Physiotherapists' Evidence-Based Practice profiles by HS-EBP questionnaire in Spain: A cross-sectional normative study.

Evidence-Based Practice (EBP) is a cost-effective approach for improving the quality of clinical care and implementing only well-tested evidence. Health professions, especially physiotherapy, must embrace EBP principles. This paper presents normative data from the Spanish physiotherapist population using the Health-Sciences Evidence-Based Practice questionnaire and explores EBP clusters/profiles of professionals in practice. An intentional sample of 419 practicing physiotherapists was recruited from the Spanish Professional Council of Physiotherapy. Participants completed a cross-sectional online survey with 60 Likert items (scale 1-10) measuring 5 dimensions: 1) Beliefs and attitudes, 2) Results from literature, 3) Professional practice, 4) Assessment of results, and 5) Barriers and Facilitators. The protocol also included sociodemographic, training, and practice-related contrast variables. Normative data were estimated and tabulated for each dimension and then a K-means clustering procedure was implemented using the contrast variables. Results for normative data showed, in descending order, the following 50th percentile values for the five EBP factors: Beliefs and attitudes (8.25), Professional practice (8.00), Assessment of results (7.42), Results from literature (6.71), and EBP Barriers and Facilitators (5.17); all expressed on a scale of 1 to 10. Academic degree, EBP training level, and work time shared in healthcare activity, research, or teaching activity were all statistically significant for discriminating EBP dimension scores. Finally, six different clusters showed that when EBP level is low, the scores in all dimensions are equally low, and vice-versa. The EBP dimensions "Beliefs and attitudes", "Professional practice", and "Evaluation of results" obtained better normative scores overall than "Search for bibliographic evidence and its inclusion in practice" and especially "Perception of EBP barriers", which had the worst score. Normative data are useful for comparing individual scores and the reference population, and information about clusters will enable appropriate global EBP intervention programs to be designed and implemented.

Cross-cultural Adaptation of the Health Sciences Evidence-based Practice Questionnaire into Japanese and Its Test-Retest Reliability in Undergraduate Students.

OBJECTIVES: The Health Sciences Evidence-Based Practice (HS-EBP) questionnaire was recently developed for measuring five constructs of evidence-based clinical practice among Spanish health professionals by applying content and construct validity investigation. The current study aims to undertake a cross-cultural adaptation of the HS-EBP into Japanese and to investigate the internal consistency and test-retest reliability of the Japanese HS-EBP among undergraduate students of nursing and physical and occupational therapies. METHODS: Cross-cultural adaptation was undertaken by following Beaton's five-step process. Subsequently, the Japanese HS-EBP test-retest reliability was assessed with a 2-week interval. Participants were recruited from among third and fourth grade undergraduate students of nursing and physical and occupational therapies with clinical training experience. RESULTS: Pilot testing included 30 participants (11 nursing students, 11 physical therapy students, 8 occupational therapy students). Consequently, we developed the Japanese HS-EBP to be understandable for undergraduate students of nursing and physical and occupational therapies. Data from 52 participants who completed test-retest reliability questionnaires demonstrated adequate test-retest reliability in the total scores of Domains 1, 3, 4, and 5 [intraclass correlation coefficients were (ICC)=0.74, 0.70, 0.75, and 0.74, respectively]; the exception was Domain 2, which had an ICC of 0.66. Internal consistency (Cronbach's α) was adequate for Domains 1-5, for which α was 0.87, 0.94, 0.86, 0.93, and 0.95, respectively. CONCLUSIONS: This study developed the Japanese version of HS-EBP and provided preliminary evidence of adequate internal consistency and test-retest reliability in most domains for undergraduate students of nursing and physical and occupational therapies.

Impact of the implementation of best practice guidelines on nurse's evidence-based practice and on nurses' work environment: Research protocol.

AIM: To determine the impact of the Best Practice Spotlight Organization® initiative on nurses' perception of their work environment and their attitudes to evidence-based practice. DESIGN: Quasi-experimental, multicentre study. The intervention is the participation in Best Prectice Spotilight Organizations to implement Best Practice Guidelines. METHODS: The study will include seven centres in the interventional group and 10 in the non-equivalent control group, all of them belonging to the Spanish national health system. The Practice Environment Scale of the Nursing Work Index, and the Health Sciences Evidence-Based Practice Questionnaire will be administered to a sample of 1,572 nurses at the beginning of the programme and at 1 year. This 3-year study started in April 2018 and will continue until December 2021. Statistical analyses will be carried out using the SPSS 25.0. This project was approved by the Drug Research Ethics Committee of the Parc de Salut Mar and registered in Clinical Trials. DISCUSSION: The study findings will show the current state of nurses' perception of their work environment and attitudes to evidence-based practice, and possible changes in these parameters due to the programme. IMPACT: The findings could provide a strong argument for health policymakers to scale up the Best Practice Spotlight Organization® initiative in the Spanish national health system.

