Effectiveness of a Telephone-Based Motivational Intervention for Smoking Cessation in Patients With Crohn Disease: A Randomized, Open-Label, Controlled Clinical Trial.

A randomized, open-label, controlled clinical trial was designed to assess the effectiveness of a motivational intervention based on the 5 R's model (relevance, risks, rewards, roadblocks, and repetition) delivered by specialized inflammatory bowel disease nurses every 3 months over a 1-year period as compared with patients who were followed regularly. Patients diagnosed with Crohn disease, aged 18 years or older, who reported being active smokers with Internet access at home and an e-mail address were eligible. A total of 144 patients (72 per group) were included (50% women, median age 40 years). They smoked a median of 10 cigarettes per day (range = 1-40) and had been smoking for a median of 22 years (range = 1-51). Motivation to quit (Richmond test) was low in 73 patients, moderate in 39 patients, and high in 32 patients. Statistically significant differences between the study groups in the predisposition to change, motivation to quit, and tobacco withdrawal were not found. However, 14 patients (20.9%) in the intervention group and 9 patients (13.2%) among controls stopped smoking at the end of the study. These findings support a higher trend toward smoking cessation associated with the motivational intervention 5 R's. This behavioral strategy can aid patients with Crohn disease to quit smoking.

The nurse work environment in Spanish nurses following an economic recession: From 2009 to 2014.

AIM: To detect possible changes in perception of the nurse work environment, job satisfaction and burnout between the years 2009 and 2014 among nurses working in the Spanish National Health System. BACKGROUND: The global economic crisis has had a great impact on nurses in the Spanish National Health Service: tougher working conditions, lower pay and a reduction in social benefits. It is not known whether these changes affect the nurses' work environment, job satisfaction and burnout. METHOD: Comparative, cross-sectional study performed in seven hospitals in the Spanish National Health System between 2009 and 2014, through 1,454 surveys of nurses working in internal medicine, surgery and intensive care. RESULTS: Nurses participating in the second period (2012-2014) were more satisfied with their current job (p = 0.001), perceived their work environment to be more favourable (p < 0.001) and had lower levels of burnout (p < 0.01). Professional factors as 'autonomy at work,' 'opportunities for advancement,' 'professional status' and 'nursing foundations for quality care,' as well as 'collegial nurse-physician relations' and 'nurse participation in hospital affairs' were the most important variables associated with these topics. CONCLUSIONS: Professional factors may influence these changes more than labour conditions and remuneration aspects. IMPLICATIONS FOR NURSING MANAGEMENT: In times of economic recession, encouraging interpersonal relationships, autonomy and participation in decision-making may improve the work environment, satisfaction and burnout of nurses.

Factores relacionados con la adherencia a tratamientos de larga duración en adolescentes: Estudio descriptivo en un hospital terciario / Factors related to adherence to long-term treatment in adolescents. descriptive study in a tertiary hospital

Objetivo: Identificar los factores que pueden condicionar la adherencia a tratamientos de larga duración en adolescentes. Método: Estudio observacional, descriptivo y transversal realizado en el Campus Hospitalario Vall d'Hebron de Barcelona. Los participantes fueron adolescentes entre 12 y 18 años, con las siguientes condiciones: trasplantados de órganos sólidos, enfermedad oncohematológica, diabetes tipo 1, fibrosis quística o VIH+; así como sus cuidadores. Resultados: Participaron 153 adolescentes y 153 cuidadores. La media de edad de los adolescentes fue de 15 años (DE = 2) y el 54 % (83) eran varones. El 69 % (106) de los cuidadores eran mujeres. El 49 % (75) refirió saltarse el tratamiento alguna vez al mes o más frecuentemente; de ellos, el 92 % (69) conocía las consecuencias de no cumplirlo. Los diabéticos fueron el grupo que refirieron incumplimiento frecuente en menor porcentaje (25.6 %). Las causas principales de incumplimiento fueron el olvido (64 %), no disponer de la medicación (19 %) o cansarse de tomarla (11 %). El 39 % (59) de los cuidadores afirmaron que existían problemas de aceptación y cumplimiento por parte del adolescente. Se halló una mayor frecuencia de incumplimiento en pacientes con mayor número de fármacos y vías de administración. Las mujeres refirieron una mayor participación en las visitas de seguimiento. Conclusiones: Las variables asociadas a complejidad del tratamiento se relacionaron con incumplimiento frecuente. No hubo diferencias entre patologías en cuanto a las causas de incumplimiento referidas, hecho que podría facilitar el diseño de intervenciones transversales en cronicidad pediátrica. Las diferencias halladas entre sexos sugieren un estilo más participativo entre las adolescentes

