Physical activity prescription by primary care nurses using health assets: Study design of a randomized controlled trial in patients with cardiovascular risk factors.

AIM: To analyse the efficacy of a 12-month multifactorial intervention by primary care nurses in increasing adherence to physical activity prescription (150 min/week) in patients with two or more cardiovascular risk factors and with cardiovascular risk up to 15% determined by the REGICOR equation. BACKGROUND: In Spain, cardiovascular diseases are responsible for 30.5% of deaths. Regular physical activity decreases mortality risk due to cardiovascular diseases but the effectiveness of physical activity prescription in routine in primary care settings has been shown to be low. DESIGN: Multicentre, single-blind, parallel randomized (in two different branches) clinical trial. METHODS: At least 368 participants will be recruited (184 control and 184 intervention), to show an 8% increase in adherence to the physical activity prescription (1.2% control group and 9.2% intervention group). Participants will be patients aged 35-75 years with at least two cardiovascular risk factors and with a cardiovascular risk of up to 15% measured using the Framingham-REGICOR equation. Intervention will be performed throughout baseline and three follow-up visits. A motivational interview, the trans-theoretical stages of changes of Prochaska and DiClemente and an individualized prescription of physical exercise using physical activity assets will be used in the intervention. Data will be collected at baseline and after the 1-year intervention. DISCUSSION: The present study will allow us to find out whether this brief multifactorial intervention induces greater adherence to physical activity prescription than usual practice, improving the quality of patient care. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN76069254. Protocol version 1.1, 6 July 2015.

Determining factors in evidence-based clinical practice among hospital and primary care nursing staff.

AIM: The general aim of this study is to identify key factors perceived by nurses to influence evidence-based clinical practice at different centres. BACKGROUND: During the last decade, there has been an increased interest in the identification of factors that facilitate the transfer of knowledge into clinical practice, among health care professionals. Previous research states that a suitable organisational framework and practice environment seems to have influence on a greater use of scientific evidence by nurses, which can be directly observed in patient outcomes. In consequence, several authors suggest that strategies should be encouraged from managers and nurse executives to guarantee the existence of environments that avoid emotional exhaustion and improve satisfaction of nurses with their work, and at the same time, ensure the use of research-guided nursing decisions. METHODS: Following the Spanish validation of the Practice Environment Scale-Nursing Work Index and Evidence Based Practice Questionnaire, a descriptive observational cross-sectional study has been conceived, from 2010 to 2011, in order to identify determining factors in evidence-based clinical practice at different centres. In a second phase, a qualitative study has been designed, using focus groups, to identify practice factors that can lead to a successful implementation of evidence-based clinical practice. DISCUSSION: Organisational and attitudinal interventions are needed in order to implement evidence-based clinical practice that improves the quality of patient care.

Entorno de práctica de los profesionales de enfermería y competencia para laincorporación de la evidencia a las decisiones: situación en las Islas Baleares / Nursing practice settings and competence to incorporate evidence into decisions: analysis of the situation in the Balearic Islands (Spain)

Objetivos: Establecer el diagnóstico de los factores que los profesionales de enfermería perciben como facilitadores para una práctica clínica basada en la evidencia (PCBE) en el Servicio de Salud de las Islas Baleares, identificando posibles diferencias en función de las características de los profesionales y de los entornos en que ejercen. Métodos: Estudio observacional transversal multicéntrico, tomando como población de estudio los3129 profesionales de enfermería en plantilla del Servicio de Salud de las Islas Baleares en 2009, a quienes se encuestó con los instrumentos Evidence Based Practice Questionnarie (EBPQ) y Nursing Work Index(PES-NWI). La estrategia de análisis comprendió análisis exploratorio, análisis bivariado con pruebas paramétricas y no paramétricas en función de la naturaleza de las distribuciones (correlación, ANOVA, Kruskall-Wallis, ji cuadrado) y multivariado, entre las principales variables del estudio y los factores de los cuestionarios PES-NWI y EBPQ. Los análisis se realizaron con un nivel de confianza del 95%.Resultados: Se recibieron 1753 encuestas (participación del 56,02%). Los resultados de los dos cuestionarios muestran diferencias significativas al analizar el entorno hospitalario y de atención primaria (p < 0,001). Estas diferencias se mantienen al comparar la categoría y la experiencia profesional. Conclusiones: El estudio compara entornos de práctica de enfermería de distintas características. Delos factores que componen los cuestionarios, el que mayor influencia tiene sobre la PCBE es el apoyo de los gestores de enfermería. También establece que los dos instrumentos validados son herramientas plausibles para el diagnóstico de una PCBE que permiten establecer elementos de mejora, tanto individual como de organización (AU)

