Desigualdades de género, edad y situación sociolaboral. Programa de actividad fisica Activa-Murcia / Gender, Age and Socio-Occupational Inequalities. Activa-Murcia Physical Activity Program

El objetivo de este estudio fue describir las características diferenciales por sexo y edad en un Programa de actividad física (ACTIVA-Murcia) desde una perspectiva de género. Se realizó un estudio descriptivo mediante análisis secundario en 411 participantes de dos centros de salud de Murcia. El 62,3% fueron mujeres y el 71,8% tenían entre 45 y 64 años. Entre los hombres, el 57,8% estaban laboralmente activos y tenían una actividad física cuya mediana fue de 1.939,5 METs/semanales. Entre las mujeres, el 37,4% estaban activas laboralmente y realizaban una mediana de 1.386,0 METs/semanales. El motivo de ausencia a alguna sesión por enfermedad fue del 53,4% para las mujeres y el 30,4% para los hombres. Los profesionales deben considerar estas diferencias en la promoción de actividad física

The objective of this study was to describe the differential characteristics by sex and age in a physical activity Program (ACTIVA-Murcia) from a gender perspective. A descriptive study by secondary analysis was conducted on 411 participants from two municipality health centers in Murcia. 62.3% were women and 71.8% were between 45 and 64 years of age. Among men, 57.8% were working and they had a median physical activity of 1,939.5 METs/week. Among women, 37.4% were active in work, performing a median of 1,386.0 METs/week. The most declared reason of absence from any session was illness, as stated by 53.4% of women and 30.4% of men. Professionals should consider these differences in the promotion of physical activity

Elevación óptima del cabecero para disminuir la presión intracraneal. Revisión sistemática / Optimal head elevation to minimise intracranial pressure. A systematic review

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Evaluación del impacto de un plan de cuidados de enfermería de pacientes con EPOC con diagnóstico enfermero «Manejo inefectivo del régimen terapéutico», en términos de mejora del criterio de resultado de enfermería (NOC) «Conocimiento del régimen terapeutico» / Impact assessment of a plan of nursing care of patients diagnosed with COPD nurse «Ineffective management of therapeutic regimen», in terms of improving the nursing outcomes (NOC) «Knowledge of therapeutic regime»

Objetivo: Conocer el impacto en el ‘Conocimiento del régimen terapéutico’, en pacientes con un plan de cuidados sobre ‘Manejo inefectivo del régimen terapéutico’. Método: Estudio cuasiexperimental, en dos Hospitales Generales Universitarios (junio 2007 - diciembre 2008) pacientes con EPOC. Grupo intervención: plan de cuidados desarrollado mediante taxonomías; grupo control: asistencia hospitalaria habitual. Resultados: 143 pacientes incluidos en el estudio (grupo intervención=56; grupo control =87). Mejora NOC a las 2 semanas (69.2% intervención vs. 10,7% control; p<,008); mejora NOC a las 24 semanas (68.7% vs.10.1%, p<,001). Indicadores descripción justificación régimen terapéutico; actividad prescrita; beneficios del tratamiento mejoran con p<,001. Conclusiones: La implementación de un plan de cuidados dirigido al alta orientado al incremento del Implicaciones para la práctica: La implementación de taxonomías en planificación de cuidados orientados al alta constituyen una herramienta para evaluar resultados de las intervenciones enfermeras y su evolución (AU)

Purpose: To determine the impact on the «Knowledge of the therapeutic regimen», in patients with a care plan on "ineffective management of therapeutic regimen." Methods: Quasi-experimental study in two General Hospitals University (June 2007 - December 2008) COPD patients. Group intervention: care plan developed by taxonomies; Control group: usual hospital care. Findings: 143 patients were Recruited (Intervention group = 56, control group = 87). NOC improvement at 2 weeks (69.2% vs 10.7% intervention control; p <.008); NOC improvement at 24 weeks (68.7% vs.10.1%; p <.001). Indicators "description regimen justification"; "Prescribed activity"; "Treatment benefit" better with p <.001. Conclusions: The implementation of a discharged plan care direct to increase the nursing outcome classification improves management of therapeutic regimen. Implications for nursing practice: The implementation of taxonomies in care planning discharged are a tool that allow to evaluate outcomes of nursing interventions and its evolution (AU)

