Safety and satisfaction of patients with nurse’s care in the perioperative

Objetivo: investigar a segurança e a satisfação de pacientes e sua relação com os cuidados dos enfermeiros no perioperatório. Método: estudo multinível, transversal, correlacional, realizado com 105 enfermeiros da área cirúrgica e 150 pacientes operados em um hospital terciário espanhol. Para os enfermeiros foram coletadas as variáveis sociodemográficas, a percepção do ambiente de trabalho, o desgaste profissional e a satisfação no trabalho. Para os pacientes, a segurança de eventos adversos e nível de satisfação, por meio de registros e questionários. Utilizou-se análise multinível, univariada e multivariada. Resultados: satisfação no trabalho, compromisso profissional e participação em questões hospitalares foram preditores negativos para eventos adversos relacionados ao paciente, enquanto o cuidado do enfermeiro no pós-operatório foi um preditor positivo. Conclusão: observa-se aumento dos eventos adversos quando os enfermeiros têm insatisfação no trabalho, menor compromisso profissional e baixa disponibilidade para participar nos assuntos de sua unidade. Por outro lado, os eventos adversos diminuem quando os enfermeiros realizam os cuidados no pós-operatório. A satisfação foi boa e não houve associação com as características do cuidado dos enfermeiros. Recomenda-se melhorar esses preditores para aumentar a segurança de pacientes cirúrgicos.Objetivo: investigar la seguridad y la satisfacción de los pacientes y su relación con el cuidado de los enfermeros en el perioperatorio. Método: estudio multinivel, transversal, correlacional, realizado con 105 enfermeros del área quirúrgica y 150 pacientes operados en un hospital terciario español. Para los enfermeros fueron recolectadas las variables sociodemográficas, la percepción del ambiente de trabajo, el desgaste profesional y la satisfacción en el trabajo. Para los pacientes, la seguridad de eventos adversos y el nivel de satisfacción, mediante la aplicación de cuestionarios. Se utilizó análisis univariante y multivariante. Resultados: satisfacción en el trabajo, compromiso profesional y participación en cuestiones hospitalarias fueron predictores negativos para eventos adversos relacionados al paciente, mientras que el cuidado del enfermero en el postoperatorio fue un predictor positivo. Conclusión: se observa aumento de los eventos adversos cuando los enfermeros tienen insatisfacción en el trabajo, menor compromiso profesional y baja disponibilidad para participar en los asuntos de su unidad. Por otro lado, los eventos adversos disminuyen cuando los enfermeros realizan los cuidados en el postoperatorio. La satisfacción fue buena y no hubo asociación con las características de la atención de los enfermeros. Se recomienda mejorar estos predictores para aumentar la seguridad de los pacientes quirúrgicos.Objective: to investigate the safety and satisfaction of patients and their relationship with nurse’s care in the perioperative period. Method: cross-sectional, multi-level, correlational study with 105 nurses in the surgical area and 150 patients operated in a Spanish tertiary hospital. For the nurses the sociodemographic variables, the perception of the work environment, the professional burnout and the satisfaction in the work were collected. For patients, the safety of adverse events and level of satisfaction, through the application of questionnaires. Univariate and multivariate analysis were used. Results: job satisfaction, professional commitment, and participation in hospital issues were negative predictors for adverse events related to the patient, while postoperative nurse care was a positive predictor. Conclusion: there is an increase in adverse events when nurses are dissatisfied at work, less professional commitment and low availability to participate in the subjects of their unit. On the other hand, adverse events decrease when nurses perform the care in the postoperative period. Satisfaction was good and there was no association with the characteristics of nurses’ attention. It is recommended to improve these predictors to increase the safety of surgical patients

Bologna Process, More or Less: Nursing Education in the European Economic Area: A Discussion Paper

The Bologna Declaration and the subsequent processes is the single most important reform of higher education taking place in Europe in the last 30 years. Signed in 1999, it includes 46 European Union countries and aimed to create, a more coherent, compatible, comparable and competitive European Higher Education Area. The purpose of this paper is to discuss the Bologna Declaration achievements in nursing education at 2010 within eight countries that first signed the Declaration on 1999. Researchers primarily identified national laws, policy statements, guidelines and grey literature; then, a literature review on Bologna Declaration implementation in nursing was conducted on the Medline and CINAHL databases. Critical analyses of these documents were performed by expert nurse educators. Structural, organizational, functional and cultural obstacles are hindering full Bologna Process implementation in nursing education within European Economic Area. A call for action is offered in order to achieve a functionally unified system within nursin

Implementing dedicated education units in 6 European undergraduate nursing and midwifery students clinical placements

