Socioeconomic Inequalities as a Cause of Health Inequities in Spain: A Scoping Review.

The objectives of this review were to identify the population groups most frequently studied, to determine the methods and techniques most commonly used to show health inequities, and to identify the most frequent socioeconomic and health indicators used in the studies on health inequities due to socioeconomic inequalities that have been carried out on the Spanish healthcare system. A scoping review was carried out of the studies conducted in the Spanish State and published in literature since 2004, after the publication of the Law of Cohesion and Quality of the National Health System. The PRISMA extension for scoping reviews was followed. The methodological quality of the studies was assessed using the critical reading guides of the Joanna Briggs Institute and an adaptation of the STROBE guide for ecological studies. A total of 58 articles out of 811 articles were included. Most of the articles were (77.59%, n = 45) cross-sectional studies, followed by ecological studies (13.8%, n = 8). The population group used was uneven, while the main geographical area under investigation was the whole state (51.7%, n = 30) compared to other territorial distributions (48.3%, n = 28). The studies used a multitude of health and socioeconomic indicators, highlighting self-perception of health (31.03%, n = 19) and social class (50%, n = 29). The relationship between better health and better socioeconomic status is evident. However, there is variability in the populations, methods, and indicators used to study health equity in Spain. Future health research and policies require greater systematization by public institutions and greater cooperation among researchers from disciplines such as sociology, economics, and health.

Diagnostic accuracy study of the VALENF instrument in hospitalization units for adults: a study protocol.

Recently, the VALENF instrument, Nursing Assessment by its acronym in Spanish, was developed as a meta-tool composed of only seven items with a more parsimonious approach for nursing assessment in adult hospitalization units. This meta-tool integrates the assessment of functional capacity, the risk of pressure injuries and the risk of falls. The general objective of this project is to validate the VALENF instrument by studying its diagnostic accuracy against the instruments commonly used in nursing to assess functional capacity, the risk of pressure injuries and the risk of falls. An observational, longitudinal, prospective study is presented, with recruitment and random selection based on admissions to six adult hospitalization units of the Hospital Universitario de La Plana. The study population will be made up of patients hospitalized in these units. The inclusion criteria will be patients over 18 years of age with a nursing assessment within the first 24 h of admission and an expected length of stay greater than 48 h and who sign the informed consent form. The exclusion criteria will be transfers from other units or centers. A sample of 521 participants is estimated as necessary. The evaluation test will be the VALENF instrument, and the reference tests will be the Barthel, Braden and Downton indices. Sociodemographic variables related to the care process and results such as functional loss, falls or pressure injuries will be collected. The evolution of functional capacity, the risk of falls and the risk of pressure injuries will be analyzed. The sensitivity, specificity and positive predictive values of the VALENF instrument will be calculated and compared to those of the usual instruments. A survival analysis will be performed for pressure injuries, falls and patients with functional loss. The VALENF instrument is expected to have at least the same diagnostic validity as the original instruments.Trial registration The study will be retrospectively registered (ISRCTN 17699562, 25/07/2023).

Explorando la validez de constructo del índice de Barthel en una muestra de pacientes hospitalizados españoles / Exploring the construct validity of the Barthel index in a sample of Spanish hospitalised patients

Objetivo: Examinar la validez de constructo del índice de Barthel en unidades de hospitalización de adultos. Métodos: Se realizó un análisis secundario en una muestra de 1.342 pacientes adultos ingresados en unidades de hospitalización. El análisis factorial confirmatorio del índice de Barthel no confirma su estructura unidimensional (CFA-1). Se exploraron dos métodos para encontrar una solución con un mejor ajuste. Se realizó la secuencia de los métodos clásicos de análisis factorial exploratorio y confirmatorio (CFA-2). Se realizó un modelo gráfico gaussiano y un análisis factorial confirmatorio (CFA-3). Se compararon tres modelos sobre una base de varios indicadores de bondad de ajuste. Resultados: Los resultados del CFA-1 (χ2 = 161.616; p < 0,001; RMSEA = 0,183) indicaron un mal ajuste entre el modelo y los datos obtenidos. El análisis factorial exploratorio proporcionó un modelo con dos dimensiones que explicaba 86% de la varianza y mejoró el indicador de bondad de ajuste en CFA-2 (χ2 = 846; p < 0,001; RMSEA = 0,133). El modelo gráfico gaussiano ofreció una solución con tres dimensiones que mejoró la bondad de ajuste con respecto a los modelos anteriores al eliminar el ítem continencia vesical (χ2 = 493; p < 0,001; RMSEA = 0,09). Conclusiones: El índice de Barthel no es una medida unidimensional de la capacidad funcional cuando se aplica en unidades de hospitalización de adultos. El modelo que mejor se ajusta tiene una estructura tridimensional (higiene, alimentación y eliminación, movilidad) que se relaciona con los dominios de los cuidados básicos.(AU)

