Opinion on the benefits of nurse prescribing in Catalonia. Consensus of health professionals and managers.

OBJECTIVE: To study the level of agreement among health professionals and managers in Catalonia on the benefits of nurse prescribing (NP). METHOD: An online Real Time Delphi was conducted to collect the level of agreement of health professionals and managers. Participants voted in a 6-point scale (1 low benefit and 6 high benefit) for 12 items describing benefits of NP. A total of 1332 professionals participated. The level of consensus was calculated applying interquartile ranges of scores and standardized mean differences among subgroups using effect sizes (ES) and their corresponding 95% confidence intervals. RESULTS: The scores indicate a general agreement on the perceived benefits of NP among participants. Standardized differences among scores on the perceived benefits among professionals were small to high (ES range between 0.2 and 1.2) between nurses and medical doctors and high between nurses and pharmacists (ES range: 1.2 and 2.4). Differences between scores of nurses and those of managers or other professionals in the present study were smaller for most voted benefits. CONCLUSIONS: The study shows an agreement on the benefits of NP. Nevertheless, when standardized scores are taken into consideration, differences among professionals' perceptions emerged, and aligned with documented barriers identified in the literature such as corporative aspects, cultural limitations, institutional and organisational inertia, beliefs and unawareness of what NP implies.

Opinion on the benefits of nurse prescribing in Catalonia. Consensus of health professionals and managers / Opinión sobre los beneficios de la prescripción enfermera en Cataluña. Consenso de profesionales de la salud y gestores

Objective: To study the level of agreement among health professionals and managers in Catalonia on the benefits of nurse prescribing (NP). Method: An online Real Time Delphi was conducted to collect the level of agreement of health professionals and managers. Participants voted in a 6-point scale (1 low benefit and 6 high benefit) for 12 items describing benefits of NP. A total of 1332 professionals participated. The level of consensus was calculated applying interquartile ranges of scores and standardized mean differences among subgroups using effect sizes (ES) and their corresponding 95% confidence intervals. Results: The scores indicate a general agreement on the perceived benefits of NP among participants. Standardized differences among scores on the perceived benefits among professionals were small to high (ES range between 0.2 and 1.2) between nurses and medical doctors and high between nurses and pharmacists (ES range: 1.2 and 2.4). Differences between scores of nurses and those of managers or other professionals in the present study were smaller for most voted benefits. Conclusions: The study shows an agreement on the benefits of NP. Nevertheless, when standardized scores are taken into consideration, differences among professionals’ perceptions emerged, and aligned with documented barriers identified in the literature such as corporative aspects, cultural limitations, institutional and organisational inertia, beliefs and unawareness of what NP implies.(AU)

Objetivo: Estudiar el nivel de consenso entre profesionales de salud y gestores en Cataluña sobre los beneficios de la prescripción enfermera (PE). Método: Se realizó un Delphi en tiempo real en línea para recoger el nivel de acuerdo de profesionales de la salud y gestores. Las personas participantes votaron en una escala de 6 puntos (1 bajo beneficio y 6 alto beneficio) en 12 ítems que describen los beneficios de la PE. Participaron 1332 profesionales. El nivel de consenso se calculó aplicando rangos intercuartílicos de puntuaciones y diferencias de medias estandarizadas entre subgrupos a partir de tamaños del efecto (ES) y sus correspondientes intervalos de confianza del 95%. Resultados: Las puntuaciones indican un acuerdo general sobre los beneficios percibidos de la PE entre las personas participantes. Las diferencias estandarizadas entre las puntuaciones sobre los beneficios percibidos entre profesionales fueron de pequeñas a altas (rango ES: 0,2 a 1,2) entre enfermeras y médicos, y altas entre enfermeras y farmacéuticos (rango ES: 1,2 a 2,4). Las diferencias entre las puntuaciones de profesionales de enfermería y gestión clínica u otros profesionales en el presente estudio fueron menores para los beneficios más votados. Conclusiones: El estudio muestra un acuerdo sobre los beneficios de la PE. Sin embargo, cuando se tienen en cuenta las puntuaciones estandarizadas se encontraron algunas diferencias entre las percepciones de profesionales y se alinearon con las barreras documentadas identificadas en la literatura, como aspectos corporativos, limitaciones culturales, inercia institucional y organizativa, creencias y desconocimiento de lo que implica la PE.(AU)