Objectives: To determine the factors that nursing professionals perceive as facilitating evidence-based clinical practice (EBCP) in the Balearic Islands Health Service (Spain) by identifying possible differences according to nurses’ characteristics and their occupational settings. Methods: We performed a multicenter, cross-sectional, observational study of 3,129 staff nurses in the Balearic Islands Health Service in 2009, who were surveyed using the Evidence-Based Practice Questionnaire (EBPQ) and the Nursing Work Index (PES-NWI). The strategy for the analysis encompassed an exploratory analysis, bivariate analysis with parametric and non-parametric tests according to the nature of the distributions (correlation, ANOVA, Kruskall-Wallis, chi square) and multivariate analysis of the main study variables and factors on the PES-NWI and EBPQ questionnaires. The analyses had a confidence level of 95%.Results: A total of 1,753 questionnaires were received, corresponding to a participation rate of 56.02%.The results established significant differences between the two questionnaires in the analysis of the hospital setting and primary care (p < 0.001). These differences remained significant when the questionnaires were compared according to professional category and experience. Conclusions: This study compared nursing practice environments with different characteristics. Of the factors included in the questionnaires, that with the greatest influence on EBP was the support of nursing managers. This study also found that the two validated instruments are plausible tools for assessing EBC Pand help to establish areas for improvement both at the individual and organizational level (AU)

[Nursing practice settings and competence to incorporate evidence into decisions: analysis of the situation in the Balearic Islands (Spain)]. / Entorno de práctica de los profesionales de enfermería y competencia para la incorporación de la evidencia a las decisiones: situación en las Islas Baleares.

OBJECTIVES: To determine the factors that nursing professionals perceive as facilitating evidence-based clinical practice (EBCP) in the Balearic Islands Health Service (Spain) by identifying possible differences according to nurses' characteristics and their occupational settings. METHODS: We performed a multicenter, cross-sectional, observational study of 3,129 staff nurses in the Balearic Islands Health Service in 2009, who were surveyed using the Evidence-Based Practice Questionnaire (EBPQ) and the Nursing Work Index (PES-NWI). The strategy for the analysis encompassed an exploratory analysis, bivariate analysis with parametric and non-parametric tests according to the nature of the distributions (correlation, ANOVA, Kruskall-Wallis, chi square) and multivariate analysis of the main study variables and factors on the PES-NWI and EBPQ questionnaires. The analyses had a confidence level of 95%. RESULTS: A total of 1,753 questionnaires were received, corresponding to a participation rate of 56.02%. The results established significant differences between the two questionnaires in the analysis of the hospital setting and primary care (p<0.001). These differences remained significant when the questionnaires were compared according to professional category and experience. CONCLUSIONS: This study compared nursing practice environments with different characteristics. Of the factors included in the questionnaires, that with the greatest influence on EBP was the support of nursing managers. This study also found that the two validated instruments are plausible tools for assessing EBCP and help to establish areas for improvement both at the individual and organizational level.

Validación yadaptación al españolde la escala delentorno de prácticaenfermera delNursing Work Index / Spanish validation and adaptation of the Nursing Work Index scale of nursing practice