Objective: Examine the construct validity of the Barthel Index in adult inpatient units. Methods: A secondary analysis was performed on a sample of 1342 adult patients admitted to inpatient units. A confirmatory factor analysis of the Barthel Index did not confirm its unidimensional structure (CFA-1). Therefore, two methods were explored to find a solution with a better fit. The sequence of the classical exploratory and confirmatory factor analysis methods was carried out (CFA-2). In contrast, a Gaussian graphical model and confirmatory factor analysis (CFA-3) were performed. Three models were compared on the basis of several goodness-of-fit indicators. Results: CFA-1 results (χ2 = 161616; P < .001; RMSEA = .183) indicated a poor fit between the model and the data. Exploratory factor analysis provided a model with two dimensions that explained 86% of the variance and improved the goodness-of-fit in CFA-2 (χ2 = 846; P < .001; RMSEA = .133). The Gaussian graphical model, by removing the item ‘Bladder’, offered a solution with three dimensions that improved the goodness-of-fit compared to the previous models (χ2 = 492; P < .001; RMSEA = .09). Conclusions: The Barthel Index is not a unidimensional measure of functional capacity when applied to adult inpatient units. The best-fitting model has a three-dimensional structure (Hygiene; Feeding and disposal; Mobility) that relates to the domains of care needs.

Exploring the construct validity of the Barthel index in a sample of Spanish hospitalised patients.

OBJECTIVE: Examine the construct validity of the Barthel Index in adult inpatient units. METHOD: A secondary analysis was performed on a sample of 1342 adult patients admitted to inpatient units. A confirmatory factor analysis of the Barthel Index did not confirm its unidimensional structure (CFA-1). Therefore, two methods were explored to find a solution with a better fit. The sequence of the classical exploratory and confirmatory factor analysis methods was carried out (CFA-2). In contrast, a Gaussian graphical model and confirmatory factor analysis (CFA-3) were performed. Three models were compared on the basis of several goodness-of-fit indicators. RESULTS: CFA-1 results (χ2 = 161,616; P < .001; RMSEA = .183) indicated a poor fit between the model and the data. Exploratory factor analysis provided a model with two dimensions that explained 86% of the variance and improved the goodness-of-fit in CFA-2 (χ2 = 846; P < .001; RMSEA = .133). The Gaussian graphical model, by removing the item 'Bladder', offered a solution with three dimensions that improved the goodness-of-fit compared to the previous models (χ2 = 492; P < .001; RMSEA = .09). CONCLUSION: The Barthel Index is not a unidimensional measure of functional capacity when applied to adult inpatient units. The best-fitting model has a three-dimensional structure (Hygiene; Feeding and disposal; Mobility) that relates to the domains of care needs.

Improving Nursing Assessment in Adult Hospitalization Units: A Secondary Analysis.

The main objective of this study was to analyze the impact of a multifaceted strategy to improve the assessment of functional capacity, risk of pressure injuries, and risk of falls at the time of admission of patients in adult hospitalization units. This was a secondary analysis of the VALENF project databases during two periods (October-December 2020, before the strategy, and October-December 2021, after the strategy). The quantity and quality of nursing assessments performed on patients admitted to adult hospitalization units were evaluated using the Barthel index, Braden index, and Downton scale. The number of assessments completed before the implementation of the new strategy was n = 686 (28.01%), versus n = 1445 (58.73%) in 2021 (p < 0.001). The strategy improved the completion of the evaluations of the three instruments from 63.4% (n = 435) to 71.8% (n = 1038) (p < 0.001). There were significant differences depending on the hospitalization unit and the assessment instrument (p < 0.05). The strategy employed was, therefore, successful. The nursing assessments show a substantial improvement in both quantity and quality, representing a noticeable improvement in nursing practice. This study was not registered.

Development and Validation of the Breastfeeding Literacy Assessment Instrument (BLAI) for Obstetric Women.

