge, currently there is no reliable method of determining IgE-mediated hypersensitivity to LAs and cocaine. OBJECTIVE: To assess the clinical value of allergy tests (prick, IgE, challenges, and arrays) in people suffering hypersensitivity reactions (asthma and anaphylaxis) during local anesthesia with cocaine derivatives and drug abusers with allergic symptoms after cocaine inhalation. METHODS: We selected cocaine-dependent patients and allergic patients who suffered severe reactions during local anesthesia from a database of 23,873 patients. The diagnostic yield (sensitivity, specificity, and predictive value) of allergy tests using cocaine and coca leaf extracts in determining cocaine allergy was assessed, taking a positive challenge as the criterion standard. RESULTS: After prick tests, specific IgE, and challenge with cocaine extract, 41 of 211 patients (19.4%) were diagnosed as sensitized to cocaine. Prick tests and IgE to coca leaves (coca tea) had a good sensitivity (95.1% and 92.7%, respectively) and specificity (92.3 and 98.8%, respectively) for the diagnosis of cocaine allergy and LA-derived allergy. CONCLUSIONS: Cocaine may be an important allergen. Drug abusers and patients sensitized to local anesthesia and tobacco are at risk. Both prick tests and specific IgE against coca leaf extract detected sensitization to cocaine. The highest levels were related to severe clinical profiles.

Analysis of illicit drugs by direct ablation of solid samples.

Analysis of illicit drugs arises as an important field of work given the high social impacts presented by drugs in the modern society. Direct laser ablation of solid compounds allows their analysis without sampling or preparation procedures. For that purpose, an experimental set-up that combines laser ablation with time-of- flight mass spectrometry has been constructed very recently to perform studies on the mass spectra of such drugs as 3,4-methylenedioxy-N-methylamphetamine, commonly known as MDMA or ecstasy. Analysis of the observed fragmentation pattern in mass spectra may elucidate the ablation-induced photofragmentation phenomena produced, which differ from those previously observed with conventional ionization methods.

[On the ultimate goal of management in Spanish hospitals]. / Reflexión sobre el fin último de la gestión en el sector hospitalario español.

The European Foundation for Quality Management (EFQM) is the most introduced model in Spanish hospitals. The main target of this model is the internal and external client's satisfaction. The model of strategic management Balanced Scorecard (BSC) facilitates the alignment between management and the mission and vision of hospitals. For this reason, we propose a model of integrated management: EFQM-BSC. In order to obtain the items of this research, a survey was conducted among managers of Spanish hospitals on a battery of 46 indicators, selected from the EFQM model, and prioritised and included in the four perspectives of the BSC model. The research shows two possible models of hypothesis: the client model, where the final effect would be the client perspective (patient, staff and society's satisfaction), or the financial model, where the final effect would be the economic and financial results. After a reliability, dimension analysis and a discriminant analysis, it was obtained more consistent indicators which better explain each perspective. The relationship among these perspectives are determined by structural equations based on methods of partial least squares. The research confirms that the client model reflects a better consistency in its hypothesis.

Reflexión sobre el fin último de la gestión en el sector hospitalario español / On the ultimate goal of management in Spanish hospitals

El Modelo Europeo de Gestión de la Calidad (European Foundation for Quality Management, EFQM) es el más implantado en los hospitales españoles. Este modelo tiene como fin último la satisfacción del cliente interno y externo. El modelo de gestión estratégica Cuadro de Mando Integral (CMI) facilita la alineación de la gestión con la misión y la visión del hospital. En este estudio se propone un modelo de gestión integrado EFQM-CMI. Para la obtención de los ítems del estudio se realizó una encuesta a los responsables de la gestión de los hospitales españoles, con una batería de 46 indicadores seleccionados del EFQM, priorizados y englobados en las cuatro perspectivas del modelo de gestión CMI. El estudio plantea dos posibles modelos causales: el modelo del cliente, en el cual el efecto final sería la perspectiva del cliente (satisfacción del paciente, personal y de la sociedad en general), o el modelo financiero, cuyo efecto final serían los resultados económico-financieros. Tras un análisis exploratorio de fiabilidad y dimensionalidad, y con un análisis discriminante, se obtienen los indicadores más consistentes y que mejor explican cada una de las perspectivas. Las relaciones entre estas perspectivas se determinan mediante ecuaciones estructurales, basadas en técnicas de mínimos cuadrados parciales. El estudio confirma que el modelo del cliente refleja una mayor consistencia en sus hipótesis (AU)

