Predictive validity of the INTEGRARE scale in identifying the risk of hospital-acquired pressure ulcers in acute care hospital settings

Background: Hospital-acquired pressure ulcers (HAPUs) are prevalent around the world and are an indicator of care quality. Numerous instruments are available to predict their appearance, but few evaluate predictive val idity. No instruments based on Nursing Outcomes Classification indicators have been found, despite these in dicators reflecting the patient’s condition. The aim of the study was to analyse the predictive validity of the INTEGRARE scale in preventing the risk of HAPUs. Methods: A multicentre prospective observational cohort study design was used. 1,004 patients from 11 public hospitals in Andalusia (Spain) were recruited between February 2015 and October 2017. Participants were aged over 18 and had been admitted to medical and surgical units, with a predicted stay exceeding 48 h. Predictive validity was checked using a multivariate logistic regression model and a receiver operating characteristic curve, with development of pressure ulcers during the hospital stay as the dependent variable. Results: The INTEGRARE scale obtained an area under the curve of 0.886 (95% CI = 0.85–0.923). Within the 30- point range, the optimal cut-off value is 23 points with a sensitivity of 80.8% and a specificity of 80%. The odds ratio was 16.86 (95% CI = 8.54–33.28). Among the patient variables, age was significant, while among the hospital variables, the type of unit and the Nurse Staffing Level (NSL) were significant. Conclusions: The INTEGRARE scale has robust predictive validity when patients are admitted to medical and surgical inpatient units. Patients with a higher risk of developing HAPUs are in surgical units, are elderly, and have an NSL exceeding 10.4

Umsorgt werden und umsorgen - Leben mit mehreren Langzeiterkrankungen (Leila) : eine qualitative Studie zum Beitrag von APN in integrierter Versorgung

Hintergrund: Das Leben mit mehreren chronischen Krankheiten ist komplex und führt zu einer erhöhten Pflege- und Betreuungsbedürftigkeit. Zur Förderung der integrierten Versorgung wurde ein dreijähriges Projekt namens «Leben mit Langzeiterkrankung» (Leila) initiiert. Ziel: Das Projekt hatte zum Ziel, Leistungen von Pflegeexpertinnen in Advanced Practice Nursing (APN) für chronisch erkrankte Menschen in Zusammenarbeit mit Hausarztpraxen zu entwickeln. Folgende Fragestellungen wurden untersucht: 1. Wie erleben Patient(inn)en, Zuweisende und Pflegeexpertinnen APN das Leila-Dienstleistungsangebot? 2. Wie gestalten sich Zuweisungsprozesse? 3. Wie erleben die Beteiligten die Zusammenarbeit und die APN-Rollenausübung? Methode: Es wurde ein qualitativer Ansatz gemäß Grounded Theory nach Corbin und Strauss gewählt, um Erfahrungen mit Leila und Interaktionen der an Leila beteiligten Personen zu untersuchen. Dabei wurden 38 Interviews mit Patient(inn)en, die mit multiplen chronischen Krankheiten leben, deren betreuende Pflegeexpertinnen APN und zuweisenden Ärzt(inn)en durchgeführt und evaluiert. Ergebnisse: «Umsorgt werden und umsorgen» zeigte sich als zentrale Kategorie. Diese beschreibt wie auf die Patient(inn)en eingegangen wurde, sie einbezogen und ernst genommen wurden. Die Hauptkategorie «Den Alltag gestalten» zeigt, dass die Patient(inn)en lernten, mit den Folgen chronischer Erkrankungen im Alltag umzugehen. «Alle Ressourcen nutzen» legt dar, wie Potenziale und Stärken eingesetzt wurden. Schlussfolgerungen: Die Ergebnisse zu Zuweisungs- und Kooperationsprozessen ergaben, dass die APN-Rollenanerkennung und -ausübung noch ausgehandelt werden muss. Zukünftige APN-Angebote für diese Patient(inn)engruppe sollten nebst Ärztenetzwerken in weitere Dienstleistungen und die Spitex integriert werden. Background: Living with multiple chronic diseases is complex and leads to enhanced care needs. To foster integrated care a project called “Living with chronic disease” (Leila) was initiated. Aim: The aim was to develop an Advanced Practice Nursing (APN) service in collaboration with medical centers for persons who are living with multiple chronic diseases. The following research questions were addressed: 1. What are patients' experiences, referring physicians and APNs with the Leila-Service? 2. How are referral processes performed? 3. How do the involved groups experience collaboration and APN role development? Methods: A qualitative approach according grounded theory of Corbin and Strauss was used to explore the experiences with the Leila project and the interaction of the persons involved. 38 interviews were conducted with patients who are living with multiple chronic diseases, their APN's and the referring physicians. Results: The findings revealed “Being cared for and caring” as main category. The data demonstrated how patients responded to their involvement into care and that they were taken as serious partners in the care process. The category “organizing everyday life” describes how patients learned to cope with the consequences of living with multiple chronic diseases. “Using all resources” as another category demonstrates how capabilities and strengths were adopted. Conclusions: The results of the cooperation- and allocation processes showed that the APN recognition and APN role performance have to be negotiated. Prospective APN-services for this patient population should be integrated along with physician networks and other service providers including community health nursing

