Addressing Acute Stress among Professionals Caring for COVID-19 Patients: Lessons Learned during the First Outbreak in Spain (March-April 2020).

Objectives: To describe lessons learned during the first COVID-19 outbreak in developing urgent interventions to strengthen healthcare workers' capacity to cope with acute stress caused by health care pressure, concern about becoming infected, despair of witnessing patients' suffering, and critical decision-making requirements of the SARS-CoV-2 pandemic during the first outbreak in Spain. Methods: A task force integrated by healthcare professionals and academics was activated following the first observations of acute stress reactions starting to compromise the professionals' capacity for caring COVID-19 patients. Literature review and qualitative approach (consensus techniques) were applied. The target population included health professionals in primary care, hospitals, emergencies, and nursing homes. Interventions designed for addressing acute stress were agreed and disseminated. Findings: There are similarities in stressors to previous outbreaks, and the solutions devised then may work now. A set of issues, interventions to cope with, and their levels of evidence were defined. Issues and interventions were classified as: adequate communication initiative to strengthen work morale (avoiding information blackouts, uniformity of criteria, access to updated information, mentoring new professionals); resilience and recovery from physical and mental fatigue (briefings, protecting the family, regulated recovery time during the day, psychological first aid, humanizing care); reinforce leadership of intermediate commands (informative leadership, transparency, realism, and positive messages, the current state of emergency has not allowed for an empirical analysis of the effectiveness of proposed interventions. Sharing information to gauge expectations, listening to what professionals need, feeling protected from threats, organizational flexibility, encouraging teamwork, and leadership that promotes psychological safety have led to more positive responses. Attention to the needs of individuals must be combined with caring for the teams responsible for patient care. Conclusions: Although the COVID-19 pandemic has a more devastating effect than other recent outbreaks, there are common stressors and lessons learned in all of them that we must draw on to increase our capacity to respond to future healthcare crises.

An Acute Stress Scale for Health Care Professionals Caring for Patients With COVID-19: Validation Study.

BACKGROUND: The COVID-19 pandemic has affected the response capacity of the health care workforce, and health care professionals have been experiencing acute stress reactions since the beginning of the pandemic. In Spain, the first wave was particularly severe among the population and health care professionals, many of whom were infected. These professionals required initial psychological supports that were gradual and in line with their conditions. OBJECTIVE: In the early days of the pandemic in Spain (March 2020), this study aimed to design and validate a scale to measure acute stress experienced by the health care workforce during the care of patients with COVID-19: the Self-applied Acute Stress Scale (EASE). METHODS: Item development, scale development, and scale evaluation were considered. Qualitative research was conducted to produce the initial pool of items, assure their legibility, and assess the validity of the content. Internal consistency was calculated using Cronbach α and McDonald ω. Confirmatory factor analysis and the Mann-Whitney-Wilcoxon test were used to assess construct validity. Linear regression was applied to assess criterion validity. Back-translation methodology was used to translate the scale into Portuguese and English. RESULTS: A total of 228 health professionals from the Spanish public health system responded to the 10 items of the EASE scale. Internal consistency was .87 (McDonald ω). Goodness-of-fit indices confirmed a two-factor structure, explaining 55% of the variance. As expected, the highest level of stress was found among professionals working in health services where a higher number of deaths from COVID-19 occurred (P<.05). CONCLUSIONS: The EASE scale was shown to have adequate metric properties regarding consistency and construct validity. The EASE scale could be used to determine the levels of acute stress among the health care workforce in order to give them proportional support according to their needs during emergency conditions, such as the COVID-19 pandemic.

Are Spanish primary care professionals aware of patient safety?

BACKGROUND: Knowledge about safety culture improves patient safety (PS) in health-care organizations. The first contact a patient has with health care occurs at the primary level. We conducted a survey to measure patient safety culture (PSC) among primary care professionals (PCPs) of health centres (HCs) in Spain and analyzed PS dimensions that influence PSC. METHODS: We used Agency for Healthcare Research and Quality (AHRQ) Medical Office Survey on Patient Safety Culture translated and validated into Spanish to conduct a cross-sectional anonymous postal survey. We randomly selected a sample of 8378 PCPs at 289 HCs operated by 17 Regional Health Services. Statistical analysis was performed on sociodemographic variables, survey items, PS dimensions and a patient safety synthetic index (PSSI), calculated as average score of the items per dimension, to identify potential predictors of PSC. We used AHRQ data to conduct international comparison. RESULTS: A total of 4344 PCPs completed the questionnaire. The response rate was 55.69%. Forty-two percent were general practitioners, 34.9% nurses, 18% administrative staff and 4.9% other professionals. The highest scoring dimension was 'PS and quality issues' 4.18 (4.1-4.20) 'Work pressure and pace' was the lowest scored dimension with 2.76 (2.74-2.79). Professionals over 55 years, with managerial responsibilities, women, nurses and administrative staff, had better PSSI scores. Professionals with more than 1500 patients and working for more than 11 years at primary care had lower PSSI scores. CONCLUSIONS: This is the first national study to measure PSC in primary care in Spain. Results may reflect on-going efforts to build a strong PSC. Further research into its association with safety outcomes and patients' perceptions is required.

