Healthcare service use for children with chronic complex diseases: A longitudinal six-year follow-up study.

PURPOSE: The objective was analysed the patterns use of healthcare services of this population and the influence of their clinical and sociodemographic characteristics. DESIGN AND METHODS: A six-year longitudinal follow-up study was performed to evaluate the annual healthcare resources use and clinical data among children with complex chronic diseases in Spain between 2015 and 2021. The sample trends in healthcare usage and the associated factors were analysed using ANCOVA and multivariable linear regression models. RESULTS: Patients had high attendance during the follow-up period, with >15 episodes year. This trend decreased over time, especially in children with oncological diseases compared with other diseases (F (16.75; 825.4) = 32.457; p < 0.001). A multivariable model showed that children with a greater number of comorbidities (ß = 0.17), shorter survival time (ß = -0.23), who had contact with the palliative care unit (ß = 0.16), and whose mothers had a higher professional occupation (ß = 0.14), had a greater use of the healthcare system. CONCLUSIONS: Children with a higher number of comorbidities and the use of medical devices made a greater frequentation of health services, showing a trend of decreasing use over time. Socioeconomic factors such as mothers' occupational status determine healthcare frequentation. These results suggest the existence of persistent gaps in care coordination sustained over time. PRACTICAL IMPLICATIONS: Systematized and coordinated models of care for this population should consider the presence of inequalities in health care use.

Quality of Life and Health Services Utilization for Spanish Children With Cerebral Palsy.

PURPOSE: To examine the health-related quality of life of children with cerebral palsy and its relationship with their use of health resources, taking into account sociodemographic factors concerning the family context. DESIGN AND METHODS: Cross-sectional study of children with cerebral palsy in Granada (Spain). Quality of life was evaluated with PedsQL questionnaire. RESULTS: A total of 75 children were analysed (mean age 7.41 years; SD 4.37; 50.7% male). They made an average of 22.80 visits (SD 12.43) per year; greater use was made of resources by children who had been diagnosed with cerebral palsy for <45 months (36.00 vs. 26.93 visits per year, p < 0.0001). Older children suffered more fatigue and pain. Children aged 2-4 years who presented with fatigue had more hospitalizations (r = -0.35; p = 0.20), whereas those >4 years who had a higher quality of life for daily activities had made more visits to hospital A&E (r = 0.35, p = 0.043). Among the children studied, there was no significant association between HRQOL and the parents' education or occupation. CONCLUSION: These findings highlight variables that may influence children's quality of life and their use of health resources, identifying certain profiles of children who might need individualized interventions. PRACTICE IMPLICATIONS: These findings could inform services provided by paediatric nurses to children with cerebral palsy, to individualize interventions and improve patient centred care.

Socioeconomic Status and Health Services Utilization for Children With Complex Chronic Conditions Liable to Receive Nurse-Led Services: A Cross-Sectional Study.

AIM: To analyze the use of health services for children with severe chronic diseases, seeking to identify patterns of use according to sociodemographic and clinical conditions, and to identify unmet needs of care coordination that could benefit from nursing case management services. DESIGN: Cross-sectional study. METHODS: Children treated in ambulatory and hospital care in Granada, Spain, with complex chronic diseases in 2016 were analyzed to determine their use of healthcare resources. Socioeconomic variables were evaluated, along with clinical status and duration of their conditions. RESULTS: In total, 265 children were analyzed (mean age 7.3 years, SD 4.63; 56.6% male). The average duration of the disease was 63.26 months (SD 54.09). The most common types of disease were neurological (35.80%), congenital (23.90%), and oncological (18.90%). Multivariate analysis showed that children in need of advanced care (ß = 0.71), with a relatively recent diagnosis (ß = -0.11), with criteria for palliative care 1 (ß = -0.26), and whose mothers were older (ß = 0.36) and had a higher educational level (ß = 0.19) made greater use of healthcare resources during the preceding 12 months, whether urgent or scheduled (r2 = 78.0%, p < .001). CONCLUSIONS: Children with higher needs for advanced care have a heterogeneous use of healthcare resources depending on certain clinical and sociodemographic determinants. This finding highlights the importance of the identification of profiles of children and families for care coordination. The presence of sociodemographic determinants may need individualized approaches to assure a timely health care utilization. CLINICAL RELEVANCE: A significant proportion of the children used multiple health services, being treated at several centers simultaneously, and producing up to 139 total yearly contacts with the health system. Policymakers, healthcare providers, and patients' families should engage in a redesign of healthcare services for these children, providing comprehensive and coordinated systems of care for this population.

Conceptual framework of mental health literacy: Results from a scoping review and a Delphi survey.

