The training needs of critical care nurses: A psychometric analysis

Background/Objective: Nurses develop the care methods they learn through specific training and this enables them to provide care in a safe, effective and efficient manner. Intensive Care Units (ICU), as complex areas in terms of care, require nurses with specific training. Due to this fact, we set ourselves the objective to validate a questionnaire that detects the training needs of intensive care nurses in Spain. Methods: A cross-sectional descriptive study, using an electronic questionnaire, adapted and validated through the Delphi technique, in 85 ICUs in Spain, for which a psychometric analysis is conducted. To explore the dimensions and determine the factorial structure, an Exploratory Factor Analysis (EFA) and a Confirmatory Factor Analysis (CFA) were carried out. Internal consistency was determined through ordinal alpha. The statistical treatment was carried out using the statistical programmes Factor Analysis 10.9.02 and IBM AMOS version 24. Results: A total of 568 Spanish intensive care nurses, randomly divided into two samples, participated in the study. The EFA presented a factorial solution with suitable values for both the Kaiser-Meyer-Olsen Index and Bartlett’s Sphericity. In the CFA, the model fit achieved close to ideal values with a Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI) close to values of 0.9. The values of individual reliability, internal consistency and average variance extracted were appropriate for this type of analysis. Conclusion: The dimensions detected are close to the construct that encompasses the training needs of ICU nurses. The analyses carried out indicate that there are reasonable realities for incorporating these dimensions into the field of nursing training. This study opens the possibility of incorporating new items to adjust the model to improve the explanatory variables. Our findings help us to understand the dimensions that the training programmes should incorporate

Attitudes and Feelings towards the Work of Teachers Who Had a School Nurse in Their Educational Center during the COVID-19 Pandemic

The objective of this study was to analyze the influence of the availability of a health professional on the beliefs, attitudes, and work feelings of teaching staff when facing the COVID-19 pandemic. This is a two-phase study: In the first one, the Delphi technique was used to update an instrument used by the authors in a previous investigation in 2020. The second phase was a cross-sectional, descriptive, and comparative study, carried out through an electronic questionnaire distributed among the teaching staff of the Autonomous Community of the Canary Islands (Spain), during the first two months of the 2021/22 academic year, in the midst of the fifth wave of COVID-19. Data were analyzed using Pearson’s chi-squared test and the linear trend test. The reasons for advantages were analyzed and the dimensions of the questionnaire were compared between the groups studied (with or without a healthcare professional in the center). Out of 640 teachers in the study, 14.7% (n = 94) stated that they had a reference professional with health training in their educational center (a school nurse) for the management of possible cases of COVID-19. Significant differences were found in five of the nine dimensions studied between the groups of teachers analyzed. Teachers who had a health professional, specifically a nurse, during the pandemic indicated that they felt safer in their educational center, as they perceived that they had more personal protective equipment (OR = 2.03, [95% CI: 1.23–3.35]; p = 0.006). They were also more committed (OR = 1.89, [95% CI: 1.04–3.46]; p = 0.038) with their educational work and assumed more obligations (OR = 1.87, [95% CI: 1.01–3.44]; p = 0.045) and risks (OR = 2.82, [95% CI: 1.13–7.07]; p = 0.027). In addition, they presented fewer feelings of burnout (OR = 0.63, [95% CI: 0.41–0.98]; p = 0.041). These results indicate that having nurses in educational centers improves teachers’ ability to cope with a pandemic situation

