Cross-sectional evaluation of pharmaceutical care competences in nurse education: how well do curricula prepare students of different educational levels?

BACKGROUND: Nurses play an important role in interprofessional pharmaceutical care. Curricula related to pharmaceutical care, however, vary a lot. Mapping the presence of pharmaceutical care related domains and competences in nurse educational programs can lead to a better understanding of the extent to which curricula fit expectations of the labour market. The aim of this study was to describe 1) the presence of pharmaceutical care oriented content in nursing curricula at different educational levels and 2) nursing students' perceived readiness to provide nurse pharmaceutical care in practice. METHODS: A quantitative cross-sectional survey design was used. Nursing schools in 14 European countries offering educational programs for levels 4-7 students were approached between January and April 2021. Through an online survey final year students had to indicate to what extent pharmaceutical care topics were present in their curriculum. RESULTS: A total of 1807 students participated, of whom 8% had level 4-5, 80% level 6, 12% level 7. Up to 84% of the students indicated that pharmaceutical care content was insufficiently addressed in their curriculum. On average 14% [range 0-30] felt sufficiently prepared to achieve the required pharmaceutical care competences in practice. In level 5 curricula more pharmaceutical care domains were absent compared with other levels. CONCLUSIONS: Although several pharmaceutical care related courses are present in current curricula of level 4-7 nurses, its embedding should be extended. Too many students perceive an insufficient preparation to achieve pharmaceutical care competences required in practice. Existing gaps in pharmaceutical care should be addressed to offer more thoroughly prepared nurses to the labour market.

Autonomy of Nursing Students: Methodological Study of Validation of the PALOP Scale Portuguese Short Version.

The cultivation of critical thinking and decision-making skills promotes student autonomy. Only a few instruments measure nursing students' autonomy, and the PALOP® Scale is one of them. This study aimed to semantically and culturally adapt the PALOP® Scale to European Portuguese and assess the psychometric properties of a short version. A methodological study was conducted with 530 second and fourth-year undergraduate nursing students. Content validity was assessed using exploratory and discriminant factor analysis, and reliability was determined through analyses of internal consistency, temporal stability, and floor and ceiling effects. The analysis of the psychometric properties of a short version of the PALOP®-PT Scale revealed complete agreement (100%) among panel members for content validity. The scale also showed discriminative capacity among second- and fourth-year students (t (528) = -7.907, p < 0.001) with a five-factor structure, with a total explained variance of 57.2%. Reliability analysis showed excellent internal consistency (α = 0.935) and moderate temporal stability (95% ICC (3.1) = 0.520 [0.290-0.693], p < 0.01). The short version of the PALOP®-PT Scale is a promising tool to assess nursing students' perceived autonomy and identify necessary adjustments to their professional identity.

Medição da temperatura corporal em crianças: Estudo comparativo entre o método de medição axilar e timpânico / Child body thermometry: A comparative study of axillary and tympanic thermometry / Medición de la temperatura corporal en niños: Estudio comparativo entre el método de medición axilar y timpânico

Resumo Enquadramento: A temperatura corporal é um dos sinais vitais mais avaliados nos cuidados de saúde pediátricos para avaliação e orientação clínica. Objetivos: Avaliar a concordância entre a medição da temperatura por via axilar e timpânica em crianças dos 6 aos 36 meses. Metodologia: Estudo observacional e descritivo desenvolvido num hospital de nível II, em Portugal. O protocolo de medição da temperatura seguiu as orientações da Direção-Geral da Saúde. Resultados: Participaram no estudo 331 crianças. A diferença entre a temperatura timpânica e axilar variou entre os 0,00ºC e os 1,40ºC com uma média de 0,45ºC ± 0,30ºC e uma mediana de 0,50ºC, com uma concordância quase perfeita entre os dois métodos. Observou-se um efeito no valor da temperatura consoante o método utilizado em todas as variáveis estudadas. Conclusão: Existe uma concordância quase perfeita entre estes dois métodos de medição da temperatura, não influenciando a tomada de decisão clínica. Dado a maior facilidade de implementação e exequibilidade, as vantagens do método de avaliação via timpânica são superiores ao método tradicional via axilar, pelo que poderá ser implementado como rotina na avaliação da temperatura em crianças dos 6 aos 36 meses.

Abstract Background: Body temperature is one of the most evaluated vital signs in pediatric health care for clinical assessment and guidance. Objectives: To evaluate the agreement between axillary and tympanic thermometry in children aged 6 to 36 months. Methodology: An observational and descriptive study was carried out in a level II hospital in Portugal. The thermometry protocol followed the guidelines of the Portuguese Directorate-General of Health. Results: A total of 331 children participated in the study. The difference between tympanic and axillary temperatures ranged from 0.00ºC to 1.40ºC, with a mean of 0.45ºC ± 0.30ºC and a median of 0.50ºC, an almost perfect agreement between both methods. An effect on the temperature value was observed according to the technique used in all variables studied. Conclusion: There is an almost perfect agreement between these two thermometry methods, not influencing clinical decision-making. Advantages of the tympanic method over the traditional axillary method include easy implementation and feasibility. Therefore, it can be routinely implemented in assessing temperature in children aged 6 to 36 months.