Análisis crítico de la prescripción enfermera en la Atención Primaria: experiencia de uso en Cataluña / Critical analysis of nurse prescribing in primary care: Experience of its use in Catalonia

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Prescripción enfermera: análisis de concepto / Nurse prescription: A concept analysis

Objetivo: Examinar críticamente el concepto de prescripción enfermera mediante el estudio de los antecedentes y una revisión de la literatura científica con el fin de desarrollar una concepción precisa de esta actuación enfermera e identificar los elementos esenciales que envuelven este concepto. Método: Aplicación del procedimiento de análisis de concepto descrito por Wilson y adaptado por Avant. Resultados: El concepto de prescripción enfermera implica prescribir por parte de la enfermera el mejor régimen terapéutico frente a un problema de salud. Esta prescripción estará guiada por la valoración del problema de salud, por el criterio de la buena práctica clínica del profesional enfermero y estará dirigida a satisfacer las necesidades de salud del usuario y la población. Conclusiones: Los resultados aclaran el significado del concepto de estudio para ayudar a los profesionales a comprender y abordar esta actuación en todas sus dimensiones y promover el reconocimiento social de la profesión enfermera

Objective: To critically analyse the concept of nursing prescription through the study of its background and a review of the scientific literature, in order to develop an accurate conception of this nursing activity and to identify the essential elements surrounding this concept. Method: Application of the concept analysis method described by Wilson, and adapted by Avant. Results: The concept of nurse prescription implies prescribing, by the nurse, the best therapeutic regimen for a health problem. This prescription will be guided by the assessment of the health problem, by the criterion of the good clinical practice of the nurse, and will be focused to satisfy the health needs of the patient and the population. Conclusions: The results clarify the meaning of the study's concept to help professionals understand and address this nursing activity in all its dimensions, and promote social recognition of the nursing profession

[Nurse prescription: A concept analysis]. / Prescripción enfermera: análisis de concepto.

OBJECTIVE: To critically analyse the concept of nursing prescription through the study of its background and a review of the scientific literature, in order to develop an accurate conception of this nursing activity and to identify the essential elements surrounding this concept. METHOD: Application of the concept analysis method described by Wilson, and adapted by Avant. RESULTS: The concept of nurse prescription implies prescribing, by the nurse, the best therapeutic regimen for a health problem. This prescription will be guided by the assessment of the health problem, by the criterion of the good clinical practice of the nurse, and will be focused to satisfy the health needs of the patient and the population. CONCLUSIONS: The results clarify the meaning of the study's concept to help professionals understand and address this nursing activity in all its dimensions, and promote social recognition of the nursing profession.

Implantación de la gestión enfermera de la demanda en las entidades proveedoras de servicios de Atención Primaria de Salud de Cataluña / Implementation of nurse demand managment in primary health care service providers in Catalonia

Objetivo: Describir y analizar la aplicación de la gestión enfermera de la demanda (GED) en los distintos proveedores de salud de Atención Primaria de Salud en Cataluña desde 2005 hasta finales de 2014. Diseño: Estudio transversal. Participantes: Todos los proveedores de servicios de Atención Primaria de Salud en Cataluña (n = 37). Mediciones principales: Encuestas con la dirección de enfermería de cada proveedor sobre las dificultades y elementos facilitadores en relación a la implantación de la GED. Los factores facilitadores y las barreras se clasificaron en 3 tipos: a) profesionales de la salud (competencias, actitudes, motivación para el cambio y características individuales); b) contexto social (pacientes y acompañantes), y c) factores relacionados con el sistema (organización y estructura, incentivos económicos). Resultados: De los 37 proveedores, 26 (70,3%) han aplicado la GED. Las principales barreras identificadas son la regulación de la prescripción enfermera, la falta de conocimientos y habilidades de las enfermeras y la falta de protocolos en el inicio de la implantación. Entre los factores facilitadores destacan la formación específica de los profesionales, una mayor proporción de ratio de enfermeras por cada médico (médico de familia o pediatra), consenso en los circuitos con todos los profesionales y la vinculación de la introducción de la GED a incentivos económicos. Conclusiones: La GED se está consolidando en Cataluña. Sin embargo, la GED debería ser introducida en el plan de estudios de grado de enfermería y programas de educación continua en equipos de atención primaria (AU)

