Implantación de la Guía de buenas prácticas para el cuidado y manejo de la ostomía: resultados en cuidados / Implementation of best practice guidelines for ostomy care and management: Care outcomes

INTRODUCCIÓN: Los cuidados proporcionados a las personas ostomizadas son cruciales para su evolución y rehabilitación. Las Guías de práctica clínica de la Registered Nurses' Association of Ontario recogen las intervenciones enfermeras con mayor evidencia en el cuidado del paciente ostomizado. El objetivo del estudio es analizar el impacto en los cuidados y los resultados de salud de los pacientes tras la implantación de la guía Cuidado y manejo de la ostomía. MÉTODO: Estudio cuasiexperimental pre-post test en todos los pacientes a los que se les realizó una ostomía digestiva o urológica en 8 Centros Comprometidos con la Excelencia en Cuidados® donde se implanta la guía para el cuidado y manejo de la ostomía, desde 2012 hasta 2018. Se analizaron y compararon variables clínicas de proceso y de resultados en salud en 3 períodos de tiempo. Se realizó un análisis descriptivo y se compararon las proporciones entre períodos, mediante Chi cuadrado, aplicando la corrección de Yates, considerando un nivel de confianza del 95%. RESULTADOS: La educación preoperatoria pasó del 36,7 al 47,3% (p < 0,05); el marcaje de la ostomía, del 25,2 al 33,8% (p < 0,05); la evaluación postoperatoria, del 94,8 al 59% (p < 0,05); la educación postoperatoria, del 75,5 al 91,9% (p < 0,05); las complicaciones en la piel periestomal, del 16,6 al 10,9% (p < 0,05), y las complicaciones en la ostomía, del 21,8 al 27,9% (p < 0,05). CONCLUSIONES: La implantación de la guía para el cuidado y manejo de la ostomía produjo mejoras en los cuidados preoperatorios, el marcaje del estoma y en las complicaciones de la piel periestomal

INTRODUCTION: Care provided to ostomized people is crucial in their progress and rehabilitation. The Registered Nurses' Association of Ontario clinical practice guidelines include greatest evidence nursing interventions for ostomized patient care. The aim of the study is to analyze the impact on patients' care and health outcomes after Care and management of ostomy guideline implementation. METHOD: Pre-post quasi-experimental study, carried out in all patients who underwent a digestive or urological ostomy in 8 centres of Best Practices Spotlight Organization® where the ostomy care and management guideline was implanted from 2012 to 2018. Clinical, process and health outcome variables were analyzed and compared in 3 periods of time. Descriptive analysis and comparison of proportions between the periods was performed, using Chi square, applying Yates correction, considering a 95% confidence interval. RESULTS: Preoperative education went from 36.7 to 47.3% (P<.05); stoma site marking from 25.2 to 33.8% (P<.05); postoperative evaluation from 94.8 to 59% (P<.05); postoperative education from 75.5 to 91.9% (P<.05); peristomal skin complications from 16.6 to 10.9% (P<.05), and ostomy complications from 21.8 to 27.9% (P<.05). CONCLUSIONS: The implementation of the ostomy care and management improved preoperative care, stoma site marking and peristomal skin complications

Consulta de enfermería y adherencia terapéutica del paciente en hemodiálisis / Nursing consultation and therapeutic adherence of the hemodialysis patient

