Factores de complejidad de cuidados asociados a la reconsulta en un servicio de urgencias / Care complexity factors associated with revisits to an emergency department

Objetivo: Analizar la prevalencia de factores de complejidad de cuidados en los pacientes atendidos en el servicio de urgencias y determinar su relación con las reconsultas durante los 30 días posteriores a la vista inicial. Método: Estudio observacional transversal correlacional. Se incluyeron de forma consecutiva todos aquellos pacientes adultos que consultaron al servicio de urgencias de un hospital de tercer nivel durante un periodo de 6 meses. Las variables principales del estudio fueron la reconsulta a los 30 días y 26 factores individuales de complejidad de cuidados categorizados en 5 fuentes (psicoemocional, mental-cognitiva, sociocultural, evolutiva, comorbilidades-complicaciones). Los datos fueron recogidos de la historia clínica electrónica. Resultados: Se incluyeron un total de 15.556 episodios de pacientes. El 82,4% (12.811) presentó algún factor de complejidad de cuidados y el 11,9% (1.088) de los pacientes dados de alta reconsultaron durante los 30 días posteriores. La presencia de mayor número de factores de complejidad de cuidados se asoció a la reconsulta a los 30 días (OR: 1,26; IC 95%: 1,11-1,43; p < 0,05), y los siguientes factores se asociaron con reconsulta: incontinencia, inestabilidad hemodinámica, riesgo de hemorragia, extremo de edad, ansiedad y temor, deterioro de funciones cognitivas y analfabetismo (p < 0,05). Conclusiones: La prevalencia de factores de complejidad de cuidados en pacientes que consultan en el servicio de urgencias es elevada. Los pacientes que reconsultaron a los 30 días presentaron mayor número de factores de complejidad, por lo que su identificación precoz podría ayudar a estratificar los pacientes y diseñar estrategias preventivas para disminuir la incidencia de reconsultas. (AU)

Objectives: To analyze the prevalence of care complexity factors (CCFs) in patients coming to an emergency department (ED) and to analyze their relation to 30-day ED revisits. Methods: Observational, correlational, and cross-sectional study. Consecutive patients seeking care from a tertiarylevel hospital ED were included over a period of 6 months. The main variables studied were 30-day revisits to the ED and 26 CCFs categorized in 5 domains: psychoemotional, mental-cognitive, sociocultural, developmental, and comorbidity/complications. Data were collected from hospital records for analysis of descriptive and inferential statistics. Results: A total of 15 556 patient episodes were studied. A CCF was recorded in 12 811 patient records (82.4%), and 1088 (11.9%) of the patients discharged directly from the ED revisited within 30 days. The presence of more CCFswas associated with 30-day revisits (odds ratio, 1.26; 95% CI, 1.11-1.43; P < .05). The CCFs that were significantly associated with revisits were incontinence, hemodynamic instability, risk for bleeding, anxiety, very advanced age, anxiety and fear, cognitive impairment, and illiteracy. Conclusions: The prevalence of CCFs is high in patients who seek ED care. Patients revisiting within 30 days of an episode have more CCFs. Early identification of such patients would help to stratify risk and develop preventive strategies to decrease the incidence of revisiting. (AU)

Care complexity factors associated with revisits to an emergency department. / Factores de complejidad de cuidados asociados a la reconsulta en un servicio de urgencias.

OBJECTIVES: To analyze the prevalence of care complexity factors (CCFs) in patients coming to an emergency department (ED) and to analyze their relation to 30-day ED revisits. MATERIAL AND METHODS: Observational, correlational, and cross-sectional study. Consecutive patients seeking care from a tertiarylevel hospital ED were included over a period of 6 months. The main variables studied were 30-day revisits to the ED and 26 CCFs categorized in 5 domains: psychoemotional, mental-cognitive, sociocultural, developmental, and comorbidity/complications. Data were collected from hospital records for analysis of descriptive and inferential statistics. RESULTS: A total of 15 556 patient episodes were studied. A CCF was recorded in 12 811 patient records (82.4%), and 1088 (11.9%) of the patients discharged directly from the ED revisited within 30 days. The presence of more CCFs was associated with 30-day revisits (odds ratio, 1.26; 95% CI, 1.11-1.43; P .05). The CCFs that were significantly associated with revisits were incontinence, hemodynamic instability, risk for bleeding, anxiety, very advanced age, anxiety and fear, cognitive impairment, and illiteracy. CONCLUSION: The prevalence of CCFs is high in patients who seek ED care. Patients revisiting within 30 days of an episode have more CCFs. Early identification of such patients would help to stratify risk and develop preventive strategies to decrease the incidence of revisiting.

