Publications by authors named "Paulo Santos-Costa"

14 Publications

  • Page 1 of 1

Nursing Students' Perceptions on Healthcare-Associated Infection Control and Prevention Teaching and Learning Experience: Development and Validation of a Scale in Four European Countries.

Front Psychol 2021 8;12:701208. Epub 2021 Oct 8.

Nursing School of Coimbra (ESEnfC), Coimbra, Portugal.

Healthcare-associated infections are one of the major concerns worldwide. This study presents the development and the validation process of the InovSafeCare scale and aimed at identifying and measuring the ecosystem variables related to healthcare-associated infection (HCAI) prevention and control practices in European nurse students. Qualitative and quantitative approaches were used to (1) elaborate an item pool related to the educational environment, the healthcare setting environment, and the attitudes, beliefs, and performance of the nursing students regarding HCAI prevention and control and (2) analyze psychometric properties of the scale using factor analysis. The validated InovSafeCare scale was applied to undergraduate nursing students of five European Higher Education Institutions. The partial least square structural equation modeling (PLS-SEM) method with SMART-PLS3 software was used. The study sample consists of 657 nursing students, who responded a self-report inventory. From the analyzed data were identified 14 factors. The InovSafeCare scale reveals good validity and reliability of the dimensions in different European countries.
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http://dx.doi.org/10.3389/fpsyg.2021.701208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8531406PMC
October 2021

The skin microbiome of infected pressure ulcers: A review and implications for health professionals.

Eur J Clin Invest 2021 Oct 3:e13688. Epub 2021 Oct 3.

The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal.

Background: Pressure ulcers (PUs) are injuries resulting from ischaemia caused by prolonged compression or shear forces on the skin, adjacent tissues and bones. Advanced stages of PUs are associated with infectious complications and constitute a major clinical challenge, with high social and economic impacts in health care.

Goals: This study aims to identify and describe the relationship between PU risk factors, stages and anatomical locations, and the relevance of microbial cohabitation and biofilm growth.

Methods: The narrative review method to advocating a critical and objective analysis of the current knowledge on the topic was performed. Indexed databases and direct consultation to specialized and high-impact journals on the subject were used to extract relevant information, guided by co-authors. The Medical Subject Headings of pressure ulcer (or injury), biofilms, infection and other analogues terms were used.

Results: Development of PUs and consequent infection depends on several direct and indirect risk factors, including cutaneous/PU microbiome, microclimate and behavioural factors. Infected PUs are polymicrobial and characterized by biofilm-associated infection, phenotypic hypervariability of species and inherent resistance to antimicrobials. The different stages and anatomical locations also play an important role in their colonization. The prevention and monitoring of PUs remain crucial for avoiding the emergence of systemic infections and reducing health care-associated costs, improve the quality of life of patients and reduce the mortality-associated infected PUs.
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http://dx.doi.org/10.1111/eci.13688DOI Listing
October 2021

Suitability for e-health of non-pharmacological interventions in connective tissue diseases: scoping review with a descriptive analysis.

RMD Open 2021 07;7(2)

Section for Outcomes Research, Medical University of Vienna, Vienna, Austria

Objective: Non-pharmacological interventions support patients with connective tissue diseases to better cope with and self-manage their diseases. This study aimed to map existing evidence on non-pharmacological interventions in patients with systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and mixed connective tissue diseases regarding content, feasibility and potential suitability in an e-health setting.

Methods: A literature search was performed in eight different databases in July 2020. The intervention's content was extracted using the 'Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide'. A Sankey diagram and descriptive statistics were used to analyse the data and illustrate the relationships between the interventions.

Results: Of 8198 identified records, 119 papers were eligible. One hundred and four of them (87.4%) were conducted between 2000 and 2020, mainly in the USA (SLE n=24 (21.2%), SSc n=16 (14.2%)), Brazil (SLE n=8 (7.1%), SSc n=5 (4.4%)) and Italy (SLE n=0 (0%), SSc n=12 (10.6%)). Fifty-two studies (SLE n=24 (21.2%), SSc n=28 (24.8%)) used multicomponent interventions. The single interventions were physical exercises (SLE n=16 (14.2%), SSc n=17 (15.0%)), coaching/counselling (SLE n=11 (18.0%), SSc n=0 (0%)) and education (SLE n=2 (1.8%), SSc n=3 (2.7%)). Primary outcomes focused on physical function (SLE n=1 (0.9%), SSc n=15 (13.3%)), mouth opening in SSc (n=4 (5.9%)) and physical capacity (SLE n=2 (1.8%), SSc n=1 (0.9%)). No interventions for mixed connective tissue disease were found.