Health Sciences-Evidence Based Practice Questionnaire (HS-EBP): Normative Data and Differential Profiles in Spanish Osteopathic Professionals.

The main goal of this study was to obtain normative data of the scores of the Health-Sciences Evidence Based Practice (HS-EBP) questionnaire, and to analyse evidence-based practice (EBP) among potential clusters of osteopathy professionals in Spain. An online descriptive cross-sectional study has been applied. A total number of 443 Spanish practicing osteopaths answered a survey including the 5 dimensions of the HS-EBP questionnaire and sociodemographic, training, and practice variables using the "LimeSurvey" online platform. Results point out that the median scores for each five HS-EBP questionnaire dimensions were 95.00, 86.00, 78.00, 84.00 and 62.00 considering that the range of possible scores in each of the dimensions was: from 12 to 120 in dimensions 1, 4 and 5; from 14-140 in dimension 2; and from 10-100 in dimension 3. A clustering algorithm extracted 6 different profiles across the five HS-EBP latent dimensions: low scores in all dimensions (cluster 1); low scores in all dimensions but with medium scores in dimension 1 (cluster 2); mixed pattern of scores, low in dimensions 2 and 5 and medium in the rest of the dimensions; medium scores in all dimensions (cluster 4); high scores in all dimensions and low scores in dimension 5 (cluster 5); and high scores in all dimensions (cluster 6). Significant relationship was found among the response patterns in the clusters and: academic degree level, EBP training and training level, and work time invested in healthcare activity, research and teaching activity. These results allow a description of the actual level of EBP and differential profiles of Osteopathy care practice in Spain. Knowledge of normative scores of the HS-EBP questionnaire and identification of different predictors of Spanish osteopaths' EBP, e.g., academic degree, EBP training and training level, work time invested in healthcare activity, research, and teaching activity, and having a working relationship with an accredited educational centre, enable a comprehensive evaluation of the EBP of osteopathic professionals and can also be useful for developing and implementing formative intervention programs for improving EBP practice in osteopathic practice.

Latent structure and factor invariance of somatic symptoms in the patient health questionnaire (PHQ-15).

BACKGROUND: Somatic symptoms are highly prevalent in primary care although insufficiently understood. The Patient Health Questionnaire (PHQ-15) is a valuable screening test but it has not yet been possible to unequivocally demonstrate its latent structure and measurement invariance. METHODS: A total of 1,255 patients from 28 primary care centres suffering symptoms of anxiety, depression or somatisation participated in a clinical trial. They completed the PHQ-15 at baseline and 374 retook it at three months. Exploratory structural equation modelling (ESEM) was used to compare three models: 1) a single global factor for somatisation, 2) four specific correlated factors, and 3) a bifactor model integrating the first two models. RESULTS: A multi-group invariance analysis of the best-fit model was performed: the bifactor model (χ2=25.17, df=23, p = 0.34, RMSEA=0.009, CFI=1.00, TLI=0.999). Strict invariance was good for both gender (RMSEA = 0.046, CFI = 0.973, TLI = 0.963) and age (RMSEA = 0.048, CFI = 0.964, TLI = 0.962). Configural and metric invariance were confirmed for moment of assessment, but scalar invariance was not. LIMITATIONS: The two main limitations were the sample (primary care patients with emotional disorders), which was not representative of the general population, and the utilisation of ESEM (vs. confirmatory factor analysis), which did not allow a second-order factor model to be tested. CONCLUSIONS: PHQ-15 showed a bifactor structure, providing both a single global measure of somatisation and specific measures of pain, gastrointestinal, cardiopulmonary and fatigue factors. Its factor invariance with regard to both gender and age was confirmed.

Health Sciences-Evidence Based Practice questionnaire (HS-EBP) for measuring transprofessional evidence-based practice: Creation, development and psychometric validation.

