Publications by authors named "Marta Romero-García"

12 Publications

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Coping strategies in health care providers as second victims: A systematic review.

Int Nurs Rev 2021 Jun 12. Epub 2021 Jun 12.

Fundamental Care and Medical-Surgical Nursing Department, School of Nursing, L'Hospitalet de Llobregat, University of Barcelona, Barcelona, Spain.

Aim: To analyze personal and organizational strategies described in the literature for dealing with the second victim phenomenon among healthcare providers.

Background: The second victim phenomenon involves many associated signs and symptoms, which can be physical, psychological, emotional, or behavioral. Personal and organizational strategies have been developed to deal with this phenomenon.

Materials And Methods: A systematic review was carried out in PubMed, Cochrane Library, Web of Science, Scopus, PsycINFO, Science Direct, and Cumulative Index to Nursing and Allied Health Literature databases, searching for evidence published between 2010 and 2019 in Spanish, English, German, and Portuguese.

Results: Seven hundred and eighty-three articles were identified. After eliminating duplicates, applying inclusion and exclusion criteria and critical analysis tools of the Joanna Briggs Institute, 16 research articles were included: 10 quantitative studies (design: descriptive, correlational, systematic, or integrative review) and six qualitative studies (descriptive, systematic review). There are several different personal and organizational strategies for dealing with the second victim phenomenon. Among these, peer support and learning from adverse events are highly valued. In personal strategies stands out the internal analysis of the adverse event that the professional performs to deal with the generated negative feelings. In organizational strategies, the most valued are second victim support programs with rapid response teams and made up of peers.

Conclusions: The main organizational coping strategies for tackling this phenomenon are online programs in countries such as the United States, Spain, and other European countries. Formal evaluation of these programs and research is required in Latin America.

Implications For Nursing And Health Policies: Adequately coping with the second victim phenomenon allows health professionals and organizations to learn from adverse events. Furthermore, by supporting health professionals who suffer from the second victim phenomenon, the organization takes care of its most valuable resource, its human capital. This contributes toward building a culture of healthcare quality in organizations, which will reduce adverse events in the future.
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http://dx.doi.org/10.1111/inr.12694DOI Listing
June 2021

Mixed-method research protocol: Development and evaluation of a nursing intervention in patients discharged from the intensive care unit.

Nurs Open 2021 May 6. Epub 2021 May 6.

Faculty of Medicine and Health Sciences, School of Nursing, Department of Fundamental and Medical-Surgical Nursing, Universitat de Barcelona, Barcelona, Spain.

Aim: (a) To understand patients' lived experience at intensive care unit (ICU) discharge and (b) to evaluate the impact of a nursing empowerment intervention (NEI) on patients' anxiety and depression levels at ICU discharge.

Design: A mixed-methods approach will be applied.

Methods: In the qualitative phase, the hermeneutic phenomenological method will be used. Participants will be patients from three university hospitals who will be selected by purposive sampling. Data will be gathered through in-depth interviews and analysed using content analysis. The qualitative data obtained will be employed to develop the nursing intervention. Subsequently, a multicenter, parallel-group, experimental pre-test/post-test design with a control group will be used to measure the effectiveness of the nursing empowerment intervention in the quantitative phase by means of the Hospital Anxiety and Depression Scale (HADS). Simple random probabilistic sampling will include 172 patients in this phase.
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http://dx.doi.org/10.1002/nop2.894DOI Listing
May 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

Factors influencing critical care nurses' intentions to use physical restraints adopting the theory of planned behaviour: A cross-sectional multicentre study.

Aust Crit Care 2020 09 22;33(5):426-435. Epub 2020 Apr 22.

Department of Fundamental Care and Medical-Surgical Nursing, School of Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Pavelló de Govern, 3ºpl. 08907 L'Hospitalet de Llobregat, Barcelona, Spain; Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), Av. Gran Via, 199, 08908, L 'Hospitalet de Llobregat, Barcelona, Spain. Electronic address:

Background: Studies addressing critical care nurses' practices regarding physical restraints have focused on individual nurses' knowledge and attitudes but lack the understanding of other social influences that could affect nurses' intentions to use them.

Objective: The objective of this study was to determine critical care nurses' attitudes, subjective norms, perceived behavioural control, and intentions to use physical restraints in intubated patients and the relationship between them and sociodemographic, professional, and contextual factors using a survey approach.

Methods: A cross-sectional, multicentre study was conducted in a convenience sample of 12 intensive care units from eight hospitals in Spain (n = 354). The Physical Restraint-Theory of Planned Behaviour questionnaire and a researcher-developed survey were used to collect structural and clinical data from each unit. Multilevel model analysis was used.

Results: Critical care nurses showed a moderate level of intention to use physical restraints 12.52 (standard deviation = 3.81) [3-21]. More than a half (52%) agreed restraints were safe. The highest perceived barrier against physical restraint use was patient cooperation. Although nurses did not feel that others expected them to use restraints, they did not perceive high levels of disapproval of such practice. Nurses who had received previous training on restraints and who worked in units with a flexible family visitation policy, an informed consent form for restraint use, analgosedation and restraint protocols, and nurse-driven analgosedation management reported lower levels of intention to use restraints. Working in smaller units (beta -1.81; 95% confidence interval [CI]: -0.18, -3.44) and working in units with a consent form for restraint use (beta -4.82; 95% CI: -2.80, -6.85) were the variables with the highest impact on nurses' intentions to use restraints.

