Prevalence of NANDA-I Nursing Diagnoses in patients with heart failure: A systematic review and meta-analysis.

AIM: This research quantitatively explored the prevalence of NANDA-I nursing diagnoses related to the care of patients experiencing heart failure. DESIGN: A systematic review and meta-analysis were conducted with the systematic review protocol registered in PROSPERO (registration number: CRD42022382565). METHODS: Systematic searches were performed between March and April 2022, including peer review for selection, quality assessment, data extraction, and analysis of all included studies. A subsequent meta-analysis was performed, focusing on the proportion of nursing diagnoses in patients with heart failure. The logistic random effects model with maximum likelihood estimation assessed the combined proportion, and heterogeneity between studies was evaluated using the I2 statistic. The goodness-of-fit of the meta-analysis results was assessed using the leave-one-out method and by evaluating publication bias through contour-enhanced funnel plots. DATA SOURCES: PubMed, SCOPUS, CINAHL, WOS, and Embase were used. RESULTS: Of the 11 studies that met the eligibility criteria, 44 nursing diagnoses were identified as most frequently occurring in patients experiencing heart failure, and only 16 diagnoses appeared in more than one publication. The combined mean proportion was 35.73% (95% CI = [26.67%; 48.56%]), indicating the presence of heterogeneity based on the I2 value. However, no publication bias was observed. CONCLUSION: The results of the meta-analysis suggest priority diagnoses in individuals with heart failure, such as deficient knowledge (00126). Additionally, secondary diagnoses, such as activity intolerance (00092), excess fluid volume (00026), and ineffective breathing pattern (00032), were identified as responses to decreased cardiac output (00029). Less prevalent nursing diagnoses were associated with deterioration of health status and the need for hospitalization. OBJETIVO: Investigar cuantitativamente la prevalencia de diagnósticos de enfermería NANDA-I asociados con la atención de pacientes con insuficiencia cardíaca. DISEÑO: Revisión sistemática y metanálisis. El protocolo de revisión sistemática quedó registrado en PROSPERO) número de registro: CRD42022382565). MÉTODOS: Se realizaron búsquedas sistemáticas entre marzo y abril de 2022, llevándose a cabo una revisión por pares sobre la selección, evaluación de calidad, extracción de datos y análisis de todos los estudios incluidos. Se realizó un metanálisis posterior centrado en la proporción de diagnósticos de enfermería en pacientes con insuficiencia cardíaca. El modelo logístico de efectos aleatorios con estimación de máxima verosimilitud evaluó la proporción combinada y la heterogeneidad entre los estudios se evaluó mediante el estadístico I2. La bondad de ajuste de los resultados del metanálisis se evaluó mediante el método Leave-one-out y la evaluación del sesgo de publicación mediante gráficos de embudo (funnel plot), denominado Contour-Enhanced Funnel Plot. FUENTES DE DATOS: PubMed, SCOPUS, CINAHL, WOS, Embase. RESULTADOS: En los 11 estudios que cumplieron con los criterios de elegibilidad, se identificaron 44 diagnósticos de enfermería aunque sólo 16 diagnósticos aparecieron en más de una publicación. La proporción media combinada fue del 35,73% (IC del 95%) = [26,67%; 48,56%]), y el valor de I2 indica la presencia de heterogeneidad, aunque no hay sesgo de publicación. CONCLUSIÓN: Los resultados de este metaanálisis indican que habría diagnósticos prioritarios en personas con insuficiencia cardíaca, como Conocimientos deficientes (00126). Además, se han identificado otros diagnósticos de enfermería como diagnósticos secundarios: Intolerancia a la actividad (00092), Exceso de volumen de líquidos (00026) y Patrón respiratorio ineficaz (00032), que sería la respuesta a Disminución del gasto cardíaco (00029). Además de diagnósticos de enfermeríaa menos prevalentes relacionados con el deterioro del estado de salud y la necesidad de hospitalización.

Effectiveness of the best practice spotlight organizations program to reduce the prevalence of pressure injuries in acute care settings for hospitalized patients in Spain: A quasi-experimental study.

BACKGROUND: Pressure injuries are a major public health problem because of their impact on morbidity and mortality, quality of life, and increased healthcare costs. The Centros Comprometidos con la Excelencia en Cuidados/Best Practice Spotlight Organization (CCEC/BPSO®) program provides guidelines that can improve these outcomes. AIMS: This study aimed to assess the effectiveness of the CCEC/BPSO® program in improving the care of patients at risk of pressure injury (PI) at an acute care hospital in Spain. METHODS: A quasi-experimental regression discontinuity design in three periods was used: (1) baseline (2014), (2) implementation (2015-2017), and (3) sustainability (2018-2019). The study population was comprised of 6377 patients discharged from 22 units of an acute care hospital. The performance of the PI risk assessment and reassessment, the application of special pressure management surfaces, and the presence of PIs were all monitored. RESULTS: Forty-four percent of patients (n = 2086) met the inclusion criteria. After implementing the program, the number of patients assessed (53.9%-79.5%), reassessed (4.9%-37.5%), the application of preventive measures (19.6%-79.7%), and the number of people identified with a PI in implementation (1.47%-8.44%) and sustainability (1.47%-8.8%) all increased. LINKING EVIDENCE TO ACTION: The implementation of the CCEC/BPSO® program achieved improved patient safety. Risk assessment monitoring, risk reassessment, and special pressure management surfaces were practices that increased during the study period and were incorporated by professionals to prevent PIs. The training of professionals was instrumental to this process. Incorporating these programs is a strategic line to improve clinical safety and the quality of care. The implementation of the program has been effective in terms of improving the identification of patients at risk and the application of surfaces.

