Physiotherapists' Evidence-Based Practice profiles by HS-EBP questionnaire in Spain: A cross-sectional normative study.

Evidence-Based Practice (EBP) is a cost-effective approach for improving the quality of clinical care and implementing only well-tested evidence. Health professions, especially physiotherapy, must embrace EBP principles. This paper presents normative data from the Spanish physiotherapist population using the Health-Sciences Evidence-Based Practice questionnaire and explores EBP clusters/profiles of professionals in practice. An intentional sample of 419 practicing physiotherapists was recruited from the Spanish Professional Council of Physiotherapy. Participants completed a cross-sectional online survey with 60 Likert items (scale 1-10) measuring 5 dimensions: 1) Beliefs and attitudes, 2) Results from literature, 3) Professional practice, 4) Assessment of results, and 5) Barriers and Facilitators. The protocol also included sociodemographic, training, and practice-related contrast variables. Normative data were estimated and tabulated for each dimension and then a K-means clustering procedure was implemented using the contrast variables. Results for normative data showed, in descending order, the following 50th percentile values for the five EBP factors: Beliefs and attitudes (8.25), Professional practice (8.00), Assessment of results (7.42), Results from literature (6.71), and EBP Barriers and Facilitators (5.17); all expressed on a scale of 1 to 10. Academic degree, EBP training level, and work time shared in healthcare activity, research, or teaching activity were all statistically significant for discriminating EBP dimension scores. Finally, six different clusters showed that when EBP level is low, the scores in all dimensions are equally low, and vice-versa. The EBP dimensions "Beliefs and attitudes", "Professional practice", and "Evaluation of results" obtained better normative scores overall than "Search for bibliographic evidence and its inclusion in practice" and especially "Perception of EBP barriers", which had the worst score. Normative data are useful for comparing individual scores and the reference population, and information about clusters will enable appropriate global EBP intervention programs to be designed and implemented.

Desarrollo competencial y clima organizacional para el desempeño de una práctica avanzada de los profesionales de Enfermería / Competency development and organizational environment for performance of advanced practice by Nursing professionals

Objetivo: evaluar el grado de desarrollo del nivel competencial de las enfermeras de las Illes Balears relacionado con la autopercepción de los factores individuales para el desarrollo de una práctica basada en la evidencia y cultura y factores organizacionales. Método: se llevó a cabo un estudio descriptivo transversal sobre la población de profesionales de Enfermería colegiados de las Illes Balears, basado en una participación voluntaria en un proceso de autoevaluación mediante encuesta online sobre la plataforma Limesurvey ®. Las escalas de medida fueron tres escalas de competencias generales, específicas y avanzadas de Enfermería para el análisis del desarrollo competencial, así como el Nursing Work Index para medir el clima organizacional. Resultados: 600 enfermeras y enfermeros de diversos ámbitos asistenciales completaron satisfactoriamente la encuesta. El análisis arrojó resultados globales de un clima organizacional con puntuaciones moderadas-bajas, mientras que los resultados de las competencias generales y específicas puntuaban aceptablemente frente a las competencias avanzadas que puntuaron bajo en general. Discusión y conclusiones: existe una relación directa entre años de profesión y empeoramiento de la percepción del contexto organizacional. Por otro lado, y con independencia del ámbito asistencial, las competencias generales y específicas con las que los profesionales egresan de la universidad se mantienen en niveles medios-altos a lo largo de los años de profesión. No ocurre así con las competencias avanzadas que en general puntúan bajo y se ven influencias de manera directamente proporcional por el clima organizacional (AU)

