Respuesta emocional de pacientes cardiológicos en estado crítico durante la higiene en cuidados intensivos: estudio prospectivo y descriptivo / Emotional response of critically-ill cardiac patients during hygiene procedures in intensive care: a prospective and descriptive study / Resposta emocional de pacientes cardiológicos críticos durante a higiene em cuidados intensivos: um estudo prospectivo e descritivo

Objetivo: analizar la respuesta emocional de pacientes conscientes en estado crítico durante la higiene diaria en una unidad de cuidados intensivos cardiológicos y compararla en función de experiencias previas o no. Método: estudio prospectivo y descriptivo. Encuesta ad hoc de 30 ítems realizada a 148 pacientes y basada en la higiene del primer día. Se formulan preguntas sobre los sentimientos durante la higiene y aspectos positivos y negativos de la experiencia. Se compara a los pacientes en función de si se los había higienizado con anterioridad. Resultados: el 67,6% fueron hombres y la media de edad fue de 67±15 años. El 45,9% presentó conformismo, el 27% sintió vergüenza y el 86,3% agradeció que le hablaran durante la higiene. Al 33,1% de los pacientes nunca les habían realizado higiene en la cama, eran significativamente más jóvenes y solteros, y tenían menor sensación de limpieza. El 32% expresó que le gustaría que un familiar colaborase en la higiene. Conclusión: los pacientes no sienten que se invade su intimidad cuando se los higieniza y aprecian la comunicación con el personal sanitario durante estos cuidados. Los pacientes a quienes no les habían realizado higiene en la cama previamente son más jóvenes, sienten mayor vergüenza y les molestan más las interrupciones, siendo más conscientes de ellas.

Objective: to analyze the emotional response of critically-ill conscious patients during daily hygiene procedures in a Cardiology Intensive Care Unit and to compare it based on the existence of previous experiences or not. Method: a prospective and descriptive study. A 30-item ad hoc survey based on the first-day hygiene procedures was applied to 148 patients. Questions are asked about the feelings during the hygiene procedures and about positive and negative aspects of the experience. The patients are compared based on whether they had been already subjected to hygiene procedures or not. Results: 67.6% were men and their mean age was 67±15 years old; 45.9% proved to be satisfied, 27% felt embarrassment and 86.3% were grateful to the professionals for talking to them during the hygiene procedures. 33.1% of the patients had never been subjected to hygiene procedures in bed, were significantly younger and single, and presented a lower cleanliness sensation. 32% stated that they would like for a family member to collaborate in the hygiene procedures. Conclusion: the patients do not feel that their intimacy is invaded when they are subjected to hygiene procedures and appreciate communication with the health personnel while this care is provided. Those who had never been subjected to hygiene procedures in bed are younger, feel more embarrassed and are more disturbed by interruptions, in addition to being more aware of them.

Objetivo: analisar a resposta emocional de pacientes críticos conscientes durante a higiene diária em uma unidade de terapia intensiva cardíaca e compará-la considerando ou não as experiências prévias. Método: estudo prospectivo e descritivo. Foi aplicado questionário ad hoc de 30 itens a 148 pacientes, com base na higiene do primeiro dia. Foram feitas perguntas sobre sentimentos durante a higiene e aspectos positivos e negativos da experiência. Os pacientes foram comparados considerando o fato de terem sido higienizados anteriormente. Resultados: 67,6% eram homens e a idade média foi de 67±15 anos. 45,9% apresentavam conformismo, 27% se sentiram envergonhados e 86,3% estavam gratos por terem conversado com eles durante a higiene; 33,1% dos pacientes acamados nunca haviam recebido cuidados de higiene no leito, eram significativamente mais jovens e solteiros, e tinham um senso de limpeza mais baixo; 32% expressaram que gostariam que um membro da família ajudasse na higiene. Conclusão: os pacientes não se sentiram invadidos em sua intimidade quando receberam os cuidados de higiene e apreciaram a comunicação com o pessoal de saúde durante o procedimento. Os pacientes que não tinham recebido cuidados de higiene no leito anteriormente são mais jovens, sentem-se mais constrangidos e mais incomodados pelas interrupções, sendo mais conscientes delas.

