Efectividad de las intervenciones enfermeras en la prevención de caídas en adultos mayores en la comunidad y en entornos sanitarios: una revisión sistemática y metaanálisis de ECA / Effectiveness of nursing interventions in the prevention of falls in older adults in the community and in health care settings: A systematic review and meta-analysis of RCT

Objetivo: Estimar la efectividad de los programas de prevención de caídas en mayores de 65 años en los que participan profesionales de enfermería. Métodos: Se incluyeron ensayos clínicos aleatorizados disponibles a texto completo sobre la prevención de caídas en la comunidad realizada por enfermeras en personas mayores de 65 años y que informaran de la incidencia de dichas caídas. Se analizaron 14 bases de datos en el período de 2016 a 2018 de publicaciones en inglés, francés, portugués y español. La calidad de los artículos se evaluó de manera independiente y ciega por los revisores, que trabajaron en parejas usando para ello los dominios de riesgo de riesgo de la Colaboración Cochrane. Se utilizó el cociente de riesgos como medida del tamaño de efecto. Se asumió un modelo de efectos aleatorios para los análisis estadísticos. La influencia de las variables moderadoras de los estudios sobre los tamaños de efecto se realizó mediante ANOVA con un intervalo de confianza del 95% para cada categoría. Resultados: Se seleccionaron 31 estudios con 25.551 participantes, donde la intervención más frecuente fue la educación (57,1%), seguida de los modelos multifactoriales (37,1%). La probabilidad de caídas se redujo significativamente en los grupos intervención (RR +=0,87). Las intervenciones multifactoriales (RR +=0,89) y basadas en la educación (RR=+0,84) redujeron significativamente la probabilidad de caídas. Conclusiones: Descartando el sesgo de publicación, los programas de prevención llevados a cabo por enfermeras producen una reducción significativa del 10% de las caídas. Las intervenciones basadas en la educación y multifactoriales son las más efectivas cuando son llevadas a cabo por enfermeras.(AU)

Objective: To estimate the effectiveness of fall prevention programs in people aged 65 years and older involving nursing professionals. Methods: We included available full-text randomized clinical trials on nurse-led prevention of falls in the community in people over 65 years of age and reporting the incidence of such falls. An extensive search was performed in 14 databases covering the period 2016 to 2018 for publications in English, French, Portuguese and Spanish. The quality of the papers was assessed independently and blindly by reviewers working in pairs using the risk of bias dominios of the Cochrane Collaboration. The hazard ratio was used as a measure of the effect size of the incidence of falls. A random-effects model was assumed for statistical analyses. The influence of moderator variables of the studies on the effect sizes was performed using ANOVAs and its 95% CI for each moderator category. Results: A total of 31 randomized clinical trials were selected with 25,551 participants. The most frequent type of intervention was education (57.1%), followed by multifactorial models (37.1%). The probability of falling was significantly reduced by 13% in the intervention groups compared to the control groups (RR +=0.87). Multifactorial (RR +=0.89) and education-based (RR=+0.84) interventions significantly reduced the probability of falls by 11% and 16%, respectively. Conclusions: Discarding publication bias prevention programs carried out by nurses produce a significant 10% reduction in falls. Education-based and multifactorial interventions are the most effective when conducted by nurses.(AU)

Effectiveness of nursing interventions in the prevention of falls in older adults in the community and in health care settings: A systematic review and meta-analysis of RCT.

OBJECTIVE: To estimate the effectiveness of fall prevention programs in people aged 65 years and older involving nursing professionals. METHODS: We included available full-text randomized clinical trials on nurse-led prevention of falls in the community in people over 65 years of age and reporting the incidence of such falls. An extensive search was performed in 14 databases covering the period 2016-2018 for publications in English, French, Portuguese and Spanish. The quality of the papers was assessed independently and blindly by reviewers working in pairs using the risk of bias dominios of the Cochrane Collaboration. The hazard ratio was used as a measure of the effect size of the incidence of falls. A random-effects model was assumed for statistical analyses. The influence of moderator variables of the studies on the effect sizes was performed using ANOVAs and its 95% CI for each moderator category. RESULTS: A total of 31 randomized clinical trials were selected with 25,551 participants. The most frequent type of intervention was education (57.1%), followed by multifactorial models (37.1%). The probability of falling was significantly reduced by 13% in the intervention groups compared to the control groups (RR+=0.87). Multifactorial (RR+=0.89) and education-based (RR=+0.84) interventions significantly reduced the probability of falls by 11% and 16%, respectively. CONCLUSIONS: Discarding publication bias prevention programs carried out by nurses produce a significant 10% reduction in falls. Education-based and multifactorial interventions are the most effective when conducted by nurses.

