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.

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.

Adaptation and validation of the Interprofessional Socialization and Valuing Scale (ISVS) in Spanish university health sciences students.

Many interprofessional education programs are being designed to help students improve their collaborative practice. Traditionally, the evaluation of these programs is focused on attitudes, knowledge and skills, but according to some authors, the evaluation of these activities should be expanded to include the evaluation of the development of an interprofessional identity. The Interprofessional Socialization and Valuing Scale (ISVS) is a self-report tool used to measure interprofessional socialization, but it has not been validated with Spanish students. In this study, the tool was translated into Spanish and administered to a sample of 645 undergraduate students. The data were analyzed to estimate structural validity, internal consistency and convergent validity. Regarding the structural validity, our data supported the unidimensional model found in the English version of the ISVS-21 (normed chi-square = 2.3, RMSEA = 0.045, SRMR = 0.087, CFI = 0.963 and TLI = 0.969). The internal consistency reliability of the scale was adequate, Cronbach α = 0.913 [95% CI 0.903, 0.923]. The Spanish version of the ISVS-21 shows adequate psychometric properties in terms of the construct validity (structural validity and convergent validity) and internal consistency of its scores. This study provides the Spanish-speaking population with an adaptation of the only instrument that has been specifically developed to assess interprofessional socialization.

Effectiveness of a training intervention to improve communication between/awareness of team roles: A randomized clinical trial.

BACKGROUND: Interprofessional teamwork training of nursing undergraduates is essential to improving healthcare. The absence of clear role definitions and poor interprofessional communications have been listed as the main reasons behind abandonment of the profession by recently graduated nurses. PURPOSE: The aim of this parallel randomized clinical trial was to evaluate the impact of Situation-Background-Assessment-Recommendation (SBAR) role-play training on interprofessional teamwork skills (role-related and communication-related) and non-technical skills (patient assessment, patient intervention, patient safety, and critical thinking). METHOD: The intervention group were taught teamwork skills, role and task assignment skills, and use of the SBAR worksheet in a 1-hour role-play training session, while the control group received conventional lecture-based training. Teamwork and non-technical skills were then assessed in high-fidelity simulation scenarios using the KidSIM Team Performance Scale (teamwork skills) and the Clinical Simulation Evaluation Tool (non-technical skills). Cohen's d (d) was used to examine effect size differences. RESULTS: Compared to the control group, the intervention group improved in 4 teamwork items - 'verbalize out loud' (p < 0.001, d = 0.99), 'paraphrase' (p < 0.001, d = 0.77), 'cross-monitoring' (p < 0.001, d = 0.72), and 'role clarity' (p = 0.002, d = 0.66) - and in a single non-technical skill (patient intervention: p = 0.004, d = 0.66), while also reporting greater confidence in performing patient assessments (p = 0.02, d = 0.56). CONCLUSIONS: Role-play and SBAR training for undergraduate nurses improved patient intervention, enhanced information sharing in an interprofessional team, and raised awareness of their own and other team members' roles.

Validity of Chronic Venous Disease Diagnoses and Epidemiology Using Validated Electronic Health Records From Primary Care: A Real-World Data Analysis.