INTRODUCTION: Most of the EBP measuring instruments available to date present limitations both in the operationalisation of the construct and also in the rigour of their psychometric development, as revealed in the literature review performed. The aim of this paper is to provide rigorous and adequate reliability and validity evidence of the scores of a new transdisciplinary psychometric tool, the Health Sciences Evidence-Based Practice (HS-EBP), for measuring the construct EBP in Health Sciences professionals. METHODS: A pilot study and a subsequent two-stage validation test sample were conducted to progressively refine the instrument until a reduced 60-item version with a five-factor latent structure. Reliability was analysed through both Cronbach's alpha coefficient and intraclass correlations (ICC). Latent structure was contrasted using confirmatory factor analysis (CFA) following a model comparison aproach. Evidence of criterion validity of the scores obtained was achieved by considering attitudinal resistance to change, burnout, and quality of professional life as criterion variables; while convergent validity was assessed using the Spanish version of the Evidence-Based Practice Questionnaire (EBPQ-19). RESULTS: Adequate evidence of both reliability and ICC was obtained for the five dimensions of the questionnaire. According to the CFA model comparison, the best fit corresponded to the five-factor model (RMSEA = 0.049; CI 90% RMSEA = [0.047; 0.050]; CFI = 0.99). Adequate criterion and convergent validity evidence was also provided. Finally, the HS-EBP showed the capability to find differences between EBP training levels as an important evidence of decision validity. CONCLUSIONS: Reliability and validity evidence obtained regarding the HS-EBP confirm the adequate operationalisation of the EBP construct as a process put into practice to respond to every clinical situation arising in the daily practice of professionals in health sciences (transprofessional). The tool could be useful for EBP individual assessment and for evaluating the impact of specific interventions to improve EBP.

Advanced Practice Nursing Competency Assessment Instrument (APNCAI): clinimetric validation.

OBJECTIVE: To describe the development and clinimetric validation of the Advanced Practice Nursing Competency Assessment Instrument (APNCAI) through several evidence sources about reliability and validity in the Spanish context. DESIGN AND SETTING: APNCAI development was based on a multisequential and systematic process: literature review, instrument content consensus through qualitative Delphi method approach (a panel of 51 Advanced Practice in Nursing -APN- experts was selected) and the clinimetric validation process based on a sample of 600 nurses from the Balearic Islands public healthcare setting. METHODS: An initial step for tool's content development process based on Delphi method approach of expert consensus was implemented. A subsequent phase of tool validation started from the analysis of APN core competencies latent measurement model, including exploratory and confirmatory techniques. Reliability evidence for each latent factor was also obtained. Items' scores were submitted to descriptive analysis, plus univariate and multivariate normality tests. RESULTS: An eight-factor competency assessment latent model obtained adequate fit, and it was composed by 'Research and Evidence-Based Practice', 'Clinical and Professional Leadership', 'Interprofessional Relationship and Mentoring', 'Professional Autonomy', 'Quality Management', 'Care Management', 'Professional Teaching and Education' and 'Health Promotion'. CONCLUSIONS: Adequate empirical evidence of reliability and validity for APNCAI makes it useful for application in healthcare policy programmes for APN competency assessment in Spain.

Content validity of a health science evidence-based practice questionnaire (HS-EBP) with a web-based modified Delphi approach.

OBJECTIVE: To develop a tool for measuring evidence-based practice (EBP) and to evaluate its content validity by Delphi technique. A five-factor/dimensions latent structure for the EBP construct was defined a priori and operationalized. DESIGN: Online Delphi technique. SETTING AND PARTICIPANTS: A group of 32 national EBP experts from different health professions. INTERVENTION: The experts rated the initial questionnaire items according to adequacy and relevance criteria using four-point Likert scales and including open fields for suggestions, with basic and supplementary criteria consensus established a priori. MAIN OUTCOME MEASURE: Level of consensus in the Content Validity Index Item. RESULTS: An EBP construct solution was designed with the elements that constitute the operationalization proposal of the EBP. This initial version consisted of 76 items, whereas the version arising from the Delphi study was made up of 73 items. In the first round, 13 items did not reach the minimum level of consensus, and 12 of these were reformulated. Three additional items were removed in the second round. CONCLUSIONS: A new psychometric tool forms measuring EBP with a five-factor structure, and 73 items obtained adequate content validity evidence based on expert opinion.

Consenso sobre competencias para la enfermería de práctica avanzada en España / Consensus on competencies for advanced nursing practice in Spain