Conclusion: There was a great variety in the intervention's content due to differences in body structure, activity limitations and participation restrictions in SLE and SSc. These results highlight the need for personalised, multicomponent, non-pharmacological interventions, which could be delivered as e-health interventions.
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http://dx.doi.org/10.1136/rmdopen-2021-001710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8323400PMC
July 2021

Peripherally Inserted Central Catheter Placement in a Cardiology Ward: A Focus Group Study of Nurses' Perspectives.

Int J Environ Res Public Health 2021 07 17;18(14). Epub 2021 Jul 17.

The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal.

Intravenous therapy administration through peripheral venous catheters is one of the most common nursing procedures performed in clinical contexts. However, peripherally inserted central catheters (PICC) remain insufficiently used by nurses and can be considered a potential alternative for patients who need aggressive intravenous therapy and/or therapy for extended periods. The purpose of this study was to understand nurses' perspectives about PICC implementation in their clinical practice. As part of an action-research project, three focus groups were developed in June 2019 with nineteen nurses of a cardiology ward from a Portuguese tertiary hospital. From the content analysis, two main categories emerged: 'nursing practices' and 'patients'. Nurses considered PICC beneficial for their clinical practice because it facilitates maintenance care and catheter replacement rates. Moreover, nurses suggested that, since there is a need for specific skills, the constitution of vascular access teams, as recommended by international guidelines, could be an advantage. Regarding patient benefits, nurses highlighted a decrease in the number of venipunctures and also of patient discomfort, which was associated with the number of peripheral venous catheters. Infection prevention was also indicated. As an emerging medical device used among clinicians, peripherally inserted central catheters seem to be essential to clinical practice.
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http://dx.doi.org/10.3390/ijerph18147618DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8303562PMC
July 2021

Nurses' Strategies to Prevent and/or Decrease Work-Related Technostress: A Scoping Review.

Comput Inform Nurs 2021 Jun 16. Epub 2021 Jun 16.

Author Affiliations: University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention of Faculty of Psychology and Educational Sciences (Ms Lucena, Dr Carvalho, Dr Mónico); and The Health and Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC) (Drs Santos-Costa and Parreira), Coimbra, Portugal.

Although there is evidence of the impact of technostress on nurses' physical and psychological well-being, there is no clear understanding of what strategies are used by nurses to prevent/decrease work-related technostress. Thus, we aim to map existing literature that describe the strategies used by nurses to prevent or decrease work-related technostress. This review followed the methodology proposed by the Joanna Briggs Institute for scoping reviews. Data analysis, extraction, and synthesis were performed by two independent reviewers. After contrasting the found literature with the inclusion criteria outlined, no studies were found that address our review question. Overall, we found that technostress is a broad concept, thus becoming difficult to define. Given the complexity and demands of the clinical settings where nurses work, it may be that other stressors are more commonly identified and reported in the literature.
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http://dx.doi.org/10.1097/CIN.0000000000000771DOI Listing
June 2021

Work Methods for Nursing Care Delivery.

Int J Environ Res Public Health 2021 02 21;18(4). Epub 2021 Feb 21.

Enfermagem, Escola Superior de Enfermagem de Coimbra, Unidade de Investigação em Ciências da Saúde, 3004-011 Coimbra, Portugal.

