Peripheral intravenous catheter failure, nurse staffing levels and care complexity individual factors: A retrospective multicentre cohort study.

INTRODUCTION: Short peripheral intravenous catheter (PIVC) failure is a common complication that is generally underdiagnosed. Some studies have evaluated the factors associated with these complications, but the impact of care complexity individual factors and nurse staffing levels on PIVC failure is still to be assessed. The aim of this study was to determine the incidence and risk factors of PIVC failure in the public hospital system of the Southern Barcelona Metropolitan Area. METHODS: A retrospective multicentre observational cohort study of hospitalised adult patients was conducted in two public hospitals in Barcelona from 1st January 2016 to 31st December 2017. All adult patients admitted to the hospitalisation ward were included until the day of discharge. Patients were classified according to presence or absence of PIVC failure. The main outcomes were nurse staffing coverage (ATIC patient classification system) and 27-care complexity individual factors. Data were obtained from electronic health records in 2022. RESULTS: Of the 44,661 patients with a PIVC, catheter failure was recorded in 2,624 (5.9%) patients (2,577 [5.8%] phlebitis and 55 [0.1%] extravasation). PIVC failure was more frequent in female patients (42%), admitted to medical wards, unscheduled admissions, longer catheter dwell time (median 7.3 vs 2.2 days) and those with lower levels of nurse staffing coverage (mean 60.2 vs 71.5). Multivariate logistic regression analysis revealed that the female gender, medical ward admission, catheter dwell time, haemodynamic instability, uncontrolled pain, communication disorders, a high risk of haemorrhage, mental impairments, and a lack of caregiver support were independent factors associated with PIVC failure. Moreover, higher nurse staffing were a protective factor against PIVC failure (AUC, 0.73; 95% confidence interval [CI]: 0.72-0.74). CONCLUSION: About 6% of patients presented PIVC failure during hospitalisation. Several complexity factors were associated with PIVC failure and lower nurse staffing levels were identified in patients with PIVC failure. Institutions should consider that prior identification of care complexity individual factors and nurse staffing coverage could be associated with a reduced risk of PIVC failure.

Factores de complejidad de cuidados asociados a la reconsulta en un servicio de urgencias / Care complexity factors associated with revisits to an emergency department

Objetivo: Analizar la prevalencia de factores de complejidad de cuidados en los pacientes atendidos en el servicio de urgencias y determinar su relación con las reconsultas durante los 30 días posteriores a la vista inicial. Método: Estudio observacional transversal correlacional. Se incluyeron de forma consecutiva todos aquellos pacientes adultos que consultaron al servicio de urgencias de un hospital de tercer nivel durante un periodo de 6 meses. Las variables principales del estudio fueron la reconsulta a los 30 días y 26 factores individuales de complejidad de cuidados categorizados en 5 fuentes (psicoemocional, mental-cognitiva, sociocultural, evolutiva, comorbilidades-complicaciones). Los datos fueron recogidos de la historia clínica electrónica. Resultados: Se incluyeron un total de 15.556 episodios de pacientes. El 82,4% (12.811) presentó algún factor de complejidad de cuidados y el 11,9% (1.088) de los pacientes dados de alta reconsultaron durante los 30 días posteriores. La presencia de mayor número de factores de complejidad de cuidados se asoció a la reconsulta a los 30 días (OR: 1,26; IC 95%: 1,11-1,43; p < 0,05), y los siguientes factores se asociaron con reconsulta: incontinencia, inestabilidad hemodinámica, riesgo de hemorragia, extremo de edad, ansiedad y temor, deterioro de funciones cognitivas y analfabetismo (p < 0,05). Conclusiones: La prevalencia de factores de complejidad de cuidados en pacientes que consultan en el servicio de urgencias es elevada. Los pacientes que reconsultaron a los 30 días presentaron mayor número de factores de complejidad, por lo que su identificación precoz podría ayudar a estratificar los pacientes y diseñar estrategias preventivas para disminuir la incidencia de reconsultas. (AU)

Objectives: To analyze the prevalence of care complexity factors (CCFs) in patients coming to an emergency department (ED) and to analyze their relation to 30-day ED revisits. Methods: Observational, correlational, and cross-sectional study. Consecutive patients seeking care from a tertiarylevel hospital ED were included over a period of 6 months. The main variables studied were 30-day revisits to the ED and 26 CCFs categorized in 5 domains: psychoemotional, mental-cognitive, sociocultural, developmental, and comorbidity/complications. Data were collected from hospital records for analysis of descriptive and inferential statistics. Results: A total of 15 556 patient episodes were studied. A CCF was recorded in 12 811 patient records (82.4%), and 1088 (11.9%) of the patients discharged directly from the ED revisited within 30 days. The presence of more CCFswas associated with 30-day revisits (odds ratio, 1.26; 95% CI, 1.11-1.43; P < .05). The CCFs that were significantly associated with revisits were incontinence, hemodynamic instability, risk for bleeding, anxiety, very advanced age, anxiety and fear, cognitive impairment, and illiteracy. Conclusions: The prevalence of CCFs is high in patients who seek ED care. Patients revisiting within 30 days of an episode have more CCFs. Early identification of such patients would help to stratify risk and develop preventive strategies to decrease the incidence of revisiting. (AU)

Care complexity factors associated with revisits to an emergency department. / Factores de complejidad de cuidados asociados a la reconsulta en un servicio de urgencias.

