Uso y actitud hacia el diagnóstico enfermero: Revisión integrativa y análisis de patrones en dos muestras internacionales

[spa] INTRODUCCIÓN: Existe un interés creciente internacional en averiguar qué factores se encuentran detrás de un uso irregular del diagnóstico enfermero. Las actitudes hacia el mismo se han posicionado como un importante factor asociado con su uso. No obstante, la unidireccionalidad de la actitud como determinante de la conducta sigue siendo una cuestión a día de hoy, debido a que existen otros factores cognitivos que pueden determinar la conducta. Estas lagunas sugieren que el control conductual percibido y la norma subjetiva, como factores cognitivos enmarcados en la Teoría de la Conducta Planificada, podrían determinar el uso del diagnóstico enfermero de la misma manera que lo hacen las actitudes. Asimismo, el hecho que en estudios previos, el campo de trabajo haya sido una variable relacionada con la actitud, induce a pensar que los entornos de práctica enfermera podrían conformar la norma subjetiva e influir sobre el uso del diagnóstico. Por lo que investigar estos factores llevará a conocer qué otros determinantes están detrás de un uso irregular de diagnóstico enfermero. Esto permitirá guiar las estrategias de implantación en las instituciones de salud y que éstas aborden diferentes factores organizativos y profesionales. OBJETIVO: Describir el uso y actitud de las enfermeras hacia el diagnóstico enfermero, y su relación con el control conductual percibido y las normas subjetivas enmarcadas en los entornos de práctica enfermera. MÉTODOS: Estudio de diseño transversal llevado a cabo en tres fases. En la fase 1 se realizó una revisión bibliográfica de acuerdo con las recomendaciones de Whittemore y las directrices PRISMA mediante búsqueda en bases de datos electrónicas a partir de descriptores y palabras claves. En la fase 2 se llevó a cabo un diseño transversal por conglomerados mediante encuesta en formato electrónico. La muestra fue de conveniencia en enfermeras del ámbito de atención primaria y se obtuvo a través de la dirección enfermera del Ámbito de Atención Primaria de Cataluña. En la fase 3, se llevó a cabo un diseño transversal por conglomerados mediante una encuesta en una muestra binacional (Italia y España). Las enfermeras italianas fueron reclutadas en dos hospitales (hospital universitario y hospital general) del centro de Italia. En España, las enfermeras fueron reclutadas de los centros de Atención Primaria de Cataluña. RESULTADOS: En primer lugar la fase 1 obtuvo que catorce estudios incluidos aglutinaban un total de 2497 enfermeras estudiadas. Cinco estudios utilizaron metodología cualitativa para abordar el estudio de las actitudes, opiniones y experiencias de las enfermeras, y nueve utilizaron metodología cuantitativa para estudiarlas. La calidad de los estudios seleccionados fue media para el 64,2% de los artículos y alta para el 35,71% de los artículos (artículo pendiente de envío a revista). En segundo lugar, de la fase 2 se obtuvo una muestra de 239 enfermeras que respondieron correctamente al cuestionario completo. La mayoría de las enfermeras trabajaban en el campo asistencial, mientras que sólo el 15% trabajaban en el campo de gestión de salud o servicios. Las enfermeras pertenecientes a grupos con una mayor tasa de utilización del diagnóstico enfermero mostraron actitudes más positivas hacia el DE. La edad se asoció con mayor utilización del diagnóstico enfermero (p=0.014) y el campo de trabajo con la actitud hacia el DE (p=0,031). Los análisis realizados han mostrado que las enfermeras que trabajaban en entornos de práctica enfermera favorables, pertenecían a los grupos con actitud más positiva (p<0,001) y una mayor tasa de utilización del diagnóstico enfermero (p=0,034) con diferencias significativas entre conglomerados. Y en tercer lugar, la fase 3 obtuvo una muestra de 549 enfermeras, en la cual, la muestra española e italiana los niveles de actitud, intención y comportamiento eran generalmente más altas para los grupos con niveles de creencias (conductuales, normativas y de control conductual) más altas de manera significativa. CONCLUSIONES: La actitud hacia el diagnóstico enfermero se ha mostrado una vez más como un importante factor asociado con su uso. El campo de trabajo continúa siendo una variable determinante en las actitudes, y las variables demográficas por primera vez han mostrado tener una relación estrecha con el uso del diagnóstico enfermero. Por otro lado, la norma subjetiva evaluada mediante los entornos de práctica enfermera se ha posicionado como un factor relacionado con su uso del diagnóstico enfermero y un factor asociado a la actitud hacia el mismo. Por último, el control conductual percibido también ha mostrado ser determinante en la intención y uso del diagnóstico enfermero, por lo que podemos concluir que la Teoría de la Conducta Planificada podría ser adecuada para una mejor comprensión de los factores influyentes en el uso del diagnóstico enfermero.