Percepción del equipo de enfermería sobre sí mismo ante el cuidado espiritual / Nursing team's perception of themselves before spiritual care

Objetivo: Comprender la percepción de los integrantes del equipo de enfermería (EE) sobre sí mismos ante el cuidado espiritual ofrecido en el Hospital Universitari Germans Trias i Pujol, centro público con 638 camas, de Badalona. Antecedentes: El cuidado espiritual se ha considerado necesario para la provisión de cuidados holísticos, a fin de evitar la angustia espiritual y favorecer el afrontamiento de la enfermedad. Diseño: Estudio fenomenológico hermenéutico. Método: Se incluyó un total de 31 informantes: 16 profesionales del EE -8 enfermeras y 8 auxiliares de enfermería- de un servicio de Hospitalización General y 10 de la Unidad de Onco-Hematología. Tras un muestreo teórico, se realizaron entrevistas en profundidad y un grupo focal de cinco enfermeros de áreas diferentes a la de Hospitalización General. Resultados:La percepción ante el cuidado espiritual del EE se observa a nivel de sensación y a nivel de la propia capacitación para resolver la demanda de cuidado espiritual. Ambos niveles están mediatizados por el tipo de demanda, por el tiempo de relación terapéutica y el grado de confianza establecido entre el profesional y la persona atendida y por la sobrecarga laboral en relación con el tiempo de jornada. En dicho escenario, el profesional puede autopercibirse con temor o gratitud, y sentirse o no preparado para resolverla. Conclusiones: Para ofrecer cuidados espirituales efectivos, los profesionales del EE deben sentirse capacitados a nivel formativo y a nivel personal previo. Aplicabilidad para la práctica clínica: Los profesionales del EE deben estar preparados para proporcionar atención espiritual en el ámbito hospitalario, puesto que las competencias de enfermería están relacionadas con el cuidado espiritual, sin el cual el cuidado de la persona deja de ser holístico

Aim: To understand nursing team staff (NT) spiritual coping experience regarding the spiritual care at the Hospital Universitari Germans Trias i Pujol, a public health centre with 638 beds, located in Badalona. Background: Spiritual care has been considered necessary for the provision of holistic care, avoiding spiritual distress and coping with illness. Design: A phenomenological hermeneutic approach. Method: The total sample was 31 informants, included 16 NT -8 graduates and 8 assistants- from a general hospitalization service and 10 staff from the Onco-Hematology unit. After theoretical sampling, the data consisted of in-depth interviews and a focal group with five nurses from different units but general hospitalization. Results: The perception of spiritual care of NT occurs at the level of sensation and at the level of the training itself to resolve the demand for spiritual care. Both mediated by the type of demand; the time of therapeutic relationship and degree of trust established between professional and person served; and the work overload in relation to the time of day. In this scenario, the professional can self-perceive with fear or gratitude, feeling prepared to solve it or not prepared. Conclusions: NT Professionals should feel prepared -at a formative level, at their own previous level, and at the level of training- to offer an effective spiritual care. RELEVANCE TO CLINICAL PRACTICE. NTs should be prepared to provide spiritual care within the hospital environment as nursing competencies related to spiritual care

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.

Impact of a quality improvement intervention on nurses' management of same-day primary care flow.

AIM: To evaluate the impact of an interdisciplinary intervention designed to improve the capacity of nurses to manage walk-in patient demand for primary health care. BACKGROUND: Implementation of a programme to expand nursing practice is a complex process that requires the application of context-appropriate measures and adaptation when results do not meet expectations. METHODS: A longitudinal, uncontrolled intervention study with a 3-year follow-up, from 2009 to 2012, was carried out in Catalonia (northeast Spain). The intervention included three training periods focused on clinical and instrumentation topics. The capacity of nurses to manage walk-in patient demand was assessed by determining the number of cases resolved and of return visits for the same complaint within 72 hours. RESULTS: In total, 2751 patient care demands were evaluated. Resolved cases increased (χ(2)  = 54.624, df = 1, P < 0.001) and the number of return visits decreased (χ(2)  = 54.585, df = 1, P < 0.001) significantly from baseline to the end of the study period. CONCLUSIONS: Nurses' capacity to manage walk-in patient demand improved after an interdisciplinary intervention using a mutually agreed upon, locally adapted approach. IMPLICATIONS FOR NURSING MANAGEMENT: To improve outcomes, nurses in management positions should systematically consider the need for skills training, specific academic courses, leadership development and, as appropriate, legislative initiatives.

[Implementation of an integrated nursing liaison model: a descriptive study]. / Implementación de un modelo integrado de enfermería de enlace: un estudio descriptivo.