OBJECTIVES: To analyze the prevalence of care complexity factors (CCFs) in patients coming to an emergency department (ED) and to analyze their relation to 30-day ED revisits. MATERIAL AND METHODS: Observational, correlational, and cross-sectional study. Consecutive patients seeking care from a tertiarylevel hospital ED were included over a period of 6 months. The main variables studied were 30-day revisits to the ED and 26 CCFs categorized in 5 domains: psychoemotional, mental-cognitive, sociocultural, developmental, and comorbidity/complications. Data were collected from hospital records for analysis of descriptive and inferential statistics. RESULTS: A total of 15 556 patient episodes were studied. A CCF was recorded in 12 811 patient records (82.4%), and 1088 (11.9%) of the patients discharged directly from the ED revisited within 30 days. The presence of more CCFs was associated with 30-day revisits (odds ratio, 1.26; 95% CI, 1.11-1.43; P .05). The CCFs that were significantly associated with revisits were incontinence, hemodynamic instability, risk for bleeding, anxiety, very advanced age, anxiety and fear, cognitive impairment, and illiteracy. CONCLUSION: The prevalence of CCFs is high in patients who seek ED care. Patients revisiting within 30 days of an episode have more CCFs. Early identification of such patients would help to stratify risk and develop preventive strategies to decrease the incidence of revisiting.

OBJETIVO: Analizar la prevalencia de factores de complejidad de cuidados en los pacientes atendidos en el servicio de urgencias y determinar su relación con las reconsultas durante los 30 días posteriores a la vista inicial. METODO: Estudio observacional transversal correlacional. Se incluyeron de forma consecutiva todos aquellos pacientes adultos que consultaron al servicio de urgencias de un hospital de tercer nivel durante un periodo de 6 meses. Las variables principales del estudio fueron la reconsulta a los 30 días y 26 factores individuales de complejidad de cuidados categorizados en 5 fuentes (psicoemocional, mental-cognitiva, sociocultural, evolutiva, comorbilidades-complicaciones). Los datos fueron recogidos de la historia clínica electrónica. RESULTADOS: Se incluyeron un total de 15.556 episodios de pacientes. El 82,4% (12.811) presentó algún factor de complejidad de cuidados y el 11,9% (1.088) de los pacientes dados de alta reconsultaron durante los 30 días posteriores. La presencia de mayor número de factores de complejidad de cuidados se asoció a la reconsulta a los 30 días (OR: 1,26; IC 95%: 1,11-1,43; p 0,05), y los siguientes factores se asociaron con reconsulta: incontinencia, inestabilidad hemodinámica, riesgo de hemorragia, extremo de edad, ansiedad y temor, deterioro de funciones cognitivas y analfabetismo (p 0,05). CONCLUSIONES: La prevalencia de factores de complejidad de cuidados en pacientes que consultan en el servicio de urgencias es elevada. Los pacientes que reconsultaron a los 30 días presentaron mayor número de factores de complejidad, por lo que su identificación precoz podría ayudar a estratificar los pacientes y diseñar estrategias preventivas para disminuir la incidencia de reconsultas.

Risk of acute deterioration and care complexity individual factors associated with health outcomes in hospitalised patients with COVID-19: a multicentre cohort study.

BACKGROUND: Evidence about the impact of systematic nursing surveillance on risk of acute deterioration of patients with COVID-19 and the effects of care complexity factors on inpatient outcomes is scarce. The aim of this study was to determine the association between acute deterioration risk, care complexity factors and unfavourable outcomes in hospitalised patients with COVID-19. METHODS: A multicentre cohort study was conducted from 1 to 31 March 2020 at seven hospitals in Catalonia. All adult patients with COVID-19 admitted to hospitals and with a complete minimum data set were recruited retrospectively. Patients were classified based on the presence or absence of a composite unfavourable outcome (in-hospital mortality and adverse events). The main measures included risk of acute deterioration (as measured using the VIDA early warning system) and care complexity factors. All data were obtained blinded from electronic health records. Multivariate logistic analysis was performed to identify the VIDA score and complexity factors associated with unfavourable outcomes. RESULTS: Out of a total of 1176 patients with COVID-19, 506 (43%) experienced an unfavourable outcome during hospitalisation. The frequency of unfavourable outcomes rose with increasing risk of acute deterioration as measured by the VIDA score. Risk factors independently associated with unfavourable outcomes were chronic underlying disease (OR: 1.90, 95% CI 1.32 to 2.72; p<0.001), mental status impairment (OR: 2.31, 95% CI 1.45 to 23.66; p<0.001), length of hospital stay (OR: 1.16, 95% CI 1.11 to 1.21; p<0.001) and high risk of acute deterioration (OR: 4.32, 95% CI 2.83 to 6.60; p<0.001). High-tech hospital admission was a protective factor against unfavourable outcomes (OR: 0.57, 95% CI 0.36 to 0.89; p=0.01). CONCLUSION: The systematic nursing surveillance of the status and evolution of COVID-19 inpatients, including the careful monitoring of acute deterioration risk and care complexity factors, may help reduce deleterious health outcomes in COVID-19 inpatients.

