Pain assessment and management among adult patients in a gynecology ward: a best practice implementation project.

OBJECTIVES: This project aimed to improve compliance with evidence-based practice in pain assessment and management in a gynecology ward. INTRODUCTION: Effective pain control is important to prevent the negative consequences of pain that is poorly managed. However, it remains undervalued and inadequately treated. Applying evidence-based practices to correctly evaluate and manage pain is essential to improve pain relief. METHODS: This project followed the JBI Evidence Implementation Framework. A baseline audit of 41 women admitted to the gynecology ward was conducted and measured against 5 best practice criteria, along with a patient satisfaction questionnaire. Targeted strategies were then implemented and a follow-up audit was conducted using the same criteria, methods, and sample size as the baseline audit. RESULTS: The baseline audit revealed gaps between current and best practice. Barriers to implementation were identified and strategies to resolve the barriers were designed and implemented (nurse education, informative materials, electronic patient records system improvements). Comprehensive pain assessment, including dynamic and static pain assessment, use of a validated tool, and education provided to patients and carers, improved in the follow-up audit. There was no change in patient satisfaction levels; however, the discrepancy between pain measured by nurses and pain measured by patients was reduced. CONCLUSIONS: The JBI methodology was useful in improving compliance with evidence-based practice criteria. It also facilitated adaptation to new barriers, such as the COVID-19 pandemic. Improving nurses' knowledge of pain assessment can lead to more accurate assessment. Inadequate records systems also made it difficult to record the care that was provided. Subsequent audits will assess sustainability and the project will be escalated to other wards.

Circadian monitoring as an aging predictor.

The ageing process is associated with sleep and circadian rhythm (SCR) frailty, as well as greater sensitivity to chronodisruption. This is essentially due to reduced day/night contrast, decreased sensitivity to light, napping and a more sedentary lifestyle. Thus, the aim of this study is to develop an algorithm to identify a SCR phenotype as belonging to young or aged subjects. To do this, 44 young and 44 aged subjects were recruited, and their distal skin temperature (DST), activity, body position, light, environmental temperature and the integrated variable TAP rhythms were recorded under free-living conditions for five consecutive workdays. Each variable yielded an individual decision tree to differentiate between young and elderly subjects (DST, activity, position, light, environmental temperature and TAP), with agreement rates of between 76.1% (light) and 92% (TAP). These decision trees were combined into a unique decision tree that reached an agreement rate of 95.3% (4 errors out of 88, all of them around the cut-off point). Age-related SCR changes were very significant, thus allowing to discriminate accurately between young and aged people when implemented in decision trees. This is useful to identify chronodisrupted populations that could benefit from chronoenhancement strategies.

Ontogeny and aging of the distal skin temperature rhythm in humans.

In circadian terms, human ontogeny is characterized by the emergence of a daily pattern, from a previous ultradian pattern, for most variables during the first 6 months of life. Circadian aging in humans is characterized by a phase advance, accompanied by rhythm fragmentation and flattening. Despite an expanding body of literature focused on distal skin temperature, little information is available about the ontogeny and practically nothing about age-related changes in this rhythm. Thus, the aim was to evaluate the degree of maturation and aging of the circadian pattern of distal skin temperature to identify those parameters that are modified throughout life and could be used to differentiate subjects according to their age. For this, distal skin temperature was measured in 197 volunteers (55 % women), including babies aged 15 days (30 subjects), 1 month (28 subjects), 3 months (31 subjects), and 6 months (10 subjects); young adults aged 19 years (37 subjects); middle-aged persons aged 46 years (27 subjects); older people aged 72 (34 subjects). Circadian system maturation was associated with an increase in amplitude and a reduction in skin temperature during sleep. During adulthood, women showed a more robust pattern (lower fragmentation, and higher night-time temperature, amplitude, circadian function index, and first harmonic relative power); however, these differences were lost with aging, a period of life that was consistently associated with a phase advance of the rhythm. In summary, distal skin temperature pattern can be used as a robust variable to discern between different ages throughout the life.

Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study.

BACKGROUND: Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures. METHODS: For this observational study, we obtained discharge data for 422,730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26,516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics. FINDINGS: An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031-1·106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886-0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared for an average of eight patients. INTERPRETATION: Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor's education for nurses could reduce preventable hospital deaths. FUNDING: European Union's Seventh Framework Programme, National Institute of Nursing Research, National Institutes of Health, the Norwegian Nurses Organisation and the Norwegian Knowledge Centre for the Health Services, Swedish Association of Health Professionals, the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, Committee for Health and Caring Sciences and Strategic Research Program in Care Sciences at Karolinska Institutet, Spanish Ministry of Science and Innovation.

Estrés relacionado con el trabajo y exposición laboral en enfermeras de la Comunidad de Castilla y León / Work-related stress and occupational exposure in nurses from the Autonomous Community of Castilla y León (Spain)