Background: Undergraduate students' clinical experience, working directly with patients and the healthcare team is essential to ensure students acquire the necessary competence for practice. There are differences in the quality of clinical environments and in students' clinical placement experiences and not all clinical sites are optimal learning environments. The Dedicated Education Unit clinical education model allows students to develop the practical knowledge, skills and professionalism they will need as nurses/midwives. Methods: We employed the Consolidated Framework for Implementation Research to identify and compare barriers and facilitators in the implementation of the Dedicated Education Unit in 6 European undergraduate nursing/midwifery student clinical placement settings and to describe the experience of nurses/midwives involved in the Dedicated Education Unit model implementation and evaluation. A pre-post implementation interpretive assessment was based on participants' responses to the Consolidated Framework for Implementation Research construct questions. Results: Although Dedicated Education Unit model implementation in our project was heterogeneous, no main implementation barriers were perceived. Qualitative data showed that educational-service collaboration, including a focus on mutual goals, organizational communication and networking, satisfaction of educational and healthcare professionals, and the establishment of a safe space for professional discussion and feedback, were considered facilitators. Conclusions: This study describes the key elements guiding educational and healthcare stakeholders in Dedicated Education Unit implementation, engaging participants in the entire process, and offering other organizations the opportunity to consider the benefits of this clinical education model. Keywords: Dedicated education unit, Consolidated framework for implementation research, Clinical learning environment, clinical education, Nursing student

Resposta emocional de pacientes cardiológicos críticos durante a higiene em cuidados intensivos: um estudo prospectivo e descritivo

Objetivo: analizar la respuesta emocional de pacientes conscientes en estado crítico durante la higiene diaria en una unidad de cuidados intensivos cardiológicos y compararla en función de experiencias previas o no. Método: estudio prospectivo y descriptivo. Encuesta ad hoc de 30 ítems realizada a 148 pacientes y basada en la higiene del primer día. Se formulan preguntas sobre los sentimientos durante la higiene y aspectos positivos y negativos de la experiencia. Se compara a los pacientes en función de si se los había higienizado con anterioridad. Resultados: el 67,6% fueron hombres y la media de edad fue de 67±15 años. El 45,9% presentó conformismo, el 27% sintió vergüenza y el 86,3% agradeció que le hablaran durante la higiene. Al 33,1% de los pacientes nunca les habían realizado higiene en la cama, eran significativamente más jóvenes y solteros, y tenían menor sensación de limpieza. El 32% expresó que le gustaría que un familiar colaborase en la higiene. Conclusión: los pacientes no sienten que se invade su intimidad cuando se los higieniza y aprecian la comunicación con el personal sanitario durante estos cuidados. Los pacientes a quienes no les habían realizado higiene en la cama previamente son más jóvenes, sienten mayor vergüenza y les molestan más las interrupciones, siendo más conscientes de ellas.Objetivo: analisar a resposta emocional de pacientes críticos conscientes durante a higiene diária em uma unidade de terapia intensiva cardíaca e compará-la considerando ou não as experiências prévias. Método: estudo prospectivo e descritivo. Foi aplicado questionário ad hoc de 30 itens a 148 pacientes, com base na higiene do primeiro dia. Foram feitas perguntas sobre sentimentos durante a higiene e aspectos positivos e negativos da experiência. Os pacientes foram comparados considerando o fato de terem sido higienizados anteriormente. Resultados: 67,6% eram homens e a idade média foi de 67±15 anos. 45,9% apresentavam conformismo, 27% se sentiram envergonhados e 86,3% estavam gratos por terem conversado com eles durante a higiene; 33,1% dos pacientes acamados nunca haviam recebido cuidados de higiene no leito, eram significativamente mais jovens e solteiros, e tinham um senso de limpeza mais baixo; 32% expressaram que gostariam que um membro da família ajudasse na higiene. Conclusão: os pacientes não se sentiram invadidos em sua intimidade quando receberam os cuidados de higiene e apreciaram a comunicação com o pessoal de saúde durante o procedimento. Os pacientes que não tinham recebido cuidados de higiene no leito anteriormente são mais jovens, sentem-se mais constrangidos e mais incomodados pelas interrupções, sendo mais conscientes delas.Objective: to analyze the emotional response of critically-ill conscious patients during daily hygiene procedures in a Cardiology Intensive Care Unit and to compare it based on the existence of previous experiences or not. Method: a prospective and descriptive study. A 30-item ad hoc survey based on the first-day hygiene procedures was applied to 148 patients. Questions are asked about the feelings during the hygiene procedures and about positive and negative aspects of the experience. The patients are compared based on whether they had been already subjected to hygiene procedures or not. Results: 67.6% were men and their mean age was 67±15 years old; 45.9% proved to be satisfied, 27% felt embarrassment and 86.3% were grateful to the professionals for talking to them during the hygiene procedures. 33.1% of the patients had never been subjected to hygiene procedures in bed, were significantly younger and single, and presented a lower cleanliness sensation. 32% stated that they would like for a family member to collaborate in the hygiene procedures. Conclusion: the patients do not feel that their intimacy is invaded when they are subjected to hygiene procedures and appreciate communication with the health personnel while this care is provided. Those who had never been subjected to hygiene procedures in bed are younger, feel more embarrassed and are more disturbed by interruptions, in addition to being more aware of them