PURPOSE: The aim of this study was to evaluate the validity of lower limb chronic venous disease (CVD) diagnoses entered in a large electronic health record database in primary care in Catalonia, Spain; to investigate the reliability of these data for research purposes; and to estimate the prevalence and incidence of CVD, chronic venous insufficiency (CVI), and venous leg ulcer (VLU). DESIGN: Real-world data analysis based on a large electronic health record database in primary care in Catalonia, Spain. METHODS: We used a primary care research database (Information System for the Development of Research in Primary Care [SIDIAP]), which contains anonymous data on some 5.8 million people from 279 primary care centers, accounting for more than 80% of the Catalonian population and 15% of the Spanish population. We evaluated the validity of the ICD-10 codes for CVD in SIDIAP for 200 adult patients through the responses of 20 primary care physicians to a questionnaire. FINDINGS: The positive predictive value of CVD in SIDIAP was 89.95% (95% confidence interval [CI] 84.99-93.40). The prevalence rates for CVD, CVI, and VLU were 9.54% (95% CI 9.51-9.56), 3.87%, and 0.33%, respectively. The incidence rates for CVD, CVI, and VLU were 7.91/1,000 person-years (95% CI 7.82-8.00), 3.37/1,000 person-years (95% CI 3.31-3.43), and 0.23/1,000 person-years (95% CI 0.21-0.24), respectively. CONCLUSIONS: The Catalonian SIDIAP database contains valid CVD diagnoses. The prevalence and incidence rates found using real-world data are low compared with those in the literature, possibly because CVD is an underdiagnosed entity. CLINICAL RELEVANCE: Real-world data can inform clinicians on lower limb venous health in a population, show changes as individuals age, and reveal aspects where healthcare can be improved.

Using simulation and electronic health records to train nursing students in prevention and health promotion interventions.

BACKGROUND: Prevention and health promotion activities are key to reducing prevalence and halting the progress of many chronic diseases. Standardised patient simulation is a useful option for training nursing students in this area. OBJECTIVE: To evaluate skills related to prevention and health promotion activities acquired by third-year nursing students through standardised patient simulation and electronic health records. DESIGN: A descriptive, cross-sectional study. SETTINGS: A nursing faculty at a public university. PARTICIPANTS: The study population consisted of all third-year nursing students in the academic year 2017-2018 (N = 142). METHODS: The students attended three seminars on health promotion and prevention activities in adults, involving standardised patient simulation and electronic health record use. Skill acquisition was then evaluated through clinical case simulation in a fourth seminar. RESULTS: A total of 137 (96.5%) students participated in the study. The mean score for all cases evaluated was 6.76 (standard deviation 1.85) out of 10. The most frequent activities were greeting and self-introduction, checking vaccination status, assessing physical exercise and eating habits, and calculating body mass index. The least frequent activities were questions about high-risk sexual behaviour, drug use, bowel cancer screening and sun protection recommendations. When writing the nursing report, students found it hardest to plan future patient interventions. Also, 108 students made notes to set reminders of case-related activities. CONCLUSIONS: Third-year nursing students acquire good skills in health promotion and prevention activities. Some activities requiring a greater degree of confidence with the patient need to be reinforced, such as investigating high-risk sexual behaviour and drug use. Reinforcement is also needed in activities that are encountered less often in clinical practice, such as sun protection recommendations and bowel cancer screening. The use of electronic health records in conjunction with simulation enhances self-study.

Cintura hipertrigliceridémica en adultos pertenecientes al Policlínico Héroes del Moncada, en La Habana / Hypertriglyceridemic waist in adult patients belonging to Héroes del Moncada Polyclinic in Havana

Introducción: La hipertrigliceridemia es una forma de dislipidemia frecuentemente asociada con enfermedad ateroesclerótica. La obesidad se encuentra entre los factores de riesgo implicados en la aceleración del proceso ateroesclerótico. El desorden fisiopatológico provocado por el tejido adiposo disfuncionante es causa de afectaciones cardiovasculares, endocrinometabólicas y neoplásicas. Objetivo: Identificar la relación entre la presencia de hipertrigliceridemia con la circunferencia de la cintura en adultos mayores, a partir de la evaluación del índice de masa corporal, cintura-cadera y la presencia de hipertrigliceridemia, según la edad y el sexo. Métodos: Estudio descriptivo transversal realizado entre 2015-2017, con una muestra de 386 adultos de ambos sexos. La recogida de datos se realizó según el modelo de recolección del dato primario del Centro de Investigación y Referencias de Aterosclerosis de La Habana. El análisis de los datos se realizó con el programa SPSS v16- y las técnicas de Chi-Square. Resultados: La edad media de la muestra fue de 55,5 años y el 70,6 por ciento eran mujeres. El 57 por ciento presentaba hipertrigliceridemia y el 63,4 por ciento un índice de masa corporal aumentado, un 37,8 por ciento de personas con sobrepeso y un 26,5 por ciento con obesidad. El índice de masa corporal fue superior en mujeres perimenopáusicas, en las que tuvieron el predominio de cintura hipertrigliceridémica. Se observó un incremento de obesidad abdominal con la edad. Conclusiones: Los factores de riesgo cardiovascular, así como, la asociación existente entre los triglicéridos y la medida de la circunferencia de cintura, requiere una valoración sistemática por sexo y edad. La consulta de enfermería de la Atención Primaria es un lugar ideal para promover estrategias de intervención para monitorizar el riesgo clínico cardiovascular a través de los diferentes parámetros antropométricos(AU)

