Estudio RN4CAST en Murcia: características organizacionales de los hospitales y perfiles enfermeros / RN4CAST Study in Murcia: Hospital organizational characteristics and nursing staff profiles

Objetivo. Conocer los perfiles de las enfermeras de los hospitales públicos de Murcia y su percepción sobre el entorno laboral, la calidad de los cuidados y su nivel de burnout (réplica metodológica proyecto RN4CAST). Material y métodos. Estudio descriptivo y transversal realizado en 8 hospitales de Murcia. Se recogieron datos entre 2009 y 2010 a 687 enfermeras (estratificando por tipo de unidades) mediante cuestionario autocumplimentado de 149 ítems con variables sociodemográficas, del trabajo, de la percepción del ambiente laboral (PES-NWI), del burnout (Maslach Burnout Inventory), de la calidad y de la seguridad del paciente. Análisis: pruebas no paramétricas para 2 muestras o k muestras según la comparación. Resultados. Se recogieron 495 encuestas (72%). El 80,4% eran mujeres con una edad media de 34,1 (DE = 7,1) años y de 9,4 (DE = 7,4) años trabajados. El 25,7% ha realizado durante los últimos 24 meses más de 300 h de formación. La ratio paciente/enfermera fue de 11,7 (DE = 3,6) con variabilidad entre hospitales. Dos hospitales tenían un clima desfavorable y 3 hospitales tuvieron clima favorable (los hospitales grandes obtuvieron peores valoraciones); se observó una baja intención de abandonar el trabajo (16,8%). Con respecto al burnout en agotamiento emocional se alcanzó una puntuación de 18,4; en despersonalización de 7,5 y en realización personal de 28,8. La percepción sobre la calidad presentó diferencias entre centros y la de los efectos adversos fue más favorable en los hospitales pequeños. Conclusiones. Los profesionales estudiados estaban satisfechos, pero habría que potenciar los factores que generan bienestar y minimizar los puntos débiles detectados en el análisis del clima laboral (AU)

Objective: To determine the profile of nurses in public hospitals in Murcia and to assess how they perceive their work environment, the quality of care and their level of burnout (the RN4CAST project repetition). Material and methods: A cross-sectional descriptive study was carried out in 8 hospitals in Murcia. Data were collected between 2009 and 2010 from 687 nurses (stratified by the type of unit) using a self-completed questionnaire with 149 items covering variables related to sociodemographics; work; perception of the work place (PES-NWI); burnout (Maslach Burnout Inventory); and the quality of patient care, and patient safety. Analysis: Non parametric tests, for two samples or k samples according to the comparison. Results: A total of 495 questionnaires were collected (72%). Most respondents were female (80.4%) having a mean age of 34.1 (SD = 7.1) years, and they had been working for 9.4 (SD = 7.4) years. Just over one-quarter (25.7%) had carried out more than 300 hours of training in the previous 24 months. The patient/nurse ratio was 11.7 (SD = 3.6), varying between hospitals. The nurses reported 25% of hospitals as having an unfavorable work environment, whereas 37.5% had favorable ones; large hospitals were less highly valued. Few respondents intended to give up their jobs (16.8%). Burnout levels revealed emotional exhaustion in 18.4% of respondents; depersonalization in 7.5%, and personal fulfillment in 28.8%. Perception of quality varied between centers and the perception of adverse effects was more favorable in small hospitals. Conclusions: Our professionals were generally satisfied, but given the unfavorable work environment, measures should be adopted for improving well-being and reducing weaknesses (AU)

[RN4CAST Study in Murcia: Hospital organizational characteristics and nursing staff profiles]. / Estudio RN4CAST en Murcia: características organizacionales de los hospitales y perfiles enfermeros.

OBJECTIVE: To determine the profile of nurses in public hospitals in Murcia and to assess how they perceive their work environment, the quality of care and their level of burnout (the RN4CAST project repetition). MATERIAL AND METHODS: A cross-sectional descriptive study was carried out in 8 hospitals in Murcia. Data were collected between 2009 and 2010 from 687 nurses (stratified by the type of unit) using a self-completed questionnaire with 149 items covering variables related to sociodemographics; work; perception of the work place (PES-NWI); burnout (Maslach Burnout Inventory); and the quality of patient care, and patient safety. ANALYSIS: Non parametric tests, for two samples or k samples according to the comparison. RESULTS: A total of 495 questionnaires were collected (72%). Most respondents were female (80.4%) having a mean age of 34.1 (SD=7.1) years, and they had been working for 9.4 (SD=7.4) years. Just over one-quarter (25.7%) had carried out more than 300 hours of training in the previous 24 months. The patient/nurse ratio was 11.7 (SD=3.6), varying between hospitals. The nurses reported 25% of hospitals as having an unfavorable work environment, whereas 37.5% had favorable ones; large hospitals were less highly valued. Few respondents intended to give up their jobs (16.8%). Burnout levels revealed emotional exhaustion in 18.4% of respondents; depersonalization in 7.5%, and personal fulfillment in 28.8%. Perception of quality varied between centers and the perception of adverse effects was more favorable in small hospitals. CONCLUSIONS: Our professionals were generally satisfied, but given the unfavorable work environment, measures should be adopted for improving well-being and reducing weaknesses.