Resumen Marco contextual: La temperatura corporal es una de las constantes vitales más valoradas en los cuidados de salud pediátricos para la evaluación y orientación clínica. Objetivos: Evaluar la concordancia entre la medición de la temperatura axilar y la timpánica en niños de 6 a 36 meses. Metodología: Estudio observacional y descriptivo desarrollado en un hospital de nivel II de Portugal. El protocolo de medición de la temperatura siguió las directrices de la Dirección General de Sanidad. Resultados: Un total de 331 niños participaron en el estudio. La diferencia entre la temperatura timpánica y la axilar varió entre 0,00ºC y 1,40ºC con una media de 0,45ºC ± 0,30ºC y una mediana de 0,50ºC, con una concordancia casi perfecta entre los dos métodos. En todas las variables estudiadas se observó un efecto sobre el valor de la temperatura según el método utilizado. Conclusión: Existe una concordancia casi perfecta entre estos dos métodos de medición de la temperatura, sin influencia en la toma de decisiones clínicas. Dada la mayor facilidad de aplicación y viabilidad, las ventajas del método de evaluación timpánica son superiores a las del método tradicional a través de la axila, por lo que puede aplicarse de forma rutinaria en la evaluación de la temperatura en niños de 6 a 36 meses.

Nurse students' competences in interprofessional pharmaceutical care in Europe: Cross-sectional evaluation.

BACKGROUND: Safe pharmaceutical care requires competent nurses with specific knowledge, skills and attitudes. It is unclear whether nursing students are adequately prepared to perform pharmaceutical care in practice. Mapping their pharmaceutical care competences can lead to a better understanding of the extent to which curricula fit expectations of the labour market. OBJECTIVES: To assess pharmaceutical care competences of final-year nursing students of different educational levels. DESIGN: A cross-sectional survey design. SETTINGS: In 14 European countries, nursing schools who offer curricula for level 4 to 7 students were approached. PARTICIPANTS: Through convenience sampling 1741 final-year student nurses of level 4 to 7 were included. Sampling strategies were country-specific. METHODS: A web-platform was developed with an assessment of the level in which students mastered pharmaceutical care competences. Knowledge questions, case studies (basic/advanced level), self-reported practical skills and attitudes were evaluated. RESULTS: Mean scores for knowledge questions differed significantly (p < 0.001) between level 5 (56/100), level 6 (68/100) and level 7 students (72/100). For basic cases level 5 students reached lower scores (64/100) compared with level 6 (71/100) and level 7 (72/100) students (p = 0.002 and p = 0.005). For more advanced cases no difference between levels was observed (overall mean 61/100). Most students (63-90 %) considered themselves skilled to perform pharmaceutical care and had positive attitudes towards their participation in pharmaceutical care (65-97 %). CONCLUSIONS: Relatively low knowledge scores were calculated for final-year student nurses. In some domains, lower levels of students might be insufficiently prepared to take up responsibilities in pharmaceutical care. Our assessment can be used as a tool for educators to evaluate how prepared nursing students are for pharmaceutical care. Its further implementation for students of different educational levels will allow benchmarking between the levels, both within and between countries.

Cross-cultural adaptation and validation of the braden qd scale for use with neonates in brazil / Adaptación transcultural y validación del instrumento braden qd scale para su uso con neonatos en brasil / Adaptação transcultural e validação do instrumento braden qd scale para uso em neonatos no brasil

ABSTRACT Objective: to cross-culturally adapt and validate the Braden QD Scale for use with neonates in Brazil. Method: a methodological study of cross-cultural adaptation and observational cross-sectional validation study, carried out between December 2017 and August 2021. The participants were 10 specialists, 38 nurses and 105 newborns. The cross-cultural adaptation process involved the initial translation, synthesis, back-translation, expert committee, pre-test and approval of the adapted version of the original instrument by the author. Validation verified the validity, reliability and internal consistency psychometric properties, from simultaneous and independent application of the adapted instrument by two evaluators, and based on time evaluation from the video of five neonates at two different moments. The statistical tests performed were Content Validity Index, Cronbach's alpha and Kappa coefficient. Results: the Braden QD scale translation process resulted in the Portuguese version adapted for the Brazilian culture. The expert committee's Content Validity Index was ≥0.90 and that of the pre-test was ≥0.80. In interobserver reliability, all items obtained Kappa coefficients > 0.90. Cronbach's alpha was 0.773 and 0.769 for Evaluators 1 and 2, respectively, with Cronbach's alpha > 0.6 considered as reliable. In intraobserver agreement, the mean scores were not different in the practice. Conclusion: the instrument was cross-culturally adapted for use with neonates and children in Brazil. The Brazilian version presented statistical validity and reliability levels, proving to be valid for use in neonates in Brazil.

RESUMEN Objetivo: adaptar transculturalmente y validar el instrumento Braden QD Scale para su uso con neonatos en Brasil. Método: estudio metodológico de adaptación transcultural y estudio transversal y observacional de validación, realizados entre diciembre de 2017 y agosto de 2021. Los participantes fueron 10 especialistas, 38 enfermeros y 105 recién nacidos. El proceso de adaptación transcultural abarcó lo siguiente: traducción inicial, síntesis, retrotraducción, comité de especialistas, pre-test y aprobación de la versión adaptada a cargo de la autora del instrumento original. La validación verificó las propiedades psicométricas de validez, confiabilidad y consistencia interna, a partir de la aplicación del instrumento adaptado por parte de dos evaluadores, en forma simultánea e independiente, además de una evaluación temporal a partir de un video de cinco neonatos en dos momentos distintos. Las pruebas estadísticas correspondieron al Índice de Validez de Contenido, Alfa de Cronbach y Coeficiente Kappa. Resultados: el proceso de traducción de la escala Braden QD tuvo como resultado la versión en portugués adaptada para la cultura de Brasil. El índice de validez de contenido del comité de especialistas fue ≥ 0.90, mientras que el del pre-test fue ≥ 0.80. Al analizar la confiabilidad interobservador, todos los ítems obtuvieron coeficientes Kappa > 0,90. Los valores del Alfa de Cronbach fueron 0,773 y 0,769 para los evaluadores 1 y 2, respectivamente, donde Alfa de Cronbach > 0,6 se considera confiable. Al analizar la concordancia intraobservador, la media de las puntuaciones no difirió en la práctica. Conclusión: el instrumento fue adaptado transculturalmente para su uso con neonatos y niños en Brasil. La versión brasileña presentó niveles estadísticos de validez y confiabilidad, demostrando así ser válida para su uso con neonatos en Brasil.