Validación de un cuestionario para evaluar la cultura de seguridad del paciente de los profesionales de atención primaria en España / Validation of a questionnaire to assess patient safety culture in Spanish Primary Health Care professionals

Objetivo: Validar un instrumento para medir la cultura de seguridad del paciente de los profesionales de atención primaria (AP) en España. Métodos: Cuestionario Medical Office Survey on Patient Safety Culture (MOSPSC) elaborado por la Agency for Healthcare and Research in Quality (AHRQ). El proceso se realizó en 5 etapas: traducción de la versión original, evaluación de la equivalencia conceptual, valoración de la aceptabilidad y viabilidad, análisis de la validez del contenido y pilotaje del cuestionario adaptado y análisis de la respuesta y evaluación de las propiedades psicométricas. Emplazamiento: Atención primaria. Participantes: Se solicitó la colaboración de profesionales de AP de distintos servicios de salud siendo la muestra final de 185 profesionales. Mediciones principales: Frecuencia, patrón de respuesta y poder de discriminación de cada pregunta. alfa de Cronbach y dimensiones obtenidas mediante análisis factorial. Resultados: El 17,8% de los participantes contestaron todas las preguntas y el 28,7% dejaron sin responder o marcaron la opción «no lo sé/no procede» entre 1 y 4 preguntas. Todas las sentencias, con una única excepción, tienen capacidad de discriminación. El alfa de Cronbach es de 0,96 y la información se resume en 15 dimensiones con una adscripción de variables idéntica en 7 de las 12 dimensiones del cuestionario original. Conclusiones: El cuestionario de la AHRQ traducido, adaptado, ampliado y validado es, para nuestro medio, un instrumento fiable y útil y debe emplearse para realizar comparaciones internacionales(AU)

Objetive: To validate a tool to measure patient safety culture in Spanish primary care professionals. Methods: Medical Office Survey on Patient Safety Culture (MOSPSC), from the Agency for Healthcare and Research in Quality (AHRQ). The process has been performed in five steps: original version traslation, conceptual equivalence evaluation, acceptability and viability assessment, content validity and questionnaire test and response analysis and psichometric properties assessment. Setting: Primary care. Subjects: 185 Primary care professionals from different Spanish regions represented the sample test. Main outcome measures: Frecuency, response pattern and discrimination power of each item. Cronbach's alpha coefficient and dimensions obtained through factor analysis. Results: 17, 8% of respondents answered all the items and 28, 7% of them did not answer, or answered the option “Don’t know/Does not apply”, to one to four items. All the sentences, with only one exception, present discrimination capacity. Cronbach's alpha coefficient results 0,96 and information is sumarized in 15 factors obtaining the same items in 7 of the total 12 factors in the original questionnaire. Conclusions: Traslated, adapted, extended and validated AHRQ questionnaire is, in this setting, a reliable and useful instrument and it must be used for international comparisons(AU)

[Validation of a questionnaire to assess patient safety culture in Spanish Primary Health Care professionals]. / Validación de un cuestionario para evaluar la cultura de seguridad del paciente de los profesionales de atención primaria en España.