How to fill an application for accreditation of Continuing Medical Education activity in Allergology.

Continuing medical education (CME) is a critical tool as well as a generally accepted concern for physicians, while being both a commitment and an obligation for the Administration. In Spain, during the past decades, CME has been a constant concern of many groups; however, it was not until the end of the eighties when efforts at accreditation began to emerge. A significant step was the establishment of the Commission on Continuing Education of Health Professions of the National Health System, an agency of the Consejo Interterritorial (Inter-regional Council), whose accreditation system started in 1998, using the figure of Sector Conference, included in Articles 5 and 8 of the Ley de Régimen Jurídico de las Administraciones Públicas y del Procedimiento Administrativo Común (Law on Legal Regime of Public Administration and Common Administrative Procedures), as Senior Technical Body on the matter. Since then, various Regional Committees and the Spanish Accreditation System of Continuing Medical Education (SEAFORMEC) have been created. Although we earlier published a guide, in this manuscript we have updated the steps that must be taken to apply for accreditation of CME activity in Allergology, explaining the different items in the official application form, clarifying to whom the request should be addressed, and outlining the foundations on which the activities will be evaluated for accreditation purposes, in order to ensure that the training meets the highest standards for quality, so that the objectives that lead to achieving maximum performance and competence of health professionals may be reached.

How to fill an application for accreditation of Continuing Medical Education activity in Allergology

Continuing medical education (CME) is a critical tool as well as a generally accepted concern forphysicians, while being both a commitment and an obligation for the Administration. In Spain, during the past decades, CME has been a constant concern of many groups; however, it was not until the end of the eighties when efforts at accreditation began to emerge. A significant step was the establishment of the Commission on Continuing Education of Health Professions of the National Health System, an agency of the Consejo Interterritorial (Inter-regional Council), whose accreditation system started in 1998, using the figure of Sector Conference, included in Articles 5 and 8 of the Ley de Régimen Jurídico de las Administraciones Públicas y del Procedimiento Administrativo Común (Law on Legal Regime of Public Administration and Common Administrative Procedures), as Senior Technical Body on the matter. Since then, various Regional Committees and the Spanish Accreditation System of Continuing Medical Education (SEAFORMEC) have been created. Although we earlier published a guide, in this manuscript we have updated the steps that must be taken to apply for accreditation of CME activity in Allergology, explaining the different items in the official application form, clarifying to whom the request should be addressed, and outlining the foundations on which the activities will be evaluated for accreditation purposes, in order to ensure that the training meets the highest standards for quality, so that the objectives that lead to achieving maximum performance and competence of health professionals may be reached

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[MIR family medicine program: cross-professional interaction in a complex reality]. / Programa MIR de medicina familiar: una interacción transprofesional en una realidad compleja.

OBJECTIVE: To find the view of trainers (tutors and teaching assistants) of third-year family and community medicine (FCM) residents concerning their own teaching activity in areas such as training, the skills and qualities required to be a teacher and the inter-professional relationships that are current and that are needed in a primary care teaching team. DESIGN: Qualitative study developed between June 2000 and May 2002. Sample design with a volunteer population. SETTING: FCM teaching unit under the Primary Care Administration of Murcia. PARTICIPANTS AND/OR CONTEXTS: Tutors and teaching assistants in the FCM residents' programme. METHOD: Semi-structured interview for information gathering. Contents analysis to construct results on the basis of the semiological analysis of the textual discourse. Systematic return of the results. RESULTS: Belonging to the teaching team is the highest motivation for taking part in teaching. It gives the tutors more benefits (affective, care load) than difficulties (organisational adaptation). The tutor profile is sustained by his/her scientific-technical and personal qualities; that of the nurse, by his/her community qualities. Collaboration between nurse and tutor is informal and the teaching strategies most employed by tutors are guidance, guide-lines and encouragement of residents' autonomy. Nurses collaborate with teaching by transmitting a model of professional development and facilitating teamwork. CONCLUSIONS: The complexity of the training process stands out. Postgraduate FCM training is cross-professional, not exclusively circumscribed by the tutor-resident teaching relationship. The qualitative paradigm is shown to be useful for obtaining a vision of the teaching process from the perspective of different actors.