RESUMO Objetivo: adaptar transculturalmente e validar o instrumento Braden QD Scale para uso em neonatos no Brasil. Método: estudo metodológico de adaptação transcultural e estudo transversal observacional de validação, realizado entre dezembro de 2017 a agosto de 2021. Participaram 10 especialistas, 38 enfermeiros e 105 recém-nascidos. O processo de adaptação transcultural envolveu a tradução inicial, síntese, retrotradução, comitê de especialistas, pré-teste e aprovação da versão adaptada pela autora do instrumento original. A validação verificou as propriedades psicométricas de validade, confiabilidade e consistência interna, a partir da aplicação do instrumento adaptado por dois avaliadores, de forma simultânea e independente, e avaliação temporal a partir de vídeo de cinco neonatos em dois momentos distintos. Os testes estatísticos foram o Índice de Validade de Conteúdo, alfa de Cronbach e coeficiente Kappa. Resultados: o processo de tradução da Braden QD scale resultou na versão em português adaptada para a cultura brasileira. O índice de validade de conteúdo do comitê de especialistas foi ≥0.90 e do pré-teste foi ≥0.80. Na confiabilidade interobservador todos os itens obtiveram coeficiente Kappa >0,90. O alfa de Cronbach do avaliador 1 foi de 0,773 e do Avaliador 2 foi de 0,769, sendo confiável o alfa de Cronbach >0,6. Na concordância intraobservador a média dos escores, na prática, não foram diferentes. Conclusão: o instrumento foi adaptado transculturalmente para uso em neonatos e crianças no Brasil. A versão brasileira apresentou níveis estatísticos de validade e confiabilidade, mostrando-se válida para uso em neonatos no Brasil.

The NUPHAC-EU Framework for Nurses' Role in Interprofessional Pharmaceutical Care: Cross-Sectional Evaluation in Europe.

Clear role descriptions promote the quality of interprofessional collaboration. Currently, it is unclear to what extent healthcare professionals consider pharmaceutical care (PC) activities to be nurses' responsibility in order to obtain best care quality. This study aimed to create and evaluate a framework describing potential nursing tasks in PC and to investigate nurses' level of responsibility. A framework of PC tasks and contextual factors was developed based on literature review and previous DeMoPhaC project results. Tasks and context were cross-sectionally evaluated using an online survey in 14 European countries. A total of 923 nurses, 240 physicians and 199 pharmacists responded. The majority would consider nurses responsible for tasks within: medication self-management (86-97%), patient education (85-96%), medication safety (83-95%), monitoring adherence (82-97%), care coordination (82-95%), and drug monitoring (78-96%). The most prevalent level of responsibility was 'with shared responsibility'. Prescription management tasks were considered to be nurses' responsibility by 48-81% of the professionals. All contextual factors were indicated as being relevant for nurses' role in PC by at least 74% of the participants. No task nor contextual factor was removed from the framework after evaluation. This framework can be used to enable healthcare professionals to openly discuss allocation of specific (shared) responsibilities and tasks.

Developing a competence framework for nurses in pharmaceutical care: A Delphi study.

BACKGROUND: Nurses play an important role in pharmaceutical care. They are involved in: detecting clinical change; communicating/discussing pharmacotherapy with patients, their advocates, and other healthcare professionals; proposing and implementing medication-related interventions; and ensuring follow-up of patients and medication regimens. To date, a framework of nurses' competences on knowledge, skills, and attitudes as to interprofessional pharmaceutical care tasks is missing. OBJECTIVES: To reach agreement with experts about nurses' competences for tasks in interprofessional pharmaceutical care. METHODS: A two-phase study starting with a scoping review followed by five Delphi rounds was performed. Competences extracted from the literature were assessed by an expert panel on relevance by using the RAND/UCLA method. The experts (n = 22) involved were healthcare professionals, nurse researchers, and educators from 14 European countries with a specific interest in nurses' roles in interprofessional pharmaceutical care. Descriptive statistics supported the data analysis. RESULTS: The expert panel reached consensus on the relevance of 60 competences for 22 nursing tasks. Forty-one competences were related to 15 generic nursing tasks and 33 competences were related to seven specific nursing tasks. CONCLUSIONS: This study resulted in a competence framework for competency-based nurse education. Future research should focus on imbedding these competences in nurse education. A structured instrument should be developed to assess students' readiness to achieve competence in interprofessional pharmaceutical care in clinical practice.

Perspectives of nurses' role in interprofessional pharmaceutical care across 14 European countries: A qualitative study in pharmacists, physicians and nurses.