Objetivo: determinar la validez y fiabilidad de una versión adaptadaculturalmente al entorno español de la escala de entorno de prácticaenfermera del Nursing Work Index para su uso en Atención Primariay hospitalaria.Material y método: estudio descriptivo, multicéntrico, transversal,de adaptación transcultural y validación. Se llevó a cabo un procesode traducción-retrotraducción siguiendo la metodología por laComisión Internacional de Tests. Fueron seleccionadas 291 enfermerasdel Servei de Salut de les Illes Balears pertenecientes a 5 hospitales,1 centro socio sanitario y 18 centros de Atención Primaria.Para el análisis de los datos se realizó un análisis descriptivo, pruebasde normalidad, análisis de fiabilidad mediante coeficiente Alfade Cronbach y análisis factorial exploratorio y confirmatorio.Resultados: la fiabilidad global mostró un alfa de Cronbach de 0,906.El análisis factorial exploratorio replicaba correctamente la estructurapentafactorial (participación de la enfermera en asuntos delcentro; fundamento enfermero de la calidad de los cuidados; capacidad,liderazgo y apoyo a las enfermeras por parte de los gestoresenfermeros; dimensión de la plantilla y adecuación de los recursoshumanos; y relaciones entre médicos y enfermeras) original salvopara un factor. El análisis factorial confirmatorio mostró un buenajuste tras la eliminación de un ítem.Conclusiones: la disponibilidad de instrumentos válidos y fiables quepermitan evaluar factores del entorno de práctica enfermera en lasorganizaciones, resulta de una utilidad enorme en la gestión de cuidados.Los resultados de este estudio ponen de manifiesto que la versiónadaptada del PES-NWI con 30 ítems es un instrumento válidopara su uso en el contexto español (AU)

Objectives: to determine the validity and reliability of a version of theNursing Work Index nursing practice scale that has been culturallyadapted to the Spanish setting for its use in Primary and Hospital Care.Material and method: descriptive, multicentre, cross-sectional studythat has been culturally adapted and validated. It was carried out bya translation-retrotranslation process following the methodology ofthe International Tests Commission. 291 nurses from the Balearic IslandsHealth Service were selected, specifically from 5 hospitals, 1sociosanitary centre and 18 Primary Care centres. Data analysis wascarried out via a descriptive analysis, normality tests, reliability analysisusing Cronbach’s Alpha coefficient and exploratory and confirmatoryfactor analysis.Results: overall reliability showed a 0,906 Cronbach alpha. The exploratoryfactor analysis correctly replicated the original five-factorstructure (participation of the nurse in the centre’s affairs; nursingprinciple of care quality; provision of capacity, leadership and supportto nurses by nursing managers; staff size and adequacy of humanresources; and relationships between physicians and nurses)except for one factor. The confirmatory factor analysis showed goodadjustment after the elimination of one item.Conclusions: the availability of valid and reliable instruments that canbe used to assess the factors surrounding nursing practice in organizationsis highly useful in care management. The results of thisstudy evidence that the 30-item adapted version of the PES-NWI is avalid instrument that can be employed in the Spanish setting (AU)

Resultados de la atención hospitalaria y número de enfermeras no es casualidad la cercanía a la causalidad / Hospital healthcare outcomes and number of nurses: causality is not the result of chance

El debate sobre los recursos humanos en salud suele realizarse desde posicionesun tanto dogmáticas y, en general, con argumentos poco contrastadoscon resultados de investigación. Paradójicamente, son muchos los estudiosque en el campo de la provisión de cuidados evidencian que elincremento de enfermeras y su cualificación, intervienen sobre los resultadosasistenciales, como la reducción de la mortalidad o la estancia hospitalaria,entre otros.A lo largo de este artículo se exponen los resultados másrelevantes sobre la línea de investigación que en los últimos 20 años ha venidoasociando el número de enfermeras a los resultados de la atención hospitalaria,con especial énfasis en el último metaanálisis publicado al respecto,en el que se sientan los principios para determinar una relación causalde esta asociación. Finalmente, se realiza una discusión sobre las luces y sombrasde estos resultados, así como una contextualización de estos resultadoscon la realidad de nuestro medio en España (AU)

The debate on healthcare human resources can be carried out from differentperspectives that are somewhat dogmatic and generally based on argumentsthat have been limitedly contrasted with research results. Paradoxically,there are many studies in the field of healthcare delivery thatdemonstrate that an increase in nurses and their qualifications has an impacton healthcare outcomes, such as a decrease in mortality or length ofhospital stay, amongst others. In this article, the most relevant results derivedfrom the research line that in the last 20 years has associated thenumber of nurses with hospital healthcare outcomes are presented. Thelast published meta-analysis regarding this topic is emphasised given thatit is where the principles to determining a causal relationship of this associationare based. Finally, there is a discussion regarding the positivesand negative aspects of these results, as well as a contextualization of theseresults with the reality of our setting in Spain (AU)