Research on missed nursing care during the COVID-19 pandemic: A scoping review.

BACKGROUND: Missed nursing care is defined as care that is delayed, partially completed, or not completed at all. The scenario created by the COVID-19 pandemic may have influenced multifactorial determinants related to the care environment, nursing processes, internal processes, and decision-making processes, increasing missed nursing care. AIM: This scoping review aimed to establish the quantity and type of research undertaken on missed nursing care during the COVID-19 pandemic. METHODS: This review was conducted following the Joanna Briggs Institute methodology for scoping reviews. We searched CINAHL, MEDLINE, Scopus, two national and regional databases, two dissertations and theses databases, a gray literature database, two study registers, and a search engine from November 1, 2019, to March 23, 2023. We included quantitative, qualitative, and mixed studies carried out in all healthcare settings that examined missed nursing care during the COVID-19 pandemic. Language restrictions were not applied. Two independent reviewers conducted study selection and data extraction. Disagreements between the reviewers were resolved through discussion or with an additional reviewer. RESULTS: We included 25 studies with different designs, the most common being acute care cross-sectional survey designs. Studies focused on determining the frequency and reasons for missed nursing care and its influence on nurses and organizational outcomes. LINKING EVIDENCE TO ACTION: Missed nursing care studies during the COVID-19 pandemic were essentially nurses-based prevalence surveys. There is an urgent need to advance the design and development of longitudinal and intervention studies, as well as to broaden the focus of research beyond acute care. Further research is needed to determine the impact of missed nursing care on nursing-sensitive outcomes and from the patient's perspective.

Actividad y características 2 de los pacientes con úlceras de la extremidad inferior en una consulta de heridas en 2019 / Activity and characteristics of patients with ulcers of the lower extremity in a wound consultation in 2019

Objetivos: Describir la actividad y características de los pacientes de Santa Coloma de Gramenet con úlceras de la extremidad inferior visitados durante 2019 en la consulta de heridas crónicas de la Fundación Hospital Espèrit Sant. Metodología: Se presenta un estudio retrospectivo descriptivo de los pacientes de Santa Coloma con úlceras de la extremidad inferior, que acudieron a la consulta de heridas crónicas. Resultados: Se atendieron a 100 pacientes, con un total de 724 visitas. Edad media 74,1 ± 13,2 años, el 39% mujeres. La etiología de las úlceras de la extremidad inferior se presentaba en las siguientes proporciones: diabéticas isquémicas un 36%, úlceras venosas un 28%, lesiones arteriales un 22%, pie diabético y lesiones por calcifilaxis un 6%, úlceras de Martorell un 4% y lesiones neoplásicas un 1%. La mayoría de los pacientes presentó pluripatologías, con un promedio de 4 patologías y factores de riesgo. El 82% de las visitas fueron visitas sucesivas, con un promedio de 7,24 visitas por paciente. Las lesiones que requirieron mayor número de visitas fueron las lesiones diabéticas isquémicas, con un 9,1 de promedio. El 53% de las primeras visitas procedía del servicio de urgencias. El 61% de los pacientes acudió a la consulta movilizado en silla de ruedas y el 40% se había trasladado en ambulancia. Conclusiones: El trabajo ha ayudado a reafirmar las cargas de trabajo y ha evidenciado una falta de registros útiles que ayuden tanto a nivel asistencial como para posibles futuras investigaciones (AU)

Objectives: Description of the activity and characteristics of the patients coming from Santa Coloma de Gramenet with ulcers of the lower extremity, visited during 2019 in the Chronic Wounds Clinic of the Hospital Espèrit Sant Foundation. Methodology: A descriptive retrospective study of patients from Santa Coloma with Ulcers of the lower extremity (UEI), who attended the clinic of chronic wounds. Results: 100 patients were treated, with a total of 724 visits. Average age of 74.1 ± 13.2 years, 39% women. The etiology of UEI was presented in the following proportions: diabetic-ischemic 36%, venous ulcers 28%, arterial lesions 22%, diabetic foot and calciphylaxis lesions 6%, Martorell ulcers 4% and neoplastic lesions 1%. Most of the patients presented pluri-pathologies with the average of 4 pathologies and risk factors. 82% of the visits were successive visits with an overall average of 7.24 visits per patient. The lesions that required the highest number of visits were diabeticischemic lesions with an average of 9.1. 53% of the first visits came from the emergency department. 61% of the patients came to the clinic mobilized in a wheelchair and 40% had been transferred by ambulance. Conclusions: The work supported to reaffirm the workloads and has evidenced a lack of useful records that help both at the level of care and for possible future research (AU)

Patient-Reported Outcome Measures of Quality of Life in People Affected by Diabetic Foot: A Psychometric Systematic Review.