Actividad y resultados del Grupo de Investigación Enfermera (GRIN), Instituto de Investigación Biomédica de Bellvitge (IDIBELL) / Activity and outcomes of the Nursing Research Group (GRIN), Bellvitge Institute for Biomedical Research (IDIBELL)

Este artículo presenta la composición, líneas de investigación y evolución del grupo de investigación enfermera (GRIN) vinculado al Instituto de Investigación Biomédica de Bellvitge (IDIBELL). Las líneas principales de investigación van dirigidas a la prestación de cuidados enfermeros y su impacto en los resultados de salud de los pacientes y familias, orientándose principalmente en la investigación en cuidados a poblaciones vulnerables, enfermos críticos, pacientes crónicos complejos y personas en extremos de edad, en las siguientes áreas de interés: i) promoción de la salud; ii) innovaciones tecnológicas, sistemas de información e inteligencia artificial para la salud; iii) desarrollo metodológico, ético y social de los cuidados; iv) gestión de cuidados y resultados sensibles a la práctica enfermera; v) cribado, detección precoz y prevención de complicaciones y discapacidades. Actualmente el grupo está formado por 33 enfermeras/os, que pertenecen a cuatro hospitales y la Universidad de Barcelona, siendo el 48% doctores y el 36% doctorandos. El grupo ha producido más de 150 publicaciones científicas en siete años, de las cuales, durante el último año, el 50% fue en Q1 y el 20% en Q2, además destacando que el 60% de los proyectos obtuvo algún tipo de financiación durante el último año. El grupo de investigación está acreditado como grupo preconsolidado por la Agencia de Gestión de Ayudas Universitarias y de Investigación (AGAUR) de la Generalitat de Cataluña

This article presents the composition, lines of research and evolution of the nursing research group (GRIN) linked to the Bellvitge Institute for Biomedical Research (IDIBELL). The main lines of research are targeted to the provision of nursing care and its impact on health outcomes for patients and relatives; it is particularly oriented towards research in care for vulnerable populations, critical patients, complex chronic patients, and people with extreme ages, within the following areas of interest: i) health promotion; ii) technological innovations, information systems and artificial intelligence for health; iii) methodological, ethical and social development of care; iv) management of care and nursing-sensitive outcomes; v) screening, early detection and prevention of complications and disabilities. Currently, the group is formed by 33 nurses from four hospitals and the University of Barcelona; 48% of its members are doctors and 36% are doctoral candidates. The group has published over 150 scientific articles in seven years; during the last year, 50% of these were in Q1 and 20% in Q2. It should also be highlighted that 60% of projects obtained some type of funding during the past year. The research group is accredited as a preconsolidated group by the Agency for Management of University and Research Grants (AGAUR) of the Generalitat of Catalonia

Care complexity individual factors associated with adverse events and in-hospital mortality.

INTRODUCTION: Measuring the impact of care complexity on health outcomes, based on psychosocial, biological and environmental circumstances, is important in order to detect predictors of early deterioration of inpatients. We aimed to identify care complexity individual factors associated with selected adverse events and in-hospital mortality. METHODS: A multicenter, case-control study was carried out at eight public hospitals in Catalonia, Spain, from January 1, 2016 to December 31, 2017. All adult patients admitted to a ward or a step-down unit were evaluated. Patients were divided into the following groups based on the presence or absence of three adverse events (pressure ulcers, falls or aspiration pneumonia) and in-hospital mortality. The 28 care complexity individual factors were classified in five domains (developmental, mental-cognitive, psycho-emotional, sociocultural and comorbidity/complications). Adverse events and complexity factors were retrospectively reviewed by consulting patients' electronic health records. Multivariate logistic analysis was performed to identify factors associated with an adverse event and in-hospital mortality. RESULTS: A total of 183,677 adult admissions were studied. Of these, 3,973 (2.2%) patients experienced an adverse event during hospitalization (1,673 [0.9%] pressure ulcers; 1,217 [0.7%] falls and 1,236 [0.7%] aspiration pneumonia). In-hospital mortality was recorded in 3,996 patients (2.2%). After adjustment for potential confounders, the risk factors independently associated with both adverse events and in-hospital mortality were: mental status impairments, impaired adaptation, lack of caregiver support, old age, major chronic disease, hemodynamic instability, communication disorders, urinary or fecal incontinence, vascular fragility, extreme weight, uncontrolled pain, male sex, length of stay and admission to a medical ward. High-tech hospital admission was associated with an increased risk of adverse events and a reduced risk of in-hospital mortality. The area under the ROC curve for both outcomes was > 0.75 (95% IC: 0.78-0.83). CONCLUSIONS: Several care complexity individual factors were associated with adverse events and in-hospital mortality. Prior identification of complexity factors may have an important effect on the early detection of acute deterioration and on the prevention of poor outcomes.

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.

Predicting patient acuity according to their main problem.

