Efecto del Programa de Ejercicios de Otago en la fragilidad de personas entre 65 y 80 años / Effect of the Otago Exercise Programme on the frailty of people between 65 and 80 years old

Objetivo: Evaluar el efecto del Programa de Ejercicios de Otago en la fragilidad de personas entre 65 y 80 años no institucionalizadas y estudiar factores asociados a la fragilidad. Método: Estudio pre-post test (basal y tras 12 meses) sin grupo control en personas de entre 65-80 años (que viven en la comunidad y con deambulación independiente) tras formarles en el Programa de Ejercicios de Otago en 5 sesiones: semanas 1, 2, 4 y 8, y una sesión de refuerzo a los 6 meses. Los pacientes se seleccionaron en 3 áreas de salud (n=200). La fragilidad se evaluó con la escala FRAIL. Resultados: Las personas que comenzaron el estudio fueron 198 y terminaron el seguimiento de 12 meses 161. La edad promedio de la muestra fue de 72,28 años; predominio del sexo femenino: 64,65%; nivel de estudios bajo 76,50%; personas viviendo solas 24,50%; sobrepeso en el 42% y obesidad grado i en el 32,32%. Se observan diferencias significativas con p=0,023 en el nivel de fragilidad entre el momento basal y a los 12 meses. El análisis exploratorio permitió identificar diferencias significativas antes y después de la intervención por sexo (ser mujer) (p=0,018) y condición de vivir solo (p=0,0468). Conclusiones: El Programa de Ejercicios de Otago presenta resultados positivos en la fragilidad en personas de 65 a 80 años y puede ayudar a mantener la funcionalidad y evitar su deterioro.(AU)

Aim: To evaluate the effect of the Otago Exercise Programme on the frailty of non-institutionalized people between 65 and 80 years of age and study factors associated with frailty. Method: Pre-post test study (baseline and after 12 months) without control group in people aged 65-80 years (living in the community and with independent ambulation) after being trained in the Otago Exercise Programme in 5 sessions: weeks 1, 2, 4 and 8, and a reinforcement session at 6 months. Patients were recruited from 3 health areas (n=200). Frailty was assessed with the FRAIL scale. Results: There were 198 people who started the study and 161 completed the 12-month follow-up. The average age of the sample was 72.28 years; predominance of female sex: 64.65%; low educational level 76.50%; people living alone 24.50%; overweight in 42%, and grade i obesity in 32.32%. Significant differences were observed with a P=.023 in the level of frailty between baseline and 12 months. The exploratory analysis identified significant differences before and after the intervention by sex (being a woman) (P=.018) and condition of living alone (P=.0468). Conclusions: The Otago Exercise Programme shows positive results in frailty in people 65 to 80 years of age and can help maintain function and prevent deterioration.(AU)

Effect of the Otago Exercise Programme on the frailty of people between 65 and 80 years old.

AIM: To evaluate the effect of the Otago Exercise Programme on the frailty of non-institutionalized people between 65 and 80 years of age and study factors associated with frailty. METHOD: Pre-post test study (baseline and after 12 months) without control group in people aged 65-80 years (living in the community and with independent ambulation) after being trained in the Otago Exercise Programme in 5 sessions: weeks 1, 2, 4 and 8, and a reinforcement session at 6 months. Patients were recruited from 3 health areas (n = 200). Frailty was assessed with the FRAIL scale. RESULTS: There were 198 people who started the study and 161 completed the 12-month follow-up. The average age of the sample was 72.28 years; predominance of female sex 64.65%; low educational level 76.50%; people living alone 24.50%; overweight in 42%, and grade I obesity in 32.32%. Significant differences were observed with a P = .023 in the level of frailty between baseline and 12 months. The exploratory analysis identified significant differences before and after the intervention by sex (being a woman) (P = .018) and condition of living alone (P = .0468). CONCLUSIONS: The Otago Exercise Programme prevents positive results in frailty in people 65 to 80 years of age and can help maintain function and prevent deterioration.

Efficacy and safety of early treatment with sarilumab in hospitalised adults with COVID-19 presenting cytokine release syndrome (SARICOR STUDY): protocol of a phase II, open-label, randomised, multicentre, controlled clinical trial.

