Publications by authors named "Laura Albornos-Muñoz"

14 Publications

  • Page 1 of 1

[Nursing mothers satisfaction with the promotion of breastfeeding and professionals adherence to the recommendations. Multi-center study.]

Rev Esp Salud Publica 2020 Dec 10;94. Epub 2020 Dec 10.

Unidad Maternidad-Pediatría. Hospital Medina del Campo. Valladolid. España.

Objective: The Baby-friendly Hospital Initiative or clinical practice guideline implementation programs have a positive impact on the promotion of breastfeeding (BF). There are knowledge gaps regarding the perceptions of new mothers towards these initiatives, and their degree of satisfaction. Our objective was to describe the satisfaction of BF mothers and adherence to the recommendations of the "Breastfeeding" guide from the Registered Nurses' Association of Ontario (RNAO).

Methods: Between 2018-2019, in 9 Spanish hospitals that implemented the guide, 2,397 nursing mothers were surveyed who met inclusion criteria. A self-administered survey was designed with sociodemographic data, mother-child, BF promotion interventions carried out and degree of satisfaction. Descriptive and bivariate analysis was performed.

Results: The recommendations for skin-to-skin contact, help in breastfeeding, observation of a breastfeeding session and resolution of doubts presented adhesions >84%. Information about support groups, rooming-in and recognize signs of baby satisfaction obtained adhesions <40%. The exclusive BF rate at discharge was 77.5%. The mean satisfaction with skin-to-skin contact and the percentage of satisfaction at discharge were 5.8 and 96.8% respectively. The differences were significant between the degree of satisfaction and the educational level, age, work situation, type of delivery and type of hospital (p<0.05).

Conclusions: According to puerperal women, adherence to the recommendations of the Clinical Practice Guide is good for most interventions and the degree of satisfaction is high.
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December 2020

Impact of the implementation of best practice guidelines on nurse's evidence-based practice and on nurses' work environment: Research protocol.

J Adv Nurs 2021 Jan 15;77(1):448-460. Epub 2020 Oct 15.

Faculty of Nursing and Physiotherapy, Balearic Islands University, Palma de Mallorca, Spain.

Aim: To determine the impact of the Best Practice Spotlight Organization® initiative on nurses' perception of their work environment and their attitudes to evidence-based practice.

Design: Quasi-experimental, multicentre study. The intervention is the participation in Best Prectice Spotilight Organizations to implement Best Practice Guidelines.

Methods: The study will include seven centres in the interventional group and 10 in the non-equivalent control group, all of them belonging to the Spanish national health system. The Practice Environment Scale of the Nursing Work Index, and the Health Sciences Evidence-Based Practice Questionnaire will be administered to a sample of 1,572 nurses at the beginning of the programme and at 1 year. This 3-year study started in April 2018 and will continue until December 2021. Statistical analyses will be carried out using the SPSS 25.0. This project was approved by the Drug Research Ethics Committee of the Parc de Salut Mar and registered in Clinical Trials.

Discussion: The study findings will show the current state of nurses' perception of their work environment and attitudes to evidence-based practice, and possible changes in these parameters due to the programme.

Impact: The findings could provide a strong argument for health policymakers to scale up the Best Practice Spotlight Organization® initiative in the Spanish national health system.
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http://dx.doi.org/10.1111/jan.14598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756465PMC
January 2021

Implementation experience of a guideline on fall prevention in Centres Committed to Excellence in Care®.

Enferm Clin 2020 May - Jun;30(3):185-197. Epub 2020 May 19.

Servicio de Medicina Preventiva, Hospital Dr. José Molina Orosa. Área de Salud de Lanzarote, Gerencia de Servicios Sanitarios, Arrecife, Lanzarote, España.

Aim: To describe the progress of implementing the «Preventing falls» Guideline of the Best Practice Spotlight Organization (BPSO®) Programme and fall outcomes in Centres Committed to Excellence in Care (CCEC®).

Method: A Quasi-experimental study pre-post test from a multicentric approach carried out between 2012-2018. The study is focused on patients aged 65 or older, discharged from guideline implementation units, analysing sociodemographic variables (sex, age, hospitalization days; fall risk assessment on admission and patient in risk; fall prevention plan; incidence of falls. Data was compared from CCEC® programme indicators measured over the periods: baseline (T1), candidate during the first three years (T2), and sustainability (T3). Descriptive and inferential analysis was performed.

