El sentido de coherencia y las habilidades para la vida como factores protectores en personas con prediabetes.

OBJETIVO: analizar el sentido de coherencia y las habilidades para la vida y su relación con el cumplimiento del estilo de vida saludable. MÉTODO: estudio observacional transversal en personas con prediabetes atendidas en atención primaria, quienes respondieron a un cuestionario con variables sociodemográficas y hábitos saludables y a los cuestionarios de sentido de coherencia y habilidades para la vida. Se realizó un análisis descriptivo, bivariante y un modelo de regresión múltiple. RESULTADOS: los y las participantes con mayor sentido de coherencia son quienes presentan mayores habilidades para la vida (Pearson = 0.470; p ⩽ 0.001) y mantienen un estilo de vida más saludable (B:1.24; p = 0.001). Una mayor puntuación de las habilidades de la vida se relaciona con un estilo de vida saludable (Pearson = 0.355, p < 0.001). El sentido de coherencia predice el estilo de vida saludable (BB = 0.21, p = 0.001). CONCLUSIÓN: las personas con prediabetes con un mayor sentido de coherencia y más habilidades para la vida realizan conductas más saludables con relación a la dieta, al ejercicio físico y al hábito tabáquico. Las personas con mayor sentido de coherencia tienen mayor probabilidad de seguir el estilo de vida saludable.

Validity of Chronic Venous Disease Diagnoses and Epidemiology Using Validated Electronic Health Records From Primary Care: A Real-World Data Analysis.

PURPOSE: The aim of this study was to evaluate the validity of lower limb chronic venous disease (CVD) diagnoses entered in a large electronic health record database in primary care in Catalonia, Spain; to investigate the reliability of these data for research purposes; and to estimate the prevalence and incidence of CVD, chronic venous insufficiency (CVI), and venous leg ulcer (VLU). DESIGN: Real-world data analysis based on a large electronic health record database in primary care in Catalonia, Spain. METHODS: We used a primary care research database (Information System for the Development of Research in Primary Care [SIDIAP]), which contains anonymous data on some 5.8 million people from 279 primary care centers, accounting for more than 80% of the Catalonian population and 15% of the Spanish population. We evaluated the validity of the ICD-10 codes for CVD in SIDIAP for 200 adult patients through the responses of 20 primary care physicians to a questionnaire. FINDINGS: The positive predictive value of CVD in SIDIAP was 89.95% (95% confidence interval [CI] 84.99-93.40). The prevalence rates for CVD, CVI, and VLU were 9.54% (95% CI 9.51-9.56), 3.87%, and 0.33%, respectively. The incidence rates for CVD, CVI, and VLU were 7.91/1,000 person-years (95% CI 7.82-8.00), 3.37/1,000 person-years (95% CI 3.31-3.43), and 0.23/1,000 person-years (95% CI 0.21-0.24), respectively. CONCLUSIONS: The Catalonian SIDIAP database contains valid CVD diagnoses. The prevalence and incidence rates found using real-world data are low compared with those in the literature, possibly because CVD is an underdiagnosed entity. CLINICAL RELEVANCE: Real-world data can inform clinicians on lower limb venous health in a population, show changes as individuals age, and reveal aspects where healthcare can be improved.

Using simulation and electronic health records to train nursing students in prevention and health promotion interventions.

BACKGROUND: Prevention and health promotion activities are key to reducing prevalence and halting the progress of many chronic diseases. Standardised patient simulation is a useful option for training nursing students in this area. OBJECTIVE: To evaluate skills related to prevention and health promotion activities acquired by third-year nursing students through standardised patient simulation and electronic health records. DESIGN: A descriptive, cross-sectional study. SETTINGS: A nursing faculty at a public university. PARTICIPANTS: The study population consisted of all third-year nursing students in the academic year 2017-2018 (N = 142). METHODS: The students attended three seminars on health promotion and prevention activities in adults, involving standardised patient simulation and electronic health record use. Skill acquisition was then evaluated through clinical case simulation in a fourth seminar. RESULTS: A total of 137 (96.5%) students participated in the study. The mean score for all cases evaluated was 6.76 (standard deviation 1.85) out of 10. The most frequent activities were greeting and self-introduction, checking vaccination status, assessing physical exercise and eating habits, and calculating body mass index. The least frequent activities were questions about high-risk sexual behaviour, drug use, bowel cancer screening and sun protection recommendations. When writing the nursing report, students found it hardest to plan future patient interventions. Also, 108 students made notes to set reminders of case-related activities. CONCLUSIONS: Third-year nursing students acquire good skills in health promotion and prevention activities. Some activities requiring a greater degree of confidence with the patient need to be reinforced, such as investigating high-risk sexual behaviour and drug use. Reinforcement is also needed in activities that are encountered less often in clinical practice, such as sun protection recommendations and bowel cancer screening. The use of electronic health records in conjunction with simulation enhances self-study.

