Consequences of the Covid-19 pandemic on complex multimorbid elderly: Follow-up of a community-based cohort. SAMAC3 Study

©2023. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This document is the Accepted version of a Published Work that appeared in final form in Journal of Nursing Scholarship. To access the final edited and published work see https://doi.org/10.1111/jnu.12860Background: The restrictions imposed during the management of the pandemic led to lack of care of other health problems. Purpose: To assess changes in the health status of complex multimorbidity elderly, functional and cognitive capacities, perception of the social surroundings, care pro vided by the nurses, including nursing diagnosis and interventions, use of health ser vices, adverse events, and use of devices and technical help during the first 6 months of the Covid-19 pandemic. Design: A 1-year longitudinal cohort study was conducted. Methods: Ninety-seven complex multimorbid elderly attended in primary care were evaluated every 3 months in a health area of the Spanish National Health System (SNHS). The research was called “SAMAC3 study”. Results: Significant negative changes were observed in the functional and cognitive ca pacity of the elderly, and in several nursing diagnoses. A decrease was observed in the frequency of visit to the nurses, hospital admittance, length of hospital stays, and falls. Conclusions: The functional and cognitive capacities of the cohort became worse. However, a significant decrease in the frequency of use of health services was ob served. The nurses detected significant changes in activity-exercise, cognitive perception, and roles-relationships, but their interventions were mostly centered on resolving clinical matters that required immediate attention. Clinical Relevance: The present study allowed us to observe that a situation of social and health stress has worsened the health indicators of multimorbid elderly, and the clinical care of community nurses was insufficient to providing care for the deteriora tion of the physical and cognitive domains

Evidence-Based Practice competency and associated factors among Primary Care nurses in Spain

©2021. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This document is the Published version of a Published Work that appeared in final form in Atención Primaria. To access the final edited and published work see https://doi.org/10.1016/j.aprim.2021.102050Objetivo: Conocer el nivel de competencia en Práctica Basada en la Evidencia (PBE) de las enfermeras de Atención Primaria (AP) en Espana˜ y analizar los factores asociados. Diseno: ˜ Estudio transversal de carácter nacional, realizado en enero-marzo de 2020. Emplazamiento: AP en Espana. ˜ Participantes: Setecientas ochenta enfermeras de AP en activo en el Sistema Nacional de Salud con experiencia profesional mínima de un ano. ˜ Mediciones principales: 1) Variables sociodemográficas, profesionales y de acceso a infor mación científica, y 2) variable de resultado: competencia en PBE (actitud, conocimientos, habilidades y utilización), evaluada mediante el cuestionario EBP-COQ Prof©. Se realizaron análisis bivariados y multivariados mediante regresión lineal. Resultados: La puntuación media en el nivel de competencia en PBE de las enfermeras de AP fue de 131,5 (desviación típica [DT] 17,0). Por dimensiones: actitud 36,8 (DT 3,6); conocimien tos 38,2 (DT 8,9); habilidades 23,0 (DT 3,5) y utilización 33,3 (DT 6,1). Leer más de 3 artículos en el último mes es la variable que tiene más influencia sobre todas las dimensiones del EBP COQ Prof©, seguida de la formación en PBE (más de 150 h) y la tutorización de alumnos de Enfermería. El nivel educativo (máster, especialista y doctorado) se asocia con las dimensio nes conocimientos y habilidades, mientras que trabajar en un centro BPSO® se asocia con la utilización de la PBE Conclusiones: Estos hallazgos pueden orientar a los gestores en los servicios de AP a planificar estrategias que mejoren el nivel de competencia en PBE de las enfermeras, dirigidas princi palmente a lograr una aplicación real en la práctica clínica. No obstante, se hace necesario considerar el posible impacto del sesgo de selección en los resultados.Objective: To describe the Evidence-Based Practice (EBP) competency level in Primary Care (PC) nurses in Spain and to determine the associated factors. Design: Cross-sectional, national survey design, carried out between January and March 2020. Setting: PC in Spain. Participants: Seven hundred eighty PC active nurses in the National Health Service with at least one year of professional experience. Main measurements: (1) Sociodemographic, professional and access to scientific information variables; (2) outcome variable: EBP competency (attitude, knowledge, skills and utilization) assessed through the EBP-COQ Prof© questionnaire. Bivariate and multiple lineal regression analyses were carried out. Results: The mean score for the EBP competency of the PC nurses was 131.5 (standard deviation [SD] 17.0), according to dimensions: attitude 36.8 (SD 3.6); knowledge 38.2 (SD 8.9); skills 23.0 (SD 3.5); and utilization 33.3 (SD 6.1). The number of articles read in the last month has showed the most influence on all the EBP-COQ Prof© dimensions, followed by EBP training (more than 150 h) and nursing students mentoring. The education level (master, specialist and doctorate) is associated with knowledge and skills dimensions, meanwhile belonging to a BPSO® center is associated with the EBP utilization. Conclusions: These findings can guide PC service managers to plan strategies that improve the EBP competency level of the nurses, aimed mainly at achieving real application in clinical practice. However, it is necessary to consider the possible impact of selection bias on the results