Implantación de la guía de práctica clínica Valoración y manejo de las lesiones por presión para equipos interprofesionales / Implementation of the clinical practice guideline “Risk assessment and prevention of pressure ulcers for interprofessional teams

Objetivo: evaluar la implantación de la guía Valoración y manejo de las lesiones por presión para equipos interprofesionales de la Asociación Profesional de Enfermeras de Ontario (RNAO®) en el Hospital Universitario Virgen de las Nieves (Granada, España), con objeto de identificar mejoras producidas en la formación de profesionales, en el proceso de cuidados y en los resultados en salud de los pacientes con lesiones por presión (LPP). Método: estudio descriptivo longitudinal retrospectivo (2018-2022). Variables: formación impartida, materiales elaborados, edad, sexo, valoración del riesgo de LPP, plan de cuidados especifico, uso de superficie especial para el manejo de la presión, LPP previas y nuevas, categoría de LPP, cicatrización y días de estancia de hospitalización. Resultados: la formación pasó de tres actividades y 86 asistentes a 16 actividades y 229 asistentes, y se elaboraron nueve materiales de apoyo a la formación. La valoración del riesgo y el plan de cuidados se realizó a más del 88% de la muestra. La aplicación de superficies especiales descendió en 2021 a 57,1%. Un 49,2% de pacientes tuvo una nueva lesión durante su estancia hospitalaria, siendo predominante la categoría II y presentaron signos de cicatrización un 42,6% de las lesiones tratadas. Conclusiones: la implantación ha supuesto un incremento de la actividad formativa en actualización de conocimientos sobre metodología de implantación de evidencia y en el manejo de LPP. El proceso de cuidados del paciente con LPP se realiza conforme a alguna de las recomendaciones de la guía, siendo necesario mejorar. Hay indicios que apuntan a que las cifras de LPP nosocomiales están disminuyendo.(AU)

Objectives: to assess the implementation of the guideline "Risk assessment and prevention of pressure ulcers (PU) for interprofessional teams” by the Registered Nurses' Association of Ontario (RNAO®) at the Hospital Universitario Virgen de las Nieves (Granada, Spain), with the objective of identifying any improvements made in professional training, in the care process, and in the health outcomes for patients with PU. Method: a descriptive longitudinal retrospective study (2018-2022). Variables: training given, materials prepared, age, gender, risk assessment for PU, specific care plan, use of a special surface for pressure management, previous and new PU, PU categories, PU healing, and hospitalization days.Results: training went from three activities and 86 attendees to 16 activities and 229 attendees, and nine support materials were prepared. Risk assessment and care plan were applied to >88% of the sample. The use of special surfaces was reduced to 57.1% in 2021; 49.2% of patients presented a new lesion during their hospital stay, with Category II as the predominant; 42.6% of the lesions treated presented healing signs. Conclusions: the implementation has represented an increase in training activities for updating the knowledge regarding methodology for evidence implementation and in PU management. The process of care for patients with PU is conducted following only some of the recommendations in the guideline, and an improvement is required. There are signs pointing to a reduction in the number of hospital PU.(AU)

Short version of the Multidimensional Scale of Dating Violence (MSDV 2.0) in Spanish-language: Instrument development and psychometric evaluation.

AIMS: To develop and psychometrically test the short version of the Multidimensional Scale of Dating Violence (MSDV 2.0) in Spanish-language to detect violence perpetrated and suffered in dating relationships. DESIGN: A psychometric instrument development and validation study. METHODS: A two-phase approach was used: Phase (1) the items of the original instrument were revised and new items related to online violence and sexual violence were incorporated. Content validation by a Delphi panel with 25 psychometric and dating violence experts were performed. Next, a face validity was performed in 32 students followed by a pilot study in another 74 participants. Phase (2) Psychometric validation, the instrument was tested in a sample of 1091 university students, analysing the psychometric properties based on construct validity and internal consistency. The study was conducted from September to November 2020 in the context of the Andalusian Public University System. RESULTS: In phase (1) 42 items for each subscale (perpetration, victimization) were accepted by the Delphi panel, and acceptable values were obtained for the criteria of clarity, coherence, and relevance. In phase (2) the MSDV 2.0 showed acceptable psychometric properties. Confirmatory factor analysis showed a five-dimensional structure with 18 items for each subscale with excellent fit rates. Reliability analysis indicated adequate internal consistency (α = .879-.802) and correlations with the Depression, Anxiety, and Stress Scale (ρ = .418-.225) and the self-perceived health item (ρ = .380-.179), providing evidence of its convergent validity. Cut-off points were also calculated for each dimension, with their corresponding sensitivity and specificity, indicating to be a good instrument for detecting possible cases of dating violence. CONCLUSION: The MSDV 2.0 is the only short instrument published to date that measures the dating violence suffered and perpetrated taking into account all its dimensions. Its use would serve as support in prevention programs and design of public policies. IMPACT: The short version of the MSDV 2.0 could be a comprehensive enough instrument to enable a detection and evaluation of dating violence in the educational setting.