Percepción de la calidad de la investigación enfermera en un hospital público

Antecedentes y objetivos Las enfermeras, como profesionales sanitarios, juegan un papel importante en la investigación, ya que sin ellas no se podría avanzar en el cuidado y en los tratamientos. Por ello nos planteamos como objetivos: primero, analizar la percepción de la enfermería sobre el actual sistema de investigación en el conjunto de su hospital y, segundo, estudiar cómo varía dicha percepción en función de su perfil investigador y de su nivel de satisfacción y compromiso con la organización en la que trabaja. Material y método Estudio descriptivo transversal, realizado en un centro hospitalario de tercer nivel. Se trabajó con una muestra de conveniencia formada por enfermeras con una experiencia superior a 6 meses. Se utilizó el cuestionario del Grupo de Expertos del III Foro de Ciencia de la Fundación Lilly, adaptándolo a las características de la población. La encuesta tenía por objeto recoger la percepción y valoración, real e ideal, sobre la investigación que tiene este colectivo. Se realizaron análisis univariados y bivariados mediante el estadístico t de Student. Resultados Para una muestra formada por 295 enfermeras, la percepción y valoración de la situación actual de la investigación en enfermería, el impacto de esta, su reconocimiento y su integración con la labor asistencial estuvieron muy por debajo de las puntuaciones que consideran ideales, obteniéndose diferencias estadísticamente significativas (p < 0,001). Resultaron significativos los valores que reconocen que se precisa mayor investigación por parte de la enfermería, el impacto y reconocimiento por la gerencia y la sinergia con la industria farmacéutica (p < 0,001). El nivel de satisfacción no influyó en la valoración, a diferencia del compromiso. No se observaron diferencias entre el personal de la UCI respecto del resto de servicios en cuanto a la percepción y valoración de la investigación de la enfermería. Conclusiones Las enfermeras asumen la investigación como parte de sus funciones y afirman que el estado de la investigación es muy mejorable. Según estas, es necesaria una infraestructura de apoyo que potencie la investigación en cuidados y el reconocimiento real por parte de las instituciones.Background and objectives Nurses, as health professionals, play an important role in research, as progress in care and treatment could not be made without it. The aim of this study is to analyse the perception by nurses of the current research system in the whole of their hospital and, second, study how this perception varies according to their research profile, as well as their level of satisfaction and commitment to the organisation in which work. Material and method A cross-sectional descriptive study was conducted in a third level hospital with a convenience sample of nurses with more than 6 months experience. The Group of Experts of the III Forum of Science of the Lilly Foundation questionnaire was used, adapting it to the characteristics of the population. The purpose of the questionnaire was to collect the perception and assessment, real and ideal, that nurses have on research. Univariate and bivariate analyses were performed using the Student t-test. Results In the sample of 295 nurses, the perception and assessment of the current situation of nursing research, its impact, its recognition, and its integration with nursing work were well below the ideal scores, obtaining statistically differences (P < .001). There was a significance in the values that recognise that more research is needed by nursing staff, the impact and recognition by management, and synergy with the pharmaceutical industry (P < .001). The level of satisfaction did not affect the assessment, the commitment of the nurses if it influenced their assessment of the research. No differences were found between the ICU staff and the other departments as regards the perception and assessment of nursing research. Conclusions Nurses take the research as part of their functions and mention that the state of the research is very much improved. A support infrastructure is needed to strengthen research in care, as well as real recognition by institutions

Necesidades de formación detectadas por enfermeras de una unidad de cuidados intensivos: un estudio fenomenológico.