AIM: To assess the ability of the patient main problem to predict acuity in adults admitted to hospital wards and step-down units. BACKGROUND: Acuity refers to the categorization of patients based on their required nursing intensity. The relationship between acuity and nurses' clinical judgment on the patient problems, including their prioritization, is an underexplored issue. METHOD: Cross-sectional, multi-centre study in a sample of 200,000 adults. Multivariate analysis of main problems potentially associated with acuity levels higher than acute was performed. Distribution of patients and outcome differences among acuity clusters were evaluated. RESULTS: The main problems identified are strongly associated with patient acuity. The model exhibits remarkable ability to predict acuity (AUC, 0.814; 95% CI, 0.81-0.816). Most patients (64.8%) match higher than acute categories. Significant differences in terms of mortality, hospital readmission and other outcomes are observed (p < .005). CONCLUSION: The patient main problem predicts acuity. Most inpatients require more intensive than acute nursing care and their outcomes are adversely affected. IMPLICATIONS FOR NURSING MANAGEMENT: Prospective measurement of acuity, considering nurses' clinical judgments on the patient main problem, is feasible and may contribute to support nurse management workforce planning and staffing decision-making, and to optimize patients, nurses and organizational outcomes.

Care Complexity Individual Factors Associated With Hospital Readmission: A Retrospective Cohort Study.

PURPOSE: To determine the frequency of care complexity individual factors documented in the nursing assessment and to identify the risk factors associated with hospital readmission within 30 days of hospital discharge. DESIGN: Observational analysis of a retrospective cohort at a 700-bed university hospital in Barcelona, Spain. A total of 16,925 adult patient admissions to a ward or intermediate care units were evaluated from January to December 2016. Most patients were admitted due to cardiocirculatory and respiratory disorders (29.3%), musculoskeletal and nervous system disorders (21.8%), digestive and hepatobiliary conditions (17.9%), and kidney or urinary disorders (11.2%). METHODS: Readmission was defined as rehospitalization for any reason within 30 days of discharge. Patients who required hospital readmission were compared with those who did not. The individual factors of care complexity included five domains (developmental, mental-cognitive, psycho-emotional, sociocultural, and comorbidity or complications) and were reviewed using the electronic nursing assessment records. Multivariate logistic analysis was performed to determine factors associated with readmission. FINDINGS: A total of 1,052 patients (6.4%) were readmitted within 30 days of hospital discharge. Care complexity individual factors from the comorbidity or complications domain were found to be the most frequently e-charted (88.3%). Care complexity individual factors from developmental (33.2%), psycho-emotional (13.2%), mental-cognitive (7.2%), and sociocultural (0.7%) domains were less frequently documented. Independent factors associated with hospital readmission were old age (≥75 years), duration of first hospitalization, admission to a nonsurgical ward, major chronic disease, hemodynamic instability, immunosuppression, and relative weight of diagnosis-related group. CONCLUSIONS: A substantial number of patients required readmission within 30 days after discharge. The most frequent care complexity individual factors recorded in the nursing assessment at index admission were related to comorbidity or complications, developmental, and psycho-emotional domains. Strategies related to transition of care that include clinical characteristics and comorbidity or complications factors should be a priority at hospital discharge and after leaving hospital, but other factors related to developmental and psycho-emotional domains could have an important effect on the use of healthcare resources. CLINICAL RELEVANCE: Nurses should identify patients with comorbidity or complications, developmental, and psycho-emotional complexity factors during the index admission in order to be able to implement an effective discharge process of care.

Accuracy and completeness of records of adverse events through interface terminology. / Precisión y exhaustividad del registro de eventos adversos mediante una terminología de interfase.

OBJECTIVE: To determine what adverse events, including pressure ulcers, infection of the surgical site and aspiration pneumonia, nurses record in clinical histories, in terms of diagnostic accuracy and completeness, through ATIC. METHOD: Observational, descriptive, cross-sectional, multicenter study of 64 medical-surgical and semi-critical units of two university hospitals in Catalonia, Spain, during 2015. The diagnostic accuracy was assessed by means of the correspondence between the event declared in the Minimum Basic Data Set and the problem documented by the nurse. The record was considered complete when it contained the risk of the event, prescriptions of care and a record of the evolution. RESULTS: The sample evaluated included 459 records. The accuracy results of pressure ulcers are highly correlated between the nursing diagnosis recorded and that declared in the Minimum Basic Data Set. The accuracy in surgical site infection is moderate, and aspiration resulting in pneumonia is very low. The completeness of results is remarkable, except for the risk of bronchoaspiration. CONCLUSION: The adverse event recorded by nurses with greatest accuracy is pressure ulcers.