Introduction: Hypertriglyceridemia is a form of dyslipidemia frequently associated with the atherosclerotic disease. Obesity is among the risk factors involved in the acceleration of the atherosclerotic process. The pathophysiologic disorder caused by the dysfuncional adipose tissue is the cause of cardiovascular, endocrinometabolic and neoplastic diseases. Objective: To identify the relationship between the presence of hypertriglyceridemia and waist circumference in older adults from the assessment of the body mass index, waist-hip ratio and the presence of hypertriglyceridemia, according to age and gender. Methods: Descriptive, cross-sectional study conducted from 2015 to 2017, with a sample of 386 adults of both sexes. Data collection was performed according to the model of primary data collection of the Center for Research and of Atherosclerosis References of Havana. The data analysis was performed with the SPSS v16- software and the Chi-Square techniques. Results: The average age of the sample was 55.5 years and 70.6 percent were women. The 57 percent had hypertriglyceridemia and 63.4 percent an increased body mass index; 37.8 percent of the people had overweight and 26.5 percent had obesity. Body mass index was higher in perimenopausal women, who had a predominance of hypertriglyceridemic waist. It was noticed an increase of the abdominal obesity with aging. Conclusions: The cardiovascular risk factors as well as the association between triglycerides and the measure of waist circumference require a systematic assessment by sex and age. The nursing consultation in Primary Care is an ideal place to promote intervention strategies to monitor the cardiovascular clinical risk through the different anthropometric parameters(AU)

Cintura hipertrigliceridémica en adultos pertenecientes al Policlínico Héroes del Moncada, en La Habana / Hypertriglyceridemic waist in adult patients belonging to "Héroes del Moncada" Polyclinic in Havana

RESUMEN Introducción: La hipertrigliceridemia es una forma de dislipidemia frecuentemente asociada con enfermedad ateroesclerótica. La obesidad se encuentra entre los factores de riesgo implicados en la aceleración del proceso ateroesclerótico. El desorden fisiopatológico provocado por el tejido adiposo disfuncionante es causa de afectaciones cardiovasculares, endocrinometabólicas y neoplásicas. Objetivo: Identificar la relación entre la presencia de hipertrigliceridemia con la circunferencia de la cintura en adultos mayores, a partir de la evaluación del índice de masa corporal, cintura-cadera y la presencia de hipertrigliceridemia, según la edad y el sexo. Métodos: Estudio descriptivo transversal realizado entre 2015-2017, con una muestra de 386 adultos de ambos sexos. La recogida de datos se realizó según el modelo de recolección del dato primario del Centro de Investigación y Referencias de Aterosclerosis de La Habana. El análisis de los datos se realizó con el programa SPSS v16- y las técnicas de Chi-Square. Resultados: La edad media de la muestra fue de 55,5 años y el 70,6 % eran mujeres. El 57 % presentaba hipertrigliceridemia y el 63,4 % un índice de masa corporal aumentado, un 37,8 % de personas con sobrepeso y un 26,5 % con obesidad. El índice de masa corporal fue superior en mujeres perimenopáusicas, en las que tuvieron el predominio de cintura hipertrigliceridémica. Se observó un incremento de obesidad abdominal con la edad. Conclusiones: Los factores de riesgo cardiovascular, así como, la asociación existente entre los triglicéridos y la medida de la circunferencia de cintura, requiere una valoración sistemática por sexo y edad. La consulta de enfermería de la Atención Primaria es un lugar ideal para promover estrategias de intervención para monitorizar el riesgo clínico cardiovascular a través de los diferentes parámetros antropométricos.

