Developing Evidence-Based Practice questionnaire for community health nurses: reliability and validity of a Spanish adaptation.

AIMS AND OBJECTIVES: This study aimed to translate the community nursing version of the Developing Evidence-Based Practice questionnaire, adapt the Spanish translation to the primary care context in Spain, and evaluate its reliability and validity. BACKGROUND: Instruments available in Spanish to date are not designed to rigorously evaluate barriers and incentives associated with evidence-based practice implementation in community health nursing. DESIGN: Classical Test Theory approach. METHODS: The 49-item Developing Evidence-Based Practice questionnaire was translated, back-translated and pilot-tested. Two items were added to assess respondents' ability to read and understand the English language. During the first six months of 2010, 513 nurses from 255 primary health care centres in Catalunya (Spain) voluntarily participated in the study. Internal consistency and test-retest reliability were evaluated. Internal structure was analysed by principal component analysis. A randomized, controlled, parallel-design study was carried out to test scores' sensitivity to change with two groups, intervention and control. The intervention consisted of eight hours of in-person training, provided by experts in evidence-based practice. RESULTS: Of 513 nurses, 445 (86·7%) nurses responded to all 51 items. Factor analysis showed six components that explained 51% of the total variance. Internal consistency and test-retest reliability were satisfactory (Cronbach α and intraclass correlation coefficients >0·70). A total of 93 nurses participated in the sensitivity-to-change tests (42 in the intervention group, 51 controls). After the training session, overall score and the 'skills for evidence-based practice' component score showed a medium (Cohen d = 0·69) and large effect (Cohen d = 0·86), respectively. CONCLUSIONS: The Developing Evidence-Based Practice questionnaire adapted to community health nursing in the primary care setting in Spain has satisfactory psychometric properties. RELEVANCE TO CLINICAL PRACTICE: The Developing Evidence-Based Practice questionnaire is a useful tool for planning and evaluating the implementation of evidence-based practice in community health nursing.

¿Cómo perciben los mayores a sus cuidadoras inmigrantes? Sobre la ayuda que necesitan y reciben en el domicilio / Perceptions of dependent elderly cared for by immigrant workers concerning the help they need and receive

Introducción. Cambios sociales como el aumento de personas dependientes, la incorporación de la mujer al mundo laboral o la disminución del tamaño de las familias, han propiciado la mercantilización del cuidado de los ancianos dependientes, dando lugar a una nueva ocupación desarrollada por mujeres inmigrantes en el entorno domiciliario, de la que se conoce poco. Objetivo. Explorar la vida cotidiana de las personas mayores cuidadas por inmigrantes contratadas por los familiares, con el objetivo de comprender en profundidad los aspectos relacionados con su salud y los cuidados que reciben. Metodología. Cualitativa, realizando doce entrevistas mediante muestreo teórico, que se grabaron, transcribieron y analizaron con soporte informático del programa Atlas Ti V5. Resultados. Los mayores no se anticipan a los problemas de la vejez. Les preocupa la enfermedad, el dolor y la muerte. Quieren ser lo más autónomos posible, por lo que la familia percibe antes que el anciano la necesidad de contratar a la cuidadora. Necesitan ayuda en las actividades de la vida diaria, cuidados sanitarios y compañía. No se han detectado conflictos culturales que interfieran en la atención. Están satisfechos con la ayuda recibida pero consideran que las trabajadoras carecen de formación para el cuidado. Conclusiones. Las personas mayores son conscientes de las dificultades actuales de la familia para cuidar y se van adaptando a esta nueva realidad. Valoran positivamente tener una cuidadora porque les ayuda en las tareas de la casa, los cuida y les aporta compañía, distracción y afecto. Las enfermeras de atención primaria tienen un rol clave en la formación de las trabajadoras inmigrantes (AU)

