COVID-19 pandemic in long-term care: An international perspective for policy considerations.

This paper identifies key factors rooted in the systemic failings of the long-term care sector amongst four high income countries during the COVID-19 pandemic. The goal is to offer practice and policy solutions to prevent future tragedies. Based on data from Australia, Canada, Spain and the United States, the findings support evidence-based recommendations at macro, meso and micro levels of practice and policy intervention. Key macro recommendations include improving funding, transparency, accountability and health system integration; and promoting not-for-profit and government-run long-term care facilities. The meso recommendation involves moving from warehouses to "green houses." The micro recommendations emphasize mandating recommended staffing levels and skill mix; providing infection prevention and control training; establishing well-being and mental health supports for residents and staff; building evidence-based practice cultures; ensuring ongoing education for staff and nursing students; and fully integrating care partners, such as families or friends, into the healthcare team. Enacting these recommendations will improve residents' safety and quality of life, families' peace of mind, and staff retention and work satisfaction.

Effects of nursing interventions to improve inpatients' sleep in intensive and non-intensive care units: Findings from an umbrella review.

AIM: This review aimed to synthesise the available reviews on the effects of nursing interventions on sleep quality among patients hospitalised in intensive care and non-intensive care units. BACKGROUND: Poor sleep quality is a common fact in hospitalised patients. Nurses can contribute to the improvement of patients' sleep quality and duration. DESIGN: A review of intervention reviews was carried out and reported following the PRISMA guidelines and checklist. METHODS: We systematically searched for reviews published from January 2009 to December 2019 in PubMed, CINAHL Plus, Scopus, Institute for Scientific Information Web of Science, Joanna Briggs Database of Systematic Reviews and Cochrane Central Register of Controlled Trials databases. Searches were repeated at 24 November 2020 to include the most recent evidence. A narrative synthesis of the results was conducted. RESULTS: Nine reviews (representing 109 original papers) met the selection criteria and were included for critical appraisal. Overall, nursing interventions and sleep quality were poorly defined. We grouped the interventions into 3 categories (environmental, barrier and internal interventions) to provide a more comprehensive overview and examine effects of nursing interventions on inpatients sleep quality. Inconsistent results were obtained and low quality of the original articles was reported, making it difficult to establish absolute conclusions. CONCLUSION: The impact of environmental changes on patients' sleep was positive but inconclusive, while use of earplugs and eye masks, music and acupuncture generally showed positive results with moderate quality of evidence, and no harmful effects were reported.

Sleep quality among inpatients of Spanish public hospitals.

Sleep is a complex process and is needed both in health and illness. Deprivation of sleep is known to have multiple negative physiological effects on people's bodies and minds. Despite the awareness of these harmful effects, previous studies have shown that sleep is poor among hospitalised patients. We utilized an observational design with 343 patients recruited from medical and surgical units in 12 hospitals located in nine Spanish regions. Sociodemographic and clinical characteristics of patients were collected. Sleep quality at admission and during hospitalisation was measured by the Pittsburgh Sleep Quality Index. Sleep quantity was self-reported by patients in hours and minutes. Mean PSQI score before and during hospitalisation were respectively 8.62 ± 4.49 and 11.31 ± 4.04. Also, inpatients slept about an hour less during their hospital stay. Lower educational level, sedative medication intake, and multi-morbidity was shown to be associated with poorer sleep quality during hospitalisation. A higher level of habitual physical activity has shown to correlate positively with sleep quality in hospital. Our study showed poor sleep quality and quantity of inpatients and a drastic deterioration of sleep in hospital versus at home. These results may be helpful in drawing attention to patients' sleep in hospitals and encouraging interventions to improve sleep.

