Effectiveness of a home-based nursing support and cognitive restructuring intervention on the quality of life of family caregivers in primary care: A pragmatic cluster-randomized controlled trial.

BACKGROUND: Caregivers of patients with chronic conditions or disability experience fatigue, burden and poor health-related quality of life. There is evidence of the effectiveness of support interventions for decreasing this impact. However, little is known about the benefits of home-based nursing intervention in primary health care. OBJECTIVES: To evaluate the effectiveness of a home-based, nurse-led-intervention (CuidaCare) on the quality of life of caregivers of individuals with disabilities or chronic conditions living in the community, measured at 12-month follow-up. METHODS: A pragmatic, two-arm, cluster-randomized controlled trial with a 1-year follow-up period was performed between June 2013 and December 2015. Consecutive caregivers aged 65 years or older, all of whom assumed the primary responsibility of caring for people with disabling conditions for at least 6 months a year, were recruited from 22 primary health care centers. Subsequently, 11 centers were randomly assigned to usual care group, and 11 were assigned to the intervention group. The caregivers in the intervention group received the usual care and additional support (cognitive restructuring, health education and emotional support). The primary outcome was quality of life, assessed with the EQ-5D instrument (visual analog scale and utility index score); the secondary outcome variables were perception of burden, anxiety, and depression. Data were collected at baseline, at the end of the intervention, and at the 6- and 12-month follow-up visits. We analyzed the primary outcome as intention-to-treat, and missing data were added using the conditional mean single imputation method. RESULTS: A total of 224 caregivers were included in the study (102 in the intervention group and 122 in the usual care group). Generalized Estimating Equation models showed that the CuidaCare intervention was associated with a 5.46 point (95% CI: 2.57; 8.35) change in the quality of life, as measured with the visual analog scale adjusted for the rest of the variables at 12 months. It also produced an increase of 0.04 point (95% CI: 0.01; 0.07) in the utilities. No statistically significant differences were found between the two groups at 12 months with respect to the secondary outcomes. CONCLUSIONS: The findings suggest that incorporating a home-based, nurse-led-intervention for caregivers into primary care can improve the health-related quality of life of caregivers of patients with chronic or disabling conditions.

Heridas en Consultas de Enfermería de Atención Primaria ¿Qué lesión genera mayor carga de trabajo? / Wounds in primary nursing care: what injuries cause an increased workload in terms of nursing time?

Introducción. El cuidado de las personas con heridas supone un aumento de la carga de trabajo en las consultas de enfermería en Atención Primaria. Objetivo. Describir las características de las lesiones de la integridad cutánea y analizar la carga laboral medida en tiempo de enfermería. Metodología. Estudio analítico multicéntrico urbano y transversal realizado en el ámbito de la Atención Primaria en los centros de salud de Castellón de la Plana, Denia, Granada, Madrid y Logroño, durante los meses de enero y febrero de 2016. Resultados. La población incluida en los 6 centros de salud participantes era de 74 277 habitantes > 15 años. Se realizaron un total de 1105 observaciones. Un 56.2 % de estas se realizaron sobre lesiones de EEII y un 43 8 % sobre heridas quirúrgicas. En el 38.5 % se realizó el procedimiento clínico de cura (PCC) en menos de 15 minutos. El resto de PCC superaron este tiempo. Discusión. La ausencia de bibliografía sobre el tema nos impide realizar comparaciones entre estudios. Pese a tener el material disponible en más de la mitad de los centros de salud a estudio, solo un 1 % de las intervenciones terapéuticas sobre úlceras venosas se realizaron con vendas multicapas en kit. Conclusiones. Son las lesiones en las EEII las que generan mayor carga de trabajo efectiva en las consultas de enfermería a demanda (AU)

Introduction. Wound care represents a significant workload in primary health care nursing consultations. Objective. To analyze the characteristics of injuries causing deterioration of cutaneous integrity, which pose an increased workload in nursing consultations in terms of nursing time. Methodology. An urban and cross multicenter analytical study in primary health care centers of Castellon de la Plana, Denia, Granada, Madrid and Logroño, between January and February 2016. Results. The 6 participating health care centers had a population assignation of 74,277 inhabitants > 15 years old. A total of 1,105 observations were performed: 56.2 % were on lower extremity wounds and 43.8 % on surgical wounds. 38.5 % of treated wounds required a clinical cure procedure that was accomplished in less than 15 minutes. The remaining clinical cure procedures exceeded the aforementioned time. Discussion. The lack of literature on the subject prevents comparisons between studies. Despite material availability in more than half of the study’s health care centers, only 1 % of therapeutic interventions on venous ulcers were performed with multilayer bandage kits. CONCLUSIONS. Lower extremity wounds generate an increased workload in nursing consultations on demand. The administration should adjust appointments to real-time needs for treatment, or assign different time slots depending on whether patients have surgical or lower extremity injuries (AU)

CuidaCare: effectiveness of a nursing intervention on the quality of life's caregiver: cluster-randomized clinical trial.