OBJECTIVES: To understand healthcare professionals' experiences and perceptions of nurses' potential or ideal roles in pharmaceutical care (PC). DESIGN: Qualitative study conducted through semi-structured in-depth interviews. SETTING: Between December 2018 and October 2019, interviews were conducted with healthcare professionals of 14 European countries in four healthcare settings: hospitals, community care, mental health and long-term residential care. PARTICIPANTS: In each country, pharmacists, physicians and nurses in each of the four settings were interviewed. Participants were selected on the basis that they were key informants with broad knowledge and experience of PC. DATA COLLECTION AND ANALYSIS: All interviews were conducted face to face. Each country conducted an initial thematic analysis. Consensus was reached through a face-to-face discussion of all 14 national leads. RESULTS: 340 interviews were completed. Several tasks were described within four potential nursing responsibilities, that came up as the analysis themes, being: 1) monitoring therapeutic/adverse effects of medicines, 2) monitoring medicines adherence, 3) decision making on medicines, including prescribing 4) providing patient education/information. Nurses' autonomy varied across Europe, from none to limited to a few tasks and emergencies to a broad range of tasks and responsibilities. Intended level of autonomy depended on medicine types and level of education. Some changes are needed before nursing roles can be optimised and implemented in practice. Lack of time, shortage of nurses, absence of legal frameworks and limited education and knowledge are main threats to European nurses actualising their ideal role in PC. CONCLUSIONS: European nurses have an active role in PC. Respondents reported positive impacts on care quality and patient outcomes when nurses assumed PC responsibilities. Healthcare professionals expect nurses to report observations and assessments. This key patient information should be shared and addressed by the interprofessional team. The study evidences the need of a unique and consensus-based PC framework across Europe.

Validation of nursing interventions to prevent skin lesions in hospitalized newborns / Validación de intervenciones de enfermería para prevenir lesiones cutáneas en recién nacidos internados / Validação de intervenções de enfermagem para prevenir lesões de pele em recém-nascidos hospitalizados

ABSTRACT Objective to determine the content validity of Nursing interventions to prevent skin lesions in hospitalized newborns, with an experts committee. Method a content validation methodological research study conducted by means of an online form between April and June 2018. The participants were five nurses from different Brazilian regions, with experience in the neonatal area: two professors, two stomatherapists, and one assistance nurse. The interventions evaluated were constructed based on scientific knowledge, resorting to the literature based on the available evidence, technical manuals and books, in addition to the researchers' experience in care for the newborn. The content was validated in two rounds. First, each intervention and its set were evaluated regarding agreement, using a minimum Committee Agreement Index (CAI) of 80%. Subsequently, a minimum Content Validity Index (CVI) of 0.8 was used to validate the clarity and relevance of the interventions. Results a total of 298 interventions were evaluated in the first round, and only eight did not obtain the adequate index. 39 interventions were evaluated in the second round, all reformulated based on the suggestions of the experts committee. Of these, there were eight not validated in the first round, 20 with small changes, and 11 newly elaborated interventions. All the interventions were validated in the second round, totaling 310 validated interventions. Conclusion the Nursing interventions proposed were considered valid regarding content, and can be used in the care provided to hospitalized newborns, in order to prevent skin lesions and to contribute with the quality of the assistance provided and with the safety of the neonatal patient.

RESUMEN Objetivo determinar la validez de contenido de diversas intervenciones de Enfermería para prevenir lesiones cutáneas en recién nacidos internados, por medio de un comité de expertos. Método investigación metodológica, de validación de contenido, realizada a través de un formulario en línea entre abril y junio de 2018. Las participantes fueron cinco enfermeras de diferentes regiones de Brasil, con experiencia en el área neonatal: dos docentes, dos estomaterapeutas y una enfermera asistencial. Las intervenciones evaluadas se elaboraron sobre la base del conocimiento científico, recurriendo a literatura basada en las evidencias disponibles, manuales y libros técnicos, además de la experiencia de las investigadoras en la atención al recién nacido. El contenido se evaluó en dos rondas. Primeramente, cada intervención y su conjunto se evaluaron en términos de concordancia, utilizándose un Índice de Concordancia del Comité (ICC) mínimo del 80%. Seguidamente se utilizó un Índice de Validez de Contenido (IVC) mínimo de 0,8 para validar la claridad y la relevancia de las intervenciones. Resultados se evaluaron 298 intervenciones en la primera ronda, y solamente ocho no obtuvieron el índice adecuado. En la segunda ronda se evaluaron 39 intervenciones, todas reformuladas sobre la base de las sugerencias del comité de expertos. De ellas, ocho no habían sido validadas en la primera ronda, 20 habían sufrido pequeñas modificaciones, y 11 eran intervenciones nuevas. Todas las intervenciones fueron validadas en la segunda ronda, totalizando 310 intervenciones validadas. Conclusión las intervenciones de Enfermería propuestas se consideraron válidas en cuanto a su contenido y pueden ser utilizadas en la atención al recién nacido internado, a fin de prevenir lesiones cutáneas y de contribuir a la calidad de la asistencia y a la seguridad del paciente neonatal.