How do healthcare professionals and managers view the role of the advanced practice nurse?

BACKGROUND: Advanced practice nurses (APN) growth depends on the implementation and acceptance of APNs in each country. INTRODUCTION: Given the diversity of the different contexts and varying population health needs where APNs are developing, this study focuses on exploring the viewpoints of the multidisciplinary and management team who have worked with APNs in public hospitals in Catalonia, Spain. METHODS: A cross-sectional study with previously identified APNs, health professionals, and health managers. EVOHIPA, a valid and reliable scale, was used. The STROBE checklist was followed. FINDINGS: The results showed high levels of agreement among the 746 participants (predominantly physicians and nurses), with statements relating to the APN's contribution in enhancing care continuity and processes, resulting in safer and more patient-centered care. The results showed low levels of agreement with statements relating to legal support for the APN position, regulation, and practice scope. DISCUSSION: The study provides discussion elements and reflection to determine the axes on which it will be necessary to act to promote APNs and their conditions of service in the context of practice within hospital teams. CONCLUSION: The study highlights the differences in opinion on APN roles among health professionals and managers who have worked with APNs and allows exploring expectations about current changes in workflows and clinical activities among healthcare team members. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Results highlight the importance of fostering a common understanding among healthcare teams to maximize the benefits of collaborative work and recognize the significant contributions of APNs within the multidisciplinary team. Health policy plays a crucial role in recognizing and promoting the contribution of APNs within hospital healthcare teams, acknowledging their autonomy and expertise in improving patient outcomes.

Emotional response of critically-ill cardiac patients during hygiene procedures in intensive care: a prospective and descriptive study. / Respuesta emocional de pacientes cardiológicos en estado crítico durante la higiene en cuidados intensivos: estudio prospectivo y descriptivo.

OBJECTIVE: to analyze the emotional response of critically-ill conscious patients during daily hygiene procedures in a Cardiology Intensive Care Unit and to compare it based on the existence of previous experiences or not. METHOD: a prospective and descriptive study. A 30-item ad hoc survey based on the first-day hygiene procedures was applied to 148 patients. Questions are asked about the feelings during the hygiene procedures and about positive and negative aspects of the experience. The patients are compared based on whether they had been already subjected to hygiene procedures or not. RESULTS: 67.6% were men and their mean age was 67±15 years old; 45.9% proved to be satisfied, 27% felt embarrassment and 86.3% were grateful to the professionals for talking to them during the hygiene procedures. 33.1% of the patients had never been subjected to hygiene procedures in bed, were significantly younger and single, and presented a lower cleanliness sensation. 32% stated that they would like for a family member to collaborate in the hygiene procedures. CONCLUSION: the patients do not feel that their intimacy is invaded when they are subjected to hygiene procedures and appreciate communication with the health personnel while this care is provided. Those who had never been subjected to hygiene procedures in bed are younger, feel more embarrassed and are more disturbed by interruptions, in addition to being more aware of them.

Impact of Hospitalization of People With Dementia or Cognitive Impairment on Family Caregivers.

People with dementia (PWD) have a higher risk of hospitalization than people without dementia. Hospitalizations are stressful events for PWD and their caregivers, representing a considerable change to their routines. The current descriptive longitudinal study aimed to identify the positive and negative reactions, experiences related to health and social integrated care, resource use, and work status of family caregivers of PWD or cognitive impairment admitted to the hospital with a proximal femur fracture undergoing surgery. Findings indicated that family caregivers (N = 174) are fully committed to providing assistance in activities of daily living and supervision, showing positive attitudes on self-esteem and negative attitudes toward lack of family support and impact on finances, schedule, and health. Overall caregiver experiences with integrated health and social care improved after hospitalization but decreased after discharge. One month after hospitalization, family caregivers maintained the same work hours but used fewer health care resources. Hospitalization represents a good opportunity to approach family caregivers and determine their needs to provide them with interventions to minimize their burden and improve their well-being. [Research in Gerontological Nursing, 16(6), 283-290.].