EFEITO DE UM INSTRUMENTO PADRONIZADO NA QUALIDADE DE REGISTROS DE ENFERMEIROS: ESTUDO QUASE-EXPERIMENTAL

RESUMO Objetivo: avaliar o efeito da implementação de um instrumento pautado nos sistemas de linguagens padronizadas de diagnósticos, intervenções e resultados na qualidade dos registros de enfermeiros. Métodos: estudo quase-experimental que comparou a qualidade dos registros de enfermeiros por meio do Quality of Diagnosis, Interventions and Outcomes em prontuários de pacientes hospitalizados em unidades cardiovasculares antes e após a implementação de um instrumento padronizado. Resultados: houve significativa melhora na qualidade dos registros após a utilização do instrumento nas dimensões "diagnóstico como processo” (p=0,018), "diagnóstico como produto” (p=0,019) e "resultados de Enfermagem" (

Acurácia das características definidoras dos diagnósticos de enfermagem relacionados à função respiratória em pacientes atendidos pelo time de resposta rápida

Introdução: a inferência de diagnósticos de enfermagem (DE) relacionados à função respiratória é dificultada pela diversidade de diagnósticos relacionados a essa condição com causas e características definidoras (CD) similares. Conhecer o potencial preditor das CD para a inferência de um DE, contribui para a capacidade intuitiva do enfermeiro produzindo diagnósticos que representam com precisão o estado do paciente. Objetivo: avaliar a acurácia das CD dos DE respiratórios Troca de gases prejudicada (TGP), Ventilação espontânea prejudicada (VEP) e Padrão respiratório ineficaz (PRI) em pacientes atendidos pelo time de resposta rápida (TRR). Método: análise transversal, retrospectiva de 391 prontuários de pacientes atendidos pelo TRR com os gatilhos FR35, SpO2 35, oxygen saturation <90%. The DC were inferred from the records and then submitted to sensitivity, specificity, predictive values (positive and negative) and accuracy. Results: the 391 patients evaluated were predominantly males (53.7%), mean age was 62.4 years (± 16.6). The reason for hospitalization was 84.6% clinical and 15.3% surgical. The most prevalent comorbidities were systemic arterial hypertension (50.1%) and Diabetes Mellitus (30.9%). In relation to personal habits, 31.7% of the participants were smokers or smokers in abstinence, and 12.8% had chronic obstructive pulmonary disease, of which 44% were hypercapnic (5.6% of the sample). The PRI diagnosis was the most prevalent ND present in 153 (39.1%) patients, ISV was present in 126 (32.2%) and IGE in 24 (6.1%) cases. The most prevalent trigger was oxygen saturation <90% in 283 (72.4%) of the sample. Nursing was the one that most triggered the RRT in 333 (85.2%) cases. 135 (34.5%) patients were admitted to the intensive care unit and 158 (40.4%) had a hospital death. There was a low accuracy of the isolated DC in relation to respiratory ND. Only the DC hypercapnia and somnolence presented an accuracy greater than 70% for IGE. The group of DC hypercapnia, tachycardia and dyspnea; restlessness and increased in accessory muscle use showed the best accuracy for the diagnoses of IGE and ISV, respectively. None of the DC isolated or grouped showed good accuracy with the IBP diagnosis, although this was the most prevalent ND in the sample. Conclusion: this study demonstrated a low accuracy of the isolated defining characteristics in relation to the respiratory nursing diagnoses listed by nurses in clinical practice. There was an increase in accuracy values when these defining characteristics were analyzed together

Sähköisen potilaskertomuksen rakenteistaminen : Menetelmät, arviointikäytännöt ja vaikutukset

Potilastietoa voidaan hyödyntää moniin eri tarkoituksiin silloin, kun se on tuotettu rakenteistamalla yhtenäisessä muodossa. Raportissa kuvataan, miten rakenteistaminen vaikuttaa hoitotyöhön, kliiniseen potilastyöhön ja potilastiedon toisiokäyttöön ja millä eri tavoilla tieto voidaan rakenteistaa. Raportti perustuu laajaan systemaattiseen kirjallisuuskatsaukseen. Vakioidun termistön käyttö edistää hoitotyön prosesseja ja hoidon jatkuvuutta. Kliinisessä potilastyössä rakenteistamisen vaikutuksia on tutkittu varsin vähän. Rakenteistamisen vaikutuksia hoidon laatuun oli arvioitu yksittäisissä artikkeleissa hoitosuositusten noudattamisen, lääkitysvirheiden vähenemisen, haitallisten lääkeinteraktioiden tai haittatapahtumien seurannan näkökulmista. Potilastiedon toisiokäytön näkökulmasta artikkelit tarkastelivat vaikutuksia kirjaamisen tehokkuuteen, tiedon laatuun, kuten kattavuuteen ja oikeellisuuteen tai arvioivat kirjattua tietoa hyödyntävien tekstilouhintajärjestelmien laatua. Raportti on tuotettu tilanteessa, jossa valtakunnallisia tietojärjestelmäpalveluja ollaan ottamassa käyttöön ja tietojen käyttö laajenee. Tieto erilaisten rakenteistamisen menetelmien vaikutuksista ja käyttömahdollisuuksista tarjoaa perustan kansallisten tietovarantojen ja niiden hyödyntämisen jatkokehitykselle