Percepciones y vivencias de escolares de 7 a 8 años del País Vasco durante la alerta sanitaria COVID-19 / Perceptions and experiences of 7-8 year old schoolchildren in the Basque Country during the COVID-19 health alert

Objetivo: Explorar las experiencias y las vivencias de escolares de 7-8 años en una situación excepcional de alerta sanitaria en la que se han aplicado a la población estrictas medidas de confinamiento. Método: Estudio cualitativo exploratorio a través del análisis de ilustraciones realizadas por 71 escolares de 7-8 años de edad. El análisis se llevó a cabo según el marco teórico de Rose. Se realizó análisis descriptivo de los datos sociodemográficos. Resultados: Del análisis del contenido emergieron cinco categorías: 1) sentimientos de tristeza y miedo; 2) importancia del núcleo familiar, seguridad y protección; 3) hábitos de vida sedentarios durante el confinamiento; 4) infraestructuras de las viviendas y desigualdades sociales (la vida tras una ventana); y 5) respuesta social, lucha colectiva y de los/las profesionales de la salud. Conclusiones: La situación de pandemia de COVID-19 y las medidas estrictas de confinamiento han tenido un importante impacto en la población escolar, que es la que ha vivido las mayores restricciones. La infraestructura del hogar se ha mostrado como un claro diferenciador que ahonda en las desigualdades sociales y el impacto que la situación tiene en los/las escolares. Es necesario ampliar los estudios acerca del impacto psicosocial que esta situación va a tener a largo plazo en su salud física y mental. (AU)

Objective: To explore the experiences of schoolchildren in an exceptional health alert situation in which strict confinement measures have been applied to the population. Method: Qualitative exploratory study through the analysis of illustrations carried out by schoolchildren aged 7 to 8. The analysis was carried out according to Rose's theoretical framework. Descriptive analysis of socio-demographic data was performed. Results: Five categories emerged from the analysis of the content: 1) feelings of sadness and fear; 2) importance of the family nucleus, safety and protection; 3) sedentary living habits during confinement; 4) housing infrastructure and social inequalities (life through a window); and 5) social response, collective struggle and through health professionals. Conclusions: The COVID-19 pandemic situation and the strict confinement measures have had a significant impact on the school population, who had experienced the greatest restrictions. Household infrastructure has been shown to be a clear differentiator that deepens social inequalities and the impact that the situation has on school children. More studies are needed on the long-term psychosocial impact of this situation on their physical and mental health.

[Perceptions and experiences of 7-8 year old schoolchildren in the Basque Country during the COVID-19 health alert]. / Percepciones y vivencias de escolares de 7 a 8 años del País Vasco durante la alerta sanitaria COVID-19.

OBJECTIVE: To explore the experiences of schoolchildren in an exceptional health alert situation in which strict confinement measures have been applied to the population. METHOD: Qualitative exploratory study through the analysis of illustrations carried out by schoolchildren aged 7 to 8. The analysis was carried out according to Rose's theoretical framework. Descriptive analysis of socio-demographic data was performed. RESULTS: Five categories emerged from the analysis of the content: 1) feelings of sadness and fear; 2) importance of the family nucleus, safety and protection; 3) sedentary living habits during confinement; 4) housing infrastructure and social inequalities (life through a window); and 5) social response, collective struggle and through health professionals. CONCLUSIONS: The COVID-19 pandemic situation and the strict confinement measures have had a significant impact on the school population, who had experienced the greatest restrictions. Household infrastructure has been shown to be a clear differentiator that deepens social inequalities and the impact that the situation has on school children. More studies are needed on the long-term psychosocial impact of this situation on their physical and mental health.

Cost-Effectiveness of an Exercise Programme That Provided Group or Individual Training to Reduce the Fall Risk in Healthy Community-Dwelling People Aged 65-80: A Secondary Data Analysis.