[eng] INTRODUCTION: There is a growing international interest to determine which factors lie behind an irregular use of nursing diagnosis. Attitudes towards it have been positioned as an important associated factor with its use. However, the unidirectional attitude as a determinant of behavior remains an issue today, because there are other cognitive factors that can determine behavior. These gaps suggest that perceived behavioral control and the subjective norm, as cognitive factors framed in the Theory of Planned Behavior, could determine the use of nursing diagnosis in the same way as attitudes do. Likewise, the fact that in previous studies, the field of work has been a variable related to attitude, leads us to think that the nursing practice environments could conform the subjective norm and influence the use of diagnosis and the attitude. The investigation of these factors may lead to understand what other determinants are behind an irregular use of nursing diagnosis. This will guide implementation strategies in health institutions and that they address different organizational and professional factors. AIM: The general objective was to describe the attitude and use of the nurses towards the nursing diagnosis in function of the perceived behavioral control and of the subjective norms framed in the nurses’ practice environments. METHODS: A cross-sectional study design carried out in three phases. In phase 1 a integrative review has been carried out in accordance with Whittemore recommendations and PRISMA guidelines by searching electronic databases based on descriptors and keywords. In phase 2, a cluster analysis was carried out using an electronic survey. The sample was of the convenience in the primary care nurses and was obtained through the direction of Primary Care in Catalonia. In phase 3, a cluster analysis was carried out using a survey in a binational sample (Italy and Spain). Italian nurses were recruited from two hospitals (university hospital and general hospital). In Spain, nurses were recruited from primary care centers in Catalonia. RESULTS: First, the phase 1 found that fourteen included studies agglutinated a total of 2,497 nurses. Five studies used qualitative methodology to address the study of nurses' attitudes, opinions and experiences, whereas nine used quantitative methodology. The quality of the selected studies was average for 64.2% of the articles and high for 35.7% of the articles. Second, from phase 2, a sample of 239 nurses was obtained that correctly answered the complete questionnaire. Most of the nurses worked in the health care field, while only 15% worked in the field of health management or services. Nurses belonging to groups with a higher rate of utilization of the nursing diagnosis showed more positive attitudes toward nursing diagnosis. Age was associated with greater use of the nursing diagnosis (P = 0.014) and the work field with the attitude towards the nursing diagnosis (p = 0.031). Nurses who were working in favorable nursing settings belonged to groups with a more positive attitude (p <0.001) and a higher rate of utilization of nursing diagnosis (p = 0.034) with significant differences between clusters. Thirdly, the phase 3 obtained a total sample of 549 nurses, in which the Spanish and Italian sample, attitude, intention and behavior levels were generally higher for groups with higher behavioral beliefs, normative beliefs and control beliefs. CONCLUSIONS: The attitude towards nursing diagnosis has once again been shown to be an important associated factor with its use. The field of work continues to be a determinant variable in attitudes, and demographic variables for the first time have been shown to be closely related to the use of nursing diagnosis. On the other hand, the subjective norm evaluated through the nurses’ practice environments is an important associated factor the use of the nursing diagnosis and a factor associated to the attitude towards the same. Finally, perceived behavioral control seems to be determinant in the intention and use of the nursing diagnosis, so we can conclude that the Theory of Planned Behavior might be adequate for a better understanding of the factors that influence the use of the nursing diagnosis