BACKGROUND: Despite international efforts to protect and promote exclusive breastfeeding (EBF) for infants up to six months of age, global rates of EBF continue to fall short of the targets proposed by the WHO for 2025. Previous studies have shown a relationship between the level of health literacy and the duration of EBF, although this relationship was not determinant, probably due to the use of a generic health literacy questionnaire. Therefore, this study aims to design and validate the first specific breastfeeding literacy instrument. METHODS: A Breastfeeding Literacy instrument was developed. Content validation was carried out by a group of 10 experts in health literacy, breastfeeding or instrument validation, obtaining a Content Validity index in Scale (S-CVI/Ave) of 0.912. A multicentre cross-sectional study was carried out in three Spanish hospitals to determine the psychometric properties (construct validity and internal consistency). The questionnaire was administered to 204 women during the clinical puerperium. RESULTS: The Kaiser-Meier-Oklin Test (KMO = 0.924) and Bartlett's Test of Sphericity (X2 = 3119.861; p ≤ 0.001) confirmed the feasibility of the Exploratory Factor Analysis, which explained 60.54% of the variance with four factors. CONCLUSIONS: The Breastfeeding Literacy Assessment Instrument (BLAI) consisting of 26 items was validated.

Development and Validation of a Meta-Instrument for the Assessment of Functional Capacity, the Risk of Falls and Pressure Injuries in Adult Hospitalization Units (VALENF Instrument) (Part II).

The nursing assessment is the first step of the nursing process and fundamental to detecting patients' care needs and at-risk situations. This article presents the psychometric properties of the VALENF Instrument, a recently developed meta-instrument with only seven items that integrates the assessment of functional capacity, risk of pressure injuries and risk of falls with a more parsimonious approach to nursing assessment in adult hospitalization units. A cross-sectional study based on recorded data in a sample of 1352 nursing assessments was conducted. Sociodemographic variables and assessments of the Barthel, Braden and Downton instruments were included at the time of admission through the electronic health history. Thus, the VALENF Instrument obtained high content validity (S-CVI = 0.961), construct validity (RMSEA = 0.072; TLI = 0.968) and internal consistency (Ω = 0.864). However, the inter-observer reliability results were not conclusive, with Kappa values ranging between 0.213 and 0.902 points. The VALENF Instrument has adequate psychometric properties (content validity, construct validity, internal consistency and inter-observer reliability) for assessing the level of functional capacity, risk of pressure injuries and risk of falls. Future studies are necessary to establish its diagnostic accuracy.

Developing and validating an integrated instrument for nursing assessments in adult hospitalization units: Study protocol.

AIMS: To develop and validate an instrument that integrates functional capacity, risk of pressure ulcers and risk of falling with a more parsimonious approach towards nursing assessments in hospitalization units. DESIGN: Cross-sectional validation multicentre study. METHODS: Socio-demographic variables and assessments of Barthel Index, Braden Index and Downton Scale are included via electronic health records. Instrument's development process will include: (i) conceptual assessments; (ii) content validity; (iii) construct validity; (iv) internal consistency and (v) interobserver reliability. The analysis will consider possible differences in medical and surgical hospitalization units, hospitalization type or being a COVID-19 patient. This study was accepted for funding in November 2020 and approved by the Ethics and Research Committee in January 2021. RESULTS: An integrated instrument that lowers the administrative load of nursing assessments and allows at-risk patients to be detected with at least the same validity and reliability as the original instruments is expected to be obtained.

Experiences with obstetric violence among healthcare professionals and students in Spain: A constructivist grounded theory study.