Introduction: Social-demographic changes such as the increasing number of dependent elderly people, the incorporation of women into the workforce, and declining family size have led to the emergence of a new occupation, that of home care for elderly dependents. This work is usually carried out by women immigrants. Little is known about how this care is perceived by the elderly. Objective: To evaluate the daily lives of elderly people cared for by hired immigrants to identify aspects of their health and the care they receive. Methodology: A qualitative study conducted through twelve theoretical sampling interviews that were recorded, transcribed and analyzed with computer support of Atlas Ti V5. Results: The elderly do not anticipate or prepare for the problems of old age. Their main concerns regarding health are illness, pain and death. All wish to remain as autonomous as possible. The need to arrange home care services is often first perceived by the family. Home-help workers assist in basic and instrumental daily activities and provide care and company. Cultural conflicts in the practice of care are rare. Despite general satisfaction with help received, the elderly consider that the workers lack specific training in caring for the elderly. Conclusions: The elderly are aware of the current difficulties of families to care for them and they are adapting to the new reality of home care. They value the worker who helps them because besides helping with housework, they provide company, entertainment and affection. Primary care nurses can play a key role in training immigrant workers in caring for the elderly (AU)

[Care for the elderly who depend on receiving care or bet on their independence?]. / Cuidar a los ancianos dependientes o apostar por su independencia?

At the present time, the social-sanitary system in our country places great emphasis on the attention and care which the elderly who depend on aid receive. This reality, basically implies a type curative care which does not correspond to the principles of the reform philosophy in primary health care which claims that most developed functions and the focus of health center activities should be promoting better health and the prevention of diseases and their complications. On the other hand, once a patient has been placed on dependence care, little remains to be done to improve it. Therefore, it is logical to question if it would not be more beneficial to concentrate health care efforts and treatment to maintain and increase a patient's independence throughout his/her lifetime.

¿Cuidar a los ancianos dependientes o apostar por su independencia? / Care for the elderly who depend on receiving care or bet on their independence?

Actualmente el sistema sanitario y social de nuestro país está poniendo un gran énfasis en la atención y el cuidado de los ancianos dependientes. Esta realidad, básicamente, implica una atención de tipo curativo que no se corresponde con los principios de la filosofía de la reforma de la atención primaria, que sostiene que las funciones más desarrolladas y el centro de las actividades deben ser la promoción de la salud y la prevención de las enfermedades y sus complicaciones. Por otro lado, una vez se ha instaurado la dependencia, ya poco se puede hacer para mejorarla. En consecuencia cabría preguntarse si no sería más provechoso centrar los esfuerzos de la atención y los cuidados a mantener y potenciar la independencia a lo largo de la vida de las personas(AU)

At the present time, the social-sanitary system in our country places great emphasis on the attention and care which the elderly who depend on aid receive. This reality, basically, implies a type curative care which does not correspond to the principles of the reform philosophy in primary health care which claims that most developed functions and the focus of health center activities should be promoting better health and the prevention of diseases and their complications. On the other hand, once a patient has been placed on dependence care, little remains to be done to improve it. Therefore, it is logical to question if it would not be more beneficial to concentrate health care efforts and treatment to maintain and increase a patient's independence throughout his/her Lifetime(AU)

[Dependency policies. Consequences for affected families]. / Políticas de dependencia. Consecuencias para las familias.

Dependency creates a social problem whose burden falls upon the affected family and which causes problems in the lives and health of caretakers. A solution to these problems depends on the policies enacted. Nurses should know these policies and their consequences and act accordingly. For nurses to do so, the author has carried out a qualitative documented research project which analyzes the main Spanish dependency policies including the Geriatrics Plan and the following laws: regarding situations requiring living together and mutual aid, conciliation of working and personal lives, family caretaking for elderly and dependent relatives. This project's results indicate the aid provided consists in monetary loans and social services. The coverage provided by these aid programs is minimal or scarce. These programs promote keeping patients in need of dependency care in their homes under the care of relatives. There is little aid directed at caretakers and frequently such aid implies high personal costs. Nurses can and should contribute to bring awareness of these situations, to alleviate them and to modify some of these problems.