BACKGROUND: In Spain, family is the main source of care for dependent people. Numerous studies suggest that providing informal (unpaid) care during a prolonged period of time results in a morbidity-generating burden. Caregivers constitute a high-risk group that experiences elevated stress levels, which reduce their quality of life.Different strategies have been proposed to improve management of this phenomenon in order to minimize its impact, but definitive conclusions regarding their effectiveness are lacking. METHODS/DESIGN: A community clinical trial is proposed, with a 1-year follow-up period, that is multicentric, controlled, parallel, and with randomized allocation of clusters in 20 health care centers within the Community of Madrid. The study's objective is to evaluate the effectiveness of a standard care intervention in primary health care (intervention CuidaCare) to improve the quality of life of the caregivers, measured at 0, 6, and 12 months after the intervention.One hundred and forty two subjects (71 from each group) ≥65 years, identified by the nurse as the main caregivers, and who provide consent to participate in the study will be included.The main outcome variable will be perceived quality of life as measured by the Visual Analogue Scale (VAS) of EuroQol-5D (EQ-5D). The secondary outcome variables will be EQ-5D Dimensions, EQ-5D Index, nursing diagnosis, and Zarit's test. Prognostic variables will be recorded for the dependent patient and the caregiver.The principle analysis will be done by comparing the average change in EQ-5D VAS value before and after intervention between the two groups. All statistical tests will be performed as intention-to-treat. Prognostic factors' estimates will be adjusted by mixed-effects regression models. Possible confounding or effect-modifying factors will be taken into account. DISCUSSION: Assistance for the caregiver should be integrated into primary care services. In order to do so, incorporating standard, effective interventions with relevant outcome variables such as quality of life is necessary. Community care nurses are at a privileged position to develop interventions like the proposed one. TRIAL REGISTRATION: This trial has been registered in ClinicalTrials.gov under code number NCT 01478295.

[Workers in primary health care and partner violence against women]. / Profesionales de atención primaria de Madrid y violencia de pareja hacia la mujer en el año 2012.

BACKGROUND: Morbidity associated to partner violence against women (PVAW) justify these patients repeated visits to Health Services. Primary Care is the ideal place for detectión and first aid, due to its easy accesibility and continuated assistance. Nevertheless, numbers show important difficulties to achieve this goal. Our aim is to find out the level of knowledge, opinions, awareness about organizacional barriers and improvement proposals suggested by the workers of primary care. METHOD: Cross-sectional descriptive study using an anonymous and voluntary survey during the months of August and September 2010, targeted to all professionals who perform their work in a Primary Care Area of Madrid. We made a descriptive analysis of variables and used chi(2) to compare the answers. RESULTS: Answer rate is 170 (21.4%). There are stereotypes regarding battered woman and perpetrador. 118 (70.7%) professionals believe that this is a major problem and 154 (91.7%) that usually goes unnoticed. 91 (55.2%) know their legal commitments. 73 (51.8%) think that there are organizational barriers, among them: the burden of care 50(29%), lack of specific training 40(23.5), lack of knowledge about the procedure to be followed 20(11.8%) and about the professional responsabilities 12 (7%). CONCLUSIONS: All profesional categoríes showed an average level of knowledge, except for social workers that was high. Primary Care workers think that PVAW is an important issue that usually goes unnoticed. Half of them know the legal commitments o detección. There are organizacional barriers and stereotypes.

Profesionales de atención primaria de Madrid y violencia de pareja hacia la mujer en el año 2010 / Workers in primary health care and partner violence against women

Fundamentos: La morbilidad asociada a la violencia de pareja hacia la mujer (VPHM) justifica que sus víctimas acudan reiteradamente a los centros de salud. La accesibilidad y continuidad asistencial hacen de la atención primaria (AP) el lugar idóneo para su detección y primer abordaje. Sin embargo, los datos reflejan las dificultades de los/as profesionales para lograr este fin. El objetivo es analizar el nivel de conocimientos, opiniones, barreras organizativas percibidas y propuestas de mejora de los profesionales de AP. Método: Estudio transversal descriptivo realizado mediante una encuesta anónima y autoadministrada durante los meses de agosto y septiembre de 2010, dirigida a todos/as profesionales de AP del área 8 de Madrid. Se realizó un análisis descriptivo de variables y la X2 para comparar las respuestas obtenidas. Resultados: Tasa de respuesta 170 (21,4%). 118 (70,7%) profesionales creen que este es un problema importante y 154(91,7%) que habitualmente pasa desapercibido. 91(55,2%) conocen las obligaciones legales que tienen cuando la detectan. 73(51,8%) piensan que existen barreras organizativas. Entre ellas: presión asistencial 50(29%), falta de formación específica 40(23,5%), desconocimiento del procedimiento a seguir 20(11,8%) y de las competencias de cada profesional 12(7%). Conclusiones: El nivel de conocimientos medio para todas las categorías profesionales estudiadas, excepto para trabajo social que es alto. Los/as profesionales de AP consideran que la VPHM es un problema importante que pasa desapercibido. La mitad de ellos/as conocen las obligaciones legales que conlleva la detección. Existen barreras organizativas y estereotipos(AU)

