Impact of the "Looking after my health after cancer" peer-led active patient education program on cancer survivors and their caregivers: A qualitative study.

BACKGROUND: Cancer survival has doubled and is likely to continue increasing in the near future. Cancer survivors experience long-term adverse effects, with associated psychological changes, and often they have needs that are yet to be met. Recognizing the lack of continuity-of-care initiatives for cancer survivors and caregivers, Osakidetza Basque Health Service has started to implement through primary care a peer-led active patient education program called "Looking after my health after cancer". This study explores how cancer survivors and their caregivers rate the experience of participating in the program, to what extent the program helps them understand and address their unmet felt needs, and helps them improve their activation for self-care and self-management. METHODS: A qualitative exploratory phenomenological study was conducted using five focus groups: four with cancer survivors (n = 29) and caregivers (n = 2), and one with peer leaders (n = 7). Narrative content analysis was performed using the constant comparison method, facilitated by Atlas-ti software. Descriptive analysis of sociodemographic and clinical data was performed. The study was developed according to the Consolidated criteria for reporting qualitative research (COREQ) checklist. RESULTS: Five main themes emerged from the content analysis: 1) satisfaction with the program as a positive learning experience; 2) peer sharing and learning ("if they can, so can I"); 3) fears prior to attending the program; 4) becoming more aware of unmet felt needs and feeling understood in the "new normal"; and 5) a more positive view of their experience, helping them become active in self-care and empowered in the self-management of their condition. CONCLUSIONS: The peer education program has shown to have a positive impact on cancer survivors and caregivers. It is necessary to design, implement and evaluate interventions of this type to address unmet felt needs during cancer survivorship and improve their quality of life.

Evaluation of the Implantation of the Good Practices Guideline for Vascular Access in the Euskadi Regional Host of Osakidetza-Basque Health Service: A Descriptive Studio of the Process / Evaluación de la implantación de la guía de buenas prácticas de acceso vascular en el Host Regional Euskadi de Osakidetza-Servicio Vasco de Salud: estudio descriptivo de proceso / Avaliação da implementação do guia de boas práticas para acesso vascular no Host Regional Euskadi de Osakidetza-Serviço Vasco de Saúde: estudo descritivo do proceso

Introduction. Intravenous treatments are necessary in multiple situations; however, they do have complications. The vascular access guideline provides assessed and synthesized evidence to be transferred to care. The aim of this study is to describe the process of implementation of the vascular access guideline in the organizations of Euskadi Regional Host by monitoring the use of alternative catheters, early removal and the presence of complications. Methodology. Descriptive study of process. The cut-off times are 3 months pre- implementation and 6, 12, 48 months post- implantation. Descriptive and comparative analysis with Chisquare. Results. A total of 7,074 patients and 12,363 devices were evaluated; The short peripheral catheter is the most frequently used. The use of alternative catheters increased over time, showing a significant difference in the 3 months pre- implementation period with the 48-month post-implantation period (from 6.81% preimplementation to 10.58% post 48 months). The percentage of short intravenous catheters removal in les than 48 hours increased from 53.25% to 57.54% of the pre-implantation of the 48 months post-implantation. Discussion. The results obtained after the implementation of the guideline highlight the impact of the use of alternative catheters and their early removal. Further work needs to be done to reduce complications and rates of peripheral venous catheter phlebitis. Conclusions. The implementation of the good practices guidelines for vascular access care improves the results in the use of alternative catheters or the reduction in peripheral venous catheters in days. Keywords: Implementation Science; Vascular Access Devices; Practice Guideline; Evidence-Based Practice; Nursing

Introducción. Los tratamientos endovenosos son necesarios en multitud de situaciones; sin embargo, presentan complicaciones. La guía de acceso vascular ofrece evidencia valorada y sintetizada para ser trasladada al cuidado. El objetivo del estudio es describir el proceso de implantación de la guía de acceso vascular en las organizaciones del Host Regional Euskadi monitorizando uso de catéteres alternativos, retirada precoz y presencia de complicaciones. Metodología. Estudio descriptivo de proceso. Se establecen como momentos de corte 3 meses preimplantación y 6, 12 y 48 meses postimplantación. Análisis descriptivo y de comparación con Chi cuadrado. Resultados. Se evaluaron 7,074 pacientes y 12,363 dispositivos; siendo el catéter periférico corto el de uso más frecuente. La utilización de catéteres alternativos aumentó a lo largo del tiempo, mostrando diferencias significativas en el periodo 3 meses preimplantación con el de 48 meses postimplantación (del 6.81% preimplantación al 10.58% post 48 meses). El porcentaje de catéteres venosos periféricos cortos retirados en menos de 48h aumentó del 53.25% al 57.54% de la preimplantación a los 48 meses postimplantación. Discusión. Los resultados obtenidos tras la implantación de la guía ponen de relieve el impacto de la utilización de catéteres alternativos y la retirada precoz de estos. Se ha de seguir trabajando en disminuir las complicaciones y las tasas de flebitis de catéter venosos periféricos. Conclusiones. La implantación de la guía de buenas prácticas para el cuidado del acceso vascular mejora los resultados en el uso de catéteres alternativos o la disminución en días de los c atéteres venosos periféricos. Palabras clave: Ciencia de la Implementación; Dispositivos de Acceso Vascular; Guía de Práctica Clínica; Práctica Clínica Basada en la Evidencia; Enfermería

