Effectiveness of intervention programs aimed at improving the nursing work environment: A systematic review.

BACKGROUND: The nursing work environment can be compromised due to workload, stress and many other issues. A good nursing work environment is needed to for the health and wellbeing of nurses and therefore measures are developed to improve nursing work environment. AIM: To determine whether measures designed to improve the work environment for nursing professionals are effective. METHODOLOGY: Online research in the Medline, Scopus, Web of Science, ERIC, CINHAL, PsycINFO, and American Doctoral Dissertations databases, along with manual search, was carried out. Primary experimental studies made up of intervention and control groups were included, with pre-/post-measure evaluation in the nursing team, based on the effects of the interventions. Risk of bias was calculated using the Cochrane tool. RESULTS: A total of 1997 studies were examined; 19 clinical trials met the inclusion criteria. A total of 1427 nurses participated in the selected studies. The fields of application of the interventions were personal and environmental. Out of the fields targeting individuals, three methodologies were identified: cognitive-behavioral techniques, stress management, channeling anxiety and physical well-being; and those aimed at environmental fields: aromatization and organization. The most evaluated characteristic was teamwork, and the most analyzed symptom was stress. Most of the interventions concluded with at least one significant improvement. CONCLUSIONS: Interventions aimed at enhancing the work environment are effective ways of increasing job satisfaction. The heterogeneity of the data did not allow us to determine which intervention is the most effective. The combination, type, and duration are variables that affect efficacy. IMPLICATION FOR NURSING AND NURSING POLICY: This systematic review provides resources for improving the work environment that affects nursing staff, other professionals, and patients. Encouraging a healthy atmosphere leads to excellence in care and improved safety.

The communication skills and quality perceived in an emergency department: The patient's perspective.

AIM: To examine the influence of health care provider's communication skills on the quality of care perceived by Emergency Department patients. BACKGROUND: Communication between patients and health care providers in the context of Emergency Department is challenging and can potentially have a negative impact on the quality of care perceived by patients. DESIGN: Cross-sectional descriptive study conducted in the Emergency Department at the University Clinical Hospital Virgen de la Arrixaca of Murcia, Spain. METHOD: Data were collected from 6 to 9 June 2016. Different instruments were used to evaluate the perception of patients on the communication skills and quality of care at the Emergency Department. RESULTS: The sample was composed of 200 patients, with an average age of 44.1 (SD = 18.3), of which 106 (53%) were men. The multiple linear regression analysis showed the association between communication skills (respect, problem solving, and nonverbal communication) and age with the quality of care perceived by the patients. CONCLUSIONS: We found that the communication skills of the health care providers were explanatory variables of the quality of care perceived in an Emergency Department.

Factors associated with grip strength among adolescents: An observational study.

STUDY DESIGN: Cross-sectional. INTRODUCTION: The muscle strength has been studied in different populations in relation with individual and other factors. PURPOSE OF THE STUDY: The purpose of this study was to determine values of grip strength in adolescents and to examine its association with sex, age, weight, height, nutritional status, handedness, and academic performance. METHODS: A total of 452 adolescents (246 men and 206 women) aged 12 to 17 years were included in the study. Grip strength was measured using a Takei dynamometer. RESULTS: Boys were significantly stronger than girls with both the dominant hand (33.1 kgf vs 25.0 kgf; mean difference = 8.1 kgf; P < .001) and the nondominant hand (30.9 kgf vs 23.1 kgf; mean difference = 7.8 kgf; P < .001), and there was a significant increase in strength values as the age rises in both sexes (P < .001). The dominant hand was stronger than the nondominant one (29.4 kgf vs 27.3 kgf; mean difference = 2.1 kgf; P < .001), except for left-handed subjects who were significantly stronger than right-handed ones in their nondominant hand. Furthermore, strength was positively associated with nutritional status and negatively associated with academic performance in men. CONCLUSIONS: Sex, age, handedness, nutritional status, and academic performance have a significant influence on the grip strength values. There seems to be a sexual dimorphism in the relationship between strength and both nutritional status and academic performance.

Prevalence and factors associated with overweight and obesity among Spanish students attending special education schools.

