Cultura de seguridad y calidad asistencial: desafíos para la práctica enfermera / Culture of healthcare safety and quality: challenges for nursing practice

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Factores predictores de la institucionalización de personas mayores en situación de dependencia en Andalucía / Predictors of institutionalization of elderly persons in dependency situation in Andalusia

OBJETIVO: Identificar las preferencias acerca del recurso asistencial y los factores de riesgo de institucionalización de personas mayores en situación de dependencia en Andalucía. MÉTODO: Se analizaron datos de 200.039 personas registradas en el Sistema para la Autonomía y Atención a la Dependencia, en el período 2007-2012. Se describió en la población: la edad, situación de dependencia, preferencias, red de apoyo y factores clínicos a la entrada en el estudio. El análisis se realizó por separado para hombres y mujeres. Se diseñó un modelo de regresión logística para determinar los factores de riesgo de institucionalización para cada sexo. RESULTADOS: El 87,4% de las mujeres y el 85,9% de los hombres manifestaron su deseo de recibir los cuidados en su domicilio particular. Los hombres tienen 3 veces más riesgo de institucionalización que las mujeres. En mujeres los factores de riesgo de institucionalización son: el nivel de dependencia, desear vivir en residencia, una consistencia y una fragilidad medias de la red de apoyo y tener un diagnóstico de demencia. En hombres: desear vivir en una residencia y una consistencia baja o media de la red de apoyo. CONCLUSIONES: El cuidado en el domicilio es la alternativa de preferencia para las personas mayores en situación de dependencia. El riesgo de institucionalización está condicionado por las preferencias de la persona y su familia y las características de la red de apoyo, más que por las condiciones clínicas del individuo

OBJECTIVE: Identifying preferences regarding type of care and risk factors for institutionalization of elderly persons in dependency situations in Andalusia. METHODS: The data on 200,039 persons registered in the System for Autonomy and Dependency Care over the period 2007-2012 were analysed. The study population was described in terms of: age, dependency situation, preferences, support network and clinical factors at the time of inclusion in the study. Separate analysis was made for men and women. A logistic regression model was designed to determine the risk factors for institutionalization for each sex. RESULTS: 87,4% of women and 85,9% of men expressed their wish to receive care in their own home. The risk of institutionalization is three times higher among men than among women. Among women, the risks of institutionalization are: level of dependency, wishing to move into a residential care home, medium consistency and fragility of support network and being diagnosed with dementia. Among men, the risks are: wishing to move into a residential care home and low or medium consistency of support network. CONCLUSIONS: Care in the home is the preferred alternative for elderly persons in dependency situations. The risk of institutionalization is conditioned more by the preferences of the person and their family and the characteristics of the support network than by individual's clinical condition

[Predictors of institutionalization of elderly persons in dependency situation in Andalusia]. / Factores predictores de la institucionalización de personas mayores en situación de dependencia en Andalucía.

OBJECTIVE: Identifying preferences regarding type of care and risk factors for institutionalization of elderly persons in dependency situations in Andalusia. METHODS: The data on 200,039 persons registered in the System for Autonomy and Dependency Care over the period 2007-2012 were analysed. The study population was described in terms of: age, dependency situation, preferences, support network and clinical factors at the time of inclusion in the study. Separate analysis was made for men and women. A logistic regression model was designed to determine the risk factors for institutionalization for each sex. RESULTS: 87,4% of women and 85,9% of men expressed their wish to receive care in their own home. The risk of institutionalization is three times higher among men than among women. Among women, the risks of institutionalization are: level of dependency, wishing to move into a residential care home, medium consistency and fragility of support network and being diagnosed with dementia. Among men, the risks are: wishing to move into a residential care home and low or medium consistency of support network. CONCLUSIONS: Care in the home is the preferred alternative for elderly persons in dependency situations. The risk of institutionalization is conditioned more by the preferences of the person and their family and the characteristics of the support network than by individual's clinical condition.

[Predisposition of citizens to use Internet-based channels to communicate with doctors in Spain]. / Predisposición ciudadana en España a utilizar canales de comunicación con el médico basados en internet.

OBJECTIVE: Analyze factors affecting the predisposition of Spanish citizens to use Internet-based communication channels (E-mail, blogs, social networks, and online recommendations). METHODS: Secondary data were analyzed by applying a boosted regression tree (BRT) to the results obtained from the survey "Use and Applications of Information and Communications Technology in Health," administered to a representative sample of the Spanish population between 16 and 85 years of age who use the Internet. RESULTS: Model forecasts achieved different degrees of precision for each of the communication channels: for E-mail, AUC (area under the curve) = 0.79; for the physician's blog or personal website, AUC = 0.736; for social networks, AUC = 0.73; for recommendations of websites related to health problems, AUC = 0.768. Being young was the most important parameter in citizen predisposition to communicate through social networks (relative influence; RI = 21.05%), while population density was the most important parameter in likelihood that the physician would have a blog or personal health-related website (RI = 19.48%). Having a positive perception of the technology when facilitating health-related transactions was the most important characteristic in wanting to receive recommendations on health-related Internet resources (RI = 18.66%), while having a higher level of education was the best predictor of wanting to establish E-mail communication (RI = 18.98%). CONCLUSIONS: Many of Spanish people are open to using physician-patient interaction channels on the Internet.