Introducción: Al entrevistar a un paciente en la sala de hemodiálisis se producen muchas interferencias en la comunicación ya que simultáneamente atendemos a otros pacientes y se presentan complicaciones que tendremos que resolver de forma inmediata. Mediante la consulta de enfermería se pretende evitar esto, y darle el valor y tiempo que tienen las intervenciones enfermeras que son parte del tratamiento. Debemos asegurar que el paciente recibe instrucciones terapéuticas correctamente escritas, revisarlas y verificarlas con él para poder hacer un ajuste de niveles de comprensión, además de motivarlo y corresponsabilizarlo para lograr la adquisición de conductas implicadas en su autocuidado. Objetivo: Evaluar el efecto de la consulta de enfermería al paciente renal en hemodiálisis sobre el cumplimiento terapéutico. Material y Método: Estudio observacional longitudinal prospectivo de cohorte. Muestra de 42 pacientes en programa de hemodiálisis desde enero a junio 2014. Los pacientes seleccionados para la consulta son aquellos para los que la investigadora del estudio es enfermera referente y colaboradora (Grupo A). Se recogen datos de las diferentes variables revisando las historias clínicas y mediante la entrevista con el paciente y cuidador principal. Resultados: Encontramos diferencias significativas al comparar las variables estudiadas entre el Grupo A y Grupo B (resto pacientes) en cuanto al fósforo y cumplimiento farmacológico, pero no se encontraron en cuanto al potasio aunque la tendencia es a mejorar los niveles. Conclusiones: La consulta de enfermería mejora la adherencia terapéutica en dieta y medicación, relacionándose con un mayor tiempo de dedicación al tratamiento y mayor contacto con el cuidador principal (AU)

Introduction: When interviewing a patient in the hemodialysis room, there is a lot of interference in communication since we simultaneously attend to other patients and present complications that we should solve immediately. Nursing consultation is intended to avoid this and give the value and time that nurses have interventions, which are part of the treatment. We must ensure that the patient receives correctly written therapeutic instructions, check and verify them with him in order to adjust comprehension levels, motivate and co-responsibility for achieving the acquisition of behaviors involved in self-care. Objective: To evaluate the effect of the nursing consultation on the therapeutic compliance in the renal patient on hemodialysis. Material and Method: A prospective longitudinal observational cohort study. Sample of 42 patients in hemodialysis program from January to June 2014. Patients selected for the consultation are those that the researcher of the study is referring nurse and collaborator (Group A). Data are collected from the different variables by reviewing the medical records and by interviewing the patient and primary caregiver. Results: Significant differences were found when comparing the variables studied between Group A and Group B (rest patients) in terms of phosphorus and pharmacological compliance, but were not found in terms of potassium although the tendency is to improve levels. Conclusions: The nursing consultation improves the therapeutic adherence in diet and medication, being related to a greater time of dedication to the treatment and greater contact with the main caregiver (AU)

Nivel de satisfacción de la población de un consultorio médico de familia con los servicios de enfermería / The level of satisfaction of the population from a family practitioner office with the nursing services

Introducción: el ilimitado alcance humanista, social, psicológico y científico que caracteriza a la enfermería está presente en Atención Primaria de Salud, donde la satisfacción de la población es un indicador de calidad en los servicios que prestamos. Objetivo: evaluar el nivel de satisfacción de la población con la labor de enfermería. Métodos: estudio descriptivo retrospectivo en la población del consultorio médico de familia del poblado de Argelia, pertenecientes al área de salud del policlínico universitario Dr. Juan Manuel Páez Inchausti en la Isla de la Juventud en 2015. Universo de 944 pacientes y muestra de 430, la información se obtuvo aplicando un cuestionario de satisfacción, se consideró satisfecho cuando obtuvo 65 puntos o más, se utilizó el porcentaje para resumir la información. Resultados: el 92,79 por ciento se encontraba satisfecho con la atención de enfermería, los indicadores: conocimientos, experiencia y amabilidad de la enfermera fueron reconocidos por el 100,00 por ciento de los pacientes. Conclusiones: a pesar de que el trabajo de enfermería que se brinda en esta área de salud se califica de bueno, es necesario reflexionar sobre los posibles aspectos o debilidades objetivas y subjetivas que tiene esta enfermera para su mejor desempeño(AU)

