[Evaluation of good practices about breastfeeding in a mother and child hospital.] / Evaluación de buenas prácticas en lactancia materna en un hospital materno infantil.

OBJECTIVE: Protection, promotion and support to the breastfeeding is considered as an area of priority in public health care and as a determining factor of child and maternal health. The use of good practice guides improves health outcomes and patients safety. The aim of study was to assess the impact on breastfeeding of a Guide of Good Clinic Practices about breastfeeding in the Mother and Child Center of the Virgen de las Nieves University Hospital in Granada. METHODS: Cross-sectional descriptive study. Mothers and newborns attended from 2015 to 2018 were studied. Process and outcome variables were considered to perform a descriptive and bivariate analysis for the comparison between years. RESULTS: The rate of exclusive breastfeeding at discharge went from 58.3% to 72.2%. Significant differences were found for the first intake of exclusive breastfeeding in eutocic births and in C-sections, from 90.8% to 93.2% in the first and from 21.7% to 60% in the second. Improvements were detected in the assessment of intake, postnatal education and onset and duration of skin-to-skin contact. CONCLUSIONS: Postnatal protocolized actions carried out by health professionals, such as the assessment of the intake of breastfeeding and postnatal education, were effective for the establishment of breastfeeding. The first moment of skin-to-skin contact and its duration are aspects to be reinforced for effective support.

OBJETIVO: La protección, promoción y apoyo a la lactancia materna (LM) está considerada como un área de atención prioritaria de salud pública, así como un factor determinante de la salud infantil y materna. La utilización de guías de buenas prácticas mejora los resultados de salud y la seguridad de los pacientes. El objetivo del estudio fue evaluar el impacto en la lactancia materna tras la implantación de la Guía de Buenas Prácticas Clínicas "Lactancia Materna" en el centro Materno Infantil del Hospital Universitario Virgen de las Nieves de Granada. METODOS: Se realizó un estudio descriptivo transversal. Se estudiaron madres y recién nacidos atendidos desde 2015 a 2018. Se examinaron variables de proceso y de resultados, realizando análisis descriptivo y bivariante para la comparativa entre años. RESULTADOS: La tasa de LM exclusiva al alta pasó del 58,3 % al 72,2 %. Se encontraron diferencias significativas para la primera toma de LM exclusiva en los partos eutócicos (del 90,8% al 93,2%) y en las cesáreas (del 21,7% al 60%). Se obtuvieron mejoras en la valoración de la toma, la educación postnatal y el inicio y duración del contacto piel con piel. CONCLUSIONES: Las acciones protocolizadas posnatales que realizan los profesionales de la salud, como la valoración de la toma de LM y la educación postnatal, resultan eficaces para instaurar la lactancia. El momento de inicio del contacto piel con piel y su duración son aspectos que deben ser reforzados para un apoyo efectivo.

Evaluación de buenas prácticas en lactancia materna en un hospital materno infantil / Evaluation of good practices about breastfeeding in a mother and child hospital

OBJETIVO:La protección, promoción y apoyo a la lactancia materna (LM) está considerada como un área de atención prioritaria de salud pública, así como un factor determinante de la salud infantil y materna. La utilización de guías de buenas prácticas mejora los resultados de salud y la seguridad de los pacientes. El objetivo del estudio fue evaluar el impacto en la lactancia materna tras la implantación de la Guía de Buenas Prácticas Clínicas "Lactancia Materna" en el centro Materno Infantil del Hospital Universitario Virgen de las Nieves de Granada. MÉTODOS: Se realizó un estudio descriptivo transversal. Se estudiaron madres y recién nacidos atendidos desde 2015 a 2018. Se examinaron variables de proceso y de resultados, realizando análisis descriptivo y bivariante para la comparativa entre años. RESULTADOS: La tasa de LM exclusiva al alta pasó del 58,3 % al 72,2 %. Se encontraron diferencias significativas para la primera toma de LM exclusiva en los partos eutócicos (del 90,8% al 93,2%) y en las cesáreas (del 21,7% al 60%). Se obtuvieron mejoras en la valoración de la toma, la educación postnatal y el inicio y duración del contacto piel con piel. CONCLUSIONES: Las acciones protocolizadas posnatales que realizan los profesionales de la salud, como la valoración de la toma de LM y la educación postnatal, resultan eficaces para instaurar la lactancia. El momento de inicio del contacto piel con piel y su duración son aspectos que deben ser reforzados para un apoyo efectivo