BACKGROUND: Obstetric violence appears to be a worldwide concern and is defined as a type of gender-based violence perpetrated by health professionals. This violence undermines and harms women's autonomy. In Spain, 38.3 % of women have identified themselves as victims of this type of violence. AIM: To explore current information and knowledge about obstetric violence within the Spanish healthcare context, as well as to develop a theoretical model to explain the concept of obstetric violence, based on the experiences of healthcare professionals (midwives, registered nurses, gynaecologists and paediatricians) and nursing students. METHODS: A constructivist grounded theory study was conducted at Jaume I University in Spain between May and July 2021, including concurrent data collection and interpretation through constant comparison analysis. An inductive analysis was carried out using the ATLAS.ti 9.0 software to organise and analyse the data. RESULTS: Twenty in-depth interviews were conducted, which revealed that healthcare professionals and students considered obstetric violence a violation of human rights and a serious public health issue. The interviews allowed them to describe certain characteristics and propose preventive strategies. Three main categories were identified from the data analysis: (i) characteristics of obstetric violence in the daily routine, (ii) defining the problem of obstetric violence and (iii) strategies for addressing obstetric violence. Participants identified obstetric violence as structural gender-based violence and emphasised the importance of understanding its characteristics. Our results indicate how participants' experiences influence their process of connecting new information to prior knowledge, and they provide a connection to specific micro- and macro-level strategic plans. DISCUSSION: Despite the lack of consensus, this study resonates with the established principles of women and childbirth care, but also generates a new theoretical model for healthcare students and professionals to identify and manage obstetric violence based on contextual factors. The term 'obstetric violence' offers a distinct contribution to the growing awareness of violence against women, helps to regulate it through national policy and legislation, and involves both structural and interpersonal gender-based abuse, rather than assigning blame only to care providers. CONCLUSIONS: Obstetric violence is the most accurate term to describe disrespect and mistreatment as forms of interpersonal and structural violence that contribute to gender and social inequality, and the definition of this term contributes to the ongoing awareness of violence against women, which may help to regulate it through national policy and legislation.

Prevalencia de las úlceras por presión al egreso hospitalario en chile: tendencia del indicador 2001 al 2019

Objetivo: Analizar la tendencia de la prevalencia de úlceras por presión en Chile y sus regiones de acuerdo con los egresos hospitalarios. Material y Método: Estudio ecológico de series temporales, que analizó la prevalencia de úlceras por presión entre 2001 y 2019. Se realizó un análisis descriptivo, bivariante y lineal de tendencias. Este último con método de autorregresión Prais Winsten, calculando el cambio porcentual anual (APC) y sus intervalos de confianza al 95% (IC-95%). Resultados: La muestra fue de 11.060 casos. El 55,2% (6.103) fueron hombres, la media de edad fue 60 años (± 27.5) y la estancia hospitalaria fue 21,80 (± 35,084) días, siendo significativamente mayor en quienes presentaban lesiones por presión (p< 0,001). Existe una tendencia creciente y significativa en la prevalencia de úlceras por presión en Chile y todas sus regiones, teniendo promedio de un 11,33% de crecimiento interanual (APC= 0,0019; IC:95%= 0,0016-0,0022). Conclusión: Los resultados no son alentadores a pesar del aumento de la notificación de medidas de prevención y estandarización en los cuidados.

Objective: To analyze the trend in the prevalence of pressure ulcers in Chile and its regions according to hospital discharges. Material and Method: Ecological time series study, which analyzed the prevalence of pressure ulcers between 2001 and 2019. A descriptive, bivariate and linear analysis of trends was carried out. The latter with the Prais Winsten auto-regression method, calculating the annual percentage change (APC) and its 95% confidence intervals (95% CI). Results: The sample was 11,060 cases. 55.2% (6,103) were men, the average age was 60 years (± 27.5) and the hospital stay was 21.80 (± 35,084) days, being significantly longer in those with pressure injuries (p< 0.001). There is a growing and significant trend in the prevalence of pressure ulcers in Chile and all its regions, with an average of 11.33% interannual growth (APC= 0.0019; 95% CI= 0.0016-0.0022). Conclusion: The results are not encouraging despite the increase in notification of prevention measures and standardization of care.

Objetivo: Analisar a tendência da prevalência de úlceras por pressão no Chile e suas regiões de acordo com as altas hospitalares. Material e Método: Estudo ecológico de série temporal, que analisou a prevalência de úlceras por pressão entre 2001 e 2019. Foi realizada análise descritiva, bivariada e linear de tendências. Este último com o método de autorregressão de Prais Winsten, calculando a variação percentual anual (APC) e seus intervalos de confiança de 95% (IC 95%). Resultados: A amostra foi de 11.060 casos. 55,2% (6.103) eram homens, a idade média foi de 60 anos (± 27,5) e o tempo de internação foi de 21,80 (± 35.084) dias, sendo significativamente maior naqueles com lesão por pressão (p< 0,001). Há uma tendência crescente e significativa na prevalência de úlceras por pressão no Chile e em todas as suas regiões, com uma média de crescimento interanual de 11,33% (APC= 0,0019; IC 95%= 0,0016-0,0022). Conclusão: Os resultados não são animadores apesar do aumento da notificação de medidas de prevenção e da padronização dos cuidados.