OBJECTIVE: [corrected] To validate a tool to measure patient safety culture in Spanish primary care professionals. METHODS: Medical Office Survey on Patient Safety Culture (MOSPSC), from the Agency for Healthcare and Research in Quality (AHRQ). The process has been performed in five steps: original version traslation, conceptual equivalence evaluation, acceptability and viability assessment, content validity and questionnaire test and response analysis and psichometric properties assessment. SETTING: Primary care. SUBJECTS: 185 Primary care professionals from different Spanish regions represented the sample test. MAIN OUTCOME MEASURES: Frecuency, response pattern and discrimination power of each item. Cronbach's alpha coefficient and dimensions obtained through factor analysis. RESULTS: 17, 8% of respondents answered all the items and 28, 7% of them did not answer, or answered the option "Don't know/Does not apply", to one to four items. All the sentences, with only one exception, present discrimination capacity. Cronbach's alpha coefficient results 0,96 and information is sumarized in 15 factors obtaining the same items in 7 of the total 12 factors in the original questionnaire. CONCLUSIONS: Traslated, adapted, extended and validated AHRQ questionnaire is, in this setting, a reliable and useful instrument and it must be used for international comparisons.

Establecimiento de prioridades de investigación en enfermería en España: estudio Delphi / To establish nurse research priorities in Spain: Delphi study

ObjetivoIdentificar las prioridades de investigación en cuidados de salud en España, desde la perspectiva de los profesionales de enfermería y de los usuarios de los servicios de salud.MétodoTécnica Delphi modificada desarrollada sobre un listado de 24 ítems identificados a partir del consenso previo de un grupo de trabajo. El panel de expertos participantes en la técnica Delphi modificada (2 vueltas) se compuso de cinco grupos: directores de enfermería (Atención Primaria y Hospitalaria), directores de escuelas de enfermería, presidentes de asociaciones científicas de enfermería, investigadores asistentes a los Encuentros de Investigación organizados por Investén-ISCIII, y representantes de usuarios. Se realizaron dos rondas de priorización.ResultadosTras el consenso de los partipantes, fueron consideradas como principales prioridades de investigación en cuidados: «la evaluación de la eficacia de intervenciones de enfermería», «la promoción de la salud: desarrollo de estrategias para implicar al usuario en sus cuidados», «cuidados basados en la evidencia: implantación y evaluación de resultados en la práctica clínica», y «medición de la calidad de cuidados enfermeros».ConclusionesLos resultados obtenidos a través de este estudio pueden contribuir a facilitar la toma de decisiones en materia de gestión de la investigación, ayudando a una mejor justificación y, previsiblemente, mayor financiación de los proyectos de investigación en esta área (AU)

ObjectiveTo identify nursing research priorities in Spain as suggested by nurses and service users.MethodA Modified Delphi technique was used. The first round started off with a 24-item document for which consensus had been previously achieved. Experts participating in this modified (two rounds) Delphi technique were: nursing managers (community and hospital care settings), nursing school directors, scientific nursing association representatives, nursing researchers attending the National Nursing Research Conference, and service users.ResultsMain priorities identified for nursing research were: 1) evaluating the effectiveness of nursing interventions, 2) identifying strategies for health promotion empowering service users, 3) developing evidence-based care through implementing and evaluating results, and 4) evaluating the quality of nursing care.ConclusionsResults may help research managers and administrators identify and develop nursing research promotion strategies as well as more strongly sustained funding policies and decisions(AU)

[To establish nurse research priorities in Spain: Delphi study]. / Establecimiento de prioridades de investigación en enfermería en España: estudio Delphi.

OBJECTIVE: To identify nursing research priorities in Spain as suggested by nurses and service users. METHOD: A Modified Delphi technique was used. The first round started off with a 24-item document for which consensus had been previously achieved. Experts participating in this modified (two rounds) Delphi technique were: nursing managers (community and hospital care settings), nursing school directors, scientific nursing association representatives, nursing researchers attending the National Nursing Research Conference, and service users. RESULTS: Main priorities identified for nursing research were: 1) evaluating the effectiveness of nursing interventions, 2) identifying strategies for health promotion empowering service users, 3) developing evidence-based care through implementing and evaluating results, and 4) evaluating the quality of nursing care. CONCLUSIONS: Results may help research managers and administrators identify and develop nursing research promotion strategies as well as more strongly sustained funding policies and decisions.