BACKGROUND: Some studies suggest that children and adolescents with intellectual disability (ID) are at elevated risk of obesity. The objective was to determine the prevalence of and factors associated with overweight and obesity among students attending special education schools in Cantabria, Spain. METHODS: Cross-sectional design. A sample of n = 220 students with intellectual disability attending seven special education schools was selected using convenience sampling. Body mass index was classified into four categories according to the International Obesity Task Force (IOTF) criteria: underweight; normal weight; overweight; obesity. RESULTS: The prevalence of overweight/obesity was 40.9% (95% CI: 34.6-47.5). Obesity was more frequent among females (26.0%) than males (9.8%), with an OR = 3.23 (95% CI: 1.53-6.85). Participants with Down syndrome showed an increased risk of obesity compared to other conditions (p = .005). CONCLUSIONS: The prevalence of overweight/obesity among children, adolescents and young adults with intellectual disability was remarkably high, with females in general and students of both sexes with Down syndrome at particularly high risk.

Water-Energy-Food Nexus and Life Cycle Thinking: A New Approach to Environmental and Nutritional Assessment of Potato Chips.

The water-energy-food (WEF) nexus has become a key concept to promote the cross-sectoral coordination toward sustainable development. In particular, understanding the interdependences of these pillars, as well as addressing a life cycle perspective, is essential when evaluating food production systems. This study explores the environmental impacts and nutritional quality of potato chips, addressing life cycle thinking and a WEF nexus approach. For this purpose, the combined application of life cycle assessment (LCA) and the Nutrient-Rich Food 9.3 (NRF9.3) index was considered to identify the main environmental hotspots and advanced opportunities. The results indicated a major contribution of the cultivation stage on water use, whereas the processing accounted for most of the impacts in energy-related indicators and eutrophication potentials. Improvement opportunities reside in the joint application of drip irrigation, allowing to achieve important water savings, as well as the use of natural gas or pellets instead of diesel, which constitute cleaner energy sources. On the other hand, a poor nutritional density of potato chips became evident from the quantification of the NRF9.3, which can be significantly improved if potatoes undergo a roasted process instead of frying.

Implementing a Care Pathway for Complex Chronic Patients from a Nursing Perspective: A Qualitative Study.

A care pathway constitutes a complex care strategy for decision-making and the organization of processes in the care of complex chronic patients, avoiding the fragmentation of care. Health professionals play a decisive role in the implementation, development, and evaluation of care pathways. This study sought to explore nurses' opinions on the care pathway for complex chronic patients three years after its implementation. The study participants were thirteen nurses with different roles who were involved in the care pathway. Thematic content analysis of the semi-structured interviews resulted in four major themes: (a) the strengths of the route; (b) the impact of the route on caregivers; (c) the weaknesses of the route; and (d) the future of the route. Overall, the pathway was positively valued for the benefits it provides to patients, the caregiver, and the administration of professional health care. Participants voiced their concerns regarding: communication and coordination difficulties among professionals across the different levels of care, the need for improved teamwork and consensus among professionals at the same center, and human and material resources. The ongoing evaluation and monitoring of facilitators and barriers is necessary throughout the implementation process, to ensure continuity and quality of care in the health system.

Using High-Fidelity Simulation to Introduce Communication Skills about End-of-Life to Novice Nursing Students.

Background: High-fidelity simulation is being considered as a suitable environment for imparting the skills needed to deal with end-of-life (EOL) situations. The objective was to evaluate an EOL simulation project that introduced communication skills to nursing students who had not yet begun their training in real healthcare environments. Methods: A sequential approach was used. The "questionnaire for the evaluation of the end-of-life project" was employed. Results: A total of 130 students participated. Increasing the time spent in high-fidelity simulation significantly favored the exploration of feelings and fears regarding EOL (t = -2.37, p = 0.019), encouraged dialogue (t = -2.23, p = 0.028) and increased the acquisition of communication skills (t = -2.32, p = 0.022). Conclusions: High-fidelity simulation promotes communication skills related to EOL in novice nursing students.

Smoking in nursing students: A prevalence multicenter study.

