El desarrollo del rol avanzado en el área de cardiología a través de la formación de postgrado

La enfermedad cardiovascular es una de las primeras causas de muerte y discapacidad en todo el mundo (OMS 2009). En los últimos años, el número de ingresos se ha duplicado aunque gracias a la efectividad de la cirugía cardiaca, la tasa de mortalidad ha disminuido (OMS 2008). Cabe señalar que este descenso no sólo depende de la cirugía sino también de un adecuado plan de alta del paciente y su familia (Tranmer & Parry 2004). No obstante, la disminución de la estancia hospitalaria ha supuesto que el profesional de enfermería posea menos tiempo para garantizar una preparación óptima del paciente y su familia a casa (Theobald & McMurray 2004, Tranmer & Parry 2004). Múltiples autores ponen de manifiesto que una adecuada planificación del alta favorece la disminución de los reingresos hospitalarios y de los costes, mejora la satisfacción del paciente con el cuidado y la adherencia del paciente al tratamiento1 (Richards & Coast 2003, Shepperd et al. 2004, Lin et al. 2009). Por su parte, Tranmer & Parry (2004) apuntan que las enfermeras de práctica avanzada (EPAs) se encuentran en una posición única para coordinar e implementar la planificación del proceso de transición a casa, ya que tienen un conocimiento exhaustivo de la situación de los pacientes, son capaces de fomentar la comunicación entre una variedad de disciplinas, y están en condiciones de brindar un cuidado holístico. Asimismo, estos autores proponen fututos estudios para evaluar el rol de la EPA en la planificación del alta de los pacientes intervenidos de cirugía cardiaca (Tranmer & Parry 2004). Con esta perspectiva, y aún siendo consciente de la incipiente aparición de este perfil en España, en este capítulo se presenta cómo se ha desarrollado el rol avanzado durante la formación de postgrado y cuál ha sido su implicación en el área de hospitalización de Cardiología

Retention of newly graduated registered nurses in the hospital setting: A systematic review

Background: There is a gap in the literature on identifying and describing effective interventions for the retention of newly graduated registered nurses in hospital set-tings. To the best of our knowledge, no systematic review has been conducted on this issue.Aim: To identify effective interventions that promote the retention of newly gradu-ated registered nurses in the hospital setting and their components.Design: A systematic review was conducted according to PRISMA 2020 Statement.Methods: Information derived from the PubMed, CINAHL, Scopus, PsycINFO and Cochrane Library databases was reviewed, for the period January 2012–October 2022. Screening, data extraction and quality appraisal were conducted independently by two reviewers. The Joanna Briggs Institute Critical Appraisal tools were used for descriptive, quasi-experimental and cohort studies. Disagreements between the two reviewers were resolved through discussion.Results: Following the critical appraisal, nine studies were included. The evidence re-veals the heterogeneity of programmes developed in the hospital context to promote the retention of newly graduated registered nurses, clarifies the three competencies to be addressed (core, cross-cutting and specific), their components (programme de-velopment framework, duration, content and support components), and shows sig-nificant improvements after their implementation.Conclusions: This systematic review identifies that either nurse residency or individu-alised mentoring programmes, lasting 1 year, and multi-component, addressing core and specific competencies and including preceptor or mentor components seem to be the most comprehensive and effective in promoting the retention of new nurses in the hospital setting.Relevance to Clinical Practice: The knowledge provided by this review will contrib-ute to developing and implementing more effective and context-specific strategies directed at retaining newly graduated registered nurses and subsequently enhancing patient safety and healthcare costs.No Patient or Public Contribution: Given the study design and focus

¿Cómo hemos adaptado las recomendaciones de los Proyectos Zero durante la pandemia?