OBJETIVO: Analizar la prevalencia de factores de complejidad de cuidados en los pacientes atendidos en el servicio de urgencias y determinar su relación con las reconsultas durante los 30 días posteriores a la vista inicial. METODO: Estudio observacional transversal correlacional. Se incluyeron de forma consecutiva todos aquellos pacientes adultos que consultaron al servicio de urgencias de un hospital de tercer nivel durante un periodo de 6 meses. Las variables principales del estudio fueron la reconsulta a los 30 días y 26 factores individuales de complejidad de cuidados categorizados en 5 fuentes (psicoemocional, mental-cognitiva, sociocultural, evolutiva, comorbilidades-complicaciones). Los datos fueron recogidos de la historia clínica electrónica. RESULTADOS: Se incluyeron un total de 15.556 episodios de pacientes. El 82,4% (12.811) presentó algún factor de complejidad de cuidados y el 11,9% (1.088) de los pacientes dados de alta reconsultaron durante los 30 días posteriores. La presencia de mayor número de factores de complejidad de cuidados se asoció a la reconsulta a los 30 días (OR: 1,26; IC 95%: 1,11-1,43; p 0,05), y los siguientes factores se asociaron con reconsulta: incontinencia, inestabilidad hemodinámica, riesgo de hemorragia, extremo de edad, ansiedad y temor, deterioro de funciones cognitivas y analfabetismo (p 0,05). CONCLUSIONES: La prevalencia de factores de complejidad de cuidados en pacientes que consultan en el servicio de urgencias es elevada. Los pacientes que reconsultaron a los 30 días presentaron mayor número de factores de complejidad, por lo que su identificación precoz podría ayudar a estratificar los pacientes y diseñar estrategias preventivas para disminuir la incidencia de reconsultas.

Implementation of advanced triage in the Emergency Department of high complexity public hospital: Research protocol.

AIM: To evaluate the efficacy of advanced nurse triage based on the quality of care outcomes of patients attending the Emergency Department of a high-complexity hospital. To analyse the concept of advanced triage and the essential elements of the construct. DESIGN: Mixed longitudinal study, divided into 4 steps; which will include an initial qualitative step, two observational studies and finally, a quasi-experimental study. CLINICAL TRIAL REGISTRATION NUMBER: NCT05230108. METHODS: Step 1 will consist of a concept analysis. Step 2 will include a mapping of advanced practice protocol terminologies. Step 3 will analyse the opinion of health professionals on advanced triage. In step 4: in the retrospective phase (n = 1095), sociodemographic and clinical variables and quality indicators such as waiting time will be analysed. After that, in the prospective phase (n = 547), advanced triage will be implemented and the two cohorts will be compared. The whole study will be carried out from January 2022 to January 2024. DISCUSSION: Patients classified as low complexity at triage are more vulnerable to emergency department overcrowding. The implementation of advanced triage would make it possible to respond to patient needs by offering equitable and quality healthcare, facilitating accessibility, safety and humanization of the emergency department.

Psychometric properties of the oral feeding assessment in premature infants scale.

Professionals that work in neonatal units need to identify the strengths and weaknesses of the premature infant who is in the transition process from feeding through a gastric tube to oral feeding. The main aim of this study was to validate the Oral FEeding Assessment in premaTure INfants (OFEATINg) instrument. A psychometric validity and reliability study was conducted in Neonatal Intensive Care Units of two public, metropolitan, university hospitals. The study population were premature infants at a postconceptional age of 31-35 weeks. The study included evaluation of the reliability, convergent, discriminant and construct validity, sensitivity and specificity of the OFEATINg instrument. A total of 621 feedings of 56 preterm infants were evaluated. Confirmatory factor analysis identified 3 factors and 13 indicators with a good fit to the model. Cronbach's alpha coefficient was 0.78. The instrument showed high indices of inter-rater reliability (Pearson 0.9 and intraclass correlation coefficient 0.95). The OFEATINg scale is a valid and reliable instrument for evaluating the readiness for oral feeding of preterm infants. It may enable clinicians to evaluate the physiological and behavioral abilities involved in the oral feeding process and help them make decisions related to the transition to full oral feeding.Clinical trial registration: This study was prospectively registered at the two Institutional review boards.

Risk of acute deterioration and care complexity individual factors associated with health outcomes in hospitalised patients with COVID-19: a multicentre cohort study.