The European Foundation for Quality Management (EFQM) is the most introduced model in Spanish hospitals. The main target of this model is the internal and external client's satisfaction. The model of strategic management Balanced Scorecard (BSC) facilitates the alignment between management and the mission and vision of hospitals. For this reason, we propose a model of integrated management: EFQM-BSC. In order to obtain the items of this research, a survey was conducted among managers of Spanish hospitals on a battery of 46 indicators, selected from the EFQM model, and prioritised and included in the four perspectives of the BSC model. The research shows two possible models of hypothesis: the client model, where the final effect would be the client perspective (patient, staff and society's satisfaction), or the financial model, where the final effect would be the economic and financial results. After a reliability, dimension analysis and a discriminant analysis, it was obtained more consistent indicators which better explain each perspective. The relationship among these perspectives are determined by structural equations based on methods of partial least squares. The research confirms that the client model reflects a better consistency in its hypothesis (AU)

La calidad de la formación especializada a través de la encuesta de opinión de residentes / Quality of specialist training measured through an opinion survey of resident physicians

Objetivos: Presentar los resultados de las encuestas de opinión que los residentes cumplimentan, en el curso de la auditoría docente, en los centros con formación sanitaria especializada. Material y métodos: Se estudian 10 hospitales generales de la red docente, tanto públicos como privados, correspondientes a 8 comunidades autónomas, dotados de 200 a 1.600 camas. La evaluación tuvo lugar en el período 2001-2004. Resultados: El 87% de los especialistas en formación que cumplimentó la encuesta considera aceptable o satisfactorio el proceso formativo en su globalidad, al tiempo que señalan déficits en aspectos o peculiaridades de la manera en que se desarrolla el aprendizaje. Conclusiones: La encuesta proporciona una importante información referente a la calidad docente y apoyo formativo que recibe el residente. La disponibilidad periódica de una encuesta acerca del grado de satisfacción con el sistema formativo ofrece una herramienta de monitorización y evaluación de la calidad, tanto para la propia sistemática de acreditación como para el centro formativo. La identificación de aspectos susceptibles de mejora implica la puesta en marcha de mecanismos de resolución ágiles y coordinados entre la propia unidad docente, el centro asistencial y las comisiones nacionales de especialidad

Objectives: To present the results of an opinion survey completed by resident physicians during the course of a teaching audit of centers imparting specialist medical training. Material and methods: Ten general hospitals, both public and private, within the teaching network and with between 200 and 1600 beds were evaluated between 2004 and 2004. The hospitals were situated in eight Autonomous Communities in Spain. Results: Eighty-seven percent of the trainee specialists who completed the questionnaire believed that, overall, the training received was acceptable or satisfactory. They also reported some deficiencies or peculiarities in the way training was imparted. Conclusions: The survey provides important information on the quality of the teaching and support given to residents. Periodic surveys on the degree of satisfaction with the training system among residents is a useful tool for monitoring and evaluating quality, both for the accreditation system and for the training center. Identification of features that could be improved requires easily implemented mechanisms that can be coordinated among the teaching unit, the institution, and national specialty commissions

Evaluación de derechos de los pacientes en el proceso de acreditación para la formación sanitaria especializada / Assessment of rights of the patients in accreditation process for specialized healthcare training

El objeto del presente trabajo es analizar la protección de los derechos de los pacientes comparando la situación real existente en 9 hospitales generales españoles, con una dotación de entre 403 a 1.600 camas, evaluados entre 2001 y 2003, con los criterios establecidos en el manual del proceso de acreditación para la formación sanitaria especializada aplicando la metodología de evaluación externa. El manual incluye criterios sobre difusión y aplicación de los derechos y deberes del paciente, el derecho a la información terapéutica, el consentimiento informado, política de actuación del hospital respecto a los derechos del paciente, desarrollo de la investigación clínica y ensayos clínicos, mantenimiento vital y atención a pacientes terminales, participación de la familia en las decisiones asistenciales y sobre donación y trasplantes de órganos y tejidos. La evaluación dio como resultado la identificación de áreas de mejora que se centraron fundamentalmente en establecer procedimientos efectivos de información a pacientes, procedimientos de evaluación periódica del grado de implantación del consentimiento informado con análisis de sus resultados y adopción de medidas correctoras precisas, procedimientos que garanticen la participación de la familia en la toma de decisiones de carácter asistencial, en el supuesto de que el paciente no esté en condiciones de adoptarlas por sí mismo, procedimientos relativos a la atención a pacientes terminales y ante interrupción de tratamientos de mantenimiento vital, y procedimientos que salvaguarden la privacidad de los pacientes (AU)