Publications by authors named "Maribel Gonzalez-Samartino"

11 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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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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September 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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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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November 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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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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September 2019

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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July 2019

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: ISRCTN39531840.
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June 2016

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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January 2014

[Develop critical thinking through the practice daily].

Rev Enferm 2012 Sep;35(9):16-21

Hospital Universitario de Bellvitge, Barcelona.

Goals: To assess critical thinking skills of students in the UB Hospital Practicum through the development of a daily practice.

Setting: School of Nursing at UB.

Design: Descriptive observational correlational.

Sample: From the total amount of 3rd course students doing the Hospitalary Practicum from October 2012 to January 2013, we will choose a convenience sample of n=10 from the number of students randomly assigned to each associate teacher, and in this case the main researcher.

Data Collection: From the California Critical Thinking skills test CCTST we'll seek personal disposition towards critical thinking through CCTDI California Critical Thinking Disposition Inventory questionnaire to be passed to the students before the start of the Hospitalary and critical thinking skills will be sought after. A modified CTS Critical Thinking skills scale will be used to analyze reflexive writings.

Analysis: Data will be statistically treated using SPSS and analized using descriptive statistic.Chi-square tests will be used to verify the existence of correlation between the research variables.
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September 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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August 2012