Qué opinan los pacientes de la e-medicina. Un estudio cualitativo / What do patients think of e-medicine? A qualitative study

Objetivos: Conocer cómo perciben los pacientes la e-medicina: historia clínica informatizada, la web como fuente de información y acceso a través del correo electrónico.Diseño: Cualitativo, fenomenológico, con grupos focales. Análisis independiente por tres investigadores.Localización: Atención primaria, urbana, País Vasco.Participantes: Con apoyo de asociaciones de vecinos, se reclutó a personas de diferentes edad, sexo y situación económica. Criterio de inclusión: uso de internet y correo electrónico.Resultados: 4 grupos focales, 35 personas, 16 mujeres, 12 menores de 25 años y 10 de más de 65 ños. Se presentó a los participantes un informe preliminar. Historia clínica informatizada: valoración muy positiva. El ordenador no altera la relación, que depende de las personas, no de la técnica. Debe llegar al domicilio y estar disponible desde cualquier punto del mundo, lo que permite el contacto entre los actores con independencia de la distancia. Única para todos los proveedores, da seguridad al paciente, quien se consideracon derecho a manipularla. La web como fuente de información: todos la utilizan buscando fuentes seguras para cuestiones concretas y para contrastar la información dada por los sanitarios. La relación con el médico sigue siendo insustituible, individualizalas demandas. Correo electrónico: alternativa útil, para cosas muy concretas, obliga a rediseñar el tiempo de trabajo y definir las condiciones de uso.Conclusiones: Las nuevas tecnologías son bien aceptadas, e ideas como la continuidad de la asistencia aprovechándolas resultan atractivas. Disponemos de una tecnología muy potente que puede facilitar la asistencia y ser un elemento trascendente en la relaciónsanitario-paciente

Objective: To find out patients’ opinions of e-medicine, obtaining general ideas related to three relevant aspects: electronic health records (EHR), the web as an information source and use of e-mail.Design: Qualitative phenomenological study, analysing the content of group interviews. Content analysis was performed by the three researchers.Participants: Urban patients. Internet and e-mail practical knowledge.Variables: age and gender, districts with different socio-economic levels.Setting: San Sebastián (Spain).Results: Four focal groups, with 35 people, 12 under 25 years old, 10 over 65, and 16 women. EHR valuation was very positive. Computer use does not change the health worker-patient relationship. It must spread to the home setting, and be available from any point, creating another kind of relationship, regardless of the distance. Single EHR for all the suppliers. Patients consider themselves authorised to manipulate it. Participants use the web as an informationsource, looking for safe sources and specific information, and to verify health workers information. The relationship with doctors is irreplaceable.E-mail is a useful alternative for specific needs. It would force a redesign of working schedule and to define the conditions of use.Conclusions: New technologies are widely used. Acceptance is practically unanimous. Ideas such as continuous care by the same person are very innovative. It seems that we are faced with a powerful technology, which could improve and facilitate patient care, as patient awareness of their individual rights coincides with unlimited access to the information (AU)

[Not Available]. / Qué opinan los pacientes de la e-medicina. Un estudio cualitativo.

OBJECTIVE: To find out patients' opinions of e-medicine, obtaining general ideas related to three relevant aspects: electronic health records (EHR), the web as an information source and use of e-mail. DESIGN: Qualitative phenomenological study, analysing the content of group interviews. Content analysis was performed by the three researchers. PARTICIPANTS: Urban patients. Internet and e-mail practical knowledge. VARIABLES: age and gender, districts with different socio-economic levels. SETTING: San Sebastián (Spain). RESULTS: Four focal groups, with 35 people, 12 under 25 years old, 10 over 65, and 16 women. EHR valuation was very positive. Computer use does not change the health worker-patient relationship. It must spread to the home setting, and be available from any point, creating another kind of relationship, regardless of the distance. Single EHR for all the suppliers. Patients consider themselves authorised to manipulate it. Participants use the web as an information source, looking for safe sources and specific information, and to verify health workers information. The relationship with doctors is irreplaceable. E-mail is a useful alternative for specific needs. It would force a redesign of working schedule and to define the conditions of use. CONCLUSIONS: New technologies are widely used. Acceptance is practically unanimous. Ideas such as continuous care by the same person are very innovative. It seems that we are faced with a powerful technology, which could improve and facilitate patient care, as patient awareness of their individual rights coincides with unlimited access to the information.

Participación del paciente como estrategia de mejora de calidad / Patient participation as a strategy to improve quality

No disponible

[Qualitative analysis of the perception of people who participate in a clinical trial, Navarra]. / Análisis cualitativo de la percepción que tienen las personas que participan en un ensayo clínico, Navarra.