Cross-cultural adaptation and validation of instrument to measure nursing care dependency.

OBJECTIVE: To cross-culturally adapt and validate the INICIARE instrument for use in Brazil. METHOD: methodological study divided into two phases: cross-cultural adaptation and validation. The first phase took place in six stages: translation, synthesis, back-translation, expert review, pre-test and submission to the author. The second, carried out with 130 patients, took place at a private hospital in Porto Alegre, Rio Grande do Sul, Brazil, between May and July 2019. The study was approved by the Research Ethics Committee. Data were analyzed for stability, equivalence and internal consistency. RESULTS: In the cross-cultural adaptation, the expert committee adjusted the translated version, validating the content. At validation, most patients were women (64.6%) with a mean age of 59 ± 15.3. The reliability index was 0.744. CONCLUSION: The version of the instrument adapted for Brazil proved to be adequate and reflects the reality of daily nursing practice.

Uso del cuestionario g_Clinic para valorar satisfacción laboral en el personal de Enfermería de hospitales públicos / Use of the g_Clinic questionnaire to assess job satisfaction in the Nursing staff from public hospitals

Objetivo: evaluar la validez externa y determinar el punto de corte del cuestionario g_Clinic para medir la satisfacción laboral de los profesionales de Enfermería y de los técnicos de cuidados auxiliares de Enfermería (TCAE) en los hospitales del Sistema Sanitario Público Andaluz. Método: estudio clinimétrico basado en la aplicabilidad del cuestionario g_Clinic en una muestra de 1.099 profesionales de Enfermería y TCAE. La recogida de datos se realizó durante los meses de octubre a diciembre de 2017 mediante un cuestionario online. El análisis clinimétrico de g_Clinic consistió en evaluar la fiabilidad y la validez. Para establecer el punto de corte de g_Clinic se hizo una curva de rendimiento diagnóstico (ROC) que permitió discriminar entre profesionales satisfechos e insatisfechos. Resultados: se garantizó la consistencia interna del cuestionario g_Clinic, siendo su valor alfa de Crombach de 0,8. La sensibilidad y especificidad fueron de 72% y 70,3 % respectivamente y el punto de corte se situó en 30 puntos. El cálculo de la curva ROC mostró un área bajo la curva de 0,754. Conclusión: el cuestionario g_Clinic es un instrumento válido y fiable para medir la satisfacción laboral de los profesionales de Enfermería y de los TCAE con el punto de corte en 30 puntos. Presenta alta sensibilidad y especificidad para la detección de la insatisfacción laboral.(AU)

Objective: to assess the external validity and determine the cut-off point of the g_Clinic questionnaire to measure the job satisfaction in Nursing professionals and Certified Nursing Assistants (CNAs) in the Andalusian Public Health System hospitals. Method: clinimetric study based on the applicability of the g_Clinic questionnaire in a sample of 1,099 Nursing professionals and CNAs. Data were collected from October to December 2017 through an online questionnaire. The clinimetric analysis of g_Clinic consisted in an evaluation of reliability and validity. In order to determine the g_Clinic cut-off point, a receiver-operating curve (ROC) was used, which allowed to discriminate between satisfied and dissatisfied professionals. Results: the internal consistency of the g_Clinic questionnaire was guaranteed, with a Cronbach alpha’s vale of 0.8. Sensitivity and specificity were 72% and 70.3 % respectively, and the cut-off point was determined at 30 points. The ROC curve calculation showed a 0.754 under the curve area. Conclusion: the g_Clinic questionnaire is a valid and reliable instrument to measure job satisfaction in Nursing professionals and CNAs with 30 as cut-off point. It presents high sensitivity and specificity to detect job dissatisfaction.(AU)

Predictive validity of the INTEGRARE scale in identifying the risk of hospital-acquired pressure ulcers in acute care hospital settings.

