Evaluación del Proceso Asistencial Cáncer de Mama

El cáncer de mama se ha convertido en un problema prioritario de salud mundial. En la actualidad, la gestión por procesos asistenciales integrados (PAIs) constituye una de las principales fórmulas organizativas orientadas a mejorar la calidad de los servicios. Esta tesis tiene como principal objetivo evaluar el impacto del Proceso Asistencial Integrado Cáncer de Mama en Andalucía a nivel organizativo, identificar las áreas deficitarias y elaborar propuestas de mejora. Se ha realizado un estudio descriptivo, transversal y multicéntrico llevado a cabo en tres fases: Adaptación cultural y validación del cuestionario “Care Process Self-Evaluation Tool” (CPSET) en el contexto español, análisis comparativo de los diferentes procesos asistenciales y evaluación del Proceso Asistencial Integrado Cáncer de Mama. En la primera y segunda fase del estudio han participado 283 profesionales sanitarios procedentes de nueve centros hospitalarios. La evaluación del Proceso Asistencial Integrado Cáncer de mama se ha realizado en cuatro hospitales andaluces referentes en el tratamiento del cáncer de mama. El proceso de adaptación cultural validación del cuestionario CPSET ha consistido en la traducción y retro-traducción del cuestionario, prueba de jueces y pilotaje inicial. La validación de contenido se ha realizado a través de un análisis factorial exploratorio (EFA) con rotación Varimax y un análisis factorial confirmatorio. Se ha calculado la consistencia interna a través del alfa de Cronbach. Se ha realizado una descripción univariada de la muestra, un análisis multivariante y se ha aplicado un modelo estructural de co-varianza para la comparación entre variables. El Test de Anova y test de Welsh han sido utilizados cuando se cumplían las condiciones de normalidad y el test no paramétrico de Kruskall-Wallis según sus criterios de aplicabilidad. Los resultados de la validación del cuestionario fueron satisfactorios, considerándose una herramienta útil para la evaluación de procesos asistenciales. Como resultados globales, los procesos asistenciales estructurados y gestionados según un PAI obtienen mejores resultados en todas las dimensiones en comparación con los sistemas de gestión tradicionales. El PAI cáncer de mama en Andalucía ha supuesto una firme apuesta por la calidad asistencial pero existen áreas deficitarias relacionadas con la coordinación y el seguimiento del proceso en las que se debe profundizar para optimizar su implementación y los resultados en salud. El PAI cáncer de mama muestra diferencias significativas en cuanto a su organización en los hospitales incluidos reflejando distintos grados de implementación a nivel asistencial. Entre las propuestas de mejora, cabe destacar la necesidad de potenciar la coordinación en las distintas fases así como establecer mecanismos que garanticen la continuidad asistencial y el seguimiento de las mujeres a lo largo del proceso. La inclusión de nuevos roles profesionales avanzados como la Enfermera de Práctica Avanzada podría dar respuesta a estas necesidades tal y como avalan los resultados en otros países.Breast cancer has become a major global health problem. At present, integrated care processes´ management constitutes a major organizational formulas aiming to improve services´ quality. This thesis aims to evaluate the impact of the breast cancer clinical pathways in Andalusia at organizational level, to identify deficient areas and make proposals for improvement. We performed a descriptive, cross-sectional multicenter study conducted in three phases: cultural adaptation and validation of the questionnaire "Self-Care Process Evaluation Tool" (CPSET) in the Spanish context, a comparative analysis of different care processes and evaluation of the Breast Cancer clinical pathway. First and second phase of the study included 283 health professionals from nine hospitals. Process Evaluation of Integrated Healthcare Breast cancer has been conducted in four Andalusian hospitals regarding the treatment of breast cancer. The process of cultural adaptation and validation of the CPSET questionnaire consisted on translation and back-translation of the questionnaire, experts´ judgement and pilot study. Content validation was performed through an exploratory factor analysis (EFA) with Varimax rotation and confirmatory factor analysis. We calculated the internal consistency by Cronbach's alpha. Univariate description of the sample was performed, multivariate analysis and a structural model of co-variance was applied for comparison between variables. Anova test and Welsh have been used when the conditions of normality and nonparametric Kruskal -Wallis test according to their applicability criteria were met. The results of the validation of the questionnaire were satisfactory, considering it a useful tool for the evaluation of care processes. As overall results, care processes structured and managed according to a clinical pathway have better outcomes on all dimensions compared to traditional management systems. The breast cancer clinical pathway implemented within the Andalusian Public Health System is part of a firm commitment to quality care improvement but there are deficient areas related to the coordination and monitoring of the process must be analyzed in depth to optimize its implementation and health outcomes. The breast cancer clinical pathway shows significant differences regarding its organization within participant hospitals showing different degrees of implementation at clinical level. Among the suggestions for improvement included there is a strong need to enhance the process coordination in all the different phases as well as to establish mechanisms to ensure continuity of care and follow-up of affected women throughout the process. The inclusion of new advanced roles such as the Advanced Practice Nurse could solve these needs as demonstrated by the results in other countries

