Diagnósticos Enfermeros prevalentes en pacientes mayores con úlceras por presión: estudio transversal / Prevalent nursing diagnoses in elderly with pressure ulcers: cross-sectional study / Diagnósticos Enfermeiros prevalentes em pacientes idosos com úlceras por pressão: estudo transversal

Resumen Objetivo Determinar la prevalencia de los diagnósticos enfermeros en pacientes adultos mayores hospitalizados con úlceras por presión e identificar los diagnósticos enfermeros reales, potenciales, de salud y síndrome por patrón funcional de salud. Material y métodos Estudio Transversal, descriptivo conformado por una muestra de pacientes adultos mayores hospitalizados en diferentes servicios de un Hospital de Acapulco, Guerrero, México. Para su evaluación, se diseñó un instrumento de acuerdo con los patrones funcionales de Marjory Gordon. Se utilizó la plataforma de mejores prácticas de enfermería E-cuidados® para el análisis. Resultados El presente estudio identificó 36 diagnósticos relevantes, de los cuales 23 (63.9 %) fueron diagnósticos centrados en el problema, 10 (27.8 %) diagnósticos de riesgo y 3 (8.3 %) de promoción a la salud. Los patrones funcionales más afectados son; Actividad-Ejercicio, Nutricional-Metabólico y Valores-Creencias. Conclusiones El presente estudio ayuda a enfatizar la importancia de adoptar estrategias preventivas y de atención integral, así como la mejora de la planificación de la atención para evitar el deterioro de las condiciones en los pacientes adultos mayores.

Abstract Objective To determine the prevalence of diverse nursing diagnostics in hospitalized older patients with pressure ulcers, identifying the real, potential, and health-related ones, as well as syndrome by health functional pattern. Methods and material This is a transversal and descriptive study with a sample of older patients in different services in a hospital of Acapulco, Guerrero, Mexico. An assessment instrument was designed following the Functional Patterns of Marjory Gordon. The E-cuidados® best nursing practices platform was used for the analysis. Results 36 relevant diagnostics were identified: 23 (63.9 %) were problem-centered; 10 (27.8 %) were risk related; and 3 (8.3 %) were health promoting. The most affected functional patterns were: Activity-Exercise; Nutrition-Metabolism; and Values-Beliefs. Conclusions This study supports the need to highlight the importance of adopting preventive and integral attention strategies, as well as improving the attention planning process in order to avoid the deterioration of health conditions of older patients.

Resumo Objetivo Determinar a prevalência dos diagnósticos enfermeiros em pacientes idosos hospitalizados com úlceras por pressão e identificar os diagnósticos enfermeiros reais, potenciais, de saúde e síndrome por padrão funcional de saúde. Material e métodos Estudo Transversal, descritivo conformado por uma amostra de pacientes idosos hospitalizados em diferentes serviços de um Hospital de Acapulco, Guerrero, México. Para sua avaliação, desenhou-se um instrumento conforme com os padrões funcionais de Marjory Gordon. Utilizou-se a plataforma de melhores práticas de enfermagem E-cuidados® para a análise. Resultados O presente estudo identificou 36 diagnósticos relevantes, dos quais 23 (63.9 %) foram diagnósticos centrados no problema, 10 (27.8 %) diagnósticos de risco e 3 (8.3 %) de promoção à saúde. Os padrões funcionais mais afetados são; Atividade-Exercício, Nutricional-Metabólico e Valores-Crenças. Conclusões O presente estudo ajuda a enfatizar a importância de adotar estratégias preventivas e de atenção integral, assim como a melhora da planificação da atenção para evitar a deterioração das condições nos pacientes idosos.

Analysis of a global random stratified sample of nurse legislation.