Introduction: The limited humanist, social, psychological and scientific scope that characterizes nursing practice is present in primary health care, where the population satisfaction is an indicator for the quality of the services provided. Objective: Assess the level of satisfaction of the population with the nursing services. Methods: Retrospective, descriptive study in the population from the family practitioner office of the village of Argelia, belonging to the health area of Dr. Juan Manuel Páez Inchausti university polyclinic of Isle of Youth in 2015. Target group of 944 patients and sample of 430, the information was obtained by conducting a satisfaction questionnaire, we considered satisfied when 65 points or more were obtained, percentage was used to summarize the information. Results: 92.79 percent was satisfied with nursing care, the indicators nurse knowledge, experience and kindness were acknowledged by 100.00 percent of the patients. Conclusion: Despite the fact the nursing work provided in this health area is qualified as good, it is necessary to reflect on the possible aspects and objective and subjective weaknesses this nurse has in her better performance(AU)

Nivel de satisfacción de la población de un consultorio médico de familia con los servicios de enfermería / The level of satisfaction of the population from a family practitioner office with the nursing services

Introducción: el ilimitado alcance humanista, social, psicológico y científico que caracteriza a la enfermería está presente en Atención Primaria de Salud, donde la satisfacción de la población es un indicador de calidad en los servicios que prestamos. Objetivo: evaluar el nivel de satisfacción de la población con la labor de enfermería. Métodos: estudio descriptivo retrospectivo en la población del consultorio médico de familia del poblado de Argelia, pertenecientes al área de salud del policlínico universitario Dr. Juan Manuel Páez Inchausti en la Isla de la Juventud en 2015. Universo de 944 pacientes y muestra de 430, la información se obtuvo aplicando un cuestionario de satisfacción, se consideró satisfecho cuando obtuvo 65 puntos o más, se utilizó el porcentaje para resumir la información. Resultados: el 92,79 por ciento se encontraba satisfecho con la atención de enfermería, los indicadores: conocimientos, experiencia y amabilidad de la enfermera fueron reconocidos por el 100,00 por ciento de los pacientes. Conclusiones: a pesar de que el trabajo de enfermería que se brinda en esta área de salud se califica de bueno, es necesario reflexionar sobre los posibles aspectos o debilidades objetivas y subjetivas que tiene esta enfermera para su mejor desempeño(AU)

Introduction: The limited humanist, social, psychological and scientific scope that characterizes nursing practice is present in primary health care, where the population satisfaction is an indicator for the quality of the services provided. Objective: Assess the level of satisfaction of the population with the nursing services. Methods: Retrospective, descriptive study in the population from the family practitioner office of the village of Argelia, belonging to the health area of Dr. Juan Manuel Páez Inchausti university polyclinic of Isle of Youth in 2015. Target group of 944 patients and sample of 430, the information was obtained by conducting a satisfaction questionnaire, we considered satisfied when 65 points or more were obtained, percentage was used to summarize the information. Results: 92.79 percent was satisfied with nursing care, the indicators nurse knowledge, experience and kindness were acknowledged by 100.00 percent of the patients. Conclusion: Despite the fact the nursing work provided in this health area is qualified as good, it is necessary to reflect on the possible aspects and objective and subjective weaknesses this nurse has in her better performance(AU)

Resultados de una Consulta de Enfermería de Tabaquismo en un hospital de tercer nivel / Results of a Smoking Habit Nursing Consultations in a tertiary hospital

Objetivo. Analizar resultados de consulta monográfica de enfermería para tratamiento del tabaquismo en un hospital de tercer nivel. Pacientes. Fumadores remitidos del propio centro, atención primaria, Salud Laboral y trabajadores del hospital. Método. Se diseña consulta monográfica con enfermera especializada en tabaquismo. Visitas protocolizadas, presenciales y telefónicas. Seguimiento total durante 12 meses. Apoyo médico para consulta y prescripción de tratamientos. Variables: edad, sexo, cigarrillos/día, edad de inicio, intentos de abandono, tabaquismo en entorno, peso, antecedentes y tratamiento, dependencia con test de Fagërstrom y cooximetría. Análisis estadístico: estudio de cohortes retrospectivo 2010-2013. Comparación entre grupos realizada mediante test de Logrank, y la probabilidad de abstinencia con método de Kaplan-Meier. Resultados. 362 fumadores (53 ± 12 años), test Fagërstrom de 7 ± 2, cooximetría 23,3 ± 14 ppm, media de 36 ± 11 años fumando, edad inicio 16 ± 4 años, e intentos previos abandono en 85% de casos. Tratamientos farmacológicos: vareniclina (65%) y TSN (25%) y solo apoyo en consulta (10%). Tras 12 meses de seguimiento, abstinencia del 33% de los pacientes, ganancia de peso media tras abandono: 2,5 kg en mujer y 3,3 en varón sin diferencias significativas según tratamiento. Conclusiones. La consulta protocolizada de enfermería obtiene resultados similares a los observados en unidades más complejas y de mayor coste, a pesar de ser pacientes reincidentes y con alta dependencia (AU)

