Factores explicativos de la aplicación de la Ley de autonomía del paciente por personal médico y de enfermería del área quirúrgica / Factors explaining the application of the law of patient autonomy by surgical staff

Objetivos Explorar qué factores del contexto explican la aplicación de la Ley de autonomía del paciente (LAP) por parte de profesionales implicados en el proceso quirúrgico. Métodos Estudio descriptivo transversal mediante encuesta en el Hospital Virgen Macarena de Sevilla con personal del área quirúrgica. Variable dependiente: aplicación de la LAP. Variables independientes: percepción de características socioestructurales, según modelo de Kanter, percepción de colaboración interprofesional y conocimiento de la LAP. Se realizó análisis exploratorio, bivariado con pruebas paramétricas y no paramétricas, y regresiones simples y múltiples. El nivel de confianza fue del 95%.ResultadosParticipantes: 170 profesionales (tasa de respuesta: 60,28%). Los comportamientos acordes con la LAP se presentan entre un nivel medio y alto, en médicos y enfermeras. Respecto a la aplicación de la LAP según las variables sociolaborales, hay diferencias estadísticamente significativas, por parte del personal médico, en el área de trabajo y en la especialidad. El análisis de regresión múltiple muestra la relación de la aplicación de la LAP con la colaboración interprofesional, en el personal médico. Conclusiones El modelo de Kanter y la escala de colaboración interprofesional pueden ayudarnos a explicar la influencia del contexto hospitalario en la aplicación de la LAP, y los resultados obtenidos podrían orientar el diseño de estrategias dirigidas a la implementación de la ley. Sería necesario superar estructuras tradicionales y generar condiciones descentralizadas y flexibles, que estimulen el trabajo en equipo y la toma de decisiones compartidas(AU)

Objective To examine which contextual factors explain the implementation of the Patient Autonomy Law (LAP) by professionals involved in the surgical process. Methods A descriptive cross sectional study survey. It was conducted at the Hospital Virgen Macarena in Seville with the surgical staff. Dependent variable: the application of LAP. Independent variables: the perception of socio-structural organizational characteristics according to Kanter's model (organizational culture, sociopolitical support, access to information, and access to resources), the perception of interprofessional collaboration, and knowledge of the LAP. We performed exploratory analysis, bivariate with parametric and nonparametric tests depending on the nature of the distributions; simple regression to determine the weight of each explanatory variable on the application of the LAP and, multiples introducing in the models those variables that had obtained significant regression coefficients. The analysis performed with a confidence level of 95%.ResultsParticipants: 170 professionals (response rate: 60.28%). Behaviour according to the LAP is present in a medium-high level among physicians and nurses. Significant differences were observed in the application of the LAP according to the different sociolaboral variables and considering medical staff, the working environment and the specialty. Multiple regression analyses revealed the relationship between the application of the LAP and interprofessional collaboration, in physicians. Conclusions Kanter's model and the scale of interprofessional collaboration, may contribute to the explanation of the influence of the hospital context in the implementation of the LAP and the results may guide us when designing strategies to implement the law. It would be necessary to overcome the traditional structures and create decentralized and flexible conditions that encourage teamwork and shared decision making(AU)

[Factors explaining the application of the law of patient autonomy by surgical staff]. / Factores explicativos de la aplicación de la Ley de autonomía del paciente por personal médico y de enfermería del área quirúrgica.

OBJECTIVE: To examine which contextual factors explain the implementation of the Patient Autonomy Law (LAP) by professionals involved in the surgical process. METHODS: A descriptive cross sectional study survey. It was conducted at the Hospital Virgen Macarena in Seville with the surgical staff. Dependent variable: the application of LAP. INDEPENDENT VARIABLES: the perception of socio-structural organizational characteristics according to Kanter's model (organizational culture, sociopolitical support, access to information, and access to resources), the perception of interprofessional collaboration, and knowledge of the LAP. We performed exploratory analysis, bivariate with parametric and nonparametric tests depending on the nature of the distributions; simple regression to determine the weight of each explanatory variable on the application of the LAP and, multiples introducing in the models those variables that had obtained significant regression coefficients. The analysis performed with a confidence level of 95%. PARTICIPANTS: 170 professionals (response rate: 60.28%). Behaviour according to the LAP is present in a medium-high level among physicians and nurses. Significant differences were observed in the application of the LAP according to the different sociolaboral variables and considering medical staff, the working environment and the specialty. Multiple regression analyses revealed the relationship between the application of the LAP and interprofessional collaboration, in physicians. CONCLUSIONS: Kanter's model and the scale of interprofessional collaboration, may contribute to the explanation of the influence of the hospital context in the implementation of the LAP and the results may guide us when designing strategies to implement the law. It would be necessary to overcome the traditional structures and create decentralized and flexible conditions that encourage teamwork and shared decision making.