Understanding knee ostheoarthritis from the patients' perspective : a qualitative study

Background: No studies of Health Coach Interventions for knee OA sufferers that include patients' perspectives have been published. The study assesses current clinical practice and primary care professionals' advice from the patients' perspective, in order to obtain a participative design for a complex intervention based on coaching psychology. Moreover, wants to analyse the experiences, perceptions, cognitive evaluation, values, emotions, beliefs and coping strategies of patients with knee osteoarthritis, and secondly the impact of these factors in the Self-management of this condition. Methods: It is an interpretative qualitative study. The study included patients with diagnosis of knee osteoarthritis (OA) from 4 primary health care centres in Barcelona. A theoretical sampling based on a prior definition of participants' characteristics was carried out. Ten semi-structured interviews with knee OA patients were carried out. A content thematic analysis was performed following a mixed-strategy text codification in Lazarus framework and in emerging codes from the data. Results: The results are structured in two blocks: Experiences and perceptions of informants and Experiences of knee osteoarthritis according to the Lazarus model. Regarding experiences and perceptions of informants: Some participants reported that the information was mostly provided by health professionals. Informants know which food they should eat to lose weight and the benefits of weight loss. Moreover, participants explained that they like walking but that sometimes it is difficult to put into practice. Regarding experiences of knee osteoarthritis according Lazarus model: Cognitive evaluation is influenced by cognitive distortions such as obligation, guilt, dramatization and catastrophism. Values: Family is the value most associated with wellbeing. Helping others is another recurring value. Emotions: Most participants explain that they feel anxiety, irritability or sadness. Beliefs: To some, physiotherapy helps them feel less pain. However, others explain that it is of no use to them. Participants are aware of the association overweight- pain. Coping strategies: The strategies for coping with emotions aim to reduce psychological distress (anxiety, sadness, anger) and some are more active than others. Conclusions: The study highlights that patients with knee osteoarthritis require a person-centered approach that provides them with strategies to overcome the psychological distress caused by this conditio

Effectiveness and cost-effectiveness of a health coaching intervention to improve the lifestyle of patients with knee osteoarthritis : cluster randomized clinical trial

Background: The prevalence of osteoarthritis and knee osteoarthritis in the Spanish population is estimated at 17% and 10.2%, respectively. The clinical guidelines concur that the first line treatment for knee osteoarthritis should be non-pharmacological and include weight loss, physical activity and self-management of pain. Health Coaching has been defined as an intervention that facilitates the achievement of health improvement goals, the reduction of unhealthy lifestyles, the improvement of self-management for chronic conditions and quality of life enhancement. The aim of this study is to analyze the effectiveness, cost-effectiveness and cost-utility of a health coaching intervention on quality of life, pain, overweight and physical activity in patients from 18 primary care centres of Barcelona with knee osteoarthritis. Methods/Design: Methodology from the Medical Research Council on developing complex interventions. Phase 1: Intervention modelling and operationalization through a qualitative, socioconstructivist study using theoretical sampling with 10 in-depth interviews to patients with knee osteoarthritis and 4 discussion groups of 8-12 primary care professionals, evaluated using a sociological discourse analysis. Phase 2: Effectiveness, cost-effectiveness and cost-utility study with a community-based randomized clinical trial. Participants: 360 patients with knee osteoarthritis (180 in each group). Randomization unit: Primary Care Centre. Intervention Group: will receive standard care plus 20-hour health coaching and follow-up sessions. Control Group: will receive standard care. Main Outcome Variable: quality of life as measured by the WOMAC index. Data Analyses: will include standardized response mean and multilevel analysis of repeated measures. Economic analysis: based on cost-effectiveness and cost-utility measures. Phase 3: Evaluation of the intervention programme with a qualitative study. Methodology as in Phase 1. Discussion: If the analyses show the cost-effectiveness and cost-utility of the intervention the results can be incorporated into the clinical guidelines for the management of knee osteoarthritis in primary care

Multidimensional instruments with an integral approach to identify frailty in community-dwelling people: protocol for a systematic psychometric review

