Promoting empowerment and self-care in older women through participatory action research: Analysis of the process of change

Aim: To generate and understand the process of change in the empowerment of women from 60 to 80 years old through a Participatory Action Research. Specific aim: To analyse the women participants' experiences concerning empowerment and self-care. Design: We use the Participatory Action Research approach (in its critical option) in the Socio-critical Paradigm and applying the Kemmis and McTaggart Model. Methods: A group of 10 women participants from 60 to 80 years old was created and developed the Participatory Action Research from June 2019 to May 2020. This group was involved in 22 group sessions, individual interviews, reflective diaries and triangulation with quantitative data. Results: Findings were interpreted based on the Gestalt Self Theory. Women generated changes in their empowerment based on three characteristics (self-determination, self-esteem and self-confidence) and, consequently, in their self-care. They did so according to two distinct patterns of behaviour: Leader women and follower women. The former took the lead in transforming their realities and the latter observed them and evolved in a slower and more reflective manner. These changes had an impact on the most individual level (inner world) and went beyond that barrier, modifying in turn their immediate surroundings and the social level (outer world). Conclusions: The group of older women began to consider their needs and consider themselves as important once they worked on their self-determination, self-esteem and self-confidence; we show these are key aspects to work on their empowerment and promote their self-care. Impact: The patterns of behaviour and dimensions of empowerment detected may help in future research designs and emancipatory community interventions in this population group.S

Effects of nursing interventions to improve inpatients' sleep in intensive and non‐intensive care units: Findings from an umbrella review

AbstractAim: This review aimed to synthesise the available reviews on the effects of nursing interventions on sleep quality among patients hospitalised in intensive care and non-intensive care units.Background: Poor sleep quality is a common fact in hospitalised patients. Nurses can contribute to the improvement of patients' sleep quality and duration.Design: A review of intervention reviews was carried out and reported following the PRISMA guidelines and checklist.Methods: We systematically searched for reviews published from January 2009 to December 2019 in PubMed, CINAHL Plus, Scopus, Institute for Scientific Information Web of Science, Joanna Briggs Database of Systematic Reviews and Cochrane Central Register of Controlled Trials databases. Searches were repeated at 24 November 2020 to include the most recent evidence. A narrative synthesis of the results was conducted.Results: Nine reviews (representing 109 original papers) met the selection criteria and were included for critical appraisal. Overall, nursing interventions and sleep quality were poorly defined. We grouped the interventions into 3 categories (environmental, barrier and internal interventions) to provide a more comprehensive overview and ex-amine effects of nursing interventions on inpatients sleep quality. Inconsistent results were obtained and low quality of the original articles was reported, making it difficult to establish absolute conclusions.Conclusion: The impact of environmental changes on patients’ sleep was positive but inconclusive, while use of earplugs and eye masks, music and acupuncture generally showed positive results with moderate quality of evidence, and no harmful effects were reported.S

Effectiveness of participatory-action-research to put in practice evidence at a nursing onco-hematology unit

