[Role of the nurse in research]. / Rol de la enfermera en la investigación.

In the last decade, the participation of nurses in research has increased and different roles have emerged in this area: clinical research nurse, research nurse, research support nurse and research consumer nurse. In this regard, the terms clinical research nurse and research nurse are often confused and used interchangeably. However, these are four different profiles, because the functions, training requirements, skills and responsibilities of these vary considerably and that is why it seems interesting to define the contents and competencies of each of them.

En la última década, la participación de las enfermeras en la investigación ha aumentado y han surgido distintos roles en esta área: enfermera de investigación clínica, enfermera investigadora, enfermeras de apoyo a la investigación y enfermeras consumidoras de investigación. En este sentido, los términos enfermera de investigación clínica y enfermera investigadora a menudo se confunden y se usan indistintamente. Sin embargo, se trata de cuatro perfiles diferentes, porque las funciones, requisitos formativos, habilidades y responsabilidades de estas varían considerablemente y es por eso que parece interesante definir los contenidos y competencias de cada una de ellas.

Características clínicas de los pacientes con enfermedades inmunomediadas inflamatorias afectados por Covid-19 / Clinical characteristics of patients with affected inflammatory immunemediated diseases by Covid-19

Objetivo principal: Describir la incidencia de Covid-19 por sexo y especialidad en pacientes con Enfermedad Inmunomediada Inflamatoria (EIMI). Metodología: Estudio observacional prospectivo de pacientes en seguimiento/tratamiento en un Centro de Enfermedades Inmuno-mediadas Inflamatorias, de marzo a junio de 2020. Resultados: El total de pacientes en seguimiento era de 1672, se realizaron 3480 consultas, siendo telemáticas 2382(68.4 %). Se confirmaron 77(4.60 %) casos de Covid-19, siendo mujeres 40 (51.98 %). Los síntomas prevalentes fueron: tos seca (81.8 %), mialgias/artralgias (77.9 %), cefalea (68.8 %), fiebre (55.8 %) y neumonía (22.4 %). Se encontraron diferencias en los síntomas por especialidad: mialgias/artralgias (p=0.001), cefalea (p=0.011), fiebre (p=0.012). Necesitaron hospitalización 17 pacientes (22.10 %) y 3 (17.65 %) en Cuidados Intensivos. Conclusión: La terapia con fármacos biológicos no se asoció con peores resultados de Covid-19. Las consultas telemáticas realizada por Enfermeras de Práctica Avanzada garantizaron el seguimiento óptimo, la detección precoz y la continuidad del tratamiento.(AU)

Objective: Describe the incidence of Covid-19 by sex and specialty in patients with Immune-Mediated Inflammatory Disease (IMID). Methods: Prospective observational study of patients in treatment at a Centre for Immune-Mediated Inflammatory Diseases, march to june 2020. Results: The patients in follow-up were 1672, 3480 consultations were carried out, 2382 were telematic (68.4 %). The cases of covid-19 were 77 (4.60 %), were women 40 (51.98 %). The prevalent symptoms were: seca (81.8 %), myalgia/arthralgia (77.9 %), headache (68.8 %), fever (55.8 %) and pneumonia (22.4 %). Statistical differences were found in symptoms by specialty: myalgia / arthralgia (p=0.001), headache (p=0.011), fever (p=0.012). Hospital admission was required in 17 (22.10 %) patients and 3 (17.65 %) in the Intensive Care Unit. Conclusions: Biological drug therapy was not associated with worse Covid-19 outcomes. Telematic consultations carried out by Advanced Nurse Practitioner ensured optimal follow-up, early detection and continuity of treatment.(AU)

Experiência de famílias de doadores falecidos durante o processo de doação de órgãos: um estudo qualitativo / Experiencia de familias de donantes fallecidos durante el proceso de donación de órganos: un estudio cualitativo / Deceased donor's family experience during the organ donation process: a qualitative study

Resumo Objetivo A família é o principal componente da doação de órgãos. Este estudo descreve a experiência da família do doador com os cuidados de enfermagem durante o processo de doação. Métodos Foi realizado um estudo fenomenológico. Os participantes eram familiares que aceitaram a doação de órgãos de um parente em hospitais, e foram recrutados por meio de amostragem intencional. Foram realizadas entrevistas em profundidade e anotações em campo, além de uma análise temática. Resultados Três temas foram identificados: Aspectos positivos do cuidado de enfermagem na unidade de terapia intensiva (UTI); Aspectos positivos do cuidado do enfermeiro coordenador de transplantes (ECT); e Aspectos improváveis do cuidado de enfermagem durante o processo de doação de órgãos. A flexibilidade dos horários na unidade de terapia intensiva para favorecer o acompanhamento dos familiares e fornecer informações adequadas e adaptadas sobre a doação são cuidados diferenciados para as famílias. Elas destacaram áreas para melhorias relacionadas à intimidade e privacidade durante o processo de doação. Conclusão As famílias dos doadores prezam e valorizam os cuidados de enfermagem no processo de doação de órgãos.