INTRODUCCIÓN: Existe falta de consenso internacional sobre la definición exacta y las competencias asociadas a los roles de enfermería de práctica avanzada (EPA), caso que resulta más acuciante en nuestro entorno nacional dada la corta trayectoria de la misma en nuestro país. El objetivo del trabajo consistió en delinear el marco competencial para enfermeras de práctica avanzada en nuestro contexto nacional mediante el proceso de consenso de expertos a través del método Delphi. MÉTODO: Basándonos en un proceso de revisión bibliográfica previo, se identificó un conglomerado de 17 dominios competenciales (clusters de competencias relacionadas). Este conjunto inicial fue revisado, refinado y validado por un conjunto de panelistas expertos en la materia (tanto clínicos como investigadores, gestores y docentes) a través de sucesivas rondas en busca del adecuado consenso sobre cada una de las diferentes competencias propuestas. RESULTADOS: Los resultados permitieron establecer una sólida base en forma de mapa de competencias que permitiera identificar aquellos conjuntos de competencias más específicos para roles de práctica avanzada, independientemente del contexto de regulación y práctica profesional, identificando dominios como investigación y práctica basada en la evidencia, liderazgo clínico y profesional o gestión de cuidados. DISCUSIÓN: Este conjunto de competencias relacionadas con roles de práctica avanzada en nuestro entorno permite delinear los estándares competenciales propios de este nivel de práctica enfermera, y servir de referencia tanto para el desarrollo normativo, la revisión de roles o el planteamiento de perfiles formativos

INTRODUCTION: There is a lack of international consensus on the exact definition and core competencies of advanced practice nursing (APN) roles, a problem particularly acute in our national context due to the lack of APN role development, which has a significantly short history in our country. The main objective of this paper was the delineation of the competence framework for Advanced Practice Nurses in our national context based on expert consensus through the Delphi method Method: Based on a preliminary literature review process, a conglomerate of 17 domains of competence (clusters of related competencies) were identified. This initial set was revised, refined and validated by a group of expert panellists on the subject (clinicians, researchers, managers, and teachers) through successive rounds in search of a suitable consensus on each of the various proposed items RESULTS: The results helped to establish a solid foundation in the form of a skills map that could identify those sets of more specific competencies for advanced practice roles, regardless of regulatory and professional practice context, identifying domains such as Research and Evidence Based Practice, Clinical and Professional Leadership, or Care Management DISCUSSION: This set of skills related to advanced practice roles in our environment can delineate competency standards common to this level of nursing practice, and serve as a reference for policy development, a review of roles, or the establishment of academic profiles

[Consensus on competencies for advanced nursing practice in Spain]. / Consenso sobre competencias para la enfermería de práctica avanzada en España.

INTRODUCTION: There is a lack of international consensus on the exact definition and core competencies of advanced practice nursing (APN) roles, a problem particularly acute in our national context due to the lack of APN role development, which has a significantly short history in our country. The main objective of this paper was the delineation of the competence framework for Advanced Practice Nurses in our national context based on expert consensus through the Delphi method METHOD: Based on a preliminary literature review process, a conglomerate of 17 domains of competence (clusters of related competencies) were identified. This initial set was revised, refined and validated by a group of expert panellists on the subject (clinicians, researchers, managers, and teachers) through successive rounds in search of a suitable consensus on each of the various proposed items RESULTS: The results helped to establish a solid foundation in the form of a skills map that could identify those sets of more specific competencies for advanced practice roles, regardless of regulatory and professional practice context, identifying domains such as Research and Evidence Based Practice, Clinical and Professional Leadership, or Care Management DISCUSSION: This set of skills related to advanced practice roles in our environment can delineate competency standards common to this level of nursing practice, and serve as a reference for policy development, a review of roles, or the establishment of academic profiles.

A multisample model validation of the evidence-based practice questionnaire.

Evidence-based practice may be implemented more successfully if the barriers to its implementation have been previously identified. Many of the available instruments to measure these barriers have been validated in single samples or without confirmatory analyses. The objective of the study was to contrast the goodness of fit of two measurement models (24 items and 19 items) for the Spanish version of the Evidence-Based Practice Questionnaire (EBPQ) in a sample of 1,673 full-time registered nurses in 10 hospitals and 57 primary health care centers in the Spanish Public Health Service. The 19-item model performed better in all four subsamples. A hypothesis of strict invariance, with equal factor loadings, intercepts, and error variance in all contexts in which it was evaluated, was supported. Goodness-of-fit indices provided strong evidence of good fit according to standard cut-off criteria in a multisample confirmatory factor analysis.

Validity and reliability of instruments aimed at measuring Evidence-Based Practice in Physical Therapy: a systematic review of the literature.

RATIONALE, AIMS AND OBJECTIVES: Our goal is to compile and analyse the characteristics - especially validity and reliability - of all the existing international tools that have been used to measure evidence-based clinical practice in physiotherapy. METHODS: A systematic review conducted with data from exclusively quantitative-type studies synthesized in narrative format. An in-depth search of the literature was conducted in two phases: initial, structured, electronic search of databases and also journals with summarized evidence; followed by a residual-directed search in the bibliographical references of the main articles found in the primary search procedure. The studies included were assigned to members of the research team who acted as peer reviewers. Relevant information was extracted from each of the selected articles using a template that included the general characteristics of the instrument as well as an analysis of the quality of the validation processes carried out, by following the criteria of Terwee. RESULTS: Twenty-four instruments were found to comply with the review screening criteria; however, in all cases, they were found to be limited as regards the 'constructs' included. Besides, they can all be seen to be lacking as regards comprehensiveness associated to the validation process of the psychometric tests used. CONCLUSION: It seems that what constitutes a rigorously developed assessment instrument for EBP in physical therapy continues to be a challenge.