Objective. Analyze results of monographic consultation from nursing department for treatment of smoking habit in a tertiary hospital. Patients. Smokers referred from the primary care, occupational health and hospital workers site of the center. Method. A monographic consultation was designed with nurses specialized in smoking habit. On-site protocolized and telephone visits. Total follow-up during 12 months. Medical support for treatment consultation and prescription. Variables: age, gender, cigarettes/day, age of initiation, attempts to quit smoking, smoking in the setting, weight, backgrounds and treatment, dependence with Fagërstrom test and cooximetry. Statistical analysis: 2010-2013 retrospective cohort study. Comparison between groups performed using Log rank Test and the likelihood of abstinence with the Kaplan-Meier method. Results. 362 smokers (53 ± 12 years), Fagërstrom test from 7 ± 2, cooximetry 23.3 ± 14 ppm, mean of 36 ± 11 years smoking, age of initiation 16 ± 4 years, and previous attempts to stop smoking in 85% of the cases. Drug treatments: varenicline (65%) and NRT (25%) and only support in consultation (10%). After 12 months of follow-up, abstinence in 33% of the patients, weight gain after quitting smoking: 2.5 kg in women and 3.3 in men, without significant differences according to the treatment. Conclusions. Protocolized nursing consultation obtains similar results to those observed in more complex units having a higher cost, in spite of being patients with recurrence and high dependence (AU)

Rol de enfermería en la consulta de prediálisis en el paciente con enfermedad renal cónica avanzada / Nursing role in predialysis visit in patients with advanced chronic kidney disease

Introducción: El paciente con enfermedad renal crónica (ERC) tiene necesidades concretas de cuidado que conllevan al profesional de enfermería nefrológica a generar una atención integral e individualizada con el fin de detectar y disminuir riesgos a través de la consulta predialítica y educar a los profesionales del área de la salud acerca de su labor en dicha actividad. Objetivo: Identificar y evaluar la efectividad de la consulta predialítica realizada por el profesional de enfermería en pacientes diagnosticados con enfermedad renal crónica, a través de la revisión sistemática de la literatura. Metodología: Búsqueda electrónica en base de datos PUBMED, Meta buscadores como google académico, Epistemonikos, Scielo, Bireme, y CUIDEN. Se consideraron 47 artículos de los cuales 22 son cuantitativos y 25 cualitativos, en pacientes adultos de 18 a 80 años, entre los años 2005-2015. Resultado: La consulta predialítica permitirá realizar intervenciones de diagnóstico temprano, educación y evaluación durante las primeras etapas de la ERC, reduciendo la morbi-mortalidad, retrasando la progresión de la enfermedad, por lo cual es necesario rediseñar los programas de gestión en enfermedades crónicas, enfatizando la colaboración de una red sanitaria liderada por el profesional de enfermería especialista que gestione los recursos existentes para el manejo de esta patología. Conclusión: La consulta predialitica ofrece beneficios tangibles al enfermo renal en las áreas de prevención de la ERC, adherencia a las recomendaciones del profesional de salud y la elección de la terapia (AU)