Research has demonstrated that some exercise programs are effective for reducing fall rates in community-dwelling older people; however, the literature is limited in providing clear recommendations of individual or group training as a result of economic evaluation. The objective of this study was to assess the cost-effectiveness of the Otago Exercise Program (OEP) for reducing the fall risk in healthy, non-institutionalized older people. An economic evaluation of a multicenter, blinded, randomized, non-inferiority clinical trial was performed on 498 patients aged over 65 in primary care. Participants were randomly allocated to the treatment or control arms, and group or individual training. The program was delivered in primary healthcare settings and comprised five initial sessions, ongoing encouragement and support to exercise at home, and a reinforcement session after six months. Our hypothesis was that the patients who received the intervention would achieve better health outcomes and therefore need lower healthcare resources during the follow-up, thus, lower healthcare costs. The primary outcome was the incremental cost-effectiveness ratio, which used the timed up and go test results as an effective measure for preventing falls. The secondary outcomes included differently validated tools that assessed the fall risk. The cost per patient was USD 51.28 lower for the group than the individual sessions in the control group, and the fall risk was 10% lower when exercises had a group delivery. The OEP program delivered in a group manner was superior to the individual method. We observed slight differences in the incremental cost estimations when using different tools to assess the risk of fall, but all of them indicated the dominance of the intervention group. The OEP group sessions were more cost-effective than the individual sessions, and the fall risk was 10% lower.

Population Health and Health Services: Old Challenges and New Realities in the COVID-19 Era.

(1) Background: Health services that were already under pressure before the COVID-19 pandemic to maximize its impact on population health, have not only the imperative to remain resilient and sustainable and be prepared for future waves of the virus, but to take advantage of the learnings from the pandemic to re-configure and support the greatest possible improvements. (2) Methods: A review of articles published by the Special Issue on Population Health and Health Services to identify main drivers for improving the contribution of health services on population health is conducted. (3) Health services have to focus not just on providing the best care to health problems but to improve its focus on health promotion and disease prevention. (4) Conclusions: Implementing innovative but complex solutions to address the problems can hardly be achieved without a multilevel and multisectoral deliberative debate. The CHRODIS PLUS policy dialog method can help standardize policy-making procedures and improve network governance, offering a proven method to strengthen the impact of health services on population health, which in the post-COVID era is more necessary than ever.

The efficacy of nursing interventions on sleep quality in hospitalized patients: A systematic review of randomized controlled trials.

OBJECTIVE: To determine the effect of interventions that could be performed by nurses to improve the sleep quality of hospitalized patients in acute and semi-acute units. DESIGN: A systematic review of randomized controlled trials and narrative synthesis. DATA SOURCES: Seven electronic databases (PubMed, CINAHL Plus, Scopus, ISI WoS, CENTRAL, PsycInfo, and Embase) were accessed on 20 May 2019 with a temporal limit of 10 years prior. REVIEW METHODS: Original research studies of interventions that could be delivered by nurses to improve sleep quality during hospitalization in acute and semi-acute units were included. Study selection, data extraction, and risk of bias assessment were performed by two independent reviewers. RESULTS: Seventeen studies met the inclusion criteria and were included in this review. The interventions carried out in the trials were classified into four categories of measurement: environmental, physical, behavioural, and combined. Fourteen studies obtained statistically significant improvements; two showed a blend of significant and non-significant improvements; and one reported non-significant results. However, only four trials of the seventeen were judged as having a low risk of bias. CONCLUSIONS: Overall evidence about interventions that could be performed by nurses to improve perceived sleep quality in hospitalized patients was found to be positive, and no negative effects were reported. However, higher quality research using both subjective and objective measures is needed, in order to strengthen the evidence.

Lessons from the Implementation of Pilot Practices to Tackle the Burden of Noncommunicable Diseases in Europe.