Resumen Objetivo La familia es el principal componente de la donación de órganos. Este estudio describe la experiencia de la familia del donante con los cuidados de enfermería durante el proceso de donación. Métodos Se realizó un estudio fenomenológico. Los participantes fueron familiares que aceptaron la donación de órganos de un pariente en hospitales, reclutados por medio de muestreo intencional. Se realizaron entrevistas en profundidad y anotaciones en campo, además de un análisis temático. Resultados Se identificaron tres temas: Aspectos positivos del cuidado de enfermería en la unidad de cuidados intensivos (UCI); Aspectos positivos del cuidado del enfermero coordinador de trasplantes (ECT); y Aspectos improbables del cuidado de enfermería durante el proceso de donación de órganos. La flexibilidad en los horarios en la unidad de cuidados intensivos para favorecer el acompañamiento de los familiares y suministrar informaciones adecuadas y adaptadas respecto a la donación constituyen cuidados diferenciados con las familias. Destacaron áreas para mejoras relacionadas con la intimidad y la privacidad durante el proceso de donación. Conclusión Las familias de los donantes precian y valoran los cuidados de enfermería en el proceso de donación de órganos.

Abstract Objective The family is the main component for organ donation. This study describes the experience of the donor's family with the nursing care during the donation process. Methods A phenomenological study was applied. Participants were family members who accepted the donation of organs from a relative in hospitals, using purposeful sampling. In-depth interviews and field notes were conducted. A thematic analysis was performed. Results Three themes were identified: Positive aspect of intensive care unit nurses' care; Positive aspects of nurses transplant coordinators' care; and Improvable aspects of nursing care during the organ donation process. The flexibility of hours in the intensive care unit to favor the accompaniment of family members, and to provide adequate and adapted information about the donation are outstanding care for families. They highlight areas for improvement related to intimacy and privacy during the donation process. Conclusion Donor's families appreciate and value nursing care within the organ donation process.

Deceased donor care provided by the nurse transplant coordinator: A qualitative research study among Spanish nurses.

AIM: The purpose of this study is to describe the experience of nursing care provided to the deceased organ donor by the nurse transplant coordinator. METHODS: A qualitative exploratory study was conducted within the National Transplant Organization and the Regional Office for Transplant Coordination. A purposive sampling method was used. Data collection methods included semistructured interviews. Sampling and data collection were pursued until the researchers achieved information redundancy. A systematic text condensation analysis was performed. The Guba and Lincoln criteria for guaranteeing trustworthiness were followed. RESULTS: A total of 16 participants were recruited, and three themes were identified regarding care of organ donors by the nurse transplant coordinator during the organ donation process: (a) fulfilling the desire and will of the donor patient; (b) the family as an extension of the donor; (c) coordinating the organ donation process. CONCLUSIONS: The donation process is both complex and delicate, and nursing care is an essential component. The care provided by the nurse transplant coordinator has the donor at the centre of the process, driven by respect for their decision. The family is seen as an extension of the donor. Nursing care should focus on continuous, honest communication, coordinating care with the intensive care unit, ensuring privacy and intimacy.

Attitudes towards multi-organ donation among intensive care unit nurses in transplant hospitals.

AIM: To evaluate the attitudes towards deceased multi-organ donation and transplantation among nurses within the critical care units of the six public tertiary transplant hospitals in Madrid, Spain. BACKGROUND: Spain has a rate of 49 donations per million population, whereas Madrid has a lower donation rate of 34.2 per million population. Nurses generate social opinion, and their attitude can be one of the barriers against organ donation. METHOD: An observational descriptive study was conducted among critical care units' nurses. The measuring instrument was the Collaborative International Donor Project in Organ Donation and Transplantation. Data were collected from January to October 2019, and a statistical analysis was performed. RESULTS: A total of n = 313 questionnaires achieved a response rate of 51%. Of the intensive care unit nurses surveyed, 85% had a favourable opinion towards the donation of their organs being affected by psychosocial variables related to social variables with respect to family, religion and attitude towards the body. CONCLUSION: The intensive care unit nurses of the Madrid transplant hospitals maintain a favourable attitude towards organ donation and transplantation. It is necessary to implement specialized training and periodically evaluate training in this sector. To maintain and improve the attitude towards organ donation, family discussion among health personnel should be encouraged. Religion influences the attitude of nurses and donation rates. IMPLICATION FOR NURSING AND HEALTH POLICY: Intensive care nurses' attitude towards organ donation is influenced by social variables. This study shows that the attitude is positive but improvable. These findings contribute to promote awareness of the lack of organs and the benefits of organ donation.