Estudio RN4CAST en Murcia: características organizacionales de los hospitales y perfiles enfermeros / RN4CAST Study in Murcia: Hospital organizational characteristics and nursing staff profiles

Objetivo. Conocer los perfiles de las enfermeras de los hospitales públicos de Murcia y su percepción sobre el entorno laboral, la calidad de los cuidados y su nivel de burnout (réplica metodológica proyecto RN4CAST). Material y métodos. Estudio descriptivo y transversal realizado en 8 hospitales de Murcia. Se recogieron datos entre 2009 y 2010 a 687 enfermeras (estratificando por tipo de unidades) mediante cuestionario autocumplimentado de 149 ítems con variables sociodemográficas, del trabajo, de la percepción del ambiente laboral (PES-NWI), del burnout (Maslach Burnout Inventory), de la calidad y de la seguridad del paciente. Análisis: pruebas no paramétricas para 2 muestras o k muestras según la comparación. Resultados. Se recogieron 495 encuestas (72%). El 80,4% eran mujeres con una edad media de 34,1 (DE = 7,1) años y de 9,4 (DE = 7,4) años trabajados. El 25,7% ha realizado durante los últimos 24 meses más de 300 h de formación. La ratio paciente/enfermera fue de 11,7 (DE = 3,6) con variabilidad entre hospitales. Dos hospitales tenían un clima desfavorable y 3 hospitales tuvieron clima favorable (los hospitales grandes obtuvieron peores valoraciones); se observó una baja intención de abandonar el trabajo (16,8%). Con respecto al burnout en agotamiento emocional se alcanzó una puntuación de 18,4; en despersonalización de 7,5 y en realización personal de 28,8. La percepción sobre la calidad presentó diferencias entre centros y la de los efectos adversos fue más favorable en los hospitales pequeños. Conclusiones. Los profesionales estudiados estaban satisfechos, pero habría que potenciar los factores que generan bienestar y minimizar los puntos débiles detectados en el análisis del clima laboral (AU)

Objective: To determine the profile of nurses in public hospitals in Murcia and to assess how they perceive their work environment, the quality of care and their level of burnout (the RN4CAST project repetition). Material and methods: A cross-sectional descriptive study was carried out in 8 hospitals in Murcia. Data were collected between 2009 and 2010 from 687 nurses (stratified by the type of unit) using a self-completed questionnaire with 149 items covering variables related to sociodemographics; work; perception of the work place (PES-NWI); burnout (Maslach Burnout Inventory); and the quality of patient care, and patient safety. Analysis: Non parametric tests, for two samples or k samples according to the comparison. Results: A total of 495 questionnaires were collected (72%). Most respondents were female (80.4%) having a mean age of 34.1 (SD = 7.1) years, and they had been working for 9.4 (SD = 7.4) years. Just over one-quarter (25.7%) had carried out more than 300 hours of training in the previous 24 months. The patient/nurse ratio was 11.7 (SD = 3.6), varying between hospitals. The nurses reported 25% of hospitals as having an unfavorable work environment, whereas 37.5% had favorable ones; large hospitals were less highly valued. Few respondents intended to give up their jobs (16.8%). Burnout levels revealed emotional exhaustion in 18.4% of respondents; depersonalization in 7.5%, and personal fulfillment in 28.8%. Perception of quality varied between centers and the perception of adverse effects was more favorable in small hospitals. Conclusions: Our professionals were generally satisfied, but given the unfavorable work environment, measures should be adopted for improving well-being and reducing weaknesses (AU)

[RN4CAST Study in Murcia: Hospital organizational characteristics and nursing staff profiles]. / Estudio RN4CAST en Murcia: características organizacionales de los hospitales y perfiles enfermeros.