BACKGROUND: Hospital-acquired pressure ulcers (HAPUs) are prevalent around the world and are an indicator of care quality. Numerous instruments are available to predict their appearance, but few evaluate predictive validity. No instruments based on Nursing Outcomes Classification indicators have been found, despite these indicators reflecting the patient's condition. The aim of the study was to analyse the predictive validity of the INTEGRARE scale in preventing the risk of HAPUs. METHODS: A multicentre prospective observational cohort study design was used. 1,004 patients from 11 public hospitals in Andalusia (Spain) were recruited between February 2015 and October 2017. Participants were aged over 18 and had been admitted to medical and surgical units, with a predicted stay exceeding 48 h. Predictive validity was checked using a multivariate logistic regression model and a receiver operating characteristic curve, with development of pressure ulcers during the hospital stay as the dependent variable. RESULTS: The INTEGRARE scale obtained an area under the curve of 0.886 (95% CI = 0.85-0.923). Within the 30-point range, the optimal cut-off value is 23 points with a sensitivity of 80.8% and a specificity of 80%. The odds ratio was 16.86 (95% CI = 8.54-33.28). Among the patient variables, age was significant, while among the hospital variables, the type of unit and the Nurse Staffing Level (NSL) were significant. CONCLUSIONS: The INTEGRARE scale has robust predictive validity when patients are admitted to medical and surgical inpatient units. Patients with a higher risk of developing HAPUs are in surgical units, are elderly, and have an NSL exceeding 10.4.

Worldwide prevalence of inadequate work ability among hospital nursing personnel: A systematic review and meta-analysis.

PURPOSE: To estimate the worldwide pooled prevalence of inadequate work ability among hospital nursing personnel using the Work Ability Index (WAI). DESIGN: Systematic review and meta-analysis. METHODS: A systematic search was conducted on Medline/PubMed, Scopus, Web of Science, Scielo, PsychInfo, CINAHL, Nursing and Allied Health, LILACS, and Google Scholar from inception to July 2021 to identify observational studies on work ability among hospital nursing personnel using the WAI. Two researchers independently completed the study selection, quality assessments, and data extraction on the prevalence of inadequate work ability that was pooled using the random effects model. Finally, subgroup analyses were performed to explore sources of heterogeneity. FINDINGS: A total of 42 studies were included, consisting of 24,728 subjects worldwide from 14 countries. Of these, 35 studies were included in the meta-analytical analyses. The worldwide pooled prevalence of inadequate work ability among hospital nursing personnel was 24.7% (95% CI = 20.2%-29.4%). High levels of heterogeneity were detected in all studies. Prevalence was higher in studies where samples were composed of nurses and nursing assistive personnel (26.8%; 95% CI = 22.4%-31.5%) than in those of nurses alone (22.2%; 95% CI = 13.1%-32.9%) and in studies where the sample was over 40 (28.1%; 95% CI = 19.5%-37.5%) than in those with a sample under that age (22.4%; 95% CI = 15.8%-29.7%). CONCLUSIONS: Almost one in four members of hospital nursing staff in the world has inadequate work ability and therefore are at risk of several negative outcomes during their working life. These prevalence data correspond to the pre-pandemic period, so new studies should also be especially useful in quantifying the impact of the COVID-19 pandemic on work ability in the hospital nursing workforce. CLINICAL RELEVANCE: The above findings justify the launch of initiatives that include annual assessment for the early identification of inadequate work ability, offering the possibility of anticipated corrective measures. Nursing workforce older than 40 years and those belonging to the professional category of nursing assistive personnel should be priority target groups for screening and intervention to improve work ability.

Defining and characterising the nurse-patient relationship: A concept analysis.

The nurse-patient relationship involves complex attitudes and behaviours with ethical and deontological implications. It has been linked to improvements in patient health outcomes, although there is still no consensus in the scientific literature as to the definition and characterisation of the concept. This article aim to define the concept of the nurse-patient relationship. A concept analysis was conducted using the Walker and Avant method to identify the attributes defining the nurse-patient relationship. An integrative review of the literature was conducted using the PubMed, Web of Science, Scopus, and Cumulative Index to Nursing & Allied Health Literature databases. A review of the grey literature and other minor non-indexed publications on the topic was also conducted. A total of 36 articles were included in the review. A model case, a contrary case, a related case, and empirical references were produced to clarify the concept and identify its essential attributes. The concept is defined as a helping relationship involving interaction between different players. It is the basis of nursing care and is intended to meet the healthcare needs of the individual receiving this care. It is also viewed as an intervention in itself, requiring a specific training process just like any other nursing skill. The essential attributes of the relationship are empathy, presence, contact, authenticity, trust, and reciprocity. In conclusion, the nurse-patient relationship is a helping relationship established with the patient and/or their family based on interaction, communication, respect for ethical values, acceptance, and empathy in order to encourage introspection and behavioural change. Key components include communication, active listening, and respect. Bioethical values and confidentiality must also be present to ensure that the relationship is built on equality and intimacy.

Filling a gap in standardized nursing terminology. Development of a new nursing diagnosis proposal on heart failure self-care.

