Barriers and Facilitators of Communication in the Medication Reconciliation Process during Hospital Discharge: Primary Healthcare Professionals' Perspectives.

The WHO established that medication errors are the most common and preventable errors and represent an expenditure of 42 billion U.S. dollars annually. The risk of medication errors increases in transitions between levels of care, mainly from hospital care to primary healthcare after hospital discharge. In this context, communication is a key element in the safety of the medication reconciliation process. The aim of this paper was to describe the barriers to, and facilitators of, effective communication during the medication reconciliation process at hospital discharge in people over 65 years of age, from the perspective of primary healthcare professionals. A qualitative descriptive study was designed, and in-depth interviews were conducted with 21 individuals, of whom 13 were nurses and 8 were physicians. This study was carried out with healthcare professionals belonging to primary healthcare centres in Huelva (Spain). Following content analysis of the discourses we identified 19 categories, grouped into three areas: interlevel communication, communication between primary healthcare professionals, and communication between healthcare professionals and patients/caregivers. The barriers found mainly relate to the adequacy and use of technological tools, time available, workload and the level of collaboration of patients/caregivers. Facilitating elements for communication in medication reconciliation included technologies, such as computerized medical history, protocolization of clinical sessions, the presence of case management nurse and interdisciplinary teamwork.

Influence of the COVID-19 Pandemic on Medication Reconciliation in Frail Elderly People at Hospital Discharge: Perception of Healthcare Professionals.

The current demographic panorama in Spain corresponds to an aging population; this situation is characterized by the need to care for an elderly population, which contains polymedicated and pluripathological individuals. Polymedication is a criterion of frailty in the elderly and a risk factor for mortality and morbidity due to the increased risk of drug interactions and medication errors. There are numerous studies that measure reconciliation at hospital discharge and at admission, and even the methodology of reconciliation, but we have not found many studies that measure reconciliation in the context of the COVID-19 pandemic from the point of view of health professionals regarding difficulties and the strategies carried out, which is essential to begin to glimpse solutions. METHODS: This was a qualitative study based on 21 in-depth interviews and two discussion groups, conducted between January and April 2021 (13 nurses and 8 doctors, in rural and urban areas). The discourse was analyzed according to the Taylor-Bodgan model and processed using Atlas.ti software. RESULTS: The areas altered by the health crisis were access to patients, their reconciliation of medication, and changes in the care modality, including the greater use of telephone communication, changes in work organization, and time dedicated to patient care and family work. Difficulties encountered during COVID-19: change in medication format, the specific characteristics of the patient and their pathologies, and difficulties arising from communication with the patient and their family. The strategies applied: the collaboration of home assistants and caregivers, emphasis on patient-health professional communication, and the use of Information and Communication Technologies (ICT). CONCLUSION: The discharge was interrupted by the health crisis caused by COVID-19, in terms of both the traditional access of patients and by the remote care modalities generated by telemedicine.

Attitudes of nursing degree students towards end of life processes. A cultural approach (Spain-Senegal).

INTRODUCTION: The concept of death is abstract, complex and has a number of meanings. Thus, its understanding and the approach taken to it depend, to a large extent, on aspects such as age, culture, training and religion. Nursing students have regular contact with the process of death and so it is of great interest to understand the attitudes they have towards it. As we live in a plural society it is even more interesting to not only understand the attitudes of Spanish students but, also, those of students coming from other countries. In the present article, we seek to identify and compare the attitudes held by nursing degree students at Hekima-Santé University (Senegal) and the University of Huelva (Spain) about end of life processes. The study identifies elements that condition attitudes and coping with death, whilst considering curricular differences with regards to specific end of life training. METHOD: A descriptive, cross-sectional and multi-center study was conducted. The overall sample (N = 142) was divided into groups: Hekima-Santé University (Dakar, Senegal) and the University of Huelva (Huelva, Spain). The measurement instruments used were an ad-hoc questionnaire and Bugen´s Coping with Death Scale. RESULTS: Statistically significant differences (p = 0.005, 95%CI) were found in relation to overall Bugen Scale scores. We can confirm that specialized end of life training (University of Huelva, Spain) did not lead to better coping when compared with a population whose academic curriculum did not provide specific training and who engaged in more religious practices (Hekima-Santé University, Senegal). CONCLUSIONS: In cultures where religion not only influences the spiritual dimension of the individual, but acts in the ethical and moral system and consequently in the economic, educational and family sphere, the accompaniment at the end of life transcends the formative plane. Considering the plural society in which we live, the training that integrates the Degree in Nursing with regard to the care of the final process, must be multidimensional in which spirituality and faith are integrated, working emotional and attentional skills, as well as cultural competence strategies in this process.

