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.

A motivational interview program for cardiac rehabilitation after acute myocardial infarction: study protocol of a randomized controlled trial in primary healthcare.

BACKGROUND: Cardiac rehabilitation after acute myocardial infarction permits recovery of the heart function and enables secondary prevention programs in which changes in lifestyle habits are crucial. Cardiac rehabilitation often takes place in hospitals without coordination with primary healthcare and is not focused on individual patient preferences and goals, which is the core of the motivational interview. The objective of this study was to evaluate the efficacy of a cardiac rehabilitation program with a motivational interview in patients discharged from hospital after acute myocardial infarction. METHODS/DESIGN: A randomized, non-pharmacological clinical trial in six primary healthcare centers in Barcelona (Spain) will assess whether a tailored cardiac rehabilitation program consisting of four motivational interviews and visits with family physicians, primary healthcare nurses and a cardiologist, coordinated with the reference hospital, results in better cardiac rehabilitation than standard care. A minimum sample of 284 participants requiring cardiac rehabilitation after acute myocardial infarction will be randomized to a cardiac rehabilitation group with a motivational interview program or to standard primary healthcare. The main outcome will be physical function measured by the six-minute walk test, and the secondary outcome will be the effectiveness of secondary prevention: a composite outcome comprising control of blood pressure, cholesterol, diabetes mellitus, smoking and body weight. Results will be evaluated at 1,3 and 6 months. DISCUSSION: This is the first clinical trial to study the impact of a new primary healthcare cardiac rehabilitation program with motivational interviews for patients discharged from hospital after myocardial infarction. Changes in lifestyles and habits after myocardial infarction are a core element of secondary prevention and require patient-centered care strategies such as motivational interviews. Therefore, this study could clarify the impact of this approach on health indicators, such as functional capacity. TRIAL REGISTRATION: ClinicalTriasl.gov NCT05285969 registered on March 18, 2022.

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.

Desarrollo de materiales educativos para pacientes crónicos y familiares / Development of educational materials for chronic patients and families

Un nivel bajo de alfabetización puede dificultar la comprensión de la información necesaria para tomar decisiones apropiadas en relación con la propia salud. Esta situación está relacionada con una peor adherencia a los tratamientos, un peor estado de bienestar y una mortalidad más elevada, sobre todo en personas de edad avanzada. Resulta esencial que la información pueda ser comprendida por el paciente y su familia. Este artículo tiene como objetivo presentar las recomendaciones internacionales existentes para el diseño y la elaboración de materiales o recursos educativos para pacientes crónicos y familiares. Se describen aspectos metodológicos que engloban la inclusión de los pacientes en distintos puntos durante el proceso de desarrollo del material, la adaptación del formato y el contenido al nivel de comprensión del paciente, así como su participación en una prueba piloto antes de la publicación de los mismos. Los materiales educativos que se han elaborado con la colaboración de los pacientes resultan más adaptados a su contexto y promueven cambios positivos en su salud

Low literacy can difficult the use of information needed to take appropriate decisions in healthcare. This situation is associated with poorer treatment adherence, lower health outcomes and higher mortality among the population and, specifically, the elderly. It is essential that information can be understood by patients and families. This article aims to present the existing international recommendations for the design and development of educational materials and resources to chronic patients and families. This process encompasses the involvement of patients at various levels during the development process of the materials, the adaptation of the format and content to the level of understanding of the patient as well as their participation in the evaluation process. Educational materials that have been developed in collaboration with patients are more adapted to their context and promote positive changes in their health

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.

Prevalencia e implicaciones pronósticas de los trastornos del sueño en la insuficiencia cardiaca crónica / Prevalence and prognostic implications of sleep disorders in patients with chronic heart failure

Objetivos. Evaluar la prevalencia e implicaciones pronosticas de los trastornos del sueño en pacientes con insuficiencia cardiaca crónica atendidos en una unidad de Insuficiencia Cardiaca hospitalaria. Método. Se realizó un estudio observacional, descriptivo y prospectivo. Ámbito: Unidad de Insuficiencia Cardiaca del Hospital de la Santa Creu i Sant Pau. Participantes: pacientes atendidos por primera vez en la Unidad entre abril de 2014 y noviembre de 2014. Variables: se realizó una evaluación de los trastornos del sueño mediante el cuestionario Insomnia Severity Index8,9 modificado. Se obtuvieron datos sociodemográficos, clínicos y farmacológicos de la historia clínica del paciente. Se evaluó la aparición de eventos adversos en el seguimiento (hospitalización por insuficiencia cardiaca o muerte de causa cardiovascular). Análisis: las variables cualitativas se describieron en forma de porcentajes y las cuantitativas en forma de media y desviaciones estándares. Resultados. La muestra total fue de 68 pacientes con una media de edad de 68 ± 12 años; un 59 % de los pacientes fueron varones. La etiología de la insuficiencia cardiaca fue en un 37 % de causa no isquémica, en un 40 % de causa isquémica, en el 10 % valvular y en un 13 % de otras etiologías. Los trastornos del sueño estaban presentes en el 48.5 % del total de la muestra (33 pacientes). Los pacientes con trastornos del sueño presentaron mayor incidencia de efectos adversos cardiovasculares en el seguimiento (21 % frente a 0 %; p < 0.05). Conclusiones. La prevalencia de los trastornos del sueño es alta en pacientes con insuficiencia cardiaca y se asocia a un peor pronóstico clínico (AU)