Using the R-mape index as a resistant measure of forecast accuracy / El índice R-MAPE como medida resistente del ajuste en la previsión

Background: The mean absolute percentage error (MAPE) is probably the most widely used goodness-of-fit measure. However, it does not meet the validity criterion due to the fact that the distribution of the absolute percentage errors is usually skewed to the right, with the presence of outlier values. In these cases, MAPE overstates the corresponding population parameter. In this study, we propose an alternative index, called Resistant MAPE or R-MAPE based on the calculation of the Huber M-estimator, which allows overcoming the aforementioned limitation. Method: The results derived from the application of Artificial Neural Network (ANN) and Autoregressive Integrated Moving Average (ARIMA) models are used to forecast a time series. Results: The arithmetic mean, MAPE, overstates the corresponding population parameter, unlike R-MAPE, on a set of error distributions with a statistically significant right skew, as well as outlier values. Conclusions: Our results suggest that R-MAPE represents a suitable alternative measure of forecast accuracy, due to the fact that it provides a valid assessment of forecast accuracy compared to MAPE (AU)

Antecedentes: el Promedio del Error Porcentual Absoluto (MAPE) es probablemente la medida de adecuación de la previsión más ampliamente utilizada. Sin embargo, no cumple el criterio de validez debido a que la distribución de los errores porcentuales absolutos habitualmente presenta una forma asimétrica a la derecha con presencia de valores alejados. En estos casos, el MAPE proporciona una sobreestimación del correspondiente parámetro poblacional. En el presente trabajo se propone un índice alternativo, denominado MAPE Resistente o R-MAPE, y basado en el cálculo del M-estimador de Huber, el cual permite superar la mencionada limitación. Método: se utilizan los resultados derivados de la aplicación de modelos de Red Neuronal Artificial (ANN) y modelos Autorregresivos Integrados de Media Móvil (ARIMA) en la previsión de una serie temporal. Resultados: se puede observar que la media aritmética, el MAPE, realiza una sobreestimación del correspondiente parámetro poblacional, a diferencia del R-MAPE, sobre un conjunto de distribuciones de errores con asimetría a la derecha y presencia de valores alejados. Conclusiones: nuestros resultados ponen de manifiesto que el R-MAPE representa una adecuada alternativa en la medición del ajuste en la previsión, debido a que proporciona una evaluación válida de dicho ajuste en comparación al MAPE (AU)

Using the R-MAPE index as a resistant measure of forecast accuracy.

BACKGROUND: The mean absolute percentage error (MAPE) is probably the most widely used goodness-of-fit measure. However, it does not meet the validity criterion due to the fact that the distribution of the absolute percentage errors is usually skewed to the right, with the presence of outlier values. In these cases, MAPE overstates the corresponding population parameter. In this study, we propose an alternative index, called Resistant MAPE or R-MAPE based on the calculation of the Huber M-estimator, which allows overcoming the aforementioned limitation. METHOD: The results derived from the application of Artificial Neural Network (ANN) and Autoregressive Integrated Moving Average (ARIMA) models are used to forecast a time series. RESULTS: The arithmetic mean, MAPE, overstates the corresponding population parameter, unlike R-MAPE, on a set of error distributions with a statistically significant right skew, as well as outlier values. CONCLUSIONS: Our results suggest that R-MAPE represents a suitable alternative measure of forecast accuracy, due to the fact that it provides a valid assessment of forecast accuracy compared to MAPE.

Psychometric testing of the Spanish version of the practice environment scale of the nursing work index in a primary healthcare context.

AIM: This paper is a report of psychometric testing of the Spanish version of the Practice Environment Scale of the Nursing Work Index for use in a primary health care. BACKGROUND: The Practice Environment Scale of the Nursing Work Index has been widely used in different studies and contexts. However, there is no validated version for primary care nursing staff in Spain. METHODS: A descriptive, multicentre, cross-sectional study for transcultural adaptation and psychometric validation purposes. Data were collected from October 2009 to January 2010. To test the reliability of the factors in the measurement model, Cronbach's alpha was used. To study the measurement model, different structural models were tested, using exploratory and confirmatory factor analyses. 377 completed questionnaires were obtained from a total of 553 nurses working for the Public Health Service in the Balearic Islands (Spain). This represents a response rate of 68·2%. RESULTS: For overall reliability, a Cronbach alpha of 0·91 was obtained. The confirmatory analysis upholds the original five-factor structure. CONCLUSION: The excellent goodness of fit of the confirmatory analysis corroborates the validity of this adapted version in primary healthcare contexts.