Objectives: to evaluate the degree of development of the competency level of nurses in the Balearic Islands regarding selfperception of individual factors for the development of a practice based on evidence and culture and organizational factors. Method: a descriptive transversal study on the population of the Nursing professionals registered in the Balearic Islands, based on voluntary participation in a self-assessment process through online survey with the Limesurvey® platform. The measurement scales were three scales for overall, specific and advanced competencies in Nursing for the analysis of competency development, as well as the Nursing Work Index in order to measure the organizational environment. Results: six hundred (600) female and male nurses from different healthcare settings completed successfully the survey. The analysis showed overall results of an organizational environment with moderate-low scores, while general and specific competencies showed an acceptable score vs. advanced competencies, with overall low scores. Discussion and conclusions: there is a direct relationship between years in the profession and a worse perception of the organizational setting. On the other hand, and regardless of the healthcare setting, the overall and specific competencies which professionals have when they complete their University studies are maintained in medium-high levels throughout their years in the profession. This is not the case with advanced competencies, which show an overall low score, and have a directly proportional influence by the organisational environment (AU)

Revisión sobre aspectos genéricos acerca de la actividad física adaptada en la persona con lesión medular / Review of generic aspects about adapted physical activity in the person with spinal cord injury

Actualmente la lesión medular ocasiona discapacidad y dependencia, y provoca alteraciones de las funciones sensitivas, motoras y/o autonómicas por debajo del nivel de lesión. La mejora de la calidad de vida junto a la de los cuidados entre otros factores, han contribuido al incremento de la expectativa de vida, permitiendo que un mayor número de personas con lesión medular (PLM) lleguen más cualitativamente a edades más longevas. La PLM requiere seguir un programa de Actividad Física Adaptada (AFA) para mantener su estado de salud. El conocimiento de los beneficios de la AFA y sus modalidades permite potenciar esta actividad. Asimismo, la situación política-social de cada país puede influir en la concepción y la posibilidad de desarrollo de la AFA. En este artículo se realizó una búsqueda en las bases de SPORTDiscus, PubMed, Embase, Science Direct, PEDro y Cochrane Library, incluyendo revisión de los últimos diez años. Se obtuvieron 108 artículos y 24 de ellos cumplieron todos los criterios, que fueron: la temporalidad señalada, artículos con grado de evidencia de A, B o C y los artículos que destacasen la AFA en la PLM como tratamiento en fase crónica. Tras la revisión se puede concluir que 1) Hay que seguir promoviendo políticas favorecedoras de la inclusión de la AFA con el fin de hacerlas accesibles a toda la población con discapacidad y/o dependencia, y en particular a la PLM 2) La elección de la práctica deportiva de la PLM dependerá de factores externos o ambientales y especialmente de internos o personales 3) Los beneficios que más se señalan sobre la AFA son: el aumento de la calidad de vida relacionada con la salud y la mejora de la autoestima e imagen corporal de la PLM respecto a la sociedad

Nowadays the Spinal Cord Injury (SCI) implies disability and dependency. The SCI causes changes in sensorial functions, motor functions and/or autonomic functions below the level of injury. The improvement of quality of life as well as the care, among other factors, have contributed to increase life expectancy. This fact allows the person with spinal cord injury to have a lengthy quality life. The person with spinal cord injury requires to follow a long-term program of Adapted Physical Activity (APA) to maintain his / her health. The benefits of APA and its modalities can enhance this activity. Likewise, political-social situation of each country can influence the design and the possibility of development of the APA. This article has been based on the following databases: SPORTDiscus, PubMed, Embase, Science Direct, PEDro and Cochrane Library, including review of the last ten years. 108 articles were found and 24 of them met all the criteria and they were included in this review. The selection criteria were the publication date during the mentioned period, articles with level of evidence A, B or C, and articles which highlight the APA in the person with spinal cord injury during the chronic phase. This research concludes with the following 1) We must continue promoting policies which support the inclusion of the APA. We must make them accessible to all people with disabilities and / or dependency, and in particular the person with spinal cord injury 2) The sport choices of the person with spinal cord injury depends on external factors and especially internal factors 3). The increase of the quality of life related to health and the improvement of self-esteem stand out as benefits of APA

[Satisfaction of Users with Spinal Cord Injury in relation to the Service of Promotion of Personal Autonomy of the Balearic Islands, Spain]. / Satisfacción de las personas con lesión medular con el Servicio de Promoción de la Autonomía Personal en las Islas Baleares.