Introduction: Patients with chronic kidney disease have specific care needs that lead to professional nephrology nursing to generate a comprehensive and individualized attention in order to identify and reduce risks through predialysis consultation and educate other healthcare professionals about their work in the activity. Objective: To identify and evaluate the effectiveness of predialysis consultation by nurses in patients diagnosed with chronic kidney disease, through the systematic review of the literature. Methodology: Electronic search of PubMed database, Meta search engines like Google Scholar, Epistemonikos, Scielo, Bireme, and care. 47 articles, 22 were quantitative and 25 qualitative, in adults 18 to 80 and between 2005-2015 were considered Result: The predialysis consultation would help to make early diagnosis interventions, education and evaluation during the firsts stages of CKD, reducing morbidity and mortality, slowing the disease progression, making it necessary to redesign programs in chronic disease management, emphasizing the collaboration of a network led by the health professional specialist nurses to manage existing resources to the management of this condition. Conclusion: The query proves that predyalisis consultation provides tangible benefits to renal patients in the areas of prevention of CKD, adherence to the recommendations of the health professional and the choice of therapy (AU)

Registro y control informático del tratamiento anticoagulante oral en Atención Primaria / Registration and computer control of oral anticoagulant therapy (OAT) in primary health care

Se calcula que en España 13.2 personas por cada 1000 habitantes reciben diariamente inhibidores de vitamina K como tratamiento anticoagulante oral por riesgo e enfermedad tromboembólica. Clásicamente, el control del tratamiento anticoagulante ha sido una labor de hematología por medio de un análisis de la extracción venosa de la sangre del enfermo, cuya pauta de tratamiento los pacientes la recogen en sus centros de salud horas después. En los últimos años, los equipos de Atención Primaria de la mayoría de los servicios sanitarios de España han sido instruidos para el empleo e interpretación, de forma autónoma, de coagulómetros portátiles y para el uso de programas informáticos que permiten el registro y control, en la correspondiente historia clínica electrónica, de los datos obtenidos, el cálculo de dosis y la programación de las citaciones de revisión. La historia clínica informatizada puede disponer de distintas secciones que permiten estas gestiones, como es el caso del módulo propio para el control y seguimiento de los pacientes en tratamiento con anticoagulación oral disponible en OMI-ap Aragón. Este módulo permite el seguimiento, dentro del programa, así como realizar auditorías clínicas, mediante el propio aplicativo TAO, lo que evita la pérdida de la perspectiva del paciente que sucedía con anterioridad a este sistema, al precisar de otras bases de registro ajenas al programa. La finalidad de este trabajo es presentar al lector esta herramienta habitual de la consulta de enfermería de Atención Primaria y describirlo, así como los pasos previos y posteriores al empleo de este módulo incluido en OMI-ap (AU)

It is estimated that in Spain 13.2 persons per 1000 inhabitants received daily vitamin K antagonists as oral anticoagulant therapy risk of thromboembolic disease. Classically control Anticoagulant Therapy has been a labor of hematology through an analysis of patient ́s venous blood and whose treatment regimen was collected, hours later, by each person in their Health Centers. In recent years, Primary Health Care Teams, of most Spanish Health Services, have been instructed to use and interpret, independently, portable coagulometers and the use of computer programs that allow the registration in the corresponding electronic medical records and control of the data, the calculation of doses and programming citations revision. The clinical history may have different sections that allow these activities as the module for control and monitoring of patients on oral anticoagulation available on OMI-ap Aragon. This module allows tracking, within the program, and clinical audits performed by the application TAO itself, avoiding the loss of the patient’s perspective, that previously happened to this system to specify other recording bases outside the program. The purpose of this paper is to present the reader with this common tool Primary Care nursing practice, describing the program as well as before and after the use of this module included in IMO-ap steps (AU)

Valoración de la eficacia de la consulta de enfermería en relación a la kalemia y la ganancia ponderal del paciente en hemodiálisis / Assessment of the efficacy of the nursing consultation relative to kalemia and weight gain in hemodialysis patients