PURPOSE: Heart failure is a highly prevalent chronic health problem associated with poor quality-of-life and negative outcomes. Self-care is a cornerstone in patients suffering from heart failure. Nurses are commonly engaged in enhancing patients' self-care behaviors, but the specific condition of deficit on self-care is not clearly identified by nurses. No nursing diagnoses focused on self-care of heart failure patients is currently available. This study aimed to develop a new nursing diagnosis that focuses on self-care in heart failure patients. DATA SOURCES: A concept and content analysis were used. Some steps of the concept analysis were performed through an integrative literature review conducted searching in PUBMED and CINAHL databases to identify attributes, antecedents, and consequences of the diagnosis. Forty-five articles were selected from the 1450 studies found. Then, the content analysis was performed by an international panel of 29 experts. Two Delphi rounds were used to achieve consensus and an item content validity index was calculated for each diagnostic element. DATA SYNTHESIS: Integrative review proposed four diagnostic labels, two definitions, 15 defining characteristics, and 44 related factors. After the two Delphi rounds a consensus was reached for each diagnostic indicator with a content validity index ranging from 82.8% to 100%. The nursing diagnosis-labeled heart failure self-care deficit-was validated with a definition, eight defining characteristics, 15 related factors, and five at-risk populations. CONCLUSIONS: This diagnosis allows nurses to document patients' self-care in daily clinical practice through a standard nursing terminology, by naming this health problem, describing its etiology, and clinical manifestations. IMPLICATIONS FOR NURSING PRACTICE: This new diagnosis is expected to assist nursing clinicians, educators, and students in clinical reasoning with the aim to improve diagnostic accuracy in identifying patients with a heart failure self-care deficit, to select the most appropriate interventions and pursue better outcomes.

Cross-cultural adaptation and validation of instrument to measure nursing care dependency / Adaptación transcultural y validación de instrumentos para medir la dependencia del cuidado de enfermería / Adaptação transcultural e validação de instrumento para medir a dependência de cuidados de enfermagem

ABSTRACT Objective: To cross-culturally adapt and validate the INICIARE instrument for use in Brazil. Method: methodological study divided into two phases: cross-cultural adaptation and validation. The first phase took place in six stages: translation, synthesis, back-translation, expert review, pre-test and submission to the author. The second, carried out with 130 patients, took place at a private hospital in Porto Alegre, Rio Grande do Sul, Brazil, between May and July 2019. The study was approved by the Research Ethics Committee. Data were analyzed for stability, equivalence and internal consistency. Results: In the cross-cultural adaptation, the expert committee adjusted the translated version, validating the content. At validation, most patients were women (64.6%) with a mean age of 59 ± 15.3. The reliability index was 0.744. Conclusion: The version of the instrument adapted for Brazil proved to be adequate and reflects the reality of daily nursing practice.

RESUMEN Objetivo: Adaptar y validar transculturalmente el instrumento INICIARE para uso en Brasil. Método: estudio metodológico dividido en dos fases: adaptación y validación transcultural. La primera, en seis etapas: traducción, síntesis, retrotraducción, revisión de expertos, pre-test y envío al autor. El segundo, realizado con 130 pacientes, se llevó a cabo en un hospital privado de Porto Alegre, Rio Grande do Sul, Brasil, entre mayo y julio/2019. El estudio fue aprobado por el Comité de Ética en Investigación. Los datos se analizaron mediante estabilidad, equivalencia y consistencia interna. Resultados: En la adaptación transcultural, el comité de expertos ajustó la versión traducida, validando el contenido. En el momento de la validación, la mayoría de los pacientes eran mujeres (64,6%) con una edad media de 59 ± 15,3 años. La fiabilidad fue de 0,744. Conclusión: La versión del instrumento adaptada para Brasil resultó adecuada y refleja la realidad de la práctica diaria de enfermería.

RESUMO Objetivo: Adaptar transculturalmente e validar o instrumento INICIARE para uso no Brasil. Método: estudo metodológico dividido em duas fases: adaptação transcultural e validação. A primeira ocorreu em seis etapas: tradução, síntese, retrotradução, revisão por especialistas, pré-teste e submissão à autora. A segunda, realizada com 130 pacientes, ocorreu em um hospital privado de Porto Alegre, Rio Grande do Sul, Brasil, entre maio e julho de 2019. O estudo obteve aprovação pelo Comitê de Ética em Pesquisa. Os dados foram analisados através da estabilidade, equivalência e da consistência interna. Resultados: Na adaptação transcultural, o comitê de especialistas ajustou a versão traduzida, validando o conteúdo. Na validação, a maioria dos pacientes era mulher (64,6%) com média de idade 59 ±15,3. A confiabilidade foi de 0,744. Conclusão: A versão do instrumento adaptado para o Brasil mostrou-se adequada e reflete a realidade da prática diária da enfermagem.