The aim was to evaluate the effectiveness of evidence implementation through participatory-action research (PAR). A prospective quasi-experimental design with two non-equivalent and non-concurrent groups (2006 and 2008) was adopted. The research was conducted at the bone marrow transplant unit of a tertiary-level Spanish hospital. To put the evidence in practice, PAR was adopted as an "intervention studied". The dependent variables were: professional performance and patient outcomes (psycho-emotional area and adverse effects). In total, 125 patients were recruited (1st period=56; 2nd period=69). The results in the second period show significant improvements in professional performance in terms of the quality of the registers of signs and symptoms. In the psycho-emotional area, the psycho-social adjustment improved significantly; without caregiver burden or satisfaction showing any clear tendencies. Among the adverse effects, catheter-related thrombosis and catheter-related infection improved significantly; there were no significant differences in the level of pain or mucositis. Through the PAR, evidence could be put in practice and the outcomes under analysis could be improved.La finalidad fue evaluar la efectividad de la implantación de evidencias mediante una investigación-acción-participante (IAP). Diseño cuasi-experimental prospectivo con dos grupos no equivalentes ni concurrentes (2006 a 2008) en una unidad de enfermería de trasplante de medula ósea de un hospital español de tercer nivel. La intervención estudiada fue la implantación de evidencias mediante una IAP. Las variables dependientes: desempeño profesional y resultados de salud (área psico-emocional y efectos adversos). Se reclutaron 125 pacientes (1er grupo=56; 2º grupo=69). Se aprecia una mejoría significativa en el segundo grupo en la calidad de los registros de valoración de signos y síntomas. En el área psico-emocional, el ajuste psico-social mejora significativamente; no hay cambios en la sobrecarga ni la satisfacción. En efectos adversos, la obstrucción e infección relacionada con catéter mejoran significativamente; no hay diferencias en dolor y mucositis. La IAP ha servido para implantar evidencias y mejorar los resultados de salud.O objetivo deste estudo foi avaliar a efetividade da aplicação de evidências pela pesquisa-ação-participante (PAR). Como método usou-se o desenho quase-experimental prospectivo, com dois grupos não equivalentes e concorrentes (2006-2008), em uma unidade de enfermagem para transplante de medula óssea de hospital terciário espanhol. A intervenção estudada foi a integração de evidências pela PAR. As variáveis dependentes estudadas foram: o desempenho profissional e os resultados de saúde nos pacientes (área psicoemocional e efeitos adversos). Recrutaram-se 125 pacientes (Grupo 1=56, Grupo 2=69). Pôde-se observar pelos resultados melhora significativa no segundo grupo, na qualidade dos registros de enfermagem na avaliação de sinais e sintomas do paciente. Na área psicoemocional, o ajuste psicossocial do paciente melhorou significativamente, porém, nenhuma mudança foi observada na sobrecarga do cuidador ou satisfação do paciente. Em relação aos efeitos adversos, tanto o bloqueio quanto a infecção relacionada ao cateter melhoraram significativamente, mas não foi encontrada nenhuma diferença na dor nem na mucosite. Conclui-se que a PAR tem servido para apresentar evidências e melhorar os resultados de saúde

Fall prevention in older people and their families: a qualitative synthesis

Objetivo: Analizar y sintetizar la evidencia sobre la prevención de las caídas de las personas mayores de 65 años y los proveedores de cuidados familiares. Método: Síntesis cualitativa que forma parte de una revisión sistemática integrativa de diseño convergente. Se retuvieron 41 estudios cualitativos para su lectura a texto completo y quedaron seleccionados nueve estudios de proveedores de cuidados familiares. Resultados: Las relaciones de parentesco y de cuidados median en las intervenciones de los familiares para prevenir las caídas de las personas mayores; la caída de la persona dependiente constituye un punto de inflexión en estas relaciones. Las personas cuidadoras son un grupo vulnerable de sufrir una caída, y por ello son merecedoras de acciones preventivas. Conclusiones: Considerar el contexto de las relaciones familiares y de cuidados mejorará la eficacia de las intervenciones preventivas y facilitará su aceptación. Las políticas y los programas de prevención de las caídas deben prestar mayor atención a la salud y el bienestar de los/las proveedores/as de cuidados familiares.Objective: To analyse and synthesize the evidence on fall prevention of people older than 65 years and their family care providers Method: Qualitative synthesis, which is a part of a convergent systematic integrative review. Forty-one qualitative studies were retained for full text scrutiny. Nine studies on family care providers were selected for this synthesis. Results: Care providing, and kinship relationships mediated family care providers’ interventions to prevent falls in older people. The fall of the dependent relative constitutes a turning point in these relationships. Family care providers are vulnerable to having a fall themselves and therefore receivers of preventive interventions. Conclusions: Taking into account the context of care and family relations will improve the effectiveness of preventive interventions and will facilitate adherence. Fall prevention policy and programmes must pay better attention to the health and wellbeing of family care providers.Proyecto financiado por el Instituto Nacional de Salud Carlos III - Ministerio de Economía, Industria y competitividad - Fondo Europeo de Desarrollo Regional (FEDER). PI 15/01351

Relationship between Falls and the Use of Medications and Diseases in an Otago Exercise Programme in Old People Living in the Community in Spain

