[Ethical considerations during health crisis: about SARS-CoV-2 coronavirus pandemic.] / Consideraciones éticas durante las crisis sanitarias: a propósito de la pandemia por el coronavirus SARS-CoV-2.

In 2009, the H1N1 pandemic raised a series of ethical considerations that influenced the approach to the crisis. In the framework of the SARS-CoV-2 coronavirus pandemic, these issues have been repeated, and the analysis of what happened in 2009 can be seen as a warning. The principles of justice, solidarity, equity, transparency and reciprocity should be included in future pandemic response plans, including lessons learned.

En 2009 se vivió la pandemia del H1N1 con una serie de implicaciones éticas que influyeron en el abordaje de la crisis. En el marco de la pandemia por el coronavirus SARS-CoV-2 se han repetido estas cuestiones, y el análisis de lo sucedido en 2009 ha resultado premonitorio. Los principios de justicia, solidaridad, equidad, transparencia y reciprocidad deben ser incluidos en los futuros planes de respuesta ante pandemias, incluyendo las lecciones aprendidas.

Los pilares irrenunciables de la práctica enfermera en el ámbito comunitario tras la crisis del COVID-19 / The essential pillars of nursing practice in the community setting after the COVID-19 crisis

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Consideraciones eticas durante las crisis sanitarias: a propósito de la pandemia por el coronavirus SARS-CoV-2 / Ethical considerations during health crisis: about SARS-CoV-2 coronavirus pandemic

En 2009 se vivió la pandemia del H1N1 con una serie de implicaciones éticas que influyeron en el abordaje de la crisis. En el marco de la pandemia por el coronavirus SARS-CoV-2 se han repetido estas cuestiones, y el análisis de lo sucedido en 2009 ha resultado premonitorio. Los principios de justicia, solidaridad, equidad, transparencia y reciprocidad deben ser incluidos en los futuros planes de respuesta ante pandemias, incluyendo las lecciones aprendidas

In 2009, the H1N1 pandemic raised a series of ethical considerations that influenced the approach to the crisis. In the framework of the SARS-CoV-2 coronavirus pandemic, these issues have been repeated, and the analysis of what happened in 2009 can be seen as a warning. The principles of justice, solidarity, equity, transparency and reciprocity should be included in future pandemic response plans, including lessons learned

El valor de las especialidades enfermeras. Una visión hacia el futuro / The value of specialist nurses. A vision for the future

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La gestión enfermera en España / No disponible

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The value of nursing care in the paradigm of chronicity and dependency. New roles and redesigns.

The future of Healthcare Systems not only faces financial troubles, but also--perhaps worse, the need to redesign its service offers. It is necessary to work for all the knowledge available to be placed at the service of patients and society, generating much more efficient services and opening to a redesign where nurses lead in new services supported on the strategy of effective care. Additionally, it is hoped that patients assume a responsibility and nurses another: that of accompanying patients during their disease process to become for them a support in their self-care efforts. The new role that must be assumed by community nurses is that of becoming the coaches of chronic patients and of their caregivers so they can reach a situation of equilibrium, between their desires and what they must do, to, thus, assume their responsibility in the self-provision of Basic Care.

El valor del cuidado de enfermería en el paradigma de la cronicidad y la dependencia. Nuevos roles y rediseños / O valor do cuidado da enfermagem no paradigma da cronicidade e a dependência. Novos papéis e redesenho / The value of nursing care in the paradigm of chronicity and dependency. New roles and redesigns

El futuro de los Sistemas Sanitarios no solo atraviesa por problemas de financiación, sino, tal vez mucho más, por la necesidad de rediseñar su oferta de servicios. Es necesario trabajar para que todo el conocimiento disponible se ponga al servicio de los pacientes y la sociedad, generando servicios mucho más eficientes y abriéndose a una rediseño en el cual las enfermeras lideren nuevos servicios que se apoyen en la estrategia de un cuidado eficaz. Además, se trata de que los pacientes asuman una responsabilidad y las enfermeras una más importante: la de acompañarlos en su proceso de enfermedad como apoyo en sus esfuerzos de autocuidado. El nuevo rol que deben asumir las enfermeras comunitarias es el de ser las entrenadoras de los pacientes crónicos y de sus cuidadores para que alcancen una situación de equilibrio entre sus deseos y lo que deben de hacer, para que así puedan asumir responsabilidad en la autoprovisión de Cuidados Básicos...