Análisis de tendencia del indicador infección del torrente sanguíneo en chile

Objetivo: Analizar la tendencia de las infecciones del torrente sanguíneo asociadas a la instalación de catéter venoso central en el sistema sanitario de Chile. Material y Método: Estudio ecológico, con análisis de tendencia de la prevalencia anual de las infecciones de torrente sanguíneo asociadas a instalación de catéter venoso central en los hospitales chilenos desde el año 2001 a 2019. Para el análisis univariado se utilizaron frecuencias, porcentajes, media y desviación estándar. En el análisis bivariado se utilizó la prueba de X 2 y T de Student en función de la naturaleza de las variables, con un nivel de significación de p=0,0034/0,0039), con un 5% de crecimiento promedio interanual de la tasa. El análisis por regiones muestra, en general, una tendencia estática. Conclusión: La infección del torrente sanguíneo por catéter venoso central es una complicación creciente en Chile, por lo que se hace necesario desarrollar programas e intervenciones que permitan controlar el avance de esta complicación.

Objective: To analyze the trend of bloodstream infections associated with central venous catheter insertion in the Chilean healthcare system. Materials and Methods: Ecological study with trend analysis of the annual prevalence of bloodstream infections associated with central venous catheter insertion in Chilean hospitals from 2001 to 2019. For univariate analysis, frequencies, percentages, mean and standard deviation were used. For bivariate analysis, the X 2 test and Student's t-test were used, according to the nature of the variables, with a significance level of p<0.01. For the trend analysis, a linear trend analysis of the annual prevalence was performed using the Prais-Winsten autoregression method, which allows the estimation of a global trend of a series of data of a quantitative indicator. The annual percent change (APC) and its 95% confidence intervals (CI-95%) were calculated. Results: A total of 27,197,232 cases were analyzed. An overall increasing and significant trend was observed throughout Chile (APC=0.00370; 95% CI=0.0034 / 0.0039), with an average interannual growth rate of 5%. In general, the analysis by region shows a static trend. Conclusion: Central venous catheter-related bloodstream infection is a growing complication in Chile. Therefore, it is necessary to develop programs and interventions to control the progression of this complication.

Objetivo: Analisar a tendência das infecções da corrente sanguínea associadas à instalação de cateter venoso central no sistema de saúde chileno. Material e Método: Estudo ecológico, com análise de tendência da prevalência anual de infecções da corrente sanguínea associadas à instalação de cateter venoso central em hospitais chilenos de 2001 a 2019. Para a análise univariada foram utilizadas frequências, porcentagens, média e desvio padrão. A análise bivariada utilizou o teste X 2 e o teste t de Student de acordo com a natureza das variáveis, com um nível de significância de p<0,01. Para a análise de tendência, foi realizada uma análise de tendência linear da prevalência anual com o método de autoregressão de Prais-Winsten, que permite estimar uma tendência global de uma série de dados de um indicador quantitativo. Foi calculada a variação percentual anual (APC sigla em inglês) e os respectivos intervalos de confiança a 95% (IC-95%). Resultados: Foram analisados 27.197.232 casos. Observou-se uma tendência global crescente e significativa em todo o Chile (APC=0,00370; IC 95%=0,0034/0,0039), com uma taxa média de crescimento anual de 5%. A análise por região mostra, em geral, uma tendência estática. Conclusão: A infecção da corrente sanguínea por cateter venoso central é uma complicação crescente no Chile. Portanto, é necessário desenvolver programas e intervenções para controlar a progressão desta complicação.

Development and Validation of a Meta-Instrument for Nursing Assessment in Adult Hospitalization Units (VALENF Instrument) (Part I).

