Impacto de la pandemia por COVID-19 en la implantación de una guía de buenas prácticas sobre las lesiones por presión / Impact of the COVID-19 pandemic on the implementation of best practice guidelines on pressure injuries

Objetivo: Evaluar el impacto de la COVID-19 en la implantaciónde la Guía de Buenas Prácticas clínicas de la Registered Nurses’Association of Ontario, de valoración del riesgo y prevención de laslesiones por presión sobre los indicadores de calidad asistencial enla Unidad de Medicina Interna del Hospital Universitari GermansTrias i Pujol. Metodología: Estudio observacional, analítico, de 2cohortes retrospectivas, que compara los indicadores de calidad pre ypostimplementación de 2017 con los del año 2021. Explotación dedatos de forma retrospectiva y pseudoanonimizada. Análisis descriptivounivariante, así como inferencial para el contraste de hipótesis deestudio. En todos los casos se utilizaron aproximaciones bilaterales,siendo el nivel de significación del 5% (α = 0,05). Resultados: Seincluyeron 946 sujetos, de los que el 49,9% fueron hombres y el50,1% mujeres. La media de edad fue de 75 años. La incidencia delesiones por presión fue del 8,1% en 2017 y del 8,9% en 2021, sinexistir evidencias estadísticamente significativas (p = 0,8). Respectoa la proporción de lesiones por presión de origen nosocomial,también se observó un considerable aumento, que fue del 27,5% en2017 y del 60% en 2021, aunque tampoco se hallaron diferenciasestadísticamente significativas (p = 0,094). Sin embargo, en cuantoal riesgo de presentar lesiones por presión y de su aparición, sí que seobservaron diferencias estadísticamente significativas en ambos años (p< 0,001 en 2017, y p = 0,011 en 2021). Conclusiones: La pandemiaobligó a detener el proceso de implantación de las guías de buenasprácticas, repercutiendo en los indicadores de calidad asistencial. (AU)

Objective: To assess the impact of COVID-19 on theimplementation of the Risk Assessment and Prevention ofPressure Ulcers Best Practice Guideline (BPG) of the RegisteredNurses’ Association of Ontario, in quality indicators in thegeneral internal medicine unit of the Hospital UniversitariGermans Trias i Pujol. Methodology: Observational studyof 2 retrospective cohorts, comparing the pre- and postimplementation quality indicators of 2017 with those ofthe year 2021. A pseudonymized data exploitation wasconducted for subsequent univariate descriptive analysis, aswell as inferential analysis and hypothesis contrasting. Bilateralapproaches were used in all cases, with a significance level of 5%(α = 0.05). Results: A total of 946 individuals were included, ofwhich 49.9% were men and 50.1% were women. The mean agewas 75 years. The incidence of PI was 8.1% in 2017 and 8.9%in 2021, with no statistically significant difference (p = 0.8).Regarding the proportion of hospital-acquired PI, a considerableincrease was also observed, being 27.5% in 2017 and 60% in2021, although no statistically significant differences were foundeither (p = 0.094). However, regarding the risk of presentingPI and their incidence, statistically significant differences wereobserved in both years (p < 0.001 in 2017, and p = 0.011 in2021). Conclusions: The pandemic made it necessary to stopthe BPG implementation process, impacting negatively on thequality of care indicators. (AU)

Reproductive decision-making of Black women living with HIV: A systematic review.

BACKGROUND: Black women living with HIV account for a higher proportion of new HIV diagnoses than other groups. These women experience restricted access to reproductive services and inadequate support from healthcare providers because their position in society is based on their sexual health and social identity in the context of this stigmatizing chronic disease. By recognizing the analytical relevance of intersectionality, the reproductive decision-making of Black women can be explored as a social phenomenon of society with varied positionality. OBJECTIVE: The purpose of this review was to synthesize the evidence about the reproductive decision-making of Black women living with HIV in high-income countries from the beginning of the HIV epidemic to the present. METHODS: This systematic review was guided by the JBI evidence synthesis recommendations. Searches were completed in seven databases from 1985 to 2021, and the review protocol was registered with PROSPERO (CRD420180919). RESULTS: Of 3503 records, 22 studies were chosen for synthesis, including 19 observational and three qualitative designs. Nearly, all studies originated from the United States; the earliest was reported in 1995. Few studies provided detailed sociodemographic data or subgroup analysis focused on race or ethnicity. Influencing factors for reproductive decision-making were organized into the following seven categories: ethnicity, race, and pregnancy; religion and spirituality; attitudes and beliefs about antiretroviral therapy; supportive people; motherhood and fulfillment; reproductive planning; and health and wellness. CONCLUSION: No major differences were identified in the reproductive decision-making of Black women living with HIV. Even though Black women were the largest group of women living with HIV, no studies reported a subgroup analysis, and few studies detailed sociodemographic information specific to Black women. In the future, institutional review boards should require a subgroup analysis for Black women when they are included as participants in larger studies of women living with HIV.

Barriers and facilitators involved in standardised care plan individualisation process in acute hospitalisation wards: A grounded theory approach.