Educational interventions by nurses in caregivers with their elderly patients at home.

INTRODUCTION: The home is the natural setting for the development of informal care. The work that nurses are required to develop in this context (the carer/the elderly dependent/the home) focuses on training and educational activities to assist these two groups, such as demonstrating care activities to help dependent seniors, instruction in self-care techniques and teaching strategies for the use of human and material resources. AIMS: This article analyzes care education interventions performed by nurses, and the factors that facilitate, or limit, health care training. METHODOLOGICAL APPROACH: This is a qualitative, descriptive study designed to be flexible and openly analytical in its approach to the research problem and the dynamic nature of the home environment. Triangulation of the methodological techniques and study subjects was applied. RESULTS: Nursing interventions related to professional attitudes, such as encouraging communication and facilitating teaching; communication interventions in health education and counseling; and technical interventions aimed at improving access to health information and support for the informal carer. Lack of will, the advanced age of the carer, emotional state and work overload are factors that undermine care instruction, which if reversed, would become learning facilitators. The lack of time and resources in the home are the major limiting factors on care teaching, according to nurses. Evidence from our study suggests that care in the home is considered a key primary health care strategy, one in which nurses play a significant role.

Communication on Safe Caregiving between Community Nurse Case Managers and Family Caregivers.

Dependent elderly individuals are usually cared for at home by untrained family members who are unaware of the risks involved. In this setting, communication on safe caregiving is key. The aim of this study is to describe the factors influencing the process followed by community nurse case managers to provide communication on safe caregiving to family members caring for dependent elderly individuals. A phenomenological study, by focus group, was done in urban healthcare facilities. Key informants were seven community nurses, case managers with more than 12 years' experience. We did a thematic analysis and we identified the units of meaning to which the most relevant discourses were assigned. The concepts expressed were grouped until subcategories were formed, which were then condensed into categories. Four categories of analysis emerged: communication-related aspects; professional skills of nurse case managers; communication on safety and the caregiving role. To planner interventions, for the prevention of adverse events at home, is essential to consider these aspects: nurses' professional communication skills, factors inherent to safe caregiving, the characteristics of the home where care is provided, the personal and family circumstances of the caregiver, and whether or not the caregiver's role has been assumed by the family caregivers.

Pain catastrophizing, kinesiophobia and fear-avoidance in non-specific work-related low-back pain as predictors of sickness absence.

The influence of pain catastrophizing, kinesiophobia and fear-avoidance attitudes towards non-specific low-back pain has been scarcely studied in an occupational insurance provider context. The objective of this work is to ascertain the relationship between these psychosocial variables with work absence, its duration and the disability of subjects with work-related low back pain. This is a descriptive observational methodological strategy. All patients with work-related non-specific low back pain who attended to an occupational health hospital during the study period were included consecutively. Clinical variables of kinesiophobia, pain catastrophizing, fear-avoidance attitudes, disability and pain were collected; sociodemographic variables of sex, age, type of work, educational level, occupational status and duration in days of work absence were recorded. Kinesiophobia (b = 1.43, P = 0.011, r = 0.333), fear-avoidance beliefs in its global dimension (b = 0.910, P = 0.014, r = 0.321), fear-avoidance beliefs in its work dimension (b = 1.255, P = 0.016, r = 0.321) and pain catastrophizing (b = 0.997, P = 0.013, r = 0.340) show individual association with the duration of sickness absence. Kinesiophobia (b = 0.821, P = 0.011, r = 0.30) and fear-avoidance beliefs (b = 1.760, P = 0.016, r = 0.28) are associated with disability (Kinesiophobia, b = 0.880, P = 0.045, r = 0.26; Fear-avoidance beliefs, b = 0.724, P = 0.010, r = 0.34). Kinesiophobia, fear-avoidance beliefs and pain catastrophizing are related to an increase in the duration of work absence and disability in patients with back pain in an occupational insurance provider context.