Objetives: To identify the factors that can condition adherence to long-term treatment in adolescents. Method: An observational, descriptive and cross-sectional study carried out at the Vall d'Hebron Hospital Campus. Participants were adolescents between 12 and 18 years of age, with the following conditions: solid organ transplants, oncohematologic disease, type 1 diabetes, cystic fibrosis or HIV+ and their caregivers. Results: 153 adolescents and 153 caregivers participated. The mean age of adolescents was 15 years (SD = 2) and 54 % (83) were boys. 69 % (106) of the caregivers were women. 49 % (75) reported that they skipped treatment once a month or more frequently, of whom 92 % (69) knew the consequences of not doing so. Diabetics were the group that reported frequent noncompliance in a lower percentage (25.6 %). The main causes of noncompliance were forgetfulness (64 %), not having medication (19 %) or getting tired of taking it (11 %). 39 % (59) of the caregivers affirmed that there were problems of acceptance and compliance of the treatment by the adolescent. A higher frequency of noncompliance was found in patients with higher numbers of drugs and routes of administration. Women reported increased participation in follow-up visits. Conclusions: Variables associated with the complexity of treatment were related to frequent non-compliance. There were no differences between pathologies regarding the causes of noncompliance referred, which could facilitate the design of global interventions in pediatric chronicity. Differences found between sexes suggest a more participatory style and greater responsibility among women

Efficiency of the modified Sims maternal position in the rotation of persistent occiput posterior position during labor: A randomized clinical trial.

BACKGROUND: Fetal occiput posterior position in labor is associated with more painful and prolonged labor, and an increase in both maternal and fetal morbidity. The aim of this study is to assess whether the modified Sims position on the side of the fetal spine increases the rotation to occiput anterior position in women with epidural analgesia and a fetus in persistent occiput posterior (POP) position. METHODS: This is an open, randomized controlled, clinical trial. One hundred and twenty women in labor with fetuses in POP position were included. The diagnosis was performed through digital vaginal examination and confirmed with an ultrasound scan. Women were randomized into the free position group or the modified Sims on the side of the fetal spine. The primary outcome was rotation to occiput anterior, and secondary outcomes were type of delivery, postpartum perineal condition, perinatal results, and maternal satisfaction. RESULTS: In pregnant women undergoing labor in the Sims position, fetuses in POP rotated to occiput anterior in 50.8% of cases, whilst in the free position group, the rotation occurred in 21.7% (P = .001). The rate of vaginal deliveries was higher in the Sims group compared with the free position group (84.7% vs 68.3%, P = .035). DISCUSSION: The modified Sims position is a maternal posture intervention efficient in POP rotation, which decreases cesarean delivery rate. It is a simple and noninvasive intervention, reproducible, and well tolerated by pregnant women.

Nurses' sleep quality, work environment and quality of care in the Spanish National Health System: observational study among different shifts.

