Publications by authors named "Maria-Eulàlia Juvé-Udina"

26 Publications

  • Page 1 of 1

Risk of acute deterioration and care complexity individual factors associated with health outcomes in hospitalised patients with COVID-19: a multicentre cohort study.

BMJ Open 2021 02 17;11(2):e041726. Epub 2021 Feb 17.

Nursing Deparment, Catalan Institute of Health (IDIBELL), Barcelona, Catalunya, Spain.

Background: Evidence about the impact of systematic nursing surveillance on risk of acute deterioration of patients with COVID-19 and the effects of care complexity factors on inpatient outcomes is scarce. The aim of this study was to determine the association between acute deterioration risk, care complexity factors and unfavourable outcomes in hospitalised patients with COVID-19.

Methods: A multicentre cohort study was conducted from 1 to 31 March 2020 at seven hospitals in Catalonia. All adult patients with COVID-19 admitted to hospitals and with a complete minimum data set were recruited retrospectively. Patients were classified based on the presence or absence of a composite unfavourable outcome (in-hospital mortality and adverse events). The main measures included risk of acute deterioration (as measured using the VIDA early warning system) and care complexity factors. All data were obtained blinded from electronic health records. Multivariate logistic analysis was performed to identify the VIDA score and complexity factors associated with unfavourable outcomes.

Results: Out of a total of 1176 patients with COVID-19, 506 (43%) experienced an unfavourable outcome during hospitalisation. The frequency of unfavourable outcomes rose with increasing risk of acute deterioration as measured by the VIDA score. Risk factors independently associated with unfavourable outcomes were chronic underlying disease (OR: 1.90, 95% CI 1.32 to 2.72; p<0.001), mental status impairment (OR: 2.31, 95% CI 1.45 to 23.66; p<0.001), length of hospital stay (OR: 1.16, 95% CI 1.11 to 1.21; p<0.001) and high risk of acute deterioration (OR: 4.32, 95% CI 2.83 to 6.60; p<0.001). High-tech hospital admission was a protective factor against unfavourable outcomes (OR: 0.57, 95% CI 0.36 to 0.89; p=0.01).

Conclusion: The systematic nursing surveillance of the status and evolution of COVID-19 inpatients, including the careful monitoring of acute deterioration risk and care complexity factors, may help reduce deleterious health outcomes in COVID-19 inpatients.
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http://dx.doi.org/10.1136/bmjopen-2020-041726DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893207PMC
February 2021

Care complexity individual factors associated with adverse events and in-hospital mortality.

PLoS One 2020 23;15(7):e0236370. Epub 2020 Jul 23.

School of Nursing, Medicine and Health Science Faculty, University of Barcelona, Bellvitge Institute of Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.

Introduction: Measuring the impact of care complexity on health outcomes, based on psychosocial, biological and environmental circumstances, is important in order to detect predictors of early deterioration of inpatients. We aimed to identify care complexity individual factors associated with selected adverse events and in-hospital mortality.

Methods: A multicenter, case-control study was carried out at eight public hospitals in Catalonia, Spain, from January 1, 2016 to December 31, 2017. All adult patients admitted to a ward or a step-down unit were evaluated. Patients were divided into the following groups based on the presence or absence of three adverse events (pressure ulcers, falls or aspiration pneumonia) and in-hospital mortality. The 28 care complexity individual factors were classified in five domains (developmental, mental-cognitive, psycho-emotional, sociocultural and comorbidity/complications). Adverse events and complexity factors were retrospectively reviewed by consulting patients' electronic health records. Multivariate logistic analysis was performed to identify factors associated with an adverse event and in-hospital mortality.

Results: A total of 183,677 adult admissions were studied. Of these, 3,973 (2.2%) patients experienced an adverse event during hospitalization (1,673 [0.9%] pressure ulcers; 1,217 [0.7%] falls and 1,236 [0.7%] aspiration pneumonia). In-hospital mortality was recorded in 3,996 patients (2.2%). After adjustment for potential confounders, the risk factors independently associated with both adverse events and in-hospital mortality were: mental status impairments, impaired adaptation, lack of caregiver support, old age, major chronic disease, hemodynamic instability, communication disorders, urinary or fecal incontinence, vascular fragility, extreme weight, uncontrolled pain, male sex, length of stay and admission to a medical ward. High-tech hospital admission was associated with an increased risk of adverse events and a reduced risk of in-hospital mortality. The area under the ROC curve for both outcomes was > 0.75 (95% IC: 0.78-0.83).

Conclusions: Several care complexity individual factors were associated with adverse events and in-hospital mortality. Prior identification of complexity factors may have an important effect on the early detection of acute deterioration and on the prevention of poor outcomes.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236370PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7377913PMC
September 2020

[Standardized nursing languages and care plans. Perception of use and utility in primary healthcare].

Aten Primaria 2020 12 13;52(10):750-758. Epub 2020 May 13.

Dirección de Cuidados, Institut Català de la Salut, Barcelona, España; Instituto de Investigación Biomédica de Bellvitge (IDIBELL) , L'Hospitalet de Llobregat, Barcelona, España; Escuela Universitaria de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, España.

Objective: To identify opinions of Primary Healthcare nurses on the use and usefulness of standardised nursing care plans and traditional nursing language systems in the practice settings.

Design: Multicentre, observational, cross-sectional study.

Setting: Primary Healthcare centres in Catalonia.

Participants: Sample size was estimated at 1,668 registered nurses. Consecutive sampling was applied.