Mental health literacy (MHL) has been identified as a factor influencing early help-seeking for mental health problems (MHPs) and stigmatizing attitudes. However, the lack of consensus on its definition has led to considerable heterogeneity in measurement and, consequently, methodological challenges in comparing data. In this way, the present study was conducted with the following objectives: in Phase I, mapping the existing literature through a scoping review; in Phase 2, 28 experts in the field of mental health participated to develop a consensus statement on the relevance and importance of the findings from Phase 1. A total of 37 articles were included for review. Notable nuances were identified in the conceptualization of MHL, particularly with regard to the fact that it should not be limited to mental disorders but should also encompass mental health. Furthermore, the sociocultural influence was highlighted as shaping MHL, recognizing it as a modifiable competence that adapts to different contexts and life stages, involving both individual and collective levels. The experts deemed the findings pertinent and relevant with a high degree of consensus, except for factors related to MHL. This framework provides a refined definition of MHL and related factors that should be taken into account to guide nursing and other disciplines' studies and interventions on MHL. The evolution of this concept includes dimensions to be considered in future research, especially when developing new measurement instruments or implementing educational programmes. This knowledge and skills cannot be determined globally without considering the context and development of the individual.

Quality of Life, Physical and Mental Health, and Economic Evaluation of Family Caregivers of Chronic Dependent Children: INFAPRINT Cohort Study Protocol.

BACKGROUND: Caregivers for children with complex chronic illnesses may experience emotional and physical strain, especially as concerns attention overload and the perceptions of their own psychosocial situation. These concerns, together with the additional financial cost and the socioeconomic inequalities that arise from caregiving responsibilities, create major challenges to the health status of this population group. METHODS: A prospective analytical longitudinal study will be conducted, based on an exposed cohort of adult caregivers (parents or guardians) for children with complex chronic processes, to evaluate the impact of caregiving responsibilities on the health status of this population group. CONCLUSIONS AND IMPLICATIONS: The practical implications of this study are of great significance for clinical practice. The results of this study have the potential to inform the decision-making process in the healthcare sector and guide future research initiatives. The findings of this study will provide crucial insights into the health-related quality of life of caregivers of children with complex chronic illnesses, which will be valuable in addressing the challenges faced by this population group. This information can be used to improve the availability and accessibility of appropriate health services and to facilitate the development of more equitable health outcomes for caregivers of children with complex chronic illnesses. By highlighting the extent to which this population is affected both physically and mentally, the study can contribute to the development of clinical practices that prioritize the health and well-being of caregivers in the care of children with complex chronic illnesses.

Professional quality of life in pediatric services: A cross-sectional study.

OBJECTIVE: Determine the quality of working life among the different pediatric nursing professionals, taking into account socio-demographic and work context factors, and the relationship of Burnout, compassion satisfaction and compassion fatigue between different job positions. METHOD: Cross-sectional descriptive observational study carried out between January-March 2019 at the national territory. The professional quality of life was measured with ProQOL IV and sociodemographic characteristics were recorded. The data was encoded in Microsoft Office Excel, and analyzed with SPPS considering statistically significant differences p < 0.05. RESULTS: A total of 68 nurses were included in the study. The results obtained show less satisfaction due to compassion in those professionals who have a permanent employment contract, as well as those who carry out their work in hospitalization positions compared to those in the oncology area. In our sample there are very high levels of compassion fatigue, in addition we observed a significant relationship between compassion fatigue and religious belief, being higher in believing professionals. CONCLUSIONS: It's necessary to identify associated factors in the professional quality of life to propose intervention strategies and improvement conditions, requiring greater involvement of health institutions to improve the professional quality of life in pediatric nursing.

Competency Gradients in Advanced Practice Nurses, Specialist Nurses, and Registered Nurses: A Multicentre Cross-Sectional Study.

(1) Background: Identifying differences in the competencies of different areas of nursing is a crucial aspect for determining the scope of practice. This would facilitate the creation of a formal structure for clinical practice in advanced and specialised services. The aims of this study are to analyse the distribution of advanced competencies in registered, specialist and advanced practice nurses in Spain, and to determine the level of complexity of the patients attended by these nurses. (2) Methods: A cross-sectional study was developed on registered, specialist and advanced practice nurses, all of whom completed an online survey on their perceived level of advanced competencies and their professional characteristics. (3) Results: In total, 1270 nurses completed the survey. Advanced practice nurses recorded the highest self-perceived level of competency, especially for the dimensions of evidence-based practice, autonomy, leadership and care management. (4) Conclusions: Among registered, specialist and advanced practice nurses, there are significant differences in the level of self-perceived competencies. Patients attended by advanced practice nurses presented the highest levels of complexity. Understanding these differences could facilitate the creation of a regulatory framework for clinical practice in advanced and specialized services.

Socioeconomic Factors and Quality of Life Perceived by Parents and Children with Complex Chronic Conditions in Spain.