The future of Healthcare Systems not only faces financial troubles, but also – perhaps worse, the need to redesign its service offers. It is necessary to work for all the knowledge available to be placed at the service of patients and society, generating much more efficient services and opening to a redesign where nurses lead in new services supported on the strategy of effective care. Additionally, it is hoped that patients assume a responsibility and nurses another: that of accompanying patients during their disease process to become for them a support in their self-care efforts. The new role that must be assumed by community nurses is that of becoming the coaches of chronic patients and of their caregivers so they can reach a situation of equilibrium, between their desires and what they must do, to, thus, assume their responsibility in the self-provision of Basic Care...

O futuro dos Sistemas Sanitários não só atravessa por problemas de financiamento, senão talvez bem mais, pela necessidade de redesenhar sua oferta de serviços. É necessário trabalhar para que todo o conhecimento disponível se ponha ao serviço dos pacientes e a sociedade, gerando serviços bem mais eficientes e abrindo-se a um redesenho onde as enfermeiras liderem novos serviços que se apoiem na estratégia de um cuidado eficaz. Ademais se trata que os pacientes assumam uma responsabilidade e as enfermeiras outra: a de acompanhar aos pacientes em seu processo de doença a fim de ser para eles um apoio em seus esforços de autocuidado. O novo papel que deve ser assumido pelas enfermeiras comunitárias é o de ser as treinadoras dos pacientes crônicos e de seus cuidadores para que atinjam uma situação de equilíbrio, entre seus desejos e o que devem de fazer, para que assim possam assumir sua responsabilidade na auto-provisão de Cuidados Básicos...

La enfermera familiar y comunitaria: referente del paciente crónico en la comunidad / The family and community nurse: Health agent and model for the chronic patient within the community

Se estima que el paciente crónico complejo y/o frágil supone un 5% de la población y consume el 65% de la totalidad de los recursos sanitarios. Las personas mayores con problemas de dependencia, con enfermedades crónicas y comorbilidades necesitan cuidados profesionales que promuevan en las personas el autocuidado y la autogestión de la enfermedad. Es necesario plantearse un reenfoque donde adquieran un mayor protagonismo aquellos servicios relacionados con necesidades de cuidados profesionales. Las enfermeras y enfermeros son profesionales con una buena proyección para mejorar la sostenibilidad del sistema porque pueden responder de manera eficaz a las demandas de los pacientes en situación de cronicidad, dependencia y fragilidad. Para que la enfermera pueda dar respuestas eficientes y coste-efectivas a las necesidades de salud de las personas dependientes y/o con enfermedades crónicas, es necesario analizar y corregir los factores que limitan el crecimiento profesional y la oferta de una cartera de servicios enfermeros, entre los que se encuentran la ausencia de enfermeras en las decisiones estratégicas, la falta de objetivos e indicadores de cuidados, la escasa medida del producto, la falta de asignación de población a la enfermera, la indefinición de competencias, la heterogeneidad en la profesión y el escaso poder en el sistema para liderar un proyecto de cuidados con autonomía

It is estimated that the chronic, fragile and complex patient represents 5% of the general population, but uses up to 65% of the total amount of health care resources. Older people who are dependent, with chronic illnesses and comorbidities need professional care that promotes self-care and self-management of their illnesses. Thus, new strategies need to be considered to channel those professional care services to focus on this group. Nurse practicioners are professionals who could lead this change to improve the sustainability of the health care system, since they are in a position to respond in an effective way to the demands of patients with chronic illnesses, dependency or fragility. For the nurse working force to provide an efficient and cost-effective response to the health needs of chronically ill and disabled persons, an analysis needs to be made of the factors that restrict professional growth, as well as those nursing services where nurses do not take part in the decision making, as well as how to correct them. The lack of goals or quality care indicators, the measurement of the problem, the lack of patients assigned to a nurse practicioners, lack of training, the disparity of the profession in Spain, and the inability of the system to lead a self-sufficient care system project, should also be taken into consideratio

CuidaCare: effectiveness of a nursing intervention on the quality of life's caregiver: cluster-randomized clinical trial.