OBJECTIVE: The main objective of this study was to determine the relationship between the characteristics of nurses' work environments in hospitals in the Spanish National Health System (SNHS) with nurse reported quality of care, and how care was provided by using different shifts schemes. The study also examined the relationship between job satisfaction, burnout, sleep quality and daytime drowsiness of nurses and shift work. METHODS: This was a multicentre, observational, descriptive, cross-sectional study, centred on a self-administered questionnaire. The study was conducted in seven SNHS hospitals of different sizes. We recruited 635 registered nurses who worked on day, night and rotational shifts on surgical, medical and critical care units. Their average age was 41.1 years, their average work experience was 16.4 years and 90% worked full time. A descriptive and bivariate analysis was carried out to study the relationship between work environment, quality and safety care, and sleep quality of nurses working different shift patterns. RESULTS: 65.4% (410) of nurses worked on a rotating shift. The Practice Environment Scale of the Nursing Work Index classification ranked 20% (95) as favourable, showing differences in nurse manager ability, leadership and support between shifts (p=0.003). 46.6% (286) were sure that patients could manage their self-care after discharge, but there were differences between shifts (p=0.035). 33.1% (201) agreed with information being lost in the shift change, showing differences between shifts (p=0.002). The Pittsburgh Sleep Quality Index reflected an average of 6.8 (SD 3.39), with differences between shifts (p=0.017). CONCLUSIONS: Nursing requires shift work, and the results showed that the rotating shift was the most common. Rotating shift nurses reported worse perception in organisational and work environmental factors. Rotating and night shift nurses were less confident about patients' competence of self-care after discharge. The most common nursing care omissions reported were related to nursing care plans. For the Global Sleep Quality score, difference were found between day and night shift workers.

Health-related quality of life and nursing-sensitive outcomes in mechanically ventilated patients in an Intensive Care Unit: a study protocol.

BACKGROUND: Mechanical ventilation (MV) is one of the most utilised techniques in the intensive care unit (ICU), but it can cause sequelae that can negatively influence the patient's health-related quality of life (HRQL). Nursing-sensitive outcomes (NSOs) can also influence the HRQL. Assessing the HRQL of mechanically ventilated patients admitted to an ICU and its relation to nurse-sensitive outcomes will give healthcare professionals with valuable information to improve patient care. METHODS: Prospective longitudinal cohort study in which all patients admitted to the ICU at Hospital Universitari Vall d'Hebron who undergo MV for more than 48 h will be included. The study will last 12 consecutive months. HRQL will be assessed by the completion of the SF-36 and the Saint Georges Respiratory Questionnaire. Pre-admission HRQL assessment will be performed by the main caregiver, and after ICU discharge, the assessment will be performed by the patient him/herself. The same questionnaires will also be completed one year after ICU discharge. Other variables (sociodemographic and those related to reason for ICU admission, ICU length of stay, MV, ICU stressors and NSO) will be included in a multiple regression model to assess their relation to the patient's HRQL. DISCUSSION: This study will show the relationship between the HRQL perceived by patients and their main caregiver, what the HRQL is one year after discharge from ICU, and what the impact of MV, NSO and ICU stressors and other clinical outcomes on the patient's HRQL is. Determining mechanically ventilated patients' HRQL and its relation to NSO and ICU stressors as well as other clinical variables will enable early nursing interventions to try to minimise possible sequelae and improve the patient's welfare. TRIAL REGISTRATION: ClinicalTrials.gov ID:NCT02636660Registration Date: 17th December 2015.

El impacto y la corrección de posiciones occipitoposteriores en el parto / The impact and correction of occiput posterior positions when giving birth

El objetivo de esta revisión bibliográfica es profundizar en la frecuencia, factores predisponentes, diagnostico, evolución, pronostico y medidas correctoras de las variedades posteriores de la cabeza fetal en el parto. Se hizo una búsqueda en las bases de datos PubMed, CINHAL, Cuidatge y Biblioteca Cochrane con los descriptores «occipitoposterior», «occiputposterior», «fetal malpresentations», «malposiciones fetales», «parto» y «labor»; se incluyeron los estudios, con cualquier tipo de diseño, publicados en los últimos 20 años en castellano o inglés .Los resultados reflejan variabilidad en los temas estudiados, excepto en la frecuencia. Las posiciones posteriores se asocian a una mayor morbilidad materno-fetal y a un trabajo de parto más doloroso, prolongado y difícil. Aunque estas posiciones no son una complicación grave ni son difíciles de tratar, tienen graves consecuencias para la madre y el hijo

