Incorporación urgente de estudiantes de Enfermería durante la pandemia por COVID-19: análisis de competencias / Emergency incorporation of Nursing students during the COVID-19 pandemic: an analysis of competences

Objetivo: describir el nivel de competencia de los y las estudiantes del Grado en Enfermería contratadas como refuerzo en el Hospital Universitario Vall d’Hebron (Barcelona) durante la primera ola de la pandemia por COVID-19 y determinar su satis-facción con el entorno clínico. Método: estudio descriptivo transversal. Se incluyó a todas las personas contratadas (n= 39) entre febrero y mayo de 2020. Al mes de la incorporación se recogieron variables demográficas académicas, laborables y se midió el nivel de competencia (Cuestionario COM_VAT© de 21 ítems puntuados entre 1: ejecución insuficiente y 4 ejecución autónoma y correcta) y la satisfacción con el entorno clínico (cuestionario diseñado ad hoc de tres dimensiones -orientación, integración con el equipo y adaptación al entorno laboral- evaluadas con 15 ítems puntuados de 1 muy en desacuerdo a 5 muy de acuerdo). Se realizó estadística descriptiva y bivariante. Resultados: participaron las 39 personas. La puntuación global mediana de la evaluación competencial fue de 3,9 sobre 4 pun-tos [RIC 3,7-4]. La competencia de valorar, diagnosticar y abordar situaciones de salud cambiantes obtuvo 3,85 puntos [RIC 3,4-4]. La competencia de ayudar al paciente a cumplir el tratamiento y hacerlo partícipe de 4 [RIC 4-4] y la competencia de contribuir a garantizar la seguridad y el proceso asistencial de 3,8 [RIC 3,6 – 4]. La mediana de satisfacción con el entorno clínico fue de 69 sobre 75 [RIC 63-74] sin diferencias estadísticamente significativas en ella en función del resto de características. Conclusión: las personas participantes mostraron un nivel de competencia que representa una correcta ejecución, pero que puede requerir ayuda ocasional. Reportaron una alta satisfacción con el entorno clínico.(AU)

Objective: to describe the level of competence among Nursing Degree students hired as support at the Hospital Universitario Vall d’Hebron (Barcelona) during the first wave of the COVID-19 pandemic, and to determine their satisfaction with the clinical environment. Method: a descriptive cross-sectional study, including all persons hired (n= 39) between February and March 2020. Demographic, academic and occupational variables were collected at one month of their incorporation, and their level of competence was measured (COM_VAT© questionnaire with 21 items scored from 1: insufficient performance, to 4: autonomous and correct performance), as well as the satisfaction with their clinical environment (questionnaire designed ad hoc with three dimensions: orientation, integration with the team, and adaptation to the work environment, evaluated through 15 items scored from 1: high disagreement, to 5: high agreement). Descriptive and bivariate statistics was used. Results: all 39 persons were included. The overall median score of the evaluation of skills was 3.9 out of 4 scores [IQR 3.7-4]. The competence of assessing, diagnosing and addressing ever-changing health situations obtained a score of 3.85 [IQR 3.4-4]. The competence of helping patients to comply with treatment and getting them involved obtained a 4 [IQR 4-4], and the competence of contributing to guarantee safety and care process obtained 3.8 [IQR 3.6 – 4]. The median satisfaction with the clinical environment was 69 out of 75 [IQR 63-74] without statistically significant differences according to the other characteristics .Conclusion: the participants showed a level of competence ensuring correct performance, but that might require occasional help. They reported high satisfaction with the clinical environment.Keywords:care; coronavirus infections; volunteers; clinical competence; nursing students; job satisfaction; working conditions; cross-sectional studies.(AU)

Impact of the COVID-19 pandemic on the activity of advanced-practice nurses on a reference unit for inflammatory bowel disease / Impacto de la pandemia por COVID-19 en la actividad de la enfermera de práctica avanzada, en enfermedad inflamatoria intestinal en una unidad de referencia