Evaluación de la simulación de alta fidelidad con actores en cuidados paliativos y estudiantes de Enfermería: un estudio de método mixto / Assessment of high fidelity simulation with actors in palliative care in nursing students: A mixed methods study

Objetivo: Los métodos formativos más efectivos son los experienciales, y entre ellos, los que están centrados en las vivencias y emociones. La simulación clínica, especialmente la de alta fidelidad, es una de las metodologías más efectivas para la adquisición de competencias en cuidados. La simulación con actores puede preparar a los futuros sanitarios en técnicas y competencias intelectuales e interpersonales. El objetivo fue valorar la simulación de alta fidelidad con actores como herramienta en la formación de cuidados paliativos en estudiantes de enfermería. Método: Durante tres años se realizó el estudio en la Facultad de Enfermería de la Universidad de Murcia con estudiantes de enfermería. Se realizó un estudio de método mixto con un diseño secuencial explicativo en tres momentos: 1)Estudio cuasi-experimental con grupo único (n=12) antes y después de cursar la asignatura de cuidados paliativos donde se realizó simulación clínica y se evaluaron competencias de comunicación mediante la escala CICAA. 2)Estudio cualitativo fenomenológico tras la simulación (174 narrativas reflexivas de estudiantes). 3)Estudio transversal observacional, un año después, para valorar la transferencia a la clínica de conocimientos y habilidades (contestaron 71 estudiantes). Resultados: La simulación de alta fidelidad con actores mejora las habilidades comunicativas y la capacidad para establecer una relación de ayuda eficaz tanto con pacientes en la fase final de la vida como con sus familiares. Es una metodología de aprendizaje innovadora, útil y que fomenta la reflexión y el traslado del aprendizaje a la clínica. Conclusiones: Se recomienda la estandarización de metodologías activas de aprendizaje para mejorar la adquisición de habilidades transversales como las de comunicación en cuidados paliativos.(AU)

Objective: The most effective training methods are experiential, including those focused on experiences and emotions. Clinical simulation, especially high-fidelity simulation, is one of the most effective methodologies for the acquisition of competencies in care like palliative care. The simulation with actors can train future healthcare science professionals in technical, intellectual, or interpersonal skills. The objective is to evaluate high-fidelity simulation with actors as a tool in palliative care training for nursing students. Method: Over three years, the study was conducted in the Faculty of Nursing of Murcia with nursing students. A mixed methods study with sequential explanatory design in three moments was conducted: 1)Quasi-experimental study in a single group (n=12) before and after attending the palliative care course with clinical simulation with actors to assess the communication skills (CICAA scale). 2)Qualitative study with phenomenological perspective after clinical simulation (174 reflective students’ narratives). 3)Cross-sectional observational study, one year later, to assess the transfer of knowledge and skills to the clinical practice (71 students). Results: Students who interacted with actors in clinical simulation improved their communication skills and the ability to establish an effective helping relationship with both end-of-life patients and their families. The students perceived the clinical simulation as an innovative learning methodology that is useful to encourage reflection and transfer of learning during their clinical internship. Conclusions: Standardization of the use of active learning methodologies is recommended for a better acquisition of transversal skills such as communication skills in palliative care.(AU)

Assessment of high fidelity simulation with actors in palliative care in nursing students: a mixed methods study.

OBJECTIVE: The most effective training methods are experiential, including those focused on experiences and emotions. Clinical simulation, especially high-fidelity simulation, is one of the most effective methodologies for the acquisition of competencies in care like palliative care. The simulation with actors can train future healthcare science professionals: in technical, intellectual, or interpersonal skills. The objective is to evaluate high-fidelity simulation with actors as a tool in palliative care training for nursing students. METHOD: Over three years, the study was conducted in a Faculty of Nursing of the south of Spain with nursing students. A mixed methods study with sequential explanatory design in three moments was conducted: (1) Quasi-experimental study in a single group (n = 12) before and after attending the palliative care course with Clinical Simulation with actors to assess the communication skills (CICAA scale), (2) Qualitative study with phenomenological perspective after Clinical Simulation (174 reflective students' narratives), (3) Cross-sectional observational study, one year later, to assess the transfer of knowledge and skills to the clinical practice (71 students). RESULTS: Students who interacted with actors in Clinical Simulation improved their communication skills and the ability to establish an effective helping relationship with both end-of-life patients and their families. The students perceived the Clinical Simulation as an innovative learning methodology that is useful to encourage reflection and transfer of learning during their clinical internship. CONCLUSIONS: Standardization of the use of active learning methodologies is recommended for a better acquisition of transversal skills such as communication skills in palliative care.