Precisión y exhaustividad del registro de eventos adversos mediante una terminología de interfase / Precisão e exaustividade no registro de eventos adversos usando uma terminologia de interface / Accuracy and completeness of records of adverse events through interface terminology

RESUMEN Objetivo: Determinar qué registran las enfermeras en la historia clínica mediante ATIC, sobre los eventos adversos: úlceras por presión, infección del sitio quirúrgico y aspiración con resultado de neumonía, en términos de precisión diagnostica y exhaustividad. Método: Estudio observacional, descriptivo, transversal, y multicéntrico de 64 unidades médico-quirúrgicas y semicríticos de dos hospitales universitarios de Cataluña, España, durante el año 2015. La precisión diagnóstica se evaluó mediante la correspondencia entre el evento declarado en el Conjunto Mínimo Básico de Datos y el problema documentado por la enfermera. La exhaustividad se consideró cuando el registro contenía el riesgo del evento, prescripciones de cuidados y registro de la evolución. Resultados: La muestra evaluada fue de 459 registros. Los resultados de precisión de úlceras por presión muestran una elevada correspondencia entre el diagnóstico enfermero registrado y el declarado en el Conjunto Mínimo Básico de Datos. La precisión en la infección del sitio quirúrgico es moderada, y la aspiración con resultado de neumonía muy baja. Los resultados de exhaustividad son notables, excepto el riesgo de broncoaspiración. Conclusión: El evento adverso que registran las enfermeras con mayor precisión es la úlcera por presión.

RESUMO Objetivo: Determinar quais informações são registradas pelas enfermeiras nos registros eletrônicos por meio da terminologia ATIC, sobre os eventos adversos: úlceras de pressão, infecção de sítio cirúrgico e aspiração com resultado de pneumonia, em termos de precisão diagnóstica e de exaustividade. Método: Estudo observacional, descritivo, transversal e multicêntrico de 64 unidades médico cirúrgicas e semicríticas de dois hospitais universitários da Catalunha, Espanha, durante o ano 2015. A precisão diagnóstica foi avaliada pela correspondência entre o evento indicado no Conjunto Mínimo Básico de Dados e o registro de problemas documentados pela enfermeira. A exaustividade foi considerada quando o registro continha a identificação do risco do evento, as prescrições de cuidados e o registro da evolução. Resultados: A amostra avaliada foi de 459 registros. Os resultados em termos de precisão de úlceras de pressão mostram uma alta correlação entre o diagnóstico de enfermagem registrado e o diagnóstico declarado no Conjunto Mínimo Básico de Dados. A precisão na infecção de sítio cirúrgico é moderada, e a aspiração com resultado de pneumonia é muito baixa. Os resultados de exaustividade são notáveis, salvo o risco de broncoaspiração. Conclusão: O evento adverso que as enfermeiras registram com maior precisão é a úlcera de pressão.

ABSTRACT Objective: To determine what adverse events, including pressure ulcers, infection of the surgical site and aspiration pneumonia, nurses record in clinical histories, in terms of diagnostic accuracy and completeness, through ATIC. Method: Observational, descriptive, cross-sectional, multicenter study of 64 medical-surgical and semi-critical units of two university hospitals in Catalonia, Spain, during 2015. The diagnostic accuracy was assessed by means of the correspondence between the event declared in the Minimum Basic Data Set and the problem documented by the nurse. The record was considered complete when it contained the risk of the event, prescriptions of care and a record of the evolution. Results: The sample evaluated included 459 records. The accuracy results of pressure ulcers are highly correlated between the nursing diagnosis recorded and that declared in the Minimum Basic Data Set. The accuracy in surgical site infection is moderate, and aspiration resulting in pneumonia is very low. The completeness of results is remarkable, except for the risk of bronchoaspiration. Conclusion: The adverse event recorded by nurses with greatest accuracy is pressure ulcers.

Una terminología interfase como eje de unos cuidados seguros. Nivel de conocimiento y de comprensión de intervenciones enfermeras ATIC(R) / Interface terminology as an axis for safe care: on line questionnaire about knowledge and understanding of ATIC(R) nursing interventions

Introducción. Los lenguajes enfermeros deben contribuir a obtener datos precisos y fiables que faciliten una comunicación eficaz y garanticen unos cuidados seguros. Las terminologías de interfase, como ATIC(R), surgen para complementar las terminologías de referencia y orientan su desarrollo hacia su uso en la práctica clínica. Además, contribuyen a proporcionar información en relación con los conceptos que representan los cuidados con suficiente especificidad clínica que conlleva a un mejor entendimiento entre los miembros del equipo asistencial. Objetivo. Evaluar el nivel de conocimiento y comprensión de las enfermeras acerca de las intervenciones de vigilancia y control de la terminología ATIC(R). Material y métodos. Estudio descriptivo, observacional, transversal y multicéntrico, mediante un cuestionario electrónico validado. Los datos recogidos se analizaron utilizando estadística descriptiva e inferencial. Resultados. Un 85 % de las enfermeras evalúan favorablemente su nivel de conocimientos sobre las intervenciones de vigilancia y control de la terminología ATIC(R). El 51.8 % refiere un nivel de conocimiento superior y el 32.8 % adecuado. Se identificaron diferencias significativas respecto el nivel de conocimientos y el tiempo de uso de ATIC(R), el lugar de trabajo o la asistencia a sesiones clínicas de cuidados (SCS). La evaluación de la comprensión indica que más del 95 % de las participantes tienen una comprensión elevada (75.8 %) o moderada (20.1 %). Además, se identificaron diferencias significativas en relación con la utilización de ATIC(R) durante más de 1 año y la asistencia a SCC. Conclusiones. Las enfermeras que utilizan la terminología ATIC(R) en los registros electrónicos de salud tienen un elevado nivel de conocimiento y comprensión de las intervenciones de vigilancia y control. Las enfermeras entienden los conceptos de forma clara y precisa, lo que contribuye a establecer la fiabilidad del eje de intervención de esta terminología en términos de usabilidad y aumenta la seguridad del proceso de prestación de cuidados (AU)