Introdução. Os tratamentos intravenosos são necessários em muitas situações; porém, apresentam complicações. O guia de acesso vascular oferece evidências avaliadas e sintetizadas para serem transferidas para o cuidado. O objetivo do estudo é descrever o processo de implementação do guia de acesso vascular nas organizações do Host Regional Euskadi, monitorando o uso de cateteres alternativos, remoção precoce e presença de complicações. Metodologia. Estudo descritivo de processo. São estabelecidos como momentos de corte 3 meses pré-implantação, e 6, 12 e 48 meses pós-implantação. Análise descritiva e comparativa com Qui-quadrado. Resultados. Foram avaliados 7,074 pacientes e 12,363 dispositivos, sendo o cateter periférico curto o mais utilizado. O uso de cateteres alternativos aumentou ao longo do tempo, apresentando diferenças significativas no período de 3 meses pré-implantação com o de 48 meses pós-implantação (de 6.81% pré-implantação para 10.58% pós 48 meses). A porcentagem de cateteres venosos periféricos curtos removidos em menos de 48 horas aumentou de 53.25% para 57.54% desde a pré-implantação até 48 meses pós-implantação. Discussão. Os resultados obtidos após a implementação do guia destacam o impacto do uso de cateteres alternativos e sua remoção precoce. O trabalho deve continuar para reduzir complicações e taxas de flebite por cateter venoso periférico. Conclusões. A implementação do guia de boas práticas para cuidados com acesso vascular melhora os resultados no uso de cateteres alternativos ou na redução de dias de cateteres venosos periféricos. Palavras-chave: Ciência da Implementação; Dispositivos de Acesso Vascular; Guia de Prática Clínica; Prática Clínica Baseada em Evidências; Enfermagem

Vascular access care in patients with multimorbidity.

BACKGROUND: More than half of patients with multimorbidity require intravenous therapy during their hospital stay. The aims of this study are to describe difficult intravenous access (DIVA) and vascular access care provided to this patient population and to explore the differences between easy and DIVA groups. METHODS: A cohort study was conducted in patients with multimorbidity admitted to 2 hospitals between March and November 2013. The variables used to describe vascular care included choice and placement of devices, catheter swell time, and occurrence of adverse events. The incidence of adverse events was expressed as number cases per 1000 catheter days and χ2, Student's t, or Mann-Whitney U tests were used to compare the care provided between both groups. Odds rates were calculated to determine the risk of complications associated with DIVA. RESULTS: We recruited 135 patients, of whom 34.8% were women. Overall, 59.3% had DIVA. A total of 224 catheters were inserted, patients with difficult access requiring a mean of 1.71 catheters and those with easy access 1.58 catheters. Two or more attempts were required to place catheters in 23% of cases in the difficult access group versus 2.50% in the easy access group. Mean catheter dwell time was 3.84 days and 3.99 days, and the adverse event rate was 111/1000 and 83.6/1000 catheter days, respectively. The odds ratio for complications was 1.596. CONCLUSIONS: Multimorbid patients with DIVA have a higher rate of complications as well as requiring more catheters and more placement attempts.

Satisfacción de las enfermeras de Osakidetza con las aplicaciones móviles para el cuidado enfermero / Satisfaction among Osakidetza nurses with mobile applications for nursing care