Conclusions: Critical care nurses' intentions to use physical restraints are moderate and are influenced by intrapersonal, patient, and contextual factors. Nurses who work in units with organisational policies and alternatives to restraints demonstrated lower levels of intention to use them.
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http://dx.doi.org/10.1016/j.aucc.2019.09.003DOI Listing
September 2020

Analysis of the evolution of competences in the clinical practice of the nursing degree.

Rev Lat Am Enfermagem 2020 3;28:e3231. Epub 2020 Feb 3.

University of Barcelona, School of Nursing, L'Hospitalet de Llobregat, Barcelona, Espanha.

Objective: to analyze the student's progression in the acquisition of specific and transversal competences in relation to the competence dimensions.Method: the cross-sectional descriptive study was carried out in the clinical practice subjects included in the Nursing Degree. We included 323 students and we contemplated the development of competences through an ad-hoc questionnaire with 4 dimensions: delivery and care management, therapeutic communication, professional development and care management.

Results: the academic results between the practice of the second and third year showed an improvement in care provision and therapeutic communication skills (Clinical Placements I: 12%-29%; Clinical Placements II: 32%-47%) and worsened in professional development and care management (Clinical Placements I: 44%-38%; Clinical Placements II: 44%-26%).

Conclusion: the correlations between these two years were high in all the dimensions analyzed. The evaluation of competence progression in the context of clinical practice in nursing university studies allows us to optimize these practices to the maximum and establish professional profiles with a greater degree of adaptation to the professional future.
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http://dx.doi.org/10.1590/1518-8345.2927.3231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000187PMC
April 2020

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

Identifying Coordination and Continuity of Care Indicators for Population-Based Cancer Screening Programs: A Delphi Study.

Nurs Res 2018 Sep/Oct;67(5):411-418

Llucia Benito, PhD, RN, is Nurse, Catalan Institute of Oncology, L'Hospitalet de Llobregat and Researcher, IDIBELL, Institute of Biomedical Research, L'Hospitalet de Llobregat, Barcelona, Spain, and Associate Professor, School of Nursing, University of Barcelona, Spain. Laura de la Cueva Ariza, RN, is Professor, School of Nursing, University of Barcelona, Spain, and Researcher, IDIBELL, Institute of Biomedical Research, L'Hospitalet de Llobregat, Barcelona, Spain. Pilar Delgado-Hito, PhD, RN, is Professor, School of Nursing, University of Barcelona, Spain, and Researcher, IDIBELL, Institute of Biomedical Research, L'Hospitalet de Llobregat, Barcelona, Spain. M. Antonia Martinez Momblan, PhD, RN, is Professor, School of Nursing, University of Barcelona, Spain. Marta Romero García, is Professor, School of Nursing, University of Barcelona, Spain, and Researcher, IDIBELL, Institute of Biomedical Research, L'Hospitalet de Llobregat, Barcelona, Spain. Montse García, PhD, BSc, is Researcher, Catalan Institute of Oncology and IDIBELL, Institute of Biomedical Research, L'Hospitalet de Llobregat, Barcelona, Spain.

Background: Continuity of care and care coordination are critical issues in virtually all healthcare systems. European guidelines for the quality of screening programs for breast and colorectal cancer describe process, structure, and outcome indicators, but none specifically evaluate coordination and continuity of care during the cancer screening process.

Objective: The aim of this study was to identify indicators reflecting care coordination and continuity in population-based breast and colorectal cancer screening program.

Methods: A two-round Delphi study was conducted in a sample of 30 cancer screening nurses to identify quality indicators.

Results: The final Delphi consensus resulted in six core indicators for the cancer screening program: adequacy of the referral of the target population from the screening program to other health services, waiting time for referral to other health services, understanding of the screening program by professionals involved in the process, effective information flow between professionals involved in the process, participants' perception of the screening program, and, finally, participants' understanding of information about the program.

Conclusion: The evaluation of indicators is crucial for quality improvement and should allow a measuring system to be established that would allow a comparison of outcomes for all population-based cancer screening programs.
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http://dx.doi.org/10.1097/NNR.0000000000000300DOI Listing
February 2019

Implementation of the evidence for the improvement of nursing care to the critical patient's family: a Participatory Action Research.

BMC Health Serv Res 2018 05 11;18(1):357. Epub 2018 May 11.

Fundamental and Medical-Surgical Nursing Department, Nursing School (Faculty of Medicine and Health Sciences), University of Barcelona, Barcelona, Spain.

Background: There are many descriptive studies regarding the needs of the family, as well as those regarding nursing care aimed directly at family members. However, there is no widespread application of such evidence in clinical practice. There has also been no analysis made of the evolution of patterns of knowing during the act of improving clinical practice. Therefore, the purpose of the study is to understand the change process aimed at improving care to critical patient's families, and to explore the evolution of patterns of knowing that nurses use in this process.