ABSTRACT Introduction: Hypertriglyceridemia is a form of dyslipidemia frequently associated with the atherosclerotic disease. Obesity is among the risk factors involved in the acceleration of the atherosclerotic process. The pathophysiologic disorder caused by the dysfuncional adipose tissue is the cause of cardiovascular, endocrinometabolic and neoplastic diseases. Objective: To identify the relationship between the presence of hypertriglyceridemia and waist circumference in older adults from the assessment of the body mass index, waist-hip ratio and the presence of hypertriglyceridemia, according to age and gender. Methods: Descriptive, cross-sectional study conducted from 2015 to 2017, with a sample of 386 adults of both sexes. Data collection was performed according to the model of primary data collection of the Center for Research and of Atherosclerosis References of Havana. The data analysis was performed with the SPSS v16- software and the Chi-Square techniques. Results: The average age of the sample was 55.5 years and 70.6% were women. The 57 % had hypertriglyceridemia and 63.4 % an increased body mass index; 37.8% of the people had overweight and 26.5 % had obesity. Body mass index was higher in perimenopausal women, who had a predominance of hypertriglyceridemic waist. It was noticed an increase of the abdominal obesity with aging. Conclusions: The cardiovascular risk factors as well as the association between triglycerides and the measure of waist circumference require a systematic assessment by sex and age. The nursing consultation in Primary Care is an ideal place to promote intervention strategies to monitor the cardiovascular clinical risk through the different anthropometric parameters.

Development of a Minimum Data Set Registry for Chronic Venous Insufficiency of the Lower Limbs.

The purpose of this study was to develop a minimum data set (MDS) registry for the prevention, diagnosis and treatment of chronic venous insufficiency (CVI) of the lower limbs. We designed the instrument in two phases, comprising a literature review and an e-Delphi study to validate the content. We obtained a total of 39 documents that we used to develop a registry with 125 items grouped in 7 categories, as follows: Patient examination, venous disease assessment methods, diagnostic tests to confirm the disease, ulcer assessment, treatments to manage the disease at all its stages, patient quality of life, and patient health education. The instrument content was validated by 25 experts, 88% of whom were primary healthcare and hospital nurses and 84% had more than 10 years' experience in wound care. Using a two-round Delphi approach, we reduced the number of items in the MDS-CVI to 106 items. The categories remained unchanged. We developed an MDS for CVI with seven categories to assist healthcare professionals in the prevention, early detection, and treatment history of CVI. This tool will allow the creation of a registry in the primary care setting to monitor the venous health state of the population.

Measuring self-directed learning readiness in health science undergraduates: A cross-sectional study.

BACKGROUND: The European Higher Education Area places students at the centre of the teacher-guided learning process and requires them to participate more in their education and to be responsible for acquiring the professional competences relevant to their career. Self-directed learning is a key means for developing the skills necessary for professional careers. OBJECTIVE: To measure self-directed learning readiness in health science undergraduates. METHOD: Observational descriptive cross-sectional study of a convenience sample drawn from the total health science (medicine, nursing, physiotherapy and psychology) undergraduate population (n = 1699) at the University of Girona (Spain). The data collection instrument was a self-directed learning readiness scale with 38 items administered to the 1134 undergraduates who agreed to participate. RESULTS: Just over three quarters of the sample (n = 865; 76.27%) completed the full questionnaire. Self-directed learning readiness was indicated by an overall mean (standard deviation) score of 143.65 (11.76) points. Nursing undergraduates obtained the highest mean (SD) score - 145.08 (14.13) - in the overall scale. Associations were observed between degree course and self-directed learning readiness in the learning planning, desire for learning, self-confidence, self-management and self-evaluation subscales. Women scored better than men (p < 0.13) and scores progressively improved with each additional academic year. CONCLUSION: The sampled students exhibited good self-directed learning readiness. Training students in self-directed learning skills is a necessary part of the teaching-learning process. This kind of training in universities needs to be reinforced to develop learning autonomy, promote lifelong learning and prepare competent future health professionals.