Facilitators and Barriers in the Organ Donation Process: A Qualitative Study among Nurse Transplant Coordinators.

BACKGROUND: Spain is the world leader in organ donation, with a rate of 49.0 donations per million population. Nurse transplant coordinators fulfill key roles for the success of the complex donation process. Our aims were: (a) to describe the experience of nurse transplant coordinators and (b) to identify barriers and facilitators during the process of organ donation. METHODS: A qualitative phenomenological study was conducted within the National Transplant Organization. A purposive sampling method was used, and data collection methods included semistructured interviews, researcher field notes, and participants' personal letters. A systematic text condensation analysis was performed. The study was approved by the Clinical Research Ethics Committee. RESULTS: A total of 16 participants were recruited and four themes were identified: (a) a different job for nurses, (b) facilitators and barriers of the coordinator's job, (c) not a job for a novice nurse, and (d) coordinators facing a paradigm shift. Coordinators described their job as being characterized with uncertainty and having to face emotional and institutional barriers. The facilitators identified were high educational level and training, and feelings of pride for being part of the National Transplant Organization. CONCLUSIONS: The organ donation process requires specialized training to avoid organizational barriers.

Grupo de Investigación en Cuidados de Enfermería. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) / Group for Research in Nursing Care. Gregorio Marañón Health Research Institute (IiSGM)

La investigación desarrollada por enfermeras en el Hospital General Universitario Gregorio Marañón (Madrid) tiene una larga trayectoria, que tuvo sus inicios en la década de 1990. La actividad docente en el área de investigación y las estructuras de apoyo a la investigación en Enfermería existentes fueron pilares básicos para el reconocimiento del Grupo de Enfermería como grupo independiente en la primera acreditación del Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM). En la actualidad, el Grupo de Enfermería está compuesto por 34 profesionales, enfermeras, matronas y fisioterapeutas, siendo doctoras el 64,7%. Las líneas de investigación se agrupan en tres ejes: Cuidados de Enfermería (Cronicidad, Críticos y Rehabilitación/Fisioterapia); Innovación y Servicios de Salud (Diseño desarrollo y usabilidad de aplicaciones, Enfermería de Práctica Avanzada y Diseño y validación de instrumentos); y Gestión (Competencias, metodología enfermera y entornos de trabajo). Desde 2011 el grupo ha obtenido un total de 288.019 (Euro) en financiación de proyectos competitivos, incluyendo la obtención de intensificaciones para la actividad investigadora y ayudas a grupos emergentes. El grupo acumula en total 187 publicaciones, habiendo publicado 105 artículos en los últimos cinco años, con un factor de impacto acumulado de 86,3. Las líneas en las que se están trabajando son la concienciación de incorporar una correcta filiación en los artículos, la búsqueda continua de colaboraciones y el reconocimiento de la participación de las enfermeras en los proyectos del hospital y del IiSGM

The research conducted by nurses at the Hospital General Universitario Gregorio Marañón (Madrid) has a long history, which started in the 1990s decade. Teaching activity in the research area and the existing structures for support to Nursing research were the basic cornerstones for the acknowledgment of the Nursing Group as an independent group at the first accreditation for the Gregorio Marañón Health Research Institute (IiSGM). Currently, the Nursing Group is formed by 34 professionals, nurses, midwives and physiotherapists; 64.7% of them are doctors. The research lines are classified along three areas: Nursing Care (Chronicity, Critical Patients and Rehabilitation / Physiotherapy); Innovation and Health Services (Design, Development and Usability of Applications, Advanced Practice Nursing, and Design and Validation of Tools); and Management (Competences; Nursing Methodology, and Work Environments). Since 2011, the group has obtained 288.019 (Euro) in total as funding for competitive projects, including achieving majors for research activity and grants for emergent groups. The group accumulates 187 publications in total; 105 articles have been published in the past 5 years, with a cumulative impact factor of 86.3. The current lines of work are: the awareness to incorporate an adequate affiliation in articles, an on-going search for collaborations, and the acknowledgement of the participation of nurses in the projects of the hospital and the IiSGM

Comunicación de las enfermeras con los pacientes. Validación de la escala "Interpersonal Communication Assessment Scale" (ICAS) / Communication of nurses with patients. Validation the "interpersonal communication assessment scale" (ICAS)