Políticas de dependencia. Consecuencias para las familias / Dependency policies. Consequences for affected families

La dependencia representa un problema social que recae en la familia y que ocasiona problemas en la vida y salud de los cuidadores. La solución depende de las políticas implementadas. Las enfermeras deben conocer dichas políticas y sus consecuencias para actuar en consecuencia. Para ello se ha realizado una investigación documental cualitativa, analizando las principales políticas de dependencia españolas que incluyen el Plan Gerontológico y las siguientes leyes: sobre Situaciones de Convivencia y Ayuda Mutua, de Conciliación de la Vida Laboral y Personal, de Acogida Familiar de Personas Mayores y de Dependencia. Los resultados indican que las ayudas consisten en prestaciones monetarias y servicios sociales. Su alcance es escaso. Promueven la permanencia en el domicilio y el cuidado por la familia. Existen pocas ayudas dirigidas a los cuidadores y con frecuencia implican altos costes personales y de oportunidad. Las enfermeras pueden y deben contribuir a evidenciar, paliar y modificar algunos de esos problemas(AU)

Dependency creates a social problem whose burden falls upon the affected family and which causes problems in the lives and health of caretakers. A solution to these problems depends on the policies enacted. Nurses should know these policies and their consequences and act accordingly. For nurses to do so, the author has carried out a qualitative documented re-search project which analyzes the main Spanish dependency policies including the Geriatrics Plan and the following laws: regarding situations requiring living together and mutual aid, conciliation of working and personal lives, family caretaking for elderly and dependent relatives. This project’s results indicate the aid provided consists in monetary loans and social services. The coverage provided by these aid programs is minimal or scarce. These programs promote keeping patients in need of dependency care in their homes under the care of relatives. There is little aid directed at caretakers and frequently such aid implies high personal costs. Nurses can and should contribute to bring awareness of these situations, to alleviate them and to modify some of these problems(AU)

[Formal care systems consequences of a vision on informal caretakers]. / El sistema formal de cuidados. Conseuencias de su visión sobre los cuidadores informales.

Care for dependent persons falls, fundamentally, on their family members who usually perceive this situation as a problem due to its repercussions on the family group in general and on the health and quality of life for the informal caretaker in particular. The burden which an informal caretaker assumes depends on diverse variables among which the most important are considered to be social assistance and the forms of help which the caretaker has to rely on. At the same time, the resources and help available are determined by the vision which the formal system has for informal caretakers; therefore, it is important that nurses, as caretakers in the formal system, have a clear idea about the situations that are created and that nurses reflect on the alternatives which allow a dependent person to be cared for without forgetting the needs and rights of the caretakers.

El discurso de las enfermeras ante el cuidado de las personas mayores dependientes y sus cuidadores familiares / Analysis of nurses attitudes to the dependent elderly and their caregivers

Actualmente existe una gran preocupación social por el cuidado de los ancianos dependientes. Como las enfermeras son las cuidadoras del sistema de salud interesa conocer su punto de vista y toma de posición al respecto. En este artículo se describen y analizan los planteamientos que los profesionales de la enfermería realizan respecto al cuidado de los ancianos dependientes. Se reflexiona sobre las repercusiones que algunos posicionamientos, propuestas y actuaciones de los profesionales pueden tener sobre los propios ancianos y los cuidadores familiares, y se comentan los cambios que deberían llevarse a cabo para que la actuación de las enfermeras fuera coherente con su discurso

Care of the dependent elderly is a topic of considerable public concern in view of recent social changes and it is important to know and analyse the viewpoint of nurses. This article discusses the repercussions that nursing attitudes and behaviour may have on the elderly and their caregivers and considers the changes that should be introduced to adapt to new circumstances and provide better care

Cuidadores informales. Necesidades y ayudas / Informal caretakers: their necessities and help

Para conocer las necesidades y problemas que presentan los cuidadores informales, e identificar las ayudas formales e informales que reciben, su percepción sobre las mismas y lo que les gustaría obtener del sistema formal, se realizó un estudio observacional, descriptivo y transversal, con cuestionario semi-estructurado cumplimentado mediante entrevista presencial en el domicilio del cuidador. Se llevó a cabo en el ABS Morera-Pomar y se ha entrevistado a 32 cuidadores. Como conclusiones se deduce que los cuidadores tienen problemas y necesidades por lo que precisan ayudas. Se muestran poco críticos con las que reciben tanto del sistema informal como formal. En general las valoran positivamente, y lo que esperan se enmarca dentro de lo que ya reciben o de la oferta existente (AU)