OBJECTIVE: To identify and classify the barriers and facilitators of the individualisation process of the standardised care plan in hospitalisation wards. BACKGROUND: The administration of individualised care is one of the features of the nursing process. Care plans are the structured record of the diagnosis, planning and evaluation stages of the nursing process. Although the creation of standardised care plan has made recording easier, it is still necessary to record the individualisation of the care. It is important to study the elements that influence the individualisation process from the nurses' perspective. DESIGN: Qualitative study with the grounded theory approach developed by Strauss and Corbin. METHODS: Thirty-nine nurses from three hospitals participated by way of theoretical sampling. In-depth interviews were conducted, as well as participant observation, document analysis and focus group discussion. The analysis consisted of open, axial and selective coding until data saturation was reached. EQUATOR guidelines for qualitative research (COREQ) were applied. RESULTS: For both barriers and facilitators, three thematic categories emerged related to organisational, professional and individual aspects. The identified barriers included routines acquired in the wards, the tradition of narrative records, lack of knowledge and limited interest in individualisation. The identified facilitators included holding clinical care sessions, use of standardised care plan and an interface terminology, the nurse's expertise and willingness to individualise. CONCLUSION: The individualisation process of the standardised care plan involves multiple barriers and facilitators, which influence its degree of accuracy. RELEVANCE TO CLINICAL PRACTICE: Implementing strategies at an organisational level, professional level and individual level to improve the way the process is carried out would encourage individualising the standardised care plan in a manner that is consistent with the needs of the patient and family; it would improve the quality of care and patient satisfaction.

Eficacia de la educación sanitaria a pacientes y familiares en la Unidad de Monitorización de Epilepsia / Efficacy of healthcare education for patients and relatives in the Epilepsy Monitoring Unit

Objetivo: evaluar la efectividad, en el conocimiento y manejo de la epilepsia, de una intervención educativa personalizada sistematizada (IEPS) versus atención convencional, en pacientes ingresados con epilepsia fármaco resistente y sus familiares, durante su estancia en la Unidad de Monitorización de Epilepsia del Hospital Universitario Germans Trias i Pujol (Barcelona). Método: ensayo controlado y aleatorizado. Muestra de 20 pacientes y 20 familiares. Se realiza una IEPS al grupo experimental por enfermeras especializadas dirigida a pacientes epilépticos ingresados en la unidad acompañados de un familiar (el grupo control recibió atención habitual). Variable dependiente: conocimientos y manejo de la epilepsia tras la intervención educativa, a los seis meses y al año, con instrumentos ad hoc (puntuación 0 a 36). Se utilizaron las pruebas de contraste de hipótesis t de Student, U de Mann-Whitney, prueba de Wilcoxon, y test de Friedman. Resultados: muestra final de 42 participantes (21 pacientes y 21 familiares). En el caso de los pacientes, el impacto de la intervención educativa fue estadísticamente significativo a favor del grupo experimental frente al grupo experimental frente al grupo control al alta (p= <0,001) y a los seis meses (p= 0,003), pero no a los 12 meses (p= 0,111). En el grupo de familiares solo se encuentran diferencias estadísticamente significativas al alta (p=0,016), no a los seis meses (p= 0,593), ni a los 12 meses (p= 0,104). Conclusiones: la intervención educativa incide en el grado de conocimientos frente al manejo de la epilepsia del paciente y familiar. Los resultados obtenidos alientan a seguir con la implantación del programa educativo y realizar la educación para la salud en la unidad de monitorización de epilepsia (AU)

Objective: to evaluate the efficacy in terms of knowledge and management of epilepsy of a systematic personalized educational intervention (SPEI) vs. conventional care, in patients hospitalized with drug-resistant epilepsy and their relatives, during their stay at the Epilepsy Monitoring Unit in the Hospital Universitario Germans Trias i Pujol (Barcelona). Method: a controlled and randomised clinical trial, with a sample of 20 patients and 20 relatives. A SPEI was conducted on the experimental group by specialized nurses, targeted to epileptic patients hospitalized in the unit and accompanied by a relative (the control arm received the usual care). Dependent variable: knowledge and management of epilepsy after the educational intervention, at six months and at one year, with ad hoc tools (score 0 to 36). The hypothesis contrast tests used were: Student’s t, Mann-Whitney’s, Wilcoxon test, and Friedman test. Results: a final sample of 42 participants (21 patients and 21 relatives). In the case of patients, the impact of educational intervention was statiscally significant in favour of the experimental arm vs. the control arm at discharge (p= <0.001) and at six months (p= 0.003), but not at 12 months (p= 0.111). In the relatives arm, statistically significant differences were only found at discharge (p= 0.016), but not at six months (p= 0.593), or at 12 months (p= 0.104). Conclusions: the educational intervention has an impact on the level of knowledge regarding epilepsy management by patients and relatives. The outcomes obtained are encouraging to continue the implementation of the educational program, and to conduct health education in the Epilepsy Monitoring Unit (AU)