Introduction. Nursing languages should contribute to obtain ccurate and reliable data to ease effective communication and ensure patients’ safety. Interface terminologies like ATIC(R), arise to complement reference terminologies and are intended to guide their use in clinical settings. Moreover, these terminologies provide information regarding healthcare concepts with sufficient clinical specificity, leading to a better understanding among healthcare team members. Objective. To evaluate nurses’ level of knowledge and understanding in clinical settings surveillance and control interventions of ATIC terminology(R). Materials and methods. A descriptive, observational, cross-sectional, multicenter study was performed administering a validated electronic questionnaire. Collected data was analyzed using descriptive and inferential statistics. Results. 85 % of nurses favorably assessed their knowledge level about surveillance and control interventions of ATIC terminology (R). Higher levels were achieved by 51.8 % and 32.8 % scored as adequate level. Significant differences were found in knowledge level and length of use of terminology, as well as workplace and attendance to clinical care sessions (CCS). The evaluation of understanding indicates that over 95 % of participants have high (75.8 %) or moderate (20.1 %) understanding levels. Furthermore, we found significant differences in relation to the level of understanding and length of time using ATIC(R) (more than 1 year) together with attendance to CCS. Conclusions. Nurses that use the ATIC Terminology© in electronic health records have a high knowledge and understanding level of surveillance and control interventions. Nurses understand the concepts clearly and accurately, what might be considered as an indirect measurement for reliability of the ATIC intervention axis in terms of usability, enhances at the same time safety in the provision process of care (AU)

Surveillance nursing diagnoses, ongoing assessment and outcomes on in-patients who suffered a cardiorespiratory arrest.

Objective The purposes of this study were to examine the frequency of surveillance-oriented nursing diagnoses and interventions documented in the electronic care plans of patients who experienced a cardiac arrest during hospitalization, and to observe whether differences exist in terms of patients' profiles, surveillance measurements and outcomes. Method A descriptive, observational, retrospective, cross-sectional design, randomly including data from electronic documentation of patients who experienced a cardiac arrest during hospitalization in any of the 107 adult wards of eight acute care facilities. Descriptive statistics were used for data analysis. Two-tailed p-values are reported. Results Almost 60% of the analyzed patients' e-charts had surveillance nursing diagnoses charted in the electronic care plans. Significant differences were found for patients who had these diagnoses documented and those who had not in terms of frequency of vital signs measurements and final outcomes. Conclusion Surveillance nursing diagnoses may play a significant role in preventing acute deterioration of adult in-patients in the acute care setting.

Surveillance nursing diagnoses, ongoing assessment and outcomes on in-patients who suffered a cardiorespiratory arrest / Diagnósticos de enfermagem de vigilância, avaliação contínua e resultados em pacientes que sofreram uma parada cardiorrespiratória / Diagnósticos enfermeros de vigilancia, evaluación en curso y resultados en pacientes hospitalizados que sufrieron paro cardiorrespiratorio

ABSTRACT Objective The purposes of this study were to examine the frequency of surveillance-oriented nursing diagnoses and interventions documented in the electronic care plans of patients who experienced a cardiac arrest during hospitalization, and to observe whether differences exist in terms of patients' profiles, surveillance measurements and outcomes. Method A descriptive, observational, retrospective, cross-sectional design, randomly including data from electronic documentation of patients who experienced a cardiac arrest during hospitalization in any of the 107 adult wards of eight acute care facilities. Descriptive statistics were used for data analysis. Two-tailed p-values are reported. Results Almost 60% of the analyzed patients' e-charts had surveillance nursing diagnoses charted in the electronic care plans. Significant differences were found for patients who had these diagnoses documented and those who had not in terms of frequency of vital signs measurements and final outcomes. Conclusion Surveillance nursing diagnoses may play a significant role in preventing acute deterioration of adult in-patients in the acute care setting.

RESUMO Objetivo Determinar a frequência de registro eletrônico de diagnósticos e intervenções de vigilância no plano de cuidados para pacientes que sofreram uma parada cardíaca durante a admissão e avaliar se existem diferenças com base no perfil do paciente, medidas de monitoramento e resultados. Método Estudo descritivo, observacional, retrospectivo, transversal, que incluiu dados dos registros eletrônicos de pacientes internados em uma das 107 unidades de oito hospitais de cuidados agudos. Para análise dos dados foram utilizados estatísticos descritivos. Os valores de p foram relatados em dois ramos. Resultados Foram obtidos dados de 492 documentos de enfermagem de pacientes que sofreram uma parada cardíaca. Quase 60% dos prontuários eletrônicos incluídos na análise continham um ou mais diagnósticos de vigilância. Diferenças significativas foram encontradas entre os pacientes com e sem registro desses diagnósticos, no que se refere à frequência das medições dos sinais vitais e aos resultados finais. Conclusão Os diagnósticos de vigilância podem desempenhar um papel importante na prevenção de deterioração aguda em pacientes adultos hospitalizados.