Results: 31,486 patients were evaluated in 7 centres (T1=465; T2=14,255; T3=16,766). Of the patients, 51.87% were men and average age was 79.06 years. Hospitalization was 8.15 days. Fall risk assessment on admission was performed in 81.96% of patients (T1=44.30%, T2=81.11%, T3=83.73%) and 52.31% patients had high risk. A prevention falls plan was registered in 47.75% of patients (T1=24.73%, T2=42.43%, T3=52.90%). Four hundred and twenty-three falls were recorded, 62.17% without injuries.

Conclusions: Despite the differences between hospitals, such as structural characteristics, strategies, assessment tools and data progression pace; adherence to recommendations is proving successful, improving widely. Guideline implementation has allowed fall problems to be addressed, producing positive changes in the process and encouraging the implementation and sustainability of evidence-based nursing practice.
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http://dx.doi.org/10.1016/j.enfcli.2020.03.015DOI Listing
May 2020

Evaluation of implementation strategies of the Best Practices Spotlight Organisations (BPSO) Project in Spain.

Enferm Clin 2020 May - Jun;30(3):222-230. Epub 2020 May 7.

Unidad de Investigación en Cuidados y Servicios de Salud (Investén-isciii), CIBERFES, Instituto de Salud Carlos III, Madrid, España.

Objective: To identify favourable elements and barriers to implementation in the Program of Best Practice Spotlight Organization® that establish clinical practice guidelines of the Registered Nurse' Association of Ontario, so that future experiences could benefit from the assessments presented here.

Method: Evaluation research study of the process of implementing guidelines in institutions that make up the first two cohorts of the programme in Spain, through analysis of contents of implantation reports and inductive process, reading, interpretation, coding and categorized according to SWOT structure: Strengths, weaknesses, opportunities and threats.

Results: Reports from 18 centres in 12 Autonomous Communities have been analyzed, including 22 different guidelines. As weaknesses, problems related to information systems and their exploitation stand out for frequency and intensity. Other elements related to dissemination of results, to professionals, care and factors related to the institution are presented. Standing out as threats are the instability of staff and continued changes in Senior Management or corporate policies. Among the strengths, the exclusive dedication of personnel to the project and its link to institutional objectives are distinguished. As opportunities, the possibility of standardized comparison of own results with others, as well as the dissemination of results are highlighted.

Conclusion: A useful pattern is set up to approach implementation in other scenarios, where changes in professional culture, training, communication and leadership, as well as aligning interests of managers and politicians, facilitate ideal conditions for Evidence-Based Practice.
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http://dx.doi.org/10.1016/j.enfcli.2019.10.027DOI Listing
May 2020

Implementation results of the assessment and management of pain guideline within Best Practice Spotlight Organisations (BPSO®).

Enferm Clin 2020 May - Jun;30(3):212-221. Epub 2020 Apr 27.

Área de Procesos, Investigación, Innovación y Sistemas de Información, Hospital Clínico San Carlos, Madrid, España.

Aim: to analyse the progress of implementing the process recommendations of the RNAO Assessment and Management of Pain guideline and health outcomes.

Method: An observational, longitudinal, retrospective study conducted in 3tertiary-level hospitals in Spain. All patients discharged over the last 5 days of each month from the units selected in the implementation process were included. We evaluated structural data, mean hospital stay, implementation strategy and degree of implementation of the process recommendations of the RNAO guideline over the first 3 years of implementation, and outcomes. A descriptive analysis was performed by calculating means and absolute and relative frequencies in periods: baseline (T0), annual, over the 3first years of implementation (T1, T2 and T3 respectively), and inferential.

Results: 8128 patients were included in the study. Hypotheses were contrasted between the different periods. The initial pain assessment in the first 24h following admission or post-surgery increased after the baseline period in all the hospitals, especially those that did not meet the guidelines from the outset. It continued to rise progressively up to 3 years following implementation (reaching 94.6% in hospital 2). By contrast, implementation of the care plan did not exceed 37.5% and 38.5% in hospitals 1 and 3 respectively. With regard to the outcome indicators, the prevalence of pain at 24hours and intense pain generally decreased in the 3hospitals from T0 or T1 to T3, however no conclusive statistically significant differences were obtained.

Conclusions: Implementation of the process recommendations improved from the outset, as did patient outcomes. A decrease in the prevalence and intensity of pain was achieved, although no conclusive data were obtained; all of which leads to better nursing practice with more recording, continuity of care and improved pain management for patients.
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http://dx.doi.org/10.1016/j.enfcli.2020.04.002DOI Listing
April 2020

Implementation results of the assessment and management of pain guideline within Best Practice Spotlight Organisations (BPSO®).