Impacto de la ratio paciente-enfermera en los resultados de salud en los hospitales públicos del Servicio Andaluz de Salud. Estudio ecológico / Impact of the patient-nurse ratio on health outcomes in public hospitals of the Andalusian Health Service. Ecological Study

Objetivo: Analizar la ratio paciente-enfermera y su asociación con los resultados en salud en hospitales públicos del Servicio Andaluz de Salud (SAS). Método: Estudio ecológico transversal realizado en unidades de adultos de 26 hospitales públicos andaluces. Se recogieron datos de estructura (camas, tipo de unidad, control de enfermería), de gestión (estancia media, índice de utilización de estancias, índice de complejidad) y de dotación enfermera. Fueron extraídos de fuentes oficiales: CMBDA, publicaciones de SAS/Consejería de Salud (CS) y específicos demandados a Direcciones de Enfermería. Se calculó la ratio paciente-enfermera y se relacionó con 19 indicadores de calidad hospitalaria, seguridad y mortalidad. Para el análisis estadístico se utilizaron medidas de tendencia central y el coeficiente de correlación de Spearman. Resultados: Se obtuvo respuesta del 100% de los hospitales andaluces. El promedio de ratio pacientes-enfermera en los 3 turnos fue menor en hospitales con cartera de servicios más amplia-ámbito regional (11,6), seguido de los de cartera media-especialidades (12,7) y los hospitales con cartera básica-comarcales (13,5). Por tipo de unidad, en las médicas fue menor 11,8 (DE=1,8) respecto a las quirúrgicas 13,5 (DE=2,7). Solo se hallaron diferencias significativas en unidades médicas de los hospitales regionales 10,5 (DE=1,4) y comarcales 13,03 (DE=1,46) (p=0,001). En cuidados críticos la ratio fue mayor de 2 pacientes por enfermera en los 3 grupos. Al relacionar la ratio con resultados en salud se hallaron 5 asociaciones significativas: úlceras por presión (p=0,005), prevalencia de infecciones nosocomiales (p=0,036), sepsis postoperatoria (p=0,022), verificación bacteriemia zero (p=0,045) y mortalidad por insuficiencia cardíaca (p=0,004).(AU)

Aim: To analyse the patient-nurse ratio and its association with health outcomes in public hospitals of the Andalusian Health Service (SAS). Method: Cross-sectional ecological study carried out in adult units of 26 Andalusian public hospitals. Data on structure (beds, type of unit, nursing control), management (average stay, index of use of stays, complexity index) and nursing staff were collected. They were extracted from official sources: CMBDA, SAS/Health Council (CS) publications and specific respondents to Nursing Directorates. The patient-nurse ratio was calculated and related to 19 indicators of hospital quality, safety, and mortality. Measures of central tendency and Spearman's correlation coefficient were used for statistical analysis. Results: A response was obtained from 100% of the Andalusian hospitals. The average patient-nurse ratio in the three shifts was lower in hospitals with a broader portfolio of services-regional scope (11.6), followed by those with a medium portfolio-specialties (12.7) and hospitals with a basic portfolio- county (13.5). By type of unit, the medical units were 11.8 (SD=1.8) lower than the surgical ones 13.5 (SD=2.7). Significant differences were only found in medical units of regional hospitals 10.5 (SD=1.4) and district hospitals 13.03 (SD=1.46) (p=.001). In critical care, the ratio was greater than 2 patients per nurse in the three groups. When relating the ratio to health outcomes, 5 significant associations were found: pressure ulcers (p=.005), prevalence of nosocomial infections (p=.036), postoperative sepsis (p=.022), zero bacteraemia verification (p=.045) and mortality from heart failure (p=.004). Conclusions: The results indicate a high patient-nurse ratio in adult hospitalization units and that there is a positive association between the patient-nurse ratio and worse results related to nursing care.(AU)

Impact of the patient-nurse ratio on health outcomes in public hospitals of the Andalusian Health Service. Ecological study.

OBJECTIVE: To analyse the patient-nurse ratio and its association with health outcomes in public hospitals of the Andalusian Health Service (SAS). METHOD: Cross-sectional ecological study carried out in adult units of 26 Andalusian public hospitals. Data on structure (beds, type of unit, nursing control), management (average stay, index of use of stays, complexity index) and nursing staff were collected. They were extracted from official sources: CMBDA, SAS/Health Council (CS) publications and specific respondents to Nursing Directorates. The patient-nurse ratio was calculated and related to 19 indicators of hospital quality, safety, and mortality. Measures of central tendency and Spearman's correlation coefficient were used for statistical analysis. RESULTS: A response was obtained from 100% of the Andalusian hospitals. The average patient-nurse ratio in the three shifts was lower in hospitals with a broader portfolio of services-regional scope (11.6), followed by those with a medium portfolio-specialties (12.7) and hospitals with a basic portfolio-county (13.5). By type of unit, the medical units were 11.8 (SD = 1.8) lower than the surgical ones 13.5 (SD = 2.7). Significant differences were only found in medical units of regional hospitals 10.5 (SD = 1.4) and district hospitals 13.03 (SD = 1.46) (p = .001). In critical care, the ratio was greater than 2 patients per nurse in the three groups. When relating the ratio to health outcomes, 5 significant associations were found: pressure ulcers (p = .005), prevalence of nosocomial infections (p = .036), postoperative sepsis (p = .022), zero bacteraemia verification (p = .045) and mortality from heart failure (p = .004). CONCLUSIONS: The results indicate a high patient-nurse ratio in adult hospitalization units and that there is a positive association between the patient-nurse ratio and worse results related to nursing care.