Relationship between Falls and the Use of Medications and Diseases in an Otago Exercise Programme in Old People Living in the Community in Spain.

(1) Background: Falls are a significant health problem among older adults, and can result in severe injuries, disability, and even death. In Spain, the prevalence of falls is lower if the person lives in the community than if they are institutionalized. Research has shown that exercise is an effective strategy for reducing the risk of falls among older adults. The objective of this study was to study the influence of a multicomponent exercise intervention on falls in people between 65 and 80 years of age despite the presence of diseases and drug use that are risk factors for falls; (2) Methods: This is a quasi-experimental study that focuses on people aged 65-80 who attended 21 primary healthcare centres. Target: Inclusion criteria were people between 65 and 80 years of age, living in the community with independent ambulation, and who were served by the healthcare centre of their region. Variables analysed: The number and characteristics of falls, sociodemographic, drug use, and previous diseases; (3) Results: The drugs associated with falls are benzodiazepines (OR 2.58), vasodilators (OR = 2.51), and psychotropics (OR = 1.61). For one of the years, a relationship was found between the consumption of antidepressants and falls (OR = 1.83). The associated diseases were mental and behavioural (OR = 2.53); (4) Discussion: The intervention has been related to the reduction in falls in people who consumed benzodiazepines, vasodilators, and psychotropics and in people with mental disorders; (5) Conclusion: This research concludes the importance of the implementation of the Otago Exercise Programme in the prevention of falls in the elderly.

Investigación-acción-participativa sobre empoderamiento en mujeres mayores: un análisis teórico-metodológico / Participatory Action Research on empowerment in older women: a theoretical-methodological analysis

Este artículo tiene como objetivo analizar conceptual y metodológicamente el uso de la investigación-acción-participativa (IAP), a través de una investigación de campo, con el fin de aumentar los conocimientos sobre el mismo, e ilustrar sus fortalezas y debilidades para favorecer su uso en Ciencias de la Salud.Dentro de la metodología cualitativa, la IAP se puede utilizar como herramienta de análisis del cambio y de transformación, cuyo objetivo es la emancipación y liberación de las personas que se encuentran en un determinado contexto social opresivo.Se realiza la valoración de este enfoque en base a una investigación de campo con mujeres mayores que buscaba mejorar su autocuidado a través del empoderamiento. Para ello, se desarrolló una IAP compuesta por 22 sesiones y dos llamadas telefónicas individuales donde se utilizaron herramientas de generación de datos cualitativas y cuantitativas; todo ello mediante la modalidad más crítica de la IAP. En un ejercicio de reflexividad, se detectan modificaciones y mejoras en la intervención para trabajar con mujeres mayores en futuras investigaciones.El análisis realizado permite generar nuevo conocimiento sobre la IAP para futuras investigaciones gracias a la identificación de puntos críticos: el vínculo generado, la adaptación de herramientas a las mujeres mayores y el manejo del elevado volumen de datos que se produce.(AU)

This article aims to conceptually and methodologically analyse the use of Participatory Action Research (PAR), through field research, in order to increase knowledge about it, and to illustrate its strengths and weaknesses to encourage its use in Health Sciences.Within qualitative methodology, PAR can be used as a tool for the analysis of change and transformation, whose objective is the emancipation and liberation of people who find themselves in an oppressive social context.The assessment of this approach is based on field research with older women who sought to improve their self-care through empowerment. For this purpose, PAR was undertaken, consisting of 22 sessions and two individual telephone calls where qualitative and quantitative data generation tools were used; all this through the most critical modality of PAR. In an exercise of reflexivity, modifications and improvements in the intervention were detected to work with older women in future research.The analysis carried out makes it possible to generate new knowledge on PAR for future research thanks to the identification of critical points: the link generated, the adaptation of tools to older women, and the handling of the high volume of data produced.(AU)

Promoting empowerment and self-care in older women through participatory action research: Analysis of the process of change.