Influence of Psychosocial and Sociodemographic Variables on Sickness Leave and Disability in Patients with Work-Related Neck and Low Back Pain.

The purpose of this study was to describe the association between psychosocial factors in patients with work-related neck or low back pain (n = 129), in order to study sickness leave, its duration, the disability reported, and to analyze the relationship of these factors with different sociodemographic variables. This was a descriptive cross-sectional study. Data on kinesiophobia, catastrophizing, disability, and pain were gathered. Sociodemographic variables analyzed included sex, age, occupational, and educational level. Other data such as location of pain, sick leave status and duration of sickness absence were also collected. Educational level (p = 0.001), occupational level (p < 0.001), and kinesiophobia (p < 0.001) were found to be associated with sickness leave; kinesiophobia (b = 1.47, p = 0.002, r = 0.35) and catastrophizing (b = 0.72, p = 0.012, r = 0.28) were associated with the duration of sickness leave. Educational level (p =0.021), kinesiophobia (b = 1.69, p < 0.000, r = 0.505), catastrophizing (b = 0.76, p < 0.000, r = 0.372), and intensity of pain (b = 4.36, p < 0.000, r = 0.334) were associated with the degree of disability. In the context of occupational insurance providers, educational and occupational factors, as well as kinesiophobia and catastrophizing, may have an influence on sickness leave, its duration and the degree of disability reported.

Coping strategies and quality of life in caregivers of dependent elderly relatives.

BACKGROUND: Despite the importance of coping in caregiving, there are few studies on the relationship between coping and quality of life in caregivers of the frail dependent elderly. Thus, this study aims to analyze the relationship between coping strategies and quality of life dimensions in primary caregivers of dependent elderly relatives. METHODS: A cross-sectional study was conducted from 86 caregivers. Predictive variables were coping strategies (problem-focused, emotion-focused, socially-supported, and dysfunctional); dependent variables were quality of life dimensions (psychological, physical, relational, and environmental); and potential confounding variables were age, gender, perceived health and burden of caregiver, and functional capacity of care receiver. Correlation coefficients were calculated and multiple linear regression analysis was performed. RESULTS: After controlling for potential confounders, dysfunctional coping was related to worse quality of life in the psychological dimension, while emotion-focused and socially-supported coping were related to superior psychological and environmental dimensions of quality of life. The physical and relational dimensions of quality of life were not related to coping strategies. CONCLUSIONS: 1) it is important to consider coping strategies in the assessment of primary caregivers of dependent elderly relatives; 2) the quality of life of caregivers is related to their coping strategies, 3) their quality of life can be worsened by avoidance-type coping, and 4) their quality of life can be improved by active emotion-focused coping and socially-supported coping.

Nivel de dependencia y percepción de salud tras la valoración enfermera / Level of dependency and perceived health nurse after the valuation

Objetivo: Identificar la capacidad funcional de un colectivode ancianos medida a través de las actividades dela vida diaria y la percepción de salud. Método: Se realizóun estudio descriptivo de carácter retrospectivo enuna residencia geriátrica con un total de 156 ancianos.La muestra estuvo compuesta por todos los residentesque en el momento del estudio estaban valorados por laenfermera. Resultados: El perfil demográfico es el de unresidente de una media superior a 75 años. El 71,3% delos residentes son mujeres. Las actividades del Índicede Barthel que reflejan mayor grado de dependencia son“lavarse” y “subir y bajar escaleras” y, la que menos,“comer”. La percepción de salud mediante las láminasde Coop-Wonca refleja una percepción “regular” o “mala”en la mayoría de los casos. A mayor grado de limitaciónfísica para las actividades de la vida diaria mayorpercepción negativa de salud. Conclusiones: El uso deinstrumentos estandarizados para la valoración geriátricaintegral nos permite detectar de manera rápida el estadodel anciano en su globalidad. De esa manera, se mejoranla calidad prestada así como la aplicación de un plande actuación interdisciplinar(AU)