This article analyzes the work methods based on care design, identification of needs, care organization, planning, delivery, evaluation, continuity, safety, and complexity of care, and discharge preparation. It describes the diagnosis of the situation, goal setting, strategy selection, implementation, and outcome evaluation that contribute to adopting a given work conception and/or method for nursing care delivery. Later, the concepts underlying the several methods-management theories and theoretical nursing concepts-are presented, with reference to relevant authors. The process of analysis and selection of the method is explained, highlighting the importance of diagnosis of the situation, goal setting, strategy selection, implementation, and outcome evaluation. The importance of various elements is highlighted, such as structural aspects, nature of care, target population, resources, and philosophy of the institution, which may condition the adoption of a method. The importance of care conceptualization is also underlined. The work methods are presented with a description of the key characteristics, advantages, and disadvantages of the task-oriented method (functional nursing) and patient-centered methods: individual, team nursing, and primary nursing. A critical and comparative analysis of the methods is then performed, alluding to the combination of person-centered methods.
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http://dx.doi.org/10.3390/ijerph18042088DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924841PMC
February 2021

Personal and technological skills to coach people with noncommunicable diseases: development and validation of a scale for nursing students.

Heliyon 2021 Feb 2;7(2):e06140. Epub 2021 Feb 2.

Department of Nursing, Tampere University of Applied Sciences, 33520 Tampere, Finland.

Background: Current international policies converge to the need of empowering patients and families in becoming more autonomous in the self-caring and management of their noncommunicable diseases (NCDs). Given their professional scope, nurses are the most well-positioned health professionals to answer this societal challenge. In the literature, health coaching and the use of information and communication technologies (ICTs) emerge as two still under-used contributions to nursing practice in this regard. Given the lack of instruments and research developed so far in the use of health coaching and ICTs during nurses training, we aim to develop a scale that explores nursing students' perceptions regarding their coaching skills of people with NCDs and the potential role of ICTs in this domain.

Methods: After a comprehensive literature review, an initial items list (n = 39) was delineated and discussed by a panel of international experts. After conceptual and structural consensus, the pre-validated version of the Personal and Technological Skills to coach people with noncommunicable diseases scale (PTSC-NCD scale) was created. Then, the pre-validated PTSC-NCD scale was translated to Portuguese, Finnish, Flemish and Slovenian following Beaton and colleagues' recommendations, and applied to undergraduate nursing students in five European universities. Principal component analysis and reliability analysis were performed in each country through the statistical program Statistical Package for the Social Sciences (version 22.0). All ethical assumptions were complied with throughout this study.

Results: 874 nursing students enrolled in the study, predominantly female (71.1%) and with a mean age of 22.4 years (SD = 5.49). After data analysis across international settings, three dimensions emerged: Coaching Centred Personal Skills (F1); Digital Technology Improving Patient-Centred Care (F2); and Digital Technology Improving Relational Skills (F3). All the dimensions showed good reliability (Cronbach's alpha >.80).

Conclusion: The PTSC-NCD scale evidence good validity and reliability indicators across different international settings.
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http://dx.doi.org/10.1016/j.heliyon.2021.e06140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7889991PMC
February 2021

The Quality of Carer-Patient Relationship Scale: Adaptation and Validation into Portuguese.

Int J Environ Res Public Health 2021 01 31;18(3). Epub 2021 Jan 31.

Health Sciences Research Unit: Nursing of the Nursing School of Coimbra, 3004-011 Coimbra, Portugal.

Background: This study aimed to translate and adapt the Quality of the Carer-Patient Relationship (QCPR) scale into Portuguese and analyse both its psychometric properties and correlation with sociodemographic and clinical variables.

Methods: Phase (1) Translate and culturally adapt the scale. Phase (2) Assess the scale's confirmatory factorial analysis, internal consistency, construct validity, and correlations.

Results: The experts classified the overall quality of the translation as adequate. A total of 53 dyads (cared-for person and carer) were assessed. In both versions, measures of central tendency and symmetry were also adequate, and the two factors under investigation had appropriate reliability, although in the conflict/critical factor, this was more fragile. Cronbach's alpha values were 0.89 for the cared-for person version and 0.91 for the carer version.

Conclusions: The QCPR scale showed satisfactory to good values of reliability. The assessment is essential to guarantee structured interventions by health professionals, since the quality of the dyads' relationship seems to influence both older adults' quality of life and carers' health status. This study is a significant contribution to the introduction of the QCPR scale in the Portuguese clinical and scientific culture but also an opportunity to increase its use internationally.
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http://dx.doi.org/10.3390/ijerph18031264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908403PMC
January 2021

Study Protocol for Two-Steps Parallel Randomized Controlled Trial: Pre-Clinical Usability Tests for a New Double-Chamber Syringe.