RESUMO Objetivo determinar a validade de conteúdo de intervenções de enfermagem para prevenir lesões de pele em recém-nascidos hospitalizados, com comitê de experts. Método pesquisa metodológica, de validação de conteúdo, realizada através de formulário online, no período entre abril e junho de 2018. As participantes foram cinco enfermeiras de diferentes regiões do Brasil, com experiência na área neonatal: duas docentes, duas estomaterapeutas e uma assistencial. As intervenções avaliadas foram construídas com base no conhecimento científico, utilizando-se de literatura baseada nas evidências disponíveis, manuais e livros técnicos, além da experiência das pesquisadoras no cuidado ao recém-nascido. O conteúdo foi validado em duas rodadas. Primeiramente, cada intervenção e seu conjunto foram avaliadas quanto à concordância, utilizando-se uma Taxa de Concordância de Comitê (TCC) mínima de 80%. Em seguida, foi utilizado o Índice de Validade de Conteúdo (IVC) mínimo de 0,8 para validar a clareza e relevância das intervenções. Resultados 298 intervenções foram avaliadas na primeira rodada e apenas oito não obtiveram o índice adequado. Na segunda rodada foram avaliadas 39 intervenções, todas reformuladas com base nas sugestões do comitê de experts. Destas, oito não validadas na primeira rodada, 20 com pequenas modificações e 11 novas intervenções elaboradas. Todas as intervenções foram validadas na segunda rodada, totalizando-se 310 intervenções validadas. Conclusão as intervenções de enfermagem propostas foram consideradas válidas quanto ao conteúdo e podem ser utilizadas no cuidado ao recém-nascido internado, a fim de prevenir lesões de pele e contribuir com a qualidade da assistência e com a segurança do paciente neonatal.

Assessment of the quality of a software application for the prevention of skin lesions in newborns.

OBJECTIVE: to assess the technical quality of a mobile application to support the nurse's decision to prevent skin lesions in hospitalized newborns, according to the Product Quality Model. METHOD: a methodological study for technological assessment. The 20 evaluators, divided into two groups, 10 nurses and 10 information technology professionals, used the software, conducted tests based on two case studies, and evaluated six features and 23 sub-features of quality. The assessment was conducted by means of an online form. Data was analyzed through a specific formula and the items that obtained a concordance percentage over 70% were considered adequate. RESULTS: the concordance percentages of the features in the groups of nurses and of information technology specialists were the following: functional adequacy (100%-98.9%), reliability (90%-100%), usability (93.2-85%), performance efficiency (100%-100%), compatibility (97.5-90%), and safety (94%-91%). In the assessment of the sub-features, only accessibility presented a percentage value below the desired one (70%-60%). CONCLUSION: the software has excellent technical quality to meet the needs of nurses in planning the care for the prevention of skin lesions of hospitalized newborns, brings important advances to neonatal care, contributes to the work process, expands knowledge, and promotes the professional's clinical reasoning.

EUPRON: nurses' practice in interprofessional pharmaceutical care in Europe. A cross-sectional survey in 17 countries.

OBJECTIVES: Safe pharmaceutical care (PC) requires an interprofessional team approach, involving physicians, nurses and pharmacists. Nurses' roles however, are not always explicit and clear, complicating interprofessional collaboration. The aim of this study is to describe nurses' practice and interprofessional collaboration in PC, from the viewpoint of nurses, physicians and pharmacists. DESIGN: A cross-sectional survey. SETTING: The study was conducted in 17 European countries, each with their own health systems. PARTICIPANTS: Pharmacists, physicians and nurses with an active role in PC were surveyed. MAIN OUTCOME MEASURES: Nurses' involvement in PC, experiences of interprofessional collaboration and communication and views on nurses' competences. RESULTS: A total of 4888 nurses, 974 physicians and 857 pharmacists from 17 European countries responded. Providing patient education and information (PEI), monitoring medicines adherence (MMA), monitoring adverse/therapeutic effects (ME) and prescribing medicines were considered integral to nursing practice by 78%, 73%, 69% and 15% of nurses, respectively. Most respondents were convinced that quality of PC would be improved by increasing nurses' involvement in ME (95%), MMA (95%), PEI (91%) and prescribing (53%). Mean scores for the reported quality of collaboration between nurses and physicians, collaboration between nurses and pharmacists and interprofessional communication were respectively <7/10, ≤4/10, <6/10 for all four aspects of PC. CONCLUSIONS: ME, MMA, PEI and prescribing are part of nurses' activities, and most healthcare professionals felt their involvement should be extended. Collaboration between nurses and physicians on PC is limited and between nurses and pharmacists even more.

Assessment of the quality of a software application for the prevention of skin lesions in newborns* / Avaliação da qualidade de um software para prevenção de lesões de pele em recém-nascidos / Evaluación de la calidad de una aplicación de software para prevenir lesiones cutáneas en recién nacidos

Objective: to assess the technical quality of a mobile application to support the nurse's decision to prevent skin lesions in hospitalized newborns, according to the Product Quality Model. Method: a methodological study for technological assessment. The 20 evaluators, divided into two groups, 10 nurses and 10 information technology professionals, used the software, conducted tests based on two case studies, and evaluated six features and 23 sub-features of quality. The assessment was conducted by means of an online form. Data was analyzed through a specific formula and the items that obtained a concordance percentage over 70% were considered adequate. Results: the concordance percentages of the features in the groups of nurses and of information technology specialists were the following: functional adequacy (100%-98.9%), reliability (90%-100%), usability (93.2-85%), performance efficiency (100%-100%), compatibility (97.5-90%), and safety (94%-91%). In the assessment of the sub-features, only accessibility presented a percentage value below the desired one (70%-60%). Conclusion: the software has excellent technical quality to meet the needs of nurses in planning the care for the prevention of skin lesions of hospitalized newborns, brings important advances to neonatal care, contributes to the work process, expands knowledge, and promotes the professional's clinical reasoning.