To identify the functional ability of a group of elderly measuredthrough the activities of daily living and perceivedhealth. Method: A descriptive study of retrospective in a geriatricnursing home with a total of 156 elderly. The samplewas composed of all residents at the time of the studywere rated by the nurse. Results: The demographic profile isa resident of an average exceeding 75 years. The 71.3% ofresidents are women. The activities of the Barthel Index reflectinggreater reliance are “washed” and “up and downstairs” and the least “to eat”. The perception of health byCoop-Wonca reflects a perception “regulate” or “bad” inmost cases. A higher degree of physical limitations to activitiesof daily living more negative perception of health. Conclusions:The use of standardized instruments for the integratedgeriatric assessment allows us to swiftly detect thestatus of the elderly as a whole, thus improving the qualityprovided, as well as implementing an action plan interdisciplinary(AU)

Valoración del componente comunicativo/relacional de la práctica enfermera en Atención Primaria. El cuestionario GATHA-ENFERMERÍA / Assessment of the communicative/relational component in the nursing practice in primary care. The GATHA-NURSING questionnaire

Además de un pilar básico en la práctica enfermera, la comunicación es una de las variables más relevantes en la satisfacción de los usuarios con los servicios sanitarios. Objetivo: Construir un instrumento para valorar el componente comunicativo/relacional de la práctica enfermera en Atención Primaria. Metodología: Adaptación del GATHA-BASE mediante Grupo Nominal, Prueba de Jueces y pilotaje inicial. Validación a partir de 158 videograbaciones. El muestreo de ítems se realizó mediante juicio de los expertos, coeficiente de correlación ítem/total y cambio en el alfa de Cronbach. La consistencia interna, mediante el alfa de Cronbach; la fiabilidad intra e inter-observador, mediante el análisis gráfico (Bland y Altman). Resultados: Se obtuvo una Guía de Observación de 68 ítems, con un consenso entre expertos superior al 75% en todos los ítems. Tras la validación se generó un instrumento (Gatha-Enfermería), de 35 ítems, agrupados en tres ejes, con un alfa de Cronbach de 0,843. La concordancia inter e intra-observador son aceptables y con un patrón de distribución aleatoria.Conclusión: Se obtiene una validez de contenido amplia y un elevado consenso. El instrumento tiene buena consistencia interna y reproducibilidad, con capacidad para orientar diferentes ámbitos de la práctica clínica de enfermería (AU)

In addition to a core skill in Nursing practice, communication is one of the most relevant variables in the satisfaction of the users with the Health Services. Objective: To create an instrument to assess the communication/relationship component in Nursing practice in Primary Care. Method: Adaptation of the GATHA-BASE by Nominal Group, Proof of Judges and pilot study. Validation through 158 video-recorded consultations. Items Sampling by Experts Judgement, Item/Total Correlation Coefficient and change in the Cronbach's alpha. Internal consistency through the Cronbach's alpha; Intra and Inter-observer reliability by graphic analysis (Bland-Altman). Results: An Observational Guide of 68 items is obtained with a level of consensus superior to 75% amongst the experts for all the items. After the validation, a tool (GATHA-ENFERMERIA) is created consisting of 35 items organised in 3 categories, with a Cronbachs alpha of 0,843. The Inter and Intra-observer concordance are acceptable and with a pattern of random distribution. Conclusion: The outcome is wide validity of contents as well as high consensus. The tool has good internal consistency and test-retest reliability with capability to guide different aspects in clinical Nursing practice (AU)

Uso de restricciones físicas en las instituciones gerontogeriátricas / Use of physical restrictions in gerontogeriatrics institutions

El maltrato al mayor dependiente en el medio institucional es un fenómeno poco estudiado y prácticamente oculto. La restricción física en estos centros aparece como una de las prácticas más habituales y su catalogación no es identificada claramente entre los profesionales como una práctica a incluir dentro del denominado "maltrato al mayor". La infraestructura física y organizativa de las instituciones, el perfil de anciano dependiente con procesos demenciales y la toma de conciencia de los profesionales sobre el fenómeno son, entre otros, factores de riesgo muy potentes en la aparición y mantenimiento de este tipo de maltrato en la población mayor institucionalizada (AU)