Interventions: On-line survey containing questions on ease, usefulness, and use of nursing care plans and standardised nursing language systems.

Measurements: Descriptive statistics, including percentages, central tendency, and dispersion measures. Statistical significance was set at P≤.05.

Results: The final analysis included 1,813 questionnaires. Participants stated that care plans have a medium added value, however their use is frequently incorrect. They stated to have a fair level of knowledge on traditional standardised nursing languages, and most were of the opinion that these languages are difficult to use in practice (81%) and not useful to represent nursing care provision and its outcomes (78%). Regardless of their education level and years of experience, the participants assessed as insufficient the clarity (P=.058), ease of use (P=.240), and usefulness (P=.039) of these language systems in practice.

Conclusions: Nurses say that urgent changes are required in the use of care plans. This includes changing the language systems, and improving data and information that positively impacts on the provision of nursing care, as well as to enhance the health outcomes of the individuals receiving Primary Healthcare services.
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http://dx.doi.org/10.1016/j.aprim.2019.10.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8054280PMC
December 2020

Acuity, nurse staffing and workforce, missed care and patient outcomes: A cluster-unit-level descriptive comparison.

J Nurs Manag 2020 Nov 19;28(8):2216-2229. Epub 2020 Jun 19.

Nursing Research Group, IDIBELL, Bellvitge Biomedical Research Institute, Barcelona, Spain.

Aim: To compare the patient acuity, nurse staffing and workforce, missed nursing care and patient outcomes among hospital unit-clusters.

Background: Relationships among acuity, nurse staffing and workforce, missed nursing care and patient outcomes are not completely understood.

Method: Descriptive design with data from four unit-clusters: medical, surgical, combined and step-down units. Descriptive statistics were used to compare acuity, nurse staffing coverage, education and expertise, missed nursing care and selected nurse-sensitive outcomes.

Results: Patient acuity in general (medical, surgical and combined) floors is similar to step-down units, with an average of 5.6 required RN hours per patient day. In general wards, available RN hours per patient day reach only 50% of required RN hours to meet patient needs. Workforce measures are comparable among unit-clusters, and average missed nursing care is 21%. Patient outcomes vary among unit-clusters.

Conclusion: Patient acuity is similar among unit-clusters, while nurse staffing coverage is halved in general wards. While RN education, expertise and missed care are comparable among unit-clusters, mortality, skin injuries and risk of family compassion fatigue rates are higher in general wards.

Implications For Nursing Management: Nurse managers play a pivotal role in hustling policymakers to address structural understaffing in general wards, to maximize patient safety outcomes.
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http://dx.doi.org/10.1111/jonm.13040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754324PMC
November 2020

Predicting patient acuity according to their main problem.

J Nurs Manag 2019 Nov 30;27(8):1845-1858. Epub 2019 Oct 30.

Nursing Research Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain.

Aim: To assess the ability of the patient main problem to predict acuity in adults admitted to hospital wards and step-down units.

Background: Acuity refers to the categorization of patients based on their required nursing intensity. The relationship between acuity and nurses' clinical judgment on the patient problems, including their prioritization, is an underexplored issue.

Method: Cross-sectional, multi-centre study in a sample of 200,000 adults. Multivariate analysis of main problems potentially associated with acuity levels higher than acute was performed. Distribution of patients and outcome differences among acuity clusters were evaluated.

Results: The main problems identified are strongly associated with patient acuity. The model exhibits remarkable ability to predict acuity (AUC, 0.814; 95% CI, 0.81-0.816). Most patients (64.8%) match higher than acute categories. Significant differences in terms of mortality, hospital readmission and other outcomes are observed (p < .005).

Conclusion: The patient main problem predicts acuity. Most inpatients require more intensive than acute nursing care and their outcomes are adversely affected.

Implications For Nursing Management: Prospective measurement of acuity, considering nurses' clinical judgments on the patient main problem, is feasible and may contribute to support nurse management workforce planning and staffing decision-making, and to optimize patients, nurses and organizational outcomes.
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http://dx.doi.org/10.1111/jonm.12885DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328732PMC
November 2019

Barriers and facilitators involved in standardised care plan individualisation process in acute hospitalisation wards: A grounded theory approach.

J Clin Nurs 2019 Dec 1;28(23-24):4606-4620. Epub 2019 Oct 1.

Institute of Bellvitge Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Spain.

Objective: To identify and classify the barriers and facilitators of the individualisation process of the standardised care plan in hospitalisation wards.

Background: The administration of individualised care is one of the features of the nursing process. Care plans are the structured record of the diagnosis, planning and evaluation stages of the nursing process. Although the creation of standardised care plan has made recording easier, it is still necessary to record the individualisation of the care. It is important to study the elements that influence the individualisation process from the nurses' perspective.

Design: Qualitative study with the grounded theory approach developed by Strauss and Corbin.

Methods: Thirty-nine nurses from three hospitals participated by way of theoretical sampling. In-depth interviews were conducted, as well as participant observation, document analysis and focus group discussion. The analysis consisted of open, axial and selective coding until data saturation was reached. EQUATOR guidelines for qualitative research (COREQ) were applied.

Results: For both barriers and facilitators, three thematic categories emerged related to organisational, professional and individual aspects. The identified barriers included routines acquired in the wards, the tradition of narrative records, lack of knowledge and limited interest in individualisation. The identified facilitators included holding clinical care sessions, use of standardised care plan and an interface terminology, the nurse's expertise and willingness to individualise.