Objetivo: avaliar a qualidade técnica de um aplicativo móvel para apoiar a decisão do enfermeiro nos cuidados de prevenção de lesões de pele em recém-nascidos hospitalizados, de acordo com o Modelo de Qualidade do Produto. Método: estudo metodológico de avaliação tecnológica. Os 20 avaliadores, divididos em dois grupos, 10 enfermeiros e 10 profissionais da tecnologia da informação, utilizaram o software, realizaram testes a partir de dois estudos de caso e avaliaram seis características e 23 subcaracterísticas de qualidade. A avaliação foi realizada por formulário online. Os dados foram analisados através de fórmula específica e foram considerados como adequados os itens que obtiveram percentual de concordância superior a 70%. Resultados: os percentuais de concordância das características pelo grupo de enfermeiros e de tecnologia foram: adequação funcional (100%-98,9%), confiabilidade (90%-100%), usabilidade (93,2-85%), eficiência de desempenho (100%-100%), compatibilidade (97,5-90%), e segurança (94%-91%). Na avaliação das subcaracterísticas, apenas a acessibilidade apresentou percentual abaixo do desejado (70%-60%). Conclusão: o software apresenta excelente qualidade técnica para atender às necessidades do enfermeiro no planejamento dos cuidados de prevenção de lesões de pele dos recém-nascidos hospitalizados, traz importante avanço para a assistência neonatal, contribui para o processo de trabalho, amplia conhecimentos e fomenta o raciocínio clínico do profissional.

Objetivo: evaluar la calidad técnica de una aplicación para dispositivos móviles destinada a sustentar las decisiones del enfermero con respecto a los cuidados para prevenir lesiones cutáneas en recién nacidos internados, de acuerdo con el modelo de Calidad del producto. Método: estudio metodológico de evaluación tecnológica. Los 20 evaluadores, divididos en dos grupos (uno de 10 enfermeras y otro de 10 profesionales en Tecnología de la Información), utilizaron el software, realizaron pruebas a partir de dos estudios de casos, y evaluaron seis características y 23 subcaracterísticas de calidad. La evaluación se realizó por medio de un formulario en línea. Los datos se analizaron a través de una fórmula específica y se consideraron como adecuados los ítems que obtuvieron un porcentaje de acuerdo superior al 70%. Resultados: los porcentajes de acuerdo de las características que se obtuvieron en el grupo de enfermeras y en el de especialistas en Tecnología de la Información fueron los siguientes: adecuación funcional (100%-98,9%), confiabilidad (90%-100%), facilidad de uso (93,2-85%), eficiencia de rendimiento (100%-100%), compatibilidad (97,5-90%) y seguridad (94%-91%). En la evaluación de las subcaracterísticas, solamente la accesibilidad presentó un porcentaje por debajo del deseado (70%-60%). Conclusión: el software presenta excelente calidad técnica para responder a las necesidades de los enfermeros en cuanto a la planificación de los cuidados para prevenir lesiones cutáneas en recién nacidos internados, aporta un importante avance para la asistencia neonatal, contribuye al proceso de trabajo, expande conocimientos, y fomenta el raciocinio clínico de los profesionales.

Pain, sleep patterns and health-related quality of life in paediatric patients with cancer.

PURPOSE: To compare sleep and health-related quality of life (HRQOL) in children and adolescents with cancer who had pain, with those who had no pain during hospitalisation. METHOD: A prospective comparative study was used to collect data from paediatric oncology units in three countries (Portugal, Brazil, USA). Participants (n = 118; 8-18 years) completed the Quality of Life Inventory (PedsQL) Cancer module, which includes a pain subscale, and wore a wrist actigraph for at least 72 hr. RESULTS: Almost half of the participants (48.3%) reported having pain. Sleep patterns were not affected by pain. Girls, adolescents and patients diagnosed with leukaemia/lymphoma who reported pain, had significantly lower HRQOL scores. Low sleep duration and HRQOL were found, irrespectively of pain status. CONCLUSIONS: The low sleep duration and HRQOL score in children and adolescents with cancer highlight the importance of physical and psychosocial nursing interventions during hospitalisation. The mediating effect of gender, age and diagnoses on the relation between pain and HRQOL needs to be further understood.

Reliability Study in Five Languages of the Translation of the Pain Observational Scale Algoplus.

Objective: Acute pain is frequent and underestimated in older persons, especially when they suffer from cognitive impairment. Algoplus is an observational scale for acute pain evaluation, validated in French in older persons with communication disorders. We present the validation by an international expert team of the Algoplus scale in five languages: English, Spanish, Italian, Portuguese, and Turkish. Methods: A total of 181 older consecutive patients were included in five countries (Spain, Australia, Italy, Portugal, and Turkey). Test-retest and inter-rater reliabilities were determined by weighted kappa coefficient for each item and internal consistency by Kuder-Richardson-20 (KD). Results: Regarding test-retest reliability, the kappa coefficient for the five items ranged from 0.68 to 0.84. Inter-rater reliability kappa values ranged from 0.64 to 0.82. Internal consistency was indicated at a KD greater than 0.6. Satisfaction was good to excellent for all teams. Results show that reliability tests are good to excellent for all items of Algoplus. Conclusions: This study shows evidence that Algoplus is an acceptable, reproducible, reliable, and easy-to-use tool. It provides a unique opportunity to include the translated Algoplus scale in daily assessment of older persons with communication disorders in many countries.

