L'ACTITUD INFERMERA VERS LA FAMÍLIA: Adaptació transcultural al castellà i validació de l'escala Families' Importance in Nursing Care - Nurses Attitudes (FINC-NA)

L’actitud que adopten les infermeres en relació amb la família és un element cabdal en el procés de cuidar. Però, té la infermera una actitud positiva per oferir una atenció centrada en la família? L’escala Families’ Importance in Nursing Care - Nurses Attitudes (FINC-NA) és un instrument que mesura les actituds infermeres vers la importància de cuidar les famílies des d'una perspectiva d'infermeria genèrica. L’objectiu general d’aquesta tesi és adaptar transculturalment i validar la versió castellana de l’escala FINC-NA en l’àmbit hospitalari. L’estudi, de caràcter mètric i descriptiu, s’ha desenvolupat en tres fases: 1. Procés d’adaptació transcultural, 2. Procés de validació i 3. Anàlisi estadística de la versió castellana de l’escala: La actitud enfermera - La importancia de la familia en los cuidados de enfermería (AE-IFCE). La consistència interna de l’escala AE-IFCE ha estat de 0,90, igual que l’estabilitat temporal. L’anàlisi factorial ha confirmat el model de 4 factors plantejat. La mostra (n = 173) representa un 85,6% de participació. La puntuació de l’escala total ha estat de 81. Cal destacar que les infermeres han obtingut una puntuació lleugerament superior que els infermers. També han obtingut una puntuació més elevada les infermeres que feia 6 anys o més que havien acabat els estudis. Es pot concloure que l’escala AE-IFCE, un cop adaptada i validada al castellà, ha permès identificar que les infermeres enquestades tenen una actitud positiva vers la importància d’incloure la família en el procés de cures dins l’àmbit hospitalari i ha servit per deixar obertes línies d’investigació futures.La actitud que adoptan las enfermeras con la familia es un elemento fundamental en la gestión del cuidado. Pero ¿Tiene la enfermera una actitud positiva para ofrecer una atención centrada en la familia? La escala Families’ Importance in Nursing Care - Nurses Attitudes (FINC-NA) es un instrumento que mide la actitud enfermera sobre la importancia de cuidar las familias desde una perspectiva de enfermería genérica. El objetivo general de esta tesis es adaptar transculturalmente y validar la versión castellana de la escala FINC-NA en el ámbito hospitalario. El estudio, de carácter métrico y descriptivo, se ha desarrollado en tres fases: 1. Proceso de adaptación transcultural, 2. Proceso de validación y 3. Análisis estadístico de la versión castellana de la escala: La actitud enfermera - La importancia de la familia en los cuidados de enfermería (AE-IFCE). La consistencia interna de la escala AE-IFCE ha sido de 0,90, al igual que la estabilidad temporal. El análisis factorial confirmó el modelo de 4 factores planteado. La muestra (n = 173) representa un 85,6% de participación. La puntuación de la escala total ha sido de 81. Cabe destacar que las enfermeras han obtenido una puntuación ligeramente superior que los enfermeros. También se ha observado una puntuación más elevada en las enfermeras que hacía 6 años o más que habían terminado los estudios. Se puede concluir que la escala AE-IFCE, una vez adaptada y validada al castellano, ha permitido identificar que las enfermeras participantes tienen una actitud positiva sobre la importancia de incluir a la familia en los cuidados, en el ámbito hospitalario y ha servido para dejar abiertas futuras líneas de investigación.The attitude adopted by nurses in relation to family is a key element in the process of caring. However, does the nurse have a positive attitude to provide family-centered care? The scale Families' Importance in Nursing Care - Nurses Attitudes (FINC-NA) is an instrument that measures nurses’ attitudes toward the importance of caring for families from a general nursing point of view. The aims of this thesis are cross-cultural adaptation and validate the Spanish version of the scale FINC-NA in the hospital. The study, which is metric and descriptive, has been developed in three phases: 1. Cross-cultural adaptation process, 2. Validation process and 3. Statistical analysis of the Spanish version of the scale: La actitud enfermera – La importancia de la familia en los cuidados de enfermería (AE-IFCE). The internal consistency of the AE-IFCE scale was 0.90 equal to temporal stability. The factor analysis confirmed the proposed four factors model. The sample (n = 173) represents an 85.6% stake. The total scale score was 81. Should be noted that female nurses have received a slightly higher score than male nurses. Also, nurses who finished their studies more than 6 years ago obtained a higher score. It can be concluded that the scale AE-IFCE, once adapted and validated in Spanish, has allowed to identify that nurses surveyed have a positive attitude towards the importance of including the family in the care process in hospitals and have helped to leave open lines for future research