AIM: To identify, compare and contrast the major component parts of heterogeneous stratified sample of nursing legislation. BACKGROUND: Nursing legislation varies from one jurisdiction to another. Up until now no research exists into whether the variations of such legislation are random or if variations are related to a set of key attributes. METHODS: This mixed method study used a random stratified sample of legislation to map through documentary analysis the content of 14 nursing acts and then explored, using quantitative techniques, whether the material contained relates to a number of key attributes. These attributes include: legal tradition of the jurisdiction; model of regulation; administrative approach; area of the world; and the economic status of the jurisdiction. FINDINGS: Twelve component parts of nursing legislation were identified. These were remarkably similar irrespective of attributes of interest. However, not all component parts were specified in the same level of detail and the manner by which the elements were addressed did vary. A number of potential relationships between the structure of the legislation and the key attributes of interest were identified. CONCLUSIONS AND IMPLICATIONS FOR POLICY: This study generated a comprehensive and integrated map of a global sample of nursing legislation. It provides a set of descriptors to be used to undertake further quantitative work and provides an important policy tool to facilitate dialogue between regulatory bodies. At the individual nurse level it offers insights that can help nurses pursue recognition of credentials across jurisdictions.

A systematic review of nurse-related social network analysis studies.

BACKGROUND: Nurses frequently work as part of both uni- and multidisciplinary teams. Communication between team members is critical in the delivery of quality care. Social network analysis is increasingly being used to explore such communication. AIM: To explore the use of social network analysis involving nurses either as subjects of the study or as researchers. METHODS: Standard systematic review procedures were applied to identify nurse-related studies that utilize social network analysis. A comparative thematic approach to synthesis was used. Both published and grey literature written in English, Spanish and Portuguese between January 1965 and December 2013 were identified via a structured search of CINAHL, SciELO and PubMed. In addition, Google and Yahoo search engines were used to identify additional grey literature using the same search strategy. RESULTS: Forty-three primary studies were identified with literature from North America dominating the published work. So far it would appear that no author or group of authors have developed a programme of research in the nursing field using the social network analysis approach although several authors may be in the process of doing so. LIMITATIONS: The dominance of literature from North America may be viewed as problematic as the underlying structures and themes may be an artefact of cultural communication norms from this region. CONCLUSIONS: The use of social network analysis in relation to nursing and by nurse researchers has increased rapidly over the past two decades. The lack of longitudinal studies and the absence of replication across multiple sites should be seen as an opportunity for further research. IMPLICATION FOR NURSING AND HEALTH POLICY: This analytical approach is relatively new in the field of nursing but does show considerable promise in offering insights into the way information flows between individuals, teams, institutions and other structures. An understanding of these structures provides a means of improving communication.

Adherencia terapéutica en la enfermedad crónica: estado de la situación y perspectiva de futuro / Treatment compliance in chronic illness: current situation and future perspectives

Las enfermedades crónicas de larga duración poseen una elevada mortalidad y afectan por igual a ambos sexos. La falta de adherencia a las recomendaciones terapéuticas continúa siendo un obstáculo para mejorar la salud y la calidad de vida de los pacientes, además de conllevar un elevado coste sociosanitario. En este trabajo se desarrolla el concepto «adherencia terapéutica» que engloba tratamientos farmacológicos (cumplimiento terapéutico) y no farmacológicos (grado de coincidencia entre las recomendaciones ofrecidas, como pueden ser cambios en los hábitos de vida y su implantación por el paciente). También se analiza el impacto clínico y sociosanitario de la «adherencia terapéutica», así como las causas de la falta de adherencia y métodos y estrategias para mejorarla. Concluimos que la adherencia terapéutica debe ser un objetivo esencial del sistema sanitario, englobando todos los agentes implicados en la salud del paciente (AU)

Long-term chronic diseases have a high mortality rate around the world, affecting both genders equally. Despite improvements in the diagnosis and treatment of various health problems, lack of treatment compliance remains an obstacle to improving health and patient quality of life, and it carries a high associated socio-healthcare cost. The objectives of this study were to develop the concept of «therapeutic adherence», which includes both pharmacological compliance as well as non-pharmacological (level of agreement and patient involvement, lifestyle changes, etc.) treatments. The study also aimed to establish the clinical and socio-health impact of non-compliance, the reasons for non-compliance, and methods and strategies to improve compliance. The results of this study support therapeutic adherence as an essential goal of the healthcare system that encompasses all stakeholders involved in patient health (AU)

Treatment compliance in chronic illness: Current situation and future perspectives. / Adherencia terapéutica en la enfermedad crónica: estado de la situación y perspectiva de futuro.