Objective: To describe and analyse the implementaction of nurse demand managment (NDM) mong health care providers in Catalonia from 2005 to 2014. Design: Cross sectional survey. Participants All service providers in Catalonia (n=37). Main measurements Interviews with nurse manager of each health care provides about ht barriers and facilitators concerning NDM. Facilitators and barriers were classified into 3 types: (I) health professional (competence, attitudes, motivation for change and individual characteristics); (II) social context (patients and companions), and (III) system related factors (organization and structure, economic incentives). Results: Of the 37 providers, 26 (70.3%) have implemented the Demand Management Nurse (NDM). The main barriers identified are the nurse prescriptin regulation, lack of knowledge and skills of nurses, and the lack of protocols at the start of implantation. Among the facilitators are the specific training of professionals, a higher ratio of nurses to doctors, consensus circuits with all professionals and linking the implementation of NDM to economic incentives. Discussion: NDM is consolidated in Catalonia. However, the NDM should be included in the curricula of nursing degree and continuing education programs in primary care teams (AU)

[Implementation of nurse demand managment in primary health care service providers in Catalonia]. / Implantación de la gestión enfermera de la demanda en las entidades proveedoras de servicios de Atención Primaria de Salud de Cataluña.

OBJECTIVE: To describe and analyse the implementaction of nurse demand managment (NDM) among health care providers in Catalonia from 2005 to 2014. DESIGN: Cross sectional survey. Participants All service providers in Catalonia (n=37). Main measurements Interviews with nurse manager of each health care provides about ht barriers and facilitators concerning NDM. Facilitators and barriers were classified into 3 types: (i)health professional (competence, attitudes, motivation for change and individual characteristics); (ii)social context (patients and companions), and (iii)system related factors (organization and structure, economic incentives). RESULTS: Of the 37 providers, 26 (70.3%) have implemented the Demand Management Nurse (NDM). The main barriers identified are the nurse prescriptin regulation, lack of knowledge and skills of nurses, and the lack of protocols at the start of implantation. Among the facilitators are the specific training of professionals, a higher ratio of nurses to doctors, consensus circuits with all professionals and linking the implementation of NDM to economic incentives. DISCUSSION: NDM is consolidated in Catalonia. However, the NDM should be included in the curricula of nursing degree and continuing education programs in primary care teams.

Evaluación de la gestión enfermera de la demanda en atención primaria / Evaluation of Nurse Demand Management in Primary Care