AIMS: To evaluate the implementation of a liaison nursing model that integrates primary care and hospital functions and to analyze the role of this model in situations of dependency. METHOD: We performed an analytical-observational study of demand for liaison in continuity of care during the first year after implementation of the model. Patients were classified into six categories. The degree dependency was established by means of the Barthel index and Virginia Henderson's needs. RESULTS: A total of 515 cases of liaison were observed (women: 57.3%, age: 69.32 +/- 18.25). Origin: hospital (78.1%), primary care (21.9%); destination: hospital (6.8%), primary care (82.1%), other (11.1%). Most frequent patient profile: continuity of cures/techniques. Main altered needs: hygiene/skin (65.8%), movement (55.5%), dressing (47.4%) and elimination (26.2%). Degree of dependency: no dependency (15.2%), slight dependency (62.7%), moderate dependency (3.4%), high dependency (18%). The degree of dependency was lower in hospital demand than in primary care demand (p<0.001). Other services involved: social work (21.7%), Functional Interdisciplinary Social-Health Unit (10.3%), Administration (5%), Domiciliary Care Support Team Program (4.7%), Residential Physio-Rehabilitation Team (3.9%). ProdeP project (people over 65): 37.5% showed dependency (low dependency [14.5%], moderate [33%], high or complete dependency [52.5%]). CONCLUSIONS: TThe highest flow was from the hospital setting to primary care, with a lower degree of dependency but greater urgency in the provision of continuity of care. We observed a high percentage of dependency. The liaison nursing model facilitates provision of coordinated and comprehensive care, with a high component of situations of dependency.

Implementación de un modelo integrado de enfermería de enlace: un estudio descriptivo / Implementation of an integrated nursing liaison model: a descriptive study

Objetivos. Evaluar la implementación de un modelo de enfermería de enlace que integra funciones en atención primaria y hospitalaria, y analizar su relación con situaciones de dependencia. Método. Estudio analítico-observacional de la demanda de enlace de continuidad asistencial durante el primer año de funcionamiento. Se tipificaron 6 categorías de pacientes. El grado de dependencia se estableció mediante el índice de Barthel y las necesidades según V. Henderson. Resultados. Hubo 515 casos de enlace (mujeres: 57,3%; edad: 69,32 ± 18,25 años). Origen: hospital (78,1%), atención primaria (21,9%); destino: hospital (6,8%), atención primaria (82,1%), otros (11,1%). Tipología más frecuente: continuidad de curas/técnicas. Principales necesidades alteradas: higiene/piel (65,8%), movimiento (55,5%), vestir (47,4%), eliminación (26,2%). Grado de dependencia: sin dependencia: 15,2%; ligera: 62,7%; moderada: 3,4%; severa/total: 18%. La demanda de origen hospitalario presentó menor grado de dependencia que la atención primaria (p < 0,001). Otros servicios involucrados: trabajadora social, 21,7%; unidad funcional interdisciplinaria sociosanitaria, 10,3%; administración, 5%; programa de atención domiciliaria equipo de soporte, 4,7%; fisiorrehabilitación domiciliaria, 3,9%. Proyecto demostrativo (mayores de 65 años): el 37,5% presentó dependencia (baja: 14,5%; moderada: 33%; severa/total: 52,5%). Conclusiones. El mayor flujo fue desde hospital hacia atención primaria, con menor grado de dependencia pero mayor urgencia en la prestación de continuidad asistencial. Se observaron elevados porcentajes de dependencia. El modelo ha facilitado una asistencia coordinada e integral, con un elevado componente de situaciones de dependencia

Aims. To evaluate the implementation of a liaison nursing model that integrates primary care and hospital functions and to analyze the role of this model in situations of dependency. Method. We performed an analytical-observational study of demand for liaison in continuity of care during the first year after implementation of the model. Patients were classified into six categories. The degree dependency was established by means of the Barthel index and Virginia Henderson’s needs. Results. A total of 515 cases of liaison were observed (women: 57.3%, age: 69.32 ± 18.25). Origin: hospital (78.1%), primary care (21.9%); destination: hospital (6.8%), primary care (82.1%), other (11.1%). Most frequent patient profile: continuity ofcures/techniques. Main altered needs: hygiene/skin (65.8%), movement (55.5%), dressing (47.4%) and elimination (26.2%). Degree of dependency: no dependency (15.2%), slight dependency (62.7%), moderate dependency (3.4%), high dependency(18%). The degree of dependency was lower in hospital demand than in primary care demand (p<0.001). Other services involved: social work (21.7%), Functional Interdisciplinary Social-Health Unit (10.3%), Administration (5%), Domiciliary Care Support Team Program (4.7%), Residential Physio-Rehabilitation Team (3.9%). ProdeP project (people over 65): 37.5% showed dependency (low dependency [14.5%], moderate [33%], high or complete dependency [52.5%]). Conclusions. TThe highest flow was from the hospital setting to primary care, with a lower degree of dependency but greater urgency in the provision of continuity of care. We observed a high percentage of dependency. The liaison nursing model facilitates provision of coordinated and comprehensive care, with a high component of situations of dependency