Introduction An increasing number of investigations highlight the complex nature of frailty; therefore, the use of multidimensional assessment instruments could be useful in clinical decision-making. Frail people are found mainly in the community setting which is why this is the ideal environment for early screening and intervention. For this purpose, it is necessary to have valid, time-effective and easy-to-use frailty assessment instruments. The aim of this review is to critically appraise, compare and summarise the quality of the measurement properties of all multidimensional instruments with an integral approach to identify frailty in community-dwelling people. Methods and analysis Medline, Psychological Information Database (PsycINFO) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) will be searched from their inception dates. We will also conduct searches in databases of grey literature. No limits will be applied for language. A highly sensitive validated search filter will be used for finding studies on measurement properties. An additional search including the names of the instruments found in the initial search will also be undertaken. Studies aiming at the development of a measurement instrument, the evaluation of one or more measurement properties or the evaluation of its interpretability will be included. The instrument should have an integral approach (physical, psychological and social) and it should measure all three domains. The context of use should be a community setting. Two reviewers independently will screen the references and assess the risk of bias by consensus-based standards for the selection of health measurement instruments checklist. To assess the overall evidence for the measurement properties of the identified instruments, the results of the different studies, adjusted for their methodological quality, will be combined. Ethics and dissemination Ethical approval and patient consent are not required as this is a psychometric review based on published studies. The results of this review will be disseminated at conferences and published in an international peer-reviewed journal. PROSPERO registration number CRD42019120212

Prescripción enfermera: análisis de concepto

Resumen: Objetivo: Examinar críticamente el concepto de prescripción enfermera mediante el estudio de los antecedentes y una revisión de la literatura científica con el fin de desarrollar una concepción precisa de esta actuación enfermera e identificar los elementos esenciales que envuelven este concepto. Método: Aplicación del procedimiento de análisis de concepto descrito por Wilson y adaptado por Avant. Resultados: El concepto de prescripción enfermera implica prescribir por parte de la enfermera el mejor régimen terapéutico frente a un problema de salud. Esta prescripción estará guiada por la valoración del problema de salud, por el criterio de la buena práctica clínica del profesional enfermero y estará dirigida a satisfacer las necesidades de salud del usuario y la población. Conclusiones: Los resultados aclaran el significado del concepto de estudio para ayudar a los profesionales a comprender y abordar esta actuación en todas sus dimensiones y promover el reconocimiento social de la profesión enfermera. Abstract: Objective: To critically analyse the concept of nursing prescription through the study of its background and a review of the scientific literature, in order to develop an accurate conception of this nursing activity and to identify the essential elements surrounding this concept. Method: Application of the concept analysis method described by Wilson, and adapted by Avant. Results: The concept of nurse prescription implies prescribing, by the nurse, the best therapeutic regimen for a health problem. This prescription will be guided by the assessment of the health problem, by the criterion of the good clinical practice of the nurse, and will be focused to satisfy the health needs of the patient and the population. Conclusions: The results clarify the meaning of the study's concept to help professionals understand and address this nursing activity in all its dimensions, and promote social recognition of the nursing profession. Palabras clave: Análisis de concepto, Prescripción, Enfermera, Keywords: Concept analysis, Prescription, Nurs

Percepciones y factores externos de la actividad física en adolescentes mediante métodos mixtos