Health-related quality of life of children with complex chronic conditions could be affected by sociodemographic factors. Most studies focus exclusively on the parents' perceptions of quality of life. This study aimed to determine the health-related quality of life of these children, according to their parents and the children themselves. A cross-sectional study was developed on children aged over five years with complex chronic conditions. Health-related quality of life, educational attainment, and social status were evaluated. A total of 101 children were included with a mean age of 10.48 years, and 35.6% were female. The most frequent disease was oncological (28.7%). Children perceived a better health-related quality of life, compared to their parents' assessment: median difference -8.4 (95%CI: -9.2 to -3.8). Moreover, differences were observed by socioeconomic factors. Parents and children with complex chronic conditions perceive differently the health-related quality of life. Social determinants associate with an uneven perceived quality of life.

Utilization of Parallel Resources and Sociodemographic Factors in Treating Children with Complex Chronic Diseases: A Cross-Sectional Study.

BACKGROUND: Children with complex chronic conditions have a high need for health and social care resources. Many parents explore parallel resources such as alternative therapies, associations, psychological support, private medical consultations, and other out-of-pocket expenses for healthcare. The use of these alternative health resources is sometimes unclear and may lead to health inequalities. To characterize the use made of alternative healthcare resources for children with complex chronic conditions. Additionally, we evaluate the influence of sociodemographic factors on the distribution of this utilization of resources; (2) Methods: Cross-sectional study. Children with complex chronic diseases were treated at a tertiary hospital in Granada, Spain in 2016. We analyzed their use of healthcare resources and socioeconomic variables. This research complies with STROBE guidelines for observational studies; (3) Results: In total, 265 children were analyzed (mean age 7.3 years, SD 4.63). A total of 105 children (39.6%) attended private consultations with specialists, and 12.1% (n = 32) of the children had additional private health insurance. One out three parents belonged to a mutual support association (n = 78), and 26% (n = 69) of the children used alternative therapies. Furthermore, 75.4% (n = 199) of the children received no psychological support. Children whose parents had a higher educational level and occupations status made greater use of parallel healthcare resources.; (4) Conclusions: A significant proportion of children used multiple health resources in addition to the public healthcare system depending on sociodemographic determinants. Studies are needed to determine whether the use of these alternative services achieves better levels of health.

Competences of specialist nurses and advanced practice nurses. / Competencias en enfermeras Especialistas y en Enfermeras de Práctica Avanzada.

OBJECTIVE: To analyse the distribution of advanced competences in specialist nurses and advanced practice nurses and to evaluate their association with some characteristics of their professional profile. METHOD: Multicentre analytical cross-sectional study. Nurses who worked as advanced practice nurses and specialist nurses were included. Their level of perceived advanced competences was measured, as well as sociodemographic and professional characterization variables. RESULTS: A total of 277 nurses participated (149 practised as advanced practice nurses and 128 as specialists), with an average of 13.88 (11.05) years as a specialist and 10.48 (5.32) years as an advanced practice nurse. In the sample, 28.8% had a master's or doctorate level qualification, 50.2% worked in Primary Care, 24.9% in hospitals and 22.7% in Mental Health. The self-perceived global level was high in the different competences, the lowest dimensions being research, evidence-based practice, quality and safety management and leadership and consulting. The advanced practice nurses obtained a higher level of competence globally and in the dimensions of leadership and consulting, interprofessional relations, care management, and health promotion. There were no differences based on experience or possession of a master's degree or doctorate. In the advanced practice nurses, the practice context did not influence competence levels, although in the specialist nurses it did, in favour of those practicing in Mental Health. CONCLUSIONS: Specialist and advanced practice nurses have different competences that should be adequately managed for the development of advanced and specialist nursing services.

Prevalencia de diagnósticos enfermeros en pacientes crónicos en emergencias extrahospitalarias: mejorando la comprensión de la complejidad / Prevalence of out-of-hospital nursing diagnosis for patients with chronic conditions: improving our understanding of complexity

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Calidad de vida profesional en servicios de pediatría: estudio transversal / Professional quality of life in pediatric services: A cross-sectional study

Objetivo: Determinar la calidad de vida laboral entre los diferentes profesionales de enfermería pediátrica,teniendo en cuenta factores sociodemográficos y de contexto laboral, y la relación del burnout, satisfacción por compasión y fatiga por compasión entre los diferentes puestos de trabajo. Método: Estudio observacional descriptivo transversal desarrollado entre enero y marzo de 2019 en el ámbito nacional. Se recopilaron características sociodemográficas y el Cuestionario ProQOL IV. Los datos se codificaron en Microsoft Office Excel, y se analizaron con SPSS, considerándose diferencias estadísticamente significativas para valores p<0,05. Resultados: Participaron 68 enfermeras. Los resultados obtenidos muestran una menor satisfacción por compasión en aquellos profesionales que tienen un contrato de trabajo fijo, así como los que desempeñan su labor en puestos de hospitalización respecto a los del área de oncología. En nuestra muestra existe una elevada fatiga por compasión, observando una relación significativa entre la fatiga por compasión y la creencia religiosa, siendo superior en los profesionales creyentes. Conclusiones: Es necesario identificar factores asociados con la calidad de vida profesional para plantear estrategias de intervención y condiciones de mejora, siendo precisa una mayor implicación de las instituciones sanitarias para la mejora de la calidad de vida profesional en la enfermería pediátrica.(AU)