Enferm Clin 2020 May - Jun;30(3):212-221. Epub 2020 Apr 27.

Área de Procesos, Investigación, Innovación y Sistemas de Información, Hospital Clínico San Carlos, Madrid, España.

Aim: to analyse the progress of implementing the process recommendations of the RNAO Assessment and Management of Pain guideline and health outcomes.

Method: An observational, longitudinal, retrospective study conducted in 3tertiary-level hospitals in Spain. All patients discharged over the last 5 days of each month from the units selected in the implementation process were included. We evaluated structural data, mean hospital stay, implementation strategy and degree of implementation of the process recommendations of the RNAO guideline over the first 3 years of implementation, and outcomes. A descriptive analysis was performed by calculating means and absolute and relative frequencies in periods: baseline (T0), annual, over the 3first years of implementation (T1, T2 and T3 respectively), and inferential.

Results: 8128 patients were included in the study. Hypotheses were contrasted between the different periods. The initial pain assessment in the first 24h following admission or post-surgery increased after the baseline period in all the hospitals, especially those that did not meet the guidelines from the outset. It continued to rise progressively up to 3 years following implementation (reaching 94.6% in hospital 2). By contrast, implementation of the care plan did not exceed 37.5% and 38.5% in hospitals 1 and 3 respectively. With regard to the outcome indicators, the prevalence of pain at 24hours and intense pain generally decreased in the 3hospitals from T0 or T1 to T3, however no conclusive statistically significant differences were obtained.

Conclusions: Implementation of the process recommendations improved from the outset, as did patient outcomes. A decrease in the prevalence and intensity of pain was achieved, although no conclusive data were obtained; all of which leads to better nursing practice with more recording, continuity of care and improved pain management for patients.
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http://dx.doi.org/10.1016/j.enfcli.2020.04.002DOI Listing
April 2020

The implementation of Best practice guidelines in Spain through the Programme of the Best Practice Spotlight Organizations®.

Enferm Clin 2020 May - Jun;30(3):136-144. Epub 2019 Nov 26.

Registered Nurses' Association of Ontario (RNAO), Toronto, Ontario, Canadá.

The implementation of Best practice guidelines is effective in improving clinical practice and reducing clinical variability. The Best Practice Guidelines of the Ontario Nurses Association have been implemented in Spain since 2012 following the principles of the Canadian programme of the Best Practice Spotlight Organisations® (BPSO®). The Nursing and Healthcare Research Unit (Investén-isciii) coordinates this programme in Spain, having been nominated BPSO Host by the Ontario Nurses Association. Four strategies were followed: translation of the Best Practice Guidelines, dissemination of same and of the programme, implementation of the Best Practice Guidelines and assessment of the results in competitively selected centres, and, finally, the development of sustainability mechanisms. Implementation is based on the theoretical Knowledge to Action model, which establishes a cycle of 6 phases: identification of the problem and training of selected BPSO®; adaptation to the local context; assessment of facilitators and barriers; adaptation and implementation of interventions; monitoring and evaluation of results, and sustainability. Each of these phases incorporate evidence-based elements that promote the effectiveness of implementation, such as the competitive selection of candidates to participate in the programme, selection by the institution of the guidelines to be implemented, leadership by nurses with a multi-professional approach, planning of the process from work structures that are non-vertical but with the support of the institution, the simultaneous use of multiple strategies, ongoing assessment and feedback of results. All of which is mentored and supported by the BPSO Host. There are currently 27 institutions in Spain of different characteristics that implement a total of 20 clinical guidelines. The scope and structure of the programme has recently been extended with regional BPSO Host coordinating centres, which has brought the number of institutions to 36 and the number of implemented clinical guidelines to 22. The programme has had a positive impact on organisations and the system, on care processes and on patient health. This is evidenced by enriched evidence-based professional practice, the promotion of collaborative networking and by improved patient health outcomes and the quality of care provided.
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http://dx.doi.org/10.1016/j.enfcli.2019.09.018DOI Listing
November 2019

Getting guidelines into practice: lessons learned as Best Practice Spotlight Organization host.

Int J Evid Based Healthc 2019 Jun;17 Suppl 1:S15-S17

Registered Nurses' Association of Ontario (RNAO), Toronto, Ontario, Canada.

Background: The Spanish Best Practice Guidelines (BPG) Implementation Project is part of the Best Practice Spotlight Organizations international program, coordinated by the Registered Nurses' Association of Ontario (RNAO).

Aims: To influence the uptake of nursing BPG across healthcare organizations, to enable practice excellence and positive client outcomes.