The objective of this bibliographic review is to deepen into the corrective measures of the posterior positions. This is accomplished through the analysis of the predisposing factors, diagnosis, frequency, prognosis and its evolution. The research was conducted through the databases: PubMed, CINHAL, Cuidatge and the Cochrane Library; through studies with any type of design and in both English and Spanish languages. 152 articles were found, from which 40 were selected; these reflect variety in all the studied elements except for incidence. The posterior positions are associated with a higher materno-foetal morbidity, linked to a longer, more painful and complicated delivery. Even though these positions don’t necessarily lead to dangerous situations, they may still present severe consequences for the mother and the baby

Relación entre la carga de enfermedad y la financiación en investigación a través del Fondo de Investigación Sanitaria en España / Relationship between disease burden and research funding through the Health Research Foundation in Spain

OBJETIVO: Analizar la relación entre la carga de enfermedad de los años 2007-2009 y la financiación pública de la investigación sanitaria entre los años 2008-2010. MÉTODO: Estudio descriptivo transversal de la carga de enfermedad y la financiación destinada a investigación de enfermedades en el ámbito del Sistema Nacional de Salud. RESULTADOS: Se revisaron 6.573 títulos de proyectos de los años 2008, 2009 y 2010. En el período de estudio fueron asignados 472,7 millones de euros en concepto de ayudas destinadas a la realización de proyectos. Las enfermedades con mayor presupuesto fueron los tumores malignos y las neuropsiquiátricas. En el período de estudio, en España se estimaron 15.253.331,3 años de vida ajustados por discapacidad (AVAD), presentando mayor AVAD las enfermedades neuropsiquiátricas, con 4.396.900 (28,8%). Se obtuvo un coeficiente de Pearson de 0,759 (p < 0,001) entre la financiación pública y los AVAD. Las anomalías congénitas obtuvieron 290,4 Euros/AVAD. El estudio del paladar hendido o la atresia esofágica, con ratios de 3.432,7 Euros/AVAD y 3.387,6 Euros/AVAD, respectivamente, obtuvieron la mayor financiación. CONCLUSIONES: La relación estudiada refleja que la distribución de los recursos económicos en el período de estudio está en consonancia con la carga que padecía la población española. Esta relación se ve alterada por la financiación en el estudio de anomalías congénitas, ya que el número de proyectos en este ámbito es menor

OBJECTIVE: To analyze the relationship between burden of disease during 2007-2009 and public funding of research in health in Spain during 2008-2010. METHOD: Descriptive cross-sectional study of burden of disease and funding allocated for research in diseases in the Spanish National Health System. RESULTS: A review was made of a total of 6,573 project titles funded for the years 2008, 2009 and 2010. During this period, a total of 472.7 million Euros were assigned as grants for research projects. Malignant tumors and neuropsychiatric diseases were the illnesses with greatest funding support. During the study period, it was estimated that there was a total of 15,253,331.3 disability-adjusted life years (DALYs) in Spain, with neuropsychiatric diseases being the category representing most DALYs with 4,396,900 (28.8%). The relationship between funding and DALYs was obtained with a Pearson r equal to 0.759 (p < 0.001). The study of congenital diseases had higher funding per DALY than any other disease with an investment of 290.4 €/DALY. Among these, the study of cleft palate and esophageal atresia, with ratios of 3,432.7 €/DALY and 3,387.6 €/DALY respectively, obtained the greatest funding. CONCLUSIONS: The study shows that the relative distribution of economic resources in the study period is consistent with the burden suffered by the Spanish population. This relationship is altered by the funding of the study of congenital anomalies, because of the low number of projects in this area

[Relationship between disease burden and research funding through the Health Research Foundation in Spain]. / Relación entre la carga de enfermedad y la financiación en investigación a través del Fondo de Investigación Sanitaria en España.