BACKGROUND: Public Service Promotion of Personal Autonomy aims to provide care to users with severe physical and/or physical-mental disabilities, including people with spinal cord injury. These users are in a chronic phase and thus they require educational-therapeutic measures of physiotherapy. This study is meant to determine the satisfaction of people with spinal cord injury who attend this service. METHODS: A descriptive, cross-sectional, quantitative study in the Public Service Promotion of Personal Autonomy after a sixteen-month therapeutic monitoring process was carried out, which began in March 2015. The final study sample was 25 people with spinal cord injury (17 men and 8 women). At the end of therapeutic intervention, users responded to the SERVQHOS questionnaire, which consists in nineteen questions that aim to measure the quality of the care services provided. A statistical analysis was conducted, calculating averages and standard deviations or frecuencies and percentages. RESULTS: The best valued external factor was the staff appearance with 4,5 on average and the worst scored external factor was the ease of access and / or signposting of the center with 2,6 on average. On the other hand, the best valued internal factor was the kindness of the staff with 4,8 on average and the worst scored factor was the speed in which the users receive what they requested with 4,2 on average. CONCLUSIONS: We concluded that the quality offered is determined by internal factors (kindness, trust, willingness to help) and weaknesses are related to structural factors of the center (external factors).

Satisfacción de las personas con lesión medular con el servicio de promoción de la autonomía personal en las Islas Baleares / Satisfaction of users with spinarl cord injury in relation to the service of promotion of personal autonomy of the Balearic Islands, Spain

Fundamentos: El Servicio de Promoción de la Autonomía Personal pretende ofrecer atención a sujetos con discapacidad física y/o físico-psíquica grave, entre ellos, a personas con lesión medular. Estas personas se encuentran en una fase crónica y por ello requieren medidas fisioterápicas educativo-terapéuticas. El objetivo de este estudio fue determinar la satisfacción de las personas con lesión medular que acuden a este servicio. Métodos: Se llevó a cabo un estudio descriptivo, transversal, cuantitativo después de un seguimiento terapéutico de dieciséis meses que se inició en marzo de 2015. La muestra final del estudio fue de 25 personas con lesión medular (17 hombres y 8 mujeres) que supusieron el 83% del total de las atendidas. Al finalizar la intervención terapéutica, estas personas respondieron al cuestionario SERVQHOS que consta de diecinueve preguntas y pretende medir la calidad asistencial de los servicios prestados. Se llevó a cabo un análisis estadístico a través Microsoft Office Excel 2013 y SPSS 23, calculando medias y desviaciones estándar o frecuencias y porcentajes. Resultados: El factor externo mejor valorado fue la apariencia del personal con un 4,5 de media y el peor valorado la accesibilidad y/o señalización con un 2,6 de media. El factor interno mejor valorado fue la amabilidad del personal con un 4,8 de media y el peor valorado la rapidez con la que se consigue lo que se solicita, con un 4,2 de media. Conclusiones: Tras el estudio se concluye que la calidad ofrecida está determinada por los factores internos (amabilidad, confianza y disposición de ayudar) y que las debilidades vienen relacionadas con factores externos estructurales del centro (AU)

Background: Public Service Promotion of Personal Autonomy aims to provide care to users with severe physical and/or physical-mental disabilities, including people with spinal cord injury. These users are in a chronic phase and thus they require educational-therapeutic measures of physiotherapy. This study is meant to determine the satisfaction of people with spinal cord injury who attend this service. Methods: A descriptive, cross-sectional, quantitative study in the Public Service Promotion of Personal Autonomy after a sixteen-month therapeutic monitoring process was carried out, which began in March 2015. The final study sample was 25 people with spinal cord injury (17 men and 8 women). At the end of therapeutic intervention, users responded to the SERVQHOS questionnaire, which consists in nineteen questions that aim to measure the quality of the care services provided. A statistical analysis through Microsoft Office Excel 2013 and SPSS 23 was conducted, calculating averages and standard deviations. Results: The best valued external factor was the staff appearance with 4,5 on average and the worst scored external factor was the ease of access and / or signposting of the center with 2,6 on average. On the other hand, the best valued internal factor was the kindness of the staff with 4,8 on average and the worst scored factor was the speed in which the users receive what they requested with 4,2 on average. Conclusions: We concluded that the quality offered is determined by internal factors (kindness, trust, willingness to help) and weaknesses are related to structural factors of the center (external factors) (AU)

