Implementation of Nurse Prescriptions throughout the Public Health System in Catalonia (2021-2022).

BACKGROUND: Nurses in Catalonia have always prescribed health advice, health products, and medication in line with the professional competency of the discipline. Legislation about nurse prescriptions and the implementation of nurse prescribing varies widely among different countries. This article reports data regarding nurse prescribing in Catalonia in 2021 and 2022. METHODS: This retrospective longitudinal study analyzed data from all care-providing units in Catalonia's integrated public health system. RESULTS: The number of nurse prescriptions increased from 139,435 in 2021 to 573,822 in 2022, and the number of nurses issuing prescriptions increased from 3604 in 2021 to 5563 in 2022. The proportion of prescriptions for different products was similar in the two years analyzed. Prescriptions for medication increased by 7.5% in 2022. CONCLUSIONS: Nurse prescribing is a recent advance in Catalonia. Despite some difficulties in rollout, the data indicate that this practice is becoming consolidated, as in other European countries.

Actitudes y percepciones de las enfermeras hacia la conducta suicida: Revisión sistemática de estudios cualitativos / Nurses' attitudes and perceptions towards suicidal behaviour: Systematic review of qualitative studies

Objetivo principal: Conocer las percepciones y actitudes hacia la conducta suicida por parte de las enfermeras, así como su influencia en la evaluación y abordaje de esta. Metodología: Revisión sistemática de estudios cualitativos que sigue el modelo de metasíntesis para el análisis de los resultados. Resultados: El total de artículos incluidos en el trabajo han sido trece, a través de los cuales, se han obtenido cuatro categorías temáticas que sintetizan los resultados de los estudios evaluados. Conclusiones: El trabajo aporta una visión del camino que se está recorriendo, desde una postura moralista hacia la conducta suicida, a la comprensión de la patología que se ha de evaluar, tratar y prevenir.(AU)

Main objective: To know the perceptions and attitudes towards suicidal behaviour by nurses, as well as their influence on its evaluation and approach to it. Methodology: Systematic review of qualitative studies that follows the metasynthesis model for the analysis of results. Results: The total number of articles included in this paper has been thirteen, through which, four thematic categories that summarise the results of the evaluated studies have been obtained. Conclusions: The paper provides a vision of the path that is being followed, from a moralistic stance towards suicidal behaviour, to the understanding of the pathology that has to be assessed, treated and prevented.(AU)

New Life Transition of Former Caregivers: Positive Mental Health Approach.

After the end of their time as a caregiver, former caregivers have needs and feelings that have been subject to little study to date. The aim of the study is to determine and analyse the feelings, perceptions and practices of former caregivers in the reconstruction of their daily lives. This is a qualitative study based on the Grounded Theory developed by Charmaz. The study involved 14 former caregivers who had cared for their relative for more than 2 years and who had stopped caring for them more than 2 years previously. Fourteen in-depth interviews were conducted and data were collected over 13 months between 2015 and 2017. Data were analysed using the Grounded Theory Method. In addition, this study was approved by the ethics committee of the Institut Universitari d'Investigació en Atenció Primària Jordi Gol. The former caregiver experiences a transition, which begins in the days before the death of their relative and may continue for more than 3 years. Three critical moments in the post-caring transition were found: (1) the post-caring emptiness; (2) the end of the period as a caregiver; and (3) the movement towards a new life. Family and professional support is needed during this transition. Former caregivers experience a transition in the rebuilding of their daily lives; furthermore, former caregivers may be a source of support for other caregivers, which is linked to positive mental health factors. Healthcare organisations need to acknowledge the emotional, psychosocial and psychological health of former caregivers.

Efectividad de un programa comunitario de apoyo a cuidadores de pacientes con demencia: escuela del cuidar / Effectiveness of a community support program for caregivers of patients with dementia: school of care

Objetivo: conocer las necesidades que expresan los cuidadores de pacientes con demencia en relación a aspectos formativos, de apoyo psicosocial, resolución de problemas y entrenamiento de habilidades. Diseñar, implementar y evaluar un programa comunitario de apoyo a cuidadores de pacientes con demencia que mejore su calidad de vida como cuidador y su experiencia de cuidar. Método: estudio de metodología mixta según la guía de la Medical Research Council sobre evaluación de intervenciones complejas, en tres fases. Fase 1: Modelización y operativización de la intervención (cualitativo). Fase 2: Estudio cuasi-experimental pre/post-intervención con medidas repetidas antes y después de la intervención y a los seis meses. Fase 3: Evaluación del programa de intervención (cualitativo).La población objeto de estudio son los cuidadores de pacientes no institucionalizados con diagnóstico de demencia, con grado de dependencia 1, 2 o pendientes de grado de las comarcas del Montsiá y Baix Ebre (Tarragona, España) en el ámbito de Atención Primaria, para el periodo 2020-2022. Conclusiones: realizar un estudio de metodología mixta desde la Atención Primaria y con colaboración ciudadana permitirá el diseño de una intervención adaptada la realidad de los sujetos de estudio. Su aplicación podría ser relevante ya que, si se confirman los objetivos propuestos, este estudio establecería una base para modificar el abordaje a los cuidadores y el apoyo que deben recibir, iniciándose desde el momento del diagnóstico del paciente, minimizando la sobrecarga del cuidador, mejorando su calidad de vida y su apoyo social.(AU)