The role of nursing students as future health promoters of healthy behaviors is influenced by their attitude towards smoking. A cross-sectional study using a self-administered survey was performed to analyze smoking prevalence among undergraduate the nursing students who attend nursing faculties in 2 European countries (Spain and Portugal) during academic period 2015 to 2016. A total of 1469 subjects were surveyed (response rate of 79.8%). An 80% of the students were female with a mean age of 21.9 (4.8) years. The overall prevalence of tobacco use was 18.9%, with an average percentage of 16.2% in Portugal and 18.3% in Spain. Statistical significance was observed in relation to smoke and previous studies (16.4% vs 27.1%; P < .001). Only 1.1% of the students reported using electronic cigarette. 15.8% of smokers started smoking while at university with statistical gender and previous studies differences (P < .001). Fagerström and Richmond test showed low nicotine dependence (2.8 ±â€Š2) and moderate motivation to stop smoking (4.9 ±â€Š3), respectively. Smoking prevalence among nursing students was slightly higher than the general European population. For that reason, measures to reduce tobacco use have to be focused on students and university policies on tobacco control should be a challenge in the future.

The Spanish version of the stressors in nursing students scale.

WHAT IS KNOWN ON THE SUBJECT?: The mental health of health professionals is affected by their own work. Nurses and nursing students face high levels of stress, which results in anxiety, burnout, and depression. There are scales that allow the measurement of specific stress levels of nursing students, especially when they first attend their clinical practices in real settings such as hospitals. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Our study consists of validating an existing scale (the Stressors in Nursing Students Scale, SINS) that measures these stress levels in Spanish. Stress is an issue for nursing students and is related to the specific stressors they encounter in the process of their professional work and study. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The validation and adaptation of this scale to Spain will allow us to adequately assess the stress levels of our students to give them adequate tools for the emotional control of their anxiety and stress. Once we have a reliable and appropriate tool for measuring the factors of greater impact in the generation of stress, we can implement preventive measures which may be very useful for the control of anxiety. ABSTRACT: Introduction Nursing professionals and students suffer a greater number of stressors with negative health consequences. Aim To translate and test a Spanish version of the Stressors in Nursing Students Scale (SINS-S), with a cohort of nursing students in Spain. Also, we sought to examine the factor structure of this test and explore the psychometric structure of stress among this population. Method The SINS scale was translated into Spanish and administered to a cohort (n = 398) of male and female Spanish nursing students in the final three years of their nursing program. Data were analyzed using exploratory factor analysis. Results Exploratory factor analysis revealed four factors: "Clinical," "Financial," "Confidence," and "Education." Discussion There were similarities between the perception of stressors by nursing students in Spain compared with the original version of the SINS from the United Kingdom. Stress is an issue for nursing students and is related to the specific stressors they encounter in the process of their professional work and study.

Predictive capability of the injury severity score versus the new injury severity score in the categorization of the severity of trauma patients: a cross-sectional observational study.

PURPOSE: The AIS scale is a measurement tool for single injuries. The ISS is considered the gold standard for determining the severity of injured patients, and the NISS was developed to improve the ISS with respect to loss of information, as well as to facilitate its calculation. The aim of this study was to analyse what injury severity measure, calculated according to the Abbreviated Injury Scale (AIS), 1998 and 2005 (update 2008) versions, performs better with mortality, cost and hospital length of stay healthcare indicators. METHODS: This cross-sectional observational study was carried out between February 1st 2012 and February 1st 2013. Inclusion criteria were injured patients due to external causes admitted to trauma service through the emergency department. Manual coding of all injuries was performed and ISS and NISS scores were calculated for both versions of the AIS scale. Severity was then compared to mortality (in-hospital and at 30 days), healthcare cost, and length of hospital stay. RESULTS: The index with the best predictive capability for in-hospital mortality was NISS 05 (AUC = 0.811). There was a significant increase in hospital stay and healthcare cost in the most severe patients in all indexes, except for ISS 05. CONCLUSIONS: NISS is found to be an index with higher predictive capability for in-hospital mortality and correlates better to length of hospital stay and healthcare cost.

Characteristics of nursing interventions that improve the quality of life of people with chronic diseases. A systematic review with meta-analysis.

PURPOSE: The objective of this systematic review was to determine the characteristics of the interventions conducted by nurses that attempt to improve the health related quality of life (HRQoL) of people over 18 years of age with chronic diseases. METHODS: This systematic review with meta-analysis summarizes 24 studies, conducted in 10 countries, that evaluated HRQoL through the Short-Form Health Survey (SF). Five databases were accessed to find the available studies from December 31st, 2000 to May 22sd, 2017. Selected studies were coded according to the characteristics of the sample and the intervention. A model of random effects was adopted for the overall estimation and to explain the heterogeneity. RESULTS: Twenty-four studies were included in the systematic review and meta-analysis providing a sample of 4324 chronic patients aged 63.4 years. Among the 8 subscales and two summary measures that comprise the SF-36, only an overall significant effect size (ES) index was found in the Mental Health Component summary score (ES = 0.14; 95% CI:0.03 - 0.26; I2 = 44.6, p = 0.042) and the Mental Health subscale. This improvement on HRQoL was associated to interventions on "Case Management" and "Treatments and Procedures", which were based on a theory, were of shorter duration, and had a follow-up period. CONCLUSIONS: Interventions targeting people with chronic diseases resulted in a slight increase in the HRQoL that was not always significant, which suggests that there is a need for their continuous improvement.