OBJETIVO: Evaluar los resultados de la gestión enfermera de la demanda de pacientes no programados en el centro de atención primaria, siguiendo un circuito y una guía clínica diseñada y consensuada por el equipo. DISEÑO: Estudio descriptivo transversal. PARTICIPANTES: Muestra aleatoria de 558 pacientes que demandaron consulta el mismo día, atendidos entre el 1 mayo de 2011 y el 31 de enero de 2012. Intervención: La guía desarrollada describe 23 problemas de salud de posible resolución autónoma por parte de la enfermera y 18 de posible intervención de urgencia, con una resolución compartida con el médico. Cada problema de salud está dividido en 3 apartados: a) breve definición del problema; b) algoritmo de actuación y; c) posibles diagnósticos enfermeros de la North American Nursing Diagnosis Association más habituales para cada problema de salud y las posibles intervenciones de enfermería. RESULTADOS: Los 558 pacientes estudiados presentaron una edad media de 42,5 (DE: 17,7) años. El motivo de consulta que se atendió con mayor frecuencia fueron los síntomas respiratorios de vías altas (19,4%), seguidos de las diarreas/vómitos (16,5%) y heridas/quemaduras (12,5%). La enfermera resolvió un 73,3% de los casos atendidos. El 65,8% de los pacientes atendidos recibió consejos de salud y los fármacos más indicados fueron los analgésicos y antiinflamatorios (56%). DISCUSIÓN: La gestión enfermera de la demanda ha demostrado presentar una alta resolución de las afecciones atendidas, aportando a la vez un porcentaje elevado de consejos de salud y de educación sanitaria en las visitas atendidas

OBJECTIVE: to evaluate the health outcomes of nurse demand management on unscheduled patients in a Primary Care Centre, following a clinical guide designed by the whole primary care team. DESIGN: Cross-sectional study. SETTING: A primary care team from Castelldefels. Barcelona, Spain. PARTICIPANTS: A random sample of 558 patients requesting a consultation for the same day in a Primary Care setting, attended between May 1st, 2011 and January 31st, 2012. Intervention: The guide includes 23 health problems that can be dealt by a nurse autonomously, 18 of them possibly requiring an emergency intervention, and shared decision with the physician. Each health problem is divided into three sections: a) a brief definition of the problem; b) an intervention algorithm; and c) nursing diagnoses of North American Nursing Diagnosis Association for each health problem and a description of the possible nursing interventions. RESULTS: We studied 558 patients with a mean age of 42.5 years old (SD 17.7). The most commonly consulted problems were upper respiratory tract symptoms (19.4%), followed by nausea/vomiting (16.5%), and burns/wounds (12.5%).73.3% of the problems were resolved autonomously by a nurse.65,8% of the patients attended received health advice. DISCUSSION: Nurse demand management has shown to be highly effective at handling the conditions attended, while it provides a high percentage of health advice and education during consultations

[Evaluation of Nurse Demand Management in Primary Care]. / Evaluación de la gestión enfermera de la demanda en atención primaria.

OBJECTIVE: to evaluate the health outcomes of nurse demand management on unscheduled patients in a Primary Care Centre, following a clinical guide designed by the whole primary care team. DESIGN: Cross-sectional study. SETTING: A primary care team from Castelldefels. Barcelona, Spain. PARTICIPANTS: A random sample of 558 patients requesting a consultation for the same day in a Primary Care setting, attended between May 1st, 2011 and January 31st, 2012. INTERVENTION: The guide includes 23 health problems that can be dealt by a nurse autonomously, 18 of them possibly requiring an emergency intervention, and shared decision with the physician. Each health problem is divided into three sections: a) a brief definition of the problem; b) an intervention algorithm; and c) nursing diagnoses of North American Nursing Diagnosis Association for each health problem and a description of the possible nursing interventions. RESULTS: We studied 558 patients with a mean age of 42.5 years old (SD 17.7). The most commonly consulted problems were upper respiratory tract symptoms (19.4%), followed by nausea/vomiting (16.5%), and burns/wounds (12.5%). 73.3% of the problems were resolved autonomously by a nurse. 65,8% of the patients attended received health advice. DISCUSSION: Nurse demand management has shown to be highly effective at handling the conditions attended, while it provides a high percentage of health advice and education during consultations.

[An approach to acute diseases using a nursing practice guide]. / Abordaje de la demanda de visitas espontáneas de un equipo de atención primaria mediante una guía de intervenciones de enfermería.