OBJECTIVE: To analyze the relationship between burden of disease during 2007-2009 and public funding of research in health in Spain during 2008-2010. METHOD: Descriptive cross-sectional study of burden of disease and funding allocated for research in diseases in the Spanish National Health System. RESULTS: A review was made of a total of 6,573 project titles funded for the years 2008, 2009 and 2010. During this period, a total of 472.7 million Euros were assigned as grants for research projects. Malignant tumors and neuropsychiatric diseases were the illnesses with greatest funding support. During the study period, it was estimated that there was a total of 15,253,331.3 disability-adjusted life years (DALYs) in Spain, with neuropsychiatric diseases being the category representing most DALYs with 4,396,900 (28.8%). The relationship between funding and DALYs was obtained with a Pearson r equal to 0.759 (p<0.001). The study of congenital diseases had higher funding per DALY than any other disease with an investment of 290.4€/DALY. Among these, the study of cleft palate and esophageal atresia, with ratios of 3,432.7€/DALY and 3,387.6€/DALY respectively, obtained the greatest funding. CONCLUSIONS: The study shows that the relative distribution of economic resources in the study period is consistent with the burden suffered by the Spanish population. This relationship is altered by the funding of the study of congenital anomalies, because of the low number of projects in this area.

El cuidado como elemento transversal en la atención a pacientes crónicos complejos / Care as a cross-cutting element in the health care of complex chronic patients

La atención a las personas que presentan enfermedades crónicas constituye hoy en día una prioridad en las agendas de todos los sistemas sanitarios. Dentro de estas estrategias, merece destacar el abordaje específico que requiere un grupo de población que se caracteriza por presentar pluripatología y comorbilidad asociada. Estas personas son especialmente vulnerables, frágiles, requieren cuidados muy complejos y consumen una elevada cantidad de recursos sociosanitarios. Se estima una prevalencia en España del 1,4% en población general y de aproximadamente el 5% en mayores de 64 años. La atención sociosanitaria a esta población requiere un enfoque centrado en la persona, como paradigma de atención a pacientes y no a enfermedades. Los modelos deben dar el salto del enfoque segmentado por enfermedades a la visión holística e integral, teniendo en cuenta la situación social, psicoafectiva, la vivencia que la persona tiene de la enfermedad, su contexto familiar y el abordaje de las respuestas humanas que todo ello genera. Los profesionales sanitarios necesitan herramientas que les orienten y faciliten la toma de decisiones en este grupo de población. Las guías de práctica clínica para el abordaje de pacientes con comorbilidad y pluripatología presentan numerosas limitaciones. Las recomendaciones de expertos en este sentido, nos orientan hacia un abordaje multidisciplinar, con el autocuidado y la gestión de la enfermedad por parte del propio paciente como elemento transversal de la asistencia

The care of people who live with chronic diseases is currently a priority on the roadmaps of all health care services. Within these strategies, there needs to be a specific approach required for a population group that is defined by having multiple diseases and the associated comorbidity. This group is especially vulnerable, fragile, and require very complex care, which uses up a high quantity ofsocial health resources. The estimated prevalence in Spain is 1.4% in the general population, and approximately 5% in people over 64 years. The social and healthcare of this population requires a person-centered approach, as a paradigm of caring for the patients and not of the diseases. The models must leap from the segmented approach to diseases to a holistic and integrated vision, taking into account the social and psycho-affective situation, the experience of the patient, the family context, and the approach of human experience/response that these processes produce. The health professionals need support tools that can guide them and help in making clinical decisions in this population group. The clinical practice guidelines for the approach of patients with co-morbidity and multiple diseases have numerous limitations. Expert recommendations in this sense, lead us to a multidisciplinary approach, with self-care and self-health management as a cross-cutting element of healthcare

[Care as a cross-cutting element in the health care of complex chronic patients]. / El cuidado como elemento transversal en la atención a pacientes crónicos complejos.

The care of people who live with chronic diseases is currently a priority on the roadmaps of all health care services. Within these strategies, there needs to be a specific approach required for a population group that is defined by having multiple diseases and the associated comorbidity. This group is especially vulnerable, fragile, and require very complex care, which uses up a high quantity of social health resources. The estimated prevalence in Spain is 1.4% in the general population, and approximately 5% in people over 64 years. The social and healthcare of this population requires a person-centered approach, as a paradigm of caring for the patients and not of the diseases. The models must leap from the segmented approach to diseases to a holistic and integrated vision, taking into account the social and psycho-affective situation, the experience of the patient, the family context, and the approach of human experience/response that these processes produce. The health professionals need support tools that can guide them and help in making clinical decisions in this population group. The clinical practice guidelines for the approach of patients with co-morbidity and multiple diseases have numerous limitations. Expert recommendations in this sense, lead us to a multidisciplinary approach, with self-care and self-health management as a cross-cutting element of healthcare.