Conclusion: The individualisation process of the standardised care plan involves multiple barriers and facilitators, which influence its degree of accuracy.

Relevance To Clinical Practice: Implementing strategies at an organisational level, professional level and individual level to improve the way the process is carried out would encourage individualising the standardised care plan in a manner that is consistent with the needs of the patient and family; it would improve the quality of care and patient satisfaction.
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http://dx.doi.org/10.1111/jocn.15059DOI Listing
December 2019

Level of satisfaction of critical care patients regarding the nursing care received: Correlation with sociodemographic and clinical variables.

Aust Crit Care 2019 11 24;32(6):486-493. Epub 2018 Dec 24.

Fundamental Care and Medical-Surgical Nursing Department, School of Nursing, University of Barcelona, Pavelló de Govern, 3° pl. 08907 L'Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, Bellvitge Biomedical Research Institute, Avinguda de la Granvia, 199. 08908 L'Hospitalet de Llobregat, Barcelona, Spain.

Background: The satisfaction of critical care patients regarding the nursing care received is a key indicator of the quality of hospital care. It is, therefore, essential to identify the factors associated with the level of satisfaction of critical care patients.

Objectives: To analyse the level of satisfaction of critical care patients in relation to the nursing care received and to determine the relationship between the level of satisfaction and the sociodemographic and clinical variables.

Methods: This is a prospective and descriptive correlational study. The population were all patients discharged (January 2013 to January 2015) from three intensive care units of a third-level hospital (n = 200). The data on the satisfaction level were collected using the previously validated Nursing Intensive-Care Satisfaction Scale, and the sociodemographic and clinical data were recorded by means of a questionnaire.

Results: Mean participants' age in the study (n = 200) was 65.9 years (standard deviation 13.4 years), with a 66% proportion of men (n = 132). There was a very high level of satisfaction regarding the nursing care received during the patients' stay in the intensive care unit, with a rating of 5.73 (standard deviation 0.41). There is no correlation between the level of satisfaction and the sociodemographic variables collected. However, there were statistically significant differences in the average score of the overall level of satisfaction (rho = 0.182, p = 0.010) with respect to the perception of the state of health.

Conclusion: Critical care patients expressed very high rates of satisfaction, for both the scale as a whole and each of the factors. A high level of satisfaction is strongly influenced by the perception of the state of health.
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http://dx.doi.org/10.1016/j.aucc.2018.11.002DOI Listing
November 2019

Individualization process of the standardized care plan in acute care hospitalization units: Study protocol.

J Adv Nurs 2019 Jan 4;75(1):197-204. Epub 2018 Sep 4.

Institute of Bellvitge Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Spain.

Aim: To understand the individualization process of the standardized care plan (SCP) that nurses design for hospitalized patients.

Background: To apply the nursing process, it is advisable to use SCP to standardize the diagnosis, planning and evaluation stages. However, the fundamental element of this methodology is the individualization of the care plan.

Design: A qualitative study, framed within the constructivist paradigm and applying the Grounded Theory method, in accordance with Strauss and Corbin's approach.

Methods: Multicentre study. Theoretical sampling with maximum variation will be used. The data collection will consist of: in-depth individual interviews, participant observation, document analysis, focus group, and the questionnaires for Critical Thinking Assessment in relation to clinical practice and Nursing Competency Assessment for hospital nurses. The qualitative data will be analysed according to the constant comparative method of Strauss and Corbin's Grounded Theory, which involves performing open, axial and selective coding. The questionnaire results will be used to make a qualitative analysis that will consist of a triangulation between the level of critical thinking, level of expertise and record of the individualization process performed by the nurses. This protocol was approved in July 2015.

Discussion: By knowing the possible stages used in the individualization of a SCP, together with the elements that facilitate or hinder said individualization and nurses' attitudes and experiences regarding this phenomenon, it could help direct improvement strategies in the standardization and individualization process. In addition to recommendations for teaching and research.
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http://dx.doi.org/10.1111/jan.13823DOI Listing
January 2019

Care Complexity Individual Factors Associated With Hospital Readmission: A Retrospective Cohort Study.

J Nurs Scholarsh 2018 07 19;50(4):411-421. Epub 2018 Jun 19.

Associate Professor, University of Barcelona Medicine and Health Science School, Department of Nursing, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat (Barcelona), Spain.

Purpose: To determine the frequency of care complexity individual factors documented in the nursing assessment and to identify the risk factors associated with hospital readmission within 30 days of hospital discharge.

Design: Observational analysis of a retrospective cohort at a 700-bed university hospital in Barcelona, Spain. A total of 16,925 adult patient admissions to a ward or intermediate care units were evaluated from January to December 2016. Most patients were admitted due to cardiocirculatory and respiratory disorders (29.3%), musculoskeletal and nervous system disorders (21.8%), digestive and hepatobiliary conditions (17.9%), and kidney or urinary disorders (11.2%).

Methods: Readmission was defined as rehospitalization for any reason within 30 days of discharge. Patients who required hospital readmission were compared with those who did not. The individual factors of care complexity included five domains (developmental, mental-cognitive, psycho-emotional, sociocultural, and comorbidity or complications) and were reviewed using the electronic nursing assessment records. Multivariate logistic analysis was performed to determine factors associated with readmission.

