Pandemia y humanización en el sistema sanitario público de Navarra / Pandemic and humanization in the system public health of Navarre

En el año 2017, el Gobierno de Navarra diseñó y presentó la Estrategia de Humanización delSistema Sanitario Público, con el objetivo de conseguir un nuevo modelo de atención quecontemplara a cada persona como centro de atención, y no a la enfermedad o el proceso porel que es atendida. La Estrategia vigente hoy día considera que la nueva orientación de los servicios hacia una atención personal, humana, respetando la dignidad y los valores de las personas atendidas es más satisfactoria profesional y humanamente para el conjunto de profesionales del sistema sanitario y, por tanto, tiene un valor motivador y de desarrollo profesional. Esta orientación se vio interrumpida por los cambios organizativos y asistenciales imprescindibles para abordar la situación provocada por la pandemia de COVID-19. Es ahora nuestra responsabilidad contar el impacto de la pandemia en la humanización de laatención, un impacto que nos lleva a ser críticas con nosotras mismas, a considerar leccionesaprendidas de cara al futuro, y también a poner en valor cuestiones aprendidas que han venido para quedarse, siempre con el objetivo de construir.(AU)

Theory-based capacity building intervention for intersectoral action for health at local governments: An exploratory pilot study.

AIM: To design, implement and evaluate a nurse-led capacity building intervention (PromoGOB) for intersectoral action for health at local governments. DESIGN: The programme was based on theories of the policy process and organizational change and facilitated by a nurse developing a health broker role. A complex intervention perspective was adopted in carrying out the study. The intervention was evaluated using a mixed method embedded design. METHODS: Quantitative component relied on a specific questionnaire. This tool, designed and piloted ad hoc, measured the capacity in terms of knowledge, awareness, resources, skills, and commitment, both at sectoral and government levels. For the qualitative component, semi-structured interviews were conducted. These explored the perceived capacity and feasibility and acceptability issues. The programme was initiated at the end of October 2019, and it lasted a total of 5 weeks. Nineteen individuals representing various sectors at a local government in northern Spain participated in the study. The data analysis was concluded by the end of March 2020. FINDINGS: PromoGOB positively influenced participants' capacity for addressing health promotion. Awareness component, intersectoral work and the nurse as health broker were essential in the programme. The necessity of political participation was identified as an issue to be prioritized in future studies. CONCLUSION: This study highlights the relevance of capacity building at local governments and the role that nurses can play in it. Further work should be undertaken to continue developing Health in All Policies approach at local level. IMPACT: This study offers a starting point for nurses to get involved in the policy process of health promotion, performing a specific role as health brokers, building capacity at local governments for addressing social determinants of health, and delving into theories and concepts of the Health in All Policies field.

[Professional and family perception on care and compliance with the end of life regulations. A qualitative study.] / Percepción profesional y familiar sobre la atención y cumplimiento de la normativa sobre el final de la vida. Un estudio cualitativo.

OBJECTIVE: The scope and types of health interventions in the dying process are the subject of a social and professional debate that has been increasing in recent years. The objective of the study was focused on analyzing the perceptions of professionals and relatives of patients who have recently died and assessing the degree of compliance with the rights established in the current legislation on this subject. METHODS: Qualitative research with a hermeneutical phenomenological approach carried out in 2019 by conducting and analyzing two discussion groups with health professionals from hospital and primary care, and four groups with relatives of recently deceased patients, divided by age ranges: 18- 30 years old, 31-45, 46-60 and over 60. RESULTS: The total number of people included in the study was 28 participants. Family members and professionals find it difficult to communicate with each other in the context of health care at the end of life. Family members and professionals agree on their preference to die at home. There are specific deficiencies in knowledge about the terminology used at the end of life. The term "euthanasia" is the one best known by family members. CONCLUSIONS: Deficiencies in knowledge of the rights established in the regulations related to the death process have been detected, both in relatives of patients and in professionals. These deficiencies contribute to breaches of legal regulations. Communication difficulties related to death between the professionals-patient-family trinomial are the most relevant related factor.

OBJETIVO: El alcance y los tipos de intervenciones sanitarias en el proceso de la muerte están siendo motivo de un debate social y profesional que se ha acrecentado en los últimos años. El objetivo del estudio se centró en analizar las percepciones de profesionales y familiares de pacientes que han fallecido recientemente y evaluar el grado de cumplimiento de los derechos establecidos en la legislación vigente a este respecto. METODOS: Investigación cualitativa de enfoque fenomenológico hermenéutico llevada a cabo en 2019 mediante la realización y análisis de dos grupos de discusión con profesionales de salud de atención hospitalaria y atención primaria, y cuatro grupos con familiares de pacientes fallecidos recientemente, divididos por rangos de edad: 18-30 años, 31-45, 46-60 y más de 60. RESULTADOS: El total de personas incluidas en el estudio fue de 28 participantes. Familiares y profesionales encuentran dificultades para comunicarse entre sí en el contexto de la atención sanitaria al final de la vida. Familiares y profesionales coinciden en su preferencia de fallecer en su domicilio. Existen carencias puntuales en el conocimiento sobre la terminología empleada en el final de la vida. El término "eutanasia" es el más conocido por los familiares. CONCLUSIONES: Se han detectado carencias en el conocimiento de los derechos establecidos en la normativa relativa al proceso de la muerte, tanto en familiares de pacientes como en profesionales. Estas carencias contribuyen a incumplimientos de la normativa legal. Las dificultades comunicativas relacionadas con la muerte entre el trinomio profesionales-pacientes-familiares son el factor relacionado más relevante.