Percepción del entorno laboral de las enfermeras del Área III de Salud de Lorca tras la implantación del programa de guías de práctica clínica "Centros Comprometidos con la Excelencia en Cuidados"

INTRODUCCIÓN: Las organizaciones sanitarias esperan obtener cada vez mejores resultados en salud de la población a la que atienden. Entre otros aspectos, se requiere que las enfermeras se propongan conseguir la excelencia en los cuidados que prestan. Esto pasa por la actualización constante del conocimiento y habilidades y por la aplicación de las mejores prácticas. Se requiere de un adecuado entorno laboral que favorezca un clima de trabajo adecuado, que apoye las prácticas basadas en la mejor evidencia científica, que habilite los mecanismos para proveer cuidados de calidad y con seguridad y, mejorar así la satisfacción de los profesionales con su trabajo. OBJETIVOS: Conocer si existen cambios en la percepción del entorno laboral que tienen las enfermeras del área III de Salud de Lorca de la Comunidad Autónoma de Murcia tras aplicar el Programa de implantación de Guías de Práctica Clínica “Centros Comprometidos con la Excelencia en Cuidados (CCEC®)”. METODOLOGÍA: Estudio observacional, transversal que compara datos de calidad y seguridad de los cuidados de enfermería y la percepción del entorno laboral de los profesionales de enfermería del área III de Salud de Lorca en 2012 (M0) y 2016 (M1). Se puso en marcha el Programa de implantación de Guías de Práctica Clínica “Centros Comprometidos con la Excelencia en Cuidados (CCEC®)”. La población formada inicialmente por 390 participantes en el año 2012 y 395 en 2016, 100% del personal de enfermería y matronas adscritos a la División de Enfermería. Profesionales de enfermería de atención hospitalaria y comunitaria que tenían algún tipo de relación laboral con el Servicio Murciano de Salud, Área III en el momento de realizar el estudio y que se encontraban en servicio activo. Variables sociodemográficas, laborales, actitud ante la PBE, sobre percepción del entorno y satisfacción laboral, así como percepción de los profesionales de la calidad de los cuidados que prestan y seguridad del paciente. Instrumentos para la recogida de datosconstituido por 5 bloques que contenían los cuestionarios: Enfermería Basada en la Evidencia Actitud (CAPEBE). Ruzafa-Martínez (2011); Clima organizacional, Koys & Decottis (1991) y Satisfacción de los Profesionales de Enfermería y Percepción de la Calidad de los Cuidados y de la Seguridad del Paciente.Resultados significativos estadísticamente para p<0,05. Los datos se introdujeron en una base de datos y el análisis se efectuó con el paquete estadístico SSPS para Windows versión 21.0. RESULTADOS:Han participado en total 451 profesionales, 219 en la primera medida (M0) de un total de 363 profesionales de enfermería, tasa de respuesta del 60,33% y 232 en M1, de un total de 368 profesionales, tasa de respuesta del 63,04%. 75% (159) de los profesionales mujeres y en la segunda el 74,2% (170), (Ji cuadrado 0,034; p = 0,854). La percepción de los profesionales de enfermería sobre el porcentaje de aplicación de la PBE en su entorno clínico es de un 55,11% (IC 95% 51,2 – 58,9) de media en 2012 y 55,41% (IC 95% 52,2 – 58,5) en 2016 (U de Mann-Withney 24810,0; p = 0,723). Las puntuaciones más bajas en el clima organizacional se observan en las dimensiones “Reconocimiento” y “Presión”. Las puntuaciones más altas se observan en las dimensiones “Confianza” y “Apoyo”. Están muy satisfechas con la elección de enfermería como profesión y las enfermeras muy satisfechas es algo superior en M1 (Ji cuadrado 4,71; p = 0,194). 76% de profesionales de M0 y un 82% de M1 señalan que están moderadamente o muy satisfechas con el trabajo actual (Ji cuadrado 4,24; p = 0,237). Trabajar en atención primaria, percibir que los recursos humanos son adecuados, y que se tienen oportunidades de desarrollo profesional se asocia de manera positiva con la percepción de la calidad de los cuidados. CONCLUSIONES: Los resultados del presente estudio nos permiten conocer la situación local, en términos de los perfiles profesionales y las características laborales de las enfermeras, comparándonos con los contextos regionales, nacionales e internacionales. Así, seremos capaces de gestionar con la mejor información disponible los recursos humanos enfermeros. El Programa de implantación de Buenas Prácticas en Cuidados Centros Comprometidos con la Excelencia en Cuidados®, ha significado un revulsivo en la organización que nos ha obligado a evaluar la organización en general y en particular; el impacto de sus resultados en profesionales y pacientes requiere tiempo, pero nos ha permitido saber en qué situación estamos y que podemos necesitar para mejorar la práctica profesional y los resultados en salud de los pacientes y garantizar unos cuidados de máxima calidad a partir de la experiencia personal y dentro del contexto de la práctica diaria.Este estudio es el primero que se realiza en el contexto español, en el que se evalúa el entorno laboral de las enfermeras tras la implantación del Programa Implantación de Buenas Prácticas en Cuidados en Centros Comprometidos con la Excelencia en Cuidados® y aporta datos sobre las características del ambiente organizacional en el que las enfermeras del Área III de Lorca implantan las evidencias que ofrecen las Guías de Buenas Prácticas de la RNAO®.   