Entorno de práctica de los profesionales de enfermería y competencia para laincorporación de la evidencia a las decisiones: situación en las Islas Baleares / Nursing practice settings and competence to incorporate evidence into decisions: analysis of the situation in the Balearic Islands (Spain)

Objetivos: Establecer el diagnóstico de los factores que los profesionales de enfermería perciben como facilitadores para una práctica clínica basada en la evidencia (PCBE) en el Servicio de Salud de las Islas Baleares, identificando posibles diferencias en función de las características de los profesionales y de los entornos en que ejercen. Métodos: Estudio observacional transversal multicéntrico, tomando como población de estudio los3129 profesionales de enfermería en plantilla del Servicio de Salud de las Islas Baleares en 2009, a quienes se encuestó con los instrumentos Evidence Based Practice Questionnarie (EBPQ) y Nursing Work Index(PES-NWI). La estrategia de análisis comprendió análisis exploratorio, análisis bivariado con pruebas paramétricas y no paramétricas en función de la naturaleza de las distribuciones (correlación, ANOVA, Kruskall-Wallis, ji cuadrado) y multivariado, entre las principales variables del estudio y los factores de los cuestionarios PES-NWI y EBPQ. Los análisis se realizaron con un nivel de confianza del 95%.Resultados: Se recibieron 1753 encuestas (participación del 56,02%). Los resultados de los dos cuestionarios muestran diferencias significativas al analizar el entorno hospitalario y de atención primaria (p < 0,001). Estas diferencias se mantienen al comparar la categoría y la experiencia profesional. Conclusiones: El estudio compara entornos de práctica de enfermería de distintas características. Delos factores que componen los cuestionarios, el que mayor influencia tiene sobre la PCBE es el apoyo de los gestores de enfermería. También establece que los dos instrumentos validados son herramientas plausibles para el diagnóstico de una PCBE que permiten establecer elementos de mejora, tanto individual como de organización (AU)

Objectives: To determine the factors that nursing professionals perceive as facilitating evidence-based clinical practice (EBCP) in the Balearic Islands Health Service (Spain) by identifying possible differences according to nurses’ characteristics and their occupational settings. Methods: We performed a multicenter, cross-sectional, observational study of 3,129 staff nurses in the Balearic Islands Health Service in 2009, who were surveyed using the Evidence-Based Practice Questionnaire (EBPQ) and the Nursing Work Index (PES-NWI). The strategy for the analysis encompassed an exploratory analysis, bivariate analysis with parametric and non-parametric tests according to the nature of the distributions (correlation, ANOVA, Kruskall-Wallis, chi square) and multivariate analysis of the main study variables and factors on the PES-NWI and EBPQ questionnaires. The analyses had a confidence level of 95%.Results: A total of 1,753 questionnaires were received, corresponding to a participation rate of 56.02%.The results established significant differences between the two questionnaires in the analysis of the hospital setting and primary care (p < 0.001). These differences remained significant when the questionnaires were compared according to professional category and experience. Conclusions: This study compared nursing practice environments with different characteristics. Of the factors included in the questionnaires, that with the greatest influence on EBP was the support of nursing managers. This study also found that the two validated instruments are plausible tools for assessing EBC Pand help to establish areas for improvement both at the individual and organizational level (AU)

[Nursing practice settings and competence to incorporate evidence into decisions: analysis of the situation in the Balearic Islands (Spain)]. / Entorno de práctica de los profesionales de enfermería y competencia para la incorporación de la evidencia a las decisiones: situación en las Islas Baleares.

OBJECTIVES: To determine the factors that nursing professionals perceive as facilitating evidence-based clinical practice (EBCP) in the Balearic Islands Health Service (Spain) by identifying possible differences according to nurses' characteristics and their occupational settings. METHODS: We performed a multicenter, cross-sectional, observational study of 3,129 staff nurses in the Balearic Islands Health Service in 2009, who were surveyed using the Evidence-Based Practice Questionnaire (EBPQ) and the Nursing Work Index (PES-NWI). The strategy for the analysis encompassed an exploratory analysis, bivariate analysis with parametric and non-parametric tests according to the nature of the distributions (correlation, ANOVA, Kruskall-Wallis, chi square) and multivariate analysis of the main study variables and factors on the PES-NWI and EBPQ questionnaires. The analyses had a confidence level of 95%. RESULTS: A total of 1,753 questionnaires were received, corresponding to a participation rate of 56.02%. The results established significant differences between the two questionnaires in the analysis of the hospital setting and primary care (p<0.001). These differences remained significant when the questionnaires were compared according to professional category and experience. CONCLUSIONS: This study compared nursing practice environments with different characteristics. Of the factors included in the questionnaires, that with the greatest influence on EBP was the support of nursing managers. This study also found that the two validated instruments are plausible tools for assessing EBCP and help to establish areas for improvement both at the individual and organizational level.

