Enfermeria basada en la evidencia: revisión de alcance

RESUMEN Objetivos: Identificar la evidencia científica sobre el concepto, desarrollo y función, de la Enfermería Basada en la Evidencia (EBE) y analizar críticamente esta herramienta, sus elementos facilitadores y barreras para su implementación. Material y Método: Revisión de alcance según propuesta del Joanna Briggs Institute. Se consideró el rango de tiempo entre 1997 y 2019 para recuperar artículos y revisiones en inglés, portugués y español. Se utilizaron descriptores del tesauro Medical Subject Headings y términos booleanos para aplicar las estrategias de búsqueda en 4 bases de datos: PubMed, EBSCOhost, Scopus y Science Direct. Se complementó la búsqueda con la técnica de bola de nieve aplicada a la lista de referencias de los artículos relevantes seleccionados. Para evaluar la validez y el impacto de los resultados de los artículos de revisión y cualitativos se aplicó el Critical Appraisal Skills Programme Español (CASPE), y para estudios observacionales el Strengthening the Reporting of Observational studies in Epidemiology (STROBE). Para establecer los niveles de evidencia se utilizó Canadian Task Force on Preventive Health Care (CTPFCHC). Resultados: De 163.074 manuscritos iniciales, fueron seleccionados 44 para análisis y extraer datos referentes a: Historia de la EBE; Concepto y función de EBE; Etapas, barreras y facilitadores. Conclusiones: El concepto de EBE pone de manifiesto la necesidad de utilizar esta herramienta para planificar los cuidados mediante el uso del pensamiento crítico y reflexivo; la importancia de realizar el cuidado a la cabecera del paciente y cultivar un cuidado basado en la mejor evidencia, enmarcado, todo ello, en un contexto de humanización, así como considerar las barreras y facilitadores de esta herramienta.

ABSTRACT Objective: To identify the scientific evidence on the concept, development and function of Evidence-Based Nursing (EBN) and to critically analyze this tool, its facilitating elements and barriers for implementation. Material and Method: Scoping review according to the proposal of the Joanna Briggs Institute. The period between 1997 and 2019 was considered to retrieve articles and reviews in English, Portuguese and Spanish. Medical Subject Headings thesaurus descriptors and Boolean operators were used to apply search strategies in 4 databases: Pubmed, EBSCOhost, Scopus, Science Direct. The search was complemented with the snowball technique applied to the reference list of the relevant selected articles. The Critical Appraisal Skills Programme Español (CASPE) was used to assess the validity and impact of the articles review and qualitative results, and the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) was used for the observational studies. To establish the levels of evidence, The Canadian Task Force on Preventive Health Care (CTPFCHC) was used. Results: Out of 163,074 initial manuscripts, 44 were selected for analysis and data extraction regarding history of EBN; concept and function of EBN; stages, barriers and facilitators. Conclusions: The concept of EBN highlights the need to use this tool to plan nursing care through critical and reflective thinking; the importance of providing direct patient care and promoting care based on the best evidence, in a context of humanization and considering the tool's barriers and facilitators.

RESUMO Objetivo: Identificar as evidências científicas sobre o conceito, desenvolvimento e função da Enfermagem Baseada em Evidências (EBE) e analisar criticamente esta ferramenta, seus elementos facilitadores e as barreiras para sua implementação. Material e Método: Revisão do escopo de acordo com a proposta do Instituto Joanna Briggs. Considerou-se o período entre 1997 e 2019 para recuperar artigos e revisões em inglês, português e español. Foram utilizados descritores do tesauro Medical Subject Headings e operadores booleanos para aplicar estratégias de pesquisa en 4 bancos de dados diferentes: Pubmed, EBSCOhost, Scopus, Science Direct. A pesquisa foi complementada com a técnica de bola de neve aplicada à lista de referência dos artigos selecionados relevantes. O Critical Appraisal Skills Programme Español (CASPE) foi usado para avaliar a validade e o impacto da revisão dos artigos e os resultados qualitativos, e para os estudos de observação utilizou-se o Strengthening the Reporting of Observational studies in Epidemiology (STROBE). A Canadian Task Force on Preventive Health Care (CTPFCHC) foi utilizada para establecer os níveis de evidência. Resultados: Dos 163.074 manuscritos iniciais, 44 foram selecionados para análise e extração de dados referentes à história da EBN; conceito e função da EBN; etapas, barreiras e facilitadores. Conclusões: O conceito de EBN destaca a necessidade de utilizar esta ferramenta de planejamento de cuidado, através do uso do pensamento crítico e reflexivo; a importância de realizar o cuidado à beira do leito do paciente e promover cuidados baseados nas melhores evidências, em um contexto de humanização e considerando as barreiras e facilitadores desta ferramenta.