Long-term chronic diseases have a high mortality rate around the world, affecting both genders equally. Despite improvements in the diagnosis and treatment of various health problems, lack of treatment compliance remains an obstacle to improving health and patient quality of life, and it carries a high associated socio-healthcare cost. The objectives of this study were to develop the concept of «therapeutic adherence¼, which includes both pharmacological compliance as well as non-pharmacological (level of agreement and patient involvement, lifestyle changes, etc.) treatments. The study also aimed to establish the clinical and socio-health impact of non-compliance, the reasons for non-compliance, and methods and strategies to improve compliance. The results of this study support therapeutic adherence as an essential goal of the healthcare system that encompasses all stakeholders involved in patient health.

Defining nurse regulation and regulatory body performance: a policy Delphi study.

CONTEXT: Professional self-regulation is a privilege and needs to deliver against the underpinning social contract between the professional and citizens who are receiving care and services. AIMS: The aims of this study were to generate, international consensus on a contemporary definition of professional nurse regulation; and to articulate the key features of a highly performing regulatory body, and postulate which regulatory model and administrative arrangements are best suited to attain the key features. METHOD: A highly diverse and globally recruited random stratified sample of 75 experts was approached to participate in a classic three-round policy Delphi study. Quantitative and qualitative data were generated and subjected to thematic and statistical analysis. Both non-parametric and descriptive statistical techniques were used in relation to quantitative data. RESULTS: Consensus on a revision of the current International Council of Nurses definition of professional nurse regulation was developed and a set of 47 key features of high-performing regulatory bodies was agreed. Although a strong preference for the delegated self-regulatory model (43%) and single-board administrative approach (48%) was expressed the underlying rationale for such a preference was unclear. CONCLUSION: The research makes an important contribution to an underdeveloped field of study. The case for conducting more quantitative investigations to ascertain the best regulatory model and associated administrative approach has been made.

Nurse faculty migration: a systematic review of the literature.

BACKGROUND: To undertake a systematic review of English and Spanish literature relating to nurse faculty migration. METHODS: A systematic review of both published literature, using CINAHL, EMBASE, ERIC and MEDLINE, and grey literature, using Google and Yahoo search engines, utilizing a defined search strategy with key terms, wild card strings and logical operators, was undertaken. An initial limitation of searching for material published in the last ten years was removed due to the poor yield of relevant papers. In total, 18 research-based studies were identified, retrieved and reviewed. Finally, the retrieved material was reviewed and augmented by a group of nurse faculty and migration experts, who offered comments and proposed additional grey literature. With increased globalization, the impact of mutual recognition agreements and associated modes of supply of services as well as those factors influencing clinical nurse migration was also considered. RESULTS: Studies on clinical nurse migration and general academic faculty provided some insights, but nursing faculty differ in a number of key ways and this needs to be considered when interpreting the results. Based on this systematic review, the paper concludes that nurse faculty migration is a neglected topic and one that warrants urgent investigation if health systems redesign and the associated scale-up of nurses are to be achieved. Particular gaps in knowledge relate to nurse faculty workforce planning, and understanding the dynamics and flows of faculty both across and within countries. It is unclear as to the extent to which our knowledge of push and pull factors relating to clinical nurse migration can be used in understanding nurse faculty migration. CONCLUSION: The current policy position of organizations such as the World Health Organization and individual governments to increase nursing numbers is incomplete without due consideration of faculty migration.

A structured policy review of the principles of professional self-regulation.

