Development and validation of the competence in evidence based practice questionnaire (EBP-COQ) among nursing students

BACKGROUND: Nursing educators need rigorously developed instruments to assess competency in evidence based practice (EBP) at undergraduate level. This concept is defined as the capability to choose and use an integrated combination of knowledge, skills and attitudes with the intention to develop a task in a certain context. Also, we understand that EBP is gaining knowledge and skills, as well as increasing positive attitudes toward EBP that will promote a change in behaviour to implement EBP in practice. This study aims to develop a psychometric test of the Evidence Based Practice Evaluation Competence Questionnaire (EBP-COQ) among undergraduate nursing students. METHODS: The questionnaire was developed by item generation through a review of scientific literature and focus groups. The instrument was validated in terms of content validity through an expert review. The EBP-COQ was administered to a cohort of nursing students (n =100) to evaluate test reliability and select the best items. Psychometric properties of the final instrument were assessed in a sample of 261 nursing students. RESULTS: The EBP-COQ consisted of 25 items. A factorial analysis grouped the items into the three categories that define competence relating to EBP: attitude, knowledge and skills. Cronbach's alpha was 0.888 for the entire questionnaire. The factor solution explained 55.55% of the variance. CONCLUSIONS: EBP-COQ appears to measure with adequate reliability the attributes of undergraduate nursing students' competence in EBP. The instrument is quick to disseminate and easy to score, making it a suitable instrument for nursing educators to evaluate students' self-perceived competence in EBP.This work has been supported by a grant from FIS (Fondo de Investigación Sanitaria, Grant PI060913S

Nurses' sleep quality, work environment and quality of care in the Spanish National Health System: observational study among different shifts

OBJECTIVE: The main objective of this study was to determine the relationship between the characteristics of nurses' work environments in hospitals in the Spanish National Health System (SNHS) with nurse reported quality of care, and how care was provided by using different shifts schemes. The study also examined the relationship between job satisfaction, burnout, sleep quality and daytime drowsiness of nurses and shift work. METHODS: This was a multicentre, observational, descriptive, cross-sectional study, centred on a self-administered questionnaire. The study was conducted in seven SNHS hospitals of different sizes. We recruited 635 registered nurses who worked on day, night and rotational shifts on surgical, medical and critical care units. Their average age was 41.1 years, their average work experience was 16.4 years and 90% worked full time. A descriptive and bivariate analysis was carried out to study the relationship between work environment, quality and safety care, and sleep quality of nurses working different shift patterns. RESULTS: 65.4% (410) of nurses worked on a rotating shift. The Practice Environment Scale of the Nursing Work Index classification ranked 20% (95) as favourable, showing differences in nurse manager ability, leadership and support between shifts (p=0.003). 46.6% (286) were sure that patients could manage their self-care after discharge, but there were differences between shifts (p=0.035). 33.1% (201) agreed with information being lost in the shift change, showing differences between shifts (p=0.002). The Pittsburgh Sleep Quality Index reflected an average of 6.8 (SD 3.39), with differences between shifts (p=0.017). CONCLUSIONS: Nursing requires shift work, and the results showed that the rotating shift was the most common. Rotating shift nurses reported worse perception in organisational and work environmental factors. Rotating and night shift nurses were less confident about patients' competence of self-care after discharge. The most common nursing care omissions reported were related to nursing care plans. For the Global Sleep Quality score, difference were found between day and night shift workers.This study was carried out as part of a project entitled ‘Functioning of the circadian system, working environment, and the organisation of nursing care of hospitals of the National Health System’, financed by the Spanish Health Research Fund (PI 11/00646, Health Ministry), the Ministry of Science and Innovation (SAF2013-49132-C2-1-R) and the Institute of Health Carlos III (RETICEF, RD12/0043/0011, RD12/0043/0006). The project was approved by the Spanish Health Research Fund (Fondo de Investigaciones Sanitarias PI11/00646).S

Living at the Wrong Time: Effects of Unmatching Official Time in Portugal and Western Spain

Human circadian rhythmicity is subjected to the internal circadian clock, the sun and social clocks (official time, social/work schedules). The discrepancy among these clocks, as occurs when official time does not match its geographical time zone, may produce circadian disruption. Western Spain (GMT+1/+2) and Portugal (GMT0/+1) share similar longitudes (sun time) but have different official times. This provides a unique opportunity to evaluate the effects of official time on circadian rhythmicity and sleep in elderly and retired populations (with no remunerated duties presumed, although other social commitments may be present) at both locations. Although both populations slept enough for their age (7-8 h), circadian robustness (e.g., interdaily stability, relative amplitude) was greater in Portugal, especially during weekdays, while greater desynchronization (both body temperature vs. motor activity and body temperature vs. light exposure) tended to occur in the Spaniards. Once corrected by GMT0, meals took place later in Spain than in Portugal, especially as the day progresses, and a possible interplay between bed/meal timings and internal desynchronization was found. Our results point to the possible deleterious effect on circadian system robustness when official time is misaligned with its geographical time zone.This research was funded by the Ministry of Economy and Competitiveness, the Instituto de Salud Carlos III through a CIBERFES grant (CB16/10/00239, CB16/10/00468); Fundación General del Consejo Superior de Investigaciones Científicas through grant ModulEn (POCTEP 0348_CIE_6_E, Programa de cooperación INTERREG V-A España-Portugal) and Diabfrail LatAm (European Union Horizon 2020 research and innovation programme No. 825546) awarded to MAR (all co-financed by FEDER). Grant RTI2018-093528-B-I00, funded by MCIN/AEI/ 10.13039/501100011033 and by “ERDF A way of making Europe”, by the “European Union” or by the “European Union NextGenerationEU/PRTR”. A research fellowship was granted to MAB-C (20401/SF/17, Fundación Séneca, Región de Murcia (Spain)).S