Building capacity for health promotion by addressing nurses' role confusion: Study protocol of a pilot clustered randomised controlled trial.

AIM: To describe the protocol for the pilot phase of a complex intervention, designed to address primary care nurses' role confusion in health promotion. DESIGN: A pilot clustered randomized controlled trial, with control and intervention groups. METHODS: The study will be conducted in a primary care setting. Participants will be nurses from the primary care health service working in a primary care team (PCT, 15 control group; 15 intervention group). Nurses in the experimental group will receive the ROLE-AP programme over a 3-week period. The control group will continue with the normal routine. The pilot will help determine the intervention's feasibility, acceptability, fidelity and quality of the programme components. Data collected preintervention, postintervention and 3 months after intervention will provide estimates of the intervention's preliminary effects on the main variable, nurses' degree of agreement concerning their expected role in health promotion. The study received funding from the local government in December 2019. DISCUSSION: Role confusion is promoting primary care nurses' omissions in their health-promoting practice, which is far from the ideal portrayed by the Ottawa Charter. Interventions are needed that reveal the most appropriate mechanisms for addressing role confusion, which requires reaching an intraprofessional agreement about the expectations for role activities. Healthcare organisations could benefit from the incorporation of a programme of these characteristics into standard practice. IMPACT: This study will produce a novel and comprehensive complex intervention that is expected to build nurses' capacity in primary healthcare organizations for health promotion, which is key to increasing the quality, efficiency and sustainability of the National Health System. The programme evaluation and feasibility study will reveal how to better use existing resources in a full-scale clinical trial. TRIAL REGISTRATION: ClinicalTrials.gov (ID: NCT04726696).

Six-month breastfeeding maintenance after a self-efficacy promoting programme: an exploratory trial.

BACKGROUND: Breastfeeding care plays a fundamental role in establishing breastfeeding and longer duration after discharge. Practices though vary among professionals involved and are often inconsistent with good practices recommended, being a threat to women's breastfeeding self-efficacy. Breastfeeding self-efficacy is considered a predictor for successful breastfeeding and a significant variable amenable to intervention for promoting lactation AIM: To evaluate the efficacy, feasibility and acceptability of a new breastfeeding self-efficacy promoting programme (SIALAC) on 6-month breastfeeding maintenance. METHODS: In this exploratory multi-centre controlled trial, participants were allocated into control and intervention groups sequentially. Professionals in charge of the treatment groups were trained in between, with an especial focus on reducing practice variability. Control and intervention group women received usual care, and the intervention group received in addition SIALAC, a three-stage breastfeeding self-efficacy promoting programme. Primary outcome was breastfeeding maintenance up to 6 months analysed by Kaplan-Meier and Cox proportional hazard regression analysis. Student's t-test or chi-square tests were also used for continuous and categorical variables. Data on breastfeeding status and breastfeeding self-efficacy were collected at baseline, and 4, 8 and 24 weeks after birth. RESULTS: From May 2014 through November 2015, participants were enrolled. The sample consisted of 112 women. No relevant socio-demographic or obstetric difference was found between groups. The intervention achieved a significant difference between groups in breastfeeding survival (X2  = 4.94, p = 0.026). Six-month breastfeeding maintenance was significantly higher in the intervention group (67% vs. 55%; X2  = 5.384, p = 0.020). Breastfeeding dropout in the control group was 3.3 (CI 1.1, 10.1) times higher than that of the intervention group at 6 months. Breastfeeding self-efficacy scores were higher in the intervention group although without significant statistical difference. The programme showed good acceptability. CONCLUSION: Breastfeeding self-efficacy promoting programme SIALAC was beneficial in fostering 6-month breastfeeding survival. Full-scale trial should consider feasibility-related issues identified.

Design, implementation and evaluation of an education course to promote professional self-efficacy for breastfeeding care.