Caring for family caregivers: An analysis of a family-centered intervention

Objetivo Evaluar la efectividad de la Técnica de Resolución de Problemas (TRP) en cuidadoras familiares mediante escalas positivas de ansiedad, depresión y malestar emocional; explorar los factores facilitadores y barreras en su aplicación a partir de la narrativa de las enfermeras. Método Ensayo clínico y grupo focal exploratorio y metodología de análisis mixta. Ilevado a cabo en el Centro de Atención Primaria de Tarragona (España), cuya muestra fue 122 cuidadoras familiares incluidas en el programa de atención domiciliaria y 10 enfermeras del grupo intervención. Grupo experimental aplicación de la TRP, a la cuidadora familiar con síntomas de ansiedad, depresión y malestar percibido. Grupo control la enfermera realiza la intervención habitual. Medición pre-post en ambos grupos. Grupo de discusión con ocho enfermeras del grupo intervención, trascripción y análisis del contenido. Conclusión Se demuestra la efectividad de la TRP en la reducción de ansiedad, depresión y malestar percibido. Se identifican los puntos fuertes y las barreras descritas por las enfermeras en la aplicación de la técnica.
Objective To assess the effectiveness of Problem-Solving Therapy (PST) on family caregivers through the use of scales to measure anxiety, depression and emotional distress; and to explore facilitating factors and obstacles for its use based on the narrative of nurses. Method A clinical trial and an exploratory focus group with the use of mixed analysis methodology. The study was conducted in a primary health care center in Tarragona, Spain, and the sample consisted of 122 family caregivers who were included in the home care service, and 10 nurses who participated in the intervention group. Family caregivers with evident symptoms of anxiety, depression and emotional distress received PST in the intervention group. The intervention group also consisted of a discussion with eight nurses, which was transcribed and submitted to content analysis. Conclusion Problem-Solving Therapy proved to be effective in reducing perceived anxiety, depression and emotional distress. We identified its strong points and obstacles as described by nurses.

Objetivo Avaliar a efetividade da Técnica de Resolução de Problemas (TRP) em cuidadores familiares mediante escalas positivas de ansiedade, depressão e stress emocional; explorar os fatores facilitadores e as barreiras para sua aplicação a partir das narrativas das enfermeiras. Método Ensaio clínico e grupo focal exploratório, com metodologia de análise mista. Realizado em centros de cuidados primários em Tarragona (Espanha), cuja amosta foi de 122 cuidadores familiares, incluindo atendimento domiciliar e 10 enfermeiros no grupo de intervenção. Grupo implementação experimental do TRP, cuidador familiar com sintomas de ansiedade, depressão e desconforto percebido. No grupo controle a enfermeira executa a intervenção habitual. Feita medição pré e pós intervenção em ambos os grupos. Grupo de discussão com oito enfermeiros do grupo de intervenção, transcrição e análise de conteúdo. Conclusão Ficou demonstrada a eficácia da TRP na redução da ansiedade, depressão e desconforto percebido. Foram identificados os pontos fortes e as barreiras na aplicação da técnica.