BACKGROUND: Evidence about the impact of systematic nursing surveillance on risk of acute deterioration of patients with COVID-19 and the effects of care complexity factors on inpatient outcomes is scarce. The aim of this study was to determine the association between acute deterioration risk, care complexity factors and unfavourable outcomes in hospitalised patients with COVID-19. METHODS: A multicentre cohort study was conducted from 1 to 31 March 2020 at seven hospitals in Catalonia. All adult patients with COVID-19 admitted to hospitals and with a complete minimum data set were recruited retrospectively. Patients were classified based on the presence or absence of a composite unfavourable outcome (in-hospital mortality and adverse events). The main measures included risk of acute deterioration (as measured using the VIDA early warning system) and care complexity factors. All data were obtained blinded from electronic health records. Multivariate logistic analysis was performed to identify the VIDA score and complexity factors associated with unfavourable outcomes. RESULTS: Out of a total of 1176 patients with COVID-19, 506 (43%) experienced an unfavourable outcome during hospitalisation. The frequency of unfavourable outcomes rose with increasing risk of acute deterioration as measured by the VIDA score. Risk factors independently associated with unfavourable outcomes were chronic underlying disease (OR: 1.90, 95% CI 1.32 to 2.72; p<0.001), mental status impairment (OR: 2.31, 95% CI 1.45 to 23.66; p<0.001), length of hospital stay (OR: 1.16, 95% CI 1.11 to 1.21; p<0.001) and high risk of acute deterioration (OR: 4.32, 95% CI 2.83 to 6.60; p<0.001). High-tech hospital admission was a protective factor against unfavourable outcomes (OR: 0.57, 95% CI 0.36 to 0.89; p=0.01). CONCLUSION: The systematic nursing surveillance of the status and evolution of COVID-19 inpatients, including the careful monitoring of acute deterioration risk and care complexity factors, may help reduce deleterious health outcomes in COVID-19 inpatients.

Lenguajes enfermeros estandarizados y planes de cuidados. Percepción de su empleo y utilidad en atención primaria / Standardized nursing languages and care plans. Perception of use and utility in primary healthcare

OBJETIVO: Identificar la opinión de las enfermeras de atención primaria sobre el uso y la utilidad de los planes de cuidados y los lenguajes estandarizados tradicionales en la práctica asistencial. DISEÑO: Estudio descriptivo, transversal, multicéntrico. EMPLAZAMIENTO: Equipos y dispositivos de atención primaria en Cataluña. PARTICIPANTES: Se estimó una muestra necesaria de 1.668 enfermeras y se aplicó una técnica de muestreo consecutivo. INTERVENCIONES: Cuestionario de acceso on-line con preguntas sobre la percepción de facilidad, utilidad y uso de los planes de cuidados y los lenguajes estandarizados tradicionales. Mediciones: Estadísticos descriptivos con proporciones, medidas de tendencia central y de dispersión. La significación estadística se estableció si p ≤ 0,05. RESULTADOS: Se analizaron 1.813 cuestionarios. Las participantes opinaron que los planes de cuidados tienen un valor añadido medio, aunque su uso es con frecuencia incorrecto. Refirieron un nivel de conocimientos adecuado sobre los lenguajes estandarizados, y en su mayoría (81%) opinaron que son difíciles de emplear en la práctica y que son poco útiles para representar la prestación de cuidados y sus resultados (78%). Independientemente de su nivel académico y de los años de experiencia, valoraron como insuficiente la claridad (p = 0,058), facilidad de uso (p = 0,240) y utilidad de los lenguajes estandarizados (p = 0,039). CONCLUSIONES: Las enfermeras urgen a introducir cambios en el uso de los planes de cuidados, incluyendo el cambio de lenguaje, para mejorar los datos y la información que revierta positivamente la prestación de cuidados para la mejora de los resultados de salud de las personas beneficiarias de los servicios de atención primaria

OBJECTIVE: To identify opinions of Primary Healthcare nurses on the use and usefulness of standardised nursing care plans and traditional nursing language systems in the practice settings. DESIGN: Multicentre, observational, cross-sectional study. SETTING: Primary Healthcare centres in Catalonia. PARTICIPANTS: Sample size was estimated at 1,668 registered nurses. Consecutive sampling was applied. INTERVENTIONS: On-line survey containing questions on ease, usefulness, and use of nursing care plans and standardised nursing language systems. Measurements: Descriptive statistics, including percentages, central tendency, and dispersion measures. Statistical significance was set at P ≤ .05. RESULTS: The final analysis included 1,813 questionnaires. Participants stated that care plans have a medium added value, however their use is frequently incorrect. They stated to have a fair level of knowledge on traditional standardised nursing languages, and most were of the opinion that these languages are difficult to use in practice (81%) and not useful to represent nursing care provision and its outcomes (78%). Regardless of their education level and years of experience, the participants assessed as insufficient the clarity (P = .058), ease of use (P = .240), and usefulness (P = .039) of these language systems in practice. CONCLUSIONS: Nurses say that urgent changes are required in the use of care plans. This includes changing the language systems, and improving data and information that positively impacts on the provision of nursing care, as well as to enhance the health outcomes of the individuals receiving Primary Healthcare services

Care complexity individual factors associated with adverse events and in-hospital mortality.