Objectives: to understand the needs expressed by caregivers of patients with dementia regarding aspects of training, psychosocial support, solution of problems and training in skills. To design, implement and evaluate a community support program for caregivers of patients with dementia, which will improve their quality of life as caregivers and their caring experience. Method: a mixed methodology study according to the Medical Research Council guidelines on evaluation of complex interventions, in three stages. Stage 1: Modelling and implementation of the intervention (qualitative). Stage 2: Quasi-experimental pre-post intervention study with measurements repeated before and after the intervention and at six months. Stage 3: Evaluation of the intervention program (qualitative).The population object of the study are caregivers of non-institutionalized patients with diagnosis of dementia, with degree of dependence 1 or 2 or pending degree, in the Montsiá and Baix Ebre regions (Tarragona, Spain) in the Primary Care setting, for the 2020-2022 period. Conclusions: to conduct a mixed methodology study from Primary Care and with collaboration by citizens will allow to design an intervention adapted to the reality of the study subjects. Its application could be relevant, because if the objectives are confirmed, this study would establish the basis for modifying the way to address caregivers and the support they must receive, by being initiated since patient diagnosis, reducing caregiver overload to a minimum, and improving their quality of life and social support.(AU)

Effectiveness of the integrated care model Salut+Social in patients with chronic conditions: A mixed methods study protocol.

INTRODUCTION: Integrated care models aim to provide solutions to fragmentation of care by improving coordination. This study will evaluate the effectiveness of a new integrated care model (Salut + Social), which will promote the coordination and communication between social and healthcare services in southern Catalonia (Spain) to improve quality of life, adherence to treatment and access to medical services for patients with chronic conditions, and also to reduce caregiver burden. Additionally, we will evaluate the experience of caregivers, health professionals and social workers with the new model implemented. METHODS AND ANALYSIS: A clinical trial using mixed methodology will be carried out. The intervention consists of improving the coordination between the social and healthcare sectors during a 6-month period, by means of information and communication technology (ICT) tools that operate as an interface for the integrated care model. The study subjects are primary care patients with chronic health and social conditions that can benefit from a collaborative and coordinated approach. A sample size of 141 patients was estimated. Questionnaires that assess quality of life, treatment adherence, medical service and caregiver burden will be used at baseline and at 6, 9, and 12 months after the beginning of the study. The principal variable is quality of life. For statistical analysis, comparisons of means and proportions at different time points will be performed. A discussion group and semi-structured interviews will be conducted with the aim of improving the care model taking into account the opinions of professionals and caregivers. A thematic content analysis will be carried out. ETHICS AND DISSEMINATION: This study protocol has been approved by the Clinical Research Ethics Committee of the Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (code P17/100). Articles will be published in international, peer-reviewed scientific journals. TRIAL REGISTRATION: Clinical-Trials.gov: NCT04164160.

Reconstrucción de la vida cotidiana de los postcuidadores familiares: afrontando el duelo del cuidador / Former caregiver's daily life reconstruction: facing the grief of the caregiver

OBJETIVO PRINCIPAL: Conocer la experiencia, el impacto percibido y el manejo de la experiencia de la reconstrucción de la vida cotidiana de los postcuidadores familiares después del proceso de duelo. METODOLOGÍA: Se realizaron entrevistas en profundidad a 14 informantes que cuidaron a sus familiares durante más de 2 años y que dejaron de atenderlos más de 2 años antes. Los datos fueron recolectados durante un período de 13 meses en 2014-2015. El estudio se enmarca en la teoría fundamentada. RESULTADOS PRINCIPALES: Se obtuvieron tres categorías a partir del análisis de los relatos: el vacío en el postcuidar, el fin del tiempo como cuidador y la transición hacia una nueva vida. Todos los informantes mencionan un vacío, marcado por el aumento del tiempo libre y la pérdida de sentido de su vida. Conclusión principal: Los postcuidadores experimentan una transición en la reconstrucción de su vida cotidiana, en la que el apoyo de los profesionales es esencial. Los postcuidadores pueden ser una fuente de apoyo para otros cuidadores