Background: Falls are a significant health problem among older adults, and can result in severe injuries, disability, and even death. In Spain, the prevalence of falls is lower if the person lives in the community than if they are institutionalized. Research has shown that exercise is an effective strategy for reducing the risk of falls among older adults. The objective of this study was to study the influence of a multicomponent exercise intervention on falls in people between 65 and 80 years of age despite the presence of diseases and drug use that are risk factors for falls. Methods: This is a quasi-experimental study that focuses on people aged 65-80 who attended 21 primary healthcare centres. Target: Inclusion criteria were people between 65 and 80 years of age, living in the community with independent ambulation, and who were served by the healthcare centre of their region. Variables analysed: The number and characteristics of falls, sociodemographic, drug use, and previous diseases. Results: The drugs associated with falls are benzodiazepines (OR 2.58), vasodilators (OR = 2.51), and psychotropics (OR = 1.61). For one of the years, a relationship was found between the consumption of antidepressants and falls (OR = 1.83). The associated diseases were mental and behavioural (OR = 2.53). Discussion: The intervention has been related to the reduction in falls in people who consumed benzodiazepines, vasodilators, and psychotropics and in people with mental disorders. Conclusion: This research concludes the importance of the implementation of the Otago Exercise Programme in the prevention of falls in the elderly.This study was supported by the Health Research Fund PI16CIII/00031, ISCIII (Spanish Institute of Health Carlos III; grant number PI16/00821) and co-funded by ERDF “A way to make Europe”, the Region of Asturias PI16/00821, the Region of Murcia (CARM, FFIS17/AP/02/04), the Region of the Basque Country (2016111005) and the Carlos III Health Institute through the REDISSEC (RD12/0001/0016), RETICEF (RD12/0043/0006) and CIBERFES (CB16/10/00468). Open access was funded by the Official College of Nursing of the Principality of Asturias (CODEPA). The study protocol was previously published (Albornos-Muñoz et al., 2018) and registered on ClinicalTrials.org (NCT03320668).S

The care in the prevention of falls in elderly people: Meta-summary of qualitative articles

Objetivo: Resumir la evidencia cualitativa sobre el papel de los proveedores de cuidados en la prevención de las caídas de personas mayores de 65 años en centros y en la comunidad. Diseño: Metarresumen de evidencias cualitativas siguiendo el método de agregación. Fuentes de datos: Búsqueda manual y extensiva en 16 bases de datos (CINAHL, Pubmed/Medline, Embase, PsycInfo, Cochrane Library, PeDRO, Opengrey [Reports], Cuiden, Cuidatge, Enfispo, Medes, Lilacs, Teseo, Dissertation and Thesis Global e Ibecs), en inglés, francés, español y portugués; sin límite temporal. Selección de estudios: Selección y valoración crítica ciega por pares. Se realizó un primer cribado de relevancia y pertinencia y un segundo cribado de valoración crítica. Se localizaron 4.170 artículos; se evaluaron críticamente 41 artículos cualitativos y se seleccionaron 31. Extracción de datos: Se extrajeron datos relativos al autor, año, diseño de estudio, lugar, participantes (número, edad, sexo y ocupación), métodos del estudio y hallazgos. Se realizó un análisis descriptivo y temático. Resultados: El análisis reveló 4 grandes temas: factores precipitantes, modelos preventivos, sentimientos y proceso de toma de decisiones. Destaca también el difícil acto del equilibrio ético, el papel de la institución en la prevención y la fragmentación del cuidado, como claves para una implantación exitosa. Conclusiones: Los hallazgos manifiestan la complejidad de la prevención en caídas y la necesidad de incorporar opiniones de los proveedores de cuidados en los modelos preventivos.Objective: To summarize the qualitative evidence on the role of care providers in the prevention of falls of persons over 65 years of age in centres and in the community. Design: Meta-summary of qualitative evidence following the aggregation method. Data sources: Extensive manual search of 16 databases (CINAHL, Pubmed/Medline, Embase, PsycInfo, Cochrane Library, PeDRO, Opengrey (Reports), Cuiden, Cuidatge, Enfispo, Medes, Lilacs, Teseo, Dissertation and Thesis Global and Ibecs), in English, French, Spanish and Portuguese; no time limit. Selection of studies: Selection and blind critical appraisal by pairs. A first relevance and relevance screening and a second critical appraisal screening were carried out. A total of 4170 articles were located; 41 qualitative articles were critically appraised and 31 were selected. Data extraction: Data regarding author, year, study design, location, participants (number, age, sex and occupation), study methods and findings were extracted. Results: The analysis revealed four major themes: precipitating factors, preventive models, feelings and decision-making process. It also highlights the difficult act of ethical balance, the role of the institution in prevention and the fragmentation of care, as keys to successful implementation. Conclusions: The findings show the complexity of fall prevention and the need to incorporate care providers’ opinions in preventive models.Proyecto financiado por el Instituto de Salud Carlos III-Ministerio de Economía, Industria y Competitividad - Fondo Europeo de Desarrollo Regional (FEDER). PI 15/01351