El impacto negativo de la pandemia sobre las tasas de infecciones controladas ha evidenciado la necesidad de reanudar la aplicación de las recomendaciones de los Proyectos Zero (PZ). En este artículo, en primer lugar, se realiza un análisis de la situación de las unidades de cuidados intensivos de España durante la pandemia. A continuación se presenta la adaptación de las recomendaciones de cada uno de los cuatro PZ y su grado de cumplimiento y riesgo de que existan infecciones relacionadas con dispositivos invasivos y/o bacteriemias multirresistentes. Para ello, se han tenido en cuenta: 1) el documento publicado en octubre de 2020 por el Consejo Asesor del Programa de Seguridad de pacientes críticos, y 2) el estudio exploratorio realizado, un año después, por el Consejo Asesor de los PZ, junto con los líderes de los proyectos de las unidades participantes del registro ENVIN. Por último, y en base a los hallazgos encontrados, se formulan cinco recomendaciones tentativas y prioritarias.The negative impact of the pandemic on infection control rates has highlighted the need to resume the implementation of Project Zero (PZ) recommendations. This article first analyses the situation of intensive care units in Spain during the pandemic. Subsequently, it presents the adaptation of the recommendations of each of the four PZs and their degree of compliance and the risk of invasive device-related infections and/or multidrug-resistant bacteraemias. For this purpose, we have taken into account: (i) the document published in October 2020 by the Advisory Board of the Critical Patient Safety Programme, and (ii) the exploratory study conducted, one year later, by the Advisory Board of the PZs, on the leaders of the Projects of the units participating in the ENVIN registry. Finally, based on the findings, five tentative and priority recommendations are formulated

Nurses' protocol-based care decision-making: a multiple case study

Aim: To describe and explain nurses' protocol-based care decision-making. Background: Protocol-based care is a strategy to reduce variability in clinical practice. There are no studies looking at protocol-based care decision-making. Understand this process is key to successful implementation. Method: A multiple embedded case study was carried out. Nurses' protocol-based care decision-making was studied in three inpatient wards (medical, surgical and medical-surgical) of a university hospital in northern Spain. Data collection was performed between 2015 and 2016 including documentary analysis, non-participant observations, participant observations and interviews. Analysis of quantitative data involved descriptive statistics and qualitative data was submitted to Burnard's method of content analysis (1996). The data integration comprised the integration of the data set of each case separately and the integration of the findings resulting from the comparison of the cases. The following the thread method of data integration was used for this purpose. The SRQR guideline was used for reporting. Results: The multiple embedded case study revealed protocol-based care decision-making as a linear and variable process that depends on the context and consists of multiple interrelated elements, among which the risk perception is foremost. Conclusion: This study has allowed progress in protocol-based care decision-making characterisation. This knowledge is crucial to support the design of educational and management strategies aimed at implementing protocol-based care. Relevance to clinical practice: Strategies to promote protocol-based care should address the contexts of practice and the ability of professionals' to accurately assess the degree of risk of clinical activity. Hence, it will promote quality of care, patient safety and efficiency in healthcare cost

Experiences of frontline nurse managers during the COVID-19: a qualitative study

Aim The aim of this study is to explore the experiences of Jordanian first-line nurse managers during COVID-19. Background Nurses are exposed to life-threatening occupational risks during COVID-19. Exploring the first-line nurse managers' experiences will help in designing health policies to better deal with such emerging crises. Methods A descriptive phenomenological study was conducted. A purposive sample was used to recruit 16 first-line nurse managers from Jordanian hospitals. Semistructured interviews were conducted. Phenomenological data analysis method was used to analyse the data. Results Four major themes emerged: (a) unprecedented pressure (first-line nurse managers revealed their suffering with the unprecedented demanding situations during COVID-19 pandemic); (b) strengthening system and resilience (nurse managers employed several strategies to strengthen the health system and enhance resilience); (c) building a supportive team (the presence of a robust supportive system is vital to deal with the pandemic); and (d) maturity during the crisis (exposure to a new experience developed nurse managers management skills and self-awareness). Conclusions The unprecedented pressure associated with COVID-19 drained first-line nurse managers physically and psychosocially. Providing adequately trained staff and medical equipment is important to better deal with crises. Implications for Nursing Management Strengthening emergency training and improving emergency response plans of hospitals are essential

Transforming care in nursing: a concept analysis

Although the concept of ‘Transforming care’ is promising for improving healthcare, there is no consensus in the field as to its definition. The aim of this concept analysis is to develop a deeper understanding of the term ‘Transforming care’ within the nursing discipline, in order to facilitate its comprehension, implementation and evaluation. We performed a comprehensive literature review on electronic databases such as Medline (PubMed), Cinahl (Ebsco), Cochrane Library, PsycINFO (Ovid), Web of Science, Wiley- Blackwell, ScienceDirect and SpringerLink, and used Walker and Avant’s approach to analyse the concept. From the 20 studies selected for this analysis, three main attributes of ‘Transforming care’ were identified: patient-centredness, evidence-based change, and transformational leadership-driven. We suggest an operational definition to facilitate the implementation of the concept in practice. Furthermore, we propose that implementation is guided by the following key ideas: 1) fostering a culture of continuous improvement; 2) encouraging bottom-up initiatives; 3) promoting patient-centred care; and 4) using transformational leadership. Lastly, the evaluation of ‘Transforming care’ initiatives should assess care processes, and professionals’ and patients’ outcomes