Computer and laboratory simulation in the teaching of neonatal nursing: innovation and impact on learning.

Objectives: to evaluate the cognitive learning of nursing students in neonatal clinical evaluation from a blended course with the use of computer and laboratory simulation; to compare the cognitive learning of students in a control and experimental group testing the laboratory simulation; and to assess the extracurricular blended course offered on the clinical assessment of preterm infants, according to the students. Method: a quasi-experimental study with 14 Portuguese students, containing pretest, midterm test and post-test. The technologies offered in the course were serious game e-Baby, instructional software of semiology and semiotechnique, and laboratory simulation. Data collection tools developed for this study were used for the course evaluation and characterization of the students. Nonparametric statistics were used: Mann-Whitney and Wilcoxon. Results: the use of validated digital technologies and laboratory simulation demonstrated a statistically significant difference (p = 0.001) in the learning of the participants. The course was evaluated as very satisfactory for them. The laboratory simulation alone did not represent a significant difference in the learning. Conclusions: the cognitive learning of participants increased significantly. The use of technology can be partly responsible for the course success, showing it to be an important teaching tool for innovation and motivation of learning in healthcare.

Psychometric study of the European Portuguese version of the PedsQL 3.0 Cancer Module.

BACKGROUND: Health-related quality of life (HRQoL) is an important outcome to assess the impact of cancer. This article examines the psychometric properties of the European Portuguese self-report version of the Pediatric Quality of Life Inventory™ Cancer Module (PedsQL™ 3.0 Cancer Module) in children and adolescents with cancer. METHODS: The participants, 332 children/adolescents diagnosed with cancer (8-18 years old), completed measures to assess HRQoL (PedsQL™ 3.0 Cancer Module and DISABKIDS Chronic Generic Measure; DCGM-12) and anxiety (Revised Children's Manifest Anxiety Scale - second edition; RCMAS-2). A subsample (n = 52) completed the PedsQL™ 3.0 Cancer Module a second time following one-week. The pediatric oncologists completed the Intensity of Treatment Rating Scale 3.0 (ITR 3.0). RESULTS: For the whole sample, the PedsQL™ 3.0 Cancer Module demonstrated good item discrimination (rs = .30 to .54). The confirmatory factor analysis testing the presence of eight first-order factors loading significantly in a second-order factor revealed an acceptable fit (CFI = .91; RMSEA = .05). The correlation of PedsQL™ 3.0 Cancer Module with DCGM-12 (rs = .17 to .58), and with RCMAS-2 (rs = -.16 to-.51) attested convergent validity. This inventory demonstrated minimally acceptable to very good internal consistency (αs = .65 to .87) and temporal stability (ICCs = .61 to .81). CONCLUSIONS: These findings demonstrate that the European Portuguese self-report version of the PedsQL™ 3.0 Cancer Module is a valid and reliable instrument for assessing HRQoL in pediatric cancer.

Computer and laboratory simulation in the teaching of neonatal nursing: innovation and impact on learning / Simulação por computador e em laboratório no ensino em enfermagem neonatal: as inovações e o impacto na aprendizagem / Simulación por computador y en laboratorio para enseñanza de enfermería neonatal: las innovaciones y el impacto en el aprendizaje

ABSTRACT Objectives: to evaluate the cognitive learning of nursing students in neonatal clinical evaluation from a blended course with the use of computer and laboratory simulation; to compare the cognitive learning of students in a control and experimental group testing the laboratory simulation; and to assess the extracurricular blended course offered on the clinical assessment of preterm infants, according to the students. Method: a quasi-experimental study with 14 Portuguese students, containing pretest, midterm test and post-test. The technologies offered in the course were serious game e-Baby, instructional software of semiology and semiotechnique, and laboratory simulation. Data collection tools developed for this study were used for the course evaluation and characterization of the students. Nonparametric statistics were used: Mann-Whitney and Wilcoxon. Results: the use of validated digital technologies and laboratory simulation demonstrated a statistically significant difference (p = 0.001) in the learning of the participants. The course was evaluated as very satisfactory for them. The laboratory simulation alone did not represent a significant difference in the learning. Conclusions: the cognitive learning of participants increased significantly. The use of technology can be partly responsible for the course success, showing it to be an important teaching tool for innovation and motivation of learning in healthcare.

RESUMO Objetivos: avaliar a aprendizagem cognitiva de estudantes de enfermagem na avaliação clínica neonatal a partir de um curso semipresencial com uso de simulação por computador e em laboratório; comparar a aprendizagem cognitiva dos estudantes em grupo controle e experimental ao testar a simulação em laboratório; e avaliar o curso semipresencial extracurricular oferecido sobre avaliação clínica do bebê pré-termo, segundo os estudantes. Método: estudo quase-experimental com 14 estudantes portugueses contendo pré-teste, teste intermediário e pós-teste. As tecnologias oferecidas no curso foram serious game e-Baby, software instrucional de semiologia e semiotécnica e simulação em laboratório. Para a avaliação do curso e caracterização dos estudantes utilizou-se instrumentos de coleta de dados desenvolvidos para este estudo. Utilizou-se estatística não paramétrica: Mann-Whitney e Wilcoxon. Resultados: O uso de tecnologias digitais validadas e de simulação em laboratório evidenciou diferença estatisticamente significativa (p=0,001) na aprendizagem dos participantes. O curso foi avaliado como muito satisfatório pelos mesmos. A simulação em laboratório isoladamente não representou diferença significativa no aprendizado. Conclusões: a aprendizagem cognitiva dos participantes aumentou significativamente. Considera-se que o uso de tecnologia foi responsável por parte do sucesso do curso, denotando ser uma importante ferramenta de inovação didática e motivação da aprendizagem na área da saúde.