Findings: A total of 1,052 patients (6.4%) were readmitted within 30 days of hospital discharge. Care complexity individual factors from the comorbidity or complications domain were found to be the most frequently e-charted (88.3%). Care complexity individual factors from developmental (33.2%), psycho-emotional (13.2%), mental-cognitive (7.2%), and sociocultural (0.7%) domains were less frequently documented. Independent factors associated with hospital readmission were old age (≥75 years), duration of first hospitalization, admission to a nonsurgical ward, major chronic disease, hemodynamic instability, immunosuppression, and relative weight of diagnosis-related group.

Conclusions: A substantial number of patients required readmission within 30 days after discharge. The most frequent care complexity individual factors recorded in the nursing assessment at index admission were related to comorbidity or complications, developmental, and psycho-emotional domains. Strategies related to transition of care that include clinical characteristics and comorbidity or complications factors should be a priority at hospital discharge and after leaving hospital, but other factors related to developmental and psycho-emotional domains could have an important effect on the use of healthcare resources.

Clinical Relevance: Nurses should identify patients with comorbidity or complications, developmental, and psycho-emotional complexity factors during the index admission in order to be able to implement an effective discharge process of care.
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http://dx.doi.org/10.1111/jnu.12393DOI Listing
July 2018

Accuracy and completeness of records of adverse events through interface terminology.

Rev Esc Enferm USP 2018;52:e03306. Epub 2018 Apr 16.

Escuela de Enfermería, Universidad de Barcelona, Barcelona, España.

Objective: To determine what adverse events, including pressure ulcers, infection of the surgical site and aspiration pneumonia, nurses record in clinical histories, in terms of diagnostic accuracy and completeness, through ATIC.

Method: Observational, descriptive, cross-sectional, multicenter study of 64 medical-surgical and semi-critical units of two university hospitals in Catalonia, Spain, during 2015. The diagnostic accuracy was assessed by means of the correspondence between the event declared in the Minimum Basic Data Set and the problem documented by the nurse. The record was considered complete when it contained the risk of the event, prescriptions of care and a record of the evolution.

Results: The sample evaluated included 459 records. The accuracy results of pressure ulcers are highly correlated between the nursing diagnosis recorded and that declared in the Minimum Basic Data Set. The accuracy in surgical site infection is moderate, and aspiration resulting in pneumonia is very low. The completeness of results is remarkable, except for the risk of bronchoaspiration.

Conclusion: The adverse event recorded by nurses with greatest accuracy is pressure ulcers.
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http://dx.doi.org/10.1590/s1980-220x2017011203306DOI Listing
September 2019

Nursing Intensive-Care Satisfaction Scale [NICSS]: Development and validation of a patient-centred instrument.

J Adv Nurs 2018 Jun 9;74(6):1423-1435. Epub 2018 Mar 9.

Fundamental Care and Medical-Surgical Nursing Department, Bellvitge Biomedical Research Institute (IDIBELL), HU-CI International Research Project, University of Barcelona, Barcelona, Spain.

Aim: The aim of this study was to develop and validate the Nursing Intensive-Care Satisfaction Scale to measures satisfaction with nursing care from the critical care patient's perspective.

Background: Instruments that measure satisfaction with nursing cares have been designed and validated without taking the patient's perspective into consideration. Despite the benefits and advances in measuring satisfaction with nursing care, none instrument is specifically designed to assess satisfaction in intensive care units.

Design: Instrument development.

Methods: The population were all discharged patients (January 2013 - January 2015) from three Intensive Care Units of a third level hospital (N = 200). All assessment instruments were given to discharged patients and 48 hours later, to analyse the temporal stability, only the questionnaire was given again. The validation process of the scale included the analysis of internal consistency, temporal stability; validity of construct through a confirmatory factor analysis; and criterion validity.

Results: Reliability was 0.95. The intraclass correlation coefficient for the total scale was 0.83 indicating a good temporal stability. Construct validity showed an acceptable fit and factorial structure with four factors, in accordance with the theoretical model, being Consequences factor the best correlated with other factors. Criterion validity, presented a correlation between low and high (range: 0.42-0.68).

Conclusions: The scale has been designed and validated incorporating the perspective of critical care patients. Thanks to its reliability and validity, this questionnaire can be used both in research and in clinical practice. The scale offers a possibility to assess and develop interventions to improve patient satisfaction with nursing care.
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http://dx.doi.org/10.1111/jan.13546DOI Listing
June 2018

Nursing assessment as an effective tool for the identification of delirium risk in older in-patients: A case-control study.

J Clin Nurs 2018 Jan 4;27(1-2):345-354. Epub 2017 Dec 4.

Nursing Department, Universitat Rovira Virgili, Terres de l'Ebre Campus, School of Nursing, Tortosa, Spain.

Aims And Objectives: To evaluate the usefulness of comprehensive nursing assessment as a strategy for determining the risk of delirium in older in-patients from a model of care needs based on variables easily measured by nurses.

Background: There are many scales of assessment and prediction of risk of delirium, but they are little known and infrequently used by professionals. Recognition of delirium by doctors and nurses continues to be limited.

Design And Methods: A case-control study. A specific form of data collection was designed to include the risk factors for delirium commonly identified in the literature and the care needs evaluated from the comprehensive nursing assessment based on the Virginia Henderson model of care needs. We studied 454 in-patient units in a basic general hospital. Data were collected from a review of the records of patients' electronic clinical history.

Results: The areas of care that were significant in patients with delirium were dyspnoea, problems with nutrition, elimination, mobility, rest and sleep, self-care, physical safety, communication and relationships. The specific risk factors identified as independent predictors were as follows: age, urinary incontinence, urinary catheter, alcohol abuse, previous history of dementia, being able to get out of bed/not being at rest, habitual insomnia and history of social risk.