OBJECTIVE: To know the experience, the perceived impact and the management of the experience of the reconstruction of the daily life of the family post-caregivers after the grieving process. METHODS: In-depth interviews of 14 former caregivers who had cared for their relative for more than 2 years and who had stopped caring for them more than 2 years previously. Data were collected over 13 months in 2014-2015. The data analysis was performed using Grounded Theory. RESULTS: Three categories were obtained from the data analysis: The emptiness in post-caring, the end of the time as a caregiver and the transition towards a new life. All the informants mention an emptiness but a new determining factor, the increase in free time, also emerges in the study. Within this increase in their free time, caregivers feel the need to occupy their time by becoming involved in caring for others. CONCLUSIONS: Former caregivers experience a transition in the reconstruction of their everyday life, in which support from professionals is essential. Former caregivers may be a source of support for other caregivers

Exploring family members' experiences during a death process in the emergency department: A grounded theory study.

AIMS AND OBJECTIVES: To identify which are the needs arised from feelings, perceptions and experiences of the family members during any time within the death process in an emergency service of an acute care hospital, with regard to the assistance received. BACKGROUND: The publications refer to the needs expressed by bereaved families, who explain the support they received right after the death of a relative in an emergency service, and during the months after the tragedy. DESIGN: Qualitative study drawing on grounded theory based on Charmaz (2006). METHODS: Ten interviews were conducted to a member of each family, who had been in an emergency service with a relative during any of the stages of the dying process. Data were collected from September 2015-June 2016. The analysis was made while data were being collected. Three types of codification were carried out: open, axial and selective. Theoretical saturation was achieved after data collection and analysis. RESULTS: Three thematic categories emerged: the power of information/communication (a), decisions taken by professionals within the dimension of caring (b) and the humanisation of death in emergency services (c). CONCLUSIONS: The quality of the information given to families in the process of death in an emergency service affects to their satisfaction. Family support must be essential in a situation of death. Institutions must guarantee standards of practice, which include orientation on the care of people in bereavement, and the commitment to provide specialised attention those families. RELEVANCE TO CLINICAL PRACTICE: Research findings reveal the need to create changes within clinical practice, regarding how to take care of the family involved in a death process in an emergency service. From the needs detected by the participants, it could be possible to implement an interventional programme, which offers the relatives the emotional support they may need.

[Competence of triage nurses in hospital emergency departments]. / Perfil competencial en los profesionales de triaje de los servicios de urgencias hospitalarios.

OBJECTIVES: To identify associations between sociodemographic characteristics variables and competence levels of triage nurses in hospital emergency departments. MATERIAL AND METHODS: Descriptive, cross-sectional, multicenter study of triage nurses in hospital emergency departments in the southwestern area of Catalonia (Ebre River territory). We used an instrument for evaluating competencies (the COM_VA questionnaire) and recording sociodemographic variables (age, sex, total work experience, emergency department experience, training in critical patient care and triage) and perceived confidence when performing triage. We then analyzed the association between these variables and competency scores. RESULTS: Competency scores on the COM_VA questionnaire were significantly higher in nurses with training in critical patient care (P=.001) and triage (P=0.002) and in those with longer emergency department experience (P<.0001). Perceived confidence when performing triage increased with competency score (P<.0001) and training in critical patient care (P<.0001) and triage (P=.045). CONCLUSION: The competence of triage nurses and their perception of confidence when performing triage increases with emergency department experience and training.

OBJETIVO: Identificar la relación entre las variables sociodemográficas estudiadas y el nivel competencial de los enfermeros que realizan triaje en los servicios de urgencias hospitalarios (SUH). METODO: Estudio descriptivo, transversal, multicéntrico realizado a enfermeros que realizan triaje en los SUH de Terres de l'Ebre. Se analiza la relación entre variables del cuestionario evaluativo de competencias COM_VA©, sociodemográficas (edad, sexo, experiencia laboral total y en SUH, formación en paciente crítico y en triaje, seguridad percibida en la realización del triaje) y habilidades profesionales. RESULTADOS: El nivel competencial (COM_VA©) es mayor en enfermeros con formación en paciente crítico (p = 0,001) y triaje (p = 0,002) y con experiencia en el SUH (p < 0,0001). La seguridad percibida al realizar triaje aumenta con el nivel competencial (p < 0,0001) y con la formación en paciente crítico (p < 0,0001) y triaje (p = 0,045). CONCLUSIONES: La formación y experiencia en el SUH aumentan las competencias del enfermero de triaje y la seguridad percibida al realizarlo.