RESUMEN Objetivo Los objetivos de este estudio fueron examinar la frecuencia de los diagnósticos enfermeros basados en la vigilancia y las intervenciones documentadas en los planes de asistencia mediante sistema informático de pacientes que pasaron por paro cardiaco durante estancia hospitalaria y observar si existen diferencias en términos de perfil de los pacientes, medidas de vigilancia y resultados. Método Descriptivo, observacional, retrospectivo, transversal, randomizado, incluyendo datos de documentación informática de pacientes que pasaron por paro cardiaco durante estancia hospitalaria en cualquiera de las 107 alas adultas de las ocho instalaciones de cuidados intensivos. Las estadísticas descriptivas fueron utilizadas para los análisis de datos. Valores P bilaterales fueron relatados. Resultados Casi el 60% del los pacientes analizados por la gráfica electrónica tuvieron diagnóticos enfermeros de vigilancia representados en los planes de cuidados informatizados. Fueron encontradas diferencias significativas en pacientes que tuvieron dichos diagnósticos documentados y los que no los tuvieron en términos de frecuencia de mediciones de señales vitales y resultados finales. Conclusión Los diagnósticos enfermeros de vigilancia pueden jugar un rol significativo en la prevención del deterioro agudo de pacientes adultos hospitalizados en las unidades de cuidados intensivos.

Impact of an Educational Program to Reduce Healthcare Resources in Community-Acquired Pneumonia: The EDUCAP Randomized Controlled Trial.

BACKGROUND: Additional healthcare visits and rehospitalizations after discharge are frequent among patients with community-acquired pneumonia (CAP) and have a major impact on healthcare costs. We aimed to determine whether the implementation of an individualized educational program for hospitalized patients with CAP would decrease subsequent healthcare visits and readmissions within 30 days of hospital discharge. METHODS: A multicenter, randomized trial was conducted from January 1, 2011 to October 31, 2014 at three hospitals in Spain. We randomly allocated immunocompetent adults patients hospitalized for CAP to receive either an individualized educational program or conventional information before discharge. The educational program included recommendations regarding fluid intake, adherence to drug therapy and preventive vaccines, knowledge and management of the disease, progressive adaptive physical activity, and counseling for alcohol and smoking cessation. The primary trial endpoint was a composite of the frequency of additional healthcare visits and rehospitalizations within 30 days of hospital discharge. Intention-to-treat analysis was performed. RESULTS: We assigned 102 patients to receive the individualized educational program and 105 to receive conventional information. The frequency of the composite primary end point was 23.5% following the individualized program and 42.9% following the conventional information (difference, -19.4%; 95% confidence interval, -6.5% to -31.2%; P = 0.003). CONCLUSIONS: The implementation of an individualized educational program for hospitalized patients with CAP was effective in reducing subsequent healthcare visits and rehospitalizations within 30 days of discharge. Such a strategy may help optimize available healthcare resources and identify post-acute care needs in patients with CAP. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN39531840.

Detección de necesidades educativas al alta en pacientes con neumonía adquirida en la comunidad / Detection of educational needs at hospital discharge in patients with community-acquired pneumonia

OBJETIVO: identificar las necesidades educativas al alta en pacientes con neumonía adquirida en la comunidad (NAC). MÉTODO: revisión narrativa en la que se realiza una búsqueda bibliográfica de la literatura publicada, desde el año 2000 hasta la actualidad, en las bases de datos Pubmed, CINAHL, Cuiden y Cochrane Library Plus. La búsqueda se efectuó utilizando el lenguaje controlado MeSH, mediante las siguientes palabras clave en inglés: community-acquired pneumonia, patient discharge. Fueron aceptados los artículos que analizaban el consumo de recursos sanitarios posterior al alta hospitalaria (reingresos, consultas a urgencias o mortalidad) y los conocimientos de los pacientes ingresados con NAC. RESULTADOS: fueron analizados 22 estudios que examinaban el consumo de recursos sanitarios posterior al alta hospitalaria (reingresos, consultas a urgencias o mortalidad) y los conocimientos de los pacientes ingresados con NAC. Las principales necesidades educativas del paciente hospitalizado con NAC son las relativas a: hidratación, adherencia al tratamiento farmacológico y vacunas indicadas, conocimiento y control de la enfermedad, actividad física progresiva, abandono de hábitos tóxicos y manejo de las comorbilidades. CONCLUSIONES: las necesidades educativas detectadas deben incluirse en programas educativos previos al alta hospitalaria en pacientes con NAC para mejorar el manejo de la enfermedad y disminuir el consumo de recursos sanitarios posterior al alta