Comparison of injury severity scores (ISS) obtained by manual coding versus "Two-step conversion" from ICD-9-CM.

BACKGROUND: The International Classification of Diseases (ICD) is the standard diagnostic tool for classifying and coding diseases and injuries. The Abbreviated Injury Scale (AIS) is the most widely used injury severity scoring system. Although manual coding is considered the gold standard, it is sometimes unavailable or impractical. There have been many prior attempts to develop programs for the automated conversion of ICD rubrics into AIS codes. OBJECTIVE: To convert ICD, Ninth Revision, Clinical Modification (ICD-9-CM) codes into AIS 2005 (update 2008) codes via a derived map using a two-step process and, subsequently, to compare Injury Severity Score (ISS) resulting from said conversion with manually coded ISS values. METHODS: A cross-sectional retrospective study was designed in which medical records at the Hospital Universitario Marqués de Valdecilla of Cantabria (HUMV) and the Complejo Hospitalario of Navarra (CHN), both in Spain, were reviewed. Coding of injuries using AIS 2005 (update 2008) version was done manually by a certified AIS specialist and ISS values were calculated. ICD-9-CM codes were automatically converted into ISS values by another certified AIS specialist in a two-step process. ISS scores obtained from manual coding were compared to those obtained through this conversion process. RESULTS: The comparison of obtained through conversion versus manual ISS resulted in 396 concordant pairs (70.2%); the analysis of values according to ISS categories (ISS<9, ISS 9-15, ISS 16-24, ISS>24) showed 493 concordant pairs (87.4%). Regarding the criterion of "major trauma" patient (i.e., ISS> 15), 538 matching pairs (95.2%) were obtained. The conversion process resulted in underestimation of ISS in 112 cases (19.9%) and conversion was not possible in 136 cases (19%) for different reasons. CONCLUSIONS: The process used in this study has proven to be a useful tool for selecting patients who meet the ISS>15 criterion for "major trauma". Further research is needed to improve the conversion process.

Perceptions about the Self-Learning Methodology in Simulated Environments in Nursing Students: A Mixed Study.

The self-learning methodology in simulated environments (MAES©) is an active method of education. The aim of this study was to analyze the perceptions and opinions of undergraduate and graduate nursing students about the self-learning methodology in simulated environments. A mixed, cross-sectional, descriptive study based on a survey tool made ad hoc (quantitative approach) and an open questionnaire (qualitative approach) was carried out. A sample of 149 undergraduate and 25 postgraduate nursing students were tested. The score was high for all the variables of the questionnaire analyzed: for perception of simulation performance, M = 73.5 (SD = 14.5), for motivation, M = 23.9 (SD = 5.9), for the opinion about facilitators, M = 25.9 (SD = 4.5), and for the promotion of team work, M = 16.9 (SD = 3.4). Five dimensions were identified and evaluated in the qualitative research. The students were pleased with MAES© and had a positive perception, since they considered that MAES© increased their learning.

Validation of the Spanish Version of the ICECAP-O for Nursing Home Residents with Dementia.