Una revisión sistemática de las intervenciones para empoderar al paciente con insuficiencia cardiaca crónica en el entorno hospitalario

El empoderamiento del paciente con insuficiencia cardiaca crónica (ICC) es clave para mejorar su calidad de vida, autonomía, autoestima, nivel de satisfacción y los costes sanitarios. El objetivo fue identificar las intervenciones de enfermería más efectivas para favorecer el empoderamiento del paciente con ICC en el medio hospitalario. Se seleccionaron ocho artículos para revisión (cuatro experimentales, dos cuasi-experimentales y dos revisiones sistemáticas). De su análisis se identificaron tres tipos de intervenciones: educativas, cognitivo-comportamentales y combinadas, siendo estas últimas las más efectivas. Se recomienda el uso del Empowerment Questionnaire como un instrumento válido y fiable para medir el empoderamiento del paciente con ICC hospitalizado. Dada la escasez de estudios, esta revisión aboga por futuras investigaciones que potencien e incluyan intervenciones combinadas mediante una escala válida, fiable y específica para medir el empoderamiento de los pacientes hospitalizados con ICC.The empowerment of patients with chronic heart failure (CHF) is key to improving their quality of life, autonomy, self-esteem, level of satisfaction and healthcare costs. The aim was to identify the most effective nursing interventions to promote the empowerment of patients with CHF in the hospital context. Eight articles were selected for review (four experimental, two quasiexperimental and two systematic reviews). From their analysis, three types of interventions were identified: educational, cognitive-behavioral and combined, the latter being the most effective. The use of the Empowerment Questionnaire is recommended as a valid and reliable instrument to measure the empowerment of chronic hospitalized patients. Given the lack of studies on the phenomenon of interest, this review advocates for future research including combined interventions to empower hospitalized patients with chronic heart failure using a valid, reliable and specific scal

The relationship competencies guiding tool: a development, content validation and implementation study

Aim: The aims of this paper are (1) to present the results of the development, content validation and imple-mentation study of the Relationship Competencies Guiding Tool; (2) to provide examples of how each item in the tool is reflected in clinical narratives written by nurses and justify the corresponding scores after the evaluation; (3) to present how the language and content of the narratives are interpreted with the tool and to describe an exemplar; and (4) to present barriers to and facilitators of the application of the tool. Background: From a person-centered care approach, the fostering of authentic relationships with patients is key to achieving therapeutic benefits. Therefore, it is essential to help nurses establish meaningful relationships with patients and help them acquire these abilities. Clinical narratives can be used as a way to promote reflective practice and professional competency development among nurses. A tool to evaluate the knowledge, skills, at-titudes and values necessary for developing authentic encounters with patients through clinical narratives was developed, validated and implemented.Design: An instrument-development study comprised of three steps: (1) conceptualization; (2) item generation and content validity; and (3) implementation of the tool and linguistic evaluation.Methods: This study was conducted in three major steps. Step one entailed conceptualization. Step two included the generation of items and content validation. In step three, the tool was used to independently evaluate 25 narratives. One of these narratives was also linguistically analysed to provide a comprehensive view of the interpretative strategies deployed by evaluators.Results: The Relationship Competencies Guiding Tool was developed, validated and implemented. It could help nurses work on nursing relationship-based professional competencies, guided the evaluators in the process of assigning scores to the corresponding items and helped the researchers identify certain barriers and facilitators before and during the narrative evaluation process.Conclusions: The tool has been shown to be clear, relevant and conceptually and linguistically suitable for evaluating clinical narratives. The Relationship Competencies Guiding Tool could be applied to interpret how nurses reflect professional competencies in a clinical narrative as a preliminary step in the construction of a mea-surement tool.Tweetable abstract: From a person-centered relationship-based care approach, clinical narratives can be used to promote professional competencies between nurses. The Relationship Competencies Guiding Tool may help eval-uate the knowledge, skills, attitudes and values necessary for developing authentic encounters with persons/ families, as reflected by nurses' clinical narratives