Spanish Validation of the 'User Reported Measure of Care Coordination' Questionnaire for Older People with Complex, Chronic Conditions

Older people with complex, chronic conditions often receive insufficient or inefficient care provision, and few instruments are able to measure their perception of care provision. The "User ReportedMeasure of Care Coordination" instrument has been satisfactorily used to evaluate chronic care provision and integration. The aim of this study is to validate this instrument in Spanish. Methods: The questionnairewas adapted and validated in two phases: translation and cultural adaptation of the questionnaire and psychometric property measurement. Study population were chronic care conditions patients. Results: A total of 332 participants completed test re-test as part of the questionnaire validation process. The final version of the questionnaire had 6 domains: Health andWell-being (D1), Health day to day (D2), Social Services (D3), Planned Care (D4), Urgent Care (D5), and Hospital Care (D6). Cronbach's alpha for the overall questionnaire was 0.86, indicating good internal consistency. When analyzing each domain, only Planned Care (D4) and Urgent Care (D5) had Cronbach's Alphas slightly lower than 0.7, although this could be related to the low number of items in each domain. A good temporal stabilitywas observed for the distinct subscales and items,with intraclass correlation coefficients varying from0.412 to 0.929 (p < 0.05). Conclusion: The adapted version of the "User ReportedMeasure of Care Coordination" into Spanish proved to be a practical tool for use in our daily practice and an efficient instrument for assessment of care coordination in chronic, complex conditions in older people across services and levels of care

Knowledge expectations of surgical orthopaedic patients: a European survey

Ageing population entails a growing international problem of osteoarthritis. Best practices for education of these patients are lacking. This study focused on empowering education in Northern (Finland, Iceland, Lithuania and Sweden) and Southern Europe (Cyprus, Greece and Spain). The aim was to analyse associations between expected knowledge and background factors. The data were collected from European arthroplasty patients with the Knowledge Expectations of hospital patients- scale, (KE(hp) - scale), including bio-physiological, functional, experiential, ethical, social and financial dimensions. Patients had essential bio-physiological and functional knowledge expectations. Women expected more than men, employed less than retired, unemployed or who worked at home. Generally, patients in Northern countries expected more than in Southern countries. However, highest expectations were found in Sweden and Greece, lowest in Spain and Cyprus. There are differences in knowledge expectations based on patients' backgrounds. Development of common standards in European patient education needs further research

Instruments for Patient Education: Psychometric Evaluation of the Expected Knowledge (EKhp) and the Received Knowledge of Hospital Patients (RKhp)

Purpose: In patient education, there is a need for valid and reliable instruments to assess and tailor empowering educational activities. In this study, we summarize the process of producing two parallel instruments for analyzing hospital patients' expectations (Expected Knowledge of Hospital Patients, EKhp) and received knowledge (Received Knowledge of Hospital Patients, RKhp) and evaluate the psychometrics of the instruments based on international data. In the instruments, six elements of empowering knowledge are included (bio-physiological, functional, experiential, ethical, social, and financial).Patients and methods: The original Finnish versions of EKhp and RKhp were tested for the first time in 2003, after which they have been used in several national studies. For international purposes, the instruments were first translated into English, then to languages of the seven participating European countries, using double-checking procedure in each one, and subsequently evaluated and confirmed by local researchers and language experts. International data collection was performed in 2009-2012 with a total sample of 1,595 orthopedic patients. Orthopedic patients were selected due to the increase in their numbers, and need for educational activities. Here we report the psychometrics of the instruments for potential international use and future development.Results: Content validities were confirmed by each participating country. Confirmatory factor analyses supported the original theoretical, six-dimensional structure of the instruments. For some subscales, however, there is a need for further clarification. The summative factors, based on the dimensions, have a satisfactory internal consistency. The results support the use of the instruments in patient education in orthopedic nursing, and preferably also in other fields of surgical nursing care.Conclusion: EKhp and RKhp have potential for international use in the evaluation of empowering patient education. In the future, testing of the structure is needed, and validation in other fields of clinical care besides surgical nursing is especially warranted.</p

