Evaluación del ambiente de trabajo de las enfermeras en las unidades sociosanitarias de atención intermedia de Cataluña / Evaluation of the nurse working environment in health and social care intermediate care units in Catalonia

Introducción. Un ambiente laboral favorable facilita que las enfermeras realicen su trabajo con mayor satisfacción y en mejores condiciones, hecho que podría influir en la calidad de los resultados obtenidos en los centros sociosanitarios. Los objetivos del estudio fueron: 1) Identificar la tipología de centros en función del ambiente laboral percibido por las enfermeras; y 2) describir las características individuales de las enfermeras relacionadas con dicha valoración. Métodos. Estudio observacional, descriptivo, prospectivo y transversal, multicéntrico realizado el último trimestre de 2014. Se administró a las enfermeras de las unidades de atención intermedia un cuestionario con el Practice Environment Scale of the Nursing Work Index (PES-NWI), que evalúa 5 factores del entorno laboral mediante 31 ítems. Se recogieron también variables sociodemográficas, laborales/profesionales y formativas. Resultados. De 501 enfermeras en 14 centros participaron 388 (77% de respuesta). La puntuación media del PES-NWI fue 84,75. Nueve centros obtuvieron una valoración del entorno laboral «favorable» y 5 «mixto». El factor mejor valorado fue «relaciones laborales» y el peor «dotación/adecuación de recursos». El turno de trabajo rotativo, trabajar en varias unidades, tener responsabilidades de gestión y tener máster universitario fueron características de las enfermeras que se relacionaron con una mejor percepción del entorno. Conclusiones. En la mayoría de los centros el ambiente laboral fue percibido como favorable. Algunas características laborales/profesionales y formativas se relacionaron con la valoración del entorno laboral (AU)

Introduction. A favourable work environment contributes to greater job satisfaction and improved working conditions for nurses, a fact that could influence the quality of patient outcomes. The aim of the study is two-fold: Identifying types of centres, according to the working environment assessment made by nurses in intermediate care units, and describing the individual characteristics of nurses related to this assessment. Methods. An observational, descriptive, prospective, cross-sectional, and multicentre study was conducted in the last quarter of 2014. Nurses in intermediate care units were given a questionnaire containing the Practice Environment Scale of the Nursing Work Index (PES-NWI) which assesses five factors of the work environment using 31 items. Sociodemographic, employment conditions, professional and educational variables were also collected. Results. From a sample of 501 nurses from 14 centres, 388 nurses participated (77% response). The mean score on the PES-NWI was 84.75. Nine centres scored a 'favourable' working environment and five 'mixed'. The best valued factor was 'work relations' and the worst was 'resource provision/adaptation'. Rotating shift work, working in several units at the same time, having management responsibilities, and having a master degree were the characteristics related to a better perception of the nursing work environment. Conclusions. In most centres, the working environment was perceived as favourable. Some employment conditions, professional, and educational characteristics of nurses were related to the work environment assessment (AU)

[Evaluation of the nurse working environment in health and social care intermediate care units in Catalonia]. / Evaluación del ambiente de trabajo de las enfermeras en las unidades sociosanitarias de atención intermedia de Cataluña.

INTRODUCTION: A favourable work environment contributes to greater job satisfaction and improved working conditions for nurses, a fact that could influence the quality of patient outcomes. The aim of the study is two-fold: Identifying types of centres, according to the working environment assessment made by nurses in intermediate care units, and describing the individual characteristics of nurses related to this assessment. METHODS: An observational, descriptive, prospective, cross-sectional, and multicentre study was conducted in the last quarter of 2014. Nurses in intermediate care units were given a questionnaire containing the Practice Environment Scale of the Nursing Work Index (PES-NWI) which assesses five factors of the work environment using 31 items. Sociodemographic, employment conditions, professional and educational variables were also collected. RESULTS: From a sample of 501 nurses from 14 centres, 388 nurses participated (77% response). The mean score on the PES-NWI was 84.75. Nine centres scored a "favourable" working environment and five "mixed". The best valued factor was "work relations" and the worst was "resource provision/adaptation". Rotating shift work, working in several units at the same time, having management responsibilities, and having a master degree were the characteristics related to a better perception of the nursing work environment. CONCLUSIONS: In most centres, the working environment was perceived as favourable. Some employment conditions, professional, and educational characteristics of nurses were related to the work environment assessment.