OBJECTIVE: to identify the educational needs at hospital discharge in patients with Community-Acquired Pneumonia (CAP). METHOD: a narrative review where a bibliographic search was conducted on published literature, from year 2000 to the present day, in the Pubmed, CINAHL, Cuiden and Cochrane Library Plus databases. The search was conducted using the MeSH controlled vocabulary, through the following key words in English: community-acquired pneumonia, patient discharge. Articles were accepted on Use of Healthcare Resources after Hospital Discharge (re-hospitalizations, visits to the Emergency Unit or mortality), and knowledge of patients hospitalized with CAP. RESULTS: 22 studies were analyzed, which examined the use of healthcare resources after hospital discharge (re-hospitalizations, visits to the Emergency Unit or Mortality), and the level of knowledge of patients hospitalized with CAP. The main educational needs of patients hospitalized with CAP were those associated with hydration, adherence to pharmacological treatment, and vaccine indications, awareness and monitoring of the disease, progressive physical activity, giving up toxic habits, and management of comorbidities. CONCLUSIONS: the educational needs detected must be included in educational programs previous to hospital discharge in patients with CAP, in order to improve the disease management, and reduce the use of healthcare resources after discharge

[Develop critical thinking through the practice daily]. / Desarrollar el pensamiento crítico a través del diario reflexivo.

GOALS: To assess critical thinking skills of students in the UB Hospital Practicum through the development of a daily practice. SETTING: School of Nursing at UB. DESIGN: Descriptive observational correlational. SAMPLE: From the total amount of 3rd course students doing the Hospitalary Practicum from October 2012 to January 2013, we will choose a convenience sample of n=10 from the number of students randomly assigned to each associate teacher, and in this case the main researcher. DATA COLLECTION: From the California Critical Thinking skills test CCTST we'll seek personal disposition towards critical thinking through CCTDI California Critical Thinking Disposition Inventory questionnaire to be passed to the students before the start of the Hospitalary and critical thinking skills will be sought after. A modified CTS Critical Thinking skills scale will be used to analyze reflexive writings. ANALYSIS: Data will be statistically treated using SPSS and analized using descriptive statistic.Chi-square tests will be used to verify the existence of correlation between the research variables.

Desarrollar el pensamiento crítico a través del diario reflexivo / Develop critical thinking through the practice daily

Objetivo: evaluar habilidades de pensamiento crítico de los alumnos que realizan el Practicum Hospitalario (PH) de la U.B. (Universidad de Barcelona) a través del análisis del diario reflexivo. Ámbito: Escuela Universitaria de Enfermería de la UB. Diseño: estudio descriptivo observacional correlacional. Muestra: del total de alumnos de 3º que realizan el PH en el periodo de octubre de 2012 a enero 2013, escogeremos el tamaño de la muestra a partir de conveniencia; n=10, es decir, el número de alumnos que de forma aleatoria se asignan, al inicio de PH, a cada profesor asociado, y en este caso al investigador principal. Recogida de datos: a partir de la escala CCTST California Critical Thinking Skills Test, buscaremos disposiciones personales hacia el pensamiento crítico través de la CCTDI California Critical Thinking Disposition Inventory que se pasará a los alumnos antes del inicio del Practicum Hospitalario y también buscaremos habilidades de pensamiento crítico a partir de la CTS Critical Thinking Skills modificada que se utilizará para analizar los escritos reflexivos. Análisis: los datos serán tratados estadísticamente empleando el paquete SPSS y se analizarán empleando estadísticos descriptivos. Para verificar la existencia de correlación entre las variables de la investigación se utilizarán las pruebas de Ji cuadrado(AU)

Goals: To assess critical thinking skills of students in the UB Hospital Practicum through the development of a daily practice. Setting: School of Nursing at UB. Design: Descriptive observational correlational. Sample: From the total amount of 3rd course students doing the Hospitalary Practicum from October 2012 to January 2013, we will choose a convenience sample of n=10 from the number of students randomly assigned to each associate teacher, and in this case the main researcher. Data Collection: From the California Critical Thinking skills test CCTST we'll seek personal disposition towards critical thinking through CCTDI California Critical Thinking Disposition Inventory questionnaire to be passed to the students before the start of the Hospitalary and critical thinking skills will be sought after. A modified CTS Critical Thinking skills scale will be used to analyze reflexive writings. Analysis: Data will be statistically treated using SPSS and analized using descriptive statistic. Chi-square tests will be used to verify the existence of correlation between the research variables(AU)

Mapping the Diagnosis Axis of an Interface Terminology to the NANDA International Taxonomy.

Background. Nursing terminologies are designed to support nursing practice but, as with any other clinical tool, they should be evaluated. Cross-mapping is a formal method for examining the validity of the existing controlled vocabularies. Objectives. The study aims to assess the inclusiveness and expressiveness of the nursing diagnosis axis of a newly implemented interface terminology by cross-mapping with the NANDA-I taxonomy. Design/Methods. The study applied a descriptive design, using a cross-sectional, bidirectional mapping strategy. The sample included 728 concepts from both vocabularies. Concept cross-mapping was carried out to identify one-to-one, negative, and hierarchical connections. The analysis was conducted using descriptive statistics. Results. Agreement of the raters' mapping achieved 97%. More than 60% of the nursing diagnosis concepts in the NANDA-I taxonomy were mapped to concepts in the diagnosis axis of the new interface terminology; 71.1% were reversely mapped. Conclusions. Main results for outcome measures suggest that the diagnosis axis of this interface terminology meets the validity criterion of cross-mapping when mapped from and to the NANDA-I taxonomy.