Inglês no grau de enfermagem: um assunto pendente

OBJECTIVE: The new competence profile of nursing professionals, scientific and medical development, the free circulation of health professionals worldwide, and the increasing social and cultural diversity requires that nurses have specific abilities in spoken and written English. The objective of this research is to describe the characteristics of the English language training required for a Bachelors of Nursing in Spain. METHOD: A descriptive cross-sectional observational study has been performed in forty-six Spanish universities that offer the Bachelor in nursing degree. RESULTS: In line with the directives of the European Higher Education Area, all universities contemplate the mandatory credit of a second language emphasizing English, although there is considerable variability in the emphasis: 39.4% do not include any English subject, and of the remaining 60.6% who do include it, 60% considered it an elective subject, 32.5% basic education, and 7.5% mandatory. CONCLUSIONS: The English training has different characteristics in each university, which implies a different commitment from each center for this learning. This fact questions the adequacy of the education in relation to the new competence profile required by the European Higher Education Area, which may adversely affect future professional development.OBJETIVO: El nuevo perfil competencial de los profesionales de Enfermería, el desarrollo científico-sanitario, la libre circulación de profesionales sanitarios a nivel internacional y la creciente diversidad socio-cultural exige que las enfermeras posean competencias específicas en inglés hablado y escrito. El objetivo del presente estudio es describir las características de la formación en lengua inglesa en el Grado en Enfermería en España. MÉTODO: Se ha realizado un estudio observacional descriptivo y transversal en cuarenta y seis universidades españolas que imparten el Grado en Enfermería. RESULTADO: En línea con las directrices del Espacio Europeo de Educación Superior, todas las universidades contemplan la obligatoriedad de acreditar una segunda lengua, destacando el inglés, aunque existe una notable variabilidad en la importancia otorgada: el 39.4% no incluye ninguna asignatura de inglés, y del 60.6% restante que sí la incluye, el 60% la consideran asignatura optativa, el 32.5% formación básica y el 7.5% obligatoria. CONCLUSIONES: La formación en inglés presenta características diferentes en cada universidad, lo que implica una apuesta diferente de cada centro por su aprendizaje. Este hecho cuestiona la adecuación de la oferta formativa en relación al nuevo perfil competencial exigido por el Espacio Europeo de Educación Superior, pudiendo afectar negativamente al futuro desarrollo profesional.OBJETIVO: O perfil de nova competência dos profissionais de enfermagem, o desenvolvimento científico e médico, a livre circulação de profissionais de saúde em todo o mundo, e a crescente diversidade social e cultural requer que os enfermeiros têm habilidades específicas em Inglês falado e escrito. O objetivo desta pesquisa é descrever as características da formação idioma Inglês necessárias para um Bacharelado em Enfermagem, na Espanha. MÉTODO: Um estudo descritivo transversal observacional foi realizado em 46 universidades espanholas que oferecem o grau de Bacharel em enfermagem. RESULTADOS: Em conformidade com as diretivas do Espaço Europeu do Ensino Superior, todas as universidades contemplam o crédito obrigatório de uma segunda língua enfatizando Inglês, embora exista uma grande variabilidade na ênfase: 39,4% não incluem qualquer assunto Inglês, e do restante 60,6 % que o inclua, 60% considerou um assunto eletivo, 32,5% um ensino básico e 7,5% obrigatórios. CONCLUSÕES: O treinamento em Inglês tem características diferentes em cada universidade, o que implica em um compromisso diferente de cada centro para esse aprendizado. Este fato questiona a adequação da educação em relação ao perfil de competências exigidas pelo novo Espaço Europeu do Ensino Superior, o que pode prejudicar o desenvolvimento futuro profissional

Motivation, needs and expectations of nursing degree students towards English language learning

