Cultura de seguridad del paciente: evaluación de los enfermeros en la atención primaria a la salud / Patient safety culture: evaluation of nurses in primary health care / Cultura de segurança do paciente: avaliação dos enfermeiros na atenção primária à saúde

Introducción: Los estudios sobre seguridad del paciente en la Atención Primaria a la Salud son actuales, pero no profundizan el real desempeño de los profesionales con relación a la seguridad del paciente. Así, es relevante evaluar la caracterización de la cultura de seguridad entre los profesionales de enfermería en este escenario, pues va a favorecer la mejora del cuidado a los usuarios. Objetivo: Evaluar la cultura de seguridad del paciente en desde la perspectiva de las enfermeras en Atención Primaria de Salud. Método: Estudio descriptivo de abordaje cuantitativo, realizado de julio a diciembre de 2017, en catorce unidades de salud de la ciudad de Curitiba (PR). Participaron de esta investigación cuarenta y tres enfermeros. El instrumento utilizado fue el Medical Office Survey on Patient Safety Culture (MOSPSC) que consiste en cincuenta y una preguntas que miden doce dimensiones de la seguridad del paciente. La confiabilidad del instrumento es de alfa de Cronbach de 0,95. Los datos fueron analizados por estadística descriptiva, por medio de una escala de Likert. Resultados: Se notaron problemas relacionados con el intercambio de información con otras instituciones, el proceso de trabajo, el miedo a la culpa, el castigo por los errores y la gestión. En la evaluación global de la Seguridad del Paciente, 50% de los profesionales de la Estrategia Salud de la Familia consideran "muy bueno" y de las Unidades Básicas de Salud, 73,9% consideran "bueno". Conclusión: Los resultados muestran una cultura de seguridad con potencialidades y fragilidades que necesitan ser trabajadas, y el enfermero como base de este proceso para el fortalecimiento de la calidad y seguridad del paciente en la Atención Primaria a la Salud

Introduction: Studies on patient safety in Primary Health Care (PHC) are up to date; however, there are no details on professionals' actual performance in relation to this matter. Thus, it is important to evaluate the safety culture characterization among nursing professionals in this scenario, since it will promote better care for users. Objective: To evaluate the patient safety culture from the perspective of nurses in Primary Health Care. Method: Descriptive study of quantitative approach carried out in fourteen health Units in Curitiba City, Paraná State (PR), Brazil from July to December 2017. There were forty-three nurses participating in this study. Medical Office Survey on Patient Safety Culture (MOSPSC) was the tool used, comprising fifty-one questions that evaluate twelve dimensions of patient safety. This tool, Portuguese version, showed a Cronbach alpha coefficient of 0.95, which expresses high reliability. All data were analyzed by Descriptive Statistics using Likert scale. Results: Inconsistencies were found related to the information exchange with other institutions, work process, fear of guilt, punishment for errors, and management. In the overall evaluation, 50% of the Family Health Strategy (FHS) professionals rated patient safety "very good", and 73.9% of Basic Health Units (BHU) professionals rated patient safety "good". Conclusion: Results show a safety culture with potentialities and weaknesses that need to be developed, considering the nurse the cornerstone to the success of quality and safety enhancement of patient in Primary Health Care

Introdução: Os estudos sobre segurança do paciente na Atenção Primária à Saúde são atuais, mas não aprofundam o real desempenho dos profissionais em relação à segurança do paciente. Desta forma, é relevante avaliar a caracterização da cultura de segurança entre os profissionais de enfermagem neste cenário, pois favorecerá melhoria do cuidado aos usuários. Objetivo Avaliar a cultura de segurança do paciente sob a perspectiva dos enfermeiros na Atenção Primária à Saúde. Método: Estudo descritivo de abordagem quantitativa, realizado de julho a dezembro de 2017, em catorze unidades de saúde de Curitiba (PR). Participaram desta pesquisa quarenta e três enfermeiros. O instrumento utilizado foi o Medical Office Survey on Patient Safety Culture (MOSPSC) composto por cinquenta e uma perguntas que avaliam doze dimensões da segurança do paciente. A confiabilidade do instrumento é de alfa de Cronbach de 0,95. Os dados foram analisados por Estatística Descritiva, por meio da escala de Likert. Resultados: Notaram-se problemas relacionados com a troca de informação com outras instituições, ao processo de trabalho, medo da culpa, punição pelos erros e referentes à gestão. Na avaliação global da Segurança do Paciente, 50% dos profissionais da Estratégia de Saúde da Família consideram "muito bom" e na Unidades Básicas de Saúde, 73,9% consideram "bom". Conclusão: Resultados mostram uma cultura de segurança com potencialidades e fragilidades que necessitam ser trabalhadas, considerando o enfermeiro como alicerce deste processo para fortalecimento da qualidade e segurança do paciente na Atenção Primária à Saúde