Conclusions: Comprehensive nursing assessment is a valid and consistent strategy with a multifactorial model of delirium, which enables the personalised risk assessment necessary to define a plan of care with specific interventions for each patient to be made.

Relevance To Clinical Practice: The identification of the risk of delirium is particularly important in the context of prevention. In a model of care based on needs, nursing assessment is a useful component in the risk assessment of delirium and one that is necessary for developing an individualised care regime.
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http://dx.doi.org/10.1111/jocn.13921DOI Listing
January 2018

[The Role of School Nurses].

Rev Enferm 2017 Feb;40(2):22-24, 27-29

The school comes the second place where children's lives developed. Their ability to learn is closely related to their welfare and health. this paper aimed to define the roles that school nurses can play in the schools to help the children reach their educational goals through keeping them healthy and safe, and on the other hand, it will help us to evaluate the significance of school nurses and find out whether it is needed in the schools or not.
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February 2017

Surveillance nursing diagnoses, ongoing assessment and outcomes on in-patients who suffered a cardiorespiratory arrest.

Rev Esc Enferm USP 2017;51:e03286. Epub 2018 Mar 15.

School of Nursing, University of Barcelona, Barcelona, Catalonia, Spain.

Objective The purposes of this study were to examine the frequency of surveillance-oriented nursing diagnoses and interventions documented in the electronic care plans of patients who experienced a cardiac arrest during hospitalization, and to observe whether differences exist in terms of patients' profiles, surveillance measurements and outcomes. Method A descriptive, observational, retrospective, cross-sectional design, randomly including data from electronic documentation of patients who experienced a cardiac arrest during hospitalization in any of the 107 adult wards of eight acute care facilities. Descriptive statistics were used for data analysis. Two-tailed p-values are reported. Results Almost 60% of the analyzed patients' e-charts had surveillance nursing diagnoses charted in the electronic care plans. Significant differences were found for patients who had these diagnoses documented and those who had not in terms of frequency of vital signs measurements and final outcomes. Conclusion Surveillance nursing diagnoses may play a significant role in preventing acute deterioration of adult in-patients in the acute care setting.
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http://dx.doi.org/10.1590/s1980-220x2017004703286DOI Listing
July 2019

Concepts and measures of patient empowerment: a comprehensive review.

Rev Esc Enferm USP 2016 Jul-Aug;50(4):667-674

Universidad de Barcelona, Escuela Universitaria de Enfermería, Barcelona, España.

Objective: Analyze the definitions and dimensions of empowerment. Identify the strengths and weaknesses of empowerment measures based on the conceptual model.

Method: This was a comprehensive literature review of publications on the MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases.

Results: Twenty-nine articles were selected. Seventeen definitions and seven dimensions of empowerment, and 10 empowerment measures were selected. Empowerment can be seen as an enabling process involving a shift in the balance of power, or as an outcome of this process. The dimensions reflect outcome indicators, such as participation in decision-making and control, and process indicators, such as knowledge acquisition and coping skills. Six of the tools analyzed by this study could be said to provide a robust measure of patient empowerment.

Conclusion: we propose a definition of empowerment that helps to deepen understanding of the term and, therefore, its operationalization.

Objetivo: Analizar definiciones y dimensiones de empoderamiento. Identificar fortalezas y debilidades de los instrumentos de medida de empoderamiento respecto al modelo conceptual.

MÉtodo: Revisión integrativa de la literatura en las bases de datos MEDLINE y Cumulative Index to Nursing and Allied Health Literature (CINAHL).

Resultados: Fueram seleccionados 29 artículos . Se identificaron 17 definiciones, 7 propuestas de dimensiones y 10 instrumentos de medida. Empoderamiento puede ser un proceso de capacitación o habilitación en el que se transfiere el poder de un individuo a otro, o bien un resultado producto de ese proceso. Las dimensiones reflejan indicadores de resultados como son la participación en la toma de decisiones y tomar el control, e indicadores relativos al proceso como son la adquisición de conocimientos y las habilidades de afrontamiento. De los instrumentos analizados seis son los instrumentos que presentan mayor robustez.

ConclusiÓn: Se propone una definición de empoderamiento que puede ayudar a mejorar la comprensión del término y por lo tanto a operacionalizarlo.
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http://dx.doi.org/10.1590/S0080-623420160000500018DOI Listing
February 2017

[Evaluation of the nurse working environment in health and social care intermediate care units in Catalonia].

Rev Esp Geriatr Gerontol 2016 Nov - Dec;51(6):342-348. Epub 2015 Dec 17.

Escuela Universitaria de Enfermería, Universidad de Barcelona, Barcelona, España; Dirección assistencial, Instituto Catalán de la Salud, Barcelona, España; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España.

Introduction: A favourable work environment contributes to greater job satisfaction and improved working conditions for nurses, a fact that could influence the quality of patient outcomes. The aim of the study is two-fold: Identifying types of centres, according to the working environment assessment made by nurses in intermediate care units, and describing the individual characteristics of nurses related to this assessment.

Methods: An observational, descriptive, prospective, cross-sectional, and multicentre study was conducted in the last quarter of 2014. Nurses in intermediate care units were given a questionnaire containing the Practice Environment Scale of the Nursing Work Index (PES-NWI) which assesses five factors of the work environment using 31 items. Sociodemographic, employment conditions, professional and educational variables were also collected.