Predisposición ciudadana en España a utilizar canales de comunicación con el médico basados en internet / Predisposition of citizens to use Internet-based channels to communicate with doctors in Spain

OBJETIVO: Analizar los factores que condicionan la predisposición de los ciudadanos españoles a utilizar los canales de comunicación basados en internet (correo electrónico, blogs, redes sociales y recomendaciones sobre recursos en internet). MÉTODOS: Análisis de datos secundarios mediante la técnica de árboles de regresión impulsados (BRT, Boosted Regression Trees) sobre los resultados obtenidos de la encuesta "Uso y aplicaciones de las tecnologías de la información y la comunicación en el ámbito sanitario", representativa de la población española de entre 16 y 85 años que utiliza internet. RESULTADOS: Las predicciones de los modelos alcanzaron diferentes grados de precisión para cada canal de comunicación: a través de correo electrónico, AUC (Area Under the Curve, área bajo la curva) = 0,79; que el médico tenga un blog o página web personal, AUC = 0,736; a través de redes sociales, AUC = 0,73; recibir recomendaciones de páginas web relacionadas con problemas de salud, AUC = 0,768. Ser joven fue el parámetro más importante para explicar la disposición ciudadana a comunicarse a través de redes sociales (IR [influencia relativa] = 21,05%), mientras que la densidad poblacional lo fue para estar dispuesto a que el médico tenga un blog o página web personal sobre salud (IR = 19,48%). Tener una percepción positiva de las tecnologías a la hora de facilitar los trámites en salud es la característica más importante para desear recibir recomendaciones sobre recursos de internet en salud (IR = 18,66%) mientras que tener un mayor nivel educativo fue lo que mejor predice el deseo de establecer comunicación a través de correo electrónico (IR=18,98%). CONCLUSIONES: Una buena parte de la población española se encuentra suficientemente preparada para utilizar canales de interacción médico-paciente a través de internet.

OBJECTIVE: Analyze factors affecting the predisposition of Spanish citizens to use Internet-based communication channels (E-mail, blogs, social networks, and online recommendations). METHODS: Secondary data were analyzed by applying a boosted regression tree (BRT) to the results obtained from the survey "Use and Applications of Information and Communications Technology in Health," administered to a representative sample of the Spanish population between 16 and 85 years of age who use the Internet. RESULTS: Model forecasts achieved different degrees of precision for each of the communication channels: for E-mail, AUC (area under the curve) = 0.79; for the physician's blog or personal website, AUC = 0.736; for social networks, AUC = 0.73; for recommendations of websites related to health problems, AUC = 0.768. Being young was the most important parameter in citizen predisposition to communicate through social networks (relative influence; RI = 21.05%), while population density was the most important parameter in likelihood that the physician would have a blog or personal health-related website (RI = 19.48%). Having a positive perception of the technology when facilitating health-related transactions was the most important characteristic in wanting to receive recommendations on health-related Internet resources (RI = 18.66%), while having a higher level of education was the best predictor of wanting to establish E-mail communication (RI = 18.98%). CONCLUSIONS: Many of Spanish people are open to using physician-patient interaction channels on the Internet.

Evaluación y mejoría del dolor en niños atendidos por enfermeras acreditadas: estudio descriptivo / Pain assessment and improvement in children treated by accredited nurses: descriptive study

Antecedentes: la evaluación del dolor es una tarea compleja que requiere de un esfuerzo considerable dada su naturaleza multidimensional. Esta evaluación es, si cabe, más compleja en el caso de los niños debido a las dificultades de comunicación y dominio del lenguaje. Objetivos: analizar la reducción del dolor logrado por enfermeras acreditadas, en función de la edad de los niños atendidos. Metodología: se utilizaron 161 evaluaciones del dolor percibido en niños de entre 0 y 15 años, realizadas por 93 enfermeras acreditadas entre septiembre de 2006 y julio de 2011. Para la elaboración de los análisis descriptivos se utilizó el test estadístico Chi-cuadrado. Se calcularon las Odds ratio para la probabilidad de reducir el dolor a 0 en los niños según su edad. Resultados: los resultados evidenciaron que las enfermeras presentan un mayor nivel de competencias en la reducción del dolor en niños de edades comprendidas entre 2 y 3 años, observándose hasta los 10 años una leve tendencia negativa en la capacidad de reducir el dolor a cero por parte de las enfermeras, a medida que aumenta la edad del niño. Conclusiones: este trabajo aborda la evaluación del dolor, realizada por el conjunto de enfermeras de cuidados infantiles, que trabajan en los servicios de salud públicos de Andalucía, y que han sido acreditadas por la Agencia de Calidad Sanitaria de Andalucía, España. Las enfermeras utilizaron distintos tipos de escalas de medición del dolor, en función del desarrollo cognitivo de los niños atendidos.