Formación en metodología para la mejora de los servicios sanitarios / Training in methodology for the improvement of the health services

El proceso docente en la formación para la mejora de los servicios de salud exige coherencia entre el contenido de la acción formativa y la calidad de la propia actividad docente. Son características específicas de la misma las que a continuación describimos: - Los "clientes" (alumnos) son, por un lado, los responsables de la institución y, por otro, los profesionales de la organización. - La iniciativa para la formación en métodos para la mejora de la calidad debe partir de la propia dirección de la organización. - Los contenidos del programa docente deben incluir aspectos cientificotécnicos y de relación en la organización. - Es útil la integración de diferentes subgrupos profesionales en la actividad formativa y generar estrategias docentes que estimulen la participación activa de los alumnos. Son eficaces las metodologías grupales, los estudios de casos, el aprendizaje por problemas, por proyectos y por tareas en situaciones reales. Todas estas estrategias docentes son más efectivas si están centradas en las necesidades del propio alumno (aprendizaje significativo). - El alumno en la formación en esta área temática es considerado como el protagonista indispensable y "un verdadero experto" de la actividad que realiza. El profesor es más un facilitador que controla la relación docente y que favorece su aplicación al contexto real y cotidiano. Estas características dan a la formación en la mejora de la calidad de los servicios sanitarios un matiz diferenciador, no exclusivo, que debe tenerse en cuenta para incrementar su efectividad (AU)

[Construction and validation of an attitude scale to primary health care]. / Construcción y validación de una escala de actitudes hacia la atención primaria de salud.

OBJECTIVES: To elaborate and validate a scale which can be used as an instrument to find the attitudes towards primary health care of doctors at the first care level. DESIGN: Validation study and questionnaire on attitudes. SETTING: The first care level in the Murcia region. Subjects were 155 doctors (27 family and 128 general doctors) in fixed and provisional posts working in the out-clinics and health centres. MEASUREMENTS AND RESULTS: A Likert-type attitudes scale was designed with five reply options. After the pilot-study on the initial scale and the full item-item correlation, the definitive 46-item survey was elaborated. Selection of subjects was through two-stage stratified randomised sampling, by specialty (general/family medicine) and health district. Reliability was high. Contents validity was reached through various consensus methods. To test validity of construction, a factorial analysis of the main components was performed, with 7 factors isolated: overall patient care, team-work, guidance on health problems, doctor's interest in in-work training, professional role, concern for the psychosocial aspects of the illness and inclusion of second level professionals. CONCLUSIONS: The scale designed is a valid instrument, both a reliable way of identifying PHC doctors' attitudes and the attitudes, which could be improved.

[Continuing education in primary care: needs perceived by physicians, pediatricians, and nursing staff]. / Formación continuada en atención primaria: necesidades sentidas por médicos, pediatras y personal de enfermería.

OBJECTIVE: To determine the on-going training (OT) needs expressed by Primary Care professionals in the Murcia region. DESCRIPTION: A descriptive, crossover study using a postal questionnaire, filled in anonymously by the subjects themselves. SETTING: Primary Care. PARTICIPANTS: All the PC health professionals (doctors, nurses, paediatricians) in the Murcia region (n = 1052). MEASUREMENTS AND MAIN RESULTS: 37.93% of the questionnaires were returned (n = 399): 39.14% of doctors, 35.02% of nurses and 43.5% of paediatricians. 94.7% of respondents thought that OT was necessary; and 80.5% thought it should be compulsory. The main learning source was journals, although courses were considered more useful. Limitations on OT were: incompatibility with working hours, lack of financing (for cover) and lack of time to attend courses. Doctors, nurses and paediatricians agreed that the priority OT areas were: "organising the PC team," "recording procedures and programming" and "guaranteed quality". CONCLUSIONS: The PC professional who replied to our questionnaire considers that he/she needs on-going training, that this should be compulsory, that courses set up by the administration are useful and that time and financing are the limitations on OT.

[Professional profile of primary health care personnel. A Delphi study]. / Perfil profesional del personal sanitario en atención primaria. Un estudio Delphi.

OBJECTIVE: To determine the professional profile of health staff (doctors, paediatricians and nurses) in primary care (PC). DESIGN: Three simultaneous Delphi techniques (consensus method). SETTING: Primary care. PARTICIPANTS: 55 doctors, 45 nurses and 23 paediatricians from the whole of Spain and different fields of activity. INTERVENTION: The filling in of three questionnaires, using the Delphi methodology. RESULTS: The overall percentage of replies was 69.1% (first questionnaire), 70.7% (2nd) and 60.16% (3th). The PC doctor should guide in a suitable way his/her community's health problems, using the relevant diagnostic and therapeutic methods, caring for patients' all-round health, controlling the doctor-patient interview, all in collaboration with other professionals, with a planning, programming and evaluation of his/her activity and a basically community-oriented approach. The nursing professional should provide all-round care for patients, using nursing diagnostic and therapeutic methods, within a multidisciplinary team and carrying out planning, programming and evaluation of the community's health problems. The PC paediatrician should be concerned with the prevention and treatment of the most common pathologies. He/she has a vital role to play in childrens' health education, should have the training to resolve the most common paediatric emergencies and organise his/her work within a multidisciplinary team. CONCLUSIONS: The Delphi method is a useful technique for determining professional profiles. Paediatricians have a more sharply defined profile than doctors and nursing staff.