Objective: Determine the quality of working life among the different pediatric nursing professionals, taking into account socio-demographic and work context factors, and the relationship of Burnout, compassion satisfaction and compassion fatigue between different job positions. Method: Cross-sectional descriptive observational study carried out between January-March 2019 at the national territory. The professional quality of life was measured with ProQOL IV and sociodemographic characteristics were recorded. The data was encoded in Microsoft Office Excel, and analyzed with SPPS considering statistically significant differences p <0.05. Results: A total of 68 nurses were included in the study. The results obtained show less satisfaction due to compassion in those professionals who have a permanent employment contract, as well as those who carry out their work in hospitalization positions compared to those in the oncology area. In our sample there are very high levels of compassion fatigue, in addition we observed a significant relationship between compassion fatigue and religious belief, being higher in believing professionals. Conclusions: It's necessary to identify associated factors in the professional quality of life to propose intervention strategies and improvement conditions, requiring greater involvement of health institutions to improve the professional quality of life in pediatric nursing.(AU)

Competencias en enfermeras Especialistas y en Enfermeras de Práctica Avanzada / Competences of specialist nurses and advanced practice nurses

Objetivo: Analizar la distribución de competencias avanzadas en enfermeras especialistas y enfermeras de práctica avanzada y evaluar su asociación con algunas características de su perfil profesional. Método: Estudio transversal analítico multicéntrico. Se incluyeron enfermeras que ejercían como Enfermeras de Práctica Avanzada y enfermeras Especialistas. Se midió su nivel de competencias avanzadas percibidas, así como variables de caracterización profesional. Resultados: Doscientas setenta y siete enfermeras participaron (149 ejercían práctica avanzada y 128 especialistas), con una media de 13,88 (11,05) años como especialista y 10,48 (5,32) años como Enfermera de Práctica Avanzada. Un 28,8% tenía nivel de máster o doctorado. El 50,2% ejercía en atención primaria, el 24,9% en hospitales y el 22,7% en salud mental. El nivel global autopercibido fue elevado en las distintas competencias, siendo las dimensiones más bajas las de investigación, práctica basada en la evidencia, gestión de la calidad y seguridad y liderazgo y consultoría. Las Enfermeras de Práctica Avanzada obtuvieron mayor nivel competencial de forma global y en las dimensiones de liderazgo y consultoría, relaciones interprofesionales, gestión de cuidados y promoción de salud. No hubo diferencias en función de la experiencia o la posesión de nivel de máster o de doctorado. En las Enfermeras de Práctica Avanzada el contexto de práctica no influía en los niveles competenciales, aunque en las enfermeras especialistas sí, a favor de las que ejercían en salud mental. Conclusiones: Las enfermeras especialistas y de práctica avanzada tienen competencias distintas que deberían ser gestionadas adecuadamente para el desarrollo de los servicios enfermeros avanzados y especializados

Objective: To analyse the distribution of advanced competences in specialist nurses and advanced practice nurses and to evaluate their association with some characteristics of their professional profile. Method: Multicentre analytical cross-sectional study. Nurses who worked as advanced practice nurses and specialist nurses were included. Their level of perceived advanced competences was measured, as well as sociodemographic and professional characterization variables. Results: A total of 277 nurses participated (149 practised as advanced practice nurses and 128 as specialists), with an average of 13.88 (11.05) years as a specialist and 10.48 (5.32) years as an advanced practice nurse. In the sample, 28.8% had a master's or doctorate level qualification, 50.2% worked in Primary Care, 24.9% in hospitals and 22.7% in Mental Health. The self-perceived global level was high in the different competences, the lowest dimensions being research, evidence-based practice, quality and safety management and leadership and consulting. The advanced practice nurses obtained a higher level of competence globally and in the dimensions of leadership and consulting, interprofessional relations, care management, and health promotion. There were no differences based on experience or possession of a master's degree or doctorate. In the advanced practice nurses, the practice context did not influence competence levels, although in the specialist nurses it did, in favour of those practicing in Mental Health. Conclusions: Specialist and advanced practice nurses have different competences that should be adequately managed for the development of advanced and specialist nursing services