Objective: To report the impact of the COVID-19 pandemic on the activity of nurses working on an inflammatory bowel disease (IBD) unit and to identify reasons for telehealth care and its relationship to certain characteristics. Background: The COVID-19 pandemic had led to an increase in demand for remote care in patients with inflammatory bowel disease who require monitoring and frequent access to health services. Design – methods: A retrospective study of all activity (in person and by phone call or email) done on the unit during the acute phase of the pandemic at a reference hospital in Spain. Numbers of activities done by nurses, reasons for telehealth care and sociodemographic and clinical data were collected. Statistical analysis was performed using frequency, chi-squared and analysis of variance tests. Results: A total of 1095 activities for 561 patients who received care were reported. Among them, 1042 (95.2%) were telemedicine activities, amounting to a 47.3% increase over the prior year. COVID-19-related activities numbered 588 (59.5%). Consultations due to disease flare-up numbered 134 (13.7%), representing a 145% increase compared to 2019. Significant differences were found between reasons for using telemedicine and diagnosis, occupational status, contact week and treatment. Conclusion: The acute phase of the pandemic has changed the activity managed by the nursing staff on the unit. Identifying and analysing these changes has yielded valuable information to achieve more efficient management and better care quality for patients in special situations.(AU)

Objetivos: Describir el impacto de la pandemia por COVID-19 en la actividad de la enfermera, en enfermedad inflamatoria intestinal (EII) de la unidad, e identificar las razones de la asistencia telemática y la relación con las variables recogidas. Antecedentes: La pandemia de COVID-19 ha dado lugar a un aumento en la demanda de atención remota en pacientes con EII que requieren un seguimiento y un acceso frecuente a los servicios de salud. Diseño y métodos: Estudio retrospectivo de toda la actividad (presencia, llamada telefónica o correo electrónico), realizado en la unidad durante la fase aguda de la pandemia, en un hospital de referencia en España. Se recogió el número de actividades llevadas a cabo por la enfermera, motivo de asistencia telemática y datos sociodemográficos y clínicos. El análisis estadístico se realizó utilizando la prueba de frecuencia, χ2 y el análisis de varianza. Resultados: Fueron registradas 1.095 actividades por 561 pacientes atendidos, siendo 1.042 (95,2%) actividades de telemedicina, lo que supuso un incremento del 47,3% con respecto al año anterior. Las demandas relacionadas con COVID-19 fueron 588 (59,5%). Por otro lado, 134 (13,7%) fueron consultas por brote de su enfermedad, un 145% más que en 2019. Se han encontrado diferencias significativas entre los motivos del uso de la telemedicina y el diagnóstico, la situación laboral, la semana en que se realizó el contacto y el tratamiento. Conclusión: La fase aguda de la pandemia ha cambiado la actividad gestionada por enfermería en la unidad. Identificar y analizar estos cambios nos ha proporcionado información para conseguir una gestión más eficiente y de calidad al cuidado de los pacientes en situaciones excepcionales.(AU)

Impact of the COVID-19 pandemic on the activity of advanced-practice nurses on a reference unit for inflammatory bowel disease.

OBJECTIVE: To report the impact of the COVID-19 pandemic on the activity of nurses working on an inflammatory bowel disease (IBD) unit and to identify reasons for telehealth care and its relationship to certain characteristics. BACKGROUND: The COVID-19 pandemic had led to an increase in demand for remote care in patients with inflammatory bowel disease who require monitoring and frequent access to health services. DESIGN - METHODS: A retrospective study of all activity (in person and by phone call or email) done on the unit during the acute phase of the pandemic at a reference hospital in Spain. Numbers of activities done by nurses, reasons for telehealth care and sociodemographic and clinical data were collected. Statistical analysis was performed using frequency, chi-squared and analysis of variance tests. RESULTS: A total of 1095 activities for 561 patients who received care were reported. Among them, 1042 (95.2%) were telemedicine activities, amounting to a 47.3% increase over the prior year. COVID-19-related activities numbered 588 (59.5%). Consultations due to disease flare-up numbered 134 (13.7%), representing a 145% increase compared to 2019. Significant differences were found between reasons for using telemedicine and diagnosis, occupational status, contact week and treatment. CONCLUSION: The acute phase of the pandemic has changed the activity managed by the nursing staff on the unit. Identifying and analysing these changes has yielded valuable information to achieve more efficient management and better care quality for patients in special situations.