(1) Background: The gap between research findings and their application in routine practice implies that patients and populations are not benefiting from the investment in scientific research. The objective of this work is to describe the process and main lessons obtained from the pilot practices and recommendation that have been implemented by CHRODIS-PLUS partner organizations; (2) Methods: CHRODIS-PLUS is a Joint Action funded by the European Union Health Programme that continues the work of Joint Action CHRODIS-JA. CHRODIS-PLUS has developed an Implementation Strategy that is being tested to implement innovative practices and recommendations in four main areas of action: health promotion and disease prevention, multimorbidity, fostering quality of care of patients with chronic diseases, and employment and chronic conditions; (3) Results: The Three-Stages CHRODIS-PLUS Implementation Strategy, based on a Local Implementation Working Group, has demonstrated that it can be applied for interventions and in situations and contexts of great diversity, reflecting both its validity and generalizability; (4) Conclusions: Implementation has to recognize the social dynamics associated with implementation, ensuring sympathy toward the culture and values that underpin these processes, which is a key differentiation from more linear improvement approaches.

Resultados de la implantación de la Guía de valoración y manejo del dolor en Centros Comprometidos con la Excelencia en Cuidados (CCEC) en España / Implementation results of the assessment and management of pain guideline within Best Practice Spotlight Organisations (BPSO)

OBJETIVO: Analizar la evolución de la implantación de las recomendaciones de proceso de la guía RNAO Valoración y manejo del dolor y de los resultados en salud. MÉTODO: Estudio observacional, longitudinal, retrospectivo, realizado en 3hospitales de tercer nivel de España. Se incluyó a todos los pacientes dados de alta los últimos 5 días de cada mes de las unidades seleccionadas en el proceso de implantación. Se evaluaron datos estructurales, estancia media, estrategia de implantación y grado de implantación de recomendaciones de proceso según la guía RNAO durante los 3primeros años de implantación y resultados. Se realizó un análisis descriptivo mediante el cálculo de medias y frecuencias absolutas y relativas por periodos: basal (T0) y anual durante los 3primeros años de implantación (T1, T2 y T3, respectivamente) e inferencial. RESULTADOS: Se ha incluido a 8.128 pacientes. Se ha realizado contraste de hipótesis entre los diferentes periodos. La valoración inicial del dolor en las primeras 24h de ingreso o poscirugía se incrementó tras el periodo basal en todos los hospitales, especialmente en aquellos en los que no se cumplían los requisitos de la guía al inicio, y continuó creciendo de forma progresiva hasta a los 3 años de implantación (alcanzando un 94,6% en el hospital 2). En cambio, la implantación del plan de cuidados no ha llegado a superar el 37,5 o el 38,5% de los hospitales 1 y 3, respectivamente. Respecto a los indicadores de resultado, la prevalencia de dolor a las 24 h e intenso disminuyó en los 3hospitales de forma general desde T0 o T1 a T3; sin embargo, no se obtuvieron diferencias estadísticamente significativas concluyentes. CONCLUSIONES: La evolución de la implantación de las recomendaciones de proceso ha mejorado desde el inicio, al igual que los resultados sobre los pacientes, consiguiendo una disminución de la prevalencia y la intensidad del dolor, aunque no se obtuvieron datos concluyentes; todo esto conlleva una mejor práctica enfermera con mayores registros, continuidad asistencial y mejora de la gestión del dolor en los pacientes

AIM: to analyse the progress of implementing the process recommendations of the RNAO Assessment and Management of Pain guideline and health outcomes. METHOD: An observational, longitudinal, retrospective study conducted in 3tertiary-level hospitals in Spain. All patients discharged over the last 5 days of each month from the units selected in the implementation process were included. We evaluated structural data, mean hospital stay, implementation strategy and degree of implementation of the process recommendations of the RNAO guideline over the first 3 years of implementation, and outcomes. A descriptive analysis was performed by calculating means and absolute and relative frequencies in periods: baseline (T0), annual, over the 3first years of implementation (T1, T2 and T3 respectively), and inferential. RESULTS: 8128 patients were included in the study. Hypotheses were contrasted between the different periods. The initial pain assessment in the first 24h following admission or post-surgery increased after the baseline period in all the hospitals, especially those that did not meet the guidelines from the outset. It continued to rise progressively up to 3 years following implementation (reaching 94.6% in hospital 2). By contrast, implementation of the care plan did not exceed 37.5% and 38.5% in hospitals 1 and 3 respectively. With regard to the outcome indicators, the prevalence of pain at 24hours and intense pain generally decreased in the 3hospitals from T0 or T1 to T3, however no conclusive statistically significant differences were obtained. CONCLUSIONS: Implementation of the process recommendations improved from the outset, as did patient outcomes. A decrease in the prevalence and intensity of pain was achieved, although no conclusive data were obtained; all of which leads to better nursing practice with more recording, continuity of care and improved pain management for patients