OBJECTIVE: Protection, promotion and support to the breastfeeding is considered as an area of priority in public health care and as a determining factor of child and maternal health. The use of good practice guides improves health outcomes and patients safety. The aim of study was to assess the impact on breastfeeding of a Guide of Good Clinic Practices about breastfeeding in the Mother and Child Center of the Virgen de las Nieves University Hospital in Granada. METHODS: Cross-sectional descriptive study. Mothers and newborns attended from 2015 to 2018 were studied. Process and outcome variables were considered to perform a descriptive and bivariate analysis for the comparison between years. RESULTS: The rate of exclusive breastfeeding at discharge went from 58.3% to 72.2%. Significant differences were found for the first intake of exclusive breastfeeding in eutocic births and in C-sections, from 90.8% to 93.2% in the first and from 21.7% to 60% in the second. Improvements were detected in the assessment of intake, postnatal education and onset and duration of skin-to-skin contact. CONCLUSIONS: Postnatal protocolized actions carried out by health professionals, such as the assessment of the intake of breastfeeding and postnatal education, were effective for the establishment of breastfeeding. The first moment of skin-to-skin contact and its duration are aspects to be reinforced for effective support

Needs Perceived by Parents of Preterm Infants: Integrating Care Into the Early Discharge Process.

UNLABELLED: The birth of a preterm infant can have a great emotional impact on the parents when the length of stay is long. Early discharge programs facilitate the transition to the home and have beneficial effects on both the parents and children. However, only a few studies have been conducted to identify the real needs of parents of preterm infants and to determine whether early discharge programs meet such needs. The main objective of this study was to identify the experiences and obstacles, during hospitalization and after discharge, of fathers and mothers of preterm infants who did or did not participate in an early discharge program. METHOD: A qualitative study using semi-structured interviews was performed and included 23 parents of preterm infants. Thematic analysis was performed with the assistance of Atlas.ti 6.2 software. RESULTS: Two main themes were identified: the emotional experience and obstacles to care during hospitalization and the emotional experiences and obstacles at home related to the early discharge program. The results indicated that preterm birth initially has a deep emotional impact on parents. DISCUSSION: There is a remarkable lack of coordination regarding the information provided to parents on their infant's health status. Being first-time parents seems to be an important factor, although further evidence supporting this notion should be provided. CONCLUSION: Parents considered early discharge programs to be very useful in addressing the emotional aspects of hospitalization and the acquisition of neonatal care skills. Parents claim that the coordination and the information provided should be improved.

Sesiones clínicas de cuidados para profundizar en el pensamiento enfermero / Clinical sessions on patient care in order to probe into what nurses think

Desde 2009 el Hospital Universitario Virgen de las Nieves (HUVN), en Granada, viene realizando sesiones clínicas de cuidados con el objetivo de profundizar en el uso de la metodología enfermera, y crear el hábito de la reflexión continua sobre la calidad de los cuidados que se aplican. Con este trabajo se pretende dar a conocer la experiencia desarrollada durante los años 2011-2012 en la realización de sesiones clínicas de cuidados. Durante el periodo estudiado se han desarrollado un total de 35 sesiones clínicas de este tipo, distribuidas en los centros asistenciales del complejo hospitalario, de las cuales 19 han sido casos clínicos, 12 actualizaciones en cuidados, tres revisiones de guías de práctica clínica y una revisión de proceso asistencial integrado. La media de asistencia a las sesiones ha sido de 16 profesionales por sesión. Los temas tratados incluyen situaciones de salud específicas de interés en las unidades asistenciales, la indagación en diagnósticos diferénciales y la incorporación de la evidencia científica. Como mejora se propone la incorporación de criterios para la evaluación del proceso enfermero y de la estructura de las sesiones clínicas de cuidados

Since 2009, the Hospital Universitario Virgen de las Nieves (HUVN) has been conducting clinical sessions on patient care, with the objective of achieving a deep understanding about the use of nursing methodology, and creating the habit of continuous reflection about the quality of careapplied. This paper intends to make public the experience developed during the years 2011-2012 in terms of clinical sessions on patient care. During the period studied, 35 clinical sessions on patient care have been conducted, distributed among the healthcare centres of the hospital complex; 19 of these have been clinical cases, 12 have been patient care updates, three reviews of clinical practice guidelines, and one review of integrated healthcare system. The average attendance to these sessions was of 16 professionals per session. The topics covered included specific health situations of interest for patient care units, investigation into differential diagnoses, and the incorporation of scientific evidence. As an improvement, it has been suggested to incorporate criteria forthe assessment of the nursing process, and of the structure of clinical sessions on patient care