A crosswalk between the Omaha System and guiding undergraduate public health nursing education documents.

The Omaha System is the hallmark evidence-based clinical information management system used in nursing education, research, and practice. Multiple education documents guide public health workforce preparation. This qualitative study identified similarities and gaps between the Omaha System and seven guiding documents commonly used by nurse educators. A crosswalk design was employed. The setting was virtually based using online technology. Recommendations are for public health nurse educators to update their teaching practices using evidence-based approaches.

La teoría del confort en los cuidados enfermeros / Comfort theory in nursing care

Introducción: Etimológicamente, el concepto de «confort» deriva de la palabra inglesa comfort y se refiere a todo aquello que produce comodidad y genera bienestar a la persona. Una de las personas que más ha estudiado en profundidad esta idea es la enfermera gerontológica Katherine Kolcaba, que la definió como la experiencia inmediata y holística de la persona de fortalecerse cuando se abordan las necesidades para tres tipos de confort: alivio, tranquilidad y trascendencia. Además, es importante tener en cuenta los contextos donde este confort se puede aplicar: físico, psicoespiritual, ambiental y social. Los preceptos teóricos de Katherine Kolcaba reafirman la idea de que las intervenciones de confort no suelen ser intervenciones técnicas, sino que complementan la asistencia clínica, a la vez que abogan por satisfacer las necesidades humanas básicas. En este sentido, la disciplina enfermera tiene un papel relevante. Discusión y conclusiones: Como consecuencia de este concepto de subjetividad, el confort es difícil de valorar y objetivar, por lo que, dentro de su determinación, se han de tener en consideración el empleo de diversos instrumentos objetivos validados como el Comfort Questionnaire, desarrollado por Katherine Kolcaba. El confort debe valorarse y considerarse desde una perspectiva humanística, holística, multidimensional e interdisciplinar resultado de las interacciones de la persona con percepciones, situaciones y objetos modificables a lo largo del tiempo y el espacio. Dentro de esta inclusión del confort en el cuidado del paciente, la enfermera juega un papel importante

Introduction: Etymologically, «comfort» concept is derived from English language and it refers to everything that produces ease and generates welfare. One of the most important people in the study of comfort from a nursing perspective was the gerontolist Katherine Kolcaba who defined it as the immediate holistic experience of being strengthened through addressing the three types of comfort: relief, ease, and transcendence. At the same time we should also consider the four contexts in which comfort can be attained: the physical, the psychospiritual, sociocultural and environmental. Katherine Kolcaba theorical precepts reinforce the notion that comfort interventions are not related to technical interventions, but rather to clinical assistance, at the same time that it advocates for meeting basic human needs. Accordingly, nursing field has an important role. Discussion and conclusions: Comfort is a subjective concept that is very difficult to assess and objectify. Because of this subjectivity, comfort should be assessed using different tools like the comfort questionnaire developed by Katherine Kolcaba. Comfort, as a result of interactions between people, situations and objects developed over time, should be valued and considered from an humanistic, holistic, multidimensional and interdisciplinary perspective, in which the nurse plays an essential role

Theory Development Strategies for Middle-Range Theories.