AIM: To generate and understand the process of change in the empowerment of women from 60 to 80 years old through a Participatory Action Research. SPECIFIC AIM: To analyse the women participants' experiences concerning empowerment and self-care. DESIGN: We use the Participatory Action Research approach (in its critical option) in the Socio-critical Paradigm and applying the Kemmis and McTaggart Model. METHODS: A group of 10 women participants from 60 to 80 years old was created and developed the Participatory Action Research from June 2019 to May 2020. This group was involved in 22 group sessions, individual interviews, reflective diaries and triangulation with quantitative data. RESULTS: Findings were interpreted based on the Gestalt Self Theory. Women generated changes in their empowerment based on three characteristics (self-determination, self-esteem and self-confidence) and, consequently, in their self-care. They did so according to two distinct patterns of behaviour: Leader women and follower women. The former took the lead in transforming their realities and the latter observed them and evolved in a slower and more reflective manner. These changes had an impact on the most individual level (inner world) and went beyond that barrier, modifying in turn their immediate surroundings and the social level (outer world). CONCLUSIONS: The group of older women began to consider their needs and consider themselves as important once they worked on their self-determination, self-esteem and self-confidence; we show these are key aspects to work on their empowerment and promote their self-care. IMPACT: The patterns of behaviour and dimensions of empowerment detected may help in future research designs and emancipatory community interventions in this population group.

Effects of nursing interventions to improve inpatients' sleep in intensive and non-intensive care units: Findings from an umbrella review.

AIM: This review aimed to synthesise the available reviews on the effects of nursing interventions on sleep quality among patients hospitalised in intensive care and non-intensive care units. BACKGROUND: Poor sleep quality is a common fact in hospitalised patients. Nurses can contribute to the improvement of patients' sleep quality and duration. DESIGN: A review of intervention reviews was carried out and reported following the PRISMA guidelines and checklist. METHODS: We systematically searched for reviews published from January 2009 to December 2019 in PubMed, CINAHL Plus, Scopus, Institute for Scientific Information Web of Science, Joanna Briggs Database of Systematic Reviews and Cochrane Central Register of Controlled Trials databases. Searches were repeated at 24 November 2020 to include the most recent evidence. A narrative synthesis of the results was conducted. RESULTS: Nine reviews (representing 109 original papers) met the selection criteria and were included for critical appraisal. Overall, nursing interventions and sleep quality were poorly defined. We grouped the interventions into 3 categories (environmental, barrier and internal interventions) to provide a more comprehensive overview and examine effects of nursing interventions on inpatients sleep quality. Inconsistent results were obtained and low quality of the original articles was reported, making it difficult to establish absolute conclusions. CONCLUSION: The impact of environmental changes on patients' sleep was positive but inconclusive, while use of earplugs and eye masks, music and acupuncture generally showed positive results with moderate quality of evidence, and no harmful effects were reported.

Participatory Action Research on empowerment in older women: A theoretical-methodological analysis.

This article aims to conceptually and methodologically analyse the use of Participatory Action Research (PAR), through field research, in order to increase knowledge about it, and to illustrate its strengths and weaknesses to encourage its use in Health Sciences. Within qualitative methodology, PAR can be used as a tool for the analysis of change and transformation, whose objective is the emancipation and liberation of people who find themselves in an oppressive social context. The assessment of this approach is based on field research with older women who sought to improve their self-care through empowerment. For this purpose, PAR was undertaken, consisting of 22 sessions and two individual telephone calls where qualitative and quantitative data generation tools were used; all this through the most critical modality of PAR. In an exercise of reflexivity, modifications and improvements in the intervention were detected to work with older women in future research. The analysis carried out makes it possible to generate new knowledge on PAR for future research thanks to the identification of critical points: the link generated, the adaptation of tools to older women, and the handling of the high volume of data produced.

Sleep quality among inpatients of Spanish public hospitals.

Sleep is a complex process and is needed both in health and illness. Deprivation of sleep is known to have multiple negative physiological effects on people's bodies and minds. Despite the awareness of these harmful effects, previous studies have shown that sleep is poor among hospitalised patients. We utilized an observational design with 343 patients recruited from medical and surgical units in 12 hospitals located in nine Spanish regions. Sociodemographic and clinical characteristics of patients were collected. Sleep quality at admission and during hospitalisation was measured by the Pittsburgh Sleep Quality Index. Sleep quantity was self-reported by patients in hours and minutes. Mean PSQI score before and during hospitalisation were respectively 8.62 ± 4.49 and 11.31 ± 4.04. Also, inpatients slept about an hour less during their hospital stay. Lower educational level, sedative medication intake, and multi-morbidity was shown to be associated with poorer sleep quality during hospitalisation. A higher level of habitual physical activity has shown to correlate positively with sleep quality in hospital. Our study showed poor sleep quality and quantity of inpatients and a drastic deterioration of sleep in hospital versus at home. These results may be helpful in drawing attention to patients' sleep in hospitals and encouraging interventions to improve sleep.