OBJETIVO: explorar la satisfacción de las enfermeras de Osakidetza con las aplicaciones informáticas móviles para el cuidado enfermero, así como su valoración sobre la formación recibida para su utilización, la facilidad de su uso, las características de la información gestionada y el impacto sobre el cuidado del paciente. MÉTODO: estudio descriptivo transversal. Población objeto de estudio: enfermeras de Osakidetza que trabajaban con aplicaciones informáticas móviles. VARIABLES: sociodemográficas y laborales, de usabilidad, formación y soporte recibidos, impacto, satisfacción con las aplicaciones móviles incluidas. Fueron recogidas mediante cuestionario diseñado adhoc. Se realizó un análisis estadístico descriptivo y un análisis bivariantes, mediante el test Chi cuadrado. RESULTADOS: se recibieron 518 cuestionarios (33,5%). El 37,8% refirió satisfacción a nivel general con las aplicaciones utilizadas, el 27,2% mayor agilidad al efectuar el trabajo con tableta y el 36,1% una mejor realización del trabajo. La aplicación con mayor satisfacción fue la que facilita el registro de constantes (61,8%). Un 74,8% refirió impacto positivo sobre la seguridad del paciente. Se encontraron diferencias estadísticamente significativas según la función desempeñada (mayor satisfacción en las enfermeras gestoras; p= 0,023), según nivel de utilización en la vida diaria (mayor satisfacción en utilización media y alta; p= 0,036), y en función del turno de trabajo (mayor satisfacción en turno fijo; p= 0,021). CONCLUSIONES: el nivel de satisfacción con las aplicaciones móviles para el cuidado es discreto. Para conocer el impacto de estas herramientas y la satisfacción general con ellas, se recomienda ser valoradas cuando el despliegue realizado en las organizaciones esté consolidado

OBJECTIVE: to explore the satisfaction among Osakidetza nurses with the mobile applications for nursing care, as well as their evaluation of the training received for their use, ease of use, characteristics of the information managed, and impact on patient care. METHOD: a descriptive cross-sectional study. Population object of the study: Osakidetza nurses working with mobile applications. VARIABLES: sociodemographical and occupational, usability, training and support received, impact, satisfaction with the mobile applications included; these were collected through a questionnaire designed ad hoc. Descriptive statistical analysis was conducted, as well as bivariate analysis, through Chi Square Test. RESULTS: in total, 518 questionnaires (33.5%) were received; 37.8% reported overall satisfaction with the applications used, 27.2% reported that working with the tablet was faster, and 36.1% stated that their work was better conducted. The application with the highest satisfaction level was the one that provides vital sign records (61.8%); 74.8% of participants reported a positive impact on patient safety. Statistically significant differences were found depending on the role played (higher satisfaction among nurse managers; p= 0.023), according to the level of use in daily life (higher satisfaction in medium and high use; p= 0.036), and based on the working shift (higher satisfaction in regular shifts: p= 0.021). CONCLUSIONS: there is a moderate level of satisfaction with mobile applications for patient care. In order to understand the impact of these tools and the overall satisfaction with them, it is recommended to assess them once the display conducted in agencies has been firmly established

Prevalence of difficult venous access and associated risk factors in highly complex hospitalised patients.

AIMS AND OBJECTIVES: To estimate the prevalence of difficult venous access in complex patients with multimorbidity and to identify associated risk factors. BACKGROUND: In highly complex patients, factors like ageing, the need for frequent use of irritant medication and multiple venous catheterisations to complete treatment could contribute to exhaustion of venous access. DESIGN: A cross-sectional study was conducted. METHODS: 'Highly complex' patients (n = 135) were recruited from March 2013-November 2013. The main study variable was the prevalence of difficult venous access, assessed using one of the following criteria: (1) a history of difficulties obtaining venous access based on more than two attempts to insert an intravenous line and (2) no visible or palpable veins. Other factors potentially associated with the risk of difficult access were also measured (age, gender and chronic illnesses). Univariate analysis was performed for each potential risk factor. Factors with p < 0·2 were then included in multivariable logistic regression analysis. Odds ratios were also calculated. RESULTS: The prevalence of difficult venous access was 59·3%. The univariate logistic regression analysis indicated that gender, a history of vascular access complications and osteoarticular disease were significantly associated with difficult venous access. The multivariable logistic regression showed that only gender was an independent risk factor and the odds ratios was 2·85. CONCLUSIONS: The prevalence of difficult venous access is high in this population. Gender (female) is the only independent risk factor associated with this. Previous history of several attempts at catheter insertion is an important criterion in the assessment of difficult venous access. RELEVANCE TO CLINICAL PRACTICE: The prevalence of difficult venous access in complex patients is 59·3%. Significant risk factors include being female and a history of complications related to vascular access.