Perfil de los pacientes hospitalizados en dispositivos asistenciales habilitados durante la pandemia por SARS-CoV-2 / Profile of the patients hospitalized in healthcare resources provided during the SARS-CoV-2 pandemic

OBJETIVO: describir el perfil demográfico, clínico y los indicadores de progresión de los pacientes hospitalizados en dispositivos asistenciales habilitados durante la pandemia por SARS-CoV-2. MÉTODO: estudio observacional retrospectivo. Se incluyeron todos pacientes atendidos en el Pabellón Salud Vall d'Hebron (Barcelona) durante el periodo de su apertura (29 marzo al 18 abril de 2020). Se analizaron variables demográficas, clínicas y de progresión. Se llevó a cabo análisis descriptivo. RESULTADOS: 63 pacientes. El 55,6% (n= 35) era hombre, la media de edad fue de 76,5 (11,88) años. Al ingreso, el 79,3% (n= 50) no presentaba antecedentes de deterioro cognitivo; el 61,9% (n= 39) deambulaba de forma libre o controlada; el 74,6% (n= 47) no presentaba problemas de continencia; el 39,7% (n= 25) fue valorado sin riesgo de lesión por presión. La estancia media (DE) fue de 8,1 (3,8) días. En relación a la presencia de eventos adversos durante su estancia hospitalaria, el 12,7% (n= 8) presentó una lesión por presión, el 6,3% (n= 4) algún episodio de desorientación y fueron declaradas dos caídas. Un 67% (n= 42) tenía el diagnóstico principal de Enfermería de Riesgo de sepsis y el 41,3% (n= 26) precisaron continuidad de cuidados. CONCLUSIONES: el perfil del paciente atendido en estos dispositivos asistenciales correspondió a una persona anciana, sin indicadores de fragilidad evidentes y sin eventos adversos destacables durante su estancia. Las unidades de hospitalización habilitadas durante la pandemia por COVID-19 representan un recurso adecuado y seguro para la atención a los pacientes en situación de emergencia

OBJECTIVE: to describe the demographical and clinical profile and the progression indicators for patients hospitalized in healthcare resources provided during the SARS-COV-2 pandemic. METHOD: an observational retrospective study, which included all patients seen at the Pabellón Salud Vall d'Hebron (Barcelona) during its opening period (March, 29th to April, 18th, 2020). Demographic, clinical and progression variables were analyzed; descriptive analysis was conducted. RESULTS: the study included 63 patients; 55.6% (n= 35) were male, with a mean age of 76.5 (11.88) years. At admission, 79.3% (n= 50) did not present a previous history of cognitive deterioration; 61.9% (n= 39) could walk in a free or controlled way; 74.6% (n= 47) did not present continence issues; 39.7% (n= 25) were evaluated as without risk of pressure injury. The mean stay (SD) was 8.1 (3.8) days. Regarding the presence of adverse events during their hospital stay, 12.7% (n= 8) presented pressure injuries, 6.3% (n= 4) had some disorientation episode, and two falls were reported; while 67% (n= 42) had the primary Nursing diagnosis of Risk of Sepsis, and 41.3% (n= 26) required continuity of care. CONCLUSIONS: the profile of the patient managed in these healthcare resources was an elderly person, without evident frailty indicators, and without any outstanding adverse events during their stay. The hospitalization units provided during the COVID-19 represented an adequate and safe resource for patient care in an emergency situation

Acuity, nurse staffing and workforce, missed care and patient outcomes: A cluster-unit-level descriptive comparison.

AIM: To compare the patient acuity, nurse staffing and workforce, missed nursing care and patient outcomes among hospital unit-clusters. BACKGROUND: Relationships among acuity, nurse staffing and workforce, missed nursing care and patient outcomes are not completely understood. METHOD: Descriptive design with data from four unit-clusters: medical, surgical, combined and step-down units. Descriptive statistics were used to compare acuity, nurse staffing coverage, education and expertise, missed nursing care and selected nurse-sensitive outcomes. RESULTS: Patient acuity in general (medical, surgical and combined) floors is similar to step-down units, with an average of 5.6 required RN hours per patient day. In general wards, available RN hours per patient day reach only 50% of required RN hours to meet patient needs. Workforce measures are comparable among unit-clusters, and average missed nursing care is 21%. Patient outcomes vary among unit-clusters. CONCLUSION: Patient acuity is similar among unit-clusters, while nurse staffing coverage is halved in general wards. While RN education, expertise and missed care are comparable among unit-clusters, mortality, skin injuries and risk of family compassion fatigue rates are higher in general wards. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers play a pivotal role in hustling policymakers to address structural understaffing in general wards, to maximize patient safety outcomes.