Contextual factors of advanced practice nursing development: A network analysis.

AIMS: This study aimed to delineate the relationships between actors and contextual factors associated with the development of the advanced practice role in Catalonia. METHODS: A complementary data analysis was conducted based on the social network analysis (SNA) method. The primary study design was qualitative, descriptive and explanatory. Participants from diverse perspectives of practice, organization and external environment were engaged to participate in semi-structured focus groups. Data collection was conducted between March and May 2016 in Catalonia, Spain. Participants were asked to report on various dimensions of the role development context: understanding of the role, felt needs, perceived outcomes, barriers and facilitators. RESULTS: Primary data analysis performed for 44 participants identified 71 related contextual factors associated with role development. Complementary network analysis revealed multiple relationships and agreements among participants and context-related themes. Professional roles and disciplines clustered around topics show consensus and the significance of topics. CONCLUSION: Understanding the level of interactions and consensus among participants and contextual factors will ultimately allow better insight into how complex contexts influence the development of advanced practice nursing in healthcare organizations. Significant, consensual contextual factors should be used to influence further development and implementation of new roles that affect patient care and outcomes.

Teaching Strategies for Developing Clinical Reasoning Skills in Nursing Students: A Systematic Review of Randomised Controlled Trials.

BACKGROUND: Clinical reasoning (CR) is a holistic and recursive cognitive process. It allows nursing students to accurately perceive patients' situations and choose the best course of action among the available alternatives. This study aimed to identify the randomised controlled trials studies in the literature that concern clinical reasoning in the context of nursing students. METHODS: A comprehensive search of PubMed, Scopus, Embase, and the Cochrane Controlled Register of Trials (CENTRAL) was performed to identify relevant studies published up to October 2023. The following inclusion criteria were examined: (a) clinical reasoning, clinical judgment, and critical thinking in nursing students as a primary study aim; (b) articles published for the last eleven years; (c) research conducted between January 2012 and September 2023; (d) articles published only in English and Spanish; and (e) Randomised Clinical Trials. The Critical Appraisal Skills Programme tool was utilised to appraise all included studies. RESULTS: Fifteen papers were analysed. Based on the teaching strategies used in the articles, two groups have been identified: simulation methods and learning programs. The studies focus on comparing different teaching methodologies. CONCLUSIONS: This systematic review has detected different approaches to help nursing students improve their reasoning and decision-making skills. The use of mobile apps, digital simulations, and learning games has a positive impact on the clinical reasoning abilities of nursing students and their motivation. Incorporating new technologies into problem-solving-based learning and decision-making can also enhance nursing students' reasoning skills. Nursing schools should evaluate their current methods and consider integrating or modifying new technologies and methodologies that can help enhance students' learning and improve their clinical reasoning and cognitive skills.

Validation of the Spanish Version of the Double Knowledge Expectations and Received Knowledge Significant Other Scale for Informal Caregivers of People with Dementia (KESO-DEM/RKSO-DEM).

Dementia is associated with cognitive decline. Becoming an informal caregiver raises questions, requiring information and support from health professionals to guide home care. A multicenter, longitudinal study was carried out to validate the Spanish version of the double scale of expected and received knowledge for informal caregivers of people with dementia (KESO-DEM/RKSO-DEM), the analysis of the dimensional structure of the instrument, its validity and reliability, and temporary stability was carried out. An analysis of criterion and construct validity, internal consistency, and test−retest stability was performed. The evaluation of the interrelation between dimensions was statistically significant. Regarding internal consistency, the scale values were good both for the scale totals and for each dimension of knowledge, with Cronbach's alpha coefficients of 0.97. For criterion validity, all items showed temporal stability for both questionnaires (p < 0.05). The availability of a valid, reliable tool for the measurement of expected and received knowledge in caregivers of people with dementia allows an approach based on the real needs of the family and the patient. It is important to design care protocols for people with dementia that are adapted to their needs and expectations and to their non-curative treatment, to improve the emotional well-being of patients and informal caregivers.