[SANITARY WASTE IN THE HOSPITAL SETTING: ATTITUDE OF HEALTH PROFESSIONALS TOWARD ADVANCED MANAGEMENT OF SANITARY WASTE]. / Residuos sanitarios en el ámbito hospitalario (y 3).

OBJECTVE: The aim of this study was to assess the attitude of nurse assistants, nurses, physicians, and lab technicians about advanced management of medical waste. METHODS: Cross-sectional study of Attitude and explanatory variable degree of concordance between Attitude, Knowledge, and Risk Perception. The sample size was 176 health professionals from three hospitals in,the Barcelona area. A questionnaire of 44 items with responses measured on a Likert scale type questions and free and spontaneous association and incomplete sentences was used. RESULTS: Mean Attitude of health professionals surveyed was 4.40, with a standard deviation of 0.4 on a scale of 1-5, where 1 is considered a very negative and five a very positive Attitude. According to the values obtained with the Professional Category, the nurse assistants had an average value of 4.45 in Attitude, followed by nurses (4.36), physicians (4.27), and lab technicians (4.47). In the Pearson correlation, coefficients between Attitude, Risk Perception, Global Assessment, and level of Knowledge, values of r = 0.172 andp = 0.023 were obtained, r = -0.156 and p = 0.039 and r = 0.013 and p = 0.865 respectively. The mean values of the variables Knowledge, Risk Perception, Attitude, and Overall Rating were significantly different (ANOVA) in Knowledge level, according to Professional Category and Welfare Service, but not in other categories. CONCLUSIONS: The results of the current study suggest that health professionals generally have a very positive Attitude towards the management of medical waste. A significant relationship between Attitude and Risk Perception and Overall Rating was observed. In terms of the analysis of Variance, there was a significant difference in the level of Knowledge according to the Professional Category and the Assistance Service.

[MANAGEMENT OF HEALTHCARE WASTE IN THE HOSPITAL SETTING. UNDERSTANDING RISK MANAGEMENT]. / Gestión de los residuos sanitarios en el ámbito hospitalario (2).

UNLABELLED: The sanitary waste represents a potential hazard for health workers. Given the high risk of infection in labor accidents, the correct management of sanitary waste minimizes this risk and improves labor and environment conditions. OBJECTIVE: To identify risk perception with health professionals in relation to the advanced sorting and management of healthcare waste (HW). METHODOLOGY: The current study is a descriptive, cross-sectional. The sample size was 177 health workers (nurse assistants, nurses, physicians, lab technicians) from three hospitals in Barcelona (Catalonia). Homemade questionnaire and questions with a free and spontaneous association and incomplete sentences were used to analyze labor variables, perception of risk and personal security through a Likert scale. RESULTS: Using a score from 1 (the lowest perception of risk) to 5 (the high perception of risk) to assess the risk perception, the average value for nurse assistants, nurses, physicians, and lab technicians was 3.71, 3.75, 3.83 and 4.03, respectively. Referring to items with free and spontaneous response association, 44.8% of workers consider HW as a biohazard, 29.6% consider it as waste material, 22.1% state that it must be managed properly and 3.5% described it as unknown residues. CONCLUSION: The results suggest that all health professionals generally have a perception of high risk. The lab technicians have a higher perception of the real risk of inadequate management of HW A 63.2% report that everyone has to make a proper management to preserve their occupational health; the 59% consider that the HW are a biological risk to the general population and only the 47.8% that are harmful to public health. Although it should be noted that only 44.8% think that HW are toxic and dangerous.