Evaluación de estrategias de implantación del Proyecto Centros Comprometidos con la Excelencia en Cuidados en España / Evaluation of implementation strategies of the Best Practices Spotlight Organisations (BPSO) Project in Spain

OBJETIVO: Identificar elementos favorecedores y barreras de implantación en el Programa de Centros Comprometidos con la Excelencia en Cuidados® que instauran guías de práctica clínica de la Registered Nurse' Association of Ontario, con el fin de que experiencias futuras pudieran beneficiarse de las apreciaciones expuestas. MÉTODO: Estudio de investigación evaluativa del proceso de implantación de guías en instituciones que componen las dos primeras cohortes del programa en España, mediante análisis de contenido de memorias de implantación y proceso inductivo, lectura, interpretación, codificación y categorización según estructura DAFO: debilidades, amenazas, fortalezas y oportunidades. RESULTADOS: Se han analizado memorias e informes de 18 centros de 12 Comunidades Autónomas, entre los cuales implantan 22 guías distintas. Como debilidades, destacan por frecuencia e intensidad, problemas relacionados con sistemas de información y su explotación. Se exponen otros elementos relacionados con difusión de resultados, profesionales, cuidados y factores relativos a la institución. Sobresalen como amenazas, la inestabilidad de plantillas y cambios continuados en la alta dirección o políticas corporativas. Entre las fortalezas, se distinguen la dedicación exclusiva de personal al proyecto y su vinculación a objetivos institucionales. Y por último, se identifica como oportunidades, destacan la posibilidad de comparación estandarizada de resultados propios con ajenos, así como la difusión de resultados. CONCLUSIÓN: Se configura un patrón útil para el abordaje de implantación en otras realidades, donde el cambio en la cultura profesional, su formación, comunicación y liderazgo, así como alinear intereses de gestores y políticos, facilitan unas condiciones ideales para la práctica basada en la evidencia

OBJECTIVE: To identify favourable elements and barriers to implementation in the Program of Best Practice Spotlight Organization® that establish clinical practice guidelines of the Registered Nurse' Association of Ontario, so that future experiences could benefit from the assessments presented here. METHOD: Evaluation research study of the process of implementing guidelines in institutions that make up the first two cohorts of the programme in Spain, through analysis of contents of implantation reports and inductive process, reading, interpretation, coding and categorized according to SWOT structure: Strengths, weaknesses, opportunities and threats. RESULTS: Reports from 18 centres in 12 Autonomous Communities have been analyzed, including 22 different guidelines. As weaknesses, problems related to information systems and their exploitation stand out for frequency and intensity. Other elements related to dissemination of results, to professionals, care and factors related to the institution are presented. Standing out as threats are the instability of staff and continued changes in Senior Management or corporate policies. Among the strengths, the exclusive dedication of personnel to the project and its link to institutional objectives are distinguished. As opportunities, the possibility of standardized comparison of own results with others, as well as the dissemination of results are highlighted. CONCLUSION: A useful pattern is set up to approach implementation in other scenarios, where changes in professional culture, training, communication and leadership, as well as aligning interests of managers and politicians, facilitate ideal conditions for Evidence-Based Practice

Evaluation of implementation strategies of the Best Practices Spotlight Organisations (BPSO) Project in Spain. / Evaluación de estrategias de implantación del Proyecto Centros Comprometidos con la Excelencia en Cuidados en España.