Úlcera de evolución tórpida producida por depilación con cera / Ulcer with torpid development caused by waxing

Se presenta el caso clínico de una mujer de 49 años que fue derivada a la consulta de Atención Primaria de Enfermería referente de úlceras, por una herida de siete meses de duración que no cicatrizaba. La paciente presentaba una úlcera de etiología venosa en la cara anterior media tibial de la pierna derecha, producida por efecto de una depilación de vello corporal. Una valoración integral de la persona, incluida su herida, con un plan de cuidados de Enfermería individualizado permitió detectar la insuficiencia venosa que padecía la paciente, aplicar el tratamiento adecuado (compresión terapéutica) y continuarlo una vez la úlcera había cicatrizado. El infradiagnóstico y la falta de un correcto tratamiento de este tipo de lesiones repercute negativamente en la calidad de vida de los pacientes, además de un aumento en los costes sanitarios y laborales, por lo que es necesaria una adecuada formación para su prevención y tratamiento

We hereby present the case report of a 49-year-old woman who was referred to the Primary Care Nursing Unit of reference for ulcers, with a 7-month wound that did not heal. The patient presented an ulcer with venous etiology in the tibial anterior medial side of her right leg, caused by body hair removal. A comprehensive assessment of the person, including her wound, with an individualized Nursing Care Plan, allowed to detect the venous insufficiency suffered by the patient, to implement the adequate treatment (therapeutic compression) and to continue said treatment once the ulcer had healed. Underdiagnosis and lack of adequate treatment for this type of lesions will have a negative impact on patients’ quality of life, as well as lead to an increase in healthcare and occupational costs; therefore, adequate training for their prevention and treatment is required

Nurse prescribing in Spain: The law and the curriculum.

In this cross-sectional study, we explored course content related to pharmacology and/or healthcare products and supplies in all nursing degree programs in Spain. Changes in nurse-prescribing legislation in Spain require that nurses take a certification course before prescribing over-the-counter products and medications. Using a cross-sectional descriptive study, between July and September 2014, the degree programs of all centers that offer a degree in nursing in Spain were examined, selecting those with course information available online. All centers offered at least one pharmacology course. One-third of the required courses had content related to pharmacology and healthcare products/supplies. The analysis showed that the course content and training received during the current nursing degree program provides the knowledge and skills needed to prescribe healthcare products/supplies and medications that do not now require a doctor's prescription, without the need for additional training and certification. It is essential that government regulation of nursing education be aligned with nursing competencies, curriculum standards, clinical practice, and evidence-based research to provide the maximum level of confidence for nursing professionals and their patients.

Atención integral a un varón con una úlcera neoplásica, que no va a cicatrizar, en el ámbito de la atención primaria de la salud: caso clínico / Comprehensive health care in a primary health care setting of a man with a difficult-to-heal neoplastic wound: Case report