OBJETIVO: Adaptar culturalmente la escala "Interpersonal Communication Assessment Scale" en el contexto español de la práctica enfermera. METODOLOGÍA: Estudio trasversal con metodología de traducción directa e inversa, para obtener la adaptación lingüística-cultural. Participaron enfermeras de hospital general universitario. Para analizar las propiedades psicométricas, se valoró fiabilidad analizando la consistencia interna y validez mediante análisis de la estructura factorial. RESULTADOS: Participaron 188 enfermeras, el coeficiente alfa de Cronbach para el cuestionario total fue de 0,881 con coeficientes entre 0,816 y 0,622 en las subescalas. El test KMO mostró índice de 0,850, la prueba de esfericidad de Barlett con Chi cuadrado de 1208,714 con p = 0,000 y análisis factorial con 4 factores que explicaban el 49,268% de la varianza total. CONCLUSIÓN: El cuestionario obtenido comprende todos los aspectos necesarios para evaluar competencias en comunicación de estos profesionales con sus pacientes, con suficiente evidencia y características psicométricas para su utilización en población española

OBJECTIVE: The adaptation of ICAS in the Spanish context of nursing practice. METHODS: A cross-sectional study was carried, using the bidirectional translation method for linguistic-cultural adaptation. It was applied to the nursing staff in a universitary hospital. Reliability, internal consistence and construct validity were calculated to evaluate the psychometrics properties of the Spanish version. RESULTS: Participation was of 188 nurses. Cronbach's alpha coefficient for the total scale was 0,881, with coefficients between 0,816 and 0,622 in the subscales. Exploratory factor analysis resulted in four factors, which explained 49,268% of total variance, and Kaiser-Meyer-Olkin measure was 0,850. CONCLUSIONS: The Spanish version showed high internal consistency and psychometrics characteristics like appropriate tool for assessing interpersonal communications skills between nurses and patients

Actitudes de los profesionales de enfermería ante la participación familiar en los cuidados de los pacientes pediátricos hospitalizados / Nursing attitude about the family involvement in hospitalized children care

INTRODUCCIÓN. La familia es una unidad que se caracteriza por las relaciones entre sus miembros. La interdependencia entre ellos presupone, en temas de salud, que los cuidados serán más eficientes si se dirigen al sistema familiar como unidad. En este sentido, el impacto de la enfermedad y, con ello, un ingreso hospitalario, impulsa al equipo de enfermería a incluir la familia en los cuidados de salud. Las enfermeras consideran que su relación con las familias, en ocasiones, no es fácil, lo que genera diferentes actitudes hacia ellas y a plantearse la posibilidad de permitir su participación en los cuidados. El objetivo de este estudio es analizar las actitudes de los profesionales ante la involucración de la familia en los cuidados de los pacientes. MATERIAL Y MÉTODO. Se realizó un estudio observacional transversal dirigido a los profesionales de enfermería del Departamento Materno-Infantil del Hospital General Universitario Gregorio Marañón (HGUGM). Se utilizó el cuestionario «Importancia de la familia en los cuidados de enfermería: Actitudes de las enfermeras». RESULTADOS. La mayoría de los profesionales, principalmente los pertenecientes a unidades de hospitalización de pacientes con patología crónica, consideran la familia parte de los cuidados de los pacientes, y encuentran que la buena relación con ellos les proporciona satisfacción en su trabajo, sin diferencia entre categorías. Más de la mitad de los profesionales de las Unidades de Cuidados Intensivos Pediátricos (UCIP) consideran que la presencia de la familia les genera estrés. CONCLUSIONES. La diferencia en la actitud de los profesionales está relacionada con el tiempo que estos pasan con las familias y la tecnificación de los cuidados (AU)

INTRODUCTION. Family it’s a unit which is characterized by the relationship between its members, the interdependence between them in health, presupposes that care will be more efficient if targeted the family system as a unit. In that fact the impact of illness and hospitalization drives the nursing staff to include the family in health care. Nurses think their relationship with families is not easy, which generates different attitudes towards them and present the possibility to allow its participation in care. The aim of this research was to analyze the attitudes of these professionals in the family involvement in patients care. MATERIAL AND METHODS. A descriptive cross-sectional study was applied to the nursing staff in Pediatric Department of a the university general hospital Gregorio Marañón (HGUGM), in Madrid, Spain. The data was collected using the «Families’ Importance in nursing care: Nurse´s attitudes scale». RESULTS. Most of the professionals, mostly units of patients with chronic disease, take into consideration the family like a resource in nursing care, finding that a good relationship with families give them job satisfaction, without differences between categories. More than half of the professionals from the units of pediatric intensive care (PICU) considered that the presence of the family generates stress. CONCLUSIONS. The difference in the attitude of professionals is related to the time they spent with families and technification of the care (AU)