INTRODUCTION: Measuring the impact of care complexity on health outcomes, based on psychosocial, biological and environmental circumstances, is important in order to detect predictors of early deterioration of inpatients. We aimed to identify care complexity individual factors associated with selected adverse events and in-hospital mortality. METHODS: A multicenter, case-control study was carried out at eight public hospitals in Catalonia, Spain, from January 1, 2016 to December 31, 2017. All adult patients admitted to a ward or a step-down unit were evaluated. Patients were divided into the following groups based on the presence or absence of three adverse events (pressure ulcers, falls or aspiration pneumonia) and in-hospital mortality. The 28 care complexity individual factors were classified in five domains (developmental, mental-cognitive, psycho-emotional, sociocultural and comorbidity/complications). Adverse events and complexity factors were retrospectively reviewed by consulting patients' electronic health records. Multivariate logistic analysis was performed to identify factors associated with an adverse event and in-hospital mortality. RESULTS: A total of 183,677 adult admissions were studied. Of these, 3,973 (2.2%) patients experienced an adverse event during hospitalization (1,673 [0.9%] pressure ulcers; 1,217 [0.7%] falls and 1,236 [0.7%] aspiration pneumonia). In-hospital mortality was recorded in 3,996 patients (2.2%). After adjustment for potential confounders, the risk factors independently associated with both adverse events and in-hospital mortality were: mental status impairments, impaired adaptation, lack of caregiver support, old age, major chronic disease, hemodynamic instability, communication disorders, urinary or fecal incontinence, vascular fragility, extreme weight, uncontrolled pain, male sex, length of stay and admission to a medical ward. High-tech hospital admission was associated with an increased risk of adverse events and a reduced risk of in-hospital mortality. The area under the ROC curve for both outcomes was > 0.75 (95% IC: 0.78-0.83). CONCLUSIONS: Several care complexity individual factors were associated with adverse events and in-hospital mortality. Prior identification of complexity factors may have an important effect on the early detection of acute deterioration and on the prevention of poor outcomes.

[Standardized nursing languages and care plans. Perception of use and utility in primary healthcare]. / Lenguajes enfermeros estandarizados y planes de cuidados. Percepción de su empleo y utilidad en atención primaria.

OBJECTIVE: To identify opinions of Primary Healthcare nurses on the use and usefulness of standardised nursing care plans and traditional nursing language systems in the practice settings. DESIGN: Multicentre, observational, cross-sectional study. SETTING: Primary Healthcare centres in Catalonia. PARTICIPANTS: Sample size was estimated at 1,668 registered nurses. Consecutive sampling was applied. INTERVENTIONS: On-line survey containing questions on ease, usefulness, and use of nursing care plans and standardised nursing language systems. MEASUREMENTS: Descriptive statistics, including percentages, central tendency, and dispersion measures. Statistical significance was set at P≤.05. RESULTS: The final analysis included 1,813 questionnaires. Participants stated that care plans have a medium added value, however their use is frequently incorrect. They stated to have a fair level of knowledge on traditional standardised nursing languages, and most were of the opinion that these languages are difficult to use in practice (81%) and not useful to represent nursing care provision and its outcomes (78%). Regardless of their education level and years of experience, the participants assessed as insufficient the clarity (P=.058), ease of use (P=.240), and usefulness (P=.039) of these language systems in practice. CONCLUSIONS: Nurses say that urgent changes are required in the use of care plans. This includes changing the language systems, and improving data and information that positively impacts on the provision of nursing care, as well as to enhance the health outcomes of the individuals receiving Primary Healthcare services.

Acuity, nurse staffing and workforce, missed care and patient outcomes: A cluster-unit-level descriptive comparison.

AIM: To compare the patient acuity, nurse staffing and workforce, missed nursing care and patient outcomes among hospital unit-clusters. BACKGROUND: Relationships among acuity, nurse staffing and workforce, missed nursing care and patient outcomes are not completely understood. METHOD: Descriptive design with data from four unit-clusters: medical, surgical, combined and step-down units. Descriptive statistics were used to compare acuity, nurse staffing coverage, education and expertise, missed nursing care and selected nurse-sensitive outcomes. RESULTS: Patient acuity in general (medical, surgical and combined) floors is similar to step-down units, with an average of 5.6 required RN hours per patient day. In general wards, available RN hours per patient day reach only 50% of required RN hours to meet patient needs. Workforce measures are comparable among unit-clusters, and average missed nursing care is 21%. Patient outcomes vary among unit-clusters. CONCLUSION: Patient acuity is similar among unit-clusters, while nurse staffing coverage is halved in general wards. While RN education, expertise and missed care are comparable among unit-clusters, mortality, skin injuries and risk of family compassion fatigue rates are higher in general wards. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers play a pivotal role in hustling policymakers to address structural understaffing in general wards, to maximize patient safety outcomes.