Methodological considerations when translating "burnout"

No study has systematically examined how researchers address cross-cultural adaptation of burnout. We conducted an integrative review to examine how researchers had adapted the instruments to the different contexts. We reviewed the Content Validity Indexing scores for the Maslach Burnout Inventory-Human Services Survey from the 12-country comparative nursing workforce study, RN4CAST. In the integrative review, multiple issues related to translation were found in existing studies. In the cross-cultural instrument analysis, 7 out of 22 items on the instrument received an extremely low kappa score. Investigators may need to employ more rigorous cross-cultural adaptation methods when attempting to measure burnout

Guía de Práctica Clínica para el manejo del dolor en niños con cáncer

90% de los niños informan de dolor, que a menudo es intenso e infratratado. Muchas personas que sobreviven al cáncer siguen sufriendo dolor después del tratamiento durante el resto de sus vidas (Miaskowski et al., 2004). El origen del dolor es el propio cáncer, los procedimientos invasivos y/o el tratamiento. En los niños, el dolor está presente durante el proceso oncológico en casi todos los casos, aunque existe una gran variabilidad en su buen control y tratamiento, llegando incluso a estar infratratado, lo cual está bien documentado (Miaskowski et al., 2004). Todos los profesionales de la salud deberían saber cómo valorar y manejar el dolor en cualquiera de las fases evolutivas de la enfermedad (Miaskowski et al., 2004). Es necesario establecer una buena comunicación entre los profesionales y los cuidadores, ya que en ocasiones el niño con dolor no manifiesta signos externos, sino un malestar o sufrimiento psicológico que sólo es capaz de identificar su cuidador, ya que es quién mejor conoce al niño; por ello, es necesario que pase todo el tiempo posible con él durante su hospitalización (OMS, 1998). Está demostrado el hecho de que unos cuidados eficaces dependen de un enfoque interdisciplinar coordinado, que incluya la comunicación constante entre los profesionales sanitarios y el niño y sus cuidadores, teniendo siempre en cuenta las preferencias personales y las necesidades únicas de cada niño y su cuidador (OMS, 1998). Es igualmente importante el ingreso del niño y adolescente en Unidades Oncológicas Pediátricas, hasta los 18 años, para que los menores puedan recibir la atención adecuada a su edad y necesidades (II PENIA, 2013; OMS, 1998). El correcto manejo del dolor es un reto para los sistemas de salud. Se está estudiando qué tipo de atención se necesita para proporcionar una mejor respuesta a la realidad que experimentan estos pacientes, como se indica en la Estrategia del Cáncer del Sistema Nacional de Salud de España (SNS, 2010). Con la elaboración de esta guía de práctica clínica (GPC) se pretende dar respuestas a muchas de las preguntas con las que se encuentran tanto los profesionales que se ocupan de la atención de los niños con cáncer como sus familiares/ cuidadores. Se ha concebido principalmente como una herramienta de soporte para el manejo del dolor en la población pediátrica con cáncer en nuestro entorno; ofrece recomendaciones actualizadas, basadas en la evidencia y en las aportaciones de los expertos clínicos y de los familiares/cuidadores.El grupo de trabajo de la Guía de práctica clínica agradece a la Fundación CRIS contra el cáncer el apoyo prestado para la elaboración de la misma, y a los veteranos de la Asociación de Padres de Niños con Cáncer por su participación e implicación durante todo el proceso. Este proyecto ha sido realizado gracias a la financiación obtenida de la Fundación CRIS contra el cáncerPresentación. 3 Autoría y colaboraciones. 7 Preguntas para responder. 13 Niveles de evidencia y grados de recomendación. 15 Recomendaciones de la guía. 17 1. Introducción. 25 2. Alcance y objetivos. 29 3. Método de la revisión. 33 4. Diagnóstico y monitorización del dolor en niños con cáncer. 35 4.1 Objetivos. 36 4.2 Población diana. 36 4.3 Recomendaciones para el diagnóstico y monitorización del dolor . 36 4.4 Diagnóstico y valoración del dolor. 38 4.5 Instrumentos de medición de la intensidad del dolor. 45 4.6 Monitorización del dolor. 49 5. Dolor relacionado con procedimientos invasivos. 53 5.1 Recomendaciones para el manejo del dolor relacionado con procedimientos invasivos . 55 6. Intervenciones terapéuticas no farmacológicas para prevenir o tratar el dolor. 57 6.1 Objetivos. 58 6.2 Población diana. 58 6.3 Recomendaciones para prevenir o tratar el dolor con intervenciones terapéuticas no farmacológicas . 58 6.4 Intervenciones terapéuticas no farmacológicas. 60 6.4.1 Intervenciones cognitivo-conductuales (ICC). 65 6.4.2 Hipnosis. 73 6.4.3 Estrategias de apoyo . 80 6.4.4 Intervenciones físicas . 81 6.4.5 Anestésicos tópicos 81 7. Tratamiento farmacológico del dolor en niños con cáncer. 87 7.1 Objetivo . 88 7.2 Población diana. 88 7.3 Recomendaciones para el tratamiento farmacológico del dolor. 88 7.4 Tratamiento farmacológico. 90 7.4.1 Principios del manejo del dolor de la OMS. 91 7.4.2 Administración de fármacos . 93 7.4.2.1 Analgésicos no opioides. 93 7.4.2.2 Analgésicos opioides. 96 7.4.2.3 Fármacos adyuvantes. 104 7.4.2.4 Vías de administración de los fármacos. 105 7.5 Cuidados en los niños con cáncer relacionados con el tratamiento farmacológico. 108 7.5.1 Manejo de los efectos secundarios de los analgésicos opioides . 108 7.5.2 Monitorización del tratamiento farmacológico. 110 7.5.3 Valoración de la adecuación del manejo farmacológico del dolor en el niño. 112 7.5.4 Barreras para el manejo farmacológico del dolor . 112 8. Difusión e implantación. 117 9. Indicadores de calidad. 119 10. Propuestas para futuras investigaciones. 123 11. Bibliografía. 125 Anexos. 139 Anexo 1. Declaración de conflicto de intereses. 140 Anexo 2. Guías de práctica clínica y revisiones sistemáticas seleccionadas para el tratamiento farmacológico. 142S