Consenso sobre competencias para la enfermería de práctica avanzada en España / Consensus on competencies for advanced nursing practice in Spain

INTRODUCCIÓN: Existe falta de consenso internacional sobre la definición exacta y las competencias asociadas a los roles de enfermería de práctica avanzada (EPA), caso que resulta más acuciante en nuestro entorno nacional dada la corta trayectoria de la misma en nuestro país. El objetivo del trabajo consistió en delinear el marco competencial para enfermeras de práctica avanzada en nuestro contexto nacional mediante el proceso de consenso de expertos a través del método Delphi. MÉTODO: Basándonos en un proceso de revisión bibliográfica previo, se identificó un conglomerado de 17 dominios competenciales (clusters de competencias relacionadas). Este conjunto inicial fue revisado, refinado y validado por un conjunto de panelistas expertos en la materia (tanto clínicos como investigadores, gestores y docentes) a través de sucesivas rondas en busca del adecuado consenso sobre cada una de las diferentes competencias propuestas. RESULTADOS: Los resultados permitieron establecer una sólida base en forma de mapa de competencias que permitiera identificar aquellos conjuntos de competencias más específicos para roles de práctica avanzada, independientemente del contexto de regulación y práctica profesional, identificando dominios como investigación y práctica basada en la evidencia, liderazgo clínico y profesional o gestión de cuidados. DISCUSIÓN: Este conjunto de competencias relacionadas con roles de práctica avanzada en nuestro entorno permite delinear los estándares competenciales propios de este nivel de práctica enfermera, y servir de referencia tanto para el desarrollo normativo, la revisión de roles o el planteamiento de perfiles formativos

INTRODUCTION: There is a lack of international consensus on the exact definition and core competencies of advanced practice nursing (APN) roles, a problem particularly acute in our national context due to the lack of APN role development, which has a significantly short history in our country. The main objective of this paper was the delineation of the competence framework for Advanced Practice Nurses in our national context based on expert consensus through the Delphi method Method: Based on a preliminary literature review process, a conglomerate of 17 domains of competence (clusters of related competencies) were identified. This initial set was revised, refined and validated by a group of expert panellists on the subject (clinicians, researchers, managers, and teachers) through successive rounds in search of a suitable consensus on each of the various proposed items RESULTS: The results helped to establish a solid foundation in the form of a skills map that could identify those sets of more specific competencies for advanced practice roles, regardless of regulatory and professional practice context, identifying domains such as Research and Evidence Based Practice, Clinical and Professional Leadership, or Care Management DISCUSSION: This set of skills related to advanced practice roles in our environment can delineate competency standards common to this level of nursing practice, and serve as a reference for policy development, a review of roles, or the establishment of academic profiles

[Consensus on competencies for advanced nursing practice in Spain]. / Consenso sobre competencias para la enfermería de práctica avanzada en España.

INTRODUCTION: There is a lack of international consensus on the exact definition and core competencies of advanced practice nursing (APN) roles, a problem particularly acute in our national context due to the lack of APN role development, which has a significantly short history in our country. The main objective of this paper was the delineation of the competence framework for Advanced Practice Nurses in our national context based on expert consensus through the Delphi method METHOD: Based on a preliminary literature review process, a conglomerate of 17 domains of competence (clusters of related competencies) were identified. This initial set was revised, refined and validated by a group of expert panellists on the subject (clinicians, researchers, managers, and teachers) through successive rounds in search of a suitable consensus on each of the various proposed items RESULTS: The results helped to establish a solid foundation in the form of a skills map that could identify those sets of more specific competencies for advanced practice roles, regardless of regulatory and professional practice context, identifying domains such as Research and Evidence Based Practice, Clinical and Professional Leadership, or Care Management DISCUSSION: This set of skills related to advanced practice roles in our environment can delineate competency standards common to this level of nursing practice, and serve as a reference for policy development, a review of roles, or the establishment of academic profiles.