Calidad de vida en mujeres perimenopáusicas / Quality of life in perimenopausal women

OBJETIVOS: evaluar la calidad de vida en las mujeres perimenopáusicas, así como valorar la relación de distintas características de las mujeres sobre la misma. MÉTODO: estudio descriptivo transversal realizado entre 2013 y 2015, en un hospital de tercer nivel de Madrid. Se estudiaron a 163 mujeres perimenopáusicas con edades comprendidas entre los 48 y los 58 años. Las participantes cumplimentaron la Escala Cervantes y un cuestionario con variables sociodemográficas y clínicas. Se llevó a cabo un análisis descriptivo global de todas las variables, así como un análisis estratificado de la puntuación en los distintos dominios de la Escala Cervantes en función de las variables estudiadas. RESULTADOS: se estudiaron un total de 162 mujeres con una media de edad de 53 años (DE: 3,1). Las mujeres del estudio obtuvieron una puntuación global media de calidad de vida de 52,9 (24,3) sobre 155. Se observó que las mujeres con pareja estable presentaron mejores puntuaciones en el dominio global de la Escala Cervantes que las mujeres sin pareja (51,8 vs. 66,3; p= 0,05). También se apreció que las mujeres con estudios primarios tuvieron mejores puntuaciones en el dominio salud (diferencia de 3 puntos; p= 0,047) que las mujeres con estudios secundarios. Atendiendo a las mujeres con hijos se comprobó que las que aún seguían viviendo con algún hijo en casa presentaron peor puntuación en el dominio psíquico (p= 0,05). Por último, una mayor edad de la mujer se relacionó con peores puntuaciones en el dominio de envejecimiento (p= 0,05). En el resto de variables no hubo diferencias significativas en las puntuaciones de los dominios. CONCLUSIONES: las mujeres estudiadas presentaron un buen nivel de calidad de vida global. Se apreciaron peores puntuaciones en la calidad de vida, con diferencias estadísticamente significativas, a mayor edad de la mujer, en las mujeres sin pareja estable, en las mujeres con estudios secundarios, y en aquellas que ya no convivían con sus hijos en el domicilio familia

OBJECTIVES: to evaluate quality of life in perimenopausal women, as well as to evaluate its association with different women characteristics. METHOD: a descriptive transversal study conducted between 2013 and 2015, at a third level hospital in Madrid. The study included 163 perimenopausal women between 48 and 58 years of age. The participants completed the Cervantes Score and a questionnaire with sociodemographical and clinical variables. An overall descriptive analysis was conducted for all variables, as well as a stratified analysis of the score in the different domains of the Cervantes Score, based on the variables studied. RESULTS: in total, 162 women were studied, with a mean age of 53 years (SD: 3.1). The women in the study obtained a mean overall quality of life score of 52.9 (24.3) over 155. It was observed that women with a stable partner presented better scores in the overall domain of the Cervantes Score than women without a partner (51.8 vs. 66.3; p= 0.05). It was also observed that women with Primary Education had better scores in the Health Domain (a 3 point difference; p= 0.047) than women with Secondary Education. Regarding women with children, it was proven that those who still had a child living at home presented a worse score in the Psychological Score (p= 0.05). Finally, a more advanced age was associated with worse scores in the Ageing Domain (p= 0.05). In the rest of the variables, there were no significant differences in the domain scores. CONCLUSIONS: the women studied presented a good overall quality of life. A worse quality of life was observed, with statistically significant differences, at a more advanced age, in women without a stable partner, in women with secondary education, and in those who did not have any child still living in the family home

Prevalencia de hiponatremia en pacientes mayores de 65 años que sufren una caída intrahospitalaria / Prevalence of hyponatraemia in patients over the age of 65 who have an in-hospital fall