BACKGROUND: The objective of this study is to explore the perception that participants in a clinical trial have about the information disclosured by the physician, during patient recruitment and along the study as a preliminary stage for drafting a questionnaire. METHODS: Qualitative study by means of quasi-structure interviews to subjects of different features taken from a patients list obtained by randomized selection of participants in clinical trials approved within the 1998-1999 period. For conducting the interviews, a guide was prepared based on the recommendations of the Helsinki Declaration. RESULTS: Six (6) interviews were held with 7 individuals, as one married couple was interviewed. Most of the categories encountered belonged to the Helsinki Declaration. In addition, others being related to the fulfillment of expectations and to the balance of the risks/benefits done by the individuals for deciding to take part in the study. CONCLUSIONS: The patients were acceptably informed of the most points dealt with under the Helsinki Declaration. The existence of lacking areas having a major impact on the fulfillment of their expectations however having been revealed.

Análisis cualitativo de la percepción que tienen las personas que participan en un ensayo clínico, Navarra / A qualitative analysis of patient's perceptions on the participation in clinical trials, Navarra, Spain

Fundamento: El objetivo del estudio es explorar la percepción que tienen los participantes en un ensayo clínico de la información facilitada por el médico, en el proceso de captación y durante la realización del mismo, como fase previa a la realización de un cuestionario. Métodos: Estudio cualitativo mediante entrevistas semiestructuradas a sujetos de distintas características, extraídos de un listado de pacientes mediante selección aleatoria de participantes en ensayos clínicos aprobados entre los años 1998-99. Para la realización de las entrevistas se elaboró un guión que recogía las recomendaciones de la Declaración de Helsinki. De la transcripción de las entrevistas se realizó el análisis de contenido. Resultados: Se realizaron 6 entrevistas a 7 personas, pues se entrevistó conjuntamente a un matrimonio. La mayor parte de las categorías encontradas pertenecían a la Declaración de Helsinki. Además, aparecieron otras relacionadas con la satisfacción de expectativas y con el balance riesgo/beneficio que los individuos realizan para tomar la decisión de participar en un ensayo. Conclusiones: Los pacientes fueron aceptablemente informados de muchos de los puntos que considera la Declaración de Helsinki, pero se puso de manifiesto la existencia de áreas más deficitarias con importante repercusión en el cumplimiento de sus expectativas (AU)

Background: The objective of this study is to explore the perception that participants in a clinical trial have about the information disclosured by the physician, during patient recruitment and along the study as a preliminary stage for drafting a questionnaire. Methods: Qualitative study by means of quasi-structure interviews to subjects of different features taken from a patients list obtained by randomized selection of participants in clinical trials approved within the 1998-1999 period. For conducting the interviews, a guide was prepared based on the recommendations of the Helsinki Declaration. Results: Six (6) interviews were held with 7 individuals, as one married couple was interviewed. Most of the categories encountered belonged to the Helsinki Declaration. In addition, others being related to the fulfillment of expectations and to the balance of the risks/benefits done by the individuals for deciding to take part in the study. Conclusions: The patients were acceptably informed of the most points dealt with under the Helsinki Declaration. The existence of lacking areas having a major impact on the fulfillment of their expectations however having been revealed (AU)

Efecto de una intervención educativa sobre la adherencia al tratamiento antibiótico en población infantil en atención primaria / The effect of an educative intervention on adherence to antibiotic treatment in infants in primary health care

Introducción. En 1997 se realizó un estudio sobre adherencia al tratamiento antibiótico infantil en 6 centros de salud, hallándose que era muy baja. Se decidió realizar en dos de los centros (adherencia 21 por ciento) una intervención educativa basada en el Modelo de Creencias en Salud con el objetivo de valorar si con ello mejoraba la adherencia. Material y métodos. La población estaba constituida por los responsables de niños de 0 a 10 años con un proceso agudo que recibían tratamiento antibiótico por vía oral. El instrumento de medida fue el test de Morisky-Green mediante encuesta telefónica. El estudio fue prospectivo y se estudiaron variables sociodemográficas, el motivo, tipo y duración del tratamiento antibiótico y la adherencia. Resultados. La adherencia global varió de un 21,1 por ciento antes, a un 42,6 por ciento después de la intervención (p = 0,009). En el análisis multivariable resultaron estadísticamente significativas la intervención (OR, 3,17; IC 95 por ciento, 1,53-6,26) y el centro (OR, 3,18; IC 95 por ciento, 1,55-6,50), no existiendo interacción entre ellas. Conclusiones. A pesar de que incluso las intervenciones más efectivas no conllevan mejoras sustanciales en la adherencia y los resultados de los tratamientos, la utilización de un modelo de intervención capaz de provocar un cambio de conducta ha confirmado su eficacia en este caso (AU)