Pronóstico de la insuficiencia cardíaca aguda basado en datos clínicos de congestión

Acute heart failure; Congestion; Emergency departments; MortalityInsuficiència cardíaca aguda; Congestió; Serveis d'urgències; MortalitatInsuficiencia cardiaca aguda; Congestión; Servicios de urgencias; MortalidadBackground and objectives: This work aims to assess whether symptoms/signs of congestion in patients with acute heart failure (AHF) evaluated in hospital emergency departments (HED) allows for predicting short-term progress. Patients and methods: The study group comprised consecutive patients diagnosed with AHF in 45 HED from EAHFE Registry. We collected clinical variables of systemic congestion (edema in the lower extremities, jugular vein distention, hepatomegaly) and pulmonary congestion (dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, and pulmonary crackles) and analysed their individual and group association with all-cause 30-day of mortality crudely and adjusted for differences between groups. Results: We analysed 18,120 patients (median = 83 years, interquartile range [IQR] = 76-88; women = 55.7%). Of them, 44.6% had > 3 congestive symptoms/signs. Individually, the 30-day adjusted risk of death increased 14% for jugular vein distention (hazard ratio [HR] = 1.14, 95% confidence interval [95%CI] = 1.01-1.28) and 96% for dyspnea on exertion (HR = 1.96, 95% CI = 1.55-2.49). Assessed jointly, the risk progressively increased with the number of symptoms/signs present; compared to patients without symptoms/signs of congestion, the risk increased by 109%, 123 %, and 156% in patients with 1-2, 3-5, and 6-7 symptoms/signs, respectively. These associations did not show interaction with the final disposition of the patient after their emergency care (discharge/hospitalization) with the exception of edema in the lower extremities, which had a better prognosis in discharged patients (HR = 0.66, 95% CI = 0.49-0.89) than hospitalised patients (HR = 1.01, 95% CI = 0.65-1.57; interaction p < 0.001). Conclusion: The presence of a greater number of congestive symptoms/signs was associated with greater all-cause 30-day mortality. Individually, jugular vein distention and dyspnea on exertion were associated with higher short-term mortality.Antecedentes y objetivos: : Evaluar si los síntomas/signos de congestión en pacientes con insuficiencia cardíaca aguda (ICA) atendidos en los servicios de urgencias hospitalarios (SUH) permiten predecir la evolución a corto plazo. Pacientes y métodos: Pacientes consecutivos diagnosticados de ICA en 45 SUH del Registro EAHFE. Recogimos variables clínicas de congestión sistémica (edemas en miembros inferiores, ingurgitación yugular, hepatomegalia) y pulmonar (disnea de esfuerzo, disnea paroxística nocturna, ortopnea y crepitantes pulmonares) analizando su asociación con la mortalidad por cualquier causa a 30 días, de forma cruda y ajustada por diferencias entre grupos. Resultados: Analizamos 18.120 pacientes (mediana = 83 anos, ˜ rango intercuartil [RIC] = 76---88; mujeres = 55,7%). El 44,6% presentaba >3 síntomas/signos congestivos. Individualmente, el riesgo ajustado de muerte a 30 días se incrementó un 14% para la existencia de ingurgitación yugular (hazard ratio [HR] = 1,14, intervalo de confianza al 95% [IC95%] = 1,01−1,28) y un 96% para la disnea de esfuerzo (HR = 1,96, IC95% = 1,55−2,49). Valorados conjuntamente, el riesgo se incrementó progresivamente con el número de síntomas/signos presentes; así, respecto a los pacientes sin síntomas/signos de congestión, el riesgo incrementó un 109%, 123% y 156% en pacientes con 1---2, 3---5 y 6---7 síntomas/signos respectivamente. Estas asociaciones no mostraron interacción con la disposición final del paciente tras su atención en Urgencias (alta/hospitalización), con excepción de edemas en extremidades inferiores, que tuvieron mejor pronóstico en pacientes dados de alta (HR = 0,66, IC95% = 0,49−0,89) que en los hospitalizados (HR = 1,01, IC95% = 0,65−1,57; p interacción <0,001). Conclusión: La presencia de mayor número de síntomas/signos congestivos se asoció a una mayor mortalidad de cualquier causa a los 30 días. Individualmente, la ingurgitación yugular y la disnea de esfuerzo se asocian a mayor mortalidad a corto plazo

Peritumoral immune infiltrates in primary tumours are not associated with the presence of axillary lymph node metastasis in breast cancer: a retrospective cohort study