Resumen: Objetivo: Analizar los niveles de actividad física en adolescentes y su relación con las percepciones sobre actividad física y con los factores externos. Método: Estudio observacional descriptivo transversal. Participaron adolescentes entre 11 y 18 años, reclutados/as en los centros de educación secundaria del municipio de Esplugues de Llobregat, Barcelona. Las mediciones consistieron en la valoración del nivel de actividad física mediante el cuestionario IPAQ-A y la relación del nivel de práctica de actividad física con las percepciones sobre actividad física y con los factores externos descritos en el modelo de promoción de la salud de Pender. Resultados: El 60,34% de los/las adolescentes fueron insuficientemente activos/as. Los factores asociados positivamente a la práctica de actividad física fueron el sexo masculino (p < 0,01), hacer deporte extraescolar (p < 0,01), la percepción de beneficios (p < 0,01), la percepción de autoeficacia (p < 0,01), las influencias interpersonales (p < 0,01), que los padres y las madres hagan deporte (p < 0,01), los modelos (p < 0,01) y las normas (p < 0,01). Los factores correlacionados asociados negativamente fueron el sexo femenino (p < 0,01), el índice de masa corporal (p = 0,048) y la percepción de barreras (p < 0,01). No se halló relación con la clase social (p = 0,164). Las influencias situacionales fueron un factor condicionante en los chicos (p < 0,01), pero no en las chicas (p = 0,561). Conclusiones: Este estudio identifica factores que determinan la práctica de actividad física en los/las adolescentes, que teniéndolos en cuenta en el diseño de intervenciones y políticas de promoción podrían ayudar a aumentar los niveles actuales. Aun así, existen algunos condicionantes, como el sexo y la clase social, que habría que estudiar con profundidad mediante investigaciones más exploratorias y discursivas. Abstract: Objective: Analyze the levels of physical activity in adolescents and their relationship with perceptions of physical activity and external factors. Method: Cross-sectional descriptive observational study. The participants were adolescents between the ages of 11 and 18. They were recruited in secondary schools in the municipality of Esplugues de Llobregat, Barcelona, Spain. The measurements were amount of physical activity (IPAQ-A questionnaire) and the relationship between level of physical activity and the perceptions of physical activity and external factors proposed by the health promotion model. Results: Of the total sample, 60.34% participants were insufficiently active. The factors positively associated with physical activity were male gender (p < 0.01), engaging in extracurricular sports (p < 0.01), perceiving benefits (p < 0.01), perceiving self-efficacy (p < 0.01), interpersonal influences (p < 0.01), having parents who engage in sports (p < 0.01), social support (p < 0.01) and social norms supporting exercise (p < 0.01). The factors negatively associated with physical activity were female gender (p < 0.01), body mass index (p = 0.048) and perceiving obstacles (p < 0.01). There was no relationship with social class (p = 0.164). Situational influences were a conditioning factor for boys (p < 0.01), but not girls (p = 0.561). Conclusions: This study identifies factors that determinate the practice of physical activity in adolescents. Taking these factors into account in the design of health promotion interventions and policies could help increase levels of physical activity in this population. Even so, there are some variables, such as gender and socioeconomic status, that should be explored in depth through research that is more exploratory and discursive

Recording of Social Determinants in Computerized Medical Records in Primary Care Consultations: Quasi-Experimental Study

Background Social determinants of health may be more important than medical or lifestyle choices in influencing people's health. Even so, there is a deficit in recording these in patients' computerized medical histories. The Spanish administration and the World Health Organization are promoting the recording of diagnoses in computerized clinical histories with the aim of benefiting the individual, the professional, and the community. In most cases, professionals tend to record only clinical diagnoses despite evidence in the literature documenting that addressing the social determinants of health can lead to improvements in health and reductions in social disparities in disease. Objective This study aims to develop and evaluate the effectiveness of a mixed intervention (face-to-face-digital) aimed at improving the quantity and quality of the records of the social determinants of health in computerized medical records at primary care clinics. Methods A quasi-experimental, nonrandomized, controlled, multicenter study with 2 parallel study arms was conducted in the area of Central Catalonia (Spain) with primary care professionals of the Institut Català de la Salut (ICS), working from September 23, 2019, to March 31, 2020. All interested professionals were accepted. In total, 22 basic health areas were involved in the study. In Spain and Catalonia, the International Classification of Diseases is used, in which there is a coding of the social determinants of health. Five social determinants were selected by a physician, a nurse, and a social worker; these professionals had experience in primary care and were experts in community health. The choice was made taking into account the ease of use, benefit, and existing terminology. The intervention, based on the integration of a checklist, was integrated as part of the usual multidisciplinary clinical workflow in primary care consultations to influence the recording of these determinants in the patient's computerized medical record. Results After 6 months of implementing the intervention, the volume and quantity of records of 5 social determinants of health were compared, and a significant increase in the median number of pre- and postintervention diagnoses was observed (P≤.001). There was also an increase in the diversity of selected social determinants. Using the linear regression model, the significant mean increase of the experimental group with respect to the control group was estimated with a coefficient of 8.18 (95% CI 5.11-11.26). Conclusions The intervention described in this study is an effective tool for coding the social determinants of health designed by a multidisciplinary team to be incorporated into the workflow of primary care practices. The effectiveness of its usability and the description of the intervention described here should be generalizable to any environment. Trial RegistrationClinicalTrials.gov NCT04151056; https://clinicaltrials.gov/ct2/show/NCT0415105

