Acceso abierto a la mejor evidencia disponible en cuidados, herramienta para la mejora de la calidad asistencial

Ponencias de la Segunda Conferencia internacional sobre brecha digital e inclusión social, celebrada del 28 al 30 de octubre de 2009 en la Universidad Carlos III de MadridLos antecedentes: La variabilidad en la práctica clínica tiene consecuencias en los resultados de salud, no sólo en su pronóstico o en la aparición de posibles efectos secundarios, sino también en la calidad de vida percibida por los pacientes o en el coste-efectividad de las intervenciones. Por otro lado el volumen de información científica en este ámbito es de tal magnitud, que es necesario realizar una síntesis fiable y actualizada, mediante revisiones sistemáticas de la literatura existente. La Práctica clínica Basada en la Evidencias contribuye a disminuir la incertidumbre a la hora de tomar la mejor decisión de cuidados que posibilite consecuentemente la obtención del mejor resultado posible. Los objetivos: Desde 2007 el Plan de Calidad para el Sistema Nacional de Salud del Ministerio de Sanidad y Política Social financia el acceso gratuito desde cualquier lugar de España a todos los recursos electrónicos sobre cuidados de salud basados en la evidencia del Instituto Joanna Briggs, llamados JBI COnNECT. El objetivo último de esta colaboración es promover una atención de calidad en el ámbito de los cuidados, a través de la práctica clínica basada en la mejor evidencia disponible. Las conclusiones: Este acceso esta fomentando desde su inicio una práctica de calidad, un uso juicioso de las evidencias disponibles y un desarrollo de la utilización de la investigación entre los profesionales de la práctica clínica. También esta contribuyendo a la disminución de la variabilidad de las actuaciones de enfermería

Strengthening health systems through nursing: Evidence from 14 European countries. Spain.

CAPÍTULO 12 Spain‘Who is a nurse?’ and ‘What is nursing?’ seem to be simple questions yet the answers are strangely elusive. This book explores the variations in structure and organization of the nursing workforce across fourteen different countries in Europe. This diversity, and the reasons for it, are of more than academic interest. The work of nurses has always had a critical impact on patient outcomes. As health systems shift radically in response to rising demand, the role of nurses becomes even more important. The lessons learned from comparative case-study analysis demonstrate wide variation in every dimension of the workforce. It examines what a nurse is; nurse-to-doctor and nurse-to-population ratios; the education, regulation and issuing of credentials to nurses; and the planning of the workforce. While comparative analysis across countries brings these differences into sharp relief, it also reveals how the EU functions as an important ‘binding agent’, drawing these diverse elements together into a more coherent whole. This book is part of a two-volume study on the contributions that nurses make to strengthening health systems. This is the first time that the topic of nursing has been dealt with at length within the Observatory Health Policy Series. The aim is to raise the profile of nursing within health policy and draw the attention of decision-makers. Volume 1 is a series of national case studies drawn from Belgium, England, Finland, Germany, Greece, Ireland, the Netherlands, Norway, Poland, Spain, Sweden, and Switzerland. The countries were chosen as the subject of a large EU-funded study of nursing (RN4Cast). Lithuania and Slovenia were added to provide broader geographical and policy reach. Volume 2 will provide thematic analysis of important policy issues such as quality of care, workforce planning, education and training, regulation and migration

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

Pursuing precision in medicine and nutrition: the rise of electrochemical biosensing at the molecular level