BACKGROUND: Measurement of health-related quality of life (HRQoL) is important for a chronic disease, such as dementia, which impairs the quality of life of affected patients in addition to their length of life. This is important in the context of economic evaluations when interventions do not (only) affect HRQoL and these other factors also affect overall quality of life. OBJECTIVE: To validate the Spanish translation of the ICECAP-O's capability to measure Health-related quality of life in elderly with dementia who live in nursing homes. METHOD: Cross-sectional study. For 217 residents living in 8 Spanish nursing homes, questionnaires were completed by nursing professionals serving as proxy respondents. We analyzed the internal consistency and other psychometric properties. We investigated the convergent validity of the ICECAP-O with other HRQoL instruments, the EQ-5D extended with a cognitive dimension (EQ-5D+C), the Alzheimer's Disease Related Quality of Life (ADRQL) measures, and the Barthel Index measure of activities of daily living (ADL). RESULTS: The ICECAP-O presents satisfactory internal consistency (alpha 0.820). The factorial analysis indicated a structure of five principal dimensions that explain 66.57% of the total variance. Convergent validity between the ICECAP-O, EQ-5D+C, ADRQL, and Barthel Index scores was moderate to good (with correlations of 0.62, 0.61, and 0.68, respectively), but differed between dimensions of the instruments. Discriminant validity was confirmed by finding differences in ICECAP-O scores between subgroups based on ADL scores (0.70 low, 0.59 medium, and 0.39 high level care), dementia severity (0.72 mild, 0.63 medium, and 0.50 severe), and ages (0.59 below 75 years and 0.84 above 75 years). CONCLUSIONS: This study presented the first use of a Spanish version of the ICECAP-O. The results indicate that the ICECAP-O appears to be a reliable Health-related quality of life measurement instrument showing good convergent and discriminant validity for people with dementia.

Sentimientos relacionados con la muerte en estudiantes de enfermería: un estudio observacional de tres cohortes / Feelings about Death among Nursing Students: A Three-Cohort Observational Study

Objetivo principal: Conocer los sentimientos sobre la muerte en estudiantes de grado de enfermería que aún no han iniciado su prácticum en entornos asistenciales reales. Metodología: Estudio observacional de tres cohortes con análisis de pregunta abierta. La Escala de Miedo a la Muerte de Collet-Lester, el Cuestionario de factores para ayudar a morir en paz y un cuestionario con 6 preguntas abiertas fueron completados por 197 estudiantes de segundo curso de Grado de Enfermería. Resultados principales: Los estudiantes reconocen tener miedo de enfrentar la muerte en el prácticum, principalmente temen que les afecte personalmente, la reacción del paciente, el contacto con la muerte y el no saber qué hacer. Conclusión principal: Los estudiantes consideran que la muerte es algo muy presente en su profesión, expresan temer enfrentarse a ella en el prácticum, mayoritariamente reconocen no tener suficientes estrategias de afrontamiento y les gustaría recibir más formación para saber cómo afrontarla.(AU)

Objective: To describe the feelings about death of students enrolled in the Nursing Degree, who had not initiated their practicum in real care settings. Methods: Three-cohort observational study with open question analysis. The Collet-Lester Fear of Death Scale, the Questionnaire on factors to help dying in peace and ad hoc questionnaire with 6 open-ended questions was administered to 197 undergraduate nursing students. Results: The students recognized being afraid to face death in the practicum, mainly they fear that it affects them personally, the patient's reaction, contact with death and not knowing what to do. Conclusions: The students believed that death was something that was very present in their profession, expressed fear in facing it in the practicum, they mostly recognized not having enough overcoming strategies, and they would like to receive training on how to face death.(AU)

Complications of Peripherally Inserted Central Venous Catheters: A Retrospective Cohort Study.

BACKGROUND AND AIM: The use of venous catheters is a widespread practice, especially in oncological and oncohematological units. The objective of this study was to evaluate the complications associated with peripherally inserted central catheters (PICCs) in a cohort of patients. MATERIALS AND METHODS: In this retrospective cohort study, we included all patient carrying PICCs (n = 603) inserted at our institute between October 2010 and December 2013. The main variables collected were medical diagnosis, catheter care, location, duration of catheterization, reasons for catheter removal, complications, and nursing care. Complications were classified as infection, thrombosis, phlebitis, migration, edema, and/or ecchymosis. RESULTS: All patients were treated according to the same "nursing care" protocol. The incidence rate of complications was two cases per 1000 days of catheter duration. The most relevant complications were infection and thrombosis, both with an incidence of 0.17 cases per 1000 days of the total catheterization period. The total average duration of catheterization was 170 days [SD 6.06]. Additionally to "end of treatment" (48.42%) and "exitus", (22.53%) the most frequent cause of removal was migration (displacement towards the exterior) of the catheter (5.80%). CONCLUSIONS: PICCs are safe devices that allow the administration of long-term treatment and preserve the integrity of the venous system of the patient. Proper care of the catheter is very important to improve the quality life of patients with oncologic and hematologic conditions. Therefore, correct training of professionals and patients as well as following the latest scientific recommendations are particularly relevant.