BACKGROUND: The International Council of Nurses (ICN) has, for many years, based its work on professional self-regulation on a set of 12 principles. These principles are research based and were identified nearly three decades ago. ICN has conducted a number of reviews of the principles; however, changes have been minimal. In the past 5-10 years, a number of authors and governments, often as part of the review of regulatory systems, have started to propose principles to guide the way regulatory frameworks are designed and implemented. These principles vary in number and content. OBJECTIVES: This study examines the current policy literature on principle-based regulation and compares this with the set of principles advocated by the ICN. DESIGN AND DATA SOURCES: A systematic search of the literature on principle-based regulation is used as the basis for a qualitative thematic analysis to compare and contrast the 12 principles of self-regulation with more recently published work. RESULTS: A mapping of terms based on a detailed description of the principles used in the various research and policy documents was generated. This mapping forms the basis of a critique of the current ICN principles. A professional self-regulation advocated by the ICN were identified. CONCLUSIONS: A revised and extended set of 13 principles is needed if contemporary developments in the field of regulatory frameworks are to be accommodated. These revised principles should be considered for adoption by the ICN to underpin their advocacy work on professional self-regulation.

Spanish nurses' credentialing in the 20th century.

BACKGROUND: Nurses credentialing as healthcare professionals commenced in Western Europe and in the USA by the end of the 19th and the beginning of the 20th century, boosted by the protestant reform movement. In Spain, it started in 1915, during the kingdom of Alfonso XIII (1902-1931). This historical period was marked by great political instability and big flaws in the healthcare delivery system. AIM: To describe the regulatory pathway that gave rise to the nursing profession in Spain, through official credentialing and regulation during the first third of the 20th century. METHOD: Documental, historical and regulatory documental research describing and analysing the national legislative sources used to regulate the professional development, as well as the education, training and competencies of the nursing practice in Spain, as compared with the developments in the European and American context. CONCLUSIONS: Professional development of the nursing profession in Western Europe and in the USA is consolidated during the 20th century as resulting in educational and training enhancement and the establishment of national and international professional bodies. In Spain, the regulatory and legal recognition of the nursing profession come into being in 1915 in response to a request from a female religious congregation.

Inter-observer reproducibility of probing to bone in the diagnosis of diabetic foot osteomyelitis.

AIMS: The objectives of our study were (i) to analyse the inter-observer reproducibility or diagnostic variability of the probing-to-bone test, depending on the training of the professional involved, and (ii) to assess whether the probing-to-bone test can be extrapolated to any professional specialty that deals with these patients. METHODS: This was a cross-sectional study, involving 75 patients with diabetic foot ulcer and clinical suspicion of osteomyelitis. A registration sheet was completed for all patients involved in the research study, gathering data relative to the results of the probing-to-bone test performed by three observers. Observer 1 was a very experienced professional with several years of experience in the treatment of the diabetic foot; observer 2 was a medium-experienced professional whose experience ranges from 6 to 12 months in the treatment of the diabetic foot; observer 3 was a healthcare professional without experience in the treatment of the diabetic foot. Data were gathered confidentially by a fourth researcher. RESULTS: The results showed a kappa index of 0.593 (95% CI 0.407-0.778) between observer 1 and observer 2, 0.397 (95% CI 0.188-0.604) between observer 1 and observer 3 and 0.53 (95% CI 0.335-0.725) between observer 2 and observer 3. CONCLUSIONS: The probing-to-bone test demonstrated moderate to fair concordance with an experienced examiner, although the degree of concordance is not significant between groups.

Impact of diabetic foot related complications on the Health Related Quality of Life (HRQol) of patients--a regional study in Spain.

The diabetic foot reduces the health-related quality of life (HRQoL) in patients with diabetes mellitus. This study aims at ascertaining the impact of the etiological factors of the diabetic foot on the various aspects of HRQoL. This is a comparative study involving type 1 or type 2 (n = 421) diabetic patients divided into 2 groups. Group 1 (n = 258) includes diabetic patients without foot lesions and group 2 (n = 163) includes patients suffering from a diabetic foot ulcer. The HRQoL of the sample was assessed by using the SF-36 Health Questionnaire. The overall HRQoL score was 68.58 ± 18.24 in group 1 and 50.99 ± 18.98 in group 2 (P < .001). The diabetic foot-related etiological factors that significantly reduce these patients' HRQoL are neuropathy, amputation history, and poor metabolic control (P < .001). Quality of life was lower in women with diabetic foot than in men. Neuropathy--regarded as the main etiological factor in the diabetic foot--also proved to be a variable that reduces the HRQoL. Paradoxically, peripheral vascular disease did not prove to have a negative impact on the quality of life.