El informe de continuidad de cuidados como herramienta de comunicación entre atención hospitalaria y atención primaria = The continuity of care report inform as a communication tool between hospital and primary care

Resumen: La importancia de la continuidad de cuidados como medida de seguridad para los pacientes, hace que el informe de continuidad de cuidados (ICC) sea la herramienta de comunicación entre el hospital y atención primaria para conseguirlo. Es tarea de los diferentes niveles asistenciales su puesta en práctica, revisiones periódicas y la evaluación de los resultados tras su implantación. Material y método: Se realizó un estudio descriptivo mediante una revisión bibliográfica en las bases de datos Pubmed y Cuiden plus, de artículos que hacían una evaluación de los ICC por parte del personal de enfermería de atención primaria. Resultados: Las referencias bibliográficas consultadas arrojaron una opinión muy general aunque positiva, de la utilidad de los informes de continuidad de cuidados que se emiten desde el hospital. Es de destacar que no existía una evaluación detallada, de qué aspectos del informe son los que hacían que éste fuese un medio útil para garantizar la continuidad asistencial. Discusión y conclusión: Se hace evidente la necesidad de establecer canales activos de comunicación con el personal de enfermería de atención primaria, para obtener una retroalimentación sobre la utilidad y aspectos de mejora de los informes realizados. Palabras clave: Continuidad de cuidados, Evaluación, Informe de alta de enfermería Abstract: The importance of continuity of care as a measure of safety for patients, makes the continuity of care report the main communication tool between hospital and primary care. The different levels of care have to apply their implementation, the periodic review and the evaluation of results after them. Material and Methods: It´s been done a literature review in databases PubMed and Cuiden Plus, which compilates researches about the assessment of the continuity of care report by nursing staff in primary care. Results: The bibliographical references give a general opinion although positive, about the usefulness of these documents reported from the hospital. Something remarkable is that there is no detailed assessment of those aspects of the report which make them be useful to guarantee the continuity of care. Discussion and conclusion: It is evident the need to establish active forms of communication with primary care nurses to keep a feedback about the usefulness and improvement areas of existing reports. Keywords: Continuity of patient care, Evaluation, Nursing records, Patient discharg

Transferencia de pacientes de cuidados paliativos desde el hospital hasta atención primaria: un estudio cualitativo = Transferring palliative-care patients from hospital to community care: a qualitative study

Aim: To know the experience of case-manager nurses with regard to transferring palliative-care patients from the hospital to their homes. Design: Qualitative phenomenological study carried out in 2014 2015. Setting: Poniente and Almería health districts, which referral hospitals are Poniente Hospital and Torrecárdenas Hospital, respectively. Participants: A purposive sample comprised of 12 case-manager nurses was recruited from the aforementioned setting. Method: Theoretical data saturation was achieved after performing 7 in-depth individual interviews and 1 focus group. Data analysis was performed following Colaizzi’s method. Results: Three themes emerged: (1) ‘Case-management nursing as a quality, patient-centred service’ (2) ‘Failures of the information systems’, with the subthemes ‘‘patients’’ insufficient and inadequate previous information’’ and ‘‘ineffective between levels communication channels for advanced nursing’’; (3) ‘Deficiencies in discharge planning’, with the subthemes ‘‘deficient management of resources on admission’’, ‘‘uncertainty about discharge’’ and ‘‘insufficient human resources to coordinate the transfer’’. Conclusions: Case-manager nurses consider themselves a good-quality service. However, they think there are issues with coordination, information and discharge planning of palliative patients from hospital. It would be useful to review the communication pathways of both care and discharge reports, so that resources needed by palliative patients are effectively managed at the point of being transferred home