Level of empowerment of hospitalized chronic heart failure patient

Fundamento. Conocer el nivel de empoderamiento de las personas con insuficiencia cardiaca crónica hospitalizadas es crucial para identificar a las personas con un nivel de empoderamiento más bajo y fundamentar el diseño de estrategias efectivas para mejorar su control sobre las decisiones y acciones que afectan a su salud y bienestar. La falta de estudio de este fenómeno en esta población y contexto, sugiere que estos pacientes no están siendo atendidos adecuadamente. Material y métodos. Estudio descriptivo, prospectivo. Se utilizó el Cuestionario de empoderamiento del paciente con enfermedad crónica, traducido y validado al español, que consta de 47 ítems, agrupados en tres dimensiones: Actitud positiva y sentido del control, Toma de decisiones compartida e informada, y Búsqueda de información y compartir entre iguales. Fue distribuido para su cumplimentación en las 24 horas previas al alta hospitalaria. Resultados. Se recogieron 25 cuestionarios (81%). La puntuación global media de empoderamiento fue de 165,92 ± 20,9. La dimensión Actitud positiva y sentido de control fue la peor puntuada, con una media de 3,4 ± 0,5. Se encontró una relación inversa y débil entre el nivel de empoderamiento y la edad (rho=-0,240; p=0,000) y una relación débil y positiva con la supervivencia a los 10 años (rho=0,316; p=0,01). Conclusión. El nivel de empoderamiento de los pacientes de este estudio fue medio-alto. Las estrategias para abordar la atención de esta población deberían centrarse en trabajar su actitud respecto a la enfermedad y percepción de control de la situación e individualizarse conforme a la edad.Background. Establishing the level of chronic cardiac inpatient empowerment is essential. By doing so, it is possible to identify groups with a lower level. It also provides a basis for designing effective strategies to improve their control over decision making and the actions that affect their health and wellness. The shortage of studies of this phenomenon for this particular population and context suggests that such patients are not receiving proper care. Methods. A prospective and descriptive study was carried out. A validated Spanish version of the Patient empowerment in long-term conditions scale was used. The survey has 47 items, grouped into three dimensions: Positive attitude and feeling of control, Knowledge in shared decision making, and Seeking information and sharing with other patients. It was distributed 24 hours before hospital discharge. Results. Twenty five questionnaires were collected (81%). The mean global empowerment score of the patients was 165.92 ± 20.9. The dimension Positive attitude and sense of control showed the lowest score, with a mean of 3.4 ± 0.5. An inverse weak relationship was found between the level of empowerment and age (rho=-0.240; p=0.000) while a positive one was found with 10-year survival (rho=0,316; p=0.01). Conclusion. The level of empowerment of the patients in this study was medium-high. The strategies used to address the care of this population should focus on working on their attitude towards the disease and perceived control of the situation, and should be individualized according to age

Prevention of ventilator-associated pneumonia: the multimodal approach of the spanish ICU pneumonia zero program.

Objectives: The “Pneumonia Zero” project is a nationwide multimodal intervention based on the simultaneous implementation of a comprehensive evidence-based bundle measures to prevent ventilator-associated pneumonia in critically ill patients admitted to the ICU. Design: Prospective, interventional, and multicenter study. Setting: A total of 181 ICUs throughout Spain. Patients: All patients admitted for more than 24 hours to the participating ICUs between April 1, 2011, and December 31, 2012. Intervention: Ten ventilator-associated pneumonia prevention measures were implemented (seven were mandatory and three highly recommended). The database of the National ICU-Acquired Infections Surveillance Study (Estudio Nacional de Vigilancia de Infecciones Nosocomiales [ENVIN]) was used for data collection. Ventilator-associated pneumonia rate was expressed as incidence density per 1,000 ventilator days. Ventilator-associated pneumonia rates from the incorporation of the ICUs to the project, every 3 months, were compared with data of the ENVIN registry (April–June 2010) as the baseline period. Ventilator-associated pneumonia rates were adjusted by characteristics of the hospital, including size, type (public or private), and teaching (postgraduate) or university-affiliated (undergraduate) status. Measurements and Main Results: The 181 participating ICUs accounted for 75% of all ICUs in Spain. In a total of 171,237 ICU admissions, an artificial airway was present on 505,802 days (50.0% of days of stay in the ICU). A total of 3,474 ventilator-associated pneumonia episodes were diagnosed in 3,186 patients. The adjusted ventilator-associated pneumonia incidence density rate decreased from 9.83 (95% CI, 8.42–11.48) per 1,000 ventilator days in the baseline period to 4.34 (95% CI, 3.22–5.84) after 19–21 months of participation. Conclusions: Implementation of the bundle measures included in the “Pneumonia Zero” project resulted in a significant reduction of more than 50% of the incidence of ventilator-associated pneumonia in Spanish ICUs. This reduction was sustained 21 months after implementation