[Humanized care in a death for COVID-19: A case study]. / El cuidado humanizado en la muerte por COVID-19: a propósito de un caso.

The world population is experiencing a pandemic due to infection with the SARS-Cov-2 virus, which causes the COVID-19 disease. In Spain, the growth rate of the epidemic is 6.79% since the alarm activation with 9,1% of deaths of the total infected. Recommendations of the National Government to prevent health professional contagion include the placement of personal protection devices (FPP2 mask, gloves, waterproof gown, hat, and protective glasses or screen). Once healthcare professionals are using protective equipment, it is necessary to argue about the humanization of nursing caring in people suffering dying situation, who are infected with COVID-19, regarding a clinical case. The aim is to enhance nursing thinking to bridge that distance, and maintain care as human and close as possible, at the end of life.

Implementing Holistic Care in Isolated Patients During COVID-19 Pandemic: A Case Study Using Nursing Outcomes (NOC) and Interventions (NIC) Classifications.

The most effective strategy against SARS-Cov-2 virus spread is therapeutic isolation. Consequences of this measure are the presence of anxiety and depression. Therefore, it is the nurse's responsibility to identify strategies to implement humanized and holistic care in order to avoid physical and mental consequences of isolation.

[Implementation of the "Best Practice Spotlight Organization" Program at the Virgen de las Nieves University Hospital.] / Implantación del programa "Centros Comprometidos con la Excelencia en Cuidados" en el Hospital Universitario Virgen de las Nieves. Rev Esp Salud Pública.

The objective of this work was to describe the implantation project presented by the Virgen de las Nieves University Hospital (Granada, Spain) to be selected as a candidate for "Best Practice Spotlight Organization"® (in Spain CCEC®) program in the cohort (2015-2017) to implement three guidelines for Nurses Association of Canada Ontario (RNAO) clinical practice of care. The methodology used was the model called "knowledge for action" and the actions developed for each of the phases of the action cycle for applying knowledge to practice were described: 1) identification of the problem, 2) adaptation to the local context, 3) evaluation of facilitators and barriers, 4) adaptation and implementation of interventions, 5) monitoring and evaluation of results and 6) sustainability. This work adds to the set of studies that address the improvement and maintenance of evidence-based practice programs in nursing, and in health services in general. It shows the application of a framework for the implementation of clinical practice guidelines for care in a specific health environment for its replication in other different health settings. It has been shown that it is essential to dedicate efforts to planning the implementation of this type of programs, taking into account the context in which they are developed, the specific characteristics of the population being served, identifying the different barriers and facilitators that may affect during the course of the program. process and defining actions to make the changes in practice sustainable.

El objetivo de este trabajo fue describir el proyecto de implantación presentado por el Hospital Universitario Virgen de las Nieves (Granada, España) para ser seleccionado candidato del programa "Centros Comprometidos con la Excelencia en Cuidados" (CCEC)® en la cohorte (2015-2017) para implantar tres guías de práctica clínica de cuidados de la Asociación de Enfermeras de Ontario de Canadá (RNAO). La metodología utilizada fue el modelo denominado "conocimiento para la acción" y se describieron las actuaciones desarrollas para cada una de las fases de las que consta el ciclo de acción para la aplicación de conocimientos a la práctica: 1) identificación del problema, 2) adaptación al contexto local, 3) evaluación de los facilitadores y barreras, 4) adaptación e implantación de las intervenciones, 5) monitorización y evaluación de resultados y 6) sostenibilidad. Este trabajo se suma al conjunto de estudios que abordan la mejora y el mantenimiento de programas de prácticas basadas en la evidencia en enfermería, y en los servicios de salud en general. Muestra la aplicación de un marco de implantación de guías de práctica clínica de cuidados en un entorno sanitario específico para su replicación en otros escenarios de salud diferentes. Se ha demostrado que resulta esencial dedicar esfuerzos en planificar la implantación de este tipo de programas atendiendo al contexto en el que se desarrollan, a las características específicas de la población a la que se atiende, identificando las diferentes barreras y facilitadores que pueden afectar durante el proceso y definiendo acciones para hacer sostenible los cambios en la práctica.

[Effect of the guideline implementation "Risk assessment and prevention of pressure ulcers" of the Registered Nurses'Association of Ontario (RNAO).] / Alcance de la implantación de la guía "Valoración del riesgo y prevención de úlceras por presión" de la Registered Nurses' Association of Ontario (RNAO).