Int J Environ Res Public Health 2020 11 12;17(22). Epub 2020 Nov 12.

The Health Sciences Research Unit, Nursing, Nursing School of Coimbra, 3004-011 Coimbra, Portugal.

A new double-chamber syringe (DUO Syringe) was developed for intravenous drug administration and catheter flushing. This study presents a protocol for pre-clinical usability tests to validate the golden prototype of this new device, performed in a high-fidelity simulation lab by nurses. A two-steps parallel randomized controlled trial with two arms was designed (with standard syringes currently used in clinical practice and with the DUO Syringe). After randomization, eligible and consented participants will be requested to perform, individually, intravenous drug administration and flushing, following the arm that has been allocated. The procedure will be video-recorded for posterior analyses. After the completion of the tasks, nurses will be asked to answer a demographic survey, as well as an interview about their qualitative assessment of the device. A final focus group with all participants will also be conducted. Primary outcomes will concern the DUO Syringe's effectiveness, efficiency, and safety, while secondary outcomes will focus on nurses' satisfaction and intention of use. The pre-clinical protocol was defined according to the legal requirements and ISO norms and was reviewed and approved by the Ethics Committee of the Health Sciences Research Unit: Nursing of the Nursing School of Coimbra.
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http://dx.doi.org/10.3390/ijerph17228376DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7696070PMC
November 2020

Usability Assessment of an Innovative Device in Infusion Therapy: A Mix-Method Approach Study.

Int J Environ Res Public Health 2020 11 11;17(22). Epub 2020 Nov 11.

Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), 3046-851 Coimbra, Portugal.

Flushing a venous access device is an important procedure to maintain their patency and prevent malfunctioning and complications. An innovative double-chamber syringe was developed, allowing for the assessment of catheter patency, drug delivery and final flush. This study aims to assess the usability of this new device, considering three development stages (concept, semi-functional prototype, functional prototype). An iterative methodology based on a mix-method design (qualitative and quantitative) enabled the assessment of the devices' usability by their primary end-users. A usability questionnaire was developed and applied, along with focus groups and individual interviews to nurses. The usability questionnaire integrated 42 items focused on four dimensions (usefulness; ease of use; ease of learning; satisfaction and intention to use). The initial psychometric findings indicate a good internal consistency and the conceptual relevance of the items. The scores seem to be sensitive to the usability evaluation of the medical devices in different stages of product development (with lower values on functional prototype evaluation), and related to nurses' perceptions about functional and ergonomic characteristics. Quantitative and qualitative data provided a comprehensive overview of the double-chamber syringes' usability from the nurses' point of view, informing us of features that must be addressed.
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http://dx.doi.org/10.3390/ijerph17228335DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7698130PMC
November 2020

Brief Report on Double-Chamber Syringes Patents and Implications for Infusion Therapy Safety and Efficiency.

Int J Environ Res Public Health 2020 11 6;17(21). Epub 2020 Nov 6.

Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), 3046-851 Coimbra, Portugal.

This review aimed to map the existing patents of double-chamber syringes that can be used for intravenous drug administration and catheter flush. A search was conducted in the Google patents database for records published prior to 28 October 2020, using several search terms related to double-chamber syringes (DCS). Study eligibility and data extraction were performed by two independent reviewers. Of the initial 26,110 patents found, 24 were included in this review. The 24 DCS that were found display two or more independent chambers that allow for the administration of multiple solutions. While some of the DCS have designated one of the chambers as the flushing chamber, most patents only allow for the sequential use of the flushing chamber after intravenous drug administration. Most DCS were developed for drug reconstitution, usually with a freeze-dried drug in one chamber. Some patents were designed for safety purposes, with a parallel post-injection safety sheath chamber for enclosing a sharpened needle tip. None of the DCS found allow for a pre- and post-intravenous drug administration flush. Given the current standards of care in infusion therapy, future devices must allow for the sequential use of the flushing chamber to promote a pre-administration patency assessment and a post-administration device flush.
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http://dx.doi.org/10.3390/ijerph17218209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7664416PMC
November 2020

Translation and Validation of the Modified A-DIVA Scale to European Portuguese: Difficult Intravenous Access Scale for Adult Patients.

Int J Environ Res Public Health 2020 10 17;17(20). Epub 2020 Oct 17.

Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3004-011 Coimbra, Portugal.

(1) Background: In Portugal, no accurate and reliable predictive instruments are known that could assist healthcare professionals in recognizing patients with difficult venous access. Thus, this study aimed to translate and validate the Modified A-DIVA scale to European Portuguese. (2) Methods: A methodological and cross-sectional study was conducted in two phases: translation of the Modified A-DIVA scale to European Portuguese following six stages proposed by Beaton and collaborators, and assessment of its psychometric properties in a non-probability sample of 100 patients who required peripheral intravenous catheterization in a Portuguese hospital. (3) Results: The European version of the Modified A-DIVA scale (A-DM scale) showed excellent inter-rater accordance scores, k = 0.593 (95% CI, 0.847 to 0.970), < 0.0005. The A-DM scale's criterion and construct validity was assessed through predictive, convergent, and correlational analysis with variables identified in the literature as associated with difficult peripheral intravenous access, with moderate to large magnitudes and statistical significance. (4) Conclusions: The A-DM scale is a reliable and valid instrument that can support healthcare professionals and researchers in the early identification of patients at risk of difficult peripheral intravenous access. Future validation studies are needed to test the A-DM scale's applicability across clinical settings and in different patient cohorts.
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http://dx.doi.org/10.3390/ijerph17207552DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7589933PMC
October 2020

Double-chamber syringe versus classic syringes for peripheral intravenous drug administration and catheter flushing: a study protocol for a randomised controlled trial.

Trials 2020 Jan 14;21(1):78. Epub 2020 Jan 14.

Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, Apartado 7001, 3046-851, Coimbra, Portugal.

Background: The prevention of catheter-related complications is nowadays an important topic of research. Flushing catheters is considered an important clinical procedure in preventing malfunction and several complications such as phlebitis or infection. Considering the latest guidelines of the Infusion Nurses Society, the flushing should be carried out both pre- and post-drug administration, requiring different syringes (with associated overall increased times of preparation/administration of intravenous medication by nurses, and also increasing the need for manipulation of the venous catheter).

Methods/design: A multi-centre, two-arm randomised controlled trial with partially blinded outcome assessment of 146 adult patients. After eligibility analysis and informed consent, participants will receive usual intravenous administration drugs with flushing procedures, with a double-chamber syringe (arm A) or with classic syringes (arm B). The outcomes assessment will be performed on a daily basis by an unblinded ward team, with the same procedures in both groups. Some main outcomes, such as phlebitis and infiltration, will also be evaluated by nurses from a blinded research team and registered once a day.

Discussion: The study outlined in this protocol will provide valuable insight regarding the effectiveness and safety of this new medical device. The development of this medical device (dual-chamber syringe, for drug and flush solution) seems to be an important step to facilitate nurses' adoption of good clinical practices in intravenous procedures, reducing catheter manipulations.

Trial Registration: ClinicalTrials.gov, NCT04046770. Registered 13 August 2019.
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http://dx.doi.org/10.1186/s13063-019-3887-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6961373PMC
January 2020

Hand hygiene management among nurses: collective health challenges.

Rev Bras Enferm 2018 ;71(suppl 1):562-567

Instituto Politécnico de Coimbra. Coimbra, Portugal.

Objective: To describe the determining factors in hand hygiene management among nurses and identify associated collective health challenges.

Method: Cross-sectional descriptive study. Data were collected using a questionnaire that was applied in four internal medicine units of a hospital of reference in Portugal.

Results: The sample was composed of 50 nurses aged 26 to 55 years (mean age of 34.88 years); 80% were women, 58% had a Bachelor's degree, and had 5-30 years of nursing practice (X̄ =11.94;±5.92). The vast majority of nurses (90%) reported complying with the existing recommendations on hand hygiene in pre-established moments. However, none of the nurses were able to identify all the moments for hand hygiene using water and soap or alcohol-based handrub.

Conclusion: This study shows that continuous training, adequate materials/structures in the units, and redesigned administration/supervision practices are determining factors to achieve higher levels of adherence to hand hygiene among nurses, as well as increased quality and safety in care delivery, which is a current collective health challenge.
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http://dx.doi.org/10.1590/0034-7167-2017-0538DOI Listing
September 2018
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