Conocimiento de la ley de autonomía del paciente por el personal médico y de enfermería implicado en el proceso quirúrgico / Knowledge of the law of patient autonomy by medical and nursing staff involved in the surgical process

Objetivo. Explorar el conocimiento que se tiene de la Ley de Autonomía del Paciente (LAP) por parte del personal médico y de enfermería implicado en el proceso quirúrgico de dos hospitales de Sevilla. Método. Estudio transversal observacional, realizado en julio de 2008 mediante encuesta elaborada por personal del Hospital Universitario Virgen Macarena (HUVM) y revisada por un experto (jurista) de la Consejería de Salud. De una muestra de 100 profesionales (médicos, enfermeras y auxiliares de enfermería) del área quirúrgica de los hospitales Virgen del Rocío y Virgen Macarena, participaron 63. Se realizó un análisis de frecuencias de las respuestas a las preguntas de la encuesta y se aplicó el test de Chi cuadrado para determinar si existían diferencias en el conocimiento de los profesionales en función del hospital, la categoría profesional y el sexo. Resultados. El 69,8% (44) de los participantes reconoce no haber hecho nada para conocer la ley y sólo el 14,3% (9) dice conocer actividades realizadas por el hospital. No existen diferencias en el conocimiento de la ley por parte de los profesionales entre los dos hospitales. En ambos, existe poco conocimiento. La única diferencia estadísticamente significativa, corresponde a la iniciativa personal para conocer la LAP, destacándose el porcentaje superior de las auxiliares de enfermería (p=0,05) y el inferior en los médicos. Conclusiones. La adecuación de los servicios hospitalarios a la LAP requiere del conocimiento de ésta por parte del personal sanitario. Esto exige el compromiso de las direcciones de los hospitales y del personal responsable de los servicios(AU)

Objective. To study the extent to which the Law of Patient Autonomy (LAP) is known by the medical and nursing staff of the surgical areas from the two university hospitals in Seville. Methods. Cross sectional study, obtained in July 2008 from a survey prepared by Hospital Virgen Macarena (HVM) staff and reviewed by an expert (lawyer) from the Ministry of Health of the Autonomous Government of Andalusia. Sixty three out of one hundred professionals (doctors, nurses and nursing assistants) of the surgical area of the HVM and Virgen del Rocio (HVR) hospitals participated in the survey. We performed a frequency analysis of responses to the questions and applied the chi-square test to determine whether there were differences in knowledge depending on the hospital, professional status and sex. Results. Nearly seventy per cent of the participants (44) acknowledged to have made no attempt to learn the law, whereas only 14.3% (9) knew of some sort of hospital action to publicise the law. No significant difference in the knowledge of the law was found between the professionals of each hospital, while the level of knowledge was very modest in both places. However, we found a statistically significant difference in the personal initiative to learn about the LAP, depending on professional status, with the highest percentage being in nurses (P=0.05) and the lowest in doctors. Conclusions. For the implementation of the LAP in the hospitals, health personnel must have knowledge of it. This requires a commitment by hospitals directors and managers, as well as the people responsible for the different services(AU)

[Knowledge of the law of patient autonomy by medical and nursing staff involved in the surgical process]. / Conocimiento de la ley de autonomía del paciente por el personal médico y de enfermería implicado en el proceso quirúrgico.

OBJECTIVE: To study the extent to which the Law of Patient Autonomy (LAP) is known by the medical and nursing staff of the surgical areas from the two university hospitals in Seville. METHODS: Cross sectional study, obtained in July 2008 from a survey prepared by Hospital Virgen Macarena (HVM) staff and reviewed by an expert (lawyer) from the Ministry of Health of the Autonomous Government of Andalusia. Sixty three out of one hundred professionals (doctors, nurses and nursing assistants) of the surgical area of the HVM and Virgen del Rocio (HVR) hospitals participated in the survey. We performed a frequency analysis of responses to the questions and applied the chi-square test to determine whether there were differences in knowledge depending on the hospital, professional status and sex. RESULTS: Nearly seventy per cent of the participants (44) acknowledged to have made no attempt to learn the law, whereas only 14.3% (9) knew of some sort of hospital action to publicise the law. No significant difference in the knowledge of the law was found between the professionals of each hospital, while the level of knowledge was very modest in both places. However, we found a statistically significant difference in the personal initiative to learn about the LAP, depending on professional status, with the highest percentage being in nurses (P=0.05) and the lowest in doctors. CONCLUSIONS: For the implementation of the LAP in the hospitals, health personnel must have knowledge of it. This requires a commitment by hospitals directors and managers, as well as the people responsible for the different services.