INTRODUCTION: About 25% of patients with COVID-19 develop acute respiratory distress syndrome (ARDS) associated with a high release of pro-inflammatory cytokines such as interleukin-6 (IL-6). The aim of the SARICOR study is to demonstrate that early administration of sarilumab (an IL-6 receptor inhibitor) in hospitalised patients with COVID-19, pulmonary infiltrates and a high IL-6 or D-dimer serum level could reduce the progression of ARDS requiring high-flow nasal oxygen or mechanical ventilation (non-invasive or invasive). METHODS AND ANALYSIS: Phase II, open-label, randomised, multicentre, controlled clinical trial to study the efficacy and safety of the administration of two doses of sarilumab (200 and 400 mg) plus best available therapy (BAT) in hospitalised adults with COVID-19 presenting cytokine release syndrome. This strategy will be compared with a BAT control group. The efficacy and safety will be monitored up to 28 days postadministration. A total of 120 patients will be recruited (40 patients in each arm). ETHICS AND DISSEMINATION: The clinical trial has been approved by the Research Ethics Committee of the coordinating centre and authorised by the Spanish Agency of Medicines and Medical Products. If the hypothesis is verified, the dissemination of the results could change clinical practice by increasing early administration of sarilumab in adult patients with COVID-19 presenting cytokine release syndrome, thus reducing intensive care unit admissions. TRIAL REGISTRATION NUMBER: NCT04357860.

Quasiexperimental intervention study protocol to optimise the use of new antibiotics in Spain: the NEW_SAFE project.

INTRODUCTION: Ceftaroline, tedizolid, dalbavancin, ceftazidime-avibactam and ceftolozane-tazobactam are novel antibiotics used to treat infections caused by multidrug-resistant pathogens (MDR). Their use should be supervised and monitored as part of an antimicrobial stewardship programme (ASP). Appropriate use of the new antibiotics will be improved by including consensual indications for their use in local antibiotic guidelines, together with educational interventions providing advice to prescribers to ensure that the recommendations are clearly understood. METHODS AND ANALYSIS: This study will be implemented in two phases. First, a preliminary historical cohort (2017-2019) of patients from 13 Andalusian hospitals treated with novel antibiotics will be analysed. Second, a quasiexperimental intervention study will be developed with an interrupted time-series analysis (2020-2021). The intervention will consist of an educational interview between prescribers and ASP leaders at each hospital to reinforce the proper use of novel antibiotics. The educational intervention will be based on a consensus guideline designed and disseminated by leaders after the retrospective cohort data have been analysed. The outcomes will be acceptance of the intervention and appropriateness of prescription. Incidence of infection and colonisation with MDR organisms as well as incidence of Clostridioides difficile infection will also be analysed. Changes in prescription quality between periods and the safety profile of the antibiotics in terms of mortality rate and readmissions will also be measured. ETHICS AND DISSEMINATION: Ethical approval will be obtained from the Andalusian Coordinating Institutional Review Board. The study is being conducted in compliance with the protocol and regulatory requirements consistent with International Council of Harmonisation E6 Good Clinical Practice and the ethical principles of the latest version of the Declaration of Helsinki. The results will be published in peer-reviewed journals and disseminated at national and international conferences. TRIAL REGISTRATION NUMBER: NCT03941951; Pre-results.

Satisfacción de las enfermeras de Osakidetza con las aplicaciones móviles para el cuidado enfermero / Satisfaction among Osakidetza nurses with mobile applications for nursing care

OBJETIVO: explorar la satisfacción de las enfermeras de Osakidetza con las aplicaciones informáticas móviles para el cuidado enfermero, así como su valoración sobre la formación recibida para su utilización, la facilidad de su uso, las características de la información gestionada y el impacto sobre el cuidado del paciente. MÉTODO: estudio descriptivo transversal. Población objeto de estudio: enfermeras de Osakidetza que trabajaban con aplicaciones informáticas móviles. VARIABLES: sociodemográficas y laborales, de usabilidad, formación y soporte recibidos, impacto, satisfacción con las aplicaciones móviles incluidas. Fueron recogidas mediante cuestionario diseñado adhoc. Se realizó un análisis estadístico descriptivo y un análisis bivariantes, mediante el test Chi cuadrado. RESULTADOS: se recibieron 518 cuestionarios (33,5%). El 37,8% refirió satisfacción a nivel general con las aplicaciones utilizadas, el 27,2% mayor agilidad al efectuar el trabajo con tableta y el 36,1% una mejor realización del trabajo. La aplicación con mayor satisfacción fue la que facilita el registro de constantes (61,8%). Un 74,8% refirió impacto positivo sobre la seguridad del paciente. Se encontraron diferencias estadísticamente significativas según la función desempeñada (mayor satisfacción en las enfermeras gestoras; p= 0,023), según nivel de utilización en la vida diaria (mayor satisfacción en utilización media y alta; p= 0,036), y en función del turno de trabajo (mayor satisfacción en turno fijo; p= 0,021). CONCLUSIONES: el nivel de satisfacción con las aplicaciones móviles para el cuidado es discreto. Para conocer el impacto de estas herramientas y la satisfacción general con ellas, se recomienda ser valoradas cuando el despliegue realizado en las organizaciones esté consolidado