Evaluación de una intervención educativa para mejorar el consumo de frutas, vegetales y la actividad física de docentes en tres centros educativos públicos en Costa Rica / Evaluation of an educational intervention to improve teachers' fruit and vegetable intake and physical activity practice in three public schools in Costa Rica

Resumen: Introducción: El modelo Póngale Vida ® para la prevención de la obesidad infantil reconoce a docentes de las escuelas como actores clave para esta labor, pero para ello se requiere fortalecer los conocimientos y las prácticas para la promoción de la alimentación saludable y la actividad física de los escolares. Objetivo: Evaluar los resultados de la intervención educativa para mejorar la autoeficacia en consumo de frutas y vegetales y en actividad física en docentes de tres centros educativos públicos urbanos de Costa Rica. Metodología: Se aplicó y evaluó la propuesta educativa de Jara y Rivera (2011) con 70 docentes. Hubo evaluaciones antes y después de la aplicación de la intervención. Las variables evaluadas fueron demográficas, de estilo de vida y medición de la autoeficacia para actividad física y consumo de frutas y vegetales, valoraciones bioquímicas y antropométricas. A través de grupos focales, se identificó tanto facilitadores como barreras a nivel personal, familiar y laboral. Resultados: Posterior a la intervención, casi 25 % de docentes incrementó la práctica de actividad física y la autoeficacia para las prácticas de actividad física y consumo de frutas y vegetales. Las barreras identificadas fueron la doble carga de trabajo asociada al rol de género femenino, creencias limitantes y la falta de urgencia para la prevención de enfermedades. Conclusiones: La propuesta educativa favoreció el aumento de la autoeficacia en el consumo de frutas y vegetales, así como la práctica de actividad física de la población docente.

Abstract: Introduction: The Póngale Vida ® model for the prevention of childhood obesity recognizes schoolteachers as key actors in this work, but this requires strengthening their knowledge and practices to promote healthy eating and physical activity for school children. Objective: To evaluate an educational intervention to increase teacher's self-efficacy for fruit and vegetable consumption and physical activity, within three public schools in Costa Rica. Methods: Jara and Rivera's educational proposal for intervention (2011) was implemented and evaluated with 70 teachers. There were evaluations before and after the intervention, it had demographic characteristics, lifestyle variables, self-efficacy measurements for physical activity and fruit and vegetables consumption; also, biochemical and anthropometric measures. Focus groups were used to identify facilitators and barriers at personal, family and work levels. Results: After the intervention, almost 25% of teachers increased their physical activity practices, as well as self efficacy for physical activity practice and fruits and vegetables consumption. The main barriers were a double work burden linked with feminine gender roles, limiting beliefs, and, lack of urgency in preventing diseases. Conclusions: The educational intervention contributed in increasing self-efficacy regarding eating fruit and vegetables and the practice of physical activity of participating teachers.

[Implementation of a Clinical Practice Guidelines for the Management of Adults With Schizophrenia in Colombia]. / Implementacion de la guía de práctica clínica para el manejo de adultos con esquizofrenia en Colombia.

OBJECTIVES: To present overall strategies and activities for the implementation process of the recommendations contained in the clinical practice guideline for the management of adults with schizophrenia (GPC_E) published by the Colombian Ministry of Health and Welfare (MSPS). Prioritize the proposed recommendations, identify barriers and solving strategies to implement the GPC_E, and develop a monitoring and evaluation system for the key recommendations. METHOD: The Guideline Developer Group (GDG) included professionals with primary dedication to implementation issues that accompanied the entire process. During the GDG meetings implementation topics were identified and discussed, and later complemented by literature reviews concerning the experience of mental health guidelines implementation at national and international level. Additionally, feedback from the discussions raised during the socialization meetings, and joint meetings with the MSPS and the Institute of Technology Assessment in Health (IETS) were included. The prioritization of recommendations was made in conjunction with the GDG, following the proposed steps in the methodological guide for the development of Clinical Practice Guidelines with Economic Evaluation in the General System of Social Security in Colombian Health (GMEGPC) using the tools 13 and 14. the conclusions and final adjustments were discussed with the GPC_E leaders. RESULTS: The implementation chapter includes a description of the potential barriers, solution strategies, facilitators and monitoring indicators. The identified barriers were categorized in the following 3 groups: Cultural context, health system and proposed interventions. The issues related to solving strategies and facilitating education programs include community mental health, mental health training for health workers in primary care, decentralization and integration of mental health services at the primary care level, use of technologies information and communication and telemedicine. To monitor and evaluate o the implementation process, five (5) indicators were designed one (1) structure, two (2) process and two (2)outcome indicators. CONCLUSION: The GPC_E implementation within the Colombian General health System of Social Security (SGSSSC) poses multiple challenges. Potential barriers, enabling strategies and indicators for monitoring and evaluation described in this article, can provide efficient support to ensure the success of this process in the institutions that will adopt the guideline.