BACKGROUND:The health organizations hope to achieve better health outcomes for the population they serve. Among other aspects, it is required that nurses intend to achieve excellence in the care they provide. This involves constant updating of knowledge and skills and application of best practices. It requires an adequate working environment that favors an adequate working climate, that supports practices based on the best scientific evidence, that enables the mechanisms to provide quality and safe care and, thus, improve the satisfaction of professionals with their work. AIM:To know if there are changes in the perception of the work environment that nurses in the Health Area III of Lorca of the Community of Murcia after applying the Program of Implementation of Guidelines of Clinical Practice "Best Practices Spotlight Organizations (BPSO®)”. METHOD: Cross-sectional, observational study comparing data on quality and safety of nursing care and perception of the working environment of nursing professionals in Health Area III of Lorca in 2012 (M0) and 2016 (M1). The Program for the Implementation of Guidelines for Clinical Practice "Best Practices Spotlight Organizations (BPSO®)” was establish. The population initially formed by 390 participants in 2012 and 395 in 2016, 100% of nurses and midwives ascribed to the Division of Nursing. Nursing professionals in hospital and community care who had some kind of working relationship with the Murciano Health Service, Area III at the time of the study and who were in active service. Socio-demographic, labor variables, attitude to the EBP, about the perception of the environment and job satisfaction, as well as the perception of the professionals of the quality of the care they provide and patient safety. Data collection instruments consisted of 5 blocks containing the questionnaires: Evidence-Based Nursing Attitude (CAPEBE). Ruzafa-Martínez (2011); Organizational climate, Koys & Decottis (1991) and Satisfaction of Nursing Professionals and Perception of Quality of Care and Patient Safety. Statistically significant results for p <0.05. The data was entered into a database and the analysis was performed with the SSPS statistical package for Windows version 21.0. RESULTS: A total of 451 professionals participated, 219 in the first measure (M0) of a total of 363 nursing professionals, a response rate of 60.33% and 232 in M1, out of a total of 368 professionals, response rate 63.04%. 75% (159) of female professionals and in the second, 74.2% (170), (Chi square 0.034, p = 0.854). The perception of nursing professionals about the percentage of application of EBP in their clinical environment is 55.11% (CI 95% 51.2 - 58.9) on average in 2012 and 55.41% (IC 95 % 52.2-58.5) in 2016 (U of Mann-Withney 24810.0, p = 0.723). The lowest scores in the organizational climate are observed in the dimensions "Recognition" and "Pressure". The highest scores are seen in the "Confidence" and "Support" dimensions. They are very satisfied with the choice of nursing as a profession and highly satisfied nurses are somewhat higher in M1 (Chi square 4.71, p = 0.194). 76% of M0 professionals and 82% of M1 indicate that they are moderately or very satisfied with the current work (Chi square 4,24, p = 0,237). Working in primary care, perceiving that human resources are adequate, and having opportunities for professional development is positively associated with the perception of quality of care. CONCLUSIONS:The results of the present study allow us to know the local situation, in terms of professional profiles and work characteristics of nurses, compared to regional, national and international contexts. Thus, we can manage the human resources of nurses with the best available information. The Clinical Practice Guidelines Implementation Program "Best Practices Spotlight Organizations (BPSO®)" has meant a revulsive in the organization that has forced us to evaluate the organization in general and in particular. The impact of their results on professionals and patients requires time. But it has allowed us to know in what situation we are and what we may need to improve professional practice and results in the health of patients and ensure a high quality care based on personal experience and in the context of daily practice. This is the first research carried out in the Spanish context, which evaluates nurses' work environment after the implementation of the Clinical Practices Program "Best Practices of Outstanding Organizations (BPSO®)" and provides data on the characteristics of the environment In which the nurses of Area III of Lorca implement the evidence offered by the best practice guideline of RNAO

Competencia en Práctica Basada en la Evidencia y factores asociados en las enfermeras de Atención Primaria en España.