Objetivo. Conocer el nivel de estrés relacionado con el trabajo en una muestra de enfermeras e identificar los factores que se asocian con su incremento. Método. Estudio observacional transversal en una muestra de 1.656 enfermeras seleccionadas por muestreo aleatorio del total de censadas en el Consejo de Colegios Profesionales de la Comunidad de Castilla y León. La información se recogió mediante envíos postales y llamadas telefónicas durante los años 2002-2003 del cuestionario de Contenido de Trabajo y de un cuestionario específico (datos sociodemográficos, historia laboral, historia médica y estilos de vida). Se realizó un análisis descriptivo y se ajustaron modelos de regresión logística. Resultados. El porcentaje de respuesta fue del 45,4% (680 enfermeras) y osciló entre un 68 y un 33% entre las 9 provincias. El 49% manifestó tener altas demandas en el trabajo y el 22% falta de control. El análisis multivariante mostró que las variables que se asociaron con el estrés fueron: el esfuerzo físico moderado y muy intenso (odds ratio [OR] = 4,00; intervalo de confianza [IC] del 95%, 1,94-8,22), trabajar en los servicios de quirófano (OR = 3,67; IC del 95%, 1,23-10,94), unidades de cuidados intensivos y urgencias (OR = 3,25; IC del 95%, 1,41-7,49) y la falta de apoyo de los compañeros (OR = 2,77; IC del 95%, 1,58-4,87) y de los supervisores (OR = 1,88; IC del 95%, 1,21-2,94). Conclusiones. El estrés relacionado con el trabajo se asoció al esfuerzo físico y a los servicios de quirófano y unidades de cuidados intensivos y urgencias. En cambio, no se asoció con la falta de control. Finalmente, la falta de apoyo social también se asoció con el estrés laboral

Objective. To determine work-related stress in a sample of nurses and to identify associated factors. Method. We performed an observational, cross-sectional study of 1656 nurses randomly selected from those registered in the Council of Professional Colleges of the Autonomous Community of Castilla y León. Information was collected through mailing and telephone calls from 2002-2003 using the Job Content Questionnaire and a specific questionnaire (socio-demographic data, occupational records, medical records, and lifestyles). A descriptive analysis and adjustment of logistic regression models were performed. Results. The response rate was 45.4% (680 nurses), ranging between 68% and 33% among the 9 provinces. Forty-nine percent reported high job demands and 22% reported loss of control. Multivariate analysis identified the following variables as stress-related: moderate and very intense physical effort (odds ratio [OR] = 4.00; 95% confidence interval [CI], 1.94-8.22), working in operating rooms (OR = 3.67; 95% CI, 1.23-10.94), intensive care units and emergency departments (OR = 3.25; 95% CI, 1.41-7.49), and lack of support from workmates (OR = 2.77; 95% CI, 1.58-4.87) and supervisors (OR = 1.88; 95% CI, 1.21-2.94). Conclusions. Work-related stress was associated with physical effort and working in the operating room, intensive care units, or emergency department. It was not associated with low control. Finally, lack of social support was also associated with work stress

Fiabilidad de los instrumentos de medición en ciencias de la salud / Reliability of measurement instruments in the health sciences

En este artículo se presentan los tipos de fiabilidad más frecuentes que se pueden evaluar cuando se utilizan instrumentos o procedimientos de medición para investigar en ciencias de la salud, e incorpora ejemplos para cada caso, así como las pruebas estadísticas más utilizadas, según el tipo de fiabilidad que se desee evaluar y el tipo de variables medidas. La fiabilidad informa sobre la reproducibilidad de resultados obtenidos por un procedimiento de medición; es el grado de estabilidad conseguido en los resultados cuando se repite una medición en condiciones idénticas. Los 4 aspectos que hay que considerar para evaluarla son: a) la fiabilidad interobservador, que se refiere a la consistencia entre 2 observadores distintos cuando evalúan una misma medida en un mismo individuo; b) la fiabilidad intraobservador, que tiene como objetivo evaluar el grado de consistencia al efectuar la medición de un observador consigo mismo; c) la fiabilidad test-retest, que indica hasta qué punto un instrumento proporciona resultados similares cuando se aplica a una misma persona en más de una ocasión, pero en idénticas condiciones, y d) la consistencia interna, que es la propiedad que define el nivel de acuerdo o conformidad de un conjunto de mediciones consigo mismas. Las pruebas estadísticas más adecuadas que se describen en el artículo en función del tipo de datos a medir son el índice kappa, el índice kappa ponderado, el coeficiente de correlación intraclase y el alfa de Cronbach

This article presents the most frequent types of reliability that can be evaluated when using measurement instruments or procedures to perform research in the health sciences and provides examples for each case. The most frequently used statistical tests according to the type of reliability under evaluation and the type of variables measured are also discussed. Reliability provides information on the reproducibility of the results obtained by the procedure used for measurement; it is the degree of stability achieved in the results when a measurement is repeated under identical conditions. The four elements that must be considered when evaluating reliability are: a) interobserver reliability, which refers to the consistency between two distinct observers when they evaluate the same measurement in a single individual, b) intraobserver reliability, which evaluates the degree of consistency in the same observer when performing a measurement, c) test-retest reliability, which indicates the extent to which an instrument provides similar results when applied in a single individual on more than one occasion but under identical conditions, and d) internal consistency, which is the property that defines the level of agreement or conformity of a set of measurements within themselves. The most appropriate statistical tests described in the article according to the type of data to be measured are kappa index, the weighted kappa index, the intraclass correlation coefficient and Crohnbach's alpha

Identificación de las prioridades de investigación en enfermería en España: Estudio Delphi / Identification of research priorities in nursing in Spain: Delphi Study

El objetivo de este trabajo es identificar las prioridades de investigación en enfermería en España. El estudio se llevó a cabo mediante el método de consenso Delphi, entre abril de 1998 y enero de 1999 por el grupo Investen-isciii. Los sujetos del estudio fueron profesionales de los distintos ámbitos de actuación de enfermería. De los 1.250 profesionales con los que se contactó inicialmente, respondieron correctamente al cuestionario para establecer las prioridades, después de las dos vueltas realizadas, 189 (42 por ciento de los 452 que participaron en la segunda vuelta). Se establecieron prioridades relacionadas con el análisis de la continuidad y coordinación de los cuidados de enfermería, calidad de los cuidados de enfermería, repercusión de las técnicas y tratamientos agresivos en la calidad de vida, necesidades de los cuidadores principales, calidad de vida de la población anciana, satisfacción de los usuarios y necesidades del paciente terminal y su familia (AU)