Effectiveness of Complementary Therapies in Cancer Patients: A Systematic Review

According to the World Health Organization, cancer is the second leading cause of death in the world. In Spain, about a quarter of a million cases were diagnosed in 2017, and 81% of the Spanish population has used, at least once, some kind of complementary therapy. Said therapies are increasingly being used by cancer patients. The purpose of the study is to analyse the effectiveness of complementary therapies among cancer patients. A systematic peer review was conducted following the PRISMA-ScR guide in four databases (PubMed, CINAHL, Scopus and WOS). The inclusion criteria were Randomised Clinical Trials, published between 2013 and 2018, with a value of 3 or more on the Jadad Scale. The protocol was registered in PROSPERO (CRD42019127593). The study sample amounted to 1845 patients (64.55% women), the most common being breast cancer patients (794), followed by lung cancer patients (341). Fifteen complementary therapies were identified. We found two studies for each of the following: electroacupuncture, phytotherapy, hypnotherapy, guided imagery and progressive muscle relaxation. From the remaining ones, we identified a study on each therapy. The findings reveal some effective complementary therapies: auriculotherapy and acupuncture, laser moxibustion, hypnosis, Ayurveda, electroacupuncture, progressive muscle relaxation and guided imagery, yoga, phytotherapy, music therapy and traditional Chinese medicine. On the other hand, electroacupuncture, laser moxibustion and traditional Chinese medicine presented adverse effects, and kinesiology did not show effectivenes

Promoting dignified end-of-life care in the emergency department: a qualitative study

Background: Preservation of a dying person’s dignity in the emergency department (ED) is fundamental for the patient, his/her relatives and healthcare professionals. The aim of this study was to explore and interpret physicians’ and nurses’ experiences regarding conservation of dignity in end-of-life care in dying patients in the ED. Methods: A qualitative study based on the hermeneutic phenomenological approach, was carried out in the emergency department of two general hospitals. A total of 16 nurses and 10 physicians participated in the study. Data collection included 12 individual in-depth interviews and 2 focus groups. Results: The findings revealed that two themes represent the practices and proposals for the conservation of dignity in the emergency department: dignified care in hostile surroundings and the design of a system focused on the person’s dignity. Conclusion: Dignifying treatment, redesigning environmental conditions, and reorienting the healthcare system can contribute to maintaining dignity in end-of-life care in the ED

Design and psychometric analysis of the COVID-19 prevention, recognition and home-management self-efficacy scale

In order to control the spread of COVID-19, people must adopt preventive behaviours that can affect their day-to-day life. People’s self-efficacy to adopt preventive behaviours to avoid COVID-19 contagion and spread should be studied. The aim of this study was to develop and psychometrically test the COVID-19 prevention, detection, and home-management self-efficacy scale (COVID-19-SES). We conducted an observational cross-sectional study. Six-hundred and seventy-eight people participated in the study. Data were collected between March and May 2020. The COVID-19-SES’ validity (content, criterion, and construct), reliability (internal consistency and test-retest reliability), and legibility were studied. The COVID-19-SES’ reliability was high (Cronbach’s alpha = 0.906; intraclass correlation coefficient = 0.754). The COVID-19-SES showed good content validity (scale’s content validity index = 0.92) and good criterion validity when the participants’ results on the COVID-19-SES were compared to their general self-efficacy (r = 0.38; p 0.001). Construct validity analysis revealed that the COVID-19-SES’ three-factor structure explained 52.12% of the variance found and it was congruent with the World Health Organisation’s recommendations to prevent COVID-19 contagion and spread. Legibility analysis showed that the COVID-19-SES is easy to read and understand by laypeople. The COVID-19-SES is a psychometrically robust instrument that allows for a valid and reliable assessment of people’s self-efficacy in preventing, detecting symptoms, and home-managing COVID-19

Psychometric evaluation and cultural adaptation of the Spanish version of the “Scale for End-of Life Caregiving Appraisal”