Promoción de la actividad física en mujeres mayores. Un estudio cualitativo con perspectiva de género / Promoting physical activity in older women. A qualitative study with a gender perspective

Objetivos: Conocer las estrategias profesionales utilizadas para lapromoción y adherencia de la práctica de actividad física entre lasmujeres mayores. Metodología: Estudio cualitativo con enfoquesociocrítico feminista y perspectiva de género mediante 3 grupos focales y2 entrevistas en profundidad. Participaron 26 profesionales del ámbito deatención primaria y monitores de actividades físicas (el 54% enfermeras).Análisis interpretativo de contenido y uso del programa informáticoMAXQDA-18. Resultados: Surgieron 2 categorías y 7 subcategorías.Los/las profesionales definieron el vínculo que existe entre la actividadfísica y las mujeres mayores a partir de los estereotipos de géneroque perciben que se han ido construyendo histórica y culturalmentealrededor de ellas, centrados principalmente en el rol de cuidadoras y enla identidad social entre iguales. Utilizan estrategias para incentivar lapráctica de actividad física basadas en la comunicación, experimentación,personalización, fortalecimiento de redes comunitarias y suempoderamiento. Conclusiones: Las mujeres mayores actuales presentanun vínculo con la actividad física marcado por estereotipos de génerotradicionales más alejados de beneficios físicos, pero cercanos a interesessociales y de identidad. Los/las participantes se apoyan en las experienciasde estas mujeres para la toma de conciencia de su autocuidado a travésde la actividad física y de la socialización. Estos hallazgos, que relacionanla actividad física con los estereotipos femeninos de socialización entreiguales, así como la responsabilidad y cuidado de su propia salud, sonlos que pueden ayudar a los/las profesionales a conseguir la satisfacción yadherencia en las mujeres mayores con la práctica. (AU)

Objectives: To understand the professional strategies usedto promote and adherence to the physical activity practiceamong older women. Methodology: Qualitative study witha feminist socio-critical approach and gender perspectivethrough three focus groups and two in-depth interviews.Twenty-six primary care professionals and fitness instructorparticipated (54% nurses). Interpretative content analysis anduse of the MAXQDA-18 software. Results: Two categoriesand seven subcategories emerged. Professionals defined thelink between physical activity and older women based on thegender stereotypes they perceived to have been historicallyand culturally constructed focusing mainly on the role ofcaregivers and social identity among equals. They use strategiesto encourage physical activity practice based on communication,experimentation, personalisation, enhancing communitynetworks and their empowerment. Conclusions: Currentolder women present a link with physical activity markedby traditional gender stereotypes that are more distant fromphysical benefits but closer to social and identity interests.Participants draw on these women’s experiences of self-careawareness through physical activity and socialisation. Thesefindings, which link physical activity with female stereotypesof peer socialisation as well as responsibility and care for one’sown health, can help practitioners to achieve older women’ssatisfaction and adherence with the practice. (AU)

[Limited Reuse and Extended Use of Filtering Facepiece Respirators]. / Reutilización limitada y uso extendido de mascarillas de media-alta filtración.

AIM: Personal protective equipment (PPE), including respirators, is essential in a pandemic like COVID-19, which has required, on many occasions, the reuse of material due to its shortage. The aim of this review is to summarize available evidence on the reuse and extended use of filtering facepiece respirator. METHOD: Scoping review. Search through natural language in PUBMED and Centers, Agencies and Organizations for Disease Control. Limited to articles published between 2010-2020 in English and Spanish. RESULTS: 83 articles were located, 14 were selected, plus 5 recommendations. The topics included in this study are classified in 7 sections: expiration, extended use and reuse of masks, handling techniques, sealing, physical-psychological effects and compliance, contamination and decontamination of respirators. CONCLUSIONS: The reuse of masks is not recommended by official organizations or manufacturers, and is only accepted in extraordinary cases, such as pandemics. The studies are characterized by having small samples, using different models of respirators adjusting their recommendation to the model.

[Disinfectants and antiseptics facing coronavirus: synthesis of evidence and recommendations]. / Desinfectantes y antisépticos frente al coronavirus: Síntesis de evidencias y recomendaciones.

