The Relation between Functional Performance, Falls and Previous Falls Among Participants in the Otago Programme: A Secondary Data Analysis.

Fall prevention is a key priority in healthcare policies. Multicomponent exercises reduce the risk of falls. The purpose of this study is to describe the relationship between functional performance and falls after following the Otago multicomponent exercise programme and previous falls. A prospective multi-centre intervention study was performed on 498 patients aged over 65 in primary care, with or without a history of previous falls. Sociodemographic, anthropometric and functionality data were collected. The primary outcome was the occurrence of falls; functional performance was measured using the Tinetti, Short Physical Performance Battery and Timed Up and Go tests. Among the patients, 29.7% referred to previous falls. There was a statistically significant (p < 0.001) increase in falls at 6 months (10.1%) and at 12 months (7.6%) among participants with previous falls in the baseline assessment compared to those without. In addition, the existence of previous falls could be considered a risk factor at 6 and 12 months (OR =2.37, p = 0.002, and OR = 1.76, p = 0.046, respectively). With regard to balance and gait, differences between the groups were observed at 6 months in the Tinetti score (p < 0.001) and in the baseline assessment Timed Up and Go score (p < 0.044). Multicomponent exercises improve the fall rate, balance and gait in older people, although this improvement is less in people with previous falls. Earlier intervention and tailoring of exercises in patients with previous falls could help improve outcomes.

Percepción sobre la calidad de los cuidados, entorno laboral y características del sueño de las enfermeras que trabajan en el Sistema Nacional de Salud / Perception of the quality of care, work environment and sleep characteristics of nurses working in the National Health System

OBJETIVO: Describir la percepción de las enfermeras sobre la calidad de los cuidados que prestan y de su entorno laboral, así como analizar las características del sueño. Analizar si existe relación entre la unidad y el turno de trabajo con la percepción de las enfermeras de su entorno laboral y con la calidad de sueño y la somnolencia diurna. MÉTODO: Estudio multicéntrico, observacional, descriptivo realizado entre los años 2012 y 2014 en 7 hospitales españoles del Sistema Nacional de Salud que mostraron su interés por participar en este proyecto de seguimiento. Se ha medido el entorno laboral, la satisfacción laboral, la calidad del sueño y la calidad de los cuidados con herramientas validadas. RESULTADOS: Participaron en el estudio 635 enfermeras. Un 83,7% percibía la calidad de los cuidados como buena/excelente, y el 55,1% valoró el entorno laboral de su hospital como bueno/excelente. El PES-NWI clasificó al 39% de los hospitales como desfavorable y al 20% como favorable. El 15,4% de las enfermeras tenía alto nivel de burnout y el 58,3% bajo. La calidad del sueño fue de 6,38 para el turno de día, de 6,78 para el turno rotatorio y de 7,93 para el turno de noche. Se encontraron diferencias en la calidad subjetiva, en la duración, en las perturbaciones del sueño y en la disfunción durante el día. CONCLUSIONES: En la prestación de cuidados de calidad interactúan multitud de factores como el turno, la unidad, la satisfacción, la percepción de la seguridad y la calidad del sueño

OBJECTIVE: To describe nurses' perception in relation to the quality of care and their work environment, as well as to describe their quality of sleep. To analyze the relationship between ward and work shift with nurses' perception of their work environment, sleep quality and day time drowsiness. METHODS: A multicentre, observational and descriptive study carried out between 2012-2014 in seven hospitals of the Spanish National Health System. Work environment, work satisfaction, sleep quality and quality of patient care were evaluated through validated tools. RESULTS: 635 registered nurses participated in the study. Eighty-three point seven percent perceived the quality of cares as good/excellent, and 55.1% rated the work environment of their hospital as good/excellent. PES-NWI classified 39% of hospitals as unfavourable and 20% as favourable. Fifteen point four percent of the nurses had a high level of burnout and 58.3% had low burnout. Sleep quality was 6.38 for nurses working on day shifts, 6.78 for the rotational shifts and 7.93 for night shifts. Significant differences were found between subjective sleep quality score, sleep duration, sleep disturbances and daytime dysfunction. CONCLUSIONS: In the provision of quality care services, there is a multitude of related factors such as shift, ward, satisfaction, and nurses' perceptions of patient safety and sleep quality

Perception of the quality of care, work environment and sleep characteristics of nurses working in the National Health System. / Percepción sobre la calidad de los cuidados, entorno laboral y características del sueño de las enfermeras que trabajan en el Sistema Nacional de Salud.

OBJECTIVE: To describe nurses' perception in relation to the quality of care and their work environment, as well as to describe their quality of sleep. To analyze the relationship between ward and work shift with nurses' perception of their work environment, sleep quality and day time drowsiness. METHODS: A multicentre, observational and descriptive study carried out between 2012-2014 in seven hospitals of the Spanish National Health System. Work environment, work satisfaction, sleep quality and quality of patient care were evaluated through validated tools. RESULTS: 635 registered nurses participated in the study. Eighty-three point seven percent perceived the quality of cares as good/excellent, and 55.1% rated the work environment of their hospital as good/excellent. PES-NWI classified 39% of hospitals as unfavourable and 20% as favourable. Fifteen point four percent of the nurses had a high level of burnout and 58.3% had low burnout. Sleep quality was 6.38 for nurses working on day shifts, 6.78 for the rotational shifts and 7.93 for night shifts. Significant differences were found between subjective sleep quality score, sleep duration, sleep disturbances and daytime dysfunction. CONCLUSIONS: In the provision of quality care services, there is a multitude of related factors such as shift, ward, satisfaction, and nurses' perceptions of patient safety and sleep quality.

Falls assessment and interventions among older patients in two medical and one surgical hospital wards in Spain: a best practice implementation project.

OBJECTIVE: The current project aimed to improve fall prevention and management through clinical audits and the implementation of a quality-improvement cycle at the local level. INTRODUCTION: Falls are one of the most common adverse events reported in hospitals; evidence-based fall prevention interventions aim to reduce the number of people who fall. METHODS: A one-year clinical audit was conducted using a pre-post implementation audit method, namely the Joanna Briggs Institute's (JBI) Practical Application of Clinical Evidence System and the getting research into practice audit and feedback tool. Two medical wards and a surgical ward in a Spanish hospital participated. The subjects were evaluated at baseline and at a follow-up at six months after key strategies had been implemented. RESULTS: Compliance rates for the evidence-based criteria were low in the baseline audit. Five barriers were identified in relation to fall assessment and management and, based on getting research into practice, strategies were designed, developed and implemented to overcome these barriers. After implementation, most of the fall-risk-assessment criteria showed an overall improvement, but there was no effect on care plan recording. Awareness of the assessment and management of fall risks were increased among professionals and patients on all three study wards. CONCLUSIONS: The current project may improve compliance with regard to promoting evidence-based fall prevention and management interventions. Further audits are necessary to evaluate any improvements achieved, in particular, care plans.