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

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

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'

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

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

Impact of an educational program to reduce healthcare resources in community-acquired pneumonia: The EDUCAP randomized controlled trial

BACKGROUND: Additional healthcare visits and rehospitalizations after discharge are frequent among patients with community-acquired pneumonia (CAP) and have a major impact on healthcare costs. We aimed to determine whether the implementation of an individualized educational program for hospitalized patients with CAP would decrease subsequent healthcare visits and readmissions within 30 days of hospital discharge. METHODS: A multicenter, randomized trial was conducted from January 1, 2011 to October 31, 2014 at three hospitals in Spain. We randomly allocated immunocompetent adults patients hospitalized for CAP to receive either an individualized educational program or conventional information before discharge. The educational program included recommendations regarding fluid intake, adherence to drug therapy and preventive vaccines, knowledge and management of the disease, progressive adaptive physical activity, and counseling for alcohol and smoking cessation. The primary trial endpoint was a composite of the frequency of additional healthcare visits and rehospitalizations within 30 days of hospital discharge. Intention-to-treat analysis was performed. RESULTS: We assigned 102 patients to receive the individualized educational program and 105 to receive conventional information. The frequency of the composite primary end point was 23.5% following the individualized program and 42.9% following the conventional information (difference, -19.4%; 95% confidence interval, -6.5% to -31.2%; P = 0.003). CONCLUSIONS: The implementation of an individualized educational program for hospitalized patients with CAP was effective in reducing subsequent healthcare visits and rehospitalizations within 30 days of discharge. Such a strategy may help optimize available healthcare resources and identify post-acute care needs in patients with CAP. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN39531840

Acuity, nurse staffing and workforce, missed care and patient outcomes. A cluster-unit-level descriptive comparison

Aim: To compare patient acuity, nurse staffing and workforce, missed nursing care and patient outcomes among hospital unit-clusters. Background: Relationships among acuity, nurse staffing and workforce, missed nursing care and patient outcomes, are not completely understood. Method: Descriptive design with data from four unit-clusters: medical, surgical, combined and stepdown units. Descriptive statistics were used to compare acuity, nurse staffing coverage, education and expertise, missed nursing care, and selected nurse-sensitive outcomes. Results: Patient acuity in general (medical, surgical and combined) floors is similar to step-down units, with an average of 5.6 required RN hours per patient day. In general wards, available RN hours per patient day reach only 50% of required RN hours to meet patient needs. Workforce measures are comparable among unit-clusters, and average missed nursing care is 21%. Patient outcomes vary among unit-clusters. Conclusion:Patient acuity is similar among unit-clusters, whilst nurse staffing coverage is halved in general wards. While RN education, expertise and missed care are comparable among unitclusters, mortality, skin injuries and risk of family compassion fatigue rates are higher in general wards. Implications for nursing management: Nurse managers play a pivotal role in hustling policy-makers to address structural understaffing in general wards, to maximize patient safety outcomes

Recursos y consecuencias de cuidar a las personas mayores de 65 años: una revisión sistemática

Introducción: El cuidado prestado por los cuidadores principales de personas mayores constituye el principal soporte que éstas reciben. Proporcionar estos cuidados afecta de diferente manera a cada cuidador. La literatura es amplia y extensa al describir estas repercusiones de la tarea de cuidar sobre el cuidador, así como en referencia a los recursos de apoyo utilizados. Método: Se ha realizado una revisión sistemática de la literatura, en las principales bases de datos nacionales e internacionales, sobre las intervenciones, recursos y repercusiones de la tarea de cuidar sobre los cuidadores informales de personas mayores. Conclusiones: Los cuidadores informales españoles de personas mayores parecen disponer de diferentes recursos de apoyo en su tarea de cuidado, aunque sigue siendo la familia la principal fuente de ayuda frente a los sistemas formales. La literatura recoge repercusiones tanto positivas como negativas derivadas de la responsabilidad del cuidado. Entre estos últimos, encontramos como máximo exponente los estados ansioso-depresivos, así como la sobrecarga del cuidador. Sin embargo, estas consecuencias negativas se entrelazan e interactúan con las afectaciones positivas. La revisión realizada nos invita a afirmar que se precisa el desarrollo de más estudios para tratar de esclarecer la relación entre ambos polos de la experiencia del cuidado

El rol del profesional en enfermería

El desarrollo de las teorías de enfermería ha cambiado irreversiblemente el desarrollo de la ciencia de la enfermería. La teoría ha contribuido no solo a definir las competencias profesionales, sino también al desarrollo de su cuerpo de conocimientos, los cuales reflejan lo que es específico de la profesión: su enfoque en la persona, su comportamiento y el significado de sus experiencias, considerados de manera holística. Por lo tanto, las transacciones biopsicosocioculturales y espirituales del ser humano son centrales a la disciplina de la enfermería.Este trabajo presenta una visión de la enfermería que analiza los conceptos fundamentales de ser humano, salud-enfermedad, entorno y enfermería. El desarrollo teórico también ha ayudado al entendimiento y aceptación de la complejidad de la enfermería y la inevitabilidad de sus múltiples teorías. El pluralismo paradigmático del desarrollo de la disciplina refleja la diversidad de su enfoque, la persona, la diversidad de sus interacciones en la salud y en la enfermedad, y la diversidad de las intervenciones de enfermería.The development of nursing theories has changed the development of nursing science. The theory has contributed not only to define professional competencies, but also to the development of knowledge, which reflects specific aspects of the profession: its focus on the person, its behavior and the meaning of its experiences, considered in a holistic way. In consequence, the bio psycho socio cultural and spiritual transactions of the human being are the center of nursing discipline.This work presents a nursing view, analyzing main concepts of the human being, health-disease, environment and nursing. The theoretical development helped also to the comprehension and acceptation of nursing and its multiple theories. The paradigmatic pluralism of the development of the discipline shows the diversity of its focus, the person, different interactions in health and disease and different nursing interventions

El rol del profesional en enfermería

The development of nursing theories has changed the development of nursing science. The theory has contributed not only to define professional competencies, but also to the development of knowledge, which reflects specific aspects of the profession: its focus on the person, its behavior and the meaning of its experiences, considered in a holistic way. In consequence, the bio psycho socio cultural and spiritual transactions of the human being are the center of nursing discipline.This work presents a nursing view, analyzing main concepts of the human being, health-disease, environment and nursing. The theoretical development helped also to the comprehension and acceptation of nursing and its multiple theories. The paradigmatic pluralism of the development of the discipline shows the diversity of its focus, the person, different interactions in health and disease and different nursing interventions.El desarrollo de las teorías de enfermería ha cambiado irreversiblemente el desarrollo de la ciencia de la enfermería. La teoría ha contribuido no solo a definir las competencias profesionales, sino también al desarrollo de su cuerpo de conocimientos, los cuales reflejan lo que es específico de la profesión: su enfoque en la persona, su comportamiento y el significado de sus experiencias, considerados de manera holística. Por lo tanto, las transacciones biopsicosocioculturales y espirituales del ser humano son centrales a la disciplina de la enfermería.Este trabajo presenta una visión de la enfermería que analiza los conceptos fundamentales de ser humano, salud-enfermedad, entorno y enfermería. El desarrollo teórico también ha ayudado al entendimiento y aceptación de la complejidad de la enfermería y la inevitabilidad de sus múltiples teorías. El pluralismo paradigmático del desarrollo de la disciplina refleja la diversidad de su enfoque, la persona, la diversidad de sus interacciones en la salud y en la enfermedad, y la diversidad de las intervenciones de enfermería