Residuos sanitarios en el ámbito hospitalario (y 3). Actitud de los profesionales de la salud frente a la gestión avanzada / Sanitary waste in the hospital setting: attitude of health professionals toward advanced management of sanitary waste

Objetivos. Conocer la actitud que tienen los técnicos auxiliares de cuidados de enfermería, las enfermeras, los médicos y los técnicos de laboratorio frente a la gestión avanzada de los residuos sanitarios (RS). Metodología. Estudio descriptivo transversal de la variable Actitud y explicativo del grado de concordancia entre Actitud, Conocimiento y Percepción de Riesgo. El tamaño de la muestra fue de 176 profesionales sanitarios de tres hospitales de la provincia de Barcelona. Se utilizó un cuestionario de 44 ítems con respuestas medidas en una escala tipo Likert y preguntas de asociación libre y espontánea y de frases incompletas. Resultados. La Actitud media de los profesionales sanitarios estudiados es de 4.40, con una desviación típica de 0.4, en una escala de 1 a 5 donde 1 se considera una Actitud muy negativa y 5 muy positiva. De acuerdo con los valores obtenidos con la Categoría Profesional, tenemos que los técnicos auxiliares de cuidados de enfermería dan un valor medio de Actitud de 4.45, las enfermeras de 4.36, los médicos de 4.27 y los técnicos de laboratorio de 4.47. En los coeficientes de correlación de Pearson entre la Actitud, la Percepción de Riesgo, la Valoración Global y el Nivel de Conocimiento, se obtuvieron unos valores de r = 0.172 y p = 0.023, r = -0.156 y p = 0.039, y r = 0.013 y p = 0.865, respectivamente. Tras analizar los valores promedio de las variables Conocimiento, Percepción de Riesgo, Actitud y Valoración Global, se obtuvieron diferencias significativas a través del ANOVA, en nivel de Conocimiento en función de la Categoría Profesional y Servicio Asistencial, no así en el resto de categorías. Conclusiones. El análisis de los resultados sugiere que los profesionales de la salud tienen, en general, una Actitud muy positiva frente a la gestión de los RS. Se observa una relación muy significativa entre la Actitud, la Percepción de Riesgo y la Valoración Global. En cuanto al análisis de la Varianza, se obtuvo una diferencia significativa en el nivel de Conocimiento según la Categoría Profesional y el Servicio Asistencial (AU)

Objective. The aim of this study was to assess the attitude of nurse assistants, nurses, physicians, and lab technicians about advanced management of medical waste. Methods. Cross-sectional study of Attitude and explanatory variable degree of concordance between Attitude, Knowledge, and Risk Perception. The sample size was 176 health professionals from three hospitals in the Barcelona area. A questionnaire of 44 items with responses measured on a Likert scale type questions and free and spontaneous association and incomplete sentences was used. Results. Mean Attitude of health professionals surveyed was 4.40, with a standard deviation of 0.4 on a scale of 1-5, where 1 is considered a very negative and five a very positive Attitude. According to the values obtained with the Professional Category, the nurse assistants had an average value of 4.45 in Attitude, followed by nurses (4.36), physicians (4.27), and lab technicians (4.47). In the Pearson correlation, coefficients between Attitude, Risk Perception, Global Assessment, and level of Knowledge, values of r = 0.172 and p = 0.023 were obtained, r = -0.156 and p = 0.039 and r = 0.013 and p = 0.865 respectively. The mean values of the variables Knowledge, Risk Perception, Attitude, and Overall Rating were significantly different (ANOVA) in Knowledge level, according to Professional Category and Welfare Service, but not in other categories. Conclusions. The results of the current study suggest that health professionals generally have a very positive Attitude towards the management of medical waste. A significant relationship between Attitude and Risk Perception and Overall Rating was observed. In terms of the analysis of Variance, there was a significant difference in the level of Knowledge according to the Professional Category and the Assistance Service (AU)

Gestión de los residuos sanitarios en el ámbito hospitalario (2): Percepción de riesgo frente a la gestión / Management of healthcare waste in the hospital setting. Understanding risk management