BACKGROUND: In Spain, family is the main source of care for dependent people. Numerous studies suggest that providing informal (unpaid) care during a prolonged period of time results in a morbidity-generating burden. Caregivers constitute a high-risk group that experiences elevated stress levels, which reduce their quality of life.Different strategies have been proposed to improve management of this phenomenon in order to minimize its impact, but definitive conclusions regarding their effectiveness are lacking. METHODS/DESIGN: A community clinical trial is proposed, with a 1-year follow-up period, that is multicentric, controlled, parallel, and with randomized allocation of clusters in 20 health care centers within the Community of Madrid. The study's objective is to evaluate the effectiveness of a standard care intervention in primary health care (intervention CuidaCare) to improve the quality of life of the caregivers, measured at 0, 6, and 12 months after the intervention.One hundred and forty two subjects (71 from each group) ≥65 years, identified by the nurse as the main caregivers, and who provide consent to participate in the study will be included.The main outcome variable will be perceived quality of life as measured by the Visual Analogue Scale (VAS) of EuroQol-5D (EQ-5D). The secondary outcome variables will be EQ-5D Dimensions, EQ-5D Index, nursing diagnosis, and Zarit's test. Prognostic variables will be recorded for the dependent patient and the caregiver.The principle analysis will be done by comparing the average change in EQ-5D VAS value before and after intervention between the two groups. All statistical tests will be performed as intention-to-treat. Prognostic factors' estimates will be adjusted by mixed-effects regression models. Possible confounding or effect-modifying factors will be taken into account. DISCUSSION: Assistance for the caregiver should be integrated into primary care services. In order to do so, incorporating standard, effective interventions with relevant outcome variables such as quality of life is necessary. Community care nurses are at a privileged position to develop interventions like the proposed one. TRIAL REGISTRATION: This trial has been registered in ClinicalTrials.gov under code number NCT 01478295.

[The family and community nurse: Health agent and model for the chronic patient within the community]. / La enfermera familiar y comunitaria: referente del paciente crónico en la comunidad.

It is estimated that the chronic, fragile and complex patient represents 5% of the general population, but uses up to 65% of the total amount of health care resources. Older people who are dependent, with chronic illnesses and comorbidities need professional care that promotes self-care and self-management of their illnesses. Thus, new strategies need to be considered to channel those professional care services to focus on this group. Nurse practicioners are professionals who could lead this change to improve the sustainability of the health care system, since they are in a position to respond in an effective way to the demands of patients with chronic illnesses, dependency or fragility. For the nurse working force to provide an efficient and cost-effective response to the health needs of chronically ill and disabled persons, an analysis needs to be made of the factors that restrict professional growth, as well as those nursing services where nurses do not take part in the decision making, as well as how to correct them. The lack of goals or quality care indicators, the measurement of the problem, the lack of patients assigned to a nurse practicioners, lack of training, the disparity of the profession in Spain, and the inability of the system to lead a self-sufficient care system project, should also be taken into consideration.

Influencia de los factores sociodemográficos, laborales y profesionales de enfermería en la percepción del entorno de la práctica en atención primaria / Influence of socio-demographic, labour and professional factors on nursing perception concerning practice environment in Primary Health Care

Objetivo: Analizar la percepción de los profesionales enfermeros de atención primaria de Madrid sobre el entorno en el que realizan su práctica, también relacionada con los factores sociodemográficos, laborales y profesionales. Diseño: Estudio observacional analítico transversal. Participantes y contexto: 475 enfermeros de Atención Primaria de Madrid (áreas 6 y 9, en 2010). Mediciones principales: Percepción del entorno de la práctica, a través del cuestionario Practice Environment Scale of the Nursing Work Index (PES-NWI); edad; sexo; años de experiencia profesional; categoría; área de salud; contratación y nivel académico. Resultados: Se estudiaron 331 sujetos (tasa de respuesta: 69,7%). La puntuación bruta para el PES-NWI fue: 81,04 [IC 95%: 79,18-82,91]. El factor mejor valorado fue «Apoyo de los gestores» (2,9 [IC 95%: 2,8-3]) y el peor, «Adecuación de la plantilla» (2,3 [IC 95%: 2,2-2,4]). En el modelo de regresión (variable dependiente: puntuación bruta del PES-NWI), ajustado por edad, sexo, situación laboral, permanecieron con una p≤0,05, la categoría profesional (coeficiente B =6,586) y los años de ejercicio profesional en el centro (coeficiente B = 2,139, para tiempo de 0a 2 años; coeficiente B = 7,482, para tiempo de 3-10 años; coeficiente B = 7,867, para tiempo de más de 20 años).Conclusiones: Las enfermeras con cargo de responsabilidad y aquellas que tienen mayor formación tienen una mejor percepción de su entorno de práctica. Conocer los factores del entorno de la práctica es un elemento clave para la organización sanitaria con el fin de optimizar la provisión de cuidados, y mejorar los resultados en salud (AU)