Background. The axillary lymph nodes (ALNs) in breast cancer patients are the body regions to where tumoral cells most often first disseminate. The tumour immune response is important for breast cancer patient outcome, and some studies have evaluated its involvement in ALN metastasis development. Most studies have focused on the intratumoral immune response, but very few have evaluated the peritumoral immune response. The aim of the present article is to evaluate the immune infiltrates of the peritumoral area and their association with the presence of ALN metastases. Methods. The concentration of 11 immune markers in the peritumoral areas was studied in 149 patients diagnosed with invasive breast carcinoma of no special type (half of whom had ALN metastasis at diagnosis) using tissue microarrays, immunohistochemistry and digital image analysis procedures. The differences in the concentration of the immune response of peritumoral areas between patients diagnosed with and without metastasis in their ALNs were evaluated. A multivariate logistic regression model was developed to identify the clinical-pathological variables and the peritumoral immune markers independently associated with having or not having ALN metastases at diagnosis. Results. No statistically significant differences were found in the concentrations of the 11 immune markers between patients diagnosed with or without ALN metastases. Patients with metastases in their ALNs had a higher histological grade, more lymphovascular and perineural invasion and larger-diameter tumours. The multivariate analysis, after validation by bootstrap simulation, revealed that only tumour diameter (OR = 1.04; 95% CI [1.00-1.07]; p = 0.026), lymphovascular invasion (OR = 25.42; 95% CI [9.57-67.55]; p<0.001) and histological grades 2 (OR = 3.84; 95% CI [1.11-13.28]; p = 0.033) and 3 (OR = 5.18; 95% CI [1.40-19.17]; p = 0.014) were associated with the presence of ALN metastases at diagnosis. This study is one of the first to study the association of the peritumoral immune response with ALN metastasis. We did not find any association of peritumoral immune infiltrates with the presence of ALN metastasis. Nevertheless, this does not rule out the possibility that other peritumoral immune populations are associated with ALN metastasis. This matter needs to be examined in greater depth, broadening the types of peritumoral immune cells studied, and including new peritumoral areas, such as the germinal centres of the peritumoral tertiary lymphoid structures found in extensively infiltrated neoplastic lesions

Handover of Critical Patients in Urgent Care and Emergency Settings: A Systematic Review of Validated Assessment Tools

The emergency handover of critical patients is used to describe the moment when responsibility for the care of a patient is transferred from one critical patient care healthcare team to another, requiring the accurate delivery of information. However, the literature provides few validated assessment tools for the transfer of critical patients in urgent care and emergency settings. To identify the available evaluation tools that assess the handover of critical patients in urgent and emergency care settings in addition to evaluations of their psychometric properties, a systematic review was carried out using PubMed, Scopus, Cinahl, Web of Science (WoS), and PsycINFO, in accordance with PRISMA guidelines. The quality of the studies was assessed using the COSMIN checklist. Finally, eight articles were identified, of which only three included validated tools for evaluating the handover of critical patients in emergency care. Content validity, construct validity, and internal consistency were the most studied psychometric properties. Three studies evaluated error and reliability, criterion validity, hypothesis testing, and sensitivity. None of them considered cross-cultural adaptation or the translation process. This systematic psychometric review shows the existing ambiguities in the handover of critically ill patients and the scarcity of validated evaluation tools. For all of these reasons, we consider it necessary to further investigate urgent care and emergency handover settings through the design and validation of an assessment tool

Influence of Pain and Discomfort in Stroke Patients on Coping Strategies and Changes in Behavior and Lifestyle

The implementation of prevention strategies can reduce the risk of having a stroke. This prospective, longitudinal, multicenter observational study of 82 patients describes health habits, quality of life, coping strategies, and physical and neurological status at 3 months and 1 year after stroke. The EuroQoL-5D quality of life scale (EQ-5D) and the coping strategy measurement scale (COPE-28) were used to assess pain and discomfort, and behavioral and lifestyle changes. Significant differences were observed in the pain or discomfort levels of those patients with behavioral and lifestyle changes. Correlation was also found between pain or discomfort and the coping strategies associated with active emotional support at 1 year after stroke. The results of the pain or discomfort dimension were not, however, associated with better adherence to treatment. Pain and discomfort could have a predictive value in changes in lifestyles and behaviors but not for treatment adherence in patients who have had a stroke, which is significant at 1 year. In addition to important active coping strategies such as social support, these changes in behavior and lifestyle following a stroke are long-term and should therefore be assessed during the initial examination