Inserción eco-guiada de catéteres centrales de inserción periférica (PICC) en pacientes oncológicos y hematológicos: éxito en la inserción, supervivencia y complicaciones / Ultrasound-guided peripherally inserted central catheters (picc) in cancer patients: success of the insertion, survival and complications

Objetivo evaluar los resultados de los catéteres centrales de inserción periférica (PICC) insertados por enfermeras de la unidad de oncología y hematología con técnica ecoguiada en cuanto a éxito en la inserción, incidencias, dispositivos que llegan a fin de tratamiento y supervivencia de los catéteres. Método estudio observacional y prospectivo. Se incluyeron todos los PICC insertados mediante eco-guía a pie de cama en el Hospital Universitario Araba. La técnica se inició en junio de 2010. El estudio finalizó en noviembre de 2011. Se recogieron datos socio-demográficos, características del catéter, éxito en la inserción, duración, incidencias y motivo de retirada. Resultados Se insertaron 165 catéteres, el 95,2% a pacientes de oncología o hematología, 73 de ellos continúan aún en uso. Se obtuvo un éxito en la inserción del 89,7% (IC del 95%: 85,1%- 94,3%). Los días de uso total de los catéteres fueron 16.234 con una mediana de duración de 92 días por PICC. La incidencia más frecuente fue la extracción accidental 0,986/1.000 días de catéter (IC del 95%: 0,970-1,001/1.000). La tasa de trombosis fue de 0,308/1.000 días (IC del 95%: 0,299- 0,317) y la de bacteriemia relacionada con catéter de 0,062/1.000 días de catéter (IC del 95%: 0,058- 0,065).Conclusión la inserción del PICC eco-guiada a pie de cama puede ser realizada por enfermeras entrenadas con una elevada probabilidad de inserción exitosa. El PICC, por su baja tasa de complicaciones y su alta duración media, es un dispositivo válido como acceso venoso central de media y larga duración para pacientes oncológicos y hematológicos (AU)

Objective To evaluate the results of peripherally inserted central catheters (PICC) inserted by nurses using an ultrasound-guided technique at bed-side. Methods An observational and prospective study was conducted on all the PICC inserted at bed-side by an ultrasound-guided technique at the Araba University Hospital. The technique was introduced in June 2010, and the data collection period ended in November 2011. The main study variables were successful insertion, duration of PICC, incidences related to the catheter, devices reaching end of treatment and reasons for withdrawal. Patient sociodemographic data and PICC technical features were also registered. Results A total of 165 PICC were inserted, 73 are still in use, with 95.2% inserted in patients from oncology or haematology departments. Insertion was successful in the 89.7% (95% CI: 85.1%-94.3%) of the cases. The study included 16,234 catheter days, with a median dwell time of 92 days by PICC. The most frequent incidence was accidental removal in 0.986 per 1000 catheter days (95% CI=0.970-1.001). The thrombosis rate was 0.308 per 1,000 days (95% CI= 0.299-0.317), and the catheter-associated bloodstream infection rate was 0.062 per 1,000 catheter days (95% CI=0.058-0.065).Conclusion Ultrasound-guided PICC insertion can be performed at bedside by trained nurses with a high probability of success. PICC, because of its low complication rate and long indwelling catheter survival, is a suitable central venous device for long-term treatment in oncology and haematology patients (AU)

[Ultrasound-guided peripherally inserted central catheters (PICC) in cancer patients: success of the insertion, survival and complications]. / Inserción eco-guiada de catéteres centrales de inserción periférica (PICC) en pacientes oncológicos y hematológicos: éxito en la inserción, supervivencia y complicaciones.

OBJECTIVE: To evaluate the results of peripherally inserted central catheters (PICC) inserted by nurses using an ultrasound-guided technique at bed-side. METHODS: An observational and prospective study was conducted on all the PICC inserted at bed-side by an ultrasound-guided technique at the Araba University Hospital. The technique was introduced in June 2010, and the data collection period ended in November 2011. The main study variables were successful insertion, duration of PICC, incidences related to the catheter, devices reaching end of treatment and reasons for withdrawal. Patient sociodemographic data and PICC technical features were also registered. RESULTS: A total of 165 PICC were inserted, 73 are still in use, with 95.2% inserted in patients from oncology or haematology departments. Insertion was successful in the 89.7% (95% CI: 85.1%-94.3%) of the cases. The study included 16,234 catheter days, with a median dwell time of 92 days by PICC. The most frequent incidence was accidental removal in 0.986 per 1000 catheter days (95% CI=0.970-1.001). The thrombosis rate was 0.308 per 1,000 days (95% CI= 0.299-0.317), and the catheter-associated bloodstream infection rate was 0.062 per 1,000 catheter days (95% CI=0.058-0.065). CONCLUSION: Ultrasound-guided PICC insertion can be performed at bedside by trained nurses with a high probability of success. PICC, because of its low complication rate and long indwelling catheter survival, is a suitable central venous device for long-term treatment in oncology and haematology patients.