Efficacy of a videoconferencing intervention compared with standard postnatal care at primary care health centres in Catalonia.

OBJECTIVE: to evaluate the efficacy of an intervention combining videoconferencing and telephone contact compared to standard post partum care of recent mothers attending health centres in Catalonia were recorded. DESIGN: multicentre, randomised parallel controlled clinical trial. PARTICIPANTS AND SETTING: 1598 post partum women with Internet access attending eight 'Attention to Sexual and Reproductive Health' (Catalan acronym ASSIR) units at Primary Health Care centres, in Catalonia (Spain). INTERVENTION: at each of the eight ASSIR units, 100 women were randomly assigned to the intervention group (IG) and 100 to the control group (CG). Women in the IG could consult midwives by videoconference or telephone and could also receive standard care. Women in the control group received standard care from midwives at their health centres or at home. MEASURES: number and type of visits, reasons for consultation, type of feeding at six weeks and women's satisfaction with the intervention on a scale of 1 to 5. FINDINGS: 1401 women were studied (80.9% of the initial sample), 683 in the IG and 718 in the CG. Two hundred and seventy-six women (40.4%) used videoconferencing or telephone in the IG. The mean total visits, virtual and face-to-face, was higher in IG women than in controls (2.74 versus 1.22). IG women made fewer visits to the health centre (mean=1) than CG women (mean=1.17). Both differences were statistically significant, with p<0.001 and p=0.002 respectively. The prevalence of breast feeding was similar in the two groups (IG 64.5%, and CG 65.4%). The mean overall satisfaction of women with midwife care was very high in both groups (IG 4.77, CG 4.76). CONCLUSIONS AND IMPLICATIONS FOR THE PRACTICE: virtual care via videoconferencing is effective for post partum women. It reduces the number of health centre visits and allows mothers to consult health staff immediately and from their own home.

Sleepiness in Spanish nursing staff--influence of chronotype and care unit in circadian rhythm impairment: research protocol.

AIMS: To determine how prevalent circadian rhythm impairments are in nurses working in medical, surgical and intensive care units in five Spanish hospitals and how the quality of night-time sleeping and sleepiness affect the nurses' morning and evening chronotypes. BACKGROUND: Shift work is a recognized work pattern for nurses in all countries. Given the important role that nurses play in hospital care, it is vital to establish what repercussions this has on the nurses' working schedules and how any disturbance in circadian rhythm affects patient safety. DESIGN: A multicentre, observational, descriptive and cross-sectional study in seven hospitals in the Spanish National Health System. METHOD: A stratified sample of 1,300 nurses is being collected in three types of units: medical, surgical and intensive care. The 3-year study started in January 2012 and will continue until December 2014, with no exclusion criteria. The Kronowise(®) will be used to monitor the nurses' circadian rhythms, by recording their activity, position and wrist temperature. We will also use three questionnaires to evaluate sleep quality, daytime drowsiness and chronotype: (a) Pittsburg Sleep Quality Index; (b) Epworth Daytime Sleepiness Scale; and (c) Morning and Evening Questionnaire. Data will be collected from each hospital and statistical analysis will be carried out using the SPSS 19.0. DISCUSSION: The study findings will show the current state of the nurses' circadian rhythms and how shift work can affect them and their job performance. Funding for this 3-year study was granted in December 2011 by the Spanish Health Research Fund (PI 11/00646, Health Ministry). This project is also funded by the Instituto de Salud Carlos III (RETICEF, RD12/0043/0011, RD12/0043/0006).

Content validity of the Spanish version of the Practice Environment Scale of the Nursing Work Index.