Methods: After translating the RNAO's BPG into Spanish, the Host Organization published a formal call for proposals to select healthcare settings in Spain to implement the RNAO's BPG and evaluate the results. The approach is nursing-led and multidisciplinary; context specific; and involving a wide range of stakeholders. The implementation of BPG Toolkit guides the process: cascade training, selection of recommendations to be implemented, 3 years of planned implementation activities, monitoring of process and outcome results for patients discharged 60 days every year. The Host Organization supports healthcare settings selected.

Results/discussion: The first call was launched in 2012. Eight healthcare settings (11 sites), serving 1.3 million people, were selected (hospitals and primary healthcare centers). They chose 10 BPG, according to their needs. In 2015 and 2018, 16 more healthcare settings have joined the program with a total of 263 sites. And in 2019, three complete regions will join the program as a regional host. Currently, more than 3200 nurses and 40 other healthcare professionals have been trained, evidence-based protocols have been developed or updated, patient education has been promoted, and international Best Practice Spotlight Organizations indicators have been evaluated in an electronic platform.

Conclusion: The results obtained acknowledge that the RNAO implementation method could be replicated with success internationally. The strategies based on local context have worked and we have consolidated a network that shares knowledge and strategies and promotes evidence-based culture among Spanish healthcare settings and evidence-based care to patients.
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http://dx.doi.org/10.1097/XEB.0000000000000178DOI Listing
June 2019

Falls prevention strategies for patients over 65 years in a neurology ward: a best practice implementation project.

JBI Database System Rev Implement Rep 2018 07;16(7):1582-1589

Neurology/Stroke Unit, OSI Araba, Santiago, Vitoria, Spain.

Objectives: The aim of this project was to promote evidence-based practice with regard to fall prevention and management, by implementing the recommendations from the best available evidence to reduce fall rates.

Introduction: Falls are a main cause of disability in older people and the most common adverse event in all hospital patients. It is essential to implement the recommendations from evidence-based interventions to reduce these events.

Methods: A pre and post implementation audit method was used in a neurology ward, which employed the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research Into Practice (GRiP) module. The 15-month project evaluated between 20-30 patients from a sample at each audit (baseline in April 2016 and during three follow-up cycles in December 2016, March 2017 and June 2017). The data were inputted into an informatics system from nursing records and audited according to evidence-based processes and outcomes criteria.

Results: The baseline outcomes identified five barriers: incomplete fall registration, lack of an established fall prevention protocol for at-risk patients, limited knowledge about the fall prevention protocol, lack of a fall risk assessment scale and lack of multifactorial individual plans for fall prevention. Strategies were carried out and implemented following GRiP and all the criteria improved from baseline.

Conclusions: The project successfully increased evidence-based practice on falls and provided mechanisms for sustaining evidence-based practice changes. Further audits are needed to improve some outcomes.
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http://dx.doi.org/10.11124/JBISRIR-2017-003628DOI Listing
July 2018

Efficacy of the Otago Exercise Programme to reduce falls in community-dwelling adults aged 65-80 years old when delivered as group or individual training.

J Adv Nurs 2018 Jul 3;74(7):1700-1711. Epub 2018 Jun 3.

Grup de Recerca de Cures de Salut, GRECS, Institut de Recerca Biomèdica, Lleida, Spain.

Aim: This study will compare how falls can be reduced in non-institutionalized older Spanish adults aged 65-80 years by providing group or individual exercise sessions using the Otago Exercise Programme.

Background: The Otago Exercise Programme is a progressive home-based exercise programme, where trained health professionals help people engage in strength, balance and endurance exercises. Its format is based on the evidence from four clinical trials. The benefits of the Otago Exercise Programme are the same for people who have and have not suffered falls and it can also be used for visually impaired people.

Design: A multicentre, simply blinded, randomized, non-inferiority clinical trial, with two arms-group training and individual training-that started in January 2017 and will continue until December 2019.

Methods: Each study group has 364 subjects, who will take part in four individual or group sessions delivered mainly by nurses over an 8-week period, with a reinforcement session 6 months later. Data will be collected at baseline and after 6 and 12 months. The fall percentage will be the most relevant clinical variable and we will also consider safety, viability, compliance, economic analysis and therapeutic value. Approval and funding was granted in December 2016 for this 3-year study by the Spanish Health Research Fund (PI16CIII/00031).