OBJECTIVE: To synthesize the available evidence on the use of antiseptics and disinfectants in the face of VIDOC-19 infection. METHOD: Bibliographic search in the main databases (WOS, CCC, DIIDW, KJD, MEDLINE, RSCI, SCIELO, PubMed, BMJ Best Practice, Cochrane Library, UptoDate) and on the web of official bodies in March 2020, using descriptors and truncations. The search was limited to reviews published between 2016-2020. RESULTS: Thirty-six papers were identified (no duplicates) of which 17 were selected for relevance and specificity and one paper was added from the literature review. In the documents finally used, no evidence was located, but experiences and recommendations of interest were found, highlighting the importance of material, environmental and, very significantly, hand disinfection. CONCLUSION: There is no clear evidence, nor are there clear recommendations for the use of one or another antiseptic, although the action of sodium hypochlorite, ethanol and hydrogen peroxide is highlighted in comparison to others such as benzalkonium chloride, chlorhexidine digluconate, povidoeyodine and diluted ethyl alcohol. Particular importance is attached to their use in hand hygiene, the use of protective equipment and environmental disinfection.

El cuidado en la prevención de caídas en personas mayores: metaresumen de artículos cualitativos / The care in the prevention of falls in elderly people: Meta-summary of qualitative articles

Objetivo: Resumir la evidencia cualitativa sobre el papel de los proveedores de cuidados en la prevención de las caídas de personas mayores de 65años en centros y en la comunidad. Diseño: Metarresumen de evidencias cualitativas siguiendo el método de agregación. Fuentes de datos: Búsqueda manual y extensiva en 16 bases de datos (CINAHL, Pubmed/Medline, Embase, PsycInfo, Cochrane Library, PeDRO, Opengrey [Reports], Cuiden, Cuidatge, Enfispo, Medes, Lilacs, Teseo, Dissertation and Thesis Global e Ibecs), en inglés, francés, español y portugués; sin límite temporal. Selección de estudios: Selección y valoración crítica ciega por pares. Se realizó un primer cribado de relevancia y pertinencia y un segundo cribado de valoración crítica. Se localizaron 4.170 artículos; se evaluaron críticamente 41 artículos cualitativos y se seleccionaron 31. Extracción de datos: Se extrajeron datos relativos al autor, año, diseño de estudio, lugar, participantes (número, edad, sexo y ocupación), métodos del estudio y hallazgos. Se realizó un análisis descriptivo y temático. Resultados: El análisis reveló 4 grandes temas: factores precipitantes, modelos preventivos, sentimientos y proceso de toma de decisiones. Destaca también el difícil acto del equilibrio ético, el papel de la institución en la prevención y la fragmentación del cuidado, como claves para una implantación exitosa. Conclusiones: Los hallazgos manifiestan la complejidad de la prevención en caídas y la necesidad de incorporar opiniones de los proveedores de cuidados en los modelos preventivos.(AU)

Objective: To summarize the qualitative evidence on the role of care providers in the prevention of falls of persons over 65 years of age in centres and in the community. Design: Meta-summary of qualitative evidence following the aggregation method. Data sources: Extensive manual search of 16 databases (CINAHL, Pubmed/Medline, Embase, PsycInfo, Cochrane Library, PeDRO, Opengrey (Reports), Cuiden, Cuidatge, Enfispo, Medes, Lilacs, Teseo, Dissertation and Thesis Glob al and Ibecs), in English, French, Spanish and Portuguese; no time limit. Selection of studies: Selection and blind critical appraisal by pairs. A first relevance and relevance screening and a second critical appraisal screening were carried out. A total of 4170 articles were located; 41 qualitative articles were critically appraised and 31 were selected. Data extraction: Data regarding author, year, study design, location, participants (number, age, sex and occupation), study methods and findings were extracted. Results: The analysis revealed four major themes: precipitating factors, preventive models, feelings and decision-making process. It also highlights the difficult act of ethical balance, the role of the institution in prevention and the fragmentation of care, as keys to successful implementation. Conclusions: The findings show the complexity of fall prevention and the need to incorporate care providers’ opinions in preventive models.(AU)

The Relation between Functional Performance, Falls and Previous Falls Among Participants in the Otago Programme: A Secondary Data Analysis.