Development of a Minimum Data Set Registry for Chronic Venous Insufficiency of the Lower Limbs.

The purpose of this study was to develop a minimum data set (MDS) registry for the prevention, diagnosis and treatment of chronic venous insufficiency (CVI) of the lower limbs. We designed the instrument in two phases, comprising a literature review and an e-Delphi study to validate the content. We obtained a total of 39 documents that we used to develop a registry with 125 items grouped in 7 categories, as follows: Patient examination, venous disease assessment methods, diagnostic tests to confirm the disease, ulcer assessment, treatments to manage the disease at all its stages, patient quality of life, and patient health education. The instrument content was validated by 25 experts, 88% of whom were primary healthcare and hospital nurses and 84% had more than 10 years' experience in wound care. Using a two-round Delphi approach, we reduced the number of items in the MDS-CVI to 106 items. The categories remained unchanged. We developed an MDS for CVI with seven categories to assist healthcare professionals in the prevention, early detection, and treatment history of CVI. This tool will allow the creation of a registry in the primary care setting to monitor the venous health state of the population.

Úlcera de evolución tórpida producida por depilación con cera / Ulcer with torpid development caused by waxing

Se presenta el caso clínico de una mujer de 49 años que fue derivada a la consulta de Atención Primaria de Enfermería referente de úlceras, por una herida de siete meses de duración que no cicatrizaba. La paciente presentaba una úlcera de etiología venosa en la cara anterior media tibial de la pierna derecha, producida por efecto de una depilación de vello corporal. Una valoración integral de la persona, incluida su herida, con un plan de cuidados de Enfermería individualizado permitió detectar la insuficiencia venosa que padecía la paciente, aplicar el tratamiento adecuado (compresión terapéutica) y continuarlo una vez la úlcera había cicatrizado. El infradiagnóstico y la falta de un correcto tratamiento de este tipo de lesiones repercute negativamente en la calidad de vida de los pacientes, además de un aumento en los costes sanitarios y laborales, por lo que es necesaria una adecuada formación para su prevención y tratamiento

We hereby present the case report of a 49-year-old woman who was referred to the Primary Care Nursing Unit of reference for ulcers, with a 7-month wound that did not heal. The patient presented an ulcer with venous etiology in the tibial anterior medial side of her right leg, caused by body hair removal. A comprehensive assessment of the person, including her wound, with an individualized Nursing Care Plan, allowed to detect the venous insufficiency suffered by the patient, to implement the adequate treatment (therapeutic compression) and to continue said treatment once the ulcer had healed. Underdiagnosis and lack of adequate treatment for this type of lesions will have a negative impact on patients’ quality of life, as well as lead to an increase in healthcare and occupational costs; therefore, adequate training for their prevention and treatment is required

Percepción de los profesionales sanitarios sobre la gravedad de las úlceras por presión como evento adverso / Perception of health professionals on the severity of pressure ulcers as an adverse event

Introducción: La seguridad de los pacientes representa una prioridad del sistema de salud y un principio fundamental de la atención sanitaria. Las úlceras por presión, evitables en un alto porcentaje, son consideradas el primer evento adverso relacionado con los cuidados de enfermería. Objetivos: Conocer la percepción de los distintos profesionales sanitarios sobre la gravedad de las úlceras por presión como evento adverso. Metodología: Se realizó un estudio descriptivo transversal en enero de 2016 a personal sanitario de diferentes centros de trabajo, principalmente de España y Andorra. Se administró una encuesta online desarrollada por los investigadores ad hoc para la recogida de datos con variables sociodemográficas, experiencia y ámbito de trabajo y los diferentes ítems en los que se pretendía conocer su opinión sobre la importancia de tres efectos adversos: úlceras por presión, caídas y flebitis. Resultados: Participaron 459 profesionales: un 71,24% enfermeras, un 14,81% médicos y un 13,95% técnicos en cuidados auxiliares en enfermería. El 87,7% consideró las úlceras por presión como un evento adverso grave, y las enfermeras fueron el colectivo que consideró este efecto como más grave. Para la prevención de estas lesiones, el 97,8% afirmaron la evidencia de su evitabilidad. No se observó asociación sobre la importancia y consecuencias de las úlceras por presión como evento adverso entre las variables profesión y opinión. Conclusiones: Los encuestados consideraron las úlceras por presión como el evento adverso más grave entre los cuidados de enfermería y consideraron, además, que se pueden prevenir (AU)