Nursing assessment is the basis for performing interventions that match patient needs, but nurses perceive it as an administrative load. This research aims to develop and validate a meta-instrument that integrates the assessment of functional capacity, risk of pressure ulcers and risk of falling with a more parsimonious approach to nursing assessment in adult hospitalization units. Specifically, this manuscript presents the results of the development of this meta-instrument (VALENF instrument). A cross-sectional study based on recorded data was carried out in a sample of 1352 nursing assessments. Socio-demographic variables and assessments of Barthel, Braden and Downton indices at the time of admission were included. The meta-instrument's development process includes: (i) nominal group; (ii) correlation analysis; (iii) multiple linear regressions models; (iv) reliability analysis. A seven-item solution showed a high predictive capacity with Barthel (R2adj = 0.938), Braden (R2adj = 0.926) and Downton (R2adj = 0.921) indices. Likewise, reliability was significant (p < 0.001) for Barthel (ICC = 0.969; τ-b = 0.850), Braden (ICC = 0.943; τ-b = 0.842) and Downton (ICC = 0.905; κ = 7.17) indices. VALENF instrument has an adequate predictive capacity and reliability to assess the level of functional capacity, risk of pressure injuries and risk of falls.

Root cause analysis for understanding patient safety incidents in nursing student placements: A qualitative content analysis.

AIM: to explore nursing students' experiences with the use of RCA technique in patient safety-related incidents during clinical placements. A secondary descriptive qualitative content analysis BACKGROUND: Patient safety education for nursing students is an international priority. While early detection and intervention strategies, such as the root cause analysis technique, have been found to be effective for near misses and errors, little is known about how these strategies facilitate nursing students understand how patient safety incidents happen. DESIGN: A secondary qualitative content analysis was conducted as part of a larger patient safety research project. METHODS: Data were collected from nursing students at [Hidden for blinding purposes]. This study included 108 third-year undergraduate nursing students enroled in the Care Management in the Socio-Health Care Settings for the academic years 2017-2018 and 2018-2019. During hospital clinical placements, nursing students were asked to do a coursework describing a patient safety incident and using the root cause analysis technique for its analysis. A content analysis was used to provide an in-depth analysis of the collected data. RESULTS: Two main themes were identified after the data analysis process: (i) patient safety incident as learning events: highlights how these incidents were turned into learning opportunities and how the root cause analysis guided them in identifying and addressing critical incidents to prevent similar situations in the future; and (ii) strategies for improving patient safety culture: depicts how nursing students realised that following protocols and evidence-based practice reduces incidents related to patient safety and the value of reporting errors in avoiding and minimising the recurrence of similar mistakes. CONCLUSIONS: The root cause analysis technique is a versatile and flexible learning resource for nursing students that can help them understand complex patient safety incidents while also fostering critical and problem-solving thinking, teamwork and systematic communication.

Obstetric-Neonatal Care during Birth and Postpartum in Symptomatic and Asymptomatic Women Infected with SARS-CoV-2: A Retrospective Multicenter Study.

This study analyses the obstetric−neonatal outcomes of women in labour with symptomatic and asymptomatic COVID-19. A retrospective, multicenter, observational study was carried out between 1 March 2020 and 28 February 2021 in eight public hospitals in the Valencian community (Spain). The chi-squared test compared the obstetric−neonatal outcomes and general care for symptomatic and asymptomatic women. In total, 11,883 births were assisted in participating centers, with 10.9 per 1000 maternities (n = 130) infected with SARS-CoV-2. The 20.8% were symptomatic and had more complications both upon admission (p = 0.042) and during puerperium (p = 0.042), as well as transfer to the intensive care unit (ICU). The percentage of admission to the Neonatal Intensive Care Unit (NICU) was greater among offspring of symptomatic women compared to infants born of asymptomatic women (p < 0.001). Compared with asymptomatic women, those with symptoms underwent less labour companionship (p = 0.028), less early skin-to-skin contact (p = 0.029) and greater mother−infant separation (p = 0.005). The overall maternal mortality rate was 0.8%. No vertical transmission was recorded. In conclusion, symptomatic infected women are at increased risk of lack of labour companionship, mother−infant separation, and admission to the ICU, as well as to have preterm births and for NICU admissions.

Characteristics and determinants of the academic goals in nursing education: A cross-sectional study.

BACKGROUND: Academic goals guide the learning mode of nursing students, focus their objectives and influence the acquisition of skills. However, research on academic goals and related variables is scarce. OBJECTIVE: To study the relationship between different sociodemographic and academic variables with the type of academic goal in nursing students at the Universitat Jaume I (Spain). DESIGN: Cross-sectional study conducted between September 2020 and June 2021. SETTINGS AND PARTICIPANTS: Undergraduate nursing students at Universitat Jaume I (n = 263). METHODS: The Academic Goal Orientation questionnaire was administered. In addition, the variables age, gender, route to university, previous health studies, previous training in critical thinking, degree year and average grade on academic record were collected. A descriptive analysis of the sample and an analysis of the association between variables were performed. In addition, exploratory multinomial logistic regression was performed. RESULTS: The nursing students preferred the Learning Goal (95.8%; n = 263), and this increased among the students as their average grade increased. The results of the multivariate analysis indicated that students with a lower average grade, those from advanced years and those without previous training in critical thinking preferred the Work Avoidance and Self-defeating Ego Goals. CONCLUSION: The preferred goal among the students was learning. The variables that influenced the type of goal were year, average grade and previous training in critical thinking.