OBJECTIVE: To determine the profile of nurses in public hospitals in Murcia and to assess how they perceive their work environment, the quality of care and their level of burnout (the RN4CAST project repetition). MATERIAL AND METHODS: A cross-sectional descriptive study was carried out in 8 hospitals in Murcia. Data were collected between 2009 and 2010 from 687 nurses (stratified by the type of unit) using a self-completed questionnaire with 149 items covering variables related to sociodemographics; work; perception of the work place (PES-NWI); burnout (Maslach Burnout Inventory); and the quality of patient care, and patient safety. ANALYSIS: Non parametric tests, for two samples or k samples according to the comparison. RESULTS: A total of 495 questionnaires were collected (72%). Most respondents were female (80.4%) having a mean age of 34.1 (SD=7.1) years, and they had been working for 9.4 (SD=7.4) years. Just over one-quarter (25.7%) had carried out more than 300 hours of training in the previous 24 months. The patient/nurse ratio was 11.7 (SD=3.6), varying between hospitals. The nurses reported 25% of hospitals as having an unfavorable work environment, whereas 37.5% had favorable ones; large hospitals were less highly valued. Few respondents intended to give up their jobs (16.8%). Burnout levels revealed emotional exhaustion in 18.4% of respondents; depersonalization in 7.5%, and personal fulfillment in 28.8%. Perception of quality varied between centers and the perception of adverse effects was more favorable in small hospitals. CONCLUSIONS: Our professionals were generally satisfied, but given the unfavorable work environment, measures should be adopted for improving well-being and reducing weaknesses.

Estudio descriptivo sobre resultados de salud de pacientes oncohematológicos e intervenciones enfermeras / Descriptive study of nursing-sensitive outcomes in oncohematological patients and nursing interventions

Objetivo. Conocer el estado de los principales resultados de salud de los pacientes oncohematológicos durante su ingreso y evaluar algunas de sus intervenciones enfermeras. Material y métodos. Estudio prospectivo observacional realizado en las unidades de oncohematología del Hospital Morales Meseguer, con pacientes que precisaron ingreso entre marzo de 2006 y junio de 2007. Resultados. Se estudiaron a 56 pacientes. El 69,6% (39 pacientes) presentaba algún nivel de mucositis, apareciendo valoraciones enfermeras objetivas en el 10,7% (6). El 92,9% (52) de los pacientes estaba bajo tratamiento antiemético, pero en el 48,2% (27) no se recoge ningún tipo de registro de valoración enfermera del síntoma. Se realizó interconsulta a la Unidad de Nutrición para 10 pacientes (17,9%). Los niveles de ansiedad y el impacto psicosocial descienden a lo largo de la estancia hospitalaria, sin embargo, aumenta la satisfacción y los familiares presentan mayor sobrecarga. Apareció una úlcera por presión (UPP). Hubo un 8,2% (4) de colonizaciones de catéter y se produjeron 5 bacteriemias relacionadas con catéter (BRC); las obstrucciones de éstos se produjeron en el 39,3% (22). Conclusiones. La incidencia de aparición de mucositis, UPP y BRC es menor que en otros estudios. El proceso de valoración del dolor y de las náuseas y vómitos no está normalizado. La ansiedad muestra unos niveles inferiores a otros estudios. Su mejoría, al igual que en el ajuste psicosocial, apunta a un proceso de adaptación a la enfermedad. El aumento de la sobrecarga del cuidador se relaciona con el largo proceso. Su satisfacción frente a los cuidados enfermeros ha alcanzado 55 puntos de la escala, cuyo nivel máximo es de 70(AU)