La atención domiciliaria en Atención Primaria es fundamental en la provisión de cuidados de las personas con enfermedades crónicas al final de la vida. En este artículo se describe el caso de un varón de 90 años que acudió a la consulta de enfermería por una úlcera neoplásica (carcinoma epidermoide), con posible metástasis en pulmón e hígado. El paciente era completamente autónomo, pero desde el diagnóstico y las complicaciones posteriores, menguó su autonomía hasta ser incluido en el programa de atención domiciliaria. Se le realizó radioterapia, lo que mejoró el estado de la úlcera, pero debido al mal pronóstico y al deterioro del estado del paciente, se decidió realizar tratamiento sintomático. Mediante el plan de cuidados de enfermería, se controló el dolor y se evitó el estreñimiento asociado a mórficos. Además, se prescribió cura en ambiente húmedo para gestionar el exudado, disminuir el dolor y facilitar la cooperación de la familia. La atención integral y la colaboración de la familia del paciente, con un adecuado plan de cuidados de enfermería y los recursos necesarios para tratar la herida, permitieron ofrecer unos cuidados de bienestar para el paciente, quien, a pesar de padecer una úlcera que no iba a cicatrizar, no requería menos atención que otras heridas

The role of home care in Primary Care is essential in the chronically ill patient at the end of their life. In this article, the case is presented of a 90 year old man who went to the Primary Care nursing with a malignant wound, which was diagnosed as squamous cell carcinoma, with possible lung and liver metastases. The patient was completely independent, but since the diagnosis and subsequent complications, his independence decreased, and he was included in the Primary Care home care program. He underwent radiotherapy, improving the state of the ulcer, but due to the poor prognosis and the deterioration of the patient, it was decided to treat him symptomatically. By means of a nursing care plan, pain was controlled, the constipation associated with morphine was avoided, and the use of products for moist wound healing for exudate management, pain was reduced, and the family was encouraged to help him change the dressing, among others. Comprehensive care and support of the patient's family, and an adequate nursing care plan, as well as the resources required to treat the wound, allowed to offer some comfort care to the patient, who, despite having a malignant wound that would not heal, needs the same care as any other wound

Simulation-Based Learning as a Tactic for Teaching Evidence-Based Practice.

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.

Course content related to chronic wounds in nursing degree programs in Spain.

PURPOSE: To analyze content related to chronic wounds in nursing degree programs in Spain. DESIGN: Cross-sectional descriptive study. METHODS: Course descriptions available for online access during June and July of 2012 were reviewed for the 114 centers in Spain that offer a nursing degree, according to the official Registry of Universities, Centers, and Titles. FINDINGS: Of the 114 centers with degree programs, 95 (83.3%) post course content online, which make it possible to analyze 2,258 courses. In 60 (63.1%) of these centers, none of the courses included the concept of pressure ulcer prevention, and the course content posted by 36 (37.9%) centers made no mention of their treatment. None of the course descriptions contained any reference to pain management in patients with chronic wounds. Of the 728 elective courses analyzed, only one was related to chronic wounds. CONCLUSIONS: This review of available information about nursing degree programs in Spain indicates that pain management in patients with chronic wounds is not addressed in any course, and more courses consider the treatment of pressure ulcers than their prevention. CLINICAL RELEVANCE: Degree programs responsible for the training of future nurses should be reviewed and revised as needed to ensure that graduates have acquired minimum basic competencies in the prevention and treatment of chronic wounds that help to decrease the theory-practice gap in this field.

Case-based learning and simulation: useful tools to enhance nurses' education? Nonrandomized controlled trial.

PURPOSE: To compare skills acquired by undergraduate nursing students enrolled in a medical-surgical course. To compare skills demonstrated by students with no previous clinical practice (undergraduates) and nurses with clinical experience enrolled in continuing professional education (CPE). DESIGN: In a nonrandomized clinical trial, 101 undergraduates enrolled in the "Adult Patients 1" course were assigned to the traditional lecture and discussion (n = 66) or lecture and discussion plus case-based learning (n = 35) arm of the study; 59 CPE nurses constituted a comparison group to assess the effects of previous clinical experience on learning outcomes. METHODS: Scores on an objective structured clinical examination (OSCE), using a human patient simulator and cases validated by the National League for Nursing, were compared for the undergraduate control and intervention groups, and for CPE nurses (Student's t test). FINDINGS: Controls scored lower than the intervention group on patient assessment (6.3 ± 2.3 vs 7.5 ± 1.4, p = .04, mean difference, -1.2 [95% confidence interval (CI) -2.4 to -0.03]) but the intervention group did not differ from CPE nurses (7.5 ± 1.4 vs 8.8 ± 1.5, p = .06, mean difference, -1.3 [95% CI -2.6 to 0.04]). The CPE nurses committed more "rules-based errors" than did undergraduates, specifically patient identifications (77.2% vs 55%, p = .7) and checking allergies before administering medication (68.2% vs 60%, p = .1). CONCLUSIONS: The intervention group developed better patient assessment skills than the control group. Case-based learning helps to standardize the process, which can contribute to quality and consistency in practice: It is essential to correctly identify a problem in order to treat it. Clinical experience of CPE nurses was not associated with better adherence to safety protocols. CLINICAL RELEVANCE: Case-based learning improves the patient assessment skills of undergraduate nursing students, thereby preparing them for clinical practice.