The purpose of this article is to present an analysis on the theory development strategies that have been used to develop middle-range theories through an integrated literature review and to provide directions for future theoretical development in nursing. First, theory development strategies that have been suggested and used in nursing are briefly discussed. Second, the methods used for the analysis are described. Then, 4 themes reflecting the theory development strategies that have been used to develop middle-range theories are discussed. Finally, suggestions for future theoretical development in nursing are made on the basis of the findings.

Trabajo final de grado y plan de acción tutorial en el curriculum del grado en enfermería. Diseño, desarrollo y evaluación / Final project degree and tutorial action plan in the curriculum of the degree in nursing. Design, development and evaluation

La acción tutorial (PAT), en los estudios universitarios de Enfermería, se halla en el centro de la acción docente del profesorado. El tutor/a orienta en el proceso de aprendizaje y en la preparación del Trabajo Final de Grado (TFG). En este artículo presentamos los resultados de la investigación realizada con tutores y estudiantes, que tiene por objetivo evaluar el diseño y desarrollo del TFG, los resultados académicos y su vivencia y experiencia. Diseño mixto cuantitativo descriptivo y cualitativo de investigación acción participación. Muestra total de 124 estudiantes de 4º curso de Grado Enfermería y 37 tutores del TFG. Técnicas de recogida de datos: resultados académicos y evaluativos; 3 grupos focales con estudiantes y profesores; 3 entrevistas semiestructuradas abiertas a estudiantes. Los resultados constatan que las tipologías más elegidas fueron revisiones bibliográficas (38,75%) y Planes de cuidados (24,2%). El 63,9 % de la temática escogida es Enfermería Maternal, Pediátrica y Clínica. Estudiantes y tutores viven con dificultad la elaboración del TFG y se requiere una mayor cultura tutorial. Es un proceso complejo de organización y coordinación que, sin embargo, permite un trabajo colaborativo de todo el equipo docente (AU)

The Tutorial Action Plan (PAT) in the University School of Nursing, is central to the teaching action of professors. The tutor orients in the learning process and the preparation of the Final Degree Project (TFG). In this paper we present the results of research conducted with tutors and students, which aims to evaluate the design and development of the TGF, academic results and their experience and expertise. A descriptive qualitative and quantitative joint design of research and participation. A total sample of 124 students of 4th year in the nursing degree and 37 TGF tutor. Data collection techniques: Academic and evaluation results; 3 focus groups with students and professors; three semi-structured interviews open to students. Results indicate that the most commonly chosen typologies were literary reviews (38.75%) and care plans (24.2%). 63.9% of the chosen topics include Maternal, Pediatric and Clinical Nursing. Students and tutors struggle to develop the TGF and greater tutorial culture is required. It is a complex process of organization and coordination which, however, allows collaborative work of the entire faculty (AU)

Evaluación y monitorización de los cuidados enfermeros en la Atención Primaria de la Salud / Evaluation and monitoring of nursing care in the Primary Care setting

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Framework for Evaluating the Impact of Advanced Practice Nursing Roles.

PURPOSE: To address the gap in evidence-based information required to support the development of advanced practice nursing (APN) roles in Switzerland, stakeholders identified the need for guidance to generate strategic evaluation data. This article describes an evaluation framework developed to inform decisions about the effective utilization of APN roles across the country. APPROACH: A participatory approach was used by an international group of stakeholders. Published literature and an evidenced-based framework for introducing APN roles were analyzed and applied to define the purpose, target audiences, and essential elements of the evaluation framework. Through subsequent meetings and review by an expert panel, the framework was developed and refined. FINDINGS: A framework to evaluate different types of APN roles as they evolve to meet dynamic population health, practice setting, and health system needs was created. It includes a matrix of key concepts to guide evaluations across three stages of APN role development: introduction, implementation, and long-term sustainability. For each stage, evaluation objectives and questions examining APN role structures, processes, and outcomes from different perspectives (e.g., patients, providers, managers, policy-makers) were identified. CONCLUSIONS: A practical, robust framework based on well-established evaluation concepts and current understanding of APN roles can be used to conduct systematic evaluations. CLINICAL RELEVANCE: The evaluation framework is sufficiently generic to allow application in developed countries globally, both for evaluation as well as research purposes.