Methods: Qualitative study with a Participatory Action Research method, in accordance with the Kemmis and McTaggart model. In this model, nurses can observe their practice, reflect upon it and compare it with scientific evidence, as well as define, deploy and evaluate improvement strategies adapted to the context. Simultaneously, the process of empowerment derived from the Participatory Action Research allows for the identification of patterns of knowing and their development over time. The research will take place in the Intensive Care Units of a tertiary hospital. The participants will be nurses who are part of the regular workforce of these units, with more than five years of experience in critical patients, and who are motivated to consider and critique their practice. Data collection will take place through participant observation, multi-level discussion group meetings and documentary analysis. A content analysis will be carried out, following a process of codification and categorisation, with the help of Nvivo10. The approval date and the beginning of the funding were December 2012 and 2013, respectively.

Discussion: The definition, introduction and evaluation of care strategies for family members will allow for their real and immediate implementation in practice. The study of the patterns of knowing in the Participatory Action Research will be part of the theoretical and practical feedback process of a professional discipline. Also, the identification of the construction and evolution of knowledge will provide decision elements to managers and academics when choosing strategies for increased quality.
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http://dx.doi.org/10.1186/s12913-018-3177-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946428PMC
May 2018

Eliciting critical care nurses' beliefs regarding physical restraint use.

Nurs Ethics 2019 Aug 1;26(5):1458-1472. Epub 2018 Mar 1.

Nursing Research Group (GRIN-IDIBELL), University of Barcelona, Spain.

Background: Despite the reported harms and ethical concerns about physical restraint use in the critical care settings, nurses' intention to apply them is unequal across countries. According to the theory of planned behaviour, eliciting nurses' beliefs regarding the use of physical restraints would provide additional social information about nurses' intention to perform this practice.

Aim: To explore the salient behavioural, normative and control beliefs underlying the intention of critical care nurses to use physical restraints from the theory of planned behaviour.

Research Design: A belief elicitation study was conducted.

Participants And Research Context: Twenty-six critical care nurses were purposively sampled across gender, work-shift patterns and professional experience in five intensive care units of three hospitals in Spain. Data were obtained from a nine-item open-ended questionnaire and a focus group. Deductive content analysis was performed.

Ethical Considerations: Ethical approval was obtained from the hospital ethics committee. Participants were assured their participation was voluntary.

Findings: Nurses framed the use of restraints as a way of prioritising patients' physical safety. They referred to contextual factors as the main reasons to justify their application. Nurses perceived that their decision is approved by other colleagues and the patients' relatives. Some nurses started advocating against their use, but felt powerless to change this unsafe practice within an unfavourable climate. Control beliefs were linked to patients' medical condition, availability of alternative solutions, analgo-sedation policies and work organisation.

Discussion: Safety arguments based on the surrounding work environment were discussed.

Conclusion: Nurses' behavioural and control beliefs were related. Nurses should be trained in alternatives to physical restraint use. The impact of analgo-sedation protocols, relatives' involvement, leadership support and intensive care unit restraint policies on physical restraint practices need to be revised. Further research is required to explore why nurses do not act with moral courage to change this harmful practice.
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http://dx.doi.org/10.1177/0969733017752547DOI Listing
August 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

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

Development of an instrument to measure the degree of critical patient's satisfaction with nursing care: research protocol.

J Adv Nurs 2014 Jan 14;70(1):201-10. Epub 2013 Jun 14.

Intensive Care Unit, Hospital de la Santa Creu i Sant Pau (HSCSP), Barcelona, Spain.

Aim: To investigate and understand patient's satisfaction with nursing care in the intensive care unit to identify the dimensions of the concept of 'satisfaction' from the patient's point of view. To design and validate a questionnaire that measures satisfaction levels in critical patients.

Background: There are many instruments capable of measuring satisfaction with nursing care; however, they do not address the reality for critical patients nor are they applicable in our context.

Design: A dual approach study comprising: a qualitative phase employing Grounded Theory and a quantitative and descriptive phase to prepare and validate the questionnaire.

Methods: Data collection in the qualitative phase will consist of: in-depth interview after theoretical sampling, on-site diary and expert discussion group. The sample size will depend on the expected theoretical saturation n = 27-36. Analysis will be based on Grounded Theory. For the quantitative phase, the sampling will be based on convenience (n = 200). A questionnaire will be designed on the basis of qualitative data. Descriptive and inferential statistics will be used. The validation will be developed on the basis of the validity of the content, the criteria of the construct and reliability of the instrument by the Cronbach's alpha and test-retest approach. Approval date for this protocol was November 2010.

Discussion: Self-perceptions, beliefs, experiences, demographic, socio-cultural epistemological and political factors are determinants for satisfaction, and these should be taken into account when compiling a questionnaire on satisfaction with nursing care among critical patients.
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http://dx.doi.org/10.1111/jan.12184DOI Listing
January 2014