Nurse prescribing in primary care in Spain: legal framework, historical characteristics and relationship to perceived professional identity.

AIM: To identify the extent of nurse prescription and determine specific medications and/or health-care supplies routinely prescribed by primary care nurses in Spain in a changing legal context. To explore nurse perceptions of legalized nurse prescription's relationship to professional identity. BACKGROUND: Although the Spanish public has similar confidence in nurses and physicians, professional identity remains a concern for nurses. Nurse prescription has a confusing history in Spain but is increasingly common elsewhere, and may enhance nursing's professional profile. METHOD: A cross-sectional survey reporting the occurrence of nurse prescription in one province in Spain and primary care nurses' perceptions of nurse prescription and professional identity in this province. RESULT: The response rate was 69.6% (87 nurses). Frequent nurse-prescribed medications were vaccinations (63.1%), topical antiseptics (60.7%) and antipyretics(44.8%); health-care supplies included supplies for diabetes (51.8%), wound care dressings (44.2%) and incontinence (26.7%). Respondents indicated that nurse prescription positively contributes to the profession and to its development.Conclusion Nurse prescribing exists in primary care in Spain, and formal legalization is in progress but awaits a consensus formulary. Nurses indicated that full legalization would increase professional autonomy and contribute positively to the profession, as an example of how policy can have an impact on practice.Implications for nursing management Spain's experience with inconclusive shifts in the legal status of nurse prescribing may contribute to the discussion in countries where this professional practice is not yet established.

Knowledge about medications and products to prevent and treat pressure ulcers: a cross-sectional survey of nurses and physicians in a primary health care setting.

AIMS AND OBJECTIVES: To report on a study of what primary care nurses and physicians know about medications and healthcare products to prevent and treat pressure ulcers. BACKGROUND: The prevention and treatment of pressure ulcers has generally become the responsibility of the nursing staff; this has resulted in studies of nurses' knowledge of this task, although few studies include physicians in their analysis. DESIGN: Cross-sectional survey conducted in North Girona (Province) Primary Care Services from February to April 2010. METHODS: The study questionnaire had three sections: sociodemographic data, questions about division of responsibility for the care of patients with pressure ulcers or at risk of developing them, and 36 statements based on the recommendations in clinical practice guidelines provided by well-recognised national and international institutions. RESULTS: Eighty-one nurses (64·8%) and 46 physicians (36·8%) responded to this study. Nurses had greater responsibility for the care of pressure ulcers, made greater use of medical prescriptions to obtain supplies if not available in the primary care centre, were more familiar with the site's clinical practice guidelines on the topic and showed better adherence to their recommendations. Nurses also had better knowledge than the participating physicians of the use of medications and healthcare products to heal or to prevent pressure ulcers. CONCLUSIONS: Nurses had sufficient knowledge and more appropriate skills than the participating physicians for the prescription of medications and healthcare products for the prevention and treatment of pressure ulcers. RELEVANCE TO CLINICAL PRACTICE: The data demonstrated that nurses have sufficient knowledge and skill to provide wound care and could safely write these prescriptions, although Spanish law permitting nurse prescription is not fully implemented.