Results: From a sample of 501 nurses from 14 centres, 388 nurses participated (77% response). The mean score on the PES-NWI was 84.75. Nine centres scored a "favourable" working environment and five "mixed". The best valued factor was "work relations" and the worst was "resource provision/adaptation". Rotating shift work, working in several units at the same time, having management responsibilities, and having a master degree were the characteristics related to a better perception of the nursing work environment.

Conclusions: In most centres, the working environment was perceived as favourable. Some employment conditions, professional, and educational characteristics of nurses were related to the work environment assessment.
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http://dx.doi.org/10.1016/j.regg.2015.10.009DOI Listing
March 2018

Impact of an Educational Program to Reduce Healthcare Resources in Community-Acquired Pneumonia: The EDUCAP Randomized Controlled Trial.

PLoS One 2015 13;10(10):e0140202. Epub 2015 Oct 13.

Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain; Faculty of Medicine, Department of Clinical Sciences, University of Barcelona Barcelona, Spain.

Background: Additional healthcare visits and rehospitalizations after discharge are frequent among patients with community-acquired pneumonia (CAP) and have a major impact on healthcare costs. We aimed to determine whether the implementation of an individualized educational program for hospitalized patients with CAP would decrease subsequent healthcare visits and readmissions within 30 days of hospital discharge.

Methods: A multicenter, randomized trial was conducted from January 1, 2011 to October 31, 2014 at three hospitals in Spain. We randomly allocated immunocompetent adults patients hospitalized for CAP to receive either an individualized educational program or conventional information before discharge. The educational program included recommendations regarding fluid intake, adherence to drug therapy and preventive vaccines, knowledge and management of the disease, progressive adaptive physical activity, and counseling for alcohol and smoking cessation. The primary trial endpoint was a composite of the frequency of additional healthcare visits and rehospitalizations within 30 days of hospital discharge. Intention-to-treat analysis was performed.

Results: We assigned 102 patients to receive the individualized educational program and 105 to receive conventional information. The frequency of the composite primary end point was 23.5% following the individualized program and 42.9% following the conventional information (difference, -19.4%; 95% confidence interval, -6.5% to -31.2%; P = 0.003).

Conclusions: The implementation of an individualized educational program for hospitalized patients with CAP was effective in reducing subsequent healthcare visits and rehospitalizations within 30 days of discharge. Such a strategy may help optimize available healthcare resources and identify post-acute care needs in patients with CAP.

Trial Registration: Controlled-Trials.com ISRCTN39531840.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0140202PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4603897PMC
June 2016

Newborn physiological immaturity: a concept analysis.

Adv Neonatal Care 2015 Apr;15(2):86-93

IDIBELL Institute of Research, University of Barcelona School of Nursing, Catalonia, Spain (Drs Juvé-Udina, Fabrellas-Padrés, and Delgado-Hito); Sant Joan de Déu School of Nursing, Catalonia, Spain (Mrs Hurtado-Pardos); Department of Nursing Informatics and Knowledge, Verge de la Cinta Community Hospital, and Rovira i Virgili University School of Nursing, Tortosa, Catalonia, Spain (Mrs Martí-Cavallé); Department of Nursing Informatics and Knowledge, Dr. Josep Trueta University Hospital, Girona, Catalonia, Spain (Mrs Gironès-Nogué); Vall d'Hebron University Hospital, Barcelona, Catalonia, Spain (Mrs García-Berman); and Germans Trias i Pujol University Hospital, Badalona, Catalonia, Spain (Mr Alonso-Fernandez).

Background: Most standardized nursing care plans for healthy neonates include multiple nursing diagnoses to reflect nurses' judgments on the infant's status; however scientific literature concerning this issue is scarce. Newborn physiological immaturity is a concept in the ATIC terminology (architecture, terminology, interface, information, nursing [infermeria], and knowledge [coneixement]) to represent the natural status of vulnerability of the healthy neonate.

Purpose: To identify the essential attributes of the concept and provide its conceptual and operational definition, using the Wilsonian approach.

Findings: The concept under analysis embeds a natural cluster of vulnerabilities and environmental interactions that enhance the evolving maturation process.

Implications For Practice: The use of this diagnosis may simplify the process of charting the nursing care plans and reduce time needed for documentation while maintaining the integrity of the information.

Implications For Research: Consistent development and use of nursing concepts is essential for knowledge building. Studies on the actual use of nursing diagnoses are needed to inform decision making.
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http://dx.doi.org/10.1097/ANC.0000000000000162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4961275PMC
April 2015

Basic nursing care: retrospective evaluation of communication and psychosocial interventions documented by nurses in the acute care setting.

J Nurs Scholarsh 2014 Jan 19;46(1):65-72. Epub 2013 Dec 19.

IDIBELL Institute of Research, Nurse coordinator, Catalan Institute of Health. Associate professor, University of Barcelona School of Nursing - Health Universitat de Barcelona Campus, Barcelona, Catalonia, Spain.

Purpose: This study aimed to evaluate the frequency of psychosocial aspects of basic nursing care, as e-charted by nurses, when using an interface terminology.

Methods: An observational, multicentre study was conducted in acute wards. The main outcome measure was the frequency of use of the psychosocial interventions in the electronic nursing care plans, analysed over a 12 month retrospective review.

Findings: Overall, 150,494 electronic care plans were studied. Most of the intervention concepts from the interface terminology were used by registered nurses to illustrate the psychosocial aspects of fundamentals of care in the electronic care plans.

Conclusions And Implications: The results presented help to demonstrate that the interventions of this interface terminology may be useful to inform psychosocial aspects of basic and advanced nursing care.