Predicting patient acuity according to their main problem.

AIM: To assess the ability of the patient main problem to predict acuity in adults admitted to hospital wards and step-down units. BACKGROUND: Acuity refers to the categorization of patients based on their required nursing intensity. The relationship between acuity and nurses' clinical judgment on the patient problems, including their prioritization, is an underexplored issue. METHOD: Cross-sectional, multi-centre study in a sample of 200,000 adults. Multivariate analysis of main problems potentially associated with acuity levels higher than acute was performed. Distribution of patients and outcome differences among acuity clusters were evaluated. RESULTS: The main problems identified are strongly associated with patient acuity. The model exhibits remarkable ability to predict acuity (AUC, 0.814; 95% CI, 0.81-0.816). Most patients (64.8%) match higher than acute categories. Significant differences in terms of mortality, hospital readmission and other outcomes are observed (p < .005). CONCLUSION: The patient main problem predicts acuity. Most inpatients require more intensive than acute nursing care and their outcomes are adversely affected. IMPLICATIONS FOR NURSING MANAGEMENT: Prospective measurement of acuity, considering nurses' clinical judgments on the patient main problem, is feasible and may contribute to support nurse management workforce planning and staffing decision-making, and to optimize patients, nurses and organizational outcomes.

Barriers and facilitators involved in standardised care plan individualisation process in acute hospitalisation wards: A grounded theory approach.

OBJECTIVE: To identify and classify the barriers and facilitators of the individualisation process of the standardised care plan in hospitalisation wards. BACKGROUND: The administration of individualised care is one of the features of the nursing process. Care plans are the structured record of the diagnosis, planning and evaluation stages of the nursing process. Although the creation of standardised care plan has made recording easier, it is still necessary to record the individualisation of the care. It is important to study the elements that influence the individualisation process from the nurses' perspective. DESIGN: Qualitative study with the grounded theory approach developed by Strauss and Corbin. METHODS: Thirty-nine nurses from three hospitals participated by way of theoretical sampling. In-depth interviews were conducted, as well as participant observation, document analysis and focus group discussion. The analysis consisted of open, axial and selective coding until data saturation was reached. EQUATOR guidelines for qualitative research (COREQ) were applied. RESULTS: For both barriers and facilitators, three thematic categories emerged related to organisational, professional and individual aspects. The identified barriers included routines acquired in the wards, the tradition of narrative records, lack of knowledge and limited interest in individualisation. The identified facilitators included holding clinical care sessions, use of standardised care plan and an interface terminology, the nurse's expertise and willingness to individualise. CONCLUSION: The individualisation process of the standardised care plan involves multiple barriers and facilitators, which influence its degree of accuracy. RELEVANCE TO CLINICAL PRACTICE: Implementing strategies at an organisational level, professional level and individual level to improve the way the process is carried out would encourage individualising the standardised care plan in a manner that is consistent with the needs of the patient and family; it would improve the quality of care and patient satisfaction.

Disfunción cognitiva postoperatoria / Postoperative cognitive dysfunction: a concept analy

IntroduccIón. La disfunción cognitiva postoperatoria (DCPO) es una complicación frecuente, generalmente subestimada y que comporta un impacto negativo en la calidad de vida de los pacientes y sus familias. La heterogeneidad de los estudios clínicos publicados hasta la fecha actual explica la falta de una definición clara y estandarizada del constructo. Objetivo. Examinar críticamente el concepto de DCPO con el fin de desarrollar una concepción precisa y diferenciada de este fenómeno. Método. Análisis de concepto fundamentado en la técnica descrita por Wilson a partir de la revisión de la literatura publicada para examinar las características que definen el concepto y sus atributos. resultados. La DCPO es una complicación derivada del acto quirúrgico y anestésico; su etiología es desconocida, aunque la hipótesis fisiopatológica más aceptada es la de la neuroinflamación. Los factores de riesgo evidenciados son la edad avanzada y un nivel educacional bajo. Es un trastorno transitorio y reversible en la mayoría de los casos; de no ser así, puede desencadenar demencia. La enfermera tiene un papel fundamental en la identificación y en la detección precoz de los signos y síntomas asociados. conclusIones. El análisis resultante de este trabajo ayuda a dilucidar el concepto y permite diferenciarlo de otros afines. Se pone de manifiesto la relevancia clínica del trastorno y permite apuntar nuevas estrategias de intervención para mejorar la seguridad de los pacientes y la práctica clínica