Los nuevos estudios de Grado, Máster y Doctorado consideran que el manejo de la lengua inglesa es una competencia transversal fundamental. Este trabajo tiene como objetivo conocer la motivación, necesidades y expectativas del alumnado del Grado en Enfermería de la Universidad de Huelva en el aprendizaje del inglés como segunda lengua. Se ha realizado un estudio observacional descriptivo de corte transversal. El alumnado otorga una gran importancia a la formación en inglés para su futuro desempeño con diferencias significativas en cuanto a su aplicabilidad en los diferentes ámbitos profesionales. A pesar de su alta motivación, un alto porcentaje considera que la oferta académica universitaria no cubre sus necesidades formativas. Se cuestiona por tanto la necesidad de ampliar y reorientar la formación de manera que se cumplan las expectativas del alumnado, las demandas profesionales y conseguir potenciar el aprendizaje de otras lenguas como vehículo de desarrollo académico y profesional.The new Degree, Master and Doctorate studies considers English language use as an essential competency. This paper aims to get a better knowledge of first and second year students Nursing Degree students within the University of Huelva in terms of motivation, needs and expectations regarding learning English as second language. An observational descriptive study from a cross-sectional approach has been performed. Students consider highly important English language learning for their future professional development while showing important significant differences about its applicability on the different professional settings. Despite their high motivation, a high percentage consider than the academic catalogue do not cover their learning needs. These results justify the need for further research and for a potential reorientation of the English language educative programs to match students' expectations, their professional needs and to enhance other language learning as a vehicle for academic and professional development

Effectiveness of “Escape Room” Educational Technology in Nurses’ Education: A Systematic Review

Escape room games are educational gamification technologies that consist of introducing a team of players into a physical or digital space in search of clues to answer puzzles, riddles or enigmas and solve a mystery or problem. This study aims to determine the effectiveness of escape room games on the training of nursing students in an international context. A systematic review was carried out in MEDLINE, WOS, SCOPUS, CINAHL and LILACS databases using the MeSH terms “Education, Nursing” and “Educational Technology”, and the free term “Escape room”, combined with Boolean operators AND/OR. Intervention studies in Spanish, English and Portuguese were included, without limitation for the year of publication. Selection and critical appraisal were conducted by two independent reviewers. A total of n = 13 interventional studies were included (n = 2 Randomized Clinical Trials and n = 11 quasi-experimental design). Escape rooms are a recent and growing educational methodology, increasingly used in academia and in the training of nurses and nursing students. However, it is necessary to expand their use and the quality of the studies in a greater number of contexts. Furthermore, it is necessary to homogenize and standardize validated instruments to evaluate the effectiveness of escape rooms in the nursing education area

Impact of hospitalization on nutritional status in persons aged 65 years and over (NUTRIFRAG Study): Protocol for a prospective observational study

[ES] Background Malnutrition is a recurring problem that has become more relevant in recent years. The aim of this study is to assess the risk of malnutrition and nutritional status on admission and its evolution until discharge in patients aged 65 and over admitted to medical and surgical hospitalization units in hospitals of the Spanish National Health System. Methods Prospective observational study to be carried out in the medical-surgical hospitalization units of 9 public hospitals between 01/09/2022 and 31/12/2024. Using consecutive sampling, a total of 4077 patients will be included (453 in each hospital). Variables included are related to the care process, functionality, cognition and comorbidity, risk profile, nutritional status and dysphagia; as well as frailty, dietary quality and contextual variables. The incidence of risk of malnutrition, undernutrition and dysphagia during the care process and at discharge will be calculated. The association with risk factors will be studied with logistic regression models and multivariate Cox regression models. In addition, an analysis of participants’ satisfaction with food services will be carried out. The study was approved by the Ethics and Research Committee on 30/09/2020, approved for funding on 02/12/2021 and with registration number RBR-5jnbyhk in the Brazilian clinical trials database (ReBEC) for observational studies. Discussion Some studies address nutritional status or dysphagia in older people in various care settings. However, there is a lack of large sample studies including both processes of the impact of hospitalization. The results of the project will provide information on the incidence and prevalence of both pathologies in the study subjects, their associated factors and their relationship with the average length of stay, mortality and early readmission. In addition, early detection of a problem such as malnutrition related to the disease and/or dysphagia during a hospital stay will favor the action of professionals to resolve both pathologies and improve the health status of patients.This study has been funded by Instituto de Salud Carlos III (ISCIII) through the Project "PI21/00738" and co-funded by the European Union. The funders did not and will not have a role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Impact of hospitalization on nutritional status in persons aged 65 years and over (NUTRIFRAG Study): Protocol for a prospective observational study