Clinical Relevance: The identification of psychosocial elements of basic nursing care in the nursing documentation may lead to obtain a deeper understanding of those caring interventions nurses consider essential to represent nurse-patient interactions. The frequency of psychosocial interventions may contribute to delineate basic and advanced nursing care.
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http://dx.doi.org/10.1111/jnu.12062DOI Listing
January 2014

What patients' problems do nurses e-chart? Longitudinal study to evaluate the usability of an interface terminology.

Int J Nurs Stud 2013 Dec 14;50(12):1698-710. Epub 2013 May 14.

Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, Health Universitat de Barcelona Campus, School of Nursing, Barcelona, Spain. Electronic address:

Background: The nurses' ability to document patient's status, problems and progress is an important issue in patients' safety. Nursing terminologies are intended to support nursing practice but as any other clinical tool, they should be evaluated to assure quality and warrant effective written communication among clinicians.

Objectives: This study was aimed to evaluate the usability of the diagnosis axis of an interface terminology by assessing its completeness and the frequency of use of its concepts.

Design: Observational, longitudinal, multicentre study.

Setting: A total of 8 hospitals representing 162 acute medical-surgical, obstetric and mental health nursing wards, step-down units and home in-patient units were included.

Participants: Overall, 246,400 electronic care plans were studied; 53.5% from male patients; 14.6% paediatrics and 33.7% from patients elder than 70 years old. Most were admitted due to cardiocirculatory, respiratory, digestive or musculoskeletal conditions (50.5%), other acute medical or surgical disorders (29.8%) and obstetrics (19.3%).

Methods: The main outcome measures were: the use of nursing diagnoses from the interface terminology evaluated and their accumulated frequency, analysed over a 3-year retrospective review of the electronic nursing care plans. The analysis of data included descriptive statistics with a confidence level of 95% for confidence intervals.

Results: Most of the diagnostic concepts from the interface terminology were used (92.3%) by nurses to illustrate patients' problems in the electronic care plans. Their frequency of use widely varied, from some very frequent diagnoses like Risk for haemorrhage (51.4%; CI 95%: 51.25-51.65) or Acute pain (49.6%; CI: 49.49-49.88) to others used only in exceptional cases like Faecal impaction or Extravasation. The first nursing diagnosis related to family or caregiver emerges in the 32nd place of the ranking.

Conclusions: Results for outcome measures oriented that the diagnosis axis of this interface terminology meets the usability criterion of completeness when assessing for the use of its concepts in the acute care setting.
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http://dx.doi.org/10.1016/j.ijnurstu.2013.04.008DOI Listing
December 2013

[Health, environment and nursing. Philosophical and theoretical foundations for the development and validation of a nursing interface terminology. Part III].

Rev Enferm 2012 Jun;35(6):9-16

Programa de Doctorado en Ciencias Enfermeras, Escuela Universitaria de Enfermería, Universidad de Barcelona.

Introduction: This manuscript is the third of a triad of papers introducing the philosophical and theoretical approaches that support the development and validation of a nursing interface terminology as a standard vocabulary designed to ease data entry into electronic health records, to produce information and to generate knowledge.

Goals: To analyze the philosophical and theoretical approaches considered in the development of a new nursing interface terminology called ATIC.

Method: Review, analysis and discussion of the main philosophical orientations, high and mid-range theories and nursing scientific literature to develop an interpretative conceptualization of the metaparadigm concepts "Health", "Environment" and "Nursing".

Results: In the 2 previous papers the ATIC terminology, its foundation on pragmatism, holism, post-positivism and constructivism and the construction of the meaning for the concept elndividualh is discussed. In this third paper, Health is conceptualized as a multidimensional balance state and the concepts of Partial health status, Disease and Being ill are explored within. The analysis of the Environment theories drives its conceptualization as a group of variables that has the potential to affect health status. In this orientation, Nursing is understood as the scientific discipline focused on the study of health status in the particular environment and experience of the individuals, groups, communities or societies.

Conclusions: ATIC terminology is rooted on an eclectic philosophical and theoretical foundation, allowing it to be used from different trends within the totality paradigm.
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June 2012

Mapping the Diagnosis Axis of an Interface Terminology to the NANDA International Taxonomy.

ISRN Nurs 2012 4;2012:676905. Epub 2012 Jul 4.

School of Nursing, University of Barcelona, Campus of Bellvitge, Feixa Llarga s/n, 08907 Hospitalet de Llobregat, Spain.

Background. Nursing terminologies are designed to support nursing practice but, as with any other clinical tool, they should be evaluated. Cross-mapping is a formal method for examining the validity of the existing controlled vocabularies. Objectives. The study aims to assess the inclusiveness and expressiveness of the nursing diagnosis axis of a newly implemented interface terminology by cross-mapping with the NANDA-I taxonomy. Design/Methods. The study applied a descriptive design, using a cross-sectional, bidirectional mapping strategy. The sample included 728 concepts from both vocabularies. Concept cross-mapping was carried out to identify one-to-one, negative, and hierarchical connections. The analysis was conducted using descriptive statistics. Results. Agreement of the raters' mapping achieved 97%. More than 60% of the nursing diagnosis concepts in the NANDA-I taxonomy were mapped to concepts in the diagnosis axis of the new interface terminology; 71.1% were reversely mapped. Conclusions. Main results for outcome measures suggest that the diagnosis axis of this interface terminology meets the validity criterion of cross-mapping when mapped from and to the NANDA-I taxonomy.
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http://dx.doi.org/10.5402/2012/676905DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399394PMC
August 2012

[Philosophical and theoretical foundations for the development and validation of a nursing interface terminology. Part I].

