ABSTRACT
BACKGROUND: The information generated by nurses through standardised nursing languages is insufficiently evaluated and exploited, mainly in home care services, as is its potential impact on outcomes. OBJECTIVES: To find out how often nursing diagnoses are made during nursing home care visits, and to explore their relation with use of resources, mortality, institutionalisation and satisfaction. DESIGN: Observational, longitudinal follow-up study. SETTINGS: Home care services delivered by Primary Healthcare Districts in Málaga, Costa del Sol, Almería and Granada, in Spain. PARTICIPANTS: Patients and caregivers who initiated the Home Care Programme. METHODS: The accumulated incidence of nursing diagnosis was analysed over 34 months of follow-up. Diagnoses were made by nurse case managers in their daily practice. Several regression models were devised to analyse their linkage with the use of resources, mortality, institutionalisation and satisfaction. RESULTS: Two hundred and forty-seven subjects were included (129 patients and 118 caregivers). 93.8 had been diagnosed (2.8 diagnoses per subject). Risk of caregiver strain and mobility impairment accounted for 40% of total home visits (p=0.033). Significant differences were observed in the use of physiotherapy and rehabilitation services. The home visits for caregivers were, in 78% of cases, due to the recipient's baseline functional status. No relation was detected for institutionalisation or for patient satisfaction. There was a higher rate of anxiety diagnosed in the caregiver when the recipient was at greater risk for mortality (RR: 2.08 CI 95%: 1.26-3.42) (p=0.012). CONCLUSIONS: These data confirm results from other studies which find nursing diagnoses to be sound predictors of resources use. Their synergy with other case-mix systems in home care should be investigated.
Subject(s)
Caregivers , Health Care Rationing , Nursing Diagnosis , Outcome Assessment, Health Care , Aged , Female , Humans , Longitudinal Studies , Male , Middle Aged , SpainABSTRACT
OBJECTIVE: To measure the correctness of decisions concerning counter-indications to vaccination (CV), taken by Primary Care professionals involved with the vaccination programme; to identify their associations with personal or organisational variables; and to sound out professionals' views on the source of false counter-indications and training for the programme. DESIGN: A crossover study. SETTING: Primary care centres in the city of Málaga and its metropolitan area. PARTICIPANTS: 173 nurses and 68 doctors from these centres. INTERVENTIONS: A questionnaire to professionals about their clinical decisions and views of CV. RESULTS: The worse average score was that recorded in the clinical situation involving live virus vaccines (634 points out of 1,000) and whooping cough vaccination (791 points). General counter-indicative items reached a higher score (865). CONCLUSIONS: Professional criteria on CV must be brought up to date and unified.