Competencias de investigación en las especialidades de Enfermería / Research competencies in nursing specialties

Desde que Enfermería se convirtió en profesión universitaria en 1977 han existido varias regulaciones para desarrollar las especialidades, coincidiendo todas ellas en la necesidad de incluir competencias en investigación. De hecho, la relevancia que adquieren estas competencias en todas las especialidades actuales ha permitido que el Real Decreto 99/2011, por el que se regulan las enseñanzas oficiales de doctorado, reconozca la formación de enfermeras especialistas como capacitante para acceder a los estudios de doctorado. En la actualidad se forman residentes de 6 de las 7 especialidades determinadas por el Real Decreto 450/2005. La adquisición de las competencias en investigación se percibe como una oportunidad y un reto; sin embargo, la estructura organizativa de los dispositivos formativos (unidades docentes multiprofesionales) y la incorporación de tutores clínicos enfermeros que se inician en esta actividad docente merecen especial atención para garantizar la correcta adquisición de competencias en investigación por parte de las enfermeras especialistas en formación (AU)

Since nursing became an university degree in 1977, there have been several regulations to develop specialties, all of them agreeing on the need to include skills in research. Indeed, the relevance of acquiring these skills in all current disciplines has led to Royal Decree 99/2011, which regulates the official PhD courses, and recognises specialist nurses as qualified to access PhD studies. Nowadays, students from six of the seven specialties included in the Royal Decree 450/2005 on nursing specialties, are performing their training. The acquisition of research skills is seen as an opportunity and a challenge. However, the organizational structure of training facilities (multiprofessional teaching units) and the incorporation of nurses as clinical tutors, who initiated this teaching activity, deserve special attention to ensure the correct acquisition of research skills in the training of specialist nurses (AU)

[Research competencies in nursing specialties]. / Competencias de investigación en las especialidades de Enfermería.

Since nursing became an university degree in 1977, there have been several regulations to develop specialties, all of them agreeing on the need to include skills in research. Indeed, the relevance of acquiring these skills in all current disciplines has led to Royal Decree 99/2011, which regulates the official PhD courses, and recognises specialist nurses as qualified to access PhD studies. Nowadays, students from six of the seven specialties included in the Royal Decree 450/2005 on nursing specialties, are performing their training. The acquisition of research skills is seen as an opportunity and a challenge. However, the organizational structure of training facilities (multiprofessional teaching units) and the incorporation of nurses as clinical tutors, who initiated this teaching activity, deserve special attention to ensure the correct acquisition of research skills in the training of specialist nurses.

La evolución del pensamiento enfermeroa través de los escritos de Pilar Arcas / Evolution of nursing thinking through the writings of Pilar Arcas

El presente artículo pretende realizar una revisión crítica del pensamientode una enfermera española, Pilar Arcas Ruiz (Granada 1951-1998), queen las últimas dos décadas del siglo XX desarrolló un intenso trabajoconsiderado de gran interés por su contribución al desarrollo de la profesiónenfermera actual. A través de la revisión de varios documentoshemos podido constatar aportaciones de excepcional importancia para eldesarrollo profesional de las enfermeras, como son sus reflexiones sobreel significado de cuidar y la aportación específica de la enfermera a la salud,la defensa de la necesidad de investigar en cuidados, la utilizaciónde metodología en el proceso de atención y la formación superior.Igualmente, este artículo pretende ser un homenaje y un reconocimientoa su trayectoria, además de dejar constancia, en forma de documentoescrito, para las nuevas generaciones de enfermeras (AU)

This article aims to perform a critical review of the thinking of a Spanishnurse, Pilar Arcas Ruiz (Granada, 1951-1998), who, in the last two decadesof the 20th century developed a comprehensive work that is deemedto be of great interest due to its contributions to the development ofthe current nursing profession. By means of the review of several documentswe have been able to find extremely important contributions tothe professional development of nurses, such as her reflections on the meaningof providing care and the specific contribution of nurses to health,the need to carry out research on care, the use of methodology inthe care delivery process and higher training.Likewise, this article aims to be a tribute and recognition of her trajectory,in addition to being a written record for new generations of nurses (AU)

[Problem-based learning, a strategy to employ it]. / Aprendizaje basado en problemas: estrategia de implantación.