Background. Postoperative Cognitive Dysfunction (POCD) is a frequent complication, generally underestimated and has a very negative impact on patients and their family's quality of life. At present there is no clear concept nor standardized definition POCD, possibly to the heterogeneity of the published scientific literature. Objective. To review with criticism the POCD’s concept by analyzing the current state of scientific literature in order to develop an accurate conception of this phenomenon. Method. To review the published literature and apply concept analysis based on Wilson's method to examine the characteristics that define the concept and its attributes. Results. The POCD is a complication derived from the surgical and anesthetic act, its etiology is unknown, although the most accepted physiopathological hypothesis is neuroinflammation. The most evidenced risk factors are advanced age and a low educational level. In most cases, it is a transient and reversible disorder, otherwise it can trigger dementia. Nurses play a fundamental role in the identification and early detection of associated signs and symptoms. Conclusions. The analysis resulting from this work might help to clarify the concept of POCD and allowing to establish its differences from other similar entities. It highlights the clinical relevance of the disorder and allows us to point out new intervention strategies to improve patient safety and clinical practice

Level of satisfaction of critical care patients regarding the nursing care received: Correlation with sociodemographic and clinical variables.

BACKGROUND: The satisfaction of critical care patients regarding the nursing care received is a key indicator of the quality of hospital care. It is, therefore, essential to identify the factors associated with the level of satisfaction of critical care patients. OBJECTIVES: To analyse the level of satisfaction of critical care patients in relation to the nursing care received and to determine the relationship between the level of satisfaction and the sociodemographic and clinical variables. METHODS: This is a prospective and descriptive correlational study. The population were all patients discharged (January 2013 to January 2015) from three intensive care units of a third-level hospital (n = 200). The data on the satisfaction level were collected using the previously validated Nursing Intensive-Care Satisfaction Scale, and the sociodemographic and clinical data were recorded by means of a questionnaire. RESULTS: Mean participants' age in the study (n = 200) was 65.9 years (standard deviation 13.4 years), with a 66% proportion of men (n = 132). There was a very high level of satisfaction regarding the nursing care received during the patients' stay in the intensive care unit, with a rating of 5.73 (standard deviation 0.41). There is no correlation between the level of satisfaction and the sociodemographic variables collected. However, there were statistically significant differences in the average score of the overall level of satisfaction (rho = 0.182, p = 0.010) with respect to the perception of the state of health. CONCLUSION: Critical care patients expressed very high rates of satisfaction, for both the scale as a whole and each of the factors. A high level of satisfaction is strongly influenced by the perception of the state of health.

Individualization process of the standardized care plan in acute care hospitalization units: Study protocol.

AIM: To understand the individualization process of the standardized care plan (SCP) that nurses design for hospitalized patients. BACKGROUND: To apply the nursing process, it is advisable to use SCP to standardize the diagnosis, planning and evaluation stages. However, the fundamental element of this methodology is the individualization of the care plan. DESIGN: A qualitative study, framed within the constructivist paradigm and applying the Grounded Theory method, in accordance with Strauss and Corbin's approach. METHODS: Multicentre study. Theoretical sampling with maximum variation will be used. The data collection will consist of: in-depth individual interviews, participant observation, document analysis, focus group, and the questionnaires for Critical Thinking Assessment in relation to clinical practice and Nursing Competency Assessment for hospital nurses. The qualitative data will be analysed according to the constant comparative method of Strauss and Corbin's Grounded Theory, which involves performing open, axial and selective coding. The questionnaire results will be used to make a qualitative analysis that will consist of a triangulation between the level of critical thinking, level of expertise and record of the individualization process performed by the nurses. This protocol was approved in July 2015. DISCUSSION: By knowing the possible stages used in the individualization of a SCP, together with the elements that facilitate or hinder said individualization and nurses' attitudes and experiences regarding this phenomenon, it could help direct improvement strategies in the standardization and individualization process. In addition to recommendations for teaching and research.

Care Complexity Individual Factors Associated With Hospital Readmission: A Retrospective Cohort Study.