OBJECTIVE: To identify favourable elements and barriers to implementation in the Program of Best Practice Spotlight Organization® that establish clinical practice guidelines of the Registered Nurse' Association of Ontario, so that future experiences could benefit from the assessments presented here. METHOD: Evaluation research study of the process of implementing guidelines in institutions that make up the first two cohorts of the programme in Spain, through analysis of contents of implantation reports and inductive process, reading, interpretation, coding and categorized according to SWOT structure: Strengths, weaknesses, opportunities and threats. RESULTS: Reports from 18 centres in 12 Autonomous Communities have been analyzed, including 22 different guidelines. As weaknesses, problems related to information systems and their exploitation stand out for frequency and intensity. Other elements related to dissemination of results, to professionals, care and factors related to the institution are presented. Standing out as threats are the instability of staff and continued changes in Senior Management or corporate policies. Among the strengths, the exclusive dedication of personnel to the project and its link to institutional objectives are distinguished. As opportunities, the possibility of standardized comparison of own results with others, as well as the dissemination of results are highlighted. CONCLUSION: A useful pattern is set up to approach implementation in other scenarios, where changes in professional culture, training, communication and leadership, as well as aligning interests of managers and politicians, facilitate ideal conditions for Evidence-Based Practice.

Implementation results of the assessment and management of pain guideline within Best Practice Spotlight Organisations (BPSO®). / Resultados de la implantación de la Guía de valoración y manejo del dolor en Centros Comprometidos con la Excelencia en Cuidados (CCEC®) en España.

AIM: to analyse the progress of implementing the process recommendations of the RNAO Assessment and Management of Pain guideline and health outcomes. METHOD: An observational, longitudinal, retrospective study conducted in 3tertiary-level hospitals in Spain. All patients discharged over the last 5 days of each month from the units selected in the implementation process were included. We evaluated structural data, mean hospital stay, implementation strategy and degree of implementation of the process recommendations of the RNAO guideline over the first 3 years of implementation, and outcomes. A descriptive analysis was performed by calculating means and absolute and relative frequencies in periods: baseline (T0), annual, over the 3first years of implementation (T1, T2 and T3 respectively), and inferential. RESULTS: 8128 patients were included in the study. Hypotheses were contrasted between the different periods. The initial pain assessment in the first 24h following admission or post-surgery increased after the baseline period in all the hospitals, especially those that did not meet the guidelines from the outset. It continued to rise progressively up to 3 years following implementation (reaching 94.6% in hospital 2). By contrast, implementation of the care plan did not exceed 37.5% and 38.5% in hospitals 1 and 3 respectively. With regard to the outcome indicators, the prevalence of pain at 24hours and intense pain generally decreased in the 3hospitals from T0 or T1 to T3, however no conclusive statistically significant differences were obtained. CONCLUSIONS: Implementation of the process recommendations improved from the outset, as did patient outcomes. A decrease in the prevalence and intensity of pain was achieved, although no conclusive data were obtained; all of which leads to better nursing practice with more recording, continuity of care and improved pain management for patients.

Getting guidelines into practice: lessons learned as Best Practice Spotlight Organization host.