OBJECTIVE: to explore the satisfaction among Osakidetza nurses with the mobile applications for nursing care, as well as their evaluation of the training received for their use, ease of use, characteristics of the information managed, and impact on patient care. METHOD: a descriptive cross-sectional study. Population object of the study: Osakidetza nurses working with mobile applications. VARIABLES: sociodemographical and occupational, usability, training and support received, impact, satisfaction with the mobile applications included; these were collected through a questionnaire designed ad hoc. Descriptive statistical analysis was conducted, as well as bivariate analysis, through Chi Square Test. RESULTS: in total, 518 questionnaires (33.5%) were received; 37.8% reported overall satisfaction with the applications used, 27.2% reported that working with the tablet was faster, and 36.1% stated that their work was better conducted. The application with the highest satisfaction level was the one that provides vital sign records (61.8%); 74.8% of participants reported a positive impact on patient safety. Statistically significant differences were found depending on the role played (higher satisfaction among nurse managers; p= 0.023), according to the level of use in daily life (higher satisfaction in medium and high use; p= 0.036), and based on the working shift (higher satisfaction in regular shifts: p= 0.021). CONCLUSIONS: there is a moderate level of satisfaction with mobile applications for patient care. In order to understand the impact of these tools and the overall satisfaction with them, it is recommended to assess them once the display conducted in agencies has been firmly established

Percepción de barreras para la utilización de la investigación en enfermeras de Osakidetza / Barriers to the implementation of research perceived by nurses from Osakidetza

Objetivo: Conocer la percepción de barreras para incorporar los resultados de investigación a la práctica en las enfermeras/os de Osakidetza y analizar si los factores ámbito laboral y tiempo trabajado afectan a la percepción de dichas barreras. Métodos: Estudio descriptivo, transversal, multicéntrico. El cuestionario BARRIERS fue administrado a 1.572 enfermeras de Osakidetza estratificadas y aleatorizadas según ámbito de trabajo y responsabilidad laboral (tasa de respuesta: 43,76%). Resultados: La primera barrera identificada fue ‘el tiempo insuficiente en el trabajo para implementar nuevas ideas’. La dimensión organizacional fue la mayor barrera percibida. Las enfermeras/os del ‘Hospital de Servicios Especiales’ percibieron más barreras en el factor ‘calidad de la investigación’ que los que trabajaban en ‘Atención Primaria’. El tiempo de antigüedad mostró una débil influencia. Conclusiones: Las/os enfermeras/os de Osakidetza declararon que los factores externos relacionados con la organización son los que principalmente interfirieren en la incorporación de los resultados a la práctica clínica. En segundo lugar situaron la falta de formación para hacer una lectura crítica. El ámbito laboral y la antigüedad marcan diferencias en la percepción de barreras. Este estudio puede ayudar a establecer estrategias para la planificación de programas formativos más adecuados que ayuden a facilitar la utilización de la investigación en la práctica clínica, con el fin de prestar una atención de calidad (AU)

Objective: To understand the barriers to implementing nursing research findings into practice, as perceived by the nurses working in Osakidetza and to analyze if the workplace factor and time worked affect the perception of these barriers. Methods: Cross-sectional study. BARRIERS Scale questionnaire was given to a representative sample of 1,572 Basque Health Service nurses, stratified and randomized, according to scope of work and job responsibility (response rate: 43.76%). Results: According to the research results, the first important barrier was ‘insufficient time on the job to implement new ideas’. Nurses have perceived the organizational factor as the most important barrier in their practice. Nurses in ‘Special hospital departments’ perceived more barriers in the ‘quality of research’ factor than those working in ‘Primary Care’. Years of service showed a slight influence. Conclusions: The nurses stated that external factors related to the organization principally interfered in implementing results into clinical practice. They placed lack of critical reading training second. Working environment and seniority mark differences in the perception of barriers. This study may help to develop strategies for planning training programs to facilitate the use of research in clinical practice, in order to provide quality care (AU)

Barriers to the implementation of research perceived by nurses from Osakidetza. / Percepción de barreras para la utilización de la investigación en enfermeras de Osakidetza.