Rev Enferm 2012 Apr;35(4):20-5

Universidad de Barcelona.

Introduction: An interface terminology is a standard vocabulary designed to ease data entry into electronic health records, to produce information and to generate knowledge.

Goal: To present the philosophical and theoretical underpinnings considered in the development of a new nursing interface terminology termed ATIC.

Method: Review, analysis and discussion of the main philosophical orientations, high and mid-range theories and nursing scientific literature. Interpretative conceptualization of the metaparadigm concepts: individual, health, environment and nursing.

Results: The first part of this paper introduces ATIC and its foundation on pragmatism, holism, post-positivism and constructivism as major philosophical approaches. The second and third parts reflects the analysis of the related nursing theoretical development generated from different nursing schools of thought, made explicit through the conceptualization of the meta-paradigmatic concepts.

Conclusions: ATIC terminology is rooted on an eclectic philosophical and theoretical foundation, allowing it to be used from different orientations or trends within the totality paradigm.
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April 2012

[ATIC. A nursing interface terminology. Part II].

Rev Enferm 2012 May;35(5):48-55

Escuela Universitaria de Enfermería, Universidad de Barcelona.

Introduction: This manuscript is the second part of a triad of papers introducing the philosophical and theoretical approaches that support the development and validation of a nursing interface terminology as a standard vocabulary designed to ease data entry into electronic health records, to produce information and to generate knowledge.

Goal: To present the philosophical and theoretical approaches considered in the development of a new nursing interface terminology called ATIC.

Method: Review, analysis and discussion of the main philosophical orientations, high and mid-range theories and nursing scientific literature to develop an interpretative conceptualization of the metaparadigm concept "Individual".

Results: The first part of this paper introduces ATIC and its foundation on pragmatism, holism, post-positivism and constructivism as major philosophical approaches. In this second part the construction of the concept "Individual" involves the integrality and the interaction among the three dimensions of the human being: "being physical", "being conscious" and "being autonomous".

Conclusions: ATIC terminology is rooted on an eclectic philosophical and theoretical foundation, allowing it to be used from different orientations within the totality paradigm.
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May 2012

To return or to discard? Randomised trial on gastric residual volume management.

Intensive Crit Care Nurs 2009 Oct 16;25(5):258-67. Epub 2009 Jul 16.

IDIBELL, Catalan Institute of Health, Gran Via de les Corts Catalanes, 587, Barcelona 08007, Spain.

Background: The control of gastric residual volume (GRV) is a common nursing intervention in intensive care; however the literature shows a wide variation in clinical practice regarding the management of GRV, potentially affecting patients' clinical outcomes. The aim of this study is to determine the effect of returning or discarding GRV, on gastric emptying delays and feeding, electrolyte and comfort outcomes in critically ill patients.

Method: A randomised, prospective, clinical trial design was used to study 125 critically ill patients, assigned to the return or the discard group. Main outcome measure was delayed gastric emptying. Feeding outcomes were determined measuring intolerance indicators, feeding delays and feeding potential complications. Fluid and electrolyte measures included serum potassium, glycaemia control and fluid balance. Discomfort was identified by significant changes in vital signs.

Results: Patients in both groups presented similar mean GRV with no significant differences found (p=0.111), but participants in the intervention arm showed a lower incidence and severity of delayed gastric emptying episodes (p=0.001). No significant differences were found for the rest of outcome measurements, except for hyperglycaemia.

Conclusions: The results of this study support the recommendation to reintroduce gastric content aspirated to improve GRV management without increasing the risk for potential complications.
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http://dx.doi.org/10.1016/j.iccn.2009.06.004DOI Listing
October 2009

[Measurement of residual gastric volume: in search of better evidence].

Enferm Intensiva 2006 Oct-Dec;17(4):154-62

Unidad de Cuidados Intensivos, Hospital Universitario de Bellvitge, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.

Introduction: Measurement of residual gastric volume is a frequent practice in chronic patients, but there is lack of consensus on the convenience of reintroducing or discarding aspirated gastric content (AGC).

Objective: Determine the grade of scientific evidence on the efficacy of two interventions -reintroduction/rejection- of AGC in chronic patients.

Material And Methods: Systematic review of the evidence available on the convenience of reintroducing or discarding ACG.

Procedure: a) establishment of inclusion/exclusion criteria; b) determination of the search strategy (keywords and itineraries); c) dumping of databases: MEDLINE, CINAHL, CUIDEN, IME, SCIELO and COCHRANE. Search for indirect method and manual dumping of indexes; d) independent and contrasted critical reading, using the CASPe template; and e) contrast of critical analysis results.

Results: Search itineraries generate more than 800 references that once purged make it possible to select 54. After reading them, only 4 really focused on the questions related with the reintroduction/rejection of AGC: 2 revisions, 1 observational study and a random clinical trial with a small sample. Meta-analysis techniques could not be used due to the heterogeneity of these studies. Thus, the results of the study were analyzed separately. Using this procedure, a final result was obtained that showed a low grade of scientific evidence.

Conclusions: There is limited scientific evidence on the convenience, safety and benefits of both interventions. It is difficult to establish a care protocol, so that we suggest performing an experimental study to establish the indications and contraindications of both interventions.
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http://dx.doi.org/10.1016/s1130-2399(06)73929-3DOI Listing
March 2007