Disminución del nivel de estrés en madres de prematuros en la unidad de cuidados intensivos

Objective

To determine the effectiveness of the ‘Creating Opportunities for Parent Empowerment’ (COPE) programme in reducing stress levels in mothers of preterm infants in the neonatal intensive care unit (NICU).

Modelo de aprendizaje de cuidados paliativos basado en la teoría de aprendizaje transformacional de cuidados paliativos de los estudiantes de enfermería en Indonesia

IntroductionPalliative care competence is one of the competencies that must be possessed by generalist nurses. For this reason, strategies for developing palliative care learning models need to be carried out to ensure nursing students have palliative care competencies. Therefore, this study was structured to develop a transformation theory-based palliative care learning model that prioritizes the active participation of students to deal with palliative care in future practice.MethodsThis study was a cross-sectional study involving 189 nursing students as participants. The proposed model involves six variables, namely student characteristics, educator characteristics, learning media, palliative care competencies, transformative learning theory (TLT)-based palliative learning, and competency achievement. Data were collected using a questionnaire that was tested using the Structural Equation Modeling (SEM) technique.ResultsSEM analysis showed that the R² value of TLT-based palliative care learning was 0.707 or 70.7%. These results indicate that the diversity of TLT-based palliative care learning variables can be explained by the variables of students, educators, palliative competencies, and learning media by 70.7%. Each construct has a value of Q2 > 0, which means the model is satisfactory. The path coefficient value of 0.627 indicates that the characteristics of educators have the most significant contribution to the TLT-based palliative care learning model.ConclusionIt can be concluded that the teaching-learning process based on TLT is a promising strategy to support nursing students to achieve palliative care competence.     

Prevalencia de las úlceras de pierna en la provincia de Cuenca: un estudio en Atención Primaria

ObjectiveTo determine the prevalence of leg ulcers, and to describe the affected patients, wounds, and treatment.MethodObservational, cross-sectional prevalence study. An ad hoc online questionnaire was sent to all nurses attending Primary Care centres of the “Gerencia de Atención Integrada de Cuenca” (Integrated Care Management of Cuenca, Spain). Data regarding patient sociodemographic and clinical variables, lesion characteristics and the type of intervention (concerning prevention and treatment) were collected.ResultsIn total, 152 professionals (response rate = 98.1%) completed the questionnaire, collecting data from 131,190 inhabitants. A total of 63 patients (75.5 ± 12.6 years old) with 75 ulcers were identified, finding an overall prevalence of 0.480‰ (CI 95%: 0.375-0.614), distributed as: venous ulcer 0.274‰ (n = 36), diabetic foot 0.145‰ (n = 19), and arterial ulcer 0.061‰ (n = 8).The prevalence was similar regarding gender (0.535‰ vs. 0.426‰, respectively, p = .365), but men exhibited more diabetic foot (0.214‰ vs. 0.076‰, p = .037).In all three types of lesions prevalence increased with age, reaching 1.743‰ in 64 + age group.The median of the leg ulcer duration and corrected area were 190.0 ± 340.0 days and 5.0 ± 13.7 cm², respectively, with a recurrence rate of 74.7%.ConclusionsThe prevalence of chronic leg ulcers was lower than that reported in other studies, although with high recurrence rates. Overall estimators from previous studies may have overestimated the prevalence, especially in regions with a high rural component.     

Nuevos retos en los cuidados: detección de la ansiedad en la gestante de riesgo

Pregnancy is considered a period of well-being and happiness in a woman's life. However, these expectations are occasionally disrupted by maternal and/or foetal problems, and situations of vulnerability develop.The evidence suggests that pregnancy-related anxiety is strongly associated with adverse maternal and child outcomes such as pospartum depression, premature birth, low birth weight, and health and mental development problems in childhood. On the other hand, it is evident that obstetric and perinatal complications increase the risk of pospartum anxiety and depression while anxiety levels increase as the gestational risk increases.Current recommendations about the care and treatment of mental health problems in women during pregnancy and up to one year after delivery are aimed at recognition, evaluation, care and treatment, ensuring continuity of care.The aim of this study was to recognise anxiety in pregnant women at risk, from the definition of model cases, in order to enhance critical thinking in both health professionals and pregnant women and thus improve the care of these patients.     

évaluation de la prise en charge de la douleur au centre hospitalier du Lamentin en Martinique

In a quality approach, the committee against pain made an audit of every inpatient service at Lamentin hospital center, to evaluate the prevalence of pain and emotions of patients and caregivers. The audit was conducted on a specific day for all the patients. At the same time, questionnaires for caregivers were sent to care units, and the staff had one week to fill them. 140 patients, 272 paramedics and 52 doctors, about two-third of the entire hospital, replied to the questionnaire. Results showed some weaknesses of the current system: patients information on pain management, pain evaluation and treatment delays. Two-thirds of patients felt that the staff did their best to relieve their pain, but 20% of patients endured pain at the time of the audit. The low use of pain referents and analgesia protocols is a drawback observed in this study. Doctors who were not well trained on pain management represented a major barrier to the use of analgesia protocols. Other barriers were communication difficulties between medical and paramedical staff and lack of medical supplies. The overall outcome is acceptable but much remains to be done; one caregiver in five still thinks that there is more to achieve in pain management. Short-term actions were initiated since the audit: improvement of patient information, updating analgesia protocols, systematic pain evaluation, and so on. A new audit will be needed to assess the impact of these remedial actions and to provide the best care to the patient.     