Profile of Patients with Dementia or Cognitive Impairment Hospitalized with a Proximal Femur Fracture Requiring Surgery.

This study reports the characteristics of patients with dementia or cognitive impairment hospitalized with a proximal femur fracture requiring surgery. METHODS: Multicentric descriptive longitudinal study conducted in three traumatology units, representing high-technology public hospitals across Spain. Data collection took place between August 2018 and December 2019 upon admission to hospital, discharge, one month and three months after discharge. RESULTS: Study participants (n = 174) were mainly women (81.6%), and the mean age was 90.7± 6.3 years old. Significant statistical differences were noted in the decline of functional capacity at baseline and one month later, and after three months they had still not recovered. Malnutrition increased from baseline to the one-month follow-up. The use of physical restraints increased during hospitalization, especially bilateral bedrails and a belt in the chair/bed. After one month, 15.2% of patients had pressure ulcers. Although pain decreased, it was still present after three months. CONCLUSION: Hospitalization after hip surgery for elderly people with dementia or cognitive impairment negatively impacted their global health outcomes such as malnutrition and the development of pressure ulcers, falls, functional impairment and the use of physical restraints and pain management challenges. Hospitals should implement policy-makers' strategic dementia care plans to improve their outcomes.

Condicionantes de calidad de los cuidados enfermeros durante el turno de noche / Factors Influencing Quality of Nursing Care during the Night Shifts

Introducción: El turno nocturno provoca efectos físicos y psicológicos en las enfermeras. Fatiga, estrés, ansiedad, alteraciones del sueño y percepción negativa del entorno laboral pueden condicionar la calidad del cuidado. Objetivo: Identificar las condiciones relacionadas con la calidad de los cuidados enfermeros durante los turnos de noche en los hospitales. Métodos: Se realiza una revisión sistemática según criterios PRISMA. Se utilizó como estrategia común en las bases consultadas la combinación de las palabras clave y booleanos: ("Quality of Care") AND ("Nurse"OR"Nurses") AND ("Night shift"OR"Shift"). Se exploraron las bases de datos PubMed, Cinahl, Scopus y Cochrane. Se Incluyeron ensayos, estudios transversales, revisiones y estudios cualitativos entre 2009 y 2018. Se excluyeron los que no cumplieron requisitos de contenido y criterios de evaluación de calidad metodológica descritos a priori. Se incluyeron 20 trabajos. Conclusiones: Para la mayoría de autores la calidad de los cuidados nocturnos es menor que durante el día y puede estar condicionada por exceso de horas trabajadas, percepción de salud, fatiga, calidad del sueño, menor ratio enfermera-paciente, menor apoyo institucional y menor satisfacción profesional. Los indicadores de calidad más utilizados fueron incidencia de úlceras por presión, errores en identificación de pacientes, errores de medicación, errores de comunicación, cuidados sin realizar, desmotivación profesional, despersonalización y retención institucional. La heterogeneidad de los estudios hace que pueda aumentar el sesgo en los resultados. Muchos indicadores descritos son evaluados mediante percepciones, ocasionalmente por métodos objetivos. La identificación de condicionantes clave en la calidad de cuidados nocturnos permite iniciativas institucionales de gran impacto(AU)