BACKGROUND: The Spanish Best Practice Guidelines (BPG) Implementation Project is part of the Best Practice Spotlight Organizations international program, coordinated by the Registered Nurses' Association of Ontario (RNAO). AIMS: To influence the uptake of nursing BPG across healthcare organizations, to enable practice excellence and positive client outcomes. METHODS: After translating the RNAO's BPG into Spanish, the Host Organization published a formal call for proposals to select healthcare settings in Spain to implement the RNAO's BPG and evaluate the results. The approach is nursing-led and multidisciplinary; context specific; and involving a wide range of stakeholders. The implementation of BPG Toolkit guides the process: cascade training, selection of recommendations to be implemented, 3 years of planned implementation activities, monitoring of process and outcome results for patients discharged 60 days every year. The Host Organization supports healthcare settings selected. RESULTS/DISCUSSION: The first call was launched in 2012. Eight healthcare settings (11 sites), serving 1.3 million people, were selected (hospitals and primary healthcare centers). They chose 10 BPG, according to their needs. In 2015 and 2018, 16 more healthcare settings have joined the program with a total of 263 sites. And in 2019, three complete regions will join the program as a regional host. Currently, more than 3200 nurses and 40 other healthcare professionals have been trained, evidence-based protocols have been developed or updated, patient education has been promoted, and international Best Practice Spotlight Organizations indicators have been evaluated in an electronic platform. CONCLUSION: The results obtained acknowledge that the RNAO implementation method could be replicated with success internationally. The strategies based on local context have worked and we have consolidated a network that shares knowledge and strategies and promotes evidence-based culture among Spanish healthcare settings and evidence-based care to patients.

Nursing knowledge of and attitude in cardiopulmonary arrest: cross-sectional survey analysis.

BACKGROUND: Nurses are often the first to activate the chain of survival when a cardiorespiratory arrest happens. That is why it is crucial that they keep their knowledge and skills up-to-date and their attitudes to resuscitation are very important. The main aim of this study was to analyse whether the level of theoretical and practical understanding affected the attitudes of nursing staff. METHODS: A questionnaire was designed using the Delphi technique (three rounds). The questionnaire was adjusted and it was piloted on a test-retest basis with a convenience sample of 30 registered nurses. The psychometric characteristics were evaluated using a sample of 347 nurses using Cronbach's alpha. Descriptive analysis was performed to describe the sociodemographic variables and Spearman's correlation coefficient to assess the relationship between two scale variables. Pearson's chi-squared test has been used to study the relationship between two categorical variables. Wilcoxon Mann Whitney test and the Kruskal-Wallis test were performed to establish relationships between the demographic/work related characteristics and the level of understanding. RESULTS: The Knowledge and Attitude of Nurses in the Event of a Cardiorespiratory Arrest (CAEPCR) questionnaire comprised three sections: sociodemographic information, theoretical and practical understanding, and attitudes of ethical issues. Cronbach's alpha for the internal consistency of the attitudes questionnaire was 0.621. The knowledge that nurses self-reported with regard to cardiopulmonary arrest directly affected their attitudes. Their responses raised a number of bioethical issues. CONCLUSIONS: CAEPCR questionnaire is the first one which successfully linked knowledge of cardiopulmonary resuscitation to the attitudes towards ethical issues Health policies should ensure that CPR training is mandatory for nurses and all healthcare workers, and this training should include the ethical aspects.

Desafíos y oportunidades de financiación en la Acción Estratégica en Salud 2017-2020 para la investigación en cuidados / Challenges and opportunities in financing the 2017-2010 Strategic Health Strategy for care research

No disponible

Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care.

OBJECTIVES: To determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care. DESIGN: Cross-sectional patient discharge data, hospital characteristics and nurse and patient survey data were merged and analysed using generalised estimating equations (GEE) and logistic regression models. SETTING: Adult acute care hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland. PARTICIPANTS: Survey data were collected from 13 077 nurses in 243 hospitals, and 18 828 patients in 182 of the same hospitals in the six countries. Discharge data were obtained for 275 519 surgical patients in 188 of these hospitals. MAIN OUTCOME MEASURES: Patient mortality, patient ratings of care, care quality, patient safety, adverse events and nurse burnout and job dissatisfaction. RESULTS: Richer nurse skill mix (eg, every 10-point increase in the percentage of professional nurses among all nursing personnel) was associated with lower odds of mortality (OR=0.89), lower odds of low hospital ratings from patients (OR=0.90) and lower odds of reports of poor quality (OR=0.89), poor safety grades (OR=0.85) and other poor outcomes (0.80