The objective of this study was to determine the effect of an education short course on professional' self-efficacy in the area of breastfeeding care. The intervention had a pre-post design. A total of 43 healthcare professionals attended the course. The Kirkpatrick model for the development, implementation and evaluation of education actions was used for a 4.5-h course. The aspects evaluated included professionals' satisfaction and learning regarding confidence to support lactating mothers, perceived transfer of knowledge to the workplace and organizational changes. Data were collected using self-administered questionnaires (participants, unit managers, and education planners), before and after the intervention. Participants' satisfaction with the education action was high in all of the aspects measured (greater than 3.9 in scores of 0-5). Professionals showed a significant increase in self-efficacy levels for supporting breastfeeding (Wilcoxon test p-value = < 0.05, before intervention: median = 55, [IQR] = 11; after intervention: median = 60, [IQR] = 14). Participants, managers and organizers of the course identified changes in the way that professionals cared for breastfeeding mothers. In conclusion, this educational intervention enhanced professional self-efficacy and performance in breastfeeding care.

"Missed nursing care" in health promotion: Raising awareness.

AIM(S): This commentary aims to raise awareness of the possible causes of "missed nursing care" in health promotion and to propose possible solutions. BACKGROUND: Although health promotion is an essential function of nursing practice, "missed nursing care" has been scarcely studied in this area. It is crucial to know both its causes and possible strategies to prevent it. EVALUATION: We used evidence to identify possible causes of "missed nursing care" in health promotion, and we classified them into categories. We suggested the concept of capacity building to address its underlying causes. KEY ISSUE(S): Four main factors are involved in "missed nursing care" in health promotion, that is intrapersonal, interpersonal, organisational and cultural. Capacity building, including the development of knowledge, skills, commitment, structures, systems and leadership, could reduce missed care. CONCLUSION(S): "Missed nursing care" in health promotion is complex and is multifactorial in its origins. Capacity building could be a way to address its causes. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing care in health promotion is paramount and a long-term investment that can contribute to the sustainability of the health system. Organisations and managers could view capacity building processes as a tool to prevent "missed nursing care" in health promotion.

Diseño y validez de un instrumento para evaluar la autoeficacia percibida por los profesionales de la salud acerca de su capacidad para procurar cuidados a las madres que amamantan / Design and validity of an instrument to evaluate health professionals' perceived self-efficacy to care for nursing mothers

La promoción y apoyo a la lactancia materna proporcionado por profesionales de la salud en diferentes entornos es una de las estrategias con evidencia de resultados exitosos. El propósito de este estudio es desarrollar una escala para conocer la autoeficacia percibida por los profesionales de salud acerca de su capacidad para procurar cuidados a las madres que amamantan. METODOLOGÍA. El diseño de la escala se hizo utilizando la versión española de la escala BreastfeedingSelf-EfficacyScale-Short Form para madres. Las pruebas de validación se realizaron creando un grupo de expertos y pilotando la herramienta con profesionales que cuidaban a madres lactantes de dos centros asistenciales. Las propiedades psicométricas de la escala se examinaron analizando su validez, fiabilidad, sensibilidad y factibilidad. RESULTADOS. La escala "Autoeficacia Profesional para los Cuidados en Lactancia" (APCLA)contiene 14 ítems conforme al dominio de interés, con opciones de respuesta de 1 a 5. Se elaboró en formato papel y electrónico. Tras la valoración del comité de expertos, se pilotó con 43 enfermeras y matronas. La escala muestra resultados prometedores con respecto a su validez, fiabilidad (Alpha de Cronbach 0,967), sensibilidad (p<0,05) y factibilidad. CONCLUSIÓN. Aunque será necesario continuar con el proceso de validación en otras poblaciones y con mayor número de participantes, el instrumento ha mostrado buenos resultados para la medición de la autoeficacia profesional. La valoración de la autoeficacia profesional para proporcionar cuidados a madres que amamantan ayudará a identificar áreas de formación para profesionales que permitan la reducción de la variabilidad de los cuidados.

The promotion and support of breastfeeding by health professionals in different settings is an interventional strategy with evidence of successful results. The purpose of this study is to develop a scale to understand the self-efficacy perceived by health professionals about their ability to care for breastfeeding mothers. METHODOLOGY. The design of the scale was made using the Spanish version of the 'Breastfeeding Self-Efficacy Scale-Short Form' scale for mothers. The validation tests were done by creating a group of experts and piloting the tool with professionals caring for nursing mothers from two centres. The psychometric properties of the scale were examined by analysing their validity, reliability, sensitivity and feasibility. RESULTS. The scale "Professional Self-Efficacy for Breastfeeding Care" (Autoeficacia Profesional para los Cuidados en Lactancia, APCLA) contains 14 items according to the domain of interest, with response options from 1 to 5. It was elaborated in paper and electronic format. After the assessment of the committee of experts, it was piloted with 43 nurses and midwives. The scale shows promising results with respect to its validity, reliability (Cronbach's Alpha 0.967) sensitivity (p <0.05) and feasibility. CONCLUSION. Although it will be necessary to continue the validation process in other populations and larger numbers of participants, the instrument has shown good results for the measurement of professionals' self-efficacy. Assessing professional perceived self-efficacy to care for breastfeeding mothers will help identify areas of training for professionals and reduce variability in care provision.