Spanish version of the Satisfaction with Epilepsy Care questionnaire: Adaptation and psychometric properties

OBJECTIVE: The objective of this study was to perform a cross-cultural adaption and psychometric evaluation of the Spanish version of the Satisfaction with Epilepsy Care (SEC) questionnaire and analyze patient satisfaction with epilepsy care. METHODS: Transcultural adaptation and validation of the SEC were carried out using translation and back-translation with pilot testing and an expert panel. The SEC-E (Spanish) was analyzed in 213 patients with epilepsy to examine construct and criterion validity and internal consistency. RESULTS: The SEC-E achieved conceptual, semantic, and content equivalence with the original version. For content validity, one question was eliminated from the original questionnaire as it has little relevance in our cultural setting. Positive correlations for criterion validity were obtained using the gold standard measure (Satisfaction in Hospitalized Patients scale). Construct validity replicated the three dimensions of the original questionnaire. The scale showed adequate reliability through internal consistency (Cronbach's α of 0.94) and temporal stability on retest (n = 85). Patients scored (0 to 100) 77.5 [standard deviation (SD): 19.9] for satisfaction with communication, 76.9 (SD: 17) for organization, and 67.2 (SD: 22.1) for information. SIGNIFICANCE: The SEC-E is a valid and reliable tool for the assessment of educational interventions aiming to improve the quality of care in patients with epilepsy in Spanish clinical practice. The results showed a good level of patient satisfaction with epilepsy care

Formal support for informal caregivers to older persons with dementia through the course of the disease: an exploratory, cross-sectional study

Background: In European countries, knowledge about availability and utilization of support for informal caregivers caring for older persons (>= 65 years) with dementia (PwD) is lacking. To be able to evaluate and develop the dementia support system for informal caregivers to PwD, a survey of European support systems and professionals involved is needed. The aim of this study was to explore support for informal caregivers to PwD in European countries. We investigated the availability and utilization of support in each of the participating countries, and the professional care providers involved, through the dementia disease. Methods: A mapping system was used in 2010-2011 to gather information about estimations of availability, utilization, and professional providers of support to informal caregivers caring for PwD. Data collected was representing each country as a whole. Results: There was high availability of counselling, caregiver support, and education from the diagnosis to the intermediate stage, with a decrease in the late to end of life stage. Utilization was low, although there was a small increase in the intermediate stage. Day care and respite care were highly available in the diagnosis to the intermediate stage, with a decrease in the late to end of life stage, but both types of care were utilized by few or no caregivers through any of the disease stages. Professionals specialized in dementia (Bachelor to Master's degree) provided counselling and education, whereas caregiver support for informal caregivers and day care, respite care, and respite care at home were provided by professionals with education ranging from upper secondary schooling to a Master's degree. Conclusions: Counselling, caregiver support, and education were highly available in European countries from diagnosis to the intermediate stage of the dementia disease, decreasing in the late/end of life stages but were rarely utilized. Countries with care systems based on national guidelines for dementia care seem to be more aware of the importance of professionals specialized in dementia care when providing support to informal caregivers. Mapping the systems of support for informal caregivers of PwD is a valuable tool for evaluating existing systems, internationally, nationally and locally for policy making

Modelos teóricos y estudiantes de enfermería: aspectos motivacionales para su elección durante las prácticas clínicas

Introducción: el cuerpo teórico y filosófico de enfermería es complejo; existen un gran número de teorías enfermeras, algunas de difícil comprensión, por lo que habitualmente su aplicación práctica se ve restringida. Objetivo: identificar el modelo teórico de enfermería que los estudiantes dicen utilizar durante las prácticas clínicas, la motivación para su elección, y la escuela universitaria donde estaban cursando sus estudios. Sujetos y métodos: estudio descriptivo en el que participaron 105 estudiantes (de una población total de 108) que realizaban prácticas de enfermería en el hospital durante el curso 2006-2007. La variables de estudio fueron los modelos teóricos enfermeros, las razones de la elección y variables sociodemográficas. La recogida de datos se llevo a cabo mediante un cuestionario cumplimentado durante su experiencia clínica. El análisis de los datos se realizó mediante un análisis temático de texto, categorizando para crear finalmente un marco explicativo. Resultados y conclusiones: el modelo elegido es principalmente el de Virginia Henderson. Las motivaciones para la elección, según los estudiantes, son su uso en la enseñanza universitaria y la facilidad de ejecución del modelo. Se evidenció confusión entre los términos 'modelo conceptual y/o teórico' y 'metodología enfermera'