To describe the Evidence-Based Practice (EBP) competency level in Primary Care (PC) nurses in Spain and to determine the associated factors. Cross-sectional, national survey design, carried out between January and March 2020. PC in Spain. Seven hundred eighty PC active nurses in the National Health Service with at least one year of professional experience. (1) Sociodemographic, professional and access to scientific information variables; (2) outcome variable: EBP competency (attitude, knowledge, skills and utilization) assessed through the EBP-COQ Prof© questionnaire. Bivariate and multiple lineal regression analyses were carried out. The mean score for the EBP competency of the PC nurses was 131.5 (standard deviation [SD] 17.0), according to dimensions: attitude 36.8 (SD 3.6); knowledge 38.2 (SD 8.9); skills 23.0 (SD 3.5); and utilization 33.3 (SD 6.1). The number of articles read in the last month has showed the most influence on all the EBP-COQ Prof© dimensions, followed by EBP training (more than 150h) and nursing students mentoring. The education level (master, specialist and doctorate) is associated with knowledge and skills dimensions, meanwhile belonging to a BPSO® center is associated with the EBP utilization. These findings can guide PC service managers to plan strategies that improve the EBP competency level of the nurses, aimed mainly at achieving real application in clinical practice. However, it is necessary to consider the possible impact of selection bias on the results

Changes in nurse job outcomes after 4 years of a Best Practice Spotlight Organization® programme implementation in the Spanish National Health Context

Aim: To evaluate the changes produced after the application of the Best Practice Spotlight Organization® (BPSO® ) Program on the attitude towards the evidence-based practice, the nurses' perception of the organisational climate and nurse outcomes in a health area of the Spanish National Health System. Background: There is limited research that associates strategies of evidence-based practice implementation with changes on the work environment and nurse outcomes. Methods: Cross-sectional study that compared data on the nurses' perception of the work environment. Five guidelines were implemented between 2012 and 2015 in a health area. Data were collected in 2012 and 2016/2017, using a questionnaire consisting of five previously validated tools. X2 , t test, ANOVA and multivariate analysis were carried out. Results: A total of 451 nurses participated. Compared with the baseline evaluation in 2012, several outcomes changed significantly (p < .001), nurses were younger and were more satisfied with "salary", "annual leaves" and "sick leave". The rest of the nurse outcomes were not modified. Conclusions: Nurses' perception of the work environment is favourable, although the application of the BPSO® Program has not produced any major changes. Implications for nursing management: Measures are suggested that are oriented towards the planning of staffing and the increase in the participation of the nursing staff in programmes of implementation of guidelines. Keywords: BPSO; Evidence-based Practice; clinical practice guideline; job satisfaction; organisational climate; patient safety; quality of care

Effects of a Clinical Simulation-Based Training Program for Nursing Students to Address Social Isolation and Loneliness in the Elderly: A Quasi-Experimental Study

Introduction: The population of older adults is rapidly increasing worldwide, presenting both prospects and complexities for society and healthcare professionals to maximize the functional capacity of this age group. Social isolation and loneliness significantly affect this population. The objective was to determine the effectiveness, satisfaction, and perceptions of the simulation-based education practices of a training program for nursing students, which was created to palliate the social isolation and loneliness of older adults. Method: A quasi-experimental study was conducted with nursing students who participated in an online training program using teleservice based on high-fidelity clinical simulation. The program included asynchronous theoretical training and synchronous practical training using an online platform. Five scenarios were designed using simulated phone calls to address the social isolation and loneliness of older adults. Results: Twenty-five nursing students participated in the program, and they had a mean age of 27.44, with 76% of them being women. After the training program, the participants showed statistically significant improvements (p < 0.05) with respect to their knowledge and attitudes towards older adults, and the program was adapted to the best educational practices in simulations. Conclusions: Simulation-based online training efficiently improved the knowledge and attitudes of nursing students towards older adults, improving their ability to address social isolation and loneliness. The high satisfaction and adhesion to the best educational practices underline the usefulness of high-fidelity online simulations, especially in situations in which face-to-face training is not feasible, and accessibility and equilibrium could be guaranteed between work and personal life