Objetivo. Identificar la percepción de riesgo que tienen los profesionales sanitarios, en relación con la clasificación y gestión avanzada de los residuos sanitarios (RS). Metodología. Estudio descriptivo y/o explicativo. El tamaño de la muestra fue de 177 participantes (técnicos auxiliares en cuidados de enfermería, enfermeras, médicos y técnicos de laboratorio) de tres hospitales de la provincia de Barcelona. Se utilizó un cuestionario de elaboración propia, para analizar las variables laborales y de percepción de riesgo para la salud laboral y la seguridad personal, tanto para la población en general como para la salud pública, con preguntas en una escala tipo Likert y preguntas de asociación libre y espontánea y de frases incompletas. Resultados. El nivel medio de percepción de riesgo de los técnicos auxiliares de cuidados de enfermería, las enfermeras, los médicos y los técnicos de laboratorio, en una escala de 1 (baja percepción) a 5 (alta percepción), es de 3.71, 3.75, 3.83 y 4.03, respectivamente. En referencia a los ítems con respuesta de asociación libre y espontánea, el 44.8 % de profesionales consideran los RS un riesgo biológico, el 29.6 % lo consideran material de desecho, el 22.1 % manifiestan que deben gestionarse correctamente y un 3.5 % los describen como residuos desconocidos. Conclusiones. Los resultados sugieren que todos los profesionales de la salud tienen en general una percepción de riesgo alta, siendo los técnicos de laboratorio los que tienen una percepción más alta respecto al riesgo real de la gestión inadecuada de los RS. El 63.2 % manifiesta que se ha de realizar una gestión adecuada para preservar su salud laboral; el 59 % responde que son un riesgo biológico para la población en general y el 47.8 % que son nocivos para la salud pública. Aunque cabe destacar que solo el 44.8 considera que los RS son tóxicos y peligrosos (AU)

The sanitary waste represents a potential hazard for health workers. Given the high risk of infection in labor accidents, the correct management of sanitary waste minimizes this risk and improves labor and environment conditions. Objective. To identify risk perception with health professionals in relation to the advanced sorting and management of healthcare waste (HW). Methodology. The current study is a descriptive, cross-sectional. The sample size was 177 health workers (nurse assistants, nurses, physicians, lab technicians) from three hospitals in Barcelona (Catalonia). Homemade questionnaire and questions with a free and spontaneous association and incomplete sentences were used to analyze labor variables, perception of risk and personal security through a Likert scale. Results. Using a score from 1 (the lowest perception of risk) to 5 (the high perception of risk) to assess the risk perception, the average value for nurse assistants, nurses, physicians, and lab technicians was 3.71, 3.75, 3.83 y 4.03, respectively. Referring to items with free and spontaneous response association, 44.8 % of workers consider HW as a biohazard, 29.6 % consider it as waste material, 22.1 % state that it must be managed properly and 3.5 % described it as unknown residues. Conclusions. The results suggest that all health professionals generally have a perception of high risk. The lab technicians have a higher perception of the real risk of inadequate management of HW. A 63.2 % report that everyone has to make a proper management to preserve their occupational health; the 59% consider that the HW are a biological risk to the general population and only the 47.8 % that are harmful to public health. Although it should be noted that only 44.8 % think that HW are toxic and dangerous (AU)

Gestión de los residuos sanitarios en el ámbito hospitalario. Nivel de conocimiento y valoración Global / Sanitary waste in the hospital setting: Knowledge level and overall rating