Objective.To assess the main nursing-sensitive outcomes in oncohematological patients admitted to hospital and to evaluate nursing interventions. Material and methods. We performed a prospective, observational study in the oncohematological units of the Morales Meseguer Hospital. The sample included patients admitted from March 2006 to June 2007. Results. A total of 56 patients were studied. Of these, 39 patients (69.6%) had some degree of mucositis but only six patients (10.7%) were assessed objectively by nurses. Fifty-two patients (92.9%) received anti-emetic treatment, but there were no reports of nausea or vomiting in 27 (48.2%). Ten patients (17.9%) were referred to the nutritional unit. Anxiety levels and psychosocial impact decreased during hospital admission and patient satisfaction increased but family members experienced greater stress. Pressure ulcer developed in only one patient. Four catheters (8.2%) became infected and there were five cases of catheter-related bacteremia. There were 22 cases of catheter obstruction (39.9%). Conclusions. The incidence of mucositis, pressure ulcer and catheter-related bacteremia was lower than in other studies. There was no standard assessment of pain, nausea or vomiting. Anxiety levels were lower than in other studies. Improvement and psychosocial adjustment suggested a process of adaptation to the disease. The increase in caregiver burden was related to the disease in the long term. Satisfaction with nursing care was 55 points on a 70-point scale(AU)

[Descriptive study of nursing-sensitive outcomes in oncohematological patients and nursing interventions]. / Estudio descriptivo sobre resultados de salud de pacientes oncohematológicos e intervenciones enfermeras.

OBJECTIVE: To assess the main nursing-sensitive outcomes in oncohematological patients admitted to hospital and to evaluate nursing interventions. MATERIAL AND METHODS: We performed a prospective, observational study in the oncohematological units of the Morales Meseguer Hospital. The sample included patients admitted from March 2006 to June 2007. RESULTS: A total of 56 patients were studied. Of these, 39 patients (69.6%) had some degree of mucositis but only six patients (10.7%) were assessed objectively by nurses. Fifty-two patients (92.9%) received anti-emetic treatment, but there were no reports of nausea or vomiting in 27 (48.2%). Ten patients (17.9%) were referred to the nutritional unit. Anxiety levels and psychosocial impact decreased during hospital admission and patient satisfaction increased but family members experienced greater stress. Pressure ulcer developed in only one patient. Four catheters (8.2%) became infected and there were five cases of catheter-related bacteremia. There were 22 cases of catheter obstruction (39.9%). CONCLUSIONS: The incidence of mucositis, pressure ulcer and catheter-related bacteremia was lower than in other studies. There was no standard assessment of pain, nausea or vomiting. Anxiety levels were lower than in other studies. Improvement and psychosocial adjustment suggested a process of adaptation to the disease. The increase in caregiver burden was related to the disease in the long term. Satisfaction with nursing care was 55 points on a 70-point scale.

[Nursing care for patients with toxic epidermal necrolysis]. / Cuidados de enfermería en el paciente con necrólisis epidérmica tóxica.

Toxic Epidermal Necrolysis (TEN) is a severe skin disorder characterised by separation of the dermal-epidermal junction, as it is observed in second degree superficial burns, and it may also involve any mucosal surface area (otic, buccal, conjunctival, respiratory, genital). This condition is generally induced by the ingestion of drugs, particularly certain antibiotics, nonsteroidal antiinflammatory drugs, and antiepileptic drugs. Mortality has decreased over the last decades, from 80% to about 25% in recent series. This improvement in survival rate has been related to early diagnosis, management in specialized burn units, proper immunosuppressive treatment and intensive specialised nursing care. The main nursing diagnosis include abnormalities in the skin and mucose membranes integrity, risk of infection, loss of blood volume, risk of hypothermia, acute pain, upper airway insufficiency and anxiety. We here review the nursing care of patients with TEN. We emphasize the daily skin and mucose membranes care, and the prevention of conjunctival sinequiae, including daily conjunctival cleaning and debridement of necrotic tissue and fibrin debris using a handle needle.