Background: Malnutrition is a recurring problem that has become more relevant in recent years. The aim of this study is to assess the risk of malnutrition and nutritional status on admission and its evolution until discharge in patients aged 65 and over admitted to medical and surgical hospitalization units in hospitals of the Spanish National Health System. Methods: Prospective observational study to be carried out in the medical-surgical hospitalization units of 9 public hospitals between 01/09/2022 and 31/12/2024. Using consecutive sampling, a total of 4077 patients will be included (453 in each hospital). Variables included are related to the care process, functionality, cognition and comorbidity, risk profile, nutritional status and dysphagia; as well as frailty, dietary quality and contextual variables. The incidence of risk of malnutrition, undernutrition and dysphagia during the care process and at discharge will be calculated. The association with risk factors will be studied with logistic regression models and multivariate Cox regression models. In addition, an analysis of participants' satisfaction with food services will be carried out. The study was approved by the Ethics and Research Committee on 30/09/2020, approved for funding on 02/12/2021 and with registration number RBR-5jnbyhk in the Brazilian clinical trials database (ReBEC) for observational studies. Discussion: Some studies address nutritional status or dysphagia in older people in various care settings. However, there is a lack of large sample studies including both processes of the impact of hospitalization. The results of the project will provide information on the incidence and prevalence of both pathologies in the study subjects, their associated factors and their relationship with the average length of stay, mortality and early readmission. In addition, early detection of a problem such as malnutrition related to the disease and/or dysphagia during a hospital stay will favor the action of professionals to resolve both pathologies and improve the health status of patients.This study has been funded by Instituto de Salud Carlos III (ISCIII) through the project "PI21/00738" and co-funded by the European Union. The funders did not and will not have a role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.S

The Care Process Self-Evaluation Tool: a valid and reliable instrument for measuring care process organization of health care teams

Background: Patient safety can be increased by improving the organization of care. A tool that evaluates the actual organization of care, as perceived by multidisciplinary teams, is the Care Process Self-Evaluation Tool (CPSET). CPSET was developed in 2007 and includes 29 items in five subscales: (a) patient-focused organization, (b) coordination of the care process, (c) collaboration with primary care, (d) communication with patients and family, and (e) follow-up of the care process. The goal of the present study was to further evaluate the psychometric properties of the CPSET at the team and hospital levels and to compile a cutoff score table. Methods: The psychometric properties of the CPSET were assessed in a multicenter study in Belgium and the Netherlands. In total, 3139 team members from 114 hospitals participated. Psychometric properties were evaluated by using confirmatory factor analysis (CFA), Cronbach’s alpha, interclass correlation coefficients (ICCs), Kruskall-Wallis test, and Mann–Whitney test. For the cutoff score table, percentiles were used. Demographic variables were also evaluated. Results: CFA showed a good model fit: a normed fit index of 0.93, a comparative fit index of 0.94, an adjusted goodness-of-fit index of 0.87, and a root mean square error of approximation of 0.06. Cronbach’s alpha values were between 0.869 and 0.950. The team-level ICCs varied between 0.127 and 0.232 and were higher than those at the hospital level (0.071-0.151). Male team members scored significantly higher than females on 2 of the 5 subscales and on the overall CPSET. There were also significant differences among age groups. Medical doctors scored significantly higher on 4 of the 5 subscales and on the overall CPSET. Coordinators of care processes scored significantly lower on 2 of the 5 subscales and on the overall CPSET. Cutoff scores for all subscales and the overall CPSET were calculated. Conclusions: The CPSET is a valid and reliable instrument for health care teams to measure the extent care processes are organized. The cutoff table permits teams to compare how they perceive the organization of their care process relative to other teams