OBJECTIVE: The objective of this study is to evaluate the content validity of the Iberian Spanish version of the questionnaire The Practice Environment Scale of the Nursing Work Index (PES-NWI) by using the Content Validity Indexing (CVI). METHODS: A descriptive cross-sectional observational study was conducted. The Spanish version of the questionnaire was translated from the American English instrument through forward and back translation processes. Experts evaluated the translated items through content validity indexing. Once the assessments were completed, CVI indicators were calculated: number of agreements, item Content Validity Index and overall content validity and modified kappa coefficient of the instrument. RESULTS: The overall content validity of the instrument was 0.82. The average modified kappa coefficient of the items was 0.80, with a rating of 'excellent'. Only 4 of the items were rated as weak or poor. CONCLUSIONS: The study demonstrates that the content validity of the Spanish version of the PES-NWI is acceptable. Some results indicate that some items have cross-cultural applicability challenges that need to be addressed in future research studies. Use of the instrument in other Spanish language speaking countries should be taken with caution since some words may not reflect the language of the healthcare systems there.

[Work environment and patient safety: data comparison between Seneca and RN4CAST projects]. / Entorno laboral y seguridad del paciente: comparación de datos entre los estudios SENECA y RN4CAST.

OBJECTIVE: To analyze the relationship between the work environment and burnout of nurses and the quality of care for patient safety at the Spanish National Health System Hospitals included in SENECA and RN4CAST studies. METHOD: Descriptive study with a secondary analysis that compares data of 984 patient records, 1469 patient, and 1886 professional surveys from SENECA project, with 2139 nurses' surveys from RN4CAST study, in 24 hospitals. Adverse events data related to care, and patient's and professional's perception of safety were compared with work environment (measured by the Nursing Work Index) and burnout (measured by Maslach Burnout Inventory). RESULTS: There was a statistically significant relation of pain with «Staffing and resource adequacy¼ (r=-0,435, p=0,03) and nosocomial infection with «Nursing foundations for quality of care¼ (r=-0,424; p=0,04) and «Nurse participation in hospital affairs¼ (r=-0,516, p=0,01) of the Nursing Work Index. The hospital classification obtained from the Nursing Work Index was associated with the patients' perception of safety (r=0,66, p<0,01). Professionals' perception of participation in patient safety issues was associated with the five factors of the Nursing Work Index (r ∈ [|0,41|-|0,78 |], p<0,046) and with Maslach emotional exhaustion (r=-0,518, p=0,01). CONCLUSIONS: The organizations that foster a supportive work environment will have patients that perceive safer care. In addition, proper resource management could decrease the occurrence of adverse events such as pain.

Validation of the Spanish version of the questionnaire Practice Environment Scale of the Nursing Work Index.

BACKGROUND: The importance of the practice environment in the provision of care and its relation with patient outcomes and nurse-reported outcomes, support the need to have an instrument to measure such practice environment. OBJECTIVE: To evaluate the validity and reliability of the Spanish version of the Practice Environment Scale of the Nursing Work Index (PES-NWI), determining the content validity, test-retest reliability, internal consistency and construct validity. DESIGN: A cross-sectional survey of bedside care nurses undertaken in 2009 in medical, surgical and critical care wards of 33 Spanish National Health Service hospitals with more than 150 beds. METHODS: The validation process followed the internationally recognized guidelines about psychometric properties of instruments: translation and back-translation, content validity, test-retest reliability, internal consistency and construct validity. Other study variables included, like nurses' intention to leave and job satisfaction. RESULTS: The Intraclass Correlation Coefficient (ICC) for an overall score on the 31 item questionnaire was 0.87 (CI 95%: 0.85-0.89). Cronbach's alpha was 0.90 (CI 95%: 0.87-0.93). The weighted Kappa Index obtained for each of the items ranges from 0.24 (CI 95%: 0.22-0.26) to 0.51 (CI 95%: 0.49-0.53). The Content Validity Index score ranges from 0.5 for the item "Opportunities for advancement" to 1. Five of the terms attain this maximum level of agreement: "Active staff development or continuing education programs for nurses", "Enough registered nurses on staff to provide quality patient care", "Enough staff to get the work done", "Management that listens and responds to employee concerns" and "Collaboration between nurses and physicians". CONCLUSIONS: The validation process indicates that the Spanish version of the PES-NWI is valid and reliable in its current version and it can be used to measure the practice environment of Spanish nurses working in clinical practice in hospitals of the Spanish NHS.