OBJECTIVE: To evaluate the health results of patients who make spontaneous visits when attended by nurses in a primary health care team and by applying a nursing practice guide. DESIGN: Cross-sectional, descriptive study. SETTING: Primary health care team from the Barcelona metropolitan area, Spain. PARTICIPANTS: Patients who request a spontaneous visit for the same day in the primary health care centre (PHC). INTERVENTION: A nursing practice guide was prepared in which health problems were classified into 3 groups according to seriousness and possibility of being resolved by the nursing staff: a) group 1, problems where the protocols allowed that the nurse could finalise the process; b) group 2, problems that might require emergency action; and c) group 3, problems that required an assessment of the level of seriousness. When the patient arrived at the PHC requesting an urgent visit, and the problem fell into group 1 it was dealt with by a nurse. RESULTS: There were 202 patients with health problems included in group 1.The mean age was 36.3 years (SD, 18.6 years).The most consulted health problems were musculo-skeletal (32.7%), followed by skin (22.3%), and the digestive system (22.3%). Of those, 63.9% of the problems were completely resolved and only 5.9% required visits by the out of hours doctor. DISCUSSION: The nursing practice guide meant that the nurse became the entrance door to the primary care system, with a high possibility of resolving health problems.

Abordaje de la demanda de visitas espontáneas de un equipo de atención primaria mediante una guía de intervenciones de enfermería / An Approach to Acute Diseases Using a Nursing Practice Guide

Objetivo. Evaluar los resultados de salud de los pacientes atendidos por profesionales de enfermería en la demanda de visitas espontáneas en un equipo de atención primaria, aplicando una guía de intervención de enfermería. Diseño. Estudio descriptivo, transversal. Emplazamiento. Un equipo de atención primaria del área metropolitana de Barcelona. Participantes. Pacientes que solicitan visita espontánea para el mismo día en el centro de atención primaria (CAP). Intervención. Se elaboró una guía de intervención de enfermería en la que los problemas de salud se clasificaron en 3 grupos según la gravedad y la posibilidad de resolución por parte de enfermería: a) grupo 1, problemas en los que la protocolización permitió que el personal de enfermería finalizara el proceso; b) grupo 2, problemas de posible intervención de urgencia, y c) grupo 3, problemas que requieren valorar el grado de gravedad. Cuando un paciente acudía al CAP solicitando una visita urgente, si el problema de salud pertenecía al grupo 1 fue atendido por personal de enfermería. Resultados. Se atendieron 202 pacientes cuyos problemas de salud pertenecían al grupo 1. La edad media fue de 36,3 años (DE = 18,6 años). Los problemas de salud más consultados fueron los del sistema musculosquelético (32,7%), seguidos de los de la piel (22,3%) y del sistema digestivo (22,3%). Se resolvieron completamente el 63,9% de los problemas, y únicamente un 5,9% requirió ser visitado por el médico de guardia. Discusión. La guía de intervenciones de enfermería permite que los profesionales de ésta sean una puerta de entrada en el sistema de atención primaria, con un alto poder de resolución de los problemas de salud

Objective. To evaluate the health results of patients who make spontaneous visits when attended by nurses in a primary health care team and by applying a nursing practice guide. Design. Cross-sectional, descriptive study. Setting. Primary health care team from the Barcelona metropolitan area, Spain. Participants. Patients who request a spontaneous visit for the same day in the primary health care centre (PHC). Intervention. A nursing practice guide was prepared in which health problems were classified into 3 groups according to seriousness and possibility of being resolved by the nursing staff: a) group 1, problems where the protocols allowed that the nurse could finalise the process; b) group 2, problems that might require emergency action; and c) group 3, problems that required an assessment of the level of seriousness. When the patient arrived at the PHC requesting an urgent visit, and the problem fell into group 1 it was dealt with by a nurse. Results. There were 202 patients with health problems included in group 1.The mean age was 36.3 years (SD, 18.6 years).The most consulted health problems were musculo-skeletal (32.7%), followed by skin (22.3%), and the digestive system (22.3%). Of those, 63.9% of the problems were completely resolved and only 5.9% required visits by the out of hours doctor. Discussion. The nursing practice guide meant that the nurse became the entrance door to the primary care system, with a high possibility of resolving health problems