Fall prevention is a key priority in healthcare policies. Multicomponent exercises reduce the risk of falls. The purpose of this study is to describe the relationship between functional performance and falls after following the Otago multicomponent exercise programme and previous falls. A prospective multi-centre intervention study was performed on 498 patients aged over 65 in primary care, with or without a history of previous falls. Sociodemographic, anthropometric and functionality data were collected. The primary outcome was the occurrence of falls; functional performance was measured using the Tinetti, Short Physical Performance Battery and Timed Up and Go tests. Among the patients, 29.7% referred to previous falls. There was a statistically significant (p < 0.001) increase in falls at 6 months (10.1%) and at 12 months (7.6%) among participants with previous falls in the baseline assessment compared to those without. In addition, the existence of previous falls could be considered a risk factor at 6 and 12 months (OR =2.37, p = 0.002, and OR = 1.76, p = 0.046, respectively). With regard to balance and gait, differences between the groups were observed at 6 months in the Tinetti score (p < 0.001) and in the baseline assessment Timed Up and Go score (p < 0.044). Multicomponent exercises improve the fall rate, balance and gait in older people, although this improvement is less in people with previous falls. Earlier intervention and tailoring of exercises in patients with previous falls could help improve outcomes.

[The care in the prevention of falls in elderly people: Meta-summary of qualitative articles]. / El cuidado en la prevención de caídas en personas mayores: metaresumen de artículos cualitativos.

OBJECTIVE: To summarize the qualitative evidence on the role of care providers in the prevention of falls of persons over 65 years of age in centres and in the community. DESIGN: Meta-summary of qualitative evidence following the aggregation method. DATA SOURCES: Extensive manual search of 16 databases (CINAHL, Pubmed/Medline, Embase, PsycInfo, Cochrane Library, PeDRO, Opengrey (Reports), Cuiden, Cuidatge, Enfispo, Medes, Lilacs, Teseo, Dissertation and Thesis Global and Ibecs), in English, French, Spanish and Portuguese; no time limit. SELECTION OF STUDIES: Selection and blind critical appraisal by pairs. A first relevance and relevance screening and a second critical appraisal screening were carried out. A total of 4170 articles were located; 41 qualitative articles were critically appraised and 31 were selected. DATA EXTRACTION: Data regarding author, year, study design, location, participants (number, age, sex and occupation), study methods and findings were extracted. RESULTS: The analysis revealed four major themes: precipitating factors, preventive models, feelings and decision-making process. It also highlights the difficult act of ethical balance, the role of the institution in prevention and the fragmentation of care, as keys to successful implementation. CONCLUSIONS: The findings show the complexity of fall prevention and the need to incorporate care providers' opinions in preventive models.

La prevención de las caídas de las personas mayores y sus familiares: una síntesis cualitativa / Fall prevention in older people and their families: a qualitative synthesis

Objetivo: Analizar y sintetizar la evidencia sobre la prevención de las caídas de las personas mayores de 65 años y los proveedores de cuidados familiares.Método: Síntesis cualitativa que forma parte de una revisión sistemática integrativa de diseño convergente. Se retuvieron 41 estudios cualitativos para su lectura a texto completo y quedaron seleccionados nueve estudios de proveedores de cuidados familiares.Resultados: Las relaciones de parentesco y de cuidados median en las intervenciones de los familiares para prevenir las caídas de las personas mayores; la caída de la persona dependiente constituye un punto de inflexión en estas relaciones. Las personas cuidadoras son un grupo vulnerable de sufrir una caída, y por ello son merecedoras de acciones preventivas. Conclusiones: Considerar el contexto de las relaciones familiares y de cuidados mejorará la eficacia de las intervenciones preventivas y facilitará su aceptación. Las políticas y los programas de prevención de las caídas deben prestar mayor atención a la salud y el bienestar de los/las proveedores/as de cuidados familiares. (AU)

Objective: To analyse and synthesize the evidence on fall prevention of people older than 65 years and their family care providers Method: Qualitative synthesis, which is a part of a convergent systematic integrative review. Forty-one qualitative studies were retained for full text scrutiny. Nine studies on family care providers were selected for this synthesis. Results: Care providing, and kinship relationships mediated family care providers' interventions to prevent falls in older people. The fall of the dependent relative constitutes a turning point in these relationships. Family care providers are vulnerable to having a fall themselves and therefore receivers of preventive interventions. Conclusions: Taking into account the context of care and family relations will improve the effectiveness of preventive interventions and will facilitate adherence. Fall prevention policy and programmes must pay better attention to the health and wellbeing of family care providers. (AU)

Grupo de Investigación en Cuidados Enfermeros Avanzados (ENFERAVANZA) del Instituto Murciano de Investigación Biosanitaria, IMIB-Arrixaca / Group for Research on Advanced Nursing Care (ENFERAVANZA) from the Murcia BioHealth Research Institute, IMIB-Arrixaca