Introducción: La consulta de enfermería es una herramienta imprescindible en el tratamiento sustitutivo renal al proporcionar al paciente y familia los conocimientos necesarios para el autocuidado. La kalemia y la ganancia ponderal constituyen 2 de las variables con mayor asociación a morbi-mortalidad. Objetivo: Evaluar la eficacia de la consulta de enfermería sobre kalemia y ganancia ponderal del paciente en hemodiálisis. Material y métodos: Estudio descriptivo y retrospectivo, realizado en 121 pacientes en programa de Hemodiálisis del Hospital Parc Taulí. Se analizó: - La kalemia previa a la consulta de enfermería y a los 2, 4 y 6 meses de la intervención estratificando en función de si recibe tratamiento farmacológico. - La ganancia de peso inter-diálisis de 14 sesiones pre-consulta de enfermería y 14 posteriores, considerando si mantenían diuresis. Resultados: n Kalemia: · De los 51 pacientes con hiperkalemia en basal, mejoran a los 2 meses post intervención un 68,61% sin cambios en el tratamiento farmacológico. Resultados que se mantenían a los 4 y 6 meses. · Estratificando la muestra: K= 5’1-5’5 mEq/l mejoran en un 67.85%, K > 5’5-6’5 mEq/l un 72,99%, K > 6’5 mEq/l el 100%. · Ganancia ponderal: · Pacientes que pre-consulta de enfermería acumulaban > 2 kg después de la intervención mejoran en un 52.45%. De este grupo solo el 16.39% mantenía diuresis y de estos mejoran un 60%. Conclusiones: Los resultados obtenidos demuestran la eficacia de la consulta de enfermería ya que tanto la hiperkalemia como la hipervolemia disminuyen de modo significativo tras la intervención, pudiendo reducir la morbi-mortalidad de nuestros pacientes (AU)

Introduction: Nursing consultation is an indispensable tool in renal replacement therapy by providing the knowledge necessary for the self-management of the patient and family. Kalemia and weight gain are two of the variables with greater association with morbi-mortality. Alm: To evaluate the effectiveness of nursing consultation regarding kalemia and weight gain in hemodialysis patients. Material and methods: Descriptive and retrospective study conducted in 121 patients in hemodialysis program of the Parc Taulí Hospital. Were analyzed: - Kalemia before nursing consultation and at 2, 4 and 6 months after intervention stratified according to the presence of drug treatment - Interdialytic weight gain of 14 sessions before and after the nursing consultation, considering whether patients maintained diuresis. Results: n Kalemia: · 68.61% of the 51 patients with hyperkalemia at baseline improved at 2 months post-intervention, without changes in drug treatment. Results were maintained at 4 and 6 months. · Stratifying the sample: K = 5'1-5'5 mEq / l were improved at 67.85%, K > 5'5-6'5 mEq / l at 72.99% and K > 6.5 mEq / l at 100 %. n Weight gain: · Patients before nursing consultation accumulated more than 2 kg improved post-intervention in 52.45%. Conclusions: Results demonstrate the effectiveness of the nursing consultation because after the intervention was significantly decreased hyperkalemia and hypervolemia, reducing the morbimortality of our patients (AU)

Variables que condicionan la utilización de la consulta de enfermería en centros de salud de la Comunidad de Madrid / Differences in the nursing consultation utilization in primary care, Spain