Aim: To analyze the perception of nursing professionals of the Madrid Primary Health Care environment in which they practice, as well as its relationship with socio-demographic, work-related and professional factors. Design: Cross-sectional, analytical, observational study. Participants and context: Questionnaire sent to a total of 475 nurses in Primary Health Care in Madrid (former Health Care Areas 6 and 9), in 2010. Main measurements: Perception of the practice environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI) questionnaire, as well as; age; sex; years of professional experience; professional category; Health Care Area; employment status and education level. Results: There was a response rate of 69.7% (331). The raw score for the PES-NWI was: 81.04 [95%CI: 79.18–82.91]. The factor with the highest score was “Support from Managers” (2.9 [95%CI: 2.8–3]) and the lowest “Workforce adequacy” (2.3 [95%CI: 2.2–2.4]). In the regression model (dependent variable: raw score in PES-NWI), adjusted by age, sex, employment status, professional category (coefficient B = 6.586), and years worked at the centre (coefficient B = 2.139, for a time of 0–2 years; coefficient B = 7.482, for 3–10 years; coefficient B = 7.867, for over 20 years) remained at p ≤ 0.05. Conclusions: The support provided by nurse managers is the most highly valued factor in this practice environment, while workforce adequacy is perceived as the lowest. Nurses in posts of responsibility and those possessing a higher degree of training perceive their practice environment more favourably. Knowledge of the factors in the practice environment is a key element for health care organizations to optimize provision of care and to improve health care results (AU)

Niveles de cuidados en pacientes ingresados en hospitales de media y larga estancia / Levels of care in medium and long-stay hospital patients

Objetivo: determinar los niveles de cuidados en pacientes ingresados en hospitales de media y larga estancia de la Comunidad de Madrid. Material y método: estudio descriptivo longitudinal en los hospitales de media estancia de la Comunidad de Madrid (La Fue fría y Guadarrama), sobre el total de pacientes ingresados del año 2000 al 2010 (n= 23.595). La herramienta utilizada para la clasificación de los enfermos fue la parrilla de Montesinos. Se clasificaron las necesidades de cuidados en nueve de las once acciones cuidadoras propuestas por SIGNO II, adjudicándoseles un valor del1 al 4 (1: menor nivel de dependencia), lo que se traducía en necesidad de tiempo de enfermera o de auxiliar de Enfermería. El índice de complejidad de cuidados resultaba de la media aritmética de las puntuaciones registradas para cada una de las nueve acciones cuidadoras. Resultados: no se han mostrado cambios relevantes a lo largo de los años estudiados en lo que respecta a los niveles de dependencia, aunque se ha podido observar un incremento de pacientes dependientes y muy dependientes desde el año 2005. Sin embargo, el peso en otros aspectos estudiados tiene como consecuencia que no se produzca un cambio de nivel. Conclusiones: la herramienta utilizada para la clasificación de enfermos resulta insuficiente para medir las necesidades de cuidados, ya que no recoge muchos aspectos que son relevantes para el cuidado en el momento actual. Se propone la aplicación de una nueva herramienta que mida la atención directa y que incluya intervenciones sistemáticas, seguridad, trabajo en equipo, función administrativa y docente, y cuidados de trazabilidad (AU)