PURPOSE: To determine the frequency of care complexity individual factors documented in the nursing assessment and to identify the risk factors associated with hospital readmission within 30 days of hospital discharge. DESIGN: Observational analysis of a retrospective cohort at a 700-bed university hospital in Barcelona, Spain. A total of 16,925 adult patient admissions to a ward or intermediate care units were evaluated from January to December 2016. Most patients were admitted due to cardiocirculatory and respiratory disorders (29.3%), musculoskeletal and nervous system disorders (21.8%), digestive and hepatobiliary conditions (17.9%), and kidney or urinary disorders (11.2%). METHODS: Readmission was defined as rehospitalization for any reason within 30 days of discharge. Patients who required hospital readmission were compared with those who did not. The individual factors of care complexity included five domains (developmental, mental-cognitive, psycho-emotional, sociocultural, and comorbidity or complications) and were reviewed using the electronic nursing assessment records. Multivariate logistic analysis was performed to determine factors associated with readmission. FINDINGS: A total of 1,052 patients (6.4%) were readmitted within 30 days of hospital discharge. Care complexity individual factors from the comorbidity or complications domain were found to be the most frequently e-charted (88.3%). Care complexity individual factors from developmental (33.2%), psycho-emotional (13.2%), mental-cognitive (7.2%), and sociocultural (0.7%) domains were less frequently documented. Independent factors associated with hospital readmission were old age (≥75 years), duration of first hospitalization, admission to a nonsurgical ward, major chronic disease, hemodynamic instability, immunosuppression, and relative weight of diagnosis-related group. CONCLUSIONS: A substantial number of patients required readmission within 30 days after discharge. The most frequent care complexity individual factors recorded in the nursing assessment at index admission were related to comorbidity or complications, developmental, and psycho-emotional domains. Strategies related to transition of care that include clinical characteristics and comorbidity or complications factors should be a priority at hospital discharge and after leaving hospital, but other factors related to developmental and psycho-emotional domains could have an important effect on the use of healthcare resources. CLINICAL RELEVANCE: Nurses should identify patients with comorbidity or complications, developmental, and psycho-emotional complexity factors during the index admission in order to be able to implement an effective discharge process of care.

Accuracy and completeness of records of adverse events through interface terminology. / Precisión y exhaustividad del registro de eventos adversos mediante una terminología de interfase.

OBJECTIVE: To determine what adverse events, including pressure ulcers, infection of the surgical site and aspiration pneumonia, nurses record in clinical histories, in terms of diagnostic accuracy and completeness, through ATIC. METHOD: Observational, descriptive, cross-sectional, multicenter study of 64 medical-surgical and semi-critical units of two university hospitals in Catalonia, Spain, during 2015. The diagnostic accuracy was assessed by means of the correspondence between the event declared in the Minimum Basic Data Set and the problem documented by the nurse. The record was considered complete when it contained the risk of the event, prescriptions of care and a record of the evolution. RESULTS: The sample evaluated included 459 records. The accuracy results of pressure ulcers are highly correlated between the nursing diagnosis recorded and that declared in the Minimum Basic Data Set. The accuracy in surgical site infection is moderate, and aspiration resulting in pneumonia is very low. The completeness of results is remarkable, except for the risk of bronchoaspiration. CONCLUSION: The adverse event recorded by nurses with greatest accuracy is pressure ulcers.

Nursing Intensive-Care Satisfaction Scale [NICSS]: Development and validation of a patient-centred instrument.

AIM: The aim of this study was to develop and validate the Nursing Intensive-Care Satisfaction Scale to measures satisfaction with nursing care from the critical care patient's perspective. BACKGROUND: Instruments that measure satisfaction with nursing cares have been designed and validated without taking the patient's perspective into consideration. Despite the benefits and advances in measuring satisfaction with nursing care, none instrument is specifically designed to assess satisfaction in intensive care units. DESIGN: Instrument development. METHODS: The population were all discharged patients (January 2013 - January 2015) from three Intensive Care Units of a third level hospital (N = 200). All assessment instruments were given to discharged patients and 48 hours later, to analyse the temporal stability, only the questionnaire was given again. The validation process of the scale included the analysis of internal consistency, temporal stability; validity of construct through a confirmatory factor analysis; and criterion validity. RESULTS: Reliability was 0.95. The intraclass correlation coefficient for the total scale was 0.83 indicating a good temporal stability. Construct validity showed an acceptable fit and factorial structure with four factors, in accordance with the theoretical model, being Consequences factor the best correlated with other factors. Criterion validity, presented a correlation between low and high (range: 0.42-0.68). CONCLUSIONS: The scale has been designed and validated incorporating the perspective of critical care patients. Thanks to its reliability and validity, this questionnaire can be used both in research and in clinical practice. The scale offers a possibility to assess and develop interventions to improve patient satisfaction with nursing care.

Nursing assessment as an effective tool for the identification of delirium risk in older in-patients: A case-control study.