Evolución de la Revista ROL de Enfermería (1978-2008). Un análisis bibliográfico / Evolution of Revista ROL de Enfermería (1978-2008): a bibliographic analysis

Revista ROL de Enfermería fue la primera revista de profesionales de la enfermería dirigida a la enfermería, publicada con el nacimiento de la democracia española e indexada muy pronto en MEDLINE/PubMed. Esta comunicación analiza los cambios producidos en la estructura y función de la revista. Destacan dos hechos: que ROL expresa la transformación de la nueva enfermería universitaria y que la revista se fue adaptando progresivamente a las normas establecidas por la ciencia: aunque no incrementó la proporción de artículos originales, normalizó su estructura, el patrón bibliográfico o de citas, así como el estilo de escritura científica (AU)

Revista ROL de Enfermería was the first journal of nurses and adressed to nursing published with the birth of Spanish democracy, indexed soon Medline/PubMed. This paper analyzes the changes in the structure and function of the magazine. Highlights two facts. The journal ROL expresses the transformation of the new universitary nursing, and how was adapting to scientific standards: although not increased the number of original articles, was normalizing their structure, bibliography or citations pattern, and also the scientific writing style (AU)

Development, implementation and evaluation of a peer review of teaching (PRoT) initiative in nursing education.

For many years, an area of research in higher education has been emerging around the development and implementation of fair and effective peer evaluation programs. Recently, a new body of knowledge has developed regarding the development and implementation of fair and effective peer evaluation programs resulting in formative and summative evaluations. The purpose of this article is to describe the development, implementation, and evaluation of a peer review of teaching (PRoT) program for nursing faculty, initiated at one small comprehensive university in the northeastern United States. Pairs of nursing faculty evaluated each other's teaching, syllabi, and course materials after collaborating in a pre-evaluation conference to discuss goals of the classroom visit. Qualitative data gathered in post project focus groups revealed that faculty found their modified PRoT process to be a mutually beneficial experience that was more useful, flexible and collegial, and less stressful than their previous evaluation process.

An overview and evaluation of combining an addiction liaison nurse outpatient service with hepatitis C outpatient clinics in Glasgow, Scotland.

A new purpose-built facility for the care of patients with Hepatitis C was opened at Gartnavel General Hospital in Glasgow, Scotland, in 2009, bringing together infectious diseases and gastroenterology disciplines. An addiction liaison nurse outpatient service was established alongside existing Hepatitis C outpatient clinics in October 2010. This service supports staff and patients with Hepatitis C and addiction issues. The purpose of this study was to evaluate the usefulness of combining the Addiction Liaison Nurse outpatient service with the Hepatitis C outpatient clinic. Two methods were used in data collection. A brief questionnaire asking staff their view on the addiction liaison service and addiction issues with regard to Hepatitis C was distributed and completed by personnel assigned to the clinics. Staff were also queried about their view on the number and quality of referrals generated by the addiction liaison clinic. The results from the questionnaire indicate that staff agreed that patients should be abstinent from alcohol and illicit drugs before and during treatment of Hepatitis C. Further research is called for with regard to abstinence from alcohol and drugs before and during Hepatitis C treatment.

Dificultades y oportunidades para la enfermería: una revisión narrativa sobre evaluación económica en salud / Difficulties and chances for nursing: a narrative review about the economic evaluation in health

Revisión narrativa sobre evaluación económica en salud que tuvo como objetivo identificar los estudios desarrollados sobre el tema en los últimos diez años. Fue utilizado el descriptor costo y análisis de costos en las bases de datos: LILACS, MEDLINE, IBECS y CAPES. Fueron encontradas 88 publicaciones y seleccionadas 65, de las cuales 44,62% pertenecían a la base LILACS, 44,62% a MEDLINE, 4,60% a IBECS y 6,16% a CAPES. 75,38% eran sobre evaluación parcial de costos y 24,62% sobre evaluación económica. La medicina fue la sub-área que más publicó (41,54%), considerando los dos tipos de metodologías; seguida por la enfermería, que solo publicó sobre evaluación parcial de costos (15,38%). El enfermero como herramienta administrativa dentro de la Institución de Salud, necesita buscar conocimientos sobre este segmento de la economía, reconociendo su papel como agente transformador y buscar el equilibrio entre calidad, cantidad y costos en el momento de decidir cómo distribuir los recursos financieros disponibles (AU)