OBJECTIVES: This psychometric systematic review aimed to identify the most suitable patient-reported outcome measures (PROMs) of quality of life (QoL) in people affected by diabetic foot. METHODS: We performed a literature search in MEDLINE (PubMed), CINAHL (EBSCOhost), and PsycINFO (EBSCOhost) databases from inception to February 1, 2022. We also searched gray literature databases. Eligible studies were full-text reports developing a QoL condition-specific PROM or assessing one or more of its measurement properties in people affected by diabetic foot. We assessed the methodological quality of included studies independently using the "Consensus-Based Standards for the Selection of Health Measurement Instruments Risk of Bias" checklist. The measurement properties were evaluated using specific criteria. We graded the quality of the evidence using a "Grading of Recommendations Assessment, Development and Evaluation" approach modified by Consensus-Based Standards for the Selection of Health Measurement Instruments. RESULTS: Forty-three reports (46 studies) providing information on the measurement properties of 10 different PROMs were included. We did not identify any instruments that could be recommended for use. We identified 2 PROMs that were not recommended for use and 8 that were potentially recommended but would require further investigation. Of these 8 PROMs, 4 had better evidence for content validity. CONCLUSIONS: Available PROMs to measure QoL in people affected by diabetic foot have limited evidence for their measurement properties. There is no fully suitable PROM. Pending further evidence, 4 PROMs could potentially be recommended for use.

Prevalence and characteristics of older people with pressure ulcers and legs ulcers, in nursing homes in Barcelona.

BACKGROUND: Nursing home residents are vulnerable to chronic wounds. However, the prevalence data are scarce. AIM: The purpose of this study was to determine the prevalence of pressure ulcers and/or leg ulcers in nursing home residents, and describe the characteristics of the nursing homes, the residents and the wounds, as well as possible associations between these characteristics. METHODS: This was a cross-sectional survey of nursing home residents over the age of 65 in 168 facilities in Barcelona. Those presenting category II-IV pressure ulcers and/or leg ulcers were included. The data were collected by observation/examination. Descriptive, bivariate, and multivariate analyses were performed. RESULTS: The overall prevalence of pressure ulcers and leg ulcers combined was 4.4% (3.5% were pressure ulcers and 0.9% were leg ulcers). In small nursing homes with less nursing staff, the overall prevalence was greater than in large nursing homes (5.6% vs 3.8% [p = 0.01]). As expected, residents with pressure ulcers had higher pressure ulcer risk, worse dependence and cognitive status, urinary and faecal incontinence, and most were underweight. However, residents with leg ulcers had worse venous and arterial impairment and also were overweight. A multivariate analysis showed that pressure ulcers were statistically significantly associated with faecal incontinence (OR = 0.28, 95% CI = 0.09-0.81) and dyslipidaemia (OR = 0.21, 95% CI = 0.06-0.66), and leg ulcers were statistically significantly associated with venous insufficiency (OR = 4.93, 95% CI = 1.65-15.34). The characteristics of gluteal and ischial pressure ulcers, a high prevalence of infection, and a low reference to biofilm by nurses, in both types of wounds, suggest that these aspects are not adequately taken into account. CONCLUSIONS: Pressure ulcers and leg ulcers, mainly pressure ulcers, remain a public health problem in nursing homes. Further studies are required to confirm the associations found in this study.

Effectiveness of Integrative Laughter Therapy to Reduce Anxiety, Improve Self-Esteem and Increase Happiness: A Naturalistic Study at a Day Hospital for Addictive Disorders.

Little is known about the effectiveness of laughter therapy as an adjunctive treatment for patients with addictive disorders. This study aims to evaluate the benefits of integrative laughter therapy (ILT) on levels of self-esteem, anxiety, and happiness in patients treated for addiction at a day hospital (DH). A prospective, naturalistic study with a pre-post design was conducted. All 185 participants received the standard, multicomponent treatment at the DH (treatment as usual; TAU). The participants were also invited to attend weekly ILT sessions. Upon completion of the 2-month DH treatment program, patients were classified according to their attendance at the ILT sessions: patients who attended ≥80% constituted the experimental group (TAU + ILT group) while those who attended <80% were considered controls. Although both groups achieved statistically significant increases in self-esteem and happiness with a decrease in trait anxiety, the improvement on these variables was significantly greater in the TAU + ILT group. Subject to the limitations inherent to quasi-experimental research, the findings of the present study suggest that the addition of an ILT module to the standard treatment in a DH for addictive disorders may yield greater improvement in self-esteem, anxiety, and happiness compared to TAU.

Self-Care Practices of Primary Health Care Patients Diagnosed with Chronic Heart Failure: A Cross-Sectional Survey.