AIMS AND OBJECTIVES: To evaluate the usefulness of comprehensive nursing assessment as a strategy for determining the risk of delirium in older in-patients from a model of care needs based on variables easily measured by nurses. BACKGROUND: There are many scales of assessment and prediction of risk of delirium, but they are little known and infrequently used by professionals. Recognition of delirium by doctors and nurses continues to be limited. DESIGN AND METHODS: A case-control study. A specific form of data collection was designed to include the risk factors for delirium commonly identified in the literature and the care needs evaluated from the comprehensive nursing assessment based on the Virginia Henderson model of care needs. We studied 454 in-patient units in a basic general hospital. Data were collected from a review of the records of patients' electronic clinical history. RESULTS: The areas of care that were significant in patients with delirium were dyspnoea, problems with nutrition, elimination, mobility, rest and sleep, self-care, physical safety, communication and relationships. The specific risk factors identified as independent predictors were as follows: age, urinary incontinence, urinary catheter, alcohol abuse, previous history of dementia, being able to get out of bed/not being at rest, habitual insomnia and history of social risk. CONCLUSIONS: Comprehensive nursing assessment is a valid and consistent strategy with a multifactorial model of delirium, which enables the personalised risk assessment necessary to define a plan of care with specific interventions for each patient to be made. RELEVANCE TO CLINICAL PRACTICE: The identification of the risk of delirium is particularly important in the context of prevention. In a model of care based on needs, nursing assessment is a useful component in the risk assessment of delirium and one that is necessary for developing an individualised care regime.

Precisión y exhaustividad del registro de eventos adversos mediante una terminología de interfase / Precisão e exaustividade no registro de eventos adversos usando uma terminologia de interface / Accuracy and completeness of records of adverse events through interface terminology

RESUMEN Objetivo: Determinar qué registran las enfermeras en la historia clínica mediante ATIC, sobre los eventos adversos: úlceras por presión, infección del sitio quirúrgico y aspiración con resultado de neumonía, en términos de precisión diagnostica y exhaustividad. Método: Estudio observacional, descriptivo, transversal, y multicéntrico de 64 unidades médico-quirúrgicas y semicríticos de dos hospitales universitarios de Cataluña, España, durante el año 2015. La precisión diagnóstica se evaluó mediante la correspondencia entre el evento declarado en el Conjunto Mínimo Básico de Datos y el problema documentado por la enfermera. La exhaustividad se consideró cuando el registro contenía el riesgo del evento, prescripciones de cuidados y registro de la evolución. Resultados: La muestra evaluada fue de 459 registros. Los resultados de precisión de úlceras por presión muestran una elevada correspondencia entre el diagnóstico enfermero registrado y el declarado en el Conjunto Mínimo Básico de Datos. La precisión en la infección del sitio quirúrgico es moderada, y la aspiración con resultado de neumonía muy baja. Los resultados de exhaustividad son notables, excepto el riesgo de broncoaspiración. Conclusión: El evento adverso que registran las enfermeras con mayor precisión es la úlcera por presión.

RESUMO Objetivo: Determinar quais informações são registradas pelas enfermeiras nos registros eletrônicos por meio da terminologia ATIC, sobre os eventos adversos: úlceras de pressão, infecção de sítio cirúrgico e aspiração com resultado de pneumonia, em termos de precisão diagnóstica e de exaustividade. Método: Estudo observacional, descritivo, transversal e multicêntrico de 64 unidades médico cirúrgicas e semicríticas de dois hospitais universitários da Catalunha, Espanha, durante o ano 2015. A precisão diagnóstica foi avaliada pela correspondência entre o evento indicado no Conjunto Mínimo Básico de Dados e o registro de problemas documentados pela enfermeira. A exaustividade foi considerada quando o registro continha a identificação do risco do evento, as prescrições de cuidados e o registro da evolução. Resultados: A amostra avaliada foi de 459 registros. Os resultados em termos de precisão de úlceras de pressão mostram uma alta correlação entre o diagnóstico de enfermagem registrado e o diagnóstico declarado no Conjunto Mínimo Básico de Dados. A precisão na infecção de sítio cirúrgico é moderada, e a aspiração com resultado de pneumonia é muito baixa. Os resultados de exaustividade são notáveis, salvo o risco de broncoaspiração. Conclusão: O evento adverso que as enfermeiras registram com maior precisão é a úlcera de pressão.

ABSTRACT Objective: To determine what adverse events, including pressure ulcers, infection of the surgical site and aspiration pneumonia, nurses record in clinical histories, in terms of diagnostic accuracy and completeness, through ATIC. Method: Observational, descriptive, cross-sectional, multicenter study of 64 medical-surgical and semi-critical units of two university hospitals in Catalonia, Spain, during 2015. The diagnostic accuracy was assessed by means of the correspondence between the event declared in the Minimum Basic Data Set and the problem documented by the nurse. The record was considered complete when it contained the risk of the event, prescriptions of care and a record of the evolution. Results: The sample evaluated included 459 records. The accuracy results of pressure ulcers are highly correlated between the nursing diagnosis recorded and that declared in the Minimum Basic Data Set. The accuracy in surgical site infection is moderate, and aspiration resulting in pneumonia is very low. The completeness of results is remarkable, except for the risk of bronchoaspiration. Conclusion: The adverse event recorded by nurses with greatest accuracy is pressure ulcers.