Los residuos sanitarios representan un peligro potencial para los trabajadores sanitarios. Dado el alto riesgo de infección en los accidentes laborales, la gestión correcta de los residuos sanitarios minimiza el riesgo y mejora las condiciones laborales y ambientales. Objetivos. Identificar el nivel de conocimiento que tienen los profesionales sanitarios, en relación con la clasificación y gestión avanzada de los residuos sanitarios (RS) y valorar de forma global la gestión de los mismos. Metodología. Estudio descriptivo transversal con 178 participantes (auxiliares, enfermeras, médicos y técnicos de laboratorio), de 3 hospitales de la provincia de Barcelona. Se utilizó un cuestionario de elaboración propia, que analizabalas variables laborales, el conocimiento y la valoración global de la gestión de los RS. Resultados. El nivel medio de conocimiento sobre los RS delos auxiliares, las enfermeras, los médicos y los técnicos de laboratorio, en una escala de 1 (valor mínimo) a 15 (valor máximo), es de 10.59, 10.61, 8.92 y 8.39, respectivamente. La valoración global que hacen los auxiliares, las enfermeras, los médicos y los técnicos de laboratorio de la gestión de los RS en una escala de 1 (valor mínimo) y 5 (valor máximo), es de 2.89, 2.93, 2.88, 2.94, respectivamente. Conclusiones. Los resultados sugieren que las enfermeras y los auxiliares tienen un nivel de conocimiento aceptable con respecto a la gestión correcta de los RS. En cambio, los médicos y técnicos de laboratorio tienen un nivel de conocimiento inferiorsobre la segregación y eliminación adecuada de los RS. En cuanto a la valoración global, se obtienen valores aceptables, y muy similares, entre las diferentes categorías de profesionales estudiadas, en relación con la gestión correcta de los RS en los centros asistenciales donde realizan su actividad laboral (AU)

The sanitary waste represents a potential hazard for health workers. Given the high risk of infection in labor accidents, the correct management of sanitary waste minimizes this risk and improves labor and environment conditions. Objective. The current study was aimed at identifying the knowledge that health workers have about classification and management of sanitary waste. Methodology. The current study is a descriptive, cross-sectional study of 178 health workers (physicians, nurses, nurse assistants, lab technicians) of 3 hospitals in Barcelona. Results. Using a score from 1 (minimum) to 15 (maximum) to assess the knowledge, the average value for nurse assistants, nurses, physicians and lab technicians was 10.59, 10.61, 8.92 and 8.39, respectively. The global assessment of sanitary waste management (using a score from 1 to 5) was 2.89, 2.93, 2.88 and 2.94, respectively. Conclusions. These results suggest that nurses and nurse assistants have a good level of knowledge about the management of sanitary waste. By contrast, physicians and laboratory technicians have a lower level of knowledge compared to nurses and nurse asistants in relation to segregation and disposal of sanitary waste. Concerning the global assessment, the level is good, without differences between the different categories of health workers (AU)

Aproximación a la gobernabilidad enfermera en la organización sociosanitaria en Cataluña / Approach to nurse governability at social and health centres in catalonia

La cuestionada sostenibilidad de la prestación sanitaria y el replanteamiento del modelo sociosanitario en Cataluña, permiten preguntarse sobre la gobernabilidad de las organizaciones sociosanitarias, u hospitales de media estancia, y su relación con la calidad asistencial. A través de la Teoría de la gobernabilidad se podrían explorarlos elementos del modelo sociosanitario y el rol mesogestor de la enfermera en laorganización: la toma decisiones, los intereses externos e internos, la misión y valores,y la facilitación de información y herramientas. La gobernabilidad enfermera esun concepto teórico medible con impacto claro y directo en la calidad y la sostenibilidad de los cuidados

Nowadays, in the region on Catalonia, there is an opportunity to reform social and health care model in the medium term care hospitals in order to protect and improve the quality of care and its sustainability. Due to financial crisis and limited resources in providing health care attention, nurse managers can focus to analyze their particular government practices in the organizations. So, nurse managers canexplore theory of governability in their centre: guarantee transparency, accountability, place in a structure of acute hospitals, and role respecting stakeholders interests. Furthermore, all these principles exposed can be explored, measured and compared their results with level of nursing quality care in the medium term care hospitals in Catalonia

¿Cómo perciben los mayores a sus cuidadoras inmigrantes? Sobre la ayuda que necesitan y reciben en el domicilio / Perceptions of dependent elderly cared for by immigrant workers concerning the help they need and receive