Chronic heart failure patients require self-care behaviors and active monitoring of signs and symptoms to prevent worsening. Most patients with this condition are attended in primary healthcare centers. This study aimed to evaluate the endorsement of and adherence to self-care behaviors in primary health care patients with chronic heart failure. We conducted a multicenter cross-sectional study. We randomly included chronic heart failure patients from 10 primary healthcare centers in the Barcelona metropolitan area (Spain). Patients completed the European Heart Failure Self-Care Behaviour Scale, a health literacy questionnaire. Differences between groups were studied using ANOVA tests. We included 318 patients with a mean age of 77.9 years, mild limitations in functional activity New York Heart Association scale (NYHA) II = 51.25%), and a low health literacy index of 79.6%. The endorsement of self-care behaviors was low in daily weighing (10.66%), contacting clinicians if the body weight increased (22.57%), and doing physical exercise regularly (35.58%). Patients with lower educational levels and a worse health literacy had a lower endorsement. The screening of individual self-care practices in heart failure patients might improve the clinician follow-up. We suggest that primary healthcare clinicians should routinely screen self-care behaviors to identify patients requiring a closer follow-up and to design and adapt rehabilitation programs to improve self-care.

Incidencia y características de las caídas en un hospital de cuidados intermedios de Barcelona / Incidence and characteristics falls in a hospital intermediate care of Barcelona

Objetivo: Determinar la incidencia y las características de las caídas en los ancianos ingresados en el Hospital de Cuidados Intermedios Parc Sanitari Pere Virgili (PSPV). Metodología: Estudio descriptivo, observacional y retrospectivo. Sujetos de estudio: Pacientes mayores de 65 años ingresados en el PSPV que han sufrido alguna caída en el primer trimestre del año 2014. Recogida de datos a través de un registro de caídas del centro. Resultados y discusión: El 6,3% de los ancianos ingresados han sufrido una caída, 99 en total. No hay diferencias significativas según el sexo, excepto en mayores de 75 años que es mayor en las mujeres. Mayor incidencia en los mayores de 75 años; en el turno de mañana y de tarde, y en ancianos con patologías cardiovasculares. En el momento previo a la caída, mayoritariamente estaban en bipedestación, con desorientación y sin acompañamiento. El 75% de los que se cayeron tomaban tres o más medicamentos de riesgo. Sin lesión en más del 60% de las caídas. Conclusiones: El perfil de anciano frágil ingresado en el PSPV podría justificar la mayor incidencia de caídas frente a otros estudios a nivel hospitalario. Las consecuencias son menores y no ha habido lesión en la mayoría de ellas. Las intervenciones de enfermería en el HSPV se orientarán hacia un refuerzo de la prevención de caídas en los pacientes con patología cardiovascular y a los pacientes polimedicados y durante el turno de mañana y tarde y en aquellos momentos en que no se dispone de soporte del familiar/cuidador

Objective: To determine the incidence and characteristics of falls in the elderly admitted to the Intermediate Care Hospital Parc Sanitari Pere Virgili (PSPV). Methodology: descriptive and retrospective study. Study subjects: Patients over 65 years PSPV admitted to have been dropped in the first quarter of 2014. Data collection through a record of Middle Falls. Results and discussion: 6.3% of hospitalized elderly have been dropped, 99 in total. No significant differences by gender, except in over 75 years is higher in women. Higher incidence of over 75 years; in the morning shift and afternoon; and the elderly with cardiovascular diseases. In the run up to the fall time they were mostly in standing, with disorientation and without accompaniment. 75% of those who fell were taking 3 or more medications risk. No injury almost 60% of falls. Conclusions: the profile of frail elderly entered PSPV could justify the higher incidence of falls compared to other studies in hospitals. The consequences are lower, there being injury most of them. Nursing interventions in HSPV be geared towards strengthening the prevention of falls in patients with cardiovascular disease and patients with polypharmacy and during the morning shift and afternoon and in those times when you do not have the family / caregiver support

Evaluación de la calidad de las guías de práctica clínica españolas sobre úlceras por presión / Quality assessment of the spanish clinical practice guidelines of pressure ulcers

Las guías de práctica clínica (GPC) españolas sobre úlceras por presión (UPP) han proliferado en los últimos tiempos, dudándose de su calidad y rigor científico. Sin embargo, se consideran una herramienta de trabajo donde se basa la toma de decisiones en la práctica asistencial. Método: análisis de la calidad de las GPC españolas sobre UPP a través del instrumento AGREE. Resultados y conclusiones: la calidad media de las GPC es baja. Las áreas de peor calificación son las del rigor, la participación y la aplicabilidad. Solo hay dos áreas en las que más del 50% de las GPC consiguen la excelencia: el alcance y objetivos y la claridad. Hay una GPC que destaca sobre las demás (AU)