Gender violence: trends, impact and keys for approach

Introducción: El presente artículo realiza una revisión bibliográfica sobre los aspectos más relevantes de la violencia de género, analizando la situación actual y la normativa vigente así como las consecuencias que sufren las mujeres afectadas, las principales implicaciones a nivel social y sanitario y las dificultades existentes en su abordaje. Método: Se ha realizado una búsqueda de la literatura y revisión de lo más relevante, incluyendo los documentos principales relacionados con la violencia contra mujeres en España durante los últimos diez años, acentuando estrategias nacionales y regionales para la asistencia médica. Resultados: En los últimos años, la violencia de género se ha convertido en un creciente problema de salud pública que afecta a millones de mujeres en todo el mundo aunque se estima que las cifras irán disminuyendo gradualmente. El perfil de las mujeres afectadas se relaciona con un nivel socioeconómico bajo y bajos niveles educativos. Las consecuencias de la violencia de género en la salud de la mujer incluyen las manifestaciones físicas, problemas emocionales y una mayor utilización de los servicios sanitarios, siendo algunas veces inespecífico el motivo de consulta. Entre las principales dificultades encontradas en la atención a las mujeres víctimas de la violencia de género cabe destacar la infradetección y la falta de coordinación entre los distintos organismos implicados. Conclusión: Los profesionales sanitarios juegan un papel fundamental en la prevención, detección y tratamiento, siendo necesario potenciar una formación específica en este campo y articular mecanismos y protocolos de coordinación entre los distintos servicios socio-sanitarios, que garanticen una atención integral e integrada a las mujeres afectadas.ABSTRACT Aims: To get a deeper knowledge about the most relevant aspects of gender violence, analysing the current situation and legislation, focusing on the consequences experienced by women affected, the main implications at social and health level and the existing difficulties to approach it. Method: A literature search and review of the most relevant has been performed, including the main documents related to violence against women in Spain over the last ten years, emphasising national and regional strategies for health care. Results: In recent years, domestic violence has become a growing public health problem that affects millions of women worldwide although a gradual decrease it is expected. Women profile is associated with a low social and economic status and low educational level. The consequences of domestic violence on women health include physical and psychological problems and a higher use of health services, with some non-specific symptoms as the main demand. Within the main difficulties found, it can be highlighted the number of under-diagnosis and the lack of coordination between the core services. Conclusions: Healthcare professionals play a critical role in the prevention, detection and treatment, requiring specific training in this field and the development of mechanisms and protocols for coordination between health and social services that ensure a comprehensive and integrated care to affected women

La violencia de género: evolución, impacto y claves para su abordaje

El presente artículo realiza una revisión bibliográfica sobre los aspectos más relevantes de la violencia de género, analizando la situación actual y la normativa vigente así como las consecuencias que sufren las mujeres afectadas, las principales implicaciones a nivel social y sanitario y las dificultades existentes en su abordaje. Método: Se ha realizado una búsqueda de la literatura y revisión de lo más relevante, incluyendo los documentos principales relacionados con la violencia contra mujeres en España durante los últimos diez años, acentuando estrategias nacionales y regionales para la asistencia médica. Resultados: En los últimos años, la violencia de género se ha convertido en un creciente problema de salud pública que afecta a millones de mujeres en todo el mundo aunque se estima que las cifras irán disminuyendo gradualmente. El perfil de las mujeres afectadas se relaciona con un nivel socioeconómico bajo y bajos niveles educativos. Las consecuencias de la violencia de género en la salud de la mujer incluyen las manifestaciones físicas, problemas emocionales y una mayor utilización de los servicios sanitarios, siendo algunas veces inespecífico el motivo de consulta. Entre las principales dificultades encontradas en la atención a las mujeres víctimas de la violencia de género cabe destacar la infradetección y la falta de coordinación entre los distintos organismos implicados. Conclusión: Los profesionales sanitarios juegan un papel fundamental en la prevención, detección y tratamiento, siendo necesario potenciar una formación específica en este campo y articular mecanismos y protocolos de coordinación entre los distintos servicios socio-sanitarios, que garanticen una atención integral e integrada a las mujeres afectadas.To get a deeper knowledge about the most relevant aspects of gender violence, analysing the current situation and legislation, focusing on the consequences experienced by women affected, the main implications at social and health level and the existing difficulties to approach it. Method: A literature search and review of the most relevant has been performed, including the main documents related to violence against women in Spain over the last ten years, emphasising national and regional strategies for health care. Results: In recent years, domestic violence has become a growing public health problem that affects millions of women worldwide although a gradual decrease it is expected. Women profile is associated with a low social and economic status and low educational level. The consequences of domestic violence on women health include physical and psychological problems and a higher use of health services, with some non-specific symptoms as the main demand. Within the main difficulties found, it can be highlighted the number of under-diagnosis and the lack of coordination between the core services. Conclusions: Healthcare professionals play a critical role in the prevention, detection and treatment, requiring specific training in this field and the development of mechanisms and protocols for coordination between health and social services that ensure a comprehensive and integrated care to affected women