Introduction: The night shift causes physical and psychological effects on nurses. Fatigue, stress, anxiety, sleep disturbances and negative perception of the work environment can affect the quality of care. Objective: To identify the conditions related to the quality of nursing care during night shifts in hospitals. Methods: A systematic review was carried out according to PRISMA criteria. As a common strategy in the consulted databases, the combination of the following keywords and Booleans was used: ("Quality of Care") AND ("Nurse "OR "Nurses") AND ("Night shift "OR "Shift"). The PubMed, Cinahl, Scopus and Cochrane databases were explored. Trials, cross-sectional studies, reviews and qualitative studies between 2009 and 2018 were included. Those that did not meet content requirements and methodological quality assessment criteria described a priori were excluded. Twenty papers were included. Conclusions: For most authors, the quality of night care is lower than during the day and may be affected by an excess of working hours, health perception, fatigue, sleep quality, lower nurse-patient ratio, lower institutional support and lower professional satisfaction. The most frequently used quality indicators were incidence of pressure ulcers, patient identification errors, medication errors, communication errors, unperformed care, professional demotivation, depersonalization and institutional retention. The heterogeneity of the studies may increase bias in the results. Many of the indicators described are assessed by perceptions, occasionally using objective methods. The identification of key determinants in the quality of night care allows for high-impact initiatives at the institutional level(AU)

Advanced practice nurses: Analysis of their role from a multicentre cross-sectional study.

BACKGROUND: Stronger healthcare models are increasingly sought to address new population needs, health workforce inefficiencies and nursing shortages. One strategy is to focus on employees' strengths to capitalize on their competencies and maximize their scope of practice. INTRODUCTION: Globally, there is an exponential demand for advanced practice nursing services. This study aimed to identify the roles and positions of nurses who align with APN defining criteria at all levels of care in Catalonia, Spain. METHODS: The first step of the study included the translation and validation to Catalan of the Advanced Practice Nurse Role Delineation Tool (IDREPA) and step 2 comprised a multicentre cross-sectional study, in which 126 healthcare centres participated: 1209 nurses were included in the study. The STROBE checklist was used to report this study. RESULTS: Transcultural equivalence and validation of the instrument showed a content validity index of 0.958 and the reliability of the questionnaire. The instrument identified 269 nurses who align with international APN defined criteria. They worked in specialized care, mental healthcare and primary and community care, especially in chronic conditions, ageing and end-of-life care. DISCUSSION: Most areas of Catalonia have access to nurses practicing at APN defining criteria. These nurses were developed as an optimal resource to respond to patient needs in the context of study. Both recognition and strategic implementation are necessary to apply their full competencies to solve healthcare problems. CONCLUSION: Understanding the supply of services delivered by nurses practicing at an advanced level and their scope of practice may lay the foundations for effective workforce planning in a dynamic context. Nurses who align with APN defining criteria are working mainly in large acute services without regulation and recognition. IMPLICATIONS FOR NURSING: Advanced practice nurses show the value of their role and activities in healthcare services. IMPLICATIONS FOR HEALTH POLICY: Promoting the establishment of APN defining criteria that includes credentialing and a regulatory framework within international guidelines should be a priority to make an impact on healthcare policy.

COVID-19 and the global need for knowledge on nurses' health.

AIM: To emphasize that nurses need to be fully protected to carry out their vital role, particularly during pandemics, yet the lack of a standardized and systematic collection of high-quality disaggregated data on nurses health inhibits our ability to assess this within and across countries. BACKGROUND: Nurses are the largest workforce group in the health sector, yet only 59 countries worldwide report on nurse COVID-19 infections and related deaths, and the standardized, systematic collection of disaggregated health data is not yet in place. SOURCES OF EVIDENCE: Medline, International Council of Nurses, World Health Organization, Centers of Disease Control and Prevention and the experiences of the authors. DISCUSSION: Inconsistent recording and definitions of nurses, precarious and informal employment conditions, limited transparent and reliable data, lack of mass testing and long-standing structural issues and biases have affected nursing for too long. CONCLUSIONS: These issues are reflected in the limited capacity of many national public health information systems to collect, monitor and report on the health of the largest group of health workers. Political will, accountability and public data transparency at different levels are essential to adequately protect nurses at work. IMPLICATIONS FOR NURSING PRACTICE, AND NURSING AND HEALTH POLICY: Building on current momentum in the nursing field, immediate political action is required to strengthen existing nursing and midwifery policies, standards and regulatory capacity, as well as existing public health services and information and surveillance systems. The generation of up-to-date, context-specific knowledge is needed to inform and monitor political decisions related to the protection of nurses, and the improvement of their employment conditions, as well as to strengthen accountability for these areas at various levels.