Introduction: Patient safety in the healthcare system is a priority and a fundamental principle of health care. Pressure ulcers, which in most cases are avoidable, are considered the first adverse event related to nursing care. Objectives: To understand the observations of different healthcare professionals on the severity of pressure ulcers as an adverse event. Methods: A descriptive, cross-sectional study was carried out in January 2016 amongst healthcare personnel from different workplaces, mainly in Spain and Andorra. An online survey was administered by the ad hoc investigators for the collection of data with socio-demographic variables, experience and scope of work and the different items in which it was intended to know their opinion on the importance of three adverse effects: pressure ulcers, falls and phlebitis. Results: 459 professionals participated: 71.24% nurses, 14.81% doctors and 13.95% nursing assistant. 87.7% considered pressure ulcers as a serious adverse event, with nurses being the group that considered this effect as more serious. For the prevention of these injuries, 97.8% affirmed the evidence of their avoidability. No association was observed on the importance and consequences of pressure ulcers as an adverse event, between the profession and opinion variables. Conclusions: Respondents considered pressure ulcers to be the most serious adverse event among nursing care and considered, moreover, that they can be prevented (AU)

Nurse prescribing in Spain: The law and the curriculum.

In this cross-sectional study, we explored course content related to pharmacology and/or healthcare products and supplies in all nursing degree programs in Spain. Changes in nurse-prescribing legislation in Spain require that nurses take a certification course before prescribing over-the-counter products and medications. Using a cross-sectional descriptive study, between July and September 2014, the degree programs of all centers that offer a degree in nursing in Spain were examined, selecting those with course information available online. All centers offered at least one pharmacology course. One-third of the required courses had content related to pharmacology and healthcare products/supplies. The analysis showed that the course content and training received during the current nursing degree program provides the knowledge and skills needed to prescribe healthcare products/supplies and medications that do not now require a doctor's prescription, without the need for additional training and certification. It is essential that government regulation of nursing education be aligned with nursing competencies, curriculum standards, clinical practice, and evidence-based research to provide the maximum level of confidence for nursing professionals and their patients.

Atención integral a un varón con una úlcera neoplásica, que no va a cicatrizar, en el ámbito de la atención primaria de la salud: caso clínico / Comprehensive health care in a primary health care setting of a man with a difficult-to-heal neoplastic wound: Case report

La atención domiciliaria en Atención Primaria es fundamental en la provisión de cuidados de las personas con enfermedades crónicas al final de la vida. En este artículo se describe el caso de un varón de 90 años que acudió a la consulta de enfermería por una úlcera neoplásica (carcinoma epidermoide), con posible metástasis en pulmón e hígado. El paciente era completamente autónomo, pero desde el diagnóstico y las complicaciones posteriores, menguó su autonomía hasta ser incluido en el programa de atención domiciliaria. Se le realizó radioterapia, lo que mejoró el estado de la úlcera, pero debido al mal pronóstico y al deterioro del estado del paciente, se decidió realizar tratamiento sintomático. Mediante el plan de cuidados de enfermería, se controló el dolor y se evitó el estreñimiento asociado a mórficos. Además, se prescribió cura en ambiente húmedo para gestionar el exudado, disminuir el dolor y facilitar la cooperación de la familia. La atención integral y la colaboración de la familia del paciente, con un adecuado plan de cuidados de enfermería y los recursos necesarios para tratar la herida, permitieron ofrecer unos cuidados de bienestar para el paciente, quien, a pesar de padecer una úlcera que no iba a cicatrizar, no requería menos atención que otras heridas

The role of home care in Primary Care is essential in the chronically ill patient at the end of their life. In this article, the case is presented of a 90 year old man who went to the Primary Care nursing with a malignant wound, which was diagnosed as squamous cell carcinoma, with possible lung and liver metastases. The patient was completely independent, but since the diagnosis and subsequent complications, his independence decreased, and he was included in the Primary Care home care program. He underwent radiotherapy, improving the state of the ulcer, but due to the poor prognosis and the deterioration of the patient, it was decided to treat him symptomatically. By means of a nursing care plan, pain was controlled, the constipation associated with morphine was avoided, and the use of products for moist wound healing for exudate management, pain was reduced, and the family was encouraged to help him change the dressing, among others. Comprehensive care and support of the patient's family, and an adequate nursing care plan, as well as the resources required to treat the wound, allowed to offer some comfort care to the patient, who, despite having a malignant wound that would not heal, needs the same care as any other wound

Course content related to chronic wounds in nursing degree programs in Spain.