Emociones Negativas en Pacientes con Lumbalgia Crónica / Negative Emotions in Patients with Chronic Lumbar Pain

El objetivo ha sido evaluar la ansiedad, depresión e ira en pacientes con dolor lumbar crónico y de un grupo control. Materiales y Método: la muestra incluyó n=54 pacientes y n=51 controles (15 hombres y 39 mujeres) con una media de edad de 49.20 años. Todos fueron evaluados mediante Inventario de Depresión de Beck, el Inventario de Situaciones y Respuestas de ansiedad y el Inventario de Expresión de Ira Estado-Rasgo. Los resultados muestran que los pacientes con lumbalgia crónica obtienen niveles superiores de depresión y ansiedad frente al grupo control (p< .001). El grupo de pacientes con lumbalgia obtiene niveles superiores frente al control en las subescalas de: ira estado (p< .01), ira rasgo (p< .001), temperamento (p< .001), en su inhibición (p< .001) y expresión de ira (p< .01). Se evidenciaron diferencias de género respecto a la ansiedad, la depresión y la ira tanto intragrupos (p< .01) como intergrupos (p< .05). En conclusión resulta de especial relevancia la inclusión del tratamiento psicológico de las emociones negativas para este tipo de discapacidad (AU)

The objective was to evaluate anxiety, depression and anger in patients with chronic lumbar pain and in a patient control group. Materials and Method: the sample included n=54 patients and n=51 controls (15 men and 39 women) who were an average age of 49.20 years old. All were evaluated by means of the Beck Depression Inventory, the Situations and Anxiety Answers Inventory and the Anger Expression Inventory. The results show that patients with chronic lumbar pain reach higher levels of depression and anxiety compared with the control group (p< .001). The group of patients with lumbar pain obtains high levels in the subscales: state anger (p< .01), trait anger (p< .001), temperament (p< .001), anger inhibition (p< .001) and anger expression (p< .01). Gender differences were observed, both intra-group differences (p< .01) and inter-group differences (p< .05) in anxiety, depression and anger. In conclusion, psychological treatment must be included in chronic lumbar pain protocols (AU)

Validación yadaptación al españolde la escala delentorno de prácticaenfermera delNursing Work Index / Spanish validation and adaptation of the Nursing Work Index scale of nursing practice

Objetivo: determinar la validez y fiabilidad de una versión adaptadaculturalmente al entorno español de la escala de entorno de prácticaenfermera del Nursing Work Index para su uso en Atención Primariay hospitalaria.Material y método: estudio descriptivo, multicéntrico, transversal,de adaptación transcultural y validación. Se llevó a cabo un procesode traducción-retrotraducción siguiendo la metodología por laComisión Internacional de Tests. Fueron seleccionadas 291 enfermerasdel Servei de Salut de les Illes Balears pertenecientes a 5 hospitales,1 centro socio sanitario y 18 centros de Atención Primaria.Para el análisis de los datos se realizó un análisis descriptivo, pruebasde normalidad, análisis de fiabilidad mediante coeficiente Alfade Cronbach y análisis factorial exploratorio y confirmatorio.Resultados: la fiabilidad global mostró un alfa de Cronbach de 0,906.El análisis factorial exploratorio replicaba correctamente la estructurapentafactorial (participación de la enfermera en asuntos delcentro; fundamento enfermero de la calidad de los cuidados; capacidad,liderazgo y apoyo a las enfermeras por parte de los gestoresenfermeros; dimensión de la plantilla y adecuación de los recursoshumanos; y relaciones entre médicos y enfermeras) original salvopara un factor. El análisis factorial confirmatorio mostró un buenajuste tras la eliminación de un ítem.Conclusiones: la disponibilidad de instrumentos válidos y fiables quepermitan evaluar factores del entorno de práctica enfermera en lasorganizaciones, resulta de una utilidad enorme en la gestión de cuidados.Los resultados de este estudio ponen de manifiesto que la versiónadaptada del PES-NWI con 30 ítems es un instrumento válidopara su uso en el contexto español (AU)