Introducción: Las competencias que abordan en su entorno laboral las enfermeras de cuidados intensivos (UCI), han aumentado con la adquisición de nuevas responsabilidades asociadas a cuidados y dispositivos a realizar al paciente crítico. Múltiples estudios avalan la necesidad de la especialización de las enfermeras que trabajan en este tipo de unidades. Apoyado en estas evidencias, la European Federation of Critical Care Nurse, recomienda unificar la formación de las enfermeras de cuidados intensivos. Por tanto, nos planteamos el siguiente objetivo: valorar las necesidades formativas que detectan las enfermeras de UCI a través de sus vivencias y experiencias profesionales. Método: Estudio cualitativo descriptivo, con enfoque fenomenológico, a través de una entrevista semiestructurada donde se estudiaron los 4 ámbitos que la European Federation of Critical Care Nurse recoge (clínico, profesional, gestión y educativo). Se entrevistaron a 15 enfermeras de una UCI polivalente. Resultados: Los entrevistados reconocen que la formación previa era deficiente para los cuidados y medidas de soporte que tuvieron que afrontar. Consideran que la formación posterior y la experiencia fueron determinantes para poder desarrollar efectivamente su labor profesional. Además afirman que las medidas de soporte y los cuidados son temas a desarrollar continuamente mediante una formación dirigida.Introduction: The competences of intensive care (ICU) nurses in their healthcare environment, have increased with the acquisition of new responsibilities associated with new care and devices for critical patients. Many studies suggest the need for specific training of nurses that work in these units. Based on this evidence, the European Federation of Critical Care Nurses Associations, recommends unifying the training of intensive care nurses. Therefore we set ourselves the following objective: to assess the training needs detected by ICU nurses through their experience and practical knowledge. Method: Descriptive qualitative study, with a phenomenological approach, through semistructured interview where the four areas (clinical practice, professional, management and educational) covered by the European Federation of Critical Care Nurses Associations were studied. Fifteen nurses from an adult polyvalent ICU were interviewed. Results: The interviewees acknowledged that the previous training was deficient for the care and support measures that they had to face. They considered that subsequent training and experience were decisive in order to carry out their work effectively. They also stated that support measures and care are topics to be developed continuously through targeted training. Conclusion: The nurses in this research study acknowledged that training is needed to achieve the competences required in ICU, and these are affected by the type of unit and patients

Competencias enfermeras en el ámbito clínico en una Unidad de Cuidados Intensivos Polivalente mediante un estudio fenomenológico

Ponencia presentada en CUALISALUD 2017, XII Reunión Internacional de Investigación Cualitativa en Salud "Narrativas, fuente de evidencias cualitativas", reunión digital celebrada del 16 al 17 de noviembre de 2017, organizada por Fundación Index.Algunos estudios apoyan que la especialización en cuidados mejora los resultados en la atención, es por tanto, que se debe asegurar una formación acorde a determinados puestos laborales(1). En muchos países, se está optando por la creación de programas formativos al respecto. Sobre todo, ante las evidencias demostradas por Aiken et al, donde los niveles educativos del personal de enfermería afectan a la mortalidad(2). A pesar de que estamos en el Espacio Europeo de Educación Superior (EEES), las diferentes soluciones propuestas por Lakanmaa et al desde Finlandia, no son simétricas a las que se pueden desarrollar en el Sistema Nacional de Salud Español(3,4). En el ámbito del cuidado al paciente crítico se han diseñado diferentes instrumentos de medida como el Intensive and Critical Care Nursing Competence Scale (ICCN-CS)(3,4) y el Basic Knowledge Assesment Tool, versión 7 (BKAT-7) (5), todos ellos surgidos a partir de las necesidades detectadas al respecto por la European Federation of Critical Care Nurses Association (EfCCNa), para homogeneizar los cuidados intensivos en Europa(6). La necesidad de formación detectada no procede únicamente de las asociaciones y sociedades científicas, sino también de las propias enfermeras, quienes observan carencias en formación en competencias específicas. Existe la necesidad de preguntarse, que competencias son necesarias en cada unidad (4) e incluso valorar, que demandan las propias enfermeras en su propio contexto laboral(7– 9) sin dejar atrás, que la formación continua es un puente hacia la excelencia de los cuidados, que se practican en estas áreas supertecnificadas(10), y esto puede evitar el riesgo que puede suponer la falta de formación en estas unidades(11). Es por ello, que se plantea como objetivo conocer las competencias en el ámbito clínico que detectan enfermeras de UCI son necesarias en su realidad laboral a través de sus vivencias y experiencias laborales

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase&nbsp;1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation&nbsp;disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age&nbsp; 6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score&nbsp; 652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc&nbsp;= 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N&nbsp;= 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in&nbsp;Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in&nbsp;Asia&nbsp;and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)