Impact of the politics of austerity in the quality of healthcare: ethical advice.

This article aims to provide a series of reflections before implementing a restructuring of health system management and cutbacks in health due to the possible consequences this may have on citizens' health. The Universal Declaration of Human Rights states that public healthcare shall be extended to the whole population in conditions of effective equality and overcoming geographical and social imbalances, based on a comprehensive approach to the healthcare system. All of this--while we are aware of the current situation of economic crisis--should be taken into account before carrying out adjustments that will harm the health of citizens and options or alternatives that will not affect equity and healthcare should be weighed up. In conclusion, management models that enable the empowerment of nursing are more justified than ever before, because it is nurses who mostly defend positions of patient advocacy towards attitudes of greater commitment and participation.

[Smoking among nursing and physical therapy students of the University of the Balearic Islands: opinions on regulation of smoking in public places]. / Hábito tabáquico entre los estudiantes de enfermería y fisioterapia de la Universitat de les Illes Balears: opinión ante la regulación del consumo en lugares públicos.

OBJECTIVE: To evaluate the prevalence, opinions and attitudes of nursing and physical therapy students at the University of the Balearic Islands toward smoking in public places and the influence of regulatory policies. METHOD: We performed a cross-sectional, descriptive, observational study using a self-administered questionnaire. The survey was designed to evaluate opinions on and the degree of agreement with smoking and regulatory policies on this issue. The assessment was performed using Likert scales. The survey was offered to all students attending class in the core subject with the greatest number of enrolled students on a normal academic day between February 15 and March 15, 2006. We calculated 95% confidence intervals for proportions. The Chi square test was used to compare qualitative variables and Student's t-test was used for quantitative variables. RESULTS: The sample consisted of 345 students, 82.2% of whom were women. The mean age was 21.9 years. The prevalence of regular smokers was 26.1% (26.9% among women and 22.6% among men). Almost all (93.8%) of the respondents agreed that smoking should be banned in closed spaces in educational institutions and 70.9% believed that the law should be complied with at the University of the Balearic Islands, with differences between 2003 and 2006. CONCLUSIONS: Smoking was less prevalent in our population than in the general regional and national populations, as well as in other Spanish nursing students of the same age and gender. The prevalence of occasional smokers has fallen since 2003. Most students had a favorable view of the new Smoking Prevention Act.

Hábito tabáquico entre los estudiantes de enfermería y fisioterapia de la Universitat de les Illes Balears: opinión ante la regulación del consumo en lugares públicos / Smoking among nursing and physical therapy students of the University of the Balearic Islands: opinions on regulation of smoking in public places

Objetivo. Evaluar la prevalencia, opiniones y actitudes de los alumnos de enfermería y fisioterapia de la Universitat de les Illes Balears (UIB) ante el consumo de tabaco en lugares públicos y la influencia de las políticas reguladoras. Método. Estudio observacional, descriptivo, trasversal, mediante cuestionario autocumplimentado. Se diseñó un cuestionario para evaluar la opinión y el grado de acuerdo respecto a cuestiones actitudinales y conductuales acerca del hábito tabáquico, así como las medidas reguladoras de éste. Para su valoración se utilizaron escalas tipo Likert. El cuestionario se propuso a todos los asistentes a clase en un día lectivo habitual, en la asignatura troncal del curso que tenía más alumnos matriculados entre el 15 de febrero y el 15 de marzo de 2006. Se calcularon los intervalos de confianza del 95% para las proporciones. En la comparación de variables cualitativas se ha usado el estadístico X2 y para las cuantitativas la t de Student. Resultados. Se obtuvo una muestra de 345 sujetos, con una media de edad de 21,9 años, el 82,2% eran mujeres. La prevalencia de fumadores habituales fue del 26,1%; el 26,9% entre las mujeres y el 22,6% entre los varones. El 93,8% estaba de acuerdo en que se prohibiera fumar en los espacios cerrados de los centros docentes y el 70,9% en que se cumpliera la ley en la UIB, habiendo diferencias entre 2003 y 2006. Conclusiones. La población estudiada tiene una prevalencia tabáquica menor que la población general nacional y autonómica, así como la de otros estudiantes de enfermería españoles, para su misma edad y sexo. La prevalencia de fumadores ocasionales ha descendido desde 2003. Los alumnos se muestran mayoritariamente favorables a la nueva Ley de Prevención del Tabaquismo