Objectives: to determine the validity and reliability of a version of theNursing Work Index nursing practice scale that has been culturallyadapted to the Spanish setting for its use in Primary and Hospital Care.Material and method: descriptive, multicentre, cross-sectional studythat has been culturally adapted and validated. It was carried out bya translation-retrotranslation process following the methodology ofthe International Tests Commission. 291 nurses from the Balearic IslandsHealth Service were selected, specifically from 5 hospitals, 1sociosanitary centre and 18 Primary Care centres. Data analysis wascarried out via a descriptive analysis, normality tests, reliability analysisusing Cronbach’s Alpha coefficient and exploratory and confirmatoryfactor analysis.Results: overall reliability showed a 0,906 Cronbach alpha. The exploratoryfactor analysis correctly replicated the original five-factorstructure (participation of the nurse in the centre’s affairs; nursingprinciple of care quality; provision of capacity, leadership and supportto nurses by nursing managers; staff size and adequacy of humanresources; and relationships between physicians and nurses)except for one factor. The confirmatory factor analysis showed goodadjustment after the elimination of one item.Conclusions: the availability of valid and reliable instruments that canbe used to assess the factors surrounding nursing practice in organizationsis highly useful in care management. The results of thisstudy evidence that the 30-item adapted version of the PES-NWI is avalid instrument that can be employed in the Spanish setting (AU)

Validación de la versión española del cuestionario sobre la práctica basada en la evidencia en enfermería / Validation of the spanish version of the evidence based practice questionnaire in nurses

Fundamento. La falta de instrumentos adecuados impideconocer la competencia de los profesionales en la toma dedecisiones basadas en la evidencia e identificar áreas de mejoraen las que intervenir con estrategias “ad hoc”. El objetivo dela investigación es validar en el entorno español del Evidence-Based Practice Questionnaire (EBPQ) (Upton y Upton, 2006).Métodos. Se llevó a cabo un estudio multicéntrico, descriptivoy transversal de validación psicométrica. Se siguió unproceso de traducción-retrotraducción según los estándareshabituales. Se contrastó el modelo de medida del cuestionario,replicando la estructura original anglosajona mediante análisisfactorial exploratorio (AFE) y confirmatorio (AFC), incluyendoanálisis de la fiabilidad de los factores.Resultados. Tanto el AFE (57,545% de la varianza totalexplicada) como el AFC (chi2=2359,9555; gl=252; p<0,0001;RMSEA=0,1844; SRMR=0,1081) han detectado problemas enlos ítems 7, 16, 22, 23 y 24 sobre la versión original trifactorialdel EBPQ. Una versión reducida de 19 ítems presenta una estructurafactorial exploratoria adecuada (62,29% de varianza totalexplicada), aunque el AFC no mostró adecuación, fue significativamentemejor que en la versión original (chi2=673.1261;gl=149; p<0,0001; RMSEA=0,1196; SRMR=0,0648).Conclusiones: El modelo trifactorial (EBPQ-19) ha obtenidosuficiente evidencia empírica para su sustentación ypuede ser aplicado en nuestro medio, aunque los resultadosinvitan a refinar el factor “actitud”, mediante el contraste enmuestras en otros contextos y con mayor heterogeneidad deperfiles profesionales(AU)

Background: The lack of adequate instruments preventsthe possibility of assessing the competence of health care staffin evidence-based decision making and further, theidentification of areas for improvement with tailoredstrategies. The aim of this study is to report about thevalidation process in the Spanish context of the Evidence-Based Practice Questionnaire (EBPQ) from Upton y Upton.Methods: A multicentre, cross-sectional, descriptivepsychometric validation study was carried out. For culturaladaptation, a bidirectional translation was developed, accordinglyto usual standards. The measuring model from the questionnairewas undergone to contrast, reproducing the original structure byExploratory Factorial Analysis (EFA) and Confirmatory FactorialAnalysis (CFA), including the reliability of factors.Results: Both EFA (57.545% of total variance explained)and CFA (chi2=2359,9555; gl=252; p<0.0001; RMSEA=0,1844;SRMR=0,1081), detected problems with items 7, 16, 22, 23 and24, regarding to the original trifactorial version of EBPQ. Afterdeleting some questions, a reduced version containing 19 itemsobtained an adequate factorial structure (62.29% of total varianceexplained), but the CFA did not fit well. Nevertheless, it wassignificantly better than the original version (chi2=673.1261;gl=149; p<0.0001; RMSEA=0.1196; SRMR=0.0648).Conclusions: The trifactorial model obtained goodempiric evidence and could be used in our context, but theresults invite to advance with further refinements into thefactor “attitude”, testing it in more contexts and with morediverse professional profiles(AU)