Perfil competencial en los profesionales de triaje de los servicios de urgencias hospitalarios / Competence of triage nurses in hospital emergency departments

Objetivo. Identificar la relación entre las variables sociodemográficas estudiadas y el nivel competencial de los enfermeros que realizan triaje en los servicios de urgencias hospitalarios (SUH). Método. Estudio descriptivo, transversal, multicéntrico realizado a enfermeros que realizan triaje en los SUH de Terres de l’Ebre. Se analiza la relación entre variables del cuestionario evaluativo de competencias COM_VA©, sociodemográficas (edad, sexo, experiencia laboral total y en SUH, formación en paciente crítico y en triaje, seguridad percibida en la realización del triaje) y habilidades profesionales. Resultados. El nivel competencial (COM_VA©) es mayor en enfermeros con formación en paciente crítico (p = 0,001) y triaje (p = 0,002) y con experiencia en el SUH (p < 0,0001). La seguridad percibida al realizar triaje aumenta con el nivel competencial (p < 0,0001) y con la formación en paciente crítico (p < 0,0001) y triaje (p = 0,045). Conclusiones. La formación y experiencia en el SUH aumentan las competencias del enfermero de triaje y la seguridad percibida al realizarlo (AU)

Objective. To identify associations between sociodemographic characteristics variables and competence levels of triage nurses in hospital emergency departments. Methods. Descriptive, cross-sectional, multicenter study of triage nurses in hospital emergency departments in the southwestern area of Catalonia (Ebre River territory). We used an instrument for evaluating competencies (the COM_VA questionnaire) and recording sociodemographic variables (age, sex, total work experience, emergency department experience, training in critical patient care and triage) and perceived confidence when performing triage. We then analyzed the association between these variables and competency scores. Results. Competency scores on the COM_VA questionnaire were significantly higher in nurses with training in critical patient care (P=.001) and triage (P=0.002) and in those with longer emergency department experience (P<.0001). Perceived confidence when performing triage increased with competency score (P<.0001) and training in critical patient care (P<.0001) and triage (P=.045). Conclusion. The competence of triage nurses and their perception of confidence when performing triage increases with emergency department experience and training (AU)

El proceso de cuidar a la familia en urgencias. Una aproximación desde la teoría fundamentada / The process of family care in the emergency unit: an approach from grounded theory

OBJETIVOS: analizar la percepción que tienen los profesionales enfermeros respecto al acompañamiento familiar en un servicio de urgencias, así como identificar los cuidados que proporcionan a las familias que viven situaciones de final de vida. MÉTODO: se utilizó la teoría fundamentada (Grounded Theory) como método de investigación cualitativa. La población de estudio fueron enfermeras y enfermeros que trabajaban en urgencias generales de adultos. El número de participantes se determinó mediante muestreo teórico paralelo al transcurso de las entrevistas y análisis. Los instrumentos de recogida de información fueron el cuestionario de variables sociodemográficas y las entrevistas en profundidad semiestructuradas. La recogida de datos finalizó cuando hubo redundancia de información y las categorías se saturaron teóricamente. Dichos datos fueron tratados teniendo en cuenta la Ley Orgánica 15/1999, de 13 de diciembre, de protección de datos de carácter personal. Para buscar, seleccionar y organizar los datos, se utilizó el programa Weft-QDA. RESULTADOS: la experiencia del profesional mejora el cuidado a la familia, aunque la presión asistencial repercute negativamente en poder satisfacer sus necesidades. La información es un elemento terapéutico que favorece la comunicación entre la familia y el profesional. El vínculo establecido entre familia y profesional durante el proceso de morir fomenta un cuidado más humanizado. CONCLUSIÓN: las enfermeras/os quieren incluir a la familia en sus competencias asistenciales, abordándola holísticamente dentro del contexto del cuidado humanizado. Todavía quedan aspectos de la atención que son mejorables, como la calidad de información, los cambios organizativos y estructurales del servicio y el abordaje familiar en situaciones trágicas, inesperadas y traumáticas