The Tilburg frailty indicator: a psychometric systematic review

The Tilburg Frailty Indicator (TFI) is one of the most prominent multidimensional frailty assessment instruments. This review aimed to critically appraise and summarise its measurement properties. Methods Reports were eligible if they included results of studies aimed at developing the TFI or evaluating its measurement properties. We performed a literature search in MEDLINE, CINAHL, and PsycINFO databases from their inception until September 17, 2020. We also searched grey literature databases. We assessed the methodological quality of the included studies using the 'COSMIN Risk of Bias'. The measurement properties were evaluated using specific criteria. We graded the quality of the evidence using a GRADE approach. Results Fifty-five studies were included. We found moderate sufficient evidence for TFI content validity, although it is still insufficient for the comprehensiveness of its items. TFI construct validity was based on sufficient evidence from a single study of its structural validity as well as multiple hypothesis-testing for construct validity studies with inconsistent results. We did not find any studies that assessed cross-cultural validity. The TFI showed high sufficient concurrent validity with the comprehensive geriatric assessment. We identified several studies assessing its predictive validity for adverse frailty-related outcomes, although most of the evidence from these studies was insufficient. We did not find any studies that assessed the responsiveness of TFI scores. Conclusions The TFI is a simple measurement instrument that may be helpful in the assessment of frailty. However, more studies are needed to strengthen its usefulness as a clinical decision-making tool

Multidimensional instruments with an integral approach to identify frailty in community-dwelling people: protocol for a systematic psychometric review

Community-dwelling; Frailty; Psychometrics; ScreeningVivienda comunitaria; Fragilidad; Psicometría; RevisiónVivenda comunitària; Fragilitat; Psicometria; RevisióIntroduction An increasing number of investigations highlight the complex nature of frailty; therefore, the use of multidimensional assessment instruments could be useful in clinical decision-making. Frail people are found mainly in the community setting which is why this is the ideal environment for early screening and intervention. For this purpose, it is necessary to have valid, time-effective and easy-to-use frailty assessment instruments. The aim of this review is to critically appraise, compare and summarise the quality of the measurement properties of all multidimensional instruments with an integral approach to identify frailty in community-dwelling people. Methods and analysis Medline, Psychological Information Database (PsycINFO) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) will be searched from their inception dates. We will also conduct searches in databases of grey literature. No limits will be applied for language. A highly sensitive validated search filter will be used for finding studies on measurement properties. An additional search including the names of the instruments found in the initial search will also be undertaken. Studies aiming at the development of a measurement instrument, the evaluation of one or more measurement properties or the evaluation of its interpretability will be included. The instrument should have an integral approach (physical, psychological and social) and it should measure all three domains. The context of use should be a community setting. Two reviewers independently will screen the references and assess the risk of bias by consensus-based standards for the selection of health measurement instruments checklist. To assess the overall evidence for the measurement properties of the identified instruments, the results of the different studies, adjusted for their methodological quality, will be combined. Ethics and dissemination Ethical approval and patient consent are not required as this is a psychometric review based on published studies. The results of this review will be disseminated at conferences and published in an international peer-reviewed journal

La gestió de casos a l'Atenció Primària Metropolitana Sud

Competència d'infermeria; Gestió de casos; Atenció primària de salutCompetencia de enfermería; Gestión de casos; Atención primaria de saludNursing competency; Case management; Primary healthEl present document defineix el rol de les Infermeres Gestores de Casos en totes les seves funcions, juntament amb les competències específiques que se’n deriven. Així mateix, el document ofereix un catàleg de prestacions ampli i adequat a les necessitats de les persones afectades, del seu entorn cuidador i dels professionals que conformen la xarxa assistencial i intervenen en el procés d’atenció. Per altra banda, es descriuen els set escenaris d’actuació més habituals en la pràctica diària de les infermeres per tal d’estandarditzar els processos i garantir la qualitat i l’equitat en la prestació de les cures