Objectives. To evaluate the prevalence and prognostic implications of sleep disorders in patients with chronic heart failure treated in a hospital’s Heart Failure Unit. Method. An observational, descriptive and prospective study. The study was carried out in Hospital de la Santa Creu i Sant Pau Heart Failure Unit, Barcelona. Participants consisted of patients arriving to the Unit for the first time between April and November 2014. An assessment of sleeping disorders was performed using the modified questionnaire Insomnia Severity Index8,9. Patient’s sociodemographic, clinical and pharmacological data was obtained from their medical history. Adverse events during follow-up, (hospitalization due to heart failure and/or cardiovascular death), were assessed. In the analysis, qualitative variables were described as percentages and quantitative variables as mean and standard deviations. Results. The total sample consisted of 68 patients with a mean age of 68 ± 12 years. 59 % of patients were male. The etiological cause of heart failure was: in 37 % of the cases non-ischemic, 40 % ischemic, 10 % valvular and 13 % presented other etiologies. Sleep disorders were present in 48.5 % of the total sample (33 patients). Patients with sleep disorders had a higher incidence of cardiovascular adverse effects during the follow-up: 21 % vs 0 %; p <0.05. Conclusions. The prevalence of sleep disorders is high in patients with heart failure and is associated with a worse clinical prognosis (AU)

Estudio longitudinal de la inserción laboral de los estudiantes de máster en Enfermería / Longitudinal study on employability in students pursing nursing masters degrees

Introducción. El nivel de formación incide positivamente en la tasa de ocupación. No existen datos a nivel español de las tasas de ocupación en los estudiantes de máster en Enfermería. El objetivo del estudio fue determinar la situación laboral y grado de satisfacción con su formación en esta población. Metodología. Estudio longitudinal prospectivo de los estudiantes de máster en Enfermería (EUI-Sant Pau, cursos 2010/2011-2013/2014). La recogida de información se realizó mediante un cuestionario ad hoc administrado el primer y último día de clase, y 12 meses después de finalizar los estudios. Resultados. La muestra total fue de 587 estudiantes al inicio del máster, 519 al final de curso y de 291 un año después de finalizarlo. El 86.2 % de los estudiantes trabajaba al inicio del máster. Un 43.8 % de los estudiantes desempleados al inicio del máster trabajaba a los 12 meses de completar la formación. La proporción de estudiantes que trabajaban en un área relacionada con el máster aumentó progresivamente en los tres momentos de evaluación (59.2 %, 61.6 %, 70.2 %, p = .020). El nivel de satisfacción y la utilidad percibida de los estudios de máster a final de curso se valoró con puntuaciones de 4/5 o 5/5 en un 92 % y 78.9 % de los titulados, respectivamente. Conclusiones. Los estudiantes de Enfermería presentan una alta tasa de ocupación. La proporción de alumnos que trabaja en un área relacionada con el máster aumenta desde el inicio del curso hasta un año después de la finalización del máster. La mayoría expresa un grado de satisfacción elevado y considera útil la formación recibida (AU)

Introduction. There is a positive relation between education and employment rates. Unfortunately, there is currently no available data on Spanish employment rates in students pursuing nursing Masters degrees. The aim of this study is to determine the employment situation and satisfaction with their degree among the aforementioned population. Methods. Prospective longitudinal study on nursing Masters students (EUI-Sant Pau years 2010/2011-2013/2014). Data was collected using a questionnaire completed during the first and last day of class and one year after the end of their studies. Results. The total sample included 587 students at the beginning of the course, 519 students at the end of the course and 291 students one year after the end of their studies. 86.2 % of students were employed at the beginning of their studies. 43.8% of students who were initially unemployed were employed one year after finishing the course. The proportion of students working in an area related to the Masters degree increased progressively during the three consecutive evaluations (59.2 %, 61.6 %, 70.2 %, p = .020). Satisfaction and perceived usefulness at the end of the course were rated as 4/5 and 5/5 in 92 % and 78.9 % of cases respectively. Conclusions. Nursing students have a high employment rate. The proportion of students who work in an area related to their Masers studies increases from the start of the course until the first year after completing the Masters. Most students express a high degree of satisfaction and perceived usefulness of the training received (AU)

