Development of an Information Guideline for Kidney Transplant Recipients in a Clinical Trial: Protocol for a Modified Delphi Method.

BACKGROUND: Renal transplantation is the treatment of choice for most cases of end-stage renal disease. Recipients need to lead a healthy lifestyle to minimize the potential side effects of immunosuppressive drugs and improve transplant outcomes. There is not much evidence about the best way to increase adherence to healthy lifestyles in kidney transplant recipients, so one of the objectives set by the nursing team is to train people to acquire the necessary skills and tools to be able to take care of themselves. In this sense, the consensual development of appropriate materials may be useful and of interest. OBJECTIVE: The aim of this study was to develop an information guide for adults with kidney transplants to be assessed in a subsequent clinical trial as an intervention to increase adherence to healthy habits. METHODS: We used a 3-step, methodological, sequential approach: (1) training from a group of experts and item consensus; (2) review of the medical literature available; and (3) use of the Delphi technique with on-site meetings. A total of 5 nurses from the Community of Madrid Kidney Transplantation Unit in Spain were asked to participate. The patients' lifestyle factors that, according to the medical literature available and experts' opinions, have the greatest impact on the survival of the transplanted organ and the recipients themselves were all described. RESULTS: After using the modified Delphi method to reach a consensus on the items to be included and the information needed in each, an information guide for adult kidney transplant patients was developed. This guide facilitates the structuring of health care, information, and recommendations necessary for effective self-care for each person. The result is considered to be an easy-to-understand tool, useful for transplant doctors and nurses, in simple language, with information based on the latest scientific-medical evidence published to date, aspects of which will be evaluated in a clinical trial designed for this purpose. CONCLUSIONS: Currently, this guide is the main intervention variable of a clinical trial (registered on ClinicalTrials.gov; NCT05715580) aimed at improving compliance with healthy habits in kidney transplant recipients in the Community of Madrid, Spain. The method used in its development has been useful and agile, and the result is a guide that can be easily updated periodically following the same procedure. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46961.

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.

De la Enfermería basada en la evidencia a la práctica asistencial: la evaluación de resultados como elemento integrador / From evidence-based nursing to healthcare practice: The evaluation of results as an integrating element

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Frecuencia de los diagnósticos de enfermería en el primer ingreso del paciente con un trasplante renal reciente / Frequency of nursing diagnoses on the first admission of the patient with a recent renal transplant

La insuficiencia renal crónica es un problema de salud cuya prevalencia ha ido en aumento y que conlleva serias implicaciones para el paciente. El trasplante renal mejora la calidad de vida de estos pacientes pero les obliga a modificar hábitos en su vida diaria. La enfermería busca el compromiso del paciente con su autocuidado para evitar el rechazo del órgano trasplantado y para ello es importante sistematizar el trabajo a través de planes de cuidados adecuados a la situación de cada paciente y a sus necesidades. Se trata de un estudio descriptivo retrospectivo cuyo objetivo fue conocer los diagnósticos de enfermería (DxE) más frecuentes en el primer ingreso postrasplante, así como el motivo por el que ingresan, y se realizó sobre todos aquellos pacientes que recibieron un trasplante renal, en el Hospital Clínico San Carlos de Madrid, durante el periodo 2010 a 2014. Durante este periodo se realizaron 331 trasplantes, de los cuales ingresaron durante el año postraplante el 50.8% (167). En el primer ingreso tras el trasplante renal se asignaron una mediana de 4 DxE (RI=2-7) por paciente, siendo los más frecuentes Riesgo de Infección con un 25,1% (83), Dolor agudo con un 11,8% (39) y Conocimientos deficientes con un 10,3% (34). Conocer los DxE más frecuentes nos permite establecer planes de cuidados que mejoren la calidad asistencial e intentar prevenir posibles complicaciones del trasplante que perjudican la calidad de vida del paciente. Esto nos ayudará a reducir costes en el tratamiento, y lo que es más importante, a aumentar la satisfacción del paciente y su seguridad, al mismo tiempo que le ayudamos a recuperar su salud (AU)

Chronic kidney failure is a health problem whose prevalence has increased and has serious implications for the patient. Renal transplantation improves the quality of life of these patients but it forces them to modify habits in their daily life. The nurse seeks the commitment of the patient with their self-care to avoid rejection of the transplanted organ and for this it is important to systematize the work through plans of care appropriate to the situation of each patient and their needs. A retrospective descriptive study was carried out. The aim was to know the most frequent nursing diagnoses (NxD) in the first post-transplant admission, as well as the reason for the admission. All patients who received a kidney transplant at the Hospital Clínico San Carlos of Madrid, during the period 2010 to 2014, were included. During this period, 331 transplants were performed, of which 50.8% (167) were admitted during the post-transplant year. In the first admission after kidney transplantation, a median of 4 NxD (RI = 2-7) per patient was assigned, being the most frequent ‘Infection Risk’ with 25.1% (83), ‘Acute Pain’ with 11.8% (39) and ‘Poor Knowledge’ with 10.3% (34). Knowing the most frequent NxD, allows establishing plans of care that improve the quality of care and try to prevent possible complications of transplantation that affect the quality of life of the patient. This fact will help reduce costs in treatment, and more importantly, increase patient satisfaction and safety, while at the same time recover their health (AU)