Competencias en enfermeras Especialistas y en Enfermeras de Práctica Avanzada

ObjectiveTo analyse the distribution of advanced competences in specialist nurses and advanced practice nurses and to evaluate their association with some characteristics of their professional profile.MethodMulticentre analytical cross-sectional study. Nurses who worked as advanced practice nurses and specialist nurses were included. Their level of perceived advanced competences was measured, as well as sociodemographic and professional characterization variables.ResultsA total of 277 nurses participated (149 practised as advanced practice nurses and 128 as specialists), with an average of 13.88 (11.05) years as a specialist and 10.48 (5.32) years as an advanced practice nurse. In the sample, 28.8% had a master's or doctorate level qualification, 50.2% worked in Primary Care, 24.9% in hospitals and 22.7% in Mental Health. The self-perceived global level was high in the different competences, the lowest dimensions being research, evidence-based practice, quality and safety management and leadership and consulting. The advanced practice nurses obtained a higher level of competence globally and in the dimensions of leadership and consulting, interprofessional relations, care management, and health promotion. There were no differences based on experience or possession of a master's degree or doctorate. In the advanced practice nurses, the practice context did not influence competence levels, although in the specialist nurses it did, in favour of those practicing in Mental Health.ConclusionsSpecialist and advanced practice nurses have different competences that should be adequately managed for the development of advanced and specialist nursing services.     

Le concept de qualité de vie en médecine

Résumé  Cet article résume les principaux concepts qui ont présidé à l’élaboration du ?Questionnaire Profil de la Qualité de Vie Subjective? et que nous pensons importants pour étudier la Qualité de Vie subjective en Médecine. Il est nécessaire de prendre en compte outre la santé la plupart des domaines qui comptent dans la vie d’un individu, et d’avoir une approche multidimensionnelle. Outre les satisfactions éprouvées dans ces différents domaines, les attentes qu’ils suscitent sont un paramètre très discriminant.      

Establecimiento de prioridades de investigación en enfermería en España: estudio Delphi

ObjectiveTo identify nursing research priorities in Spain as suggested by nurses and service users.MethodA Modified Delphi technique was used. The first round started off with a 24-item document for which consensus had been previously achieved. Experts participating in this modified (two rounds) Delphi technique were: nursing managers (community and hospital care settings), nursing school directors, scientific nursing association representatives, nursing researchers attending the National Nursing Research Conference, and service users.ResultsMain priorities identified for nursing research were: 1) evaluating the effectiveness of nursing interventions, 2) identifying strategies for health promotion empowering service users, 3) developing evidence-based care through implementing and evaluating results, and 4) evaluating the quality of nursing care.ConclusionsResults may help research managers and administrators identify and develop nursing research promotion strategies as well as more strongly sustained funding policies and decisions.     

Prácticas,barreras y facilitadores de proveedores de salud en clínicas para dejar de fumar en México

ObjectiveTo assess the clinical practice, barriers, and facilitators in promoting smoking cessation in primary healthcare clinics in Mexico City.Material and methodsA mixed method design was used. Surveys (n = 70) and semi-structured interviews (n = 9) were conducted with health personnel involved in smoking cessation clinics.ResultsQuantitative data revealed that physicians were more likely than nurses to 1) ask patients if they smoke (57.9% vs 34.5%, p = .057), 2) ask patients if they are interested in quitting smoking (65.7% vs 26.9%, p = .003), 3) provide advice to quit smoking (54.3% vs 29.2%, p = .056), and 4) assess whether pharmacotherapy is needed (21.9% vs 10%, p = .285). Qualitative data showed that nurses were more likely than physicians to report lack of resources to refer patients to smoking cessation services, lack of pharmacotherapy availability, and lack of provider training in smoking cessation. Reported barriers include lack of motivation among patients, lack of time for assessment, long appointment wait times, and lack of training. Reported facilitators include existence of smoking cessation programmes and pharmacotherapy at no cost to the patient, and having a multidisciplinary team.ConclusionsDue to numerous barriers, smoking cessation interventions are partially implemented in primary care clinics in Mexico City. A restructuring of services is necessary, and nurses should be given a more prominent role.     

Competencias de investigación en las especialidades de Enfermería

Since nursing became an university degree in 1977, there have been several regulations to develop specialties, all of them agreeing on the need to include skills in research. Indeed, the relevance of acquiring these skills in all current disciplines has led to Royal Decree 99/2011, which regulates the official PhD courses, and recognises specialist nurses as qualified to access PhD studies.Nowadays, students from six of the seven specialties included in the Royal Decree 450/2005 on nursing specialties, are performing their training. The acquisition of research skills is seen as an opportunity and a challenge. However, the organizational structure of training facilities (multiprofessional teaching units) and the incorporation of nurses as clinical tutors, who initiated this teaching activity, deserve special attention to ensure the correct acquisition of research skills in the training of specialist nurses.