Background: Morbidity associated to partner violence against women (PVAW) justify these patients repeated visits to Health Services. Primary Care is the ideal place for detectión and first aid, due to its easy accesibility and continuated assistance. Nevertheless, numbers show important difficulties to achieve this goal. Our aimis to find out the level of knowledge, opinions, awareness about organizacional barriers and improvement proposals suggested by the workers of primary care. Method: Cross-sectional descriptive study using an anonymous and voluntary survey during the months of August and September 2010, targeted to all professionals who performtheir work in a Primary Care Area of Madrid. We made a descriptive analysis of variables and used chi2 to compare the answers. Results: Answer rate is 170 (21.4%). There are stereotypes regarding battered woman and perpetrador. 118 (70.7%) professionals believe that this is a major problem and 154 (91.7%) that usually goes unnoticed. 91 (55.2%) know their legal commitments. 73 (51.8%) think that there are organizational barriers, among them: the burden of care 50(29%), lack of specific training 40(23.5), lack of knowledge about the procedure to be followed 20(11.8%) and about the professional responsabilities 12 (7%). Conclusions: All profesional categoríes showed an average level of knowledge, except for social workers that was high. Primary Care workers think that PVAWis an important issue that usually goes unnoticed. Half of them know the legal commitments o detección. There are organizacional barriers and stereotypes(AU)

Problemas enfermeros en pacientesen situación terminal: caminandohacia la gestión de casos / Nursing problems in terminally ill patients: heading towards case management

Objetivo: determinar la prevalencia de problemas enfermeros en los pacientesen situación terminal que precisan atención domiciliaria conequipo de soporte y en sus cuidadores; los cuales pertenecen al Área 8de la Comunidad de Madrid.Material y método: estudio descriptivo transversal mediante la revisiónde las historias clínicas de todos los pacientes atendidos en domiciliopor el Equipo de Soporte de Atención Domiciliaria (ESAD) del Área 8de Madrid entre los meses de enero y mayo de 2008. Para la valoraciónenfermera se utilizaron los Patrones Funcionales de M. Gordon y parael diagnóstico de problemas enfermeros la Taxonomía II NANDA 2005-2006. La variable principal fue la presencia de diagnósticos enfermerosen la primera visita.Resultados: 84 pacientes, 78 pacientes oncológicos y 6 no oncológicos.278 etiquetas identificadas: 21,5% en el patrón nutricional; 14,3% en elde actividad-ejercicio; 13,6% en el de autopercepción y autoconcepto;12,2% en el cognitivo-perceptual; 9,3% en el de eliminación; 8,9% enel de rol-relaciones; 7,1% en el de adaptación y tolerancia al estrés; 5%en el de reposo-sueño y 0,3% en el de valores y creencias. En pacienteslos problemas más prevalentes fueron dolor agudo (23,8%), estreñimiento(16,6%), deterioro del patrón del sueño (15,4%); y en cuidadores,el afrontamiento familiar comprometido (14,2%) seguido del riesgode cansancio en el desempeño del rol del cuidador (13,1%).Conclusiones: los problemas de cuidado coinciden con los descritos enla literatura y están derivados de las necesidades específicas planteadaspor su enfermedad y la etapa vital que están viviendo. En los cuidadores,los problemas se derivan del afrontamiento y de la posible sobrecargaversus claudicación. Identificar los problemas de cuidado ayuda a unificarlos criterios de actuación, mejora la calidad y continuidad de laatención así como facilita la capacidad que la familia requiere para afrontarla enfermedad (AU)

Objective: to determine the prevalence of nursing problems in terminallyill patients who require home care by a support team and in their caregivers,and who belong to Area 8 of the Community of Madrid.Material and method: cross-sectional descriptive study by means ofthe review of the clinical histories of all patients who received homecare by the Home Care Support Team (HCST) of Area 8 of Madrid betweenthe months of january and may of 2008. M. Gordon’s FunctionalHealth Patterns were used for the nursing assessment and the 2005-2006 2nd NANDA Taxonomy was used for the diagnosis of nursing problems.The primary variable was the presence of nursing diagnoses inthe first visit.Results: 84 patients, 78 cancer patients and 6 non-cancer patients. 278labels were identified: 21,5% in the nutritional pattern; 14,3% in theactivity-exercise pattern; 13,6% in the self-perception and self-conceptpattern; 12,2% in the cognitive-perceptual pattern; 9,3% in the eliminationpattern; 8,9% in the role-relationships pattern; 7,1% in the adaptationand tolerance to stress pattern; 5% in the rest-sleep pattern and 0,3%in the values and beliefs pattern. The most prevalent problems in patientswere acute pain (23,8%), constipation (16,6%), and deterioratedsleep pattern (15,4%); and in caregivers, compromised family coping(14,2%), followed by the risk of fatigue while exercising the caregiverrole (13,1%).Conclusions: the care problems encountered mirror those described inthe literature and are a result of the specific needs presented by the patient’sillness and the life stage the patient is in. In caregivers, problemsoriginate from coping and possible excess burden versus claudication.The identification of care problems helps to unify intervention criteria,improves the quality and continuity of care and facilitates the family’s capacityto cope with the disease (AU)