Objective: to determine the levels of care in patients admitted in medium and long-stay hospitals in the Comunidad de Madrid. Materials and method: Longitudinal descriptive study in medium-stay hospitals in the Comunidad de Madrid (La Fuenfría and Guadarrama), over the total number of patients hospitalized from 2000 to 2010 (n= 23.595). The tool used for patient classification was the Parrilla de Montesinos method. Care needs were classified into nine of the eleven care actions put forward by SIGNO II, and they were assigned a value from 1 to 4 (1 = lower level of dependence), which translated into the need for nurse or nursing assistant time. The rate of care complexity resulted from the arithmetical median of those registered scores for each one of the nine care actions. Results: no relevant changes regarding dependence levels have been shown throughout the years studied, though an increase in the number of dependent and very dependent patients has been observed since 2005. However, the weight in other aspects studied has no change of level as a consequence. Conclusions: the tool used for patient classification is insufficient to measure the needs for care, because it does not collect many aspects which are currently relevant for care. It is recommended to apply a new tool which measures direct care and includes systematic interventions, safety, team work, administrative and teaching functions, and traceability care (AU)

Influence of socio-demographic, labour and professional factors on nursing perception concerning practice environment in Primary Health Care.

AIM: To analyze the perception of nursing professionals of the Madrid Primary Health Care environment in which they practice, as well as its relationship with socio-demographic, work-related and professional factors. DESIGN: Cross-sectional, analytical, observational study. PARTICIPANTS AND CONTEXT: Questionnaire sent to a total of 475 nurses in Primary Health Care in Madrid (former Health Care Areas 6 and 9), in 2010. MAIN MEASUREMENTS: Perception of the practice environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI) questionnaire, as well as; age; sex; years of professional experience; professional category; Health Care Area; employment status and education level. RESULTS: There was a response rate of 69.7% (331). The raw score for the PES-NWI was: 81.04 [95%CI: 79.18-82.91]. The factor with the highest score was "Support from Managers" (2.9 [95%CI: 2.8-3]) and the lowest "Workforce adequacy" (2.3 [95%CI: 2.2-2.4]). In the regression model (dependent variable: raw score in PES-NWI), adjusted by age, sex, employment status, professional category (coefficient B=6.586), and years worked at the centre (coefficient B=2.139, for a time of 0-2 years; coefficient B=7.482, for 3-10 years; coefficient B=7.867, for over 20 years) remained at p≤0.05. CONCLUSIONS: The support provided by nurse managers is the most highly valued factor in this practice environment, while workforce adequacy is perceived as the lowest. Nurses in posts of responsibility and those possessing a higher degree of training perceive their practice environment more favourably. Knowledge of the factors in the practice environment is a key element for health care organizations to optimize provision of care and to improve health care results.

Prevalencia de problemasde cuidados en poblaciónvulnerable / Prevalence of care problems in vulnerable population

Objetivos: estimar la prevalencia de problemas de cuidados en población vulnerablede un Área de Atención Primaria (AP).Material y métodos: estudio de diseño descriptivo transversal, realizado enun Área de Atención Primaria, durante el año 2007, con una población menorde 15 años y mayor de 75 años y con registro en Historia Clínica Informatizada(HCI). Se realiza una única medición en diciembre de 2007 delos diagnósticos enfermeros registrados en HCI de la aplicación corporativaOMI-AP. La explotación de datos se realiza a través de un lenguaje estructuradode consulta informática (SQL). Variables estudiadas: edad, sexo,etiqueta diagnóstica (NANDA II), número de consultas, duración del proceso(días) y motivo del alta de cuidados. Análisis estadístico: las variablescualitativas se describen con su distribución de frecuencias (%) y las variablescuantitativas se resumen con mediana y rango intercuartílico. El paqueteestadístico utilizado es el SPSS® versión 15.Resultados: población diana: 20,32% de la población total. Se diagnosticaron45.384 problemas; el 23,79% en población vulnerable. Diagnósticos prevalentes:ancianos: deterioro de la integridad cutánea (3,54%) y problemasde desempeño del rol cuidador (2,70% y 2,59%); niños: conductas generadorasde salud (32,97%). Ratio de visitas/diagnóstico: ancianos: 1,44 (1,00-1,93); niños: 1,2 (1,00 -1,51). Duración proceso: ancianos: 52 (18-73); niños:17 (7,3 – 36,6). Motivos alta: resolución (79%-85%), seguimiento controlado(14%-8,60%), no resolución (3%-0,5%), fallecimiento (3%-0%),abandono (1%-4,35%).Conclusiones: el sexo es un factor determinante del diagnóstico en ancianos.Los niños se mueven en diagnósticos positivos. La utilización de laetiqueta “Conductas generadoras de salud” crea dudas de buen uso a losinvestigadores. Destaca la presencia enfermera en situaciones de riesgo. Eltiempo de resolución se asocia a la dificultad de trabajar cambios actitudinalesy comportamientos saludables (AU)