OBJECTIVE: To understand the barriers to implementing nursing research findings into practice, as perceived by the nurses working in Osakidetza and to analyze if the workplace factor and time worked affect the perception of these barriers. METHODS: Cross-sectional study. BARRIERS Scale questionnaire was given to a representative sample of 1,572 Basque Health Service nurses, stratified and randomized, according to scope of work and job responsibility (response rate: 43.76%). RESULTS: According to the research results, the first important barrier was "insufficient time on the job to implement new ideas". Nurses have perceived the organizational factor as the most important barrier in their practice. Nurses in "Special hospital departments" perceived more barriers in the "quality of research" factor than those working in "Primary Care". Years of service showed a slight influence. CONCLUSIONS: The nurses stated that external factors related to the organization principally interfered in implementing results into clinical practice. They placed lack of critical reading training second. Working environment and seniority mark differences in the perception of barriers. This study may help to develop strategies for planning training programs to facilitate the use of research in clinical practice, in order to provide quality care.

Encefalopatía metabólica secundaria a intoxicación por vitamina D / Metabolic encephalopathy secondary to vitamin d intoxication

La asociación entre la deficiencia de vitamina D y un mayor riesgo de diversas enfermedades, entre ellas cardiovasculares y autoinmunes, ha aumentado en los últimos años el uso de suplementos para la normalización de los valores plasmáticos de esta vitamina. Desde entonces se ha descrito un mayor número de casos de intoxicación iatrogénica por vitamina D. Presentamos una enferma de 81 años con encefalopatía metabólica e insuficiencia renal secundarias a una intoxicación por vitamina D. Los suplementos orales con calcio y vitamina D se le prescribieron después de sufrir una fractura vertebral osteoporótica. La enferma mejoró clínica y analíticamente tras hidratación y diuréticos. Es importante destacar la hipercalcemia como causa de encefalopatía metabólica y considerar la intoxicación por vitamina D como etiología poco frecuente pero posible de hipercalcemia e insuficiencia renal reversibles (AU)

The association between vitamin D deficiency and increased risk of, among others, cardiovascular and autoimmune diseases has lead in the last years to an enhanced interest in the usage of supplements to achieve the normalization of plasmatic values at 25(OH) D. Apparently this search for normalization is resulting in an higher incidence on vitamin D intoxication. We present the case of an 81 years old woman with metabolic encephalopathy and renal failure secondary to iatrogenic vitamin D intoxication. Calcium and vitamin D oral supplements were prescribed after an osteoporotic vertebral fracture. The patient improved clinically as well as analytically after receiving treatment with diuretics and hydration. We emphasize the importance of discarding hypercalcemia as a cause of metabolic encephalopathy; moreover we highly recommend keeping vitamin D intoxication in mind as an uncommon although always possible etiology of reversible hypercalcemia and renal failure (AU)

Tratamiento del dolor persistente de hombro con inyección subacromial de ácido hialurónico / Treatment of persistent shoulder pain with subracromial sodium hyaluronate injection