Lived Experiences of Hospitalized COVID-19 Patients: A Qualitative Study.

The COVID-19 pandemic has resulted in many hospitalized patients and deaths worldwide. Coronavirus patients were isolated from their relatives and visits were banned to prevent contagion. This has brought about a significant change in deeply rooted care habits in Mediterranean and Latin American countries where the family normally accompanies vulnerable hospitalized patients. The aim of this qualitative study was to examine the hospitalization experience of COVID-19 patients and their family members. A phenomenological qualitative approach was used. Data collection included inductive, in-depth interviews with 11 COVID-19 hospitalized patients. The mean age of patients was 55.4 years and 45% were female. Nearly 50% required Intensive Care Unit (ICU) admission. Ten meaningful statements were identified and grouped in three themes: Positive and negative aspects of the care provided, the patient's perspective, and perception of the experience of the disease. In conclusion, COVID-19 patients, aware of the severity of the pandemic, were very adaptable to the situation and had full confidence in health professionals. Patient isolation was perceived as necessary. Technology has helped to maintain communication between patients and relatives.

Implementing dedicated education units in 6 European undergraduate nursing and midwifery students clinical placements.

BACKGROUND: Undergraduate students' clinical experience, working directly with patients and the healthcare team is essential to ensure students acquire the necessary competence for practice. There are differences in the quality of clinical environments and in students' clinical placement experiences and not all clinical sites are optimal learning environments. The Dedicated Education Unit clinical education model allows students to develop the practical knowledge, skills and professionalism they will need as nurses/midwives. METHODS: We employed the Consolidated Framework for Implementation Research to identify and compare barriers and facilitators in the implementation of the Dedicated Education Unit in 6 European undergraduate nursing/midwifery student clinical placement settings and to describe the experience of nurses/midwives involved in the Dedicated Education Unit model implementation and evaluation. A pre-post implementation interpretive assessment was based on participants' responses to the Consolidated Framework for Implementation Research construct questions. RESULTS: Although Dedicated Education Unit model implementation in our project was heterogeneous, no main implementation barriers were perceived. Qualitative data showed that educational-service collaboration, including a focus on mutual goals, organizational communication and networking, satisfaction of educational and healthcare professionals, and the establishment of a safe space for professional discussion and feedback, were considered facilitators. CONCLUSIONS: This study describes the key elements guiding educational and healthcare stakeholders in Dedicated Education Unit implementation, engaging participants in the entire process, and offering other organizations the opportunity to consider the benefits of this clinical education model.

The emerging role of the advanced practice epilepsy nurse: A comparative study between two countries.

AIMS AND OBJECTIVES: The aim of the study was to compare advanced practice in epilepsy nurses in Spain and United Kingdom, identifying differences in the domains of standard advanced practice. BACKGROUND: Europe has recently faced the challenge of providing high-quality care for patients with epilepsy, a disease that generates many health demands. In some countries, such as the United Kingdom, advanced practice nursing is well established and could serve as a guide for implantation in countries where it is still in development, as is the case of Spain. DESIGN: A multicentre cross-sectional descriptive cohort study compared differences in the roles of advanced practice nurses in Spain and the United Kingdom. METHODS: The Advanced Practice Role Delineation Tool and its validated Spanish version were administered using an online questionnaire in a cohort of advanced practice epilepsy nurses in both countries. A convenience sample was recruited between January to December 2019. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. RESULTS: Most United Kingdom nurses in our sample came from community environments, in contrast to Spanish nurses who worked in hospital. All domains analysed in the survey had significantly higher scores in the United Kingdom than in the Spanish cohort, especially in the research and leadership domains. CONCLUSIONS: The advanced practice role in Spain is underdeveloped compared with the United Kingdom. Differences in the settings of advanced roles in epilepsy nurses may be explained by greater community practice in the United Kingdom and differences in organisational and health systems. RELEVANCE TO CLINICAL PRACTICE: Our study showed the need to implement specific policies to develop advance practice nurse roles in Spain to improve the quality of care of patients with epilepsy.