Introducción. Cambios sociales como el aumento de personas dependientes, la incorporación de la mujer al mundo laboral o la disminución del tamaño de las familias, han propiciado la mercantilización del cuidado de los ancianos dependientes, dando lugar a una nueva ocupación desarrollada por mujeres inmigrantes en el entorno domiciliario, de la que se conoce poco. Objetivo. Explorar la vida cotidiana de las personas mayores cuidadas por inmigrantes contratadas por los familiares, con el objetivo de comprender en profundidad los aspectos relacionados con su salud y los cuidados que reciben. Metodología. Cualitativa, realizando doce entrevistas mediante muestreo teórico, que se grabaron, transcribieron y analizaron con soporte informático del programa Atlas Ti V5. Resultados. Los mayores no se anticipan a los problemas de la vejez. Les preocupa la enfermedad, el dolor y la muerte. Quieren ser lo más autónomos posible, por lo que la familia percibe antes que el anciano la necesidad de contratar a la cuidadora. Necesitan ayuda en las actividades de la vida diaria, cuidados sanitarios y compañía. No se han detectado conflictos culturales que interfieran en la atención. Están satisfechos con la ayuda recibida pero consideran que las trabajadoras carecen de formación para el cuidado. Conclusiones. Las personas mayores son conscientes de las dificultades actuales de la familia para cuidar y se van adaptando a esta nueva realidad. Valoran positivamente tener una cuidadora porque les ayuda en las tareas de la casa, los cuida y les aporta compañía, distracción y afecto. Las enfermeras de atención primaria tienen un rol clave en la formación de las trabajadoras inmigrantes (AU)

Introduction: Social-demographic changes such as the increasing number of dependent elderly people, the incorporation of women into the workforce, and declining family size have led to the emergence of a new occupation, that of home care for elderly dependents. This work is usually carried out by women immigrants. Little is known about how this care is perceived by the elderly. Objective: To evaluate the daily lives of elderly people cared for by hired immigrants to identify aspects of their health and the care they receive. Methodology: A qualitative study conducted through twelve theoretical sampling interviews that were recorded, transcribed and analyzed with computer support of Atlas Ti V5. Results: The elderly do not anticipate or prepare for the problems of old age. Their main concerns regarding health are illness, pain and death. All wish to remain as autonomous as possible. The need to arrange home care services is often first perceived by the family. Home-help workers assist in basic and instrumental daily activities and provide care and company. Cultural conflicts in the practice of care are rare. Despite general satisfaction with help received, the elderly consider that the workers lack specific training in caring for the elderly. Conclusions: The elderly are aware of the current difficulties of families to care for them and they are adapting to the new reality of home care. They value the worker who helps them because besides helping with housework, they provide company, entertainment and affection. Primary care nurses can play a key role in training immigrant workers in caring for the elderly (AU)

[Perceptions of dependent elderly cared for by immigrant workers concerning the help they need and receive]. / ¿Cómo perciben los mayores a sus cuidadoras inmigrantes? Sobre la ayuda que necesitan y reciben en el domicilio.

INTRODUCTION: Social-demographic changes such as the increasing number of dependent elderly people, the incorporation of women into the workforce, and declining family size have led to the emergence of a new occupation, that of home care for elderly dependents. This work is usually carried out by women immigrants. Little is known about how this care is perceived by the elderly. OBJECTIVE: To evaluate the daily lives of elderly people cared for by hired immigrants to identify aspects of their health and the care they receive. METHODOLOGY: A qualitative study conducted through twelve theoretical sampling interviews that were recorded, transcribed and analyzed with computer support of Atlas Ti V5. RESULTS: The elderly do not anticipate or prepare for the problems of old age. Their main concerns regarding health are illness, pain and death. All wish to remain as autonomous as possible. The need to arrange home care services is often first perceived by the family. Home-help workers assist in basic and instrumental daily activities and provide care and company. Cultural conflicts in the practice of care are rare. Despite general satisfaction with help received, the elderly consider that the workers lack specific training in caring for the elderly. CONCLUSIONS: The elderly are aware of the current difficulties of families to care for them and they are adapting to the new reality of home care. They value the worker who helps them because besides helping with housework, they provide company, entertainment and affection. Primary care nurses can play a key role in training immigrant workers in caring for the elderly.