It is a narrativre review about the economic evaluation in health which had as an objective to identify the developed studies about the topic in the last ten years. The expenses and cost analysis descriptors were used at the data bases: LILACS, MEDLINE, IBECS AND CAPES. 88 publications were found and 65 were selected, from which the 44’62% belonged to the database LILACS, the 44’62% to MEDLINE, 4’6% to IBECS and to CAPES. The 75’38% were about the partial assessment of expenses and the 24’62% about the economic assessment. The medicine was the sub-area that published (41’54%), considering the two types of methodologies; followed by the nursing, which only published about partial evaluation of expenses (15’38%). The nurse as an administrative tool in the Health Institution, needs to look for the knowledge about this segment of the economy, recognizying his role as a transformator agent and looking for the balance betewwen quality, quantity and expenses when deciding how to distribute the available financial resources (AU)

"The midwifery two-step": a study on evidence-based midwifery practice.

INTRODUCTION: To date, there has been little documentation of how practice-based midwifery networks in the United States might influence the transfer and development of knowledge in childbearing and women's health care. The first phase of this participatory action research project was to conduct a qualitative study with a community of midwifery practices to understand their perspectives on evidence-based practice and how an organized network could facilitate their work. METHODS: Midwives within the community of interest were invited by letter or e-mail to participate in individual or small group interviews about knowledge transfer, primary concerns of evidence-based practice, and potential for a midwifery practice-based research network. Participatory action research strategies and organizational ethnographic approaches to data collection were used to guide qualitative interviews. RESULTS: Eight midwifery practices enrolled in the study with 23 midwives participating in interviews. They attended births at 2 hospitals in the community. Two broad areas of discourse about evidence-based practice were identified: 1) challenges from influential persons, finances and resources, and the cultural perception of midwifery, and 2) strategies to foster best practice in the face of those challenges. The midwives believed a research network could be useful in learning collectively about their practices and in the support of their work. DISCUSSION: Evidence-based practice is a goal but also has many challenges in everyday implementation. Practice-based research networks hold promise to support clinicians to examine the evidence and form strong coalitions to foster best clinical practice. The second phase of this study will work with this community of midwives to explore collective strategies to examine and improve practice.

An innovation in design of a school of nursing evaluation protocol.

Program evaluations in schools of nursing (SONs) serve the purpose of clearly demonstrating how the SON meets the quality standards established by governance, regulatory, and accreditation bodies. The authors describe the step-by-step process taken by a SON to develop a new model of an evaluation protocol that includes linkages to external criteria for evaluation of the plan itself. This analysis and feedback step is often neglected but is essential to the quality improvement process.

Alberta: evaluation of nursing retention and recruitment programs.

Retention and recruitment strategies are essential to address nursing workforce supply and ensure the viability of healthcare delivery in Canada. Knowledge transfer between experienced nurses and those new to the profession is also a focus for concern. The Multi-Employer/United Nurses of Alberta Joint Committee attempted to address these issues by introducing a number of retention and recruitment (R&R) initiatives for nurses in Alberta: in total, seven different programs that were introduced to some 24,000 nurses and employers across the province of Alberta in 2001 (the Transitional Graduate Nurse Recruitment Program) and 2007 (the remaining six R&R programs). Approximately 1,600 nurses participated in the seven programs between 2001 and 2009. Of the seven strategies, one supported entry into the workplace, two were pre-retirement strategies and four involved flexible work options. This project entailed a retrospective evaluation of the seven programs and differed from the other Research to Action (RTA) projects because it was solely concerned with evaluation of pre-existing initiatives. All seven programs were launched without a formal evaluation component, and the tracking of local uptake varied throughout the province. The union and various employers faced challenges in implementing these strategies in a timely fashion, as most were designed at the bargaining table during negotiations. As a result, systems, policy and procedural changes had to be developed to support their implementation after they became available.Participants in the programs indicated improvements over time in several areas, including higher levels of satisfaction with work­life balance, hours worked and their current practice and profession. The evaluation found that participation led to perceived improvements in nurses' confidence, greater control over their work environment, decreased stress levels, increased energy and morale and perceived improved ability to provide high-quality care. However, no formal implementation plan had been developed or made available to assist employers with implementation of the programs. The findings highlight the need for more discipline in communicating, implementing and evaluating initiatives such as those evaluated retrospectively in this project. In particular, key performance indicators, baseline data, monitoring mechanisms and an evaluation plan need to be developed prior to implementation.