Experiences of nursing students as healthcare aid during the COVID-19 pandemic in Spain: A phemonenological research study.

BACKGROUND: The coronavirus disease (COVID-19) pandemic has caused a worldwide health and social crisis directly impacting the healthcare system. Hospitals had to rearrange its structure to meet clinical needs. Spain has been experiencing a shortage of working nurses. Student nurses in their last year at university were employed to help the National Health System respond to the COVID-19 crisis. AIM: The aim of this study was to explore and understand the experience of nursing students' roles as healthcare aid in responding to the COVID-19 crisis. METHODS: A qualitative phenomenology design was used to explore undergraduate nursing students' perceptions of their experiences as HAs during the COVID-19 outbreak. Open face-to-face interviews were conducted to nursing students (n = 10) in May 2020. Data was analyzed using the hermeneutic interpretative approach. RESULTS: All participants were women aged between 21 and 25 years. Seven main themes emerged: learning, ambivalent emotions and adaptation were classified at a personal level; teamwork, patient communication, and unclear care processes were categorized under hospital structure; and coping mechanisms were part of external factors. CONCLUSIONS: Orientation, follow-up, and emotional support in crisis situations are key to unexperienced healthcare workers overcoming stressful emotions. Previous academic education and training may help novice future nurses feel more confident about their tasks and responsibilities as well as improve patient outcomes, resource management, and staff safety.

Associated factors of suicidal ideation among older persons with dementia living at home in eight European countries.

OBJECTIVES: This study aimed to investigate the occurrence of suicidal ideation and associated factors in older persons with dementia living at home in eight European countries, and its association with quality of life. Furthermore, changes in suicidal ideation over time were investigated. METHODS: This cohort study (n = 1,223) was part of the European "RightTimePlaceCare" project conducted in 2010-2013. Participating countries were Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden and the United Kingdom. Baseline and follow-up data were analysed using bivariate and multivariate logistic regression. RESULTS: The occurrence of suicidal ideation in the participating countries varied between 6% and 24%. Factors significantly (p < 0.0018) associated with suicidal ideation using bivariate analysis were: nationality, depressive symptoms, delusions, hallucinations, agitation, anxiety, apathy, disinhibition, irritability, night-time behaviour disturbances, anxiolytics and anti-dementia medication. In the multivariate regression analysis, country of origin, moderate stage of the dementia, depressive and delusional symptoms, and anti-dementia medication were significantly associated with suicidal ideation (p < 0.05). Over time, suicidal ideation decreased from severe to mild or became absent in 54% of the persons with dementia. CONCLUSION: It is essential that professionals identify older persons with dementia and suicidal ideation and depressive and other psychological symptoms in order to give them appropriate treatment and provide relief for their informal caregivers. We emphasize the importance of identifying suicidal ideation, irrespective of depressive symptoms, and specifically of paying attention to persons with moderate dementia. Living with the informal caregiver seems to be associated with staying stable without suicidal ideation.

[Management and leadership of nursing services in the emergency plan for the pandemic COVID-19: the experience of the Clinic Hospital of Barcelona]. / Gestión y liderazgo de los servicios de Enfermería en el plan de emergencia de la pandemia COVID-19: la experiencia del Hospital Clínic de Barcelona.