OBJECTIVES: to analyze the perception by nursing professionals of family accompaniment in an Emergency Unit, as well as to analyze the care provided to families facing end-of-life situations. METHOD: grounded Theory was used as a method for qualitative research. The study population consisted of male and female nurses working in the General Emergency Unit for adults. The number of participants was determined through theoretical sampling parallel to the course of interviews and analysis. The tools for data collection were the questionnaire of sociodemographical variables, and in-depth semi-structured interviews. Data collection ended when there was redundant information, and categories were theoretically saturated. Said data were treated according to Organic Law 15/1999 of December, 13th, on Personal Data Protection. The Weft-QDA program was used for data search, selection and organization. RESULTS: the experience of the professional will improve the care for the family, though high workload has a negative impact on the ability to meet their needs. Information is a therapeutic element that will encourage communication between the family and the professional. The link established between family and professional during the death process will favour a more human care. CONCLUSION: nurses want to include the family within their care responsibilities, with a holistic approach in the context of humanized care. There is still room for improvement in some aspects of care, such as the quality of information, organization and structural changes in the unit, and the approach to relatives in tragic, unexpected and traumatic situations

Apoyo tecnológico a los cuidadores no profesionales de personas con enfermedades crónicas / Technological support for non-professional caregivers for patients with chronic conditions

OBJETIVO: identificar el uso y las potencialidades de las Tecnologías de la Información y de la Comunicación (TIC) en los cuidadores no profesionales de personas con enfermedades crónicas. MÉTODO: se realizó una revisión bibliográfica de la literatura publicada entre 2008 y 2014 en las bases de datos Scopus, Cuiden,I Cercador Plus, Teseo, Pubmed, Cinahl, Proquest Health & Medical Complete y el buscador Google Academic, sobre el uso de las tecnologías en personas cuidadoras. RESULTADOS: se seleccionaron 13 artículos. El análisis de los artículos ha identificado que las TIC: ayudan a los cuidadores no profesionales a adquirir conocimientos y habilidades, son un medio de comunicación que ofrece un estímulo social y cognitivo útil y disminuye la sobrecarga del cuidador, así como la ansiedad, el estrés y los conflictos familiares y/o conyugales. Aunque hay diferentes servicios de apoyo presenciales, los cuidadores los subutilizan por falta de tiempo, derivado de cuidar a la persona enferma, y por limitaciones geográficas, dificultades de transporte y/o problemas de salud. CONCLUSIONES: las TIC pueden contribuir a una mejora de calidad de vida de los cuidadores y pueden configurar un nuevo modelo de atención. Es imprescindible diseñar programas de intervención utilizando estas tecnologías. En España son escasas las publicación es sobre el tema, especialmente si se habla de estudios que traten de la eficacia del uso de las tecnologías como soporte a las cuidadoras

OBJECTIVE: to identify the use and potentialities of Information and Communication Technologies (ITC) in non-professional caregivers for persons with chronic conditions. METHOD: a bibliographic review was conducted on the literature published between 2008 and 2014 in the following databases: Scopus, Cuiden, I cercador plus, Teseo, Pubmed, Cinahl, Proquest Health and Medical Complete, and in the Google Academic search engine, about the use of technologies in caregivers. RESULTS: thirteen (13) articles were selected. The analysis of these articles has identified that: ITCs help non-professional caregivers to acquire knowledge and abilities, they are a means of communication that offers a useful social and cognitive stimulus, and also reduces the overload of caregivers, as well as their anxiety, stress, and conflicts within their family and/or marriage. Even though there are different personal support services available, caregivers will under-use them due to lack of time caused by looking after the patient, and also due to geographical limitations, difficulties to travel, and/or health problems. CONCLUSIONS: ITCs can contribute to an improvement in the quality of life of caregivers, and can become a new model of care. It is essential to design intervention programs using these technologies. There are few publications on this matter in Spain, particularly in terms of studies dealing with the efficacy of using technologies as a support for caregivers

Analysis of the transition process among family caregivers in a hospital in the region of Catalonia in Spain.

PURPOSE: The aim of this study is to explore and understand the experience of the adaptation process among family caregivers in hospitals, who have an active presence in hospital and are essential in ensuring proper patient care. METHODS: A qualitative phenomenological approach was used to gain a deeper understanding of caregivers' lived experiences. Data were collected using in-depth interviews to explore six caregivers' experiences of hospitalization. RESULTS: The caregivers' accounts highlight the different determining factors in the transition process of a chronically ill patient's family caregiver during the patient's time in hospital. The most important themes emerging from the analysis were the importance of cultural beliefs and attitudes, meaning of the situation, caregiver's training and knowledge, socio-economic status and the hospital as a community. These categories can be analyzed using transitions theory. CONCLUSIONS: The most important conclusion is that the hospital in this study was not designed to accommodate caregivers, and the mechanisms used to meet caregivers' needs endanger their privacy, health, and coexistence in the hospital's rooms. Transitions theory provides a holistic understanding of the experience of the family caregiver.