Fundamento y objetivo: La hiponatremia es el trastorno electrolítico más frecuente. Algunos estudios afirman que aumenta la morbimortalidad. Existen nuevas líneas de investigación que buscan la relación entre hiponatremia y caídas. Objetivo: Determinar si la hiponatremia es un factor relacionado con las caídas en ancianos hospitalizados. Método: Diseño observacional analítico de casos y controles. Población de estudio: Se consideraron casos los pacientes mayores de 65 años que experimentaron una caída durante su ingreso en unidades de hospitalización del Hospital General Universitario Gregorio Marañón de Madrid. Los controles fueron pacientes que no wxperimentaron caída, pareados según las variables: unidad, edad, periodo de ingreso, género y Downton. El tamaño fue de 206 sujetos. Recogida de datos: Se estudiaron factores sociodemográficos, las variables incluidas en la ficha de registro de caídas y escala de Downton, y el sodio sérico. Se consideró hiponatremia Na+<135mmol/l. Análisis: Se realizó un análisis descriptivo para valorar la homogeneidad de la muestra, un análisis analítico utilizando el test chi cuadrado, calculando la OR y un análisis multivariante con regresión logística. Resultados: De 103 casos, 61 eran hombres (50,4%) y 42 mujeres (49,4%). En 29 se detectó hiponatremia; la relación con las caídas fue p: 0,002. La OR ajustada fue de 3,708 (1,6-8,3), IC 95%. Se identificaron como factores de riesgo para las caídas: hiponatremia y déficits sensoriales en extremidades. Conclusiones: Dado que la hiponatremia puede considerarse un factor de riesgo de caídas, sería importante valorar la inclusión de la determinación de sodio sérico dentro de las estrategias de prevención de caídas en ancianos (AU)

Background and aim: Hyponatraemia is the most common electrolyte disorder. Some studies have found that it increases morbidity and mortality. There are new lines of research that are investigating the link between hyponatraemia and patient falls. Aim: To determine if hyponatraemia is associated with falls in elderly hospitalised patients. Methods: Design observational, analytical, case-control study. Study population: Patients older than 65 years who had fallen during their hospitalisation at Gregorio Marañón Hospital (Madrid) were considered cases. Patients who did not fall were considered to be controls, paired according to the following variables: hospital ward, age, length of hospital stay, gender and Downton fall risk index. The sample size was 206 subjects. Data collection: Socio-demographic factors, variables included in the falls record sheet, Downton fall risk index and sodium levels were studied (hyponatraemia was considered Na+< 135mmol/l). Analysis: A descriptive analysis was performed to determine the sample homogeneity. The OR was calculated, and an analytical analysis using Chi-square test and a multivariate logistic regression analysis were also performed. Results: Of 103 cases recruited, 61 were men (50.4%) and 42 were women (49.4%). Hyponatraemia was detected in 29 cases with an association with falls of P: 0.002. The adjusted OR was 3.708 (1.6-8.3), 95% CI. Risk factors for falls were identified as hyponatraemia and limb sensory deficits. Conclusions: Given that hyponatraemia could be considered a risk factor for falls, the inclusion of the determination of sodium level would be important for fall prevention strategies in the elderly (AU)

Prevalence of hyponatraemia in patients over the age of 65 who have an in-hospital fall. / Prevalencia de hiponatremia en pacientes mayores de 65 años que sufren una caída intrahospitalaria.

BACKGROUND AND AIM: Hyponatraemia is the most common electrolyte disorder. Some studies have found that it increases morbidity and mortality. There are new lines of research that are investigating the link between hyponatraemia and patient falls. AIM: To determine if hyponatraemia is associated with falls in elderly hospitalised patients. METHODS: Design observational, analytical, case-control study. STUDY POPULATION: Patients older than 65 years who had fallen during their hospitalisation at Gregorio Marañón Hospital (Madrid) were considered cases. Patients who did not fall were considered to be controls, paired according to the following variables: hospital ward, age, length of hospital stay, gender and Downton fall risk index. The sample size was 206 subjects. DATA COLLECTION: Socio-demographic factors, variables included in the falls record sheet, Downton fall risk index and sodium levels were studied (hyponatraemia was considered Na(+)< 135mmol/l). ANALYSIS: A descriptive analysis was performed to determine the sample homogeneity. The OR was calculated, and an analytical analysis using Chi-square test and a multivariate logistic regression analysis were also performed. RESULTS: Of 103 cases recruited, 61 were men (50.4%) and 42 were women (49.4%). Hyponatraemia was detected in 29 cases with an association with falls of P: 0.002. The adjusted OR was 3.708 (1.6-8.3), 95% CI. Risk factors for falls were identified as hyponatraemia and limb sensory deficits. CONCLUSIONS: Given that hyponatraemia could be considered a risk factor for falls, the inclusion of the determination of sodium level would be important for fall prevention strategies in the elderly.

[EVALUATION OF THE EFFICIENCY OF CLEANING THE AIR BETWEEN TWO METHODS OF MAKING IN PATIENTS WITH AEROSOL CHRONIC OBSTRUCTIVE PULMONARY DISEASE]. / Evaluación de la eficacia en la limpieza de la vía aérea entre dos métodos de toma de aerosolterapia en pacientes con enfermedad pulmonar obstructiva croníca.