Objective: To translate, culturally adapt and psychometrically evaluate the Spanish version of the ‘Scale for End-of Life Caregiving Appraisal’ (SEOLCAS). Methods: Observational cross-sectional study. Convenience sample of 201 informal end-of-life caregivers recruited in a southern Spanish hospital. The reliability of the questionnaire was assessed through its internal consistency (Cronbach’s α) and temporal stability (Pearson’s correlation coefficient (r) between test-retest). The content validity index of the items (I-CVI) and the scale (S-CVI/Ave) was calculated. Its criterion validity was explored through performing a linear regression analysis to evaluate the SEOLCAS’ predictive validity. Exploratory factor analysis was used to examine its construct validity. Results: The SEOLCAS’s reliability was very high (Cronbach’s α=0.92). Its content validity was excellent (all items’ content validity index=0.8–1; scale’s validity index=0.88). Evidence of the SEOLCAS’ criterion validity showed that the participants’ scores on the SEOLCAS explained approximately 79.3% of the between-subject variation of their results on the Zarit Burden Interview. Exploratory factor analysis provided evidence of the SEOLCAS’ construct validity. This analysis revealed that two factors (‘internal contingencies’ and ‘external contingencies’) explained 53.77% of the total variance found and reflected the stoic Hispanic attitude towards adversity. Significance of the results: The Spanish version of the ‘Scale for End-of Life Caregiving Appraisal’ has shown to be an easily-applicable, valid, reliable and culturally-appropriate tool to measure the impact of end-of-life care provision on Hispanic informal caregivers. This tool offers healthcare professionals the opportunity to easily explore Hispanic informal end-of-life caregivers’ experiences and discover the type of support they may need (instrumental or emotional) even when there are communicational and organisational constraints

Design and psychometric evaluation of the 'Clinical Communication Self-Efficacy Toolkit'

Nursing students experience difficulties when communicating in clinical practice. Their self-efficacy in clinical communication should be explored as part of their competence assessment before they are exposed to real human interactions in the clinical setting. The aim of this study was to design and psychometrically evaluate a toolkit to comprehensively assess nursing students’ self-efficacy in clinical communication. The study followed an observational cross-sectional design. A sample of 365 nursing students participated in the study. The ‘Clinical Communication Self-Efficacy Toolkit’ (CC-SET) was comprised of three tools: the ‘Patient-Centered Communication Self-efficacy Scale’ (PCC-SES), the ‘Patient clinical Information Exchange and interprofessional communication Self-Efficacy Scale’ (PIE-SES), and the ‘Intrapersonal communication and Self-Reflection Self-Efficacy Scale’ (ISR-SES). The tools’ reliability, validity (content, criterion, and construct) and usability were rigorously tested. The Cronbach’s alpha coefficient of the three tools comprising the CC-SET was very high and demonstrated their excellent reliability (PCC-SES = 0.93; PIE-SES = 0.87; ISR-SES = 0.86). The three tools evidenced to have excellent content validity (scales’ content validity index > 0.95) and very good criterion validity. Construct validity analysis demonstrated that the PCC-SES, PIE-SES, and ISR-SES have a clear and theoretically-congruent structure. The CC-SET is a comprehensive toolkit that allows the assessment of nursing students’ self-efficacy in interpersonal, interprofessional, and intrapersonal communication

To a paradigm shift to the evaluation of scientific activity into Higher Education

La evaluación actual de la actividad científica se lleva a cabo mediante un mismo patrón internacional. Esta circunstancia ha estimulado un notable número de investigaciones críticas. Sin embargo, la abundancia de críticas contrasta con la falta de propuestas alternativas. En este trabajo se presenta una síntesis de los inconvenientes observados en las prácticas de evaluación, identificando consecuencias negativas para la propia ciencia, sus miembros y su utilidad pública respecto a las Instituciones de Educación Superior. También se añade una revisión de voces alternativas. Finalmente, se propone un conjunto de ocho principios para ayudar a promover un cambio de paradigma.The current assessment of scientific activity is performed by the same international pattern. This has stimulated a remarkable number of critical researches. However, the abundance of critical publications contrasts with the lack of alternative proposals. This paper presents a synthesis of the drawbacks observed in assessment practices, identifying negative consequences for science itself, its members and its public utility, in reference to Higher Education Institutions. A review of alternative voices is also added. Finally, this paper proposes a set of eight principles to assist in promoting a paradigm shift

Experiencias de pacientes en cuidados paliativos sobre comunicación y estados de conciencia al final de la vida. Una teoría fundamentada.

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