Objectives: to estimate the prevalence of care problems in vulnerable populationin a Primary Care (PC) Area.Material and methods: cross-sectional descriptive design, performed in a PrimaryCare Area, throughout 2007, with a population under the age of 15years and over the age of 75 years and with a registry in ComputerisedClinical History (CCH). One single measurement of nursing diagnosesrecorded in the CCH of the corporate application OMI-AP is recorded inDecember 2007. Data analysis is performed using a structured computerisedconsultation language (SQL). Studied variables: age, gender, diagnosticlabel (NANDA II), number of consultations, process duration (days)and reason for care discharge. Statistical analysis: qualitative variablesare described in terms of their frequency distribution (%) and quantitativevariables are summarised using median and interquartile range. The statisticalpackage used is SPSS® version 15.Results: target population: 20,32% of the total population. 45,384 problemswere diagnosed; 23,79% in vulnerable population. Prevalent diagnoses:elderly: deterioration of skin integrity (3,54%) and carer role problems(2,70% and 2,59%); children: health generating behaviours (32,97%).Consultations/diagnosis ratio: elderly: 1,44 (1,00-1,93); children: 1,2 (1,00-1,51). Process duration: elderly: 52 (18-73); children: 17 (7,3-36,6). Reasonsfor discharge reasons: resolution (79%-85%), controlled follow-up(14%-8,60%), no resolution (3%-0,5%), death (3%-0%), discontinuation (1%-4,35%).Conclusions: gender is a key factor of diagnosis in elderly patients. Childrenhave positive diagnoses. The use of the “Health generating behaviours”label creates good use doubts in researchers. The nursing presencein situations of risk stands out. The timeframe for resolution is associatedwith the difficulty of working on attitude changes and healthy habits (AU)

La Enfermería comunitaria en un modelo de gestión clínica en Atención Primaria / No disponible

Las organizaciones sanitarias re -lacionadas con el primer nivel deatención se encuentran inmersas enun proceso reflexivo, realizando análisisde los logros y de los errorescometidos en este modelo de atención.Algunas de estas reflexioneshan venido dadas desde antes de lapu blicación del documento de AP21.Los enfermeros comunitarios, comoun miembro más de los equipos deAtención Primaria, también aportanreflexiones a este proceso; en sucaso, existe cierto desánimo por sentirfalta de reconocimiento en suaportación al desarrollo del modelode Atención Primaria, pero lo cierto es que también hay que reconocerque los servicios de cuidados hanalcanzado visibilidad, si bien todavíahay dudas sobre la consolidación delos aspectos específicos que aportana los equipos intedisciplinares, comoson el fomento del autocuidado y lapromoción de la salud; lo cierto esque nadie duda de su trabajo en todolo que ha tenido que ver con la prevencióny el fomento de los hábitossaludables en la población generaly, sobre todo, en la población quepadece enfermedades crónicas. Ademásla Enfermería ha contribuido aestabilizar los procesos de gestióny logística. Lo mismo sucede con eldesarrollo de los servicios domiciliariosrelacionados con los pacientesinmovilizados y terminales. Se proponela aplicación de la gestión clínicacomo una solución para mejorar elabordaje de problemas de maneraintegral, con alta participación en lagestión de recurso y un aumento dela motivación de los profesionales.La propuesta de la gestión clínica abreunas posibilidades para abordar problemasde cuidados de la población,y está claro que la dependencia puedetener una oportunidad con estaherramienta y que supone para la en -fermería la ocasión de liderar este proyectoen estructuras mucho más aplanadasy más orientadas al trabajo porproyecto(AU)