Objective. To evaluate the prevalence, opinions and attitudes of nursing and physical therapy students at the University of the Balearic Islands toward smoking in public places and the influence of regulatory policies. Method. We performed a cross-sectional, descriptive, observational study using a self-administered questionnaire. The survey was designed to evaluate opinions on and the degree of agreement with smoking and regulatory policies on this issue. The assessment was performed using Likertscales. The survey was offered to all students attending class in the core subject with the greatest number of enrolled students on a normal academic day between February 15 and March 15, 2006. We calculated 95% confidence intervals for proportions. The Chi square test was used to compare qualitative variables and Student’s t-test was used for quantitative variables. Results. The sample consisted of 345 students, 82.2% of whom were women. The mean age was 21.9 years. The prevalence of regular smokers was 26.1% (26.9% among women and 22.6% among men). Almost all (93.8%) of the respondents agreed that smoking should be banned inclosed spaces in educational institutions and 70.9% believed that the law should be complied with at the University of the Balearic Islands, with differences between 2003 and 2006. Conclusions. Smoking was less prevalent in our population than in the general regional and national populations, as well as in other Spanish nursing students of the same age and gender. The prevalence of occasional smokers has fallen since 2003. Most students had a favorable view ofthe new Smoking Prevention Act

[What perspective do intensive care nurses have of their relationship with the relatives of a critical patient?]. / ¿Qué perspectiva tienen las enfermeras de unidades de cuidados intensivos de su relación con los familiares del paciente crítico?

Introduction and aim. Nursing professionals in intensive care units (ICU) face situations of uncertainty and anxiety, above all in patients' relatives. In the literature, we find that the way in which the family and their needs are valued by professionals in the unit is not very systematical, even though there are instruments that have been validated for this purpose. Therefore, we decided to value what perspective ICU nurses have of the relationship they establish with patients' relatives, in order to find possible explanations for this situation. Material and methods. A qualitative study with a critical-social orientation. This was carred out in three ICUs in three state hospitals in Mallorca. Research techniques: 8 observations of the visit of relatives to the unit and 6 semi-structured interviews with nurses from the three hospitals. The transcripts of the interviews were analysed and codified in significance units. Sources and methods were triangulated.Results. Categories of the relationship process: 1) who the social actors are; 2) what the actions of the nurses with respect to the relatives are; 3) what the relationships are like between both; and 4) expectations of the nurses regarding this relationship.Conclusions. a) It is necessary to establish quality standards for attending the relatives of critical patients. b) Continuous nursing training is necessary in order to provide emotional support to families and to protect nurses from the added stress involved in providing this emotional support.

¿Qué perspectiva tienen las enfermeras de unidades de cuidados intensivos de su relación con los familiares del paciente crítico? / What perspective do intensive care nurses have of their relationship with the relatives of a critical patient?

Conclusiones. a) Se necesita establecer los estándares de calidad para la atención a las familias del paciente crítico. b) Es necesaria formación continuada de enfermería para proporcionar soporte emocional a las familias y las enfermeras deben protegerse del estrés añadido que supone proporcionar este soporte emocional (AU)