The spanish clinical practice guidelines (CPG) on pressure ulcers has proliferated in recent times but the quality and scientific rigor is doubted. However, it is considered as a working tool for decision making in clinical practice. Method: quality appraisal of the Spanish CPG on pressure ulcers through the AGREE instrument. Results and conclusions: the average quality of the CPG is low. The worst areas are the rigor, the participation and the applicability. There are only two areas in which more than 50% of the CPG achieve excellence: the scope and objectives and clarity. There is one CPG that stands out over the others (AU)

Iniciativa deformación virtualentre la empresa y la universidad: academia global de heridas / Virtual training initiative between the private business and the university: global wound academy

En este artículo se presenta una iniciativa deformación entre el Área de Enfermería Geriátrica, del Departamento de Enfermería de la Universidad de Cantabria y la empresa Smith-Nephew, consistente en un Máster sobre Heridas Crónicas, diseñado de modo virtual, que viene realizándose desde hace cuatro años. Se imparte, por Internet, a través del Aula Virtual de la Universidadde Cantabria, dentro del Centro de Formación de Nuevas Tecnologías(CeFoNT). En este momento se encuentra en transformación y se ha plasmado en un acuerdo interuniversitario entre la Universidad de Cantabria y la Universidad Complutensede Madrid, estando sometido a estudio por ambas instituciones a fin de convertirlo en un programa oficial de postgrado,debiendo valorarse la necesidad de adecuación de la formación de los profesionales sanitarios, así como garantizar que la formación que se ofrezca tenga la calidad y cualificación necesarias (AU)

This article described a training initiative in the area of Geriatric Nursing, between the Department of Nursing of the Universidad de Cantabria and the Smith-Nephew corporation, consisting of a virtual post-graduate course on chronic wounds offered for the last four years. The course is an Internet based course through the virtual classroom of the University of Cantabria, within the Centre for Training of New Technologies.(CeFoNT). At this time, this initiative is undergoing changes and being reviewed inthe framework of an interuniversity agreement between the Universidad de Cantabria and the Universidad Complutense de Madrid, in order to make it an accredited official postgraduate course. Aspects to be assessed include the need to adequate thetraining of healthcare professionals and to ensure that the training offered metes quality criteria and the required qualification (AU)

Úlceras por presión en los talones. Estudio comparativo entre el vendaje protector de talones y un apósito hidrocelular con forma especial para los talones / Pressure sores on heels. Comparative study between a protective heel bandage and a hydrocellular dressing having a special form for heels

Introducción. Los talones, junto a la zona sacra, son una de las localizaciones más frecuentes de Úlceras por Presión (UPP) en España. Cualquier medida de prevención de UPP en talones tendría que ir orientada hacia dos grandes objetivos: el alivio efectivo de presión y su compatibilidad con el cuidado local y la inspección de la piel para la detección precoz de lesiones al menos una vez al día. Pacientes, material y métodos. Se planteó un estudio comparativo multicéntrico, abierto, etiquetado y controlado en el que los pacientes fueron asignados a dos grupos de intervención: uno con las medidas habituales de prevención de UPP y vendaje de protección en los talones, y otro con las mismas medidas utilizando un apósito hidrocelular especial para la protección de talones (Allevyn Heel®). Los pacientes fueron incluidos en el estudio durante un período de ocho semanas. La variable de respuesta para determinar la efectividad de las medidas de prevención en estudio fue la aparición de UPP. Resultados. Inicialmente se incluyeron 130 pacientes en el estudio, 65 en cada uno de los grupos de tratamiento. En el grupo de vendaje culminaron el estudio 50 pacientes, mientras que en el grupo apósito fueron 61. La incidencia de UPP en los talones en el grupo de vendaje protector fue de un 44 por ciento (22 sobre 50) mientras que en el grupo de apósito alcanzó el 3,3 por ciento (2 sobre 61 pacientes) con un valor de ji cuadrado de p < 0,001. La estimación de riesgo para desarrollar UPP en relación nos aportó unos valores de riesgo relativo de 13,42 (IC 95 por ciento: 3,31-54,3) en el grupo de vendaje protector frente al grupo de apósito. Discusión. Los resultados del estudio nos permiten dar como buena la hipótesis alternativa de que existen diferencias estadísticamente significativas entre ambos grupos de intervención a favor del grupo Allevyn Heel® frente al grupo que utilizaba el vendaje protector para prevenir UPP. La utilización de este apósito, aunque a priori es más cara que el vendaje protector (en cuanto a coste unitario de material) ha demostrado ser más efectiva en prevención de UPP, y más barata que el vendaje protector, si tenemos en cuenta la combinación de las variables tiempo de utilización, de aplicación y retirada (AU)