In the era that we seek personalization in material things, it is becoming increasingly clear that the individualized management of medicine and nutrition plays a key role in life expectancy and quality of life, allowing participation to some extent in our welfare and the use of societal resources in a rationale and equitable way. The implementation of precision medicine and nutrition are highly complex challenges which depend on the development of new technologies able to meet important requirements in terms of cost, simplicity, and versatility, and to determine both individually and simultaneously, almost in real time and with the required sensitivity and reliability, molecular markers of different omics levels in biofluids extracted, secreted (either naturally or stimulated), or circulating in the body. Relying on representative and pioneering examples, this review article critically discusses recent advances driving the position of electrochemical bioplatforms as one of the winning horses for the implementation of suitable tools for advanced diagnostics, therapy, and precision nutrition. In addition to a critical overview of the state of the art, including groundbreaking applications and challenges ahead, the article concludes with a personal vision of the imminent roadmap.The financial support of PID2019-103899RBI00 (Spanish Ministerio de Ciencia e Innovación), and PMP22/00084, PI17CIII/00045, PI20CIII/00019 and PI22/00727 (AES-ISCIII) cofounded with FEDER funds Research Projects and the TRANSNANOAVANSENS-CM Program from the Comunidad de Madrid (Grant S2018/NMT-4349) are gratefully acknowledged. Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature.S

Nursing knowledge of and attitude in cardiopulmonary arrest: cross-sectional survey analysis

Background: Nurses are often the first to activate the chain of survival when a cardiorespiratory arrest happens. That is why it is crucial that they keep their knowledge and skills up-to-date and their attitudes to resuscitation are very important. The main aim of this study was to analyse whether the level of theoretical and practical understanding affected the attitudes of nursing staff. Methods: A questionnaire was designed using the Delphi technique (three rounds). The questionnaire was adjusted and it was piloted on a test-retest basis with a convenience sample of 30 registered nurses. The psychometric characteristics were evaluated using a sample of 347 nurses using Cronbach's alpha. Descriptive analysis was performed to describe the sociodemographic variables and Spearman's correlation coefficient to assess the relationship between two scale variables. Pearson's chi-squared test has been used to study the relationship between two categorical variables. Wilcoxon Mann Whitney test and the Kruskal-Wallis test were performed to establish relationships between the demographic/work related characteristics and the level of understanding. Results: The Knowledge and Attitude of Nurses in the Event of a Cardiorespiratory Arrest (CAEPCR) questionnaire comprised three sections: sociodemographic information, theoretical and practical understanding, and attitudes of ethical issues. Cronbach's alpha for the internal consistency of the attitudes questionnaire was 0.621. The knowledge that nurses self-reported with regard to cardiopulmonary arrest directly affected their attitudes. Their responses raised a number of bioethical issues. Conclusions: CAEPCR questionnaire is the first one which successfully linked knowledge of cardiopulmonary resuscitation to the attitudes towards ethical issues Health policies should ensure that CPR training is mandatory for nurses and all healthcare workers, and this training should include the ethical aspects.We thank Miguel Ángel de la Cal López and Teresa Gómez-García for supporting this project. This work was partially funded by the OSI Bilbao-Basurto (Osakidetza). There was no additional external funding received for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.S

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

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

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

Effects of nursing interventions to improve inpatients' sleep in intensive and non‐intensive care units: Findings from an umbrella review

AbstractAim: This review aimed to synthesise the available reviews on the effects of nursing interventions on sleep quality among patients hospitalised in intensive care and non-intensive care units.Background: Poor sleep quality is a common fact in hospitalised patients. Nurses can contribute to the improvement of patients' sleep quality and duration.Design: A review of intervention reviews was carried out and reported following the PRISMA guidelines and checklist.Methods: We systematically searched for reviews published from January 2009 to December 2019 in PubMed, CINAHL Plus, Scopus, Institute for Scientific Information Web of Science, Joanna Briggs Database of Systematic Reviews and Cochrane Central Register of Controlled Trials databases. Searches were repeated at 24 November 2020 to include the most recent evidence. A narrative synthesis of the results was conducted.Results: Nine reviews (representing 109 original papers) met the selection criteria and were included for critical appraisal. Overall, nursing interventions and sleep quality were poorly defined. We grouped the interventions into 3 categories (environmental, barrier and internal interventions) to provide a more comprehensive overview and ex-amine effects of nursing interventions on inpatients sleep quality. Inconsistent results were obtained and low quality of the original articles was reported, making it difficult to establish absolute conclusions.Conclusion: The impact of environmental changes on patients’ sleep was positive but inconclusive, while use of earplugs and eye masks, music and acupuncture generally showed positive results with moderate quality of evidence, and no harmful effects were reported.S