A study protocol for development and validation of a clinical prediction model for frailty (ModulEn): a new European commitment to tackling frailty

There is a growing need to implement and evaluate the technological solutions that allow the early detection of age-related frailty and enable assessment of the predictive values of frailty components. The broad use of these solutions may ensure an efficient and sustainable response of health and social care systems to the challenges related to demographic aging. In this paper, we present the protocol of the ModulEn study that aims to develop and validate a predictive model for frailty. For this purpose, the sample composed by older adults aged 65-80 years and recruited from the community will be invited to use an electronic device ACM Kronowise® 2.0. This device allows proactive and continuous monitoring of circadian health, physical activity, and sleep and eating habits. It will be used during a period of seven to ten days. The participants will also be given the questionnaires evaluating the variables of interest, including frailty level, as well as their experience and satisfaction with the device use. Data provided from these two sources will be combined and the relevant associations will be identified. In our view, the implications of this study' findings for clinical practice include the possibility to develop and validate tools for timely prevention of frailty progress. In the long term, the ModulEn may contribute to the critical reduction of frailty burden in Europe

Nurse forecasting in Europe (RN4CAST): Rationale, design and methodology

Contains fulltext : 97171.pdf (postprint version ) (Open Access)BACKGROUND: Current human resources planning models in nursing are unreliable and ineffective as they consider volumes, but ignore effects on quality in patient care. The project RN4CAST aims innovative forecasting methods by addressing not only volumes, but quality of nursing staff as well as quality of patient care. METHODS/DESIGN: A multi-country, multilevel cross-sectional design is used to obtain important unmeasured factors in forecasting models including how features of hospital work environments impact on nurse recruitment, retention and patient outcomes. In each of the 12 participating European countries, at least 30 general acute hospitals were sampled. Data are gathered via four data sources (nurse, patient and organizational surveys and via routinely collected hospital discharge data). All staff nurses of a random selection of medical and surgical units (at least 2 per hospital) were surveyed. The nurse survey has the purpose to measure the experiences of nurses on their job (e.g. job satisfaction, burnout) as well as to allow the creation of aggregated hospital level measures of staffing and working conditions. The patient survey is organized in a sub-sample of countries and hospitals using a one-day census approach to measure the patient experiences with medical and nursing care. In addition to conducting a patient survey, hospital discharge abstract datasets will be used to calculate additional patient outcomes like in-hospital mortality and failure-to-rescue. Via the organizational survey, information about the organizational profile (e.g. bed size, types of technology available, teaching status) is collected to control the analyses for institutional differences.This information will be linked via common identifiers and the relationships between different aspects of the nursing work environment and patient and nurse outcomes will be studied by using multilevel regression type analyses. These results will be used to simulate the impact of changing different aspects of the nursing work environment on quality of care and satisfaction of the nursing workforce. DISCUSSION: RN4CAST is one of the largest nurse workforce studies ever conducted in Europe, will add to accuracy of forecasting models and generate new approaches to more effective management of nursing resources in Europe