At the international level, the enormous demand to manage the COVID-19 pandemic has posed a challenge both in the provision of personnel and in supplies and sanitary material. There is no precedent or publication related to the management and leadership of nursing services in Spain within the emergency plan for the COVID-19 pandemic. This article describes the experience of the Hospital Clinico de Barcelona in the current extraordinary circumstances that undoubtedly constitute a nursing management of enormous magnitude and unprecedented due to the high number of people affected and the extraordinary risk of healthcare personnel. Following national and international guidelines to alleviate the pandemic, protect health and prevent the spread of the outbreak. The ability to work as a team, emotional management and respect for organizational decisions have made it possible to face the challenges that the pandemic has put in place and that the Nursing Department can lead in a calm and orderly manner the different actions to perform. Lastly, it will be necessary to continue with an in-depth analysis of the situation and of the actions carried out in order to identify the areas for improvement as well as to evaluate the overall nature of the process.

Validity and reliability of the Spanish caregiver reaction assessment scale for caregivers of people with dementia.

AIM: Of the few instruments available to measure the important, positive aspects of caring, the Caregiver Reaction Assessment is regarded as the most suitable, but there is no validated Spanish version. The aim of this study was to translate the Caregiver Reaction Assessment into Spanish and assess its psychometric properties. METHODS: The Caregiver Reaction Assessment was translated into Spanish and then back translated. Validation included construct validity, criterion validity and reliability: 287 interviews were conducted with informal caregivers of patients with dementia between November 2010 and April 2012. RESULTS: Principal component analysis confirmed the original instrument's five subscales. Criterion validity showed a moderate negative correlation between the impact on health and the EQ-5D (r = -.43), that is, a greater impact on health correlated with lower health-related quality of life. The Caregiver Reaction Assessment showed good internal consistency, with a Cronbach alpha of .804, and good temporal stability for the distinct subscales, with intraclass correlation coefficients varying from .683 to .729 (p < .001). CONCLUSION: The Caregiver Reaction Assessment is a reliable, valid instrument for the measurement of the reactions of informal caregivers of patients with dementia, with good psychometric properties.

Emergency department and hospital admissions among people with dementia living at home or in nursing homes: results of the European RightTimePlaceCare project on their frequency, associated factors and costs.

BACKGROUND: Evidence is lacking on the differences between hospitalisation of people with dementia living in nursing homes and those living in the community. The objectives of this study were: 1) to describe the frequency of hospital admission among people with dementia in eight European countries living in nursing homes or in the community, 2) to examine the factors associated with hospitalisation in each setting, and 3) to evaluate the costs associated with it. METHODS: The present study is a secondary data analysis of the RightTimePlaceCare European project. A cross-sectional survey was conducted with data collected from people with dementia living at home or who had been admitted to a nursing home in the last 3 months, as well as from their caregivers. Data on hospital admissions at 3 months, cognitive and functional status, neuropsychiatric symptoms, comorbidity, polypharmacy, caregiver burden, nutritional status, and falls were assessed using validated instruments. Multivariate regression models were used to investigate the factors associated with hospital admission for each setting. Costs were estimated by multiplying quantities of resources used with the unit cost of each resource and inflated to the year 2019. RESULTS: The study sample comprised 1700 people with dementia living in the community and nursing homes. Within 3 months, 13.8 and 18.5% of people living in nursing homes and home care, respectively, experienced ≥1 hospital admission. In the nursing home setting, only polypharmacy was associated with a higher chance of hospital admission, while in the home care setting, unintentional weight loss, polypharmacy, falls, and more severe caregiver burden were associated with hospital admission. Overall, the estimated average costs per person with dementia/year among participants living in a nursing home were lower than those receiving home care. CONCLUSION: Admission to hospital is frequent among people with dementia, especially among those living in the community, and seems to impose a remarkable economic burden. The identification and establishment of an individualised care plan for those people with dementia with polypharmacy in nursing homes, and those with involuntary weight loss, accidental falls, polypharmacy and higher caregiver burden in the home care setting, might help preventing unnecessary hospital admissions.