Fundamentos: Diferentes condiciones de utilización de servicios sanitarios pueden originar situaciones de falta de equidad. El objetivo del trabajo es conocer si existen diferencias en el uso de la consulta de enfermería en atención primaria. Métodos: Estudio multicéntrico transversal en 23 centros de salud de la Comunidad de Madrid. Se incluyó a 662 sujetos. Se recogieron variables relativas al centro de salud, de la consulta de enfermería, características sociodemograficas y de necesidad en salud. Se estudiaron la calidad de vida y la satisfacción de los sujetos. Las variables se clasificaron, según el modelo «conductual», en predisponentes, facilitadoras o de necesidad. Se construyeron modelos multivariantes explicativos. Resultados: Vivir en zonas de renta alta y la edad se asociaron con aumentos del 17% (IC95%: 0,4-36,9%) y del 11,0% por cada década (IC95%: 6,2-16,2) de las consultas/año de enfermería. De los factores facilitadores, cada minuto añadido de duración de la consulta se asoció con un aumento del 2,0% (IC95%: 1,2-2,9%) en las consultas/año, cada nueva consulta médica se asociaba con un aumento del 2,7% (IC95%: 2,1-3,2%) y la demora en conseguir cita superior a un día supuso una disminución del 32,8% (IC95%: 19,3-44,1%) del número de consultas. Cada condición crónica, que expresa necesidad en salud, se asoció con un incremento del número de consultas del 4,8% (IC 95%: 1,7-8,0%). La mejor percepción de la calidad de vida se asoció con una reducción de las consultas de un 5,4% (IC95%: 1,0-8,7%). Conclusión: Las diferencias en el uso de la consulta de enfermería responde a criterios de necesidad, pero también está influenciada por condiciones de accesibilidad(AU)

Background: Different conditions in health services utilization may create situations of inequity. The objective was analyze the differences of nurse consultation utilization in primary care. Methods: Cross-sectional study, in 23 health centres in Madrid. Environmental variables, consultation characteristics, socio-demographic and health need characteristics were collected. The quality of life and satisfaction were also studied. The variables were classified according to the «behavioral model» in predisposing, enabling or need variables. Explanatory multivariate models were constructed (Generalized-Estimating-Equations). Results: The higher income areas and aging, predisposing factors, were associated with increases of 17% (95% CI: 0.4 to 36.9%) and 11.0% per decade (95% CI: 6.2 - 16.2) in nursing consultations per year. Among enabling factors, each additional minute of consultation length was associated with an increase of 2.0% (95% CI :1.2-2, 9%) in number of nurse consultations, each new medical consultation was associated with a increase of 2.7% (95% CI: 2.1-3.2%) and the delay in getting appointment over a day, represented a decrease of 32.8% (95% CI: 19.3 to 44.1%) in the total nursing consultations. Each chronic condition, which expresses the need health, was associated with an increase in the number of visits of 4.8% (95% CI: 1.7 to 8.0%). The improved perception of quality of life was associated with a reduction of 5.4% (95% CI 1.0 to 8.7%) of the consultations. Conclusion: The difference of the use of primary care nurse consultations is based on health need criteria, but is also influenced by accessibility conditions(AU)

Chemotherapy-handling practices of outpatient and office-based oncology nurses.

PURPOSE/OBJECTIVES: To determine the current patterns of use of personal protective equipment among oncology nurses while handling antineoplastic chemotherapeutic agents in outpatient and office-based settings. DESIGN: Descriptive-correlational, mailed survey. SETTING: National survey of oncology nurses. SAMPLE: 500 randomly selected members of the Oncology Nursing Society who identified their work settings as office, clinic, or outpatient private practice; 263 responded for an overall response rate of 53%. METHODS: Mailed, self-report survey based on the current Occupational Safety and Health Administration's (OSHA's) guidelines for the handling of hazardous drugs. MAIN RESEARCH VARIABLE: Chemotherapy-handling practices. FINDINGS: More than 94% of participants reported usually wearing gloves during chemotherapy handling; 55% reported using laboratory coats as protective garments. Usual use of face and respiratory protection was less than 6%. Chemotherapy was reported to be prepared in laminar air flow hoods in 99% of work settings. Only 46% of sites reportedly provided any type of medical monitoring. CONCLUSION: Use and availability of personal protective equipment when handling chemotherapy have increased, but medical monitoring of exposed employees still is neither widely practiced nor consistent with OSHA guidelines. IMPLICATIONS FOR NURSING: Safety concerns and potential adverse health effects associated with the occupational handling of chemotherapeutic agents have been reported. Historically, nurses' adherence to chemotherapy-handling guidelines has been poor. Results suggest that adherence is increasing; however, research is lacking regarding nurses' level of knowledge of and specific barriers to safe handling of chemotherapy.

Enhancing smoking cessation of low-income smokers in managed care.