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) is a condition which requires, among others, the administration of bronchodilators and anti-inflammatory drugs to control the disease. They help to keep the airways clear and prevent the buildup of fluid and mucus. Inhalation is the most widely used form of administrating the medication because of its local and rapid action which normally is done by aerosol therapy. The objective of this study is to evaluate the effectiveness of two aerosol methods in clearing the airways of COPD patients, admitted with an exacerbation due to their disease. It also aims to evaluate its effects on the length of stay, oxygen saturation, dyspnea, autonomy and complications. METHODS: Randomized clinical trial. Traditional method (control group) and positive expiratory vibrating device (intervention group): two ways to deliver aerosol were compared. The following outcome variables were considered: length of stay, days of fever, oxygen saturation, need for NIV or VM, the basic activities of daily living index autonomy (Barthel), dyspnea (Borg scale) and peak-flow. RESULTS: 39 patients were included. Regarding hospital stay, patients in the intervention group spend an average of one day less in hospital. Also in this group there were fewer readmissions. No statistically significant differences were found in the remaining variables. CONCLUSIONS: The inhalation treatment with a vibrating device with positive exhalation, appears to reduce the length of stay and prevent readmissions. It is important to continue research on non-pharmacological interventions as to achieve the prevention of relapses.

Barreras y dificultades percibidas para el manejo desituaciones violentas: diseño y validación de un cuestionario / Barriers and difficulties perceived for the management of violent situations: design and validation of a questionnaire

OBJETIVO: evaluar las barreras y/o dificultades que perciben los profesionales de Enfermería del Hospital psiquiátrico Dr. Rodríguez Lafora (Madrid) en el manejo de situaciones violentas, para lo que previamente se diseñó y validó un cuestionario. MÉTODO: el estudio se llevó a cabo en dos fases. En la primera se realizó un panel de expertos para la posterior elaboración y validación de un cuestionario de 22 ítems sobre la percepción de barreras y/o dificultades para el manejo de situaciones violentas. Para la validación de constructo se hizo un análisis factorial exploratorio. En la segunda se hizo un estudio descriptivo transversal mediante la administración del cuestionario al equipo de Enfermería del mencionado hospital (n= 308). Se llevó a cabo un análisis bivariante (t de Student y ANOVA). RESULTADOS: se recogieron 179 cuestionarios. El coeficiente a de Cronbach fue de 0,925. El análisis factorial exploratorio realizado arrojó cinco dimensiones que explicaban el 67,01% de la varianza. El cuestionario validado se compuso de 21 ítems, que obtuvieron altas puntuaciones (entre 6,60 y 8,33), siendo aquellos relacionados con el trabajo en equipo y con las características individuales del profesional los que puntuaciones más altas obtuvieron. CONCLUSIONES: tras el diseño y validación de un cuestionario sobre barreras y/o dificultades percibidas para el manejo de situaciones violentas, se identificaron como principales dificultades en el manejo: el trabajo en equipo, la formación, los cambios habituales de personal en las unidades o la especificidad de manejo según el paciente. Es preciso continuar el proceso de validación de la herramienta

OBJECTIVE: to assess the barriers and/or difficulties perceived by the Nursing staff in the Psychiatric Hospital Dr. Rodríguez Lafora regarding the management of violent situations, through a questionnaire previously designed and validated to this aim. METHOD: the study was conducted in two phases. During the first stage, a board of experts was held for the subsequent preparation and validation of a 22-item questionnaire about the perception of barriers and/or difficulties in the management of violent situations. For construct validation, an exploratory factor analysis was conducted. In the second stage, a transversal descriptive study was conducted, through the administration of the questionnaire to the Nursing team in the above-mentioned hospital (n= 308). A bivariate analysis(Student's t and ANOVA) was conducted. RESULTS: 179 questionnaires were collected. Cronbach's a Coefficient was 0.925. The exploratory factor analysis conducted showed five dimensions which explained the 67.01%variance. The validated questionnaire included 21 items, which obtained high scores (between 6.60 and 8.33), with the highest scores obtained in those items associated with team work and individual characteristics of the professionals. CONCLUSIONS: after the design and validation of a questionnaire about perceived barriers and/or difficulties in the management of violent situations, the following were identified as the main difficulties in management: team work, training, regular changes of staff in the units, or the specificity of management according to each patient. It is necessary to continue the process of tool validation

Evaluación de la eficacia en la limpieza de la vía aérea entre dos métodos de toma de aerosolterapia en pacientes con enfermedad pulmonar obstructiva crónica / Evaluation of the efficiency of cleaning the air between two methods of making in patients with aerosol chronic obstructive pulmonary disease