Alfabetización en salud en pacientes con insuficiencia cardiaca atendidos en atención primaria / Health literacy in patients with heart failure treated in primary care

OBJETIVOS: Examinar el nivel de alfabetización en salud y los factores que la condicionan en pacientes con insuficiencia cardiaca visitados en atención primaria. DISEÑO: Estudio transversal multicéntrico. Emplazamiento. Diez centros de atención primaria del área metropolitana de Barcelona. PARTICIPANTES: Pacientes con diagnóstico de insuficiencia cardiaca. CRITERIOS DE INCLUSIÓN: visita al centro de salud en el último año, desplazarse al centro de manera autónoma y acceder a participar voluntariamente. Mediciones principales. Cuestionarios Health Literacy Survey - European Union (HLS-EU-Q) y versión española de la Escala Europea de Autocuidado en Insuficiencia Cardiaca (EHFScBS). Se analizó la relación entre ambas escalas y variables sociodemográficas y clínicas mediante el test de ANOVA y un modelo de regresión lineal múltiple. RESULTADOS: Se incluyeron 318 pacientes (51,2% mujeres), con una media de edad de 77,9±8,7 años. El índice de alfabetización en salud del 79,6% (n=253) de los participantes fue de competencia insuficiente para comprender la información de salud. Los factores que explicaron la alfabetización en salud fueron el nivel académico (p < 0,001), la clasificación funcional de insuficiencia cardiaca (p = 0,032), los autocuidados y la edad (p < 0,04). El nivel académico explicaba el 61,6% del nivel de alfabetización (IC 95% bootstrap: 44,58%; 46,75%). CONCLUSIONES: La alfabetización en salud permite explicar la actitud de los pacientes hacia el régimen terapéutico que requiere la insuficiencia cardiaca. En los pacientes con insuficiencia cardiaca, los médicos y enfermeras de atención primaria han de tener en cuenta los factores que facilitan la comprensión de la información de salud

OBJECTIVES: The level of health literacy is examined, as well as its conditioning factors in patients with heart failure who are seen routinely in a Primary Health Care Area. DESIGN: A multicentre cross-sectional study. SETTING: 10 Primary care centres from the metropolitan area of Barcelona. Participants. Patients diagnosed with heart failure. Inclusion criteria: to have visited the Primary Health Care centre in the last year, being able to arrive at the primary care setting independently, and voluntarily participation. Main measurements. Health Literacy Survey-European Union - Questionnaire (HLS-EU-Q) and Spanish version of the European Heart Failure Self-care Behaviour Scale. An analysis was made of the relationships between health literacy, self-care practices, sociodemographic, and clinical variables using ANOVA test and a multiple linear regression model. RESULTS: The study included 318 patients (51.2% women) with a mean age of 77.9±8.7 years. The index of health literacy of 79.6% (n=253) of the participants indicated problems in understanding healthcare information. Health literacy level was explained by academic level (P<.001), the extent of heart failure (P=.032), self-care, and age (P<.04).The academic level explained 61.6% of the health of literacy (95% bootstrap: 44.58%; 46.75%). CONCLUSIONS: In patients with stable heart failure, it is important to consider all factors that help patients to understand the healthcare information. Health literacy explains patient self-care attitude in heart failur

[Health literacy in patients with heart failure treated in primary care]. / Alfabetización en salud en pacientes con insuficiencia cardiaca atendidos en atención primaria.

OBJECTIVES: The level of health literacy is examined, as well as its conditioning factors in patients with heart failure who are seen routinely in a Primary Health Care Area. DESIGN: A multicentre cross-sectional study. SETTING: 10 Primary care centres from the metropolitan area of Barcelona. PARTICIPANTS: Patients diagnosed with heart failure. INCLUSION CRITERIA: to have visited the Primary Health Care centre in the last year, being able to arrive at the primary care setting independently, and voluntarily participation. MAIN MEASUREMENTS: Health Literacy Survey-European Union - Questionnaire (HLS-EU-Q) and Spanish version of the European Heart Failure Self-care Behaviour Scale. An analysis was made of the relationships between health literacy, self-care practices, sociodemographic, and clinical variables using ANOVA test and a multiple linear regression model. RESULTS: The study included 318 patients (51.2% women) with a mean age of 77.9±8.7 years. The index of health literacy of 79.6% (n=253) of the participants indicated problems in understanding healthcare information. Health literacy level was explained by academic level (P<.001), the extent of heart failure (P=.032), self-care, and age (P<.04).The academic level explained 61.6% of the health of literacy (95% bootstrap: 44.58%; 46.75%). CONCLUSIONS: In patients with stable heart failure, it is important to consider all factors that help patients to understand the healthcare information. Health literacy explains patient self-care attitude in heart failure.