Ausencia de enfermería en el equipo multidisciplinar de proyectos sociales / The absence of the nurse in the multidisciplinary team of Social Projects

El auge de la demanda de los servicios sociales, derivado de la crisis económica, ha originado nuestro interés por descubrir cuál es el rol de la enfermería en los programas de carácter social de vital importancia en la actualidad. La enfermería está formada y capacitada para integrarse en la puesta en marcha de los proyectos sociales, siendo la Salud Pública una de las áreas más desarrolladas en su campo. Por otro lado, estos programas dirigidos a la comunidad están emergiendo cada vez más debido a la situación económica actual. Es absurdo que se precise de la enfermería como agente básico de salud en los proyectos de cooperación internacional que se organizan desde España que -además- sea el profesional más cualificado para liderar los proyectos sociales según las administraciones del resto de los países, y sin embargo, en nuestro país, los enfermeros ni siquiera están presentes en los equipos multidisciplinares de los proyectos sociales. En este sentido, se pretende efectuar una llamada de atención sobre los beneficios de los que disfrutaría la comunidad al incorporarse los enfermeros a los proyectos de carácter social(AU)

The rise in demand for social services, stemming from the economic crisis has led to our interest in discovering what is the role of nursing in the social programs of vital importance today. The nurses are trained and qualified to join the implementation of social projects, with the Public Health one of the most developed areas in the field of nursing. On the other hand, these community-focused programs are emerging again because of the economic situation we are experiencing. It is absurd that is required of nursing as basic health staff in international cooperation projects that are organized from Spain, who also is the professional most qualified to lead the social projects under the administrations of other countries and yet our country, nurses are not even present in the multidisciplinary team of social projects. In this sense we try to make a call on the benefits of the community would enjoy joining the nurses to social projects(AU)

Emergency code color standardization: implementation without traumatization.

An emergency code call for a life-threatening cardiovascular emergency may be identified differently between facilities. Nurses and physicians who work secondary jobs or for temporary agencies may find themselves in the position of misunderstanding emergency code calls. The miscommunication of an emergency could easily result in a life-threatening situation for patients and staff. Therefore, the need for standardization is crucial. This article describes an entertaining education plan to assist with implementing standardization facility wide.

Developing and testing a new measure of staff nurse clinical leadership: the clinical leadership survey.

AIM: To test the psychometric properties of a newly developed measure of staff nurse clinical leadership derived from Kouzes and Posner's model of transformational leadership. BACKGROUND: While nurses have been recognized for their essential role in keeping patients safe, there has been little empirical research that has examined clinical leadership at the staff nurse level. METHODS: A non-experimental survey design was used to test the psychometric properties of the clinical leadership survey (CLS). Four hundred and eighty registered nurses (RNs) providing direct patient care in Ontario acute care hospitals returned useable questionnaires. RESULTS: Confirmatory factor analysis provided preliminary evidence for the construct validity for the new measure of staff nurse clinical leadership. Structural empowerment fully mediated the relationship between nursing leadership and staff nurse clinical leadership. CONCLUSION: The results provide encouraging evidence for the construct validity of the CLS. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing administrators must create empowering work environments to ensure staff nurses have access to work structures which enable them to enact clinical leadership behaviours while providing direct patient care.