RESUMEN Objetivos: evaluar el aprendizaje cognitivo de estudiantes de enfermería en evaluación clínica neonatal, a partir de un curso semipresencial, utilizando simulación por computador y en laboratorio; comparar el aprendizaje cognitivo de los estudiantes, entre grupo control y experimental, comprobando la simulación en el laboratorio; y evaluar el curso semipresencial extracurricular ofrecido sobre evaluación clínica del bebé pretérmino, de acuerdo a los estudiantes. Método: estudio casi experimental con 14 estudiantes portugueses, conteniendo preprueba, prueba intermedia y postprueba. Las tecnologías ofrecidas en el curso fueron serious game e-Baby, programa de instrucción en semiología y semiotecnia, y simulación en laboratorio. Para la evaluación del curso y caracterización de los estudiantes se utilizaron instrumentos de recolección de datos desarrollados para este estudio. Se utilizó la estadística no-paramétrica de Mann-Whitney y Wilcoxon. Resultados: el uso de tecnologías digitales validadas y de simulación en laboratorio evidenció diferencia estadísticamente significativa (p=0,001) en el aprendizaje de los participantes. El curso fue evaluado como muy satisfactorio por los alumnos. La simulación en laboratorio, aisladamente, no presentó diferencia significativa en el aprendizaje. Conclusiones: el aprendizaje cognitivo de los participantes aumentó significativamente. Se considera que el uso de la tecnología fue responsable por parte del éxito del curso, demostrando ser una importante herramienta de innovación didáctica y motivación del aprendizaje en el área de la salud.

Qualidade de vida em crianças com câncer: concordância entre crianças e pais / Quality of life among children with cancer: agreement between child and parent reports

Descrever a qualidade de vida relacionada com a saúde (QVRS) de crianças com câncer; avaliar a concordância entre auto e heterorrelato; e identificar fatores influenciadores das divergências no auto e heterorrelato. Métodos: Estudo descritivo e transversal desenvolvido em dois serviços oncológicos pediátricos de dois hospitais Portugueses que envolveram crianças com cancro (8-17 anos) e seus pais. Resultados: A percepção da criança da sua QVRS foi de 66,0 ± 13,3 e a dos pais de 60,3 ± 15,0. A concordância entre auto e heterorrelato foi moderada, sendo a associação forte. Variáveis relacionadas com a idade da criança, sexo, tipo de tumor tempo de diagnóstico e número de internamentos não influenciaram as divergências entre o auto e heterorrelato. Conclusão: Uma intervenção com mais apoio deve ser realizada na resolução das preocupações, gestão da dor e desconforto da criança e redução da ansiedade dos pais. É necessário esclarecer a influência dos fatores que influenciam as divergências entre o auto e heterorrelato...

Pain assessment using the adolescent pediatric pain tool: a systematic review.

BACKGROUND: The Adolescent Pediatric Pain Tool (APPT) is a multidimensional pain assessment tool designed to assess pain location (body outline diagram), intensity (word graphic rating scale) and quality (list of pain descriptors) in hospitalized children eight to 17 years of age. OBJECTIVES: To identify the age range, health conditions, settings and purpose for which APPT has been used; the components of the APPT that have been used; and the reported clinical and research utility of the APPT. METHODS: A systematic review of published studies using the APPT was performed. Studies were identified through electronic searches in CINAHL, Medline, PubMed, SciELO and PsycInfo. RESULTS: Twenty-three studies were analyzed. APPT has been used in patients between two and 68 years of age, with various acute and chronic conditions, in and out of hospital. All but six studies used the three components of the APPT. Most of the studies used the total number of sites marked, mean pain intensity and mean number of pain descriptors selected as main outcome measures; however, scoring methods varied. Studies report that the use of the APPT is relevant for clinical practice and for research. CONCLUSION: Obtaining self-report of pain using the APPT may help clinicians to tailor pain management interventions. It may also be used in studies to provide a deeper understanding of the pain experience and to examine the effectiveness of pain management interventions. However, outcome measures and methods of scoring the different components of the APPT need to be clearly identified.

A functional measurement approach to the Children’s Anxiety and Pain Scale - CAPS: contributions to its construct validity

The Children's Anxiety and Pain Scales-CAPS (Kuttner & LePage, 1989) is the only faces measure to date aimed at separately assessing anxiety and pain intensity through self-report. Despite early indications that the two sets of schematic faces included in the CAPS possess face validity regarding the constructs of anxiety/fear and pain, the extent to which they allow differentiating between them has remained controversial, especially in younger children. In this study, the inner features of CAPS’s faces were taken as factors in integration tasks performed by children differing in age (6-8 and 9-11 years old) and pain experience (pain-free and acute postoperative pain). Different integration patterns were found for the CAPS-pain and the CAPS-anxiety subscales, along with distinct profiles of relative importance among upper-and lower-face features. These differences did not depend on the assigned judgment dimension (conveyed pain or conveyed fear), and partly concurred with collateral evidence on the relative importance of facial features in prototypical pain and fear expressions. Overall, outcomes were supportive of several facets of the construct validity of the CAPS (AU)

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