The Virgen de las Nieves University School of Nursing has adopted the methodology of Problem-Based Learning (ABP in Spanish acronym) as a supplementary method to gain specific transversal competencies. In so doing, all basic required/obligatory subjects necessary for a degree have been partially affected. With the objective of identifying and administering all the structural and cultural barriers which could impede the success or effectiveness of its adoption, a strategic analysis at the School was carried out. This technique was based on a) knowing the strong and weak points the School has for adopting the Problem-Based Learning methodology; b) describing the structural problems and necessities to carry out this teaching innovation; c) to discover the needs professors have regarding knowledge and skills related to Problem-Based Learning; d) to prepare students by informing them about the characteristics of Problem-Based Learning; e) to evaluate the results obtained by means of professor and student opinions, f) to adopt the improvements identified. The stages followed were: strategic analysis, preparation, pilot program, adoption and evaluation.

Aprendizaje basado en problemas. Estrategia de implantación / Problem-based learning, a strategy to employ it

La Escuela Universitaria de Enfermería Virgen de las Nieves ha implantado la metodología del Aprendizaje Basado en Problemas (ABP), como método complementario para el logro de competencias transversales y específicas. Esto ha supuesto implicar de forma parcial a todas las asignaturas troncales y obligatorias de la titulación. Con el fin de identificar y gestionar las barreras estructurales y culturales que pudieran dificultar el éxito o la efectividad de su implantación se realizó un análisis estratégico de la Escuela. Esta técnica se basó en: a) Conocer los puntos fuertes y débiles de la Escuela para la implantación de la metodología ABP. b) Describir los problemas y necesidades de tipo estructural para llevar a cabo la innovación docente. c) Averiguar las necesidades de los profesores en cuanto a conocimientos y habilidades relacionados con el ABP. d) Preparar a los alumnos informándoles sobre las características del ABP. e) Evaluar los resultados mediante la opinión de los alumnos y profesores. f) Implantar las mejoras identificadas. Las etapas seguidas fueron: análisis estratégico, preparación, prueba piloto, implantación y evaluación(AU)

The Virgen de las Nieves University School of Nursing has adopted the methodology of Problem-Based Learning (ABP in Spanish acronym) as a supplementary method to gain specific transversal competencies. In so doing, all basic required/obligatory subjects necessary for a degree have been partially affected. With the objective of identifying and administering all the structural and cultural barriers which could impede the success or effectiveness of its adoption, a strategic analysis at the School was carried out. This technique was based on a) knowing the strong and weak points the School has for adopting the Problem-Based Learning methodology; b) describing the structural problems and necessities to carry out this teaching innovation; c) to discover the needs professors have regarding knowledge and skills related to Problem-Based Learning; d) to prepare students by informing them about the characteristics of Problem-Based Lear-ning; e) to evaluate the results obtained by means of professor and student opinions, f) to adopt the improvements identified. The stages followed were: strategic analysis, preparation, pilot program, adoption and evaluation(AU)

Plan de cuidados periquirúrgicos para el paciente trasplantado hepático / Perisurgical Nursing care plan for patients who have undergone liver transplantation

En nuestro hospital, desde el año 2002 se inició el programa de Trasplante Hepático (TH). La complejidad y especificidad de la intervención quirúrgica de TH, nos llevó a plantear la necesidad de elaborar un plan de cuidados periquirúrgico estandarizado que recogiera todas las actuaciones que realizan las/os enfermeras/os. Para ello se llevó a cabo un proceso de mejora de la calidad, que constó de dos etapas: 1ª etapa: se exploraron las actividades perioperatorias que las enfermeras realizan en el paciente trasplantado hepático, se elaboró un protocolo y se pilotó con fines de validación; 2ª etapa: se adecuó el plan de cuidados definitivo según los resultados del pilotaje (AU)

The liver transplantation (LT) programme was started in our hospital in 2002. The complexity and specificity of LT surgery led us to present the need to draw a standardised perisurgical nursing care plan that compiled all the tasks or actions undertaken by professional nursing personnel. To this end, a quality improvement process was undertaken which consisted of two stages: a first stage that explored the perioperative activities undertaken by nurses in patients with a liver transplant and that involved the elaboration of a protocol which as used as a pilot for validation purposes; and a second stage where the final nursing care plan was adapted to meet the results of the pilot phase conducted in the first stage (AU)