Variability in Healthcare Expenditure According to the Stratification of Adjusted Morbidity Groups in the Canary Islands (Spain).

Morbidity is the main item in the distribution of expenditure on healthcare services. The Adjusted Morbidity Group (AMG) measures comorbidity and complexity and classifies the patient into mutually exclusive clinical categories. The aim of this study is to analyse the variability of healthcare expenditure on users with similar scores classified by the AMG. Observational analytical and retrospective study. Population: 1,691,075 subjects, from Canary Islands (Spain), aged over 15 years with data from health cards, clinical history, Basic Minimum Specialised Healthcare Data Set, AMG, hospital agreements information system and Electronic Prescriptions. A descriptive, bivariant (ANOVA coefficient η2) and multivariant analysis was conducted. There is a correlation between the costs and the weight of AMG (rho = 0.678) and the prescribed active ingredients (rho = 0.689), which is smaller with age and does not exist with the other variables. As for the influence of the AMG morbidity group on the total costs of the patient, the coefficient η2 (0.09) obtains a median effect in terms of the variability of expenditure, hence there is intra- and inter-group variability in the cost. In a first model created with all the variables and the cost, an explanatory power of 36.43% (R2 = 0.3643) was obtained; a second model that uses solely active ingredients, AMG weight, being female and a pensioner obtained an explanatory power of 36.4%. There is room for improvement in terms of predicting the expenditure.

Student satisfaction level, clinical learning environment, and tutor participation in primary care clinical placements: An observational study.

BACKGROUND: Competence evaluations in the clinical setting represent approximately 50% of the nurse training process. Factors, such as perceived learning environment and clinical nurse participation, may influence nursing student satisfaction during clinical placements. OBJECTIVE: To evaluate the relationship between the levels of nursing student satisfaction with clinical placements, the clinical learning environment, and the level of nurse tutor participation. DESIGN: A cross-sectional study. SETTING AND PARTICIPANTS: We included 61 nursing students and 45 clinical nurses from 35 primary care centres assigned to the Universitat Jaume I. VARIABLES AND DATA COLLECTION: We assessed the overall level of student satisfaction with clinical placements, students' perception of the learning environment, tutors' level of participation, and socio-demographic variables. DATA ANALYSIS: We performed a descriptive analysis of the study sample, as well as correlation and simple linear regression analyses. Questionnaire results were analysed depending on the nature of the variables. RESULTS: The students' perception of the learning environment was 4.39 ± 0.48 points out of 5. The overall satisfaction level was 8.89 ± 1.22 points out of 10. Tutor participation level in students learning was 3.91 ± 0.58 points out of 5. CONCLUSIONS: Both student perception of the learning environment in the clinical setting and their overall level of satisfaction with clinical placements in the primary care centres were considered high. Tutors were participative, but poorly satisfied.

Infección del tracto urinario asociada a catéter urinario a permanencia: tendencia del indicador en chile

Objetivo: Analizar la tendencia del indicador "Infección del tracto urinario asociado a instalación de catéter urinario a permanencia" en Chile. Material y Método: Estudio ecológico, de series temporales en el sistema sanitario de Chile, correspondiente a un total de 15 regiones, desde el año 2001 al año 2017 (27.087.087 casos). Se incluyeron datos cuyo egreso hospitalario era infección de tracto urinario asociado a catéter urinario a permanencia, según la Clasificación Internacional de Enfermedades (CIE 10). El análisis descriptivo y correlacional (X2 y T de Student, respectivamente) se realizó en función del sexo, tipo de previsión, condición de egreso y operación quirúrgica. El análisis se realizó con el programa SPSS 24 y el nivel de significación estadística fue p< 0,05. La estimación, basada en análisis lineal, estimó cambios porcentuales anuales (APC: Annual Percentage Change) y sus intervalos de confianza al 95%. Se empleó el método de auto-regresión de Prais Winsten. El resguardo ético siguió lo dispuesto en la Ley N° 20.585. Resultados: Se observó un 2% de crecimiento interanual (APC= 0,00007; IC: 95%= 0,000069-0,000073). En los años 2005, 2008, 2009 y 2011 existió un aumento en el porcentaje de cambio de 2 a 5 puntos. Conclusión: El indicador analizado es un evento que ha presentado una tendencia creciente y significativa en Chile desde el año 2001, lo que resulta paradójico, puesto que el ordenamiento de los procesos hospitalarios, asociado a la Reforma de Salud, debería demostrar una mejora en el comportamiento de este tipo de indicadores.