Introducción y objetivo: El dolor de hombro es un motivo frecuente de consulta y se relaciona con perdida de función articular y periodos de invalidez significativa. El objetivo de este trabajo es evaluar el efecto de la infiltración subacromial con ácido hialurónico, mediante una única dosis, en el tratamiento del dolor de hombro, comparandolo con la infiltración subacromial de corticoides. Material y método: Este es un estudio aleatorizado, doble-ciego, controlado con el tratamiento con corticoides. Los pacientes que se incluyeron en el estudio fueron aleatorizados en dos grupos, uno donde se infiltró una solución de corticoides (1cc triamcinolona acetonido+2cc mepivacaína), y otro que se trató con una única infiltración de 3cc ácido hialurónico (20mg/cc).Los pacientes se evaluaron en el momento de la infiltración y luego en los meses 1, 3 y 6. Los resultados se valoraron en términos de disminución del dolor (registrado mediante la Escala Visual Analógica: EVA) y mejoría de la función articular (mediante la escala de Constant).Resultados: Se formaron dos grupos de 9 pacientes comparables en edad, valor de la EVA (media 6.29±1.54) y del Constant (media 66.17±17.9). En el momento del la última valoración (mes 6), ambos grupos mostraron una reducción significativa del dolor y una incremento de los valores del Constant. No existían diferencias significativas entre los dos grupos. Conclusiones: Los resultados muestran que la infiltración subacromial de ácido hialurónico disminuye el dolor y mejora la función articular del mismo modo que los corticoesteroides. Los corticoesteroides hacen mejorar a los pacientes más rápido, mientras que con el ácido hialurónico la mejoría es progresiva, presentando los mismos resultados a los 6 meses (AU)

Purpose: Persistent shoulder pain is a highly prevalent problem that is frequently associated with limited range of motion and decreased function. The purpose of this study is to evaluate the effect of subacromial injections of sodium hyaluronate inpatients with pain shoulder, clinical subacromial impingement, and no rotator cuff tear. Material: This was a randomized, double-blind (blinded observer),corticoid controlled study. It was designed to evaluate the efficacy of subacromial sodium hyaluronate injection in patients with persistent shoulder pain. They were randomized into two treatment groups receiving both a single subacromial injection, either corticoid solution (1cc triamcinolone acetonide + 1cc mepivacaine),or sodium hyaluronate (2cc). Patients were evaluated at baseline and at 1, 3 and 6 months. Demographic data were registered before stating the study. Entity of pain was evaluated with the use of the Visual Analogue Scale (VAS). Functional assessment was performed according to the Constant Score. Results: Nine patients were allocated in each group. The demographic characteristics were similar in the two treatment groups. At baseline mean EVA was 6.29 (SD 1.54) and mean Constant score was 66.17 (SD 17.9). Both groups showed significant reduction from baseline in the VAS and an increase in his functional score whith in the first month. No significant changes were seen between first month and neither 3 nor 6 month assessment. Conclusions: These results show that Sodium Hyaluronate subacromial injections are an effective treatment option in patients with persistent shoulder pain and no rotator cuff tear. Compare to corticoid injection have shown same results at medium term follow-up. However, sodium hyaluronate injections can prevent the occurrence of corticoids-related complication, such as local degradation of tissues, tendon tearing, or arthropathy. Most of the improvent in functional score and pain relief is seen in the first 4weeks, after that no significant changes are shown (AU)

Situación de la endocrinología y la nutrición clínica hospitalarias en España / Current situation of hospital-based endocrinology and clinical nutrition in Spain

En 2006, la Comisión de Asistencia de la Sociedad Española de Endocrinología y Nutrición realizó una encuesta para conocer la situación actual de la endocrinología y nutrición clínica en los sistemas públicos de salud de España. En esta ocasión, la encuesta ha sido más amplia que en ocasiones anteriores y, además de datos sobre el número y distribución de los especialistas en las diferentes Comunidades autónomas, se han recogido datos concretos de actividad asistencial. La participación media de los hospitales públicos con especialistas en endocrinología y nutrición ha sido del 50% (AU)

In 2006, the Healthcare Commission of Spanish Society of Endocrinology and Nutrition did a survey in order to know the actual situation of endocrinology and clinical nutrition healthcare in Public Sanitary Systems in Spain. The survey has been more extensive than the last and it has taken up number and geographical distribution of specialists in Spain in addition to data about clinical assistance. The mean of public hospitals with endocrinologist participation has been 50% (AU)

Evolución del rol del supervisor de enfermería hacia el gestor de cuidados / Evolution of the role of a nursing supervisor towards a care manager