Falls prevention among older people and care providers: Protocol for an integrative review

Aim. To review the evidence about the role of care providers in fall prevention in older adults aged ≥ 65 years, this includes their views, strategies, and approaches on falls prevention and effectiveness of nursing interventions. Background. Some fall prevention programmes are successfully implemented and led by nurses and it is acknowledged the vital role they play in developing plans for fall prevention. Nevertheless, there has not been a systematic review of the literature that describes this role and care providers' views on fall's prevention initiatives. Design. A convergent synthesis of qualitative, quantitative, and mixed methods studies. The eligibility criteria will be based on participants, interventions/exposure, comparisons, and outcomes for quantitative studies and on population, the phenomena of interest and the context, for qualitative studies. To extract data and assess study qualities members of the research team will work in pairs according to their expertise. The review will follow the guidelines for integrative reviews and the proposed methods will adhere to the PRISMA statement checklist complemented by the ENTREQ framework. As qualitative synthesis are emergent, all procedures and changes in procedure will be documented. Discussion. The review has a constructivist drive as studies that combine methods ought to be paradigmatic driven. Review questions are broad to allow issues emerge and have purposefully left the design flexible to allow for adjustments as the review progresses. The review seeks to highlight the roles that care providers play in fall prevention and their views on fall's prevention initiatives.Authors receive funds to conduct this review from the National Institute of Health Carlos III-Ministerio de Economia y Competitividad. Madrid, Spain-Grant PI 15/01351

Evaluación del impacto de un plan de cuidados de enfermería de pacientes con EPOC con diagnóstico enfermero “Manejo inefectivo del régimen terapéutico”, en términos de mejora del criterio de resultado de enfermería (NOC) “Conocimiento del régimen terapeut

Purpose: To determine the impact on the "Knowledge of the therapeutic regimen," in patients with a care plan on "ineffective management of therapeutic regimen." Methods: Quasi-experimental study in two General Hospitals University (June 2007 - December 2008) COPD patients. Group intervention: care plan developed by taxonomies; Control group: usual hospital care.Findings: 143 patients were Recruited (Intervention group = 56, control group = 87). NOC improvement at 2 weeks (69.2% vs 10.7% intervention control; p <.008); NOC improvement at 24 weeks (68.7% vs.10.1%; p <.001). Indicators "description regimen justification"; "Prescribed activity"; "Treatment benefit" better with p <.001. Conclusions: The implementation of a discharged plan care direct to increase the nursing outcome classification  improves management of therapeutic regimen. Implications for nursing practice: The implementation of taxonomies in care planning discharged are a tool that allow to evaluate outcomes of nursing interventions and its evolution.Objetivo: Conocer el impacto en el “Conocimiento del régimen terapéutico”, en pacientes con un plan de cuidados sobre “Manejo inefectivo del régimen terapéutico”. Método: Estudio cuasiexperimental, en dos Hospitales Generales Universitarios (junio 2007 - diciembre 2008) pacientes con EPOC. Grupo intervención: plan de cuidados desarrollado mediante taxonomías; grupo control: asistencia hospitalaria habitual. Resultados: 143 pacientes incluidos en el estudio (grupo intervención=56; grupo control =87). Mejora NOC a las 2 semanas (69.2% intervención vs. 10,7% control; p<,008); mejora NOC a las 24 semanas (68.7% vs.10.1%,  p<,001). Indicadores “descripción justificación régimen terapéutico”; “actividad prescrita”; “beneficios del tratamiento” mejoran con p< ,001. Conclusiones: La implementación de un plan de cuidados dirigido al alta orientado al incremento del NOC mejora el manejo del régimen terapéutico.Implicaciones para la práctica: La implementación de taxonomías en planificación de cuidados orientados al alta constituyen una herramienta para evaluar resultados de las intervenciones enfermeras y su evolució