Con este artículo se presenta al grupo “Cuidados Enfermeros Avanzados ENFERAVANZA”, integrado en el Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca) como grupo de investigación enfermera del instituto, independiente de otras disciplinas de Ciencias de la Salud. En el texto se exponen las líneas de investigación, alianzas institucionales, proyectos y producción científica desde sus inicios hasta la actualidad. Se considera que la oportunidad de investigar desde los institutos de investigación acreditados visibiliza el trabajo que se está realizando por las enfermeras desde el seno de la disciplina, a la vez que se fomenta y se fortalece la investigación clínica en cuidados, considerando que lleva implícito no solo un beneficio sanitario, sino social y económico, y entendiendo la investigación como un valor fundamental en la mejora de la sanidad.(AU)

This article introduces the “Advanced Nursing Care ENFERAVANZA” group, integrated in the Murcia BioHealth Research Institute (IMIB-Arrixaca) as a nursing research group from the institute, independent from other disciplines of Health Sciences. The text presents its lines of research, institutional alliances, projects, and scientific output from their beginning until today. The opportunity to conduct research from accredited research institutes is considered to make visible the work done by nurses within the discipline, and at the same time it encourages and strengthens clinical research on care, considering that it entails not only a benefit in terms of healthcare but also social and economic, and understanding research as an essential value in terms of healthcare improvement.(AU)

Managing and keeping control: A qualitative synthesis of nursing and care staff strategies to prevent older people from falling.

AIM: To better understand formal care providers' role in fall prevention. DESIGN: Qualitative synthesis as part of an integrative review. DATA SOURCES: Fifteen electronic databases were consulted with the time limit being December 2017. Studies included were qualitative primary studies on formal care providers and fall prevention of people over 65 years of age in health care facilities. 17 studies were included. REVIEW METHODS: Qualitative researchers carried out a critical appraisal and abstraction of the studies retained. Primary studies were imported into Nvivo 12 software; grounded theory procedures of constant comparison, microanalysis, coding, development of memos and diagrams were completed concurrently in a continuous growing process of data conceptualization. Analysis was iterative; it started with open coding and ended with the development of an integrative memo. FINDINGS: Primary studies were synthesized with the emerging core category of "Managing and keeping control" and described by the emerging strategies of risk management, risk control and articulation work. These three categories account for the formal care providers' role in fall prevention in health care facilities. CONCLUSION: Fall prevention is not given by a series of means and instruments; it is rather built in the interactions between formal care providers and the material and social world. The interactive character of prevention implies that outcomes cannot always be anticipated. IMPACT: Although falls are one of the most researched clinical problems in nursing, the role played by nursing and care staff is dispersed and scantily documented. Formal care providers alternate risk management with risk control strategies to prevent older people from falling in health care facilities, they also resort to the articulation of the health care team as a complementary strategy. This review shows the dynamic character of fall prevention, which is something that has tended to go unnoticed in the literature and in policy.

Detection of factors influencing circadian rhythms on Intensive Care inpatients and hospitalization: Protocol for an observational study.

AIMS: Identify the prevalence of circadian health disorders in ICU and hospitalized patients. Stablish the relationship of the circadian system with light, temperature, noise and nursing activities. BACKGROUND: Commonly, self-assessment through subjective questionnaires is used for research about sleep quality. However, more reliable and valid measures should be applied objectively to find out the real prevalence of the problem. There is a negative relationship between circadian rhythms and hospitalization. In this study, we will analyse sleep patterns and hospital environments to implement measures to improve the quality of care related to sleep. DESIGN: Descriptive observational study. It is estimated that 975 patients from 13 hospitals need to be recruited from ICU and hospitalization units. The sample should meet the following criteria: Patients over 18 admitted to ICU and medical units, length of stay between 96-148 hr, with no visual, hearing or moderate-severe cognitive impairment. Variables: Sleep variables are collected with an electronic device (named Kronowise® and Kronobed®), circadian and infrared light exposure, environmental noise, temperature, unit structural characteristics, nursing care (from 0 to 6 a.m.) and, characteristics of hospitalization period. The study, registered on Clinical Trials, initiated in December 2019 and it will continue up to December 2022. DISCUSSION: Using objective and subjective measures of sleep and circadian rhythms, this study will shed light on the factors that negatively affect the hospitalized patients' sleep quality and circadian health. The ultimate goal is to design hospital guidelines to minimize the adverse effects on the dependent variables studied. Arguably, these guidelines will contribute to reducing the risk of these alterations and it will also serve to improve the nursing activities. CONCLUSION: We expect to obtain adequate results for the creation of a protocol to improve the circadian health, quality of care and health outcomes related to sleep in patients.