La profesión enfermera, adaptándose a los nuevos cambios sociosanitarios,busca sistemas que le permitan gestionar mejor la asistencia alos usuarios del Sistema Nacional de Salud. Las enfermeras tienen unpoderoso foco de servicio y una buena razón profesional para influiren las decisiones relacionadas con la configuración de servicios, en laasignación de recursos y en la elaboración de la estrategia para lasalud futura. Por ello, con el presente estudio se pretende:Objetivo: conocer la opinión de las enfermeras supervisoras/es delHospital Santiago Apostol de Vitoria, sobre el papel que juega laSupervisión de Enfermería en el citado centro asistencial.Métodos: estudio cualitativo mediante grupo de discusión con supervisorasdel Hospital. Las intervenciones fueron grabadas y transcritasliteralmente, llevándose a continuación un análisis de contenido.Resultados: agrupación de los datos en categorías: a) situaciónactual de los Supervisor de Enfermería respecto a la gestión de cuidados.Se exploran los problemas que encuentran las supervisoras en suquehacer diario; b) propuestas de cambio respecto al hecho de cuidar;c) percepción del nuevo rol de la gestora de cuidados.Discusión y conclusiones: la supervisora de Enfermería se enfrentaa diario con situaciones complejas y ambiguas para el desempeño delpropio rol. Es necesario modificar las estructuras de gestión. Hay quepotenciar el cambio para garantizar la calidad de los cuidados. Lasprincipales implicaciones para la práctica clínica son: cambio en lasfunciones de la supervisora y cambio en la estructura organizacional

The nursing profession has been constantly adapting to socioeconomicchanges in its search for systems that improve the managementof healthcare for the benefit of users of the national health system.Nurses have a powerful service focus and a good professionalreason to influence the decisions related to the configuration of services,in the allocation of resources, and in the elaboration of thestrategy for future health. Because of this, this article aims to:Objective: to ascertain the opinion of supervisor nurses at theHospital Santiago Apostol de Vitoria on the role played by the nursingsupervisors at the said healthcare center.Methods: qualitative study with a discussion group composed of hospitalnursing supervisors. The interventions were recorded and transcribedliterally, with subsequent contents analysis.Results: data were group together into categories: a) Current situationof the nursing supervisor with regard to care management.Problems faced by the nurses in their daily routines are explored, b)Change proposals with regard to the fact of caring, c) Perception of anew role of the care manager.Discussion and conclusions: the nursing supervisor is faced dailywith complex and ambiguous situations for the development of theirown role. It is necessary to modify management structures. Changeneeds to be enhanced to ensure the quality of the services. The mainimplications for the clinical practice are as follows: change in the functionsof a supervisor and the change in the organisational structure

Servicio enfermero ofertado en una unidad de hospitalización de Nefrología / Nursing services offered in a hospital unit for nephrology

La aportación de la disciplina enfermera se concreta en la prestación de cuidados, y el proceso de enfermería permite reconocer la aportación de las enfermeras a los resultados de salud del paciente. En el Servicio Vasco de Salud (Osakidetza) se trabaja con el programa informático Zaineri, que recoge bajo soporte informático todos los cuidados y actividades que la enfermera realiza en la práctica diaria. Es fundamental que en las unidades se analice qué servicio estamos ofertando a nuestros clientes. Por ello el objetivo de este trabajo es describir el trabajo que realizan las enfermeras de Nefrología, a través del análisis de las necesidades alteradas de los pacientes ingresados y de los diagnósticos de enfermería planteados durante el año 2002. Material y método: estudio descriptivo de los planes de cuidados de los pacientes ingresados en la unidad entre el 1 de Enero de 2002 y el 31 de Diciembre de 2002. Resultados: del total de necesidades planteadas, el 65,30% pertenecen al área independiente de Enfermería mientras un 34,70% pertenecen al área interdependiente. Los diagnósticos derivados de Necesidades Humanas corresponden al 56,63% sobre el total, mientras aquellos diagnósticos (complicaciones) derivados de los sistemas, tienen un porcentaje del 43,37% (AU)

Nursing skills are offering a number of services to the patient, including its care. Nursing processes allow the identification of results on the patient´s health. In the Vasc Service of Health (Osakidetza) we work with the programme Zaineri that collects all processes done by nurses in their daily activities. Is is important to analyze what kind of service we are offering to our clients, therefore, the aim of this work is to describe the work done by nurses of nephrology through the analysis of the patient´s needs and nursing diagnosis during 2002. Material and methods: descriptive study of the care plan for patients from Jan 1st 2002 to Dec 31st 2002. Results: from all needs analyze, 65% belong to the nurse independent area, while 34% belong to the interdependent area. Diagnosis obtained from human needs are 57% while those obtained from systems are 43% (AU)