[Perception of work environment of nurses in hospitals of the Spanish national health system. RN4CAST-Spain project]. / Percepción del entorno laboral de las enfermeras españolas en los hospitales del Sistema Nacional de Salud. Proyecto RN4CAST-España.

OBJECTIVE: To appraise the perception of Registered Nurses working at Spanish National Health System (SNHS) hospitals about work environment, quality of care and burnout. METHOD: Cross-sectional study addressed to 7539 nurses in 59 Spanish public hospitals over 150 beds belonging to the NHS between 2009 and 2010. Data was collected on: socio-demographic and academic background, job satisfaction, perception of work environment (PES-NWI) and burnout (MBI). RESULTS: Among 7539 questionnaires, 5654 were collected (75%). The nurses' average age was 37,5 (SD=9,5) years old, 88% (4929) were female and they had a median of 12 years of experience. The patient/nurse ratio was 11/1. 26% of nurses (1468) showed their intention to leave the hospital. 55% of nurses (3080) showed moderate job satisfaction. The work environment was unfavorable for 48% (2729) of nurses. 22% (1091) showed high burnout levels. CONCLUSIONS: The results show a high nurses' participation, who relate moderate job satisfaction. However, on PES-NWI, nearly half of nurses show an unfavorable work environment.

Percepción del entorno laboral de las enfermeras españolas en los hospitales del Sistema Nacional de Salud. Proyecto RN4CAST-España / Perception of work environment of nurses in hospitals of the Spanish national health system. RN4CAST-Spain project

Objetivo Conocer la percepción de las enfermeras que trabajan en los hospitales del Sistema Nacional de Salud (SNS) en España sobre su entorno laboral y la calidad de los cuidados que prestan, así como su satisfacción con el trabajo y su nivel de burnout. Método Diseño observacional, descriptivo y transversal realizado entre 2009 y 2010 en 7.539 enfermeras de 59 hospitales españoles con más de 150 camas pertenecientes al SNS. Se recogieron, entre otros, datos sociodemográficos y de formación, satisfacción laboral, percepción del entorno laboral a través del cuestionario Practice Environment Scale of the Nursing Work Index (PES-NWI) y el grado de burnout medido con el Maslach Burnout Inventory (MBI). Resultados De los 7.539 cuestionarios entregados se recogieron 5.654 (75%). La edad media de las enfermeras era de 37,5 años (DE=9,5), un 88% (4.929) eran mujeres y tenían una mediana de 12 años de experiencia profesional. El ratio paciente/enfermera fue de 11/1. Un 26% (1.468) indicaron que les gustaría abandonar el hospital. El 55% de las enfermeras (3.080) indicaron estar moderadamente satisfechas con su trabajo. El entorno laboral fue desfavorable para el 48% (2.729) de las enfermeras. Un 22% (1.091) presentaban un alto nivel de burnout. Conclusiones Los resultados indican una alta participación de las enfermeras, que refieren una satisfacción moderada con su trabajo, aunque, según el PES-NWI casi la mitad refleja un entorno laboral desfavorable (AU)

Objective: To appraise the perception of Registered Nurses working at Spanish National Health System (SNHS) hospitals about work environment, quality of care and burnout. Method: Cross-sectional study addressed to 7539 nurses in 59 Spanish public hospitals over 150 beds belonging to the NHS between 2009 and 2010. Data was collected on: sociodemographic and academic background, job satisfaction, perception of work environment (PES-NWI) and burnout (MBI). Results: Among 7539 questionnaires, 5654 were collected (75%). The nurses’ average age was 37,5 (SD = 9,5) years old, 88% (4929) were female and they had a median of 12 years of experience. The patient/nurse ratio was 11/1. 26% of nurses (1468) showed their intention to leave the hospital. 55% of nurses (3080) showed moderate job satisfaction. The work environment was unfavorable for 48% (2729) of nurses. 22% (1091) showed high burnout levels. Conclusions: The results show a high nurses’ participation, who relate moderate job satisfaction. However, on PES-NWI, nearly half of nurses show an unfavorable work environment (AU)