Objective: To analyze the trend indicator "Urinary tract infection associated with indwelling urinary catheter insertion" in Chile. Material and Method: Ecological, time series study, carried out in the Chilean health system, corresponding to a total of 15 administrative regions, from 2001 to 2017 (27.087.087 cases). Data included information on patients whose hospital discharge was urinary tract infection associated with indwelling urinary catheter, according to the International Classification of Diseases (ICD-10). Descriptive and correlational analysis (X2 and Student's t-test, respectively) was performed according to sex, type of health insurance, hospital discharge condition and surgical operation. The analysis was performed using SPSS 24 software and the level of statistical significance was p<0.05. The estimation was based on linear analysis, estimating annual percentage changes (APC) and their 95% confidence intervals. The Prais-Winsten autoregression method was used. Ethical considerations followed the provision of Law No. 20.585. Results: A 2% interannual growth rate was observed (APC= 0.00007; CI: 95% = 0.000069-0.000073). In the years 2005, 2008, 2009 and 2011 there was an increase in the percentage change of 2 to 5 points. Conclusion: The analyzed indicator corresponds to an event that has shown a significant and increasing trend in Chile since 2001, which seems paradoxical, since hospital processes management, associated with the health care reform, should show an improvement regarding this type of trend indicator.

Objetivo: Analisar a tendência do indicador "Infecção do trato urinário associada à instalação de cateter urinário permanente" no Chile. Material e Método: Estudo ecológico, e de series temporais realizado no sistema de saúde chileno, correspondente a um total de 15 regiões administrativas, de 2001 a 2017 (27.087.087 casos). Os dados incluíram informações sobre pacientes cuja alta hospitalar foi infecção do trato urinário associada ao uso do cateter urinário permanente, de acordo com a Classificação Internacional de Doenças (CID-10). A análise descritiva e correlacional (X2 e teste t de Student, respectivamente) foi realizada segundo sexo, tipo de seguro de saúde, condição de alta hospitalar e operação cirúrgica. A estimativa foi baseada na análise linear, estimando as mudanças percentuais anuais (APC) e seus intervalos de confiança de 95%. Foi utilizado o método Prais-Winsten de auto-regressão. As considerações éticas seguiram o disposto na Lei No. 20.585. Resultados: Foi observada uma taxa de crescimento interanual de 2% (APC= 0,00007; IC:95%=0,000069-0,000073). Nos anos 2005, 2008, 2009 e 2011 houve um aumento na variação percentual de 2 a 5 pontos. Conclusão: O indicador analizado corresponde a um evento que tem mostrado uma tendência significativa e ascendente no Chile desde 2001, o que parece paradoxal, dado que a organização dos processos hospitalares associados à reforma do sistema de saúde deveria mostrar uma melhoria no comportamento deste tipo de indicador.

Healthcare Management and Quality during the First COVID-19 Wave in a Sample of Spanish Healthcare Professionals.

The aim of this study was to assess how the healthcare professionals in the Castellón Province (Spain) perceive healthcare quality and management during the first COVID-19 wave. A cross-sectional study was carried out. An online survey on healthcare quality and management during the first COVID-19 wave was sent to healthcare professionals. Almost half of the sample believed that healthcare quality worsened during the first COVID-19 wave (45.3%; n = 173). Heavier workload (m = 4.08 ± 1.011) and patients' complexity (m = 3.77 ± 1.086) were the factors that most negatively impacted healthcare quality. Health department 3, primary care center, and other doctors assessed human and material resources management as significantly worse (p < 0.05). Human and material resources management and the healthcare organization negatively affected healthcare quality during the first COVID-19 wave. Significant differences were observed according to departments, services, and professionals.