Introducción. La enfermedad pulmonar obstructiva crónica (EPOC) es un trastorno que requiere la administración de medicación broncodilatadora y antiinflamatoria, entre otras, como uno de los cuidados de la enfermedad. Ayudan a mantener la limpieza de la vía aérea y a evitar recaídas por el acúmulo de secreciones. La vía inhalatoria, por su acción local y rápida, es la más usada para la aplicación de estos fármacos, que habitualmente se realiza en forma de aerosolterapia. El objetivo de este estudio es evaluar la eficacia en la limpieza de la vía aérea entre dos métodos de administración de aerosolterapia en pacientes con EPOC ingresados por una exacerbación de su enfermedad. También se pretende evaluar su efecto sobre los días de estancia, saturación de oxígeno, grado de disnea, autonomía y complicaciones. Método. Ensayo clínico aleatorizado. Se compararon dos formas de administrar aerosolterapia: método tradicional (grupo control) y dispositivo vibratorio con espiración positiva (grupo intervención). Se consideraron las siguientes variables resultado: días de estancia, días con fiebre, saturación de oxígeno, necesidad de VMNI o VM, las actividades básicas de la vida diaria, grado de autonomía (Barthel), grado de disnea (Escala de Borg) y pico flujo. Resultados. Se incluyeron 39 pacientes. En cuanto a los días de ingreso, los pacientes del grupo intervención presentaban de media un día menos de ingreso. También en este grupo hubo menos reingresos. No se encontraron diferencias estadísticamente significativas en el resto de las variables. Conclusiones. El tratamiento inhalatorio con un dispositivo vibratorio con espiración positiva parece reducir los días de estancia y prevenir los reingresos. Es importante seguir investigando sobre intervenciones no farmacológicas que consigan prevenir sus recaídas (AU)

Introduction. Chronic Obstructive Pulmonary Disease (COPD) is a condition which requires, among others, the administration of bronchodilators and anti-inflammatory drugs to control the disease. They help to keep the airways clear and prevent the buildup of fluid and mucus. Inhalation is the most widely used form of administrating the medication because of its local and rapid action which normally is done by aerosol therapy. The objective of this study is to evaluate the effectiveness of two aerosol methods in clearing the airways of COPD patients, admitted with an exacerbation due to their disease. It also aims to evaluate its effects on the length of stay, oxygen saturation, dyspnea, autonomy and complications. Methods. Randomized clinical trial. Traditional method (control group) and positive expiratory vibrating device (intervention group): two ways to deliver aerosol were compared. The following outcome variables were considered: length of stay, days of fever, oxygen saturation, need for NIV or VM, the basic activities of daily living index autonomy (Barthel), dyspnea (Borg scale) and peak-flow. Results. 39 patients were included. Regarding hospital stay, patients in the intervention group spend an average of one day less in hospital. Also in this group there were fewer readmissions. No statistically significant differences were found in the remaining variables. Conclusions. The inhalation treatment with a vibrating device with positive exhalation, appears to reduce the length of stay and prevent readmissions. It is important to continue research on non-pharmacological interventions as to achieve the prevention of relapses (AU)

Propuesta de gestión de los recursos humanos enfermeros en el ámbito de un hospital universitario de tercer nivel / Proposal for management of nursing human resources in the setting of a third level university hospital

El cuidado que desarrollan los profesionales de Enfermería tiene que llevarse a cabo en un entorno y con un liderazgo facilitador, para que todas las situaciones estresantes que se generan en torno a estos cuidadores profesionales no repercutan en su salud física y psíquica. La gestión de Enfermería debe estar orientada para y por los profesionales porque estos son los últimos responsables de la administración de cuidados de calidad a los ciudadanos. Los gestores deben asegurar la salud en los puestos de trabajo y un desarrollo profesional continuo y adecuado. El propósito de este artículo es presentar una propuesta de ges-tión, en el ámbito hospitalario, que conlleva el desarrollo de dos departamentos: un departamento para el desarrollo profesional de Enfermería, que incluye la formación y la investigación, y otro de recursos humanos de Enfermería. Conseguir que la gestión del equipo enfermero cuide a estos profesionales es asegurar que los ciudadanos van a recibir los mejo-res cuidados por enfermeros formados y motivados

Professional care by Nursing professionals must be conducted within an enabling setting and leadership, so that all stressful situations generated for these professional careers won’t have an impact on their physical and psychological health. Nursing management must be directed to and by professionals, because these will be ultimately responsible for administering quality care to citizens. Managers must ensure health in working places, and a continuous and adequate professional development. The purpose of this article is to develop a management proposal within the hospital setting, which entails the development of two units: one unit for the professional development of Nursing, which includes training and research, and another unit of Nursing human resources. If we achieve that these professionals are looked after by nursing team management, we will be ensuring that citizens will receive the best care by trained and motivated professionals