OBJECTIVE: The Best Practice Spotlight Organizations Program is being developed in Spain to reduce the variability of clinical practice by implementing clinical practice guidelines from the Registered Nurses' Association of Ontario. This study described the results of the implementation of the guide "Risk assessment and prevention of pressure ulcers". METHODS: We carried out a retrospective observational study (2015-2018) at the Hospital Universitario Virgen de las Nieves on 4,464 patients from 22 hospitalization units, analyzing type of unit, risk assessment, preventive measures, origin and category of ulcers. Descriptive analysis and contingency tables were performed with the Chi-square statistic p<0.05. RESULTS: The patients at risk were 62.2% in medical units, 53.4% in surgical units and 90% in intensive care. The application of preventive measures was 67.9%, 60.2% and 92.1% (respectively) for each unit. In medical units, 13.1% of pressure ulcers were identified, of which 68.1% were present at the time of admission. While in surgical units and intensive care they developed during hospitalization (60.8% and 88.9% respectively) (p<0.001). The presence of ulcers seemed to show a decreasing trend in the years analyzed (19.6% to 11.2%). CONCLUSIONS: There are favorable environments for implantation (medical units and intensive care) that reflect a higher level of risk assessment, use of pressure management surfaces and a decrease in prevalence. The recommendations have not been implemented homogeneously, with differences depending on the type of unit.

OBJETIVO: El Programa Centros Compro-metidos con la Excelencia en Cuidados®, se desarrolla en España, para reducir la variabilidad de la práctica clínica, implantando guías de práctica clínica de la Registered Nurses' Association of Ontario. Este estudio describió los resultados de la implantación de la guía "Valoración del riesgo y prevención de las úlceras por presión". METODOS: Se realizó un estudio observacional retrospectivo (2015-2018) en el Hospital Universitario Virgen de las Nieves sobre 4.464 pacientes de 22 unidades de hospitalización, analizando el tipo de unidad, la valoración del riesgo, las medidas preventivas, la procedencia y la categoría de las úlceras. Se realizó análisis descriptivo y tablas de contingencia con el estadístico Chi-cuadrado p<0,05. RESULTADOS: Los pacientes de riesgo fueron el 62,2% en unidades médicas, 53,4% en las quirúrgicas y el 90% en cuidados intensivos. La aplicación de medidas preventivas fue del 67,9%, 60,2% y 92,1% (respectivamente) para cada unidad. En unidades médicas se identificaron un 13,1% de úlceras por presión, de las cuales el 68,1% estaban presentes en el momento del ingreso. Mientras que en unidades quirúrgicas y en cuidados intensivos se desarrollaron durante la hospitalización (60,8% y 88,9% respectivamente) (p<0,001). La presencia de úlceras pareció mostrar una tendencia a la disminución en los años analizados (19,6% a 11,2%). CONCLUSIONES: Existen entornos favorecedores para la implantación (unidades médicas y cuidados intensivos) que reflejan mayor nivel de valoración del riesgo, de utilización de superficies de gestión de la presión y disminución de la prevalencia. No se ha conseguido implantar las recomendaciones de forma homogénea existiendo diferencias en función del tipo de unidad.

Factors That Influence Nurse Staffing Levels in Acute Care Hospital Settings.

PURPOSE: To identify which patient and hospital characteristics are related to nurse staffing levels in acute care hospital settings. DESIGN: A cross-sectional design was used for this study. METHODS: The sample comprised 1,004 patients across 10 hospitals in the Andalucian Health Care System (southern Spain) in 2015. The sampling was carried out in a stratified, consecutive manner on the basis of (a) hospital size by geographical location, (b) type of hospital unit, and (c) patients' sex and age group. Random criteria were used to select patients based on their user identification in the electronic health record system. The variables were grouped into two categories, patient and hospital characteristics. Multilevel linear regression models (MLMs) with random intercepts were used. Two models were fitted: the first was the null model, which contained no explanatory variables except the intercepts (fixed and random), and the second (explanatory) model included selected independent variables. Independent variables were allowed to enter the explanatory model if their univariate association with the nurse staffing level in the MLM was significant at p < .05. RESULTS: Two hierarchical levels were established to control variance (patients and hospital). The model variables explained 63.4% of the variance at level 1 (patients) and 71.8% at level 2 (hospital). Statistically significant factors were the type of hospital unit (p = .002), shift (p < .001), and season (p < .001). None of the variables associated with patient characteristics obtained statistical significance in the model. CONCLUSIONS: Nurse staffing levels were associated with hospital characteristics rather than patient characteristics. CLINICAL RELEVANCE: This study provides evidence about factors that impact on nurse staffing levels in the settings studied. Further studies should determine the influence of patient characteristics in determining optimal nurse staffing levels.

Teoría y práctica: Reflexiones sobre los diagnósticos enfermeros y su aplicabilidad en los entornos clínicos / Theory and practice: reflections upon the nursing diagnosis and its applicability on the clinical settings

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