Implementación de la guía de práctica clínica para el manejo de adultos con esquizofrenia en Colombia / Implementation of a Clinical Practice Guidelines for the Management of Adults With Schizophrenia in Colombia

Objetivos: Presentar las estrategias y actividades globales que permitan llevar a la práctica las recomendaciones contenidas en la guía (GPCE). Priorizar las recomendaciones, identificar potenciales barreras y facilitadores, plantear estrategias de solución y desarrollar un sistema de seguimiento y evaluación de la implementación de las recomendaciones contenidas en la GPCE. Método: Durante el proceso de elaboración de la GPCE, se incluyeron profesionales con dedicación primordial a implementación. En las reuniones identificaron estos tópicos y posteriormente se complementaron con revisiones de literatura sobre implementación de guías de esquizofrenia. Se tuvieron en cuenta las discusiones planteadas en las reuniones de socialización, y las reuniones conjuntas con el Ministerio de Salud y Protección Social y el Instituto de Evaluación Tecnológica en Salud. Resultados: El capítulo de implementación de la GPCE incluye la descripción de las potenciales barreras, las estrategias de solución, los facilitadores y los indicadores de seguimiento, estos últimos categorizados por estructura, proceso y resultado. Las barreras identificadas se categorizaron en 3 grupos, haciendo referencia al contexto cultural, el sistema de salud y las intervenciones propuestas. Los temas referentes a estrategias de solución y facilitadoras incluyen programas de educación a la comunidad en salud mental, entrenamiento en salud mental a trabajadores de la salud de atención primaria, descentralización de los servicios de salud mental e integración a nivel primario, utilización de tecnologías de la información y la comunicación y telemedicina. Conclusión: La implementación de la GPCE dentro del Sistema General de Seguridad Social en Salud en Colombia plantea múltiples retos. Las potenciales barreras, estrategias facilitadoras e indicadores de seguimiento y evaluación descritos en el presente artículo, pueden brindar un soporte eficiente para contribuir al éxito de este proceso en las instituciones prestadoras de servicios de salud que adopten la guía.

Objectives: To present overall strategies and activities for the implementation process of the recommendations contained in the clinical practice guideline for the management of adults with schizophrenia (GPCE) published by the Colombian Ministry of Health and Welfare (MSPS). Prioritize the proposed recommendations, identify barriers and solving strategies to implement the GPCE, and develop a monitoring and evaluation system for the key recommendations. Method: The Guideline Developer Group (GDG) included professionals with primary dedication to implementation issues that accompanied the entire process. During the GDG meetings implementation topics were identified and discussed, and later complemented by literature reviews concerning the experience of mental health guidelines implementation at national and international level. Additionally, feedback from the discussions raised during the socialization meetings, and joint meetings with the MSPS and the Institute of Technology Assessment in Health (IETS) were included. The prioritization of recommendations was made in conjunction with the GDG, following the proposed steps in the methodological guide for the development of Clinical Practice Guidelines with Economic Evaluation in the General System of Social Security in Colombian Health (GMEGPC) using the tools 13 and 14. The conclusions and final adjustments were discussed with the GPCE leaders. Results: The implementation chapter includes a description of the potential barriers, solution strategies, facilitators and monitoring indicators. The identified barriers were categorized in the following 3 groups: Cultural context, health system and proposed interventions. The issues related to solving strategies and facilitating education programs include community mental health, mental health training for health workers in primary care, decentralization and integration of mental health services at the primary care level, use of technologies information and communication and telemedicine. To monitor and evaluate o the implementation process, five (5) indicators were designed one (1) structure, two (2) process and two (2) outcome indicators. Conclusion: The GPCE implementation within the Colombian General health System of Social Security (SGSSSC) poses multiple challenges. Potential barriers, enabling strategies and indicators for monitoring and evaluation described in this article, can provide efficient support to ensure the success of this process in the institutions that will adopt the guideline.