BACKGROUND: Although office-based and telephone support services enhance the rate of smoking cessation in managed care systems, it is not clear whether such services are effective for very low-income smokers. We evaluated the comparative effectiveness of usual care (physician-delivered advice and follow-up) and usual care enhanced by 6 computer-assisted telephonic-counseling sessions by office nurses and telephone counselors for smoking cessation in very low-income smokers in Medicaid managed care. METHODS: A randomized clinical trial comparing the 2 approaches was conducted in 3 Michigan community health centers. All clinicians and center staff received standard training in usual care. Selected nurses and telephone counselors received special training in a computer-assisted counseling program focusing on relapse prevention. RESULTS: The majority of the study population (233 adult smokers with telephones) were white (64%) women (70%) with annual incomes of less than $10,000 (79%) and with prescriptions of nicotine replacement therapy (>90%). At 3 months, quit rates (smoke-free status verified by carbon monoxide monitors) were 8.1% in the usual-care group and 21% in the telephonic-counseling group (P=.009) by intention-to-treat analysis. Special tracking methods were successful in maintaining participants in treatment. CONCLUSIONS: Smoking cessation rates are enhanced in a population of very low-income smokers if individualized telephonic-counseling is provided. State and Medicaid managed care plans should consider investing in both office-based nurse and centralized telephonic-counseling services for low-income smokers.

An alternative technique for evaluating the effectiveness of continuing professional development courses for health care professionals: a pilot study with practice nurses.

BACKGROUND: Increasing recognition of the need for continuing professional development (CPD) for health professionals has created an inevitable expansion in course provision. One criterion of a successful course demands that CPD must meet local health service needs, as well as the personal and professional requirements of the participants. At a more general level, a key pedagogical requirement of any educational course is that the content and process must meet the stipulated aims and objectives, and this requires appropriate evaluation procedures. Within health care CPD, very little course evaluation routinely takes place, possibly because the area is relatively new, and secondly because relevant evaluation may be difficult to operationalize. AIMS: The current study reports a small exploratory pilot investigation into the use of a valid and reliable training needs analysis questionnaire as a means of evaluating a nurse practitioner (NP) training scheme for practice nurses (PN). METHODS: Using a before/after design, the instrument involved the participants in a pre and post course self-assessment on a range of tasks. These assessments were made according to three criteria: how critical each task is considered to be to the effective delivery of the respondent's current PN role; how critical each task is considered to be to the effective delivery of the role of the NP; and how well each task is currently performed. Various comparisons of the ratings provide a considerable amount of information that may be of use to the nurse manager in planning NP programmes. Of particular relevance to the current paper, however, are the comparisons between salience of tasks for the NP role and performance on these, before and after the course. This provides an assessment of the extent to which the course has met educational requirements. RESULTS: The present study demonstrated that overall, the course reduced skill deficits in all but seven of the tasks. Of these, six related to research and audit and the seventh to clinical examination of patients. CONCLUSION: The study is discussed in terms of the implications of the technique for course development and planning to take account of local needs, as well the instrument's reliability and validity, for use in this way.

A survey of the role, benefits, and realities of the office-based oncology nurse.

The office-based oncology nurse plays an increasingly significant role in the treatment of patients with cancer as the focus of health care shifts from the inpatient to the outpatient arena. Yet the role of the office-based oncology nurse is seldom addressed. In 1989, a survey was undertaken to examine the range of tasks involved in, the expectations and disappointments associated with, and the resulting job satisfaction from the role. A random sample of self-identified, office-based oncology nurses received the survey. A total of 192 nurses responded; 87% of the respondents indicated a high level of job satisfaction. Salary analysis showed wages to be comparable to those paid to inpatient oncology nurses. The opportunity to work with patients throughout the phases of disease was identified as the most gratifying aspect of the respondents' jobs. The opportunity for better work hours and more professional independence were frequently cited benefits. The survey's results reveal the evolution of the office-based oncology nurse's role into one of a multifaceted, independent practitioner.