Background. Pain assessment is a complex task that requires considerable effort due to its multidimensional nature. This assessment is, if anything, more complex in the case of children due to the difficulties of communication and language proficiency. Aim. To analyse pain reduction achieved by accredited nurses depending on the age of the children treated. Method. 161 assessments of perceived pain in children aged 0 to 15 years conducted by 93 accredited nurses between September 2006 and July 2011 were used. Chi-square tests were applied for descriptive analysis. Odds ratio for probabilities of reducing pain to 0 was calculated according the age of the children. Results. The results show that nurses have a higher level of competency in reducing pain in children aged between 2 and 3 years, showing a mild negative trend in the ability to reduce pain to zero, with increasing child's age. Conclusions. This paper addresses the assessment of pain, held by all child-care nurses who work in Public Health Services of Andalusia (Spain), which have been accredited by the Andalusian Agency for Healthcare Quality. Nurses have used different types of pain measurement scales, depending on the cognitive development of children treated.

Revisión sistemática sobre recomendaciones de seguridad del paciente para centros sociosanitarios / Recommendations on the safety of patients for socio-health centers: Systematic review

El objetivo de esta revisión sistemática se centra en la búsqueda de recomendaciones sobre seguridad del paciente que en diferentes contextos sociosanitarios (residencias para personas de edad avanzada y centros de estancia prolongada) se orientan a lograr una atención más segura. Se seleccionaron 134 artículos en MEDLINE, EMBASE y CINAHL hasta octubre de 2012. De ellos, 17 cumplían finalmente los criterios de inclusión, y 5 estudios más se añadieron en la búsqueda secundaria. Fueron escasos los estudios con un nivel de evidencia científica alto o muy alto según la escala SIGN. Los estudios analizados se centran principalmente en el personal de enfermería. La mayoría de las recomendaciones se basan en aspectos relacionados con la medicación, la formación del personal, las úlceras por presión o caídas, la adherencia a guías y protocolos, así como aspectos relacionados con la cultura organizacional

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[Recommendations on the safety of patients for socio-health centers: systematic review]. / Revisión sistemática sobre recomendaciones de seguridad del paciente para centros sociosanitarios.

We did a systematic review to find recommendations on patient safety oriented toward improving the quality of care in nursing homes, residential facilities, housing for the elderly and long-term care facilities, among others. One hundred and thirty-four articles were selected in MEDLINE, EMBASE and CINAHL up to October 2012. Of these, 17 met inclusion criteria and 5 studies were added in the secondary search for further detailed analysis. Few studies with high or very high level of scientific evidence on the scale SIGN were identified. Analyzed studies focused primarily on nursing staff. Most of the recommendations are oriented toward medication-related issues, staff training, pressure ulcers or falls, adherence to guidelines and protocols and topics referred to organizational culture.

Stakeholder analysis: theAndalusian Agency For Healthcare Quality case.

The aim of this study was to identify the different groups that can affect or be affected by an agency charged with the promoting and guaranteeing of health care quality in Andalusian region (Spain) and to provide a framework with the stakeholders included in different categories. The study adopted a cross-sectional research design. A case study with structured interviews among Andalusian Agency for Healthcare Quality Steering Committee members was carried out in 2010 to define stakeholders' categories and map the interest groups using 5 attributes: influence, importance, legitimacy, power, and urgency. After identification and categorization, stakeholders were weighted qualitatively according to the attributes of importance and influence using 4 possible levels. A matrix was made with the collected data relating both attributes. Furthermore, 8 different types of stakeholders were identified according to attributes power, legitimacy, and urgency. The study concludes that identifying and classifying stakeholders are fundamental to ensuring the success of an organization that must respond to needs and expectations, especially those of its clients. Moreover, knowing stakeholder linkages can contribute to increase organizational worth. This is essential for organizations basically directed to the provision of services in the scope of health care.

Professional involvement in the design of accreditation manuals.

PURPOSE: This paper aims to describe the participation of health professionals as key agents for the successful definition of skills manuals supporting professional accreditation in Andalusia (Spain). DESIGN/METHODOLOGY/APPROACH: The increasing extent to which different stakeholders are recognized reflects the importance they hold in all decision-making processes. The Andalusian Agency for Healthcare Quality's commitment to this process has facilitated the healthcare professionals' participation when professional skills manuals are designed for their respective specialities. FINDINGS: The process involved over 400 healthcare professionals from 58 disciplines between March 2005 and January 2008. Results were conditioned by several factors, some acting as drivers while others represented a barrier. RESEARCH LIMITATIONS/IMPLICATIONS: The experience relates to a specific geographical context. Healthcare professionals eligible to participate had to be in active employment and working for the Andalusian Public Health Service. There was an overrepresentation of members from scientific associations. PRACTICAL IMPLICATIONS: Co-operation based on mutual trust is the essential ingredient accounting for the success of participative involvement. ORIGINALITY/VALUE: The paper incorporates all categories of personnel and specialities in a regional healthcare system that covers eight million inhabitants and employs over 90,000 professionals, includes 33 public hospitals, more than 1,500 primary care centres and other healthcare units.