PURPOSE: To analyze content related to chronic wounds in nursing degree programs in Spain. DESIGN: Cross-sectional descriptive study. METHODS: Course descriptions available for online access during June and July of 2012 were reviewed for the 114 centers in Spain that offer a nursing degree, according to the official Registry of Universities, Centers, and Titles. FINDINGS: Of the 114 centers with degree programs, 95 (83.3%) post course content online, which make it possible to analyze 2,258 courses. In 60 (63.1%) of these centers, none of the courses included the concept of pressure ulcer prevention, and the course content posted by 36 (37.9%) centers made no mention of their treatment. None of the course descriptions contained any reference to pain management in patients with chronic wounds. Of the 728 elective courses analyzed, only one was related to chronic wounds. CONCLUSIONS: This review of available information about nursing degree programs in Spain indicates that pain management in patients with chronic wounds is not addressed in any course, and more courses consider the treatment of pressure ulcers than their prevention. CLINICAL RELEVANCE: Degree programs responsible for the training of future nurses should be reviewed and revised as needed to ensure that graduates have acquired minimum basic competencies in the prevention and treatment of chronic wounds that help to decrease the theory-practice gap in this field.

Nurse prescribing in primary care in Spain: legal framework, historical characteristics and relationship to perceived professional identity.

AIM: To identify the extent of nurse prescription and determine specific medications and/or health-care supplies routinely prescribed by primary care nurses in Spain in a changing legal context. To explore nurse perceptions of legalized nurse prescription's relationship to professional identity. BACKGROUND: Although the Spanish public has similar confidence in nurses and physicians, professional identity remains a concern for nurses. Nurse prescription has a confusing history in Spain but is increasingly common elsewhere, and may enhance nursing's professional profile. METHOD: A cross-sectional survey reporting the occurrence of nurse prescription in one province in Spain and primary care nurses' perceptions of nurse prescription and professional identity in this province. RESULT: The response rate was 69.6% (87 nurses). Frequent nurse-prescribed medications were vaccinations (63.1%), topical antiseptics (60.7%) and antipyretics(44.8%); health-care supplies included supplies for diabetes (51.8%), wound care dressings (44.2%) and incontinence (26.7%). Respondents indicated that nurse prescription positively contributes to the profession and to its development.Conclusion Nurse prescribing exists in primary care in Spain, and formal legalization is in progress but awaits a consensus formulary. Nurses indicated that full legalization would increase professional autonomy and contribute positively to the profession, as an example of how policy can have an impact on practice.Implications for nursing management Spain's experience with inconclusive shifts in the legal status of nurse prescribing may contribute to the discussion in countries where this professional practice is not yet established.

Knowledge about medications and products to prevent and treat pressure ulcers: a cross-sectional survey of nurses and physicians in a primary health care setting.

AIMS AND OBJECTIVES: To report on a study of what primary care nurses and physicians know about medications and healthcare products to prevent and treat pressure ulcers. BACKGROUND: The prevention and treatment of pressure ulcers has generally become the responsibility of the nursing staff; this has resulted in studies of nurses' knowledge of this task, although few studies include physicians in their analysis. DESIGN: Cross-sectional survey conducted in North Girona (Province) Primary Care Services from February to April 2010. METHODS: The study questionnaire had three sections: sociodemographic data, questions about division of responsibility for the care of patients with pressure ulcers or at risk of developing them, and 36 statements based on the recommendations in clinical practice guidelines provided by well-recognised national and international institutions. RESULTS: Eighty-one nurses (64·8%) and 46 physicians (36·8%) responded to this study. Nurses had greater responsibility for the care of pressure ulcers, made greater use of medical prescriptions to obtain supplies if not available in the primary care centre, were more familiar with the site's clinical practice guidelines on the topic and showed better adherence to their recommendations. Nurses also had better knowledge than the participating physicians of the use of medications and healthcare products to heal or to prevent pressure ulcers. CONCLUSIONS: Nurses had sufficient knowledge and more appropriate skills than the participating physicians for the prescription of medications and healthcare products for the prevention and treatment of pressure ulcers. RELEVANCE TO CLINICAL PRACTICE: The data demonstrated that nurses have sufficient knowledge and skill to provide wound care and could safely write these prescriptions, although Spanish law permitting nurse prescription is not fully implemented.