Discussion: Older people from 65-80 years old tend to be more isolated and tackling worries about falls can improve social activities and independence. It has been shown that group training provides better adherence to exercise than individual training and this study will test that hypothesis for the Otago Exercise Programme.
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http://dx.doi.org/10.1111/jan.13583DOI Listing
July 2018

Falls assessment and interventions among older patients in two medical and one surgical hospital wards in Spain: a best practice implementation project.

JBI Database System Rev Implement Rep 2018 01;16(1):247-257

The Spanish Centre for Evidence Based Nursing and Healthcare: a Joanna Briggs Institute Centre of Excellence.

Objective: The current project aimed to improve fall prevention and management through clinical audits and the implementation of a quality-improvement cycle at the local level.

Introduction: Falls are one of the most common adverse events reported in hospitals; evidence-based fall prevention interventions aim to reduce the number of people who fall.

Methods: A one-year clinical audit was conducted using a pre-post implementation audit method, namely the Joanna Briggs Institute's (JBI) Practical Application of Clinical Evidence System and the getting research into practice audit and feedback tool. Two medical wards and a surgical ward in a Spanish hospital participated. The subjects were evaluated at baseline and at a follow-up at six months after key strategies had been implemented.

Results: Compliance rates for the evidence-based criteria were low in the baseline audit. Five barriers were identified in relation to fall assessment and management and, based on getting research into practice, strategies were designed, developed and implemented to overcome these barriers. After implementation, most of the fall-risk-assessment criteria showed an overall improvement, but there was no effect on care plan recording. Awareness of the assessment and management of fall risks were increased among professionals and patients on all three study wards.

Conclusions: The current project may improve compliance with regard to promoting evidence-based fall prevention and management interventions. Further audits are necessary to evaluate any improvements achieved, in particular, care plans.
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http://dx.doi.org/10.11124/JBISRIR-2017-003349DOI Listing
January 2018

[Access to health information sources in Spain. how to combat "infoxication"].

Enferm Clin 2012 May-Jun;22(3):154-8. Epub 2012 May 8.

Unidad de Investigación en Cuidados de Salud, Instituto de Salud Carlos III, Madrid, España.

Internet has become a priceless source for finding health information for both patients and healthcare professionals. However, the universality and the abundance of information can lead to unfounded conclusions about health issues that can confuse further than clarify the health information. This aspect causes intoxication of information: infoxication. The question lies in knowing how to filter the information that is useful, accurate and relevant for our purposes. In this regard, integrative portals, such as the Biblioteca Virtual de Salud, compile information at different levels (international, national and regional), different types of resources (databases, repositories, bibliographic sources, etc.), becoming a starting point for obtaining quality information.
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http://dx.doi.org/10.1016/j.enfcli.2012.04.001DOI Listing
October 2012

[The Spanish best practice guidelines implementation project 2011-2016].

Enferm Clin 2011 Sep-Oct;21(5):275-83. Epub 2011 Sep 15.

Facultad de Enfermería, Universidad de Murcia, España.

The Spanish Best Practice Guidelines Implementation Project 2011-2016 is intended to establish a reference framework for encouraging nursing decision-making based on the best available evidence at different levels of the National Health Service. In line with the Quality Plan for the National Health System 2010 of the Government of Spain, it pretends to improve the effectiveness, safety and efficiency of health care nurse, which will benefit our patients. This Project has been developed and will be set up thanks to the collaboration between the national Nursing Research Development and Coordination Unit (Investén-isciii), the Spanish Joanna Briggs Institute Collaboration Centre (consisted of the Institute of Health Carlos III, 14 Spanish Autonomous Communities and the Ministry of Health, Social Policy and Equality), and the Registered Nurses' Association of Ontario (RNAO), Canada. The Project is structured in four basic strategies in order to answer the objectives. The first strategy is the translation of the 41 Best Practice Guidelines, which were developed by RNAO to the date. The second strategy, the dissemination of the BPG, aims to promote awareness of the existing guidelines across the whole nursing community, and to provide free on-line access. The third and fourth strategies aim to promote and facilitate the BPGs use and maintenance. To achieve these 2 last strategies, a Network of Centres Committed to Excellence in Care will be created to implement, evaluate and sustain these BPGs.
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http://dx.doi.org/10.1016/j.enfcli.2011.07.013DOI Listing
February 2012

[Evidence based information sheet for consumer. Strategies to help smokers quit].

Enferm Clin 2011 Mar-Apr;21(2):119-21

Centro Colaborador Español del JBI, Investén-ISCIII, Instituto de Salud Carlos III, Madrid, Spain.

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http://dx.doi.org/10.1016/j.enfcli.2010.12.003DOI Listing
September 2011