Publications by authors named "Pedro L Pancorbo-Hidalgo"

23 Publications

  • Page 1 of 1

Conceptual Framework for Incontinence-Associated Dermatitis Based on Scoping Review and Expert Consensus Process.

J Wound Ostomy Continence Nurs 2021 May-Jun 01;48(3):239-250

Manuel Rodríguez-Palma, PhD, MSN, RN, Nursing Home "José Matía Calvo," Cádiz, Spain; and Executive Member of Spanish Pressure Ulcer Advisory Panel.

Incontinence-associated dermatitis (IAD) has been studied over the last decades, but gaps in the knowledge related to its identification, etiological agents, and risk factors remain. We carried out a scoping review about IAD that included systematic reviews, experimental, and observational studies about IAD and its potential risk factors. We retrieved 24 articles that described 100 potential risk factors and which were synthesized by the authors and proposed to a panel of experts. Panelists used a structured process of consensus development to create a conceptual framework of factors associated with IAD. This framework proposes that liquid fecal material, when combined with exposure to urine and stool, and bacterial contaminated urine are etiological factors for development of IAD. The framework also proposes 2 pathophysiological mechanisms and 8 main risk factors for IAD development. The proposed model could improve the quality of care for patients with or at risk of IAD, assisting healthcare professionals to identify at-risk patients, diagnose the type of lesion, and establish adequate and effective prevention and treatment measures.
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http://dx.doi.org/10.1097/WON.0000000000000754DOI Listing
May 2021

Multidisciplinary Unit Improves Pregnancy Outcomes in Women with Rheumatic Diseases and Hereditary Thrombophilias: An Observational Study.

J Clin Med 2021 Apr 3;10(7). Epub 2021 Apr 3.

Department of Nursing, Faculty of Health Sciences, University of Jaén, 23003 Jaén, Spain.

Rheumatic diseases (RD) and hereditary thrombophilias (HT) can be associated with high-risk pregnancies. This study describes obstetric outcomes after receiving medical care at a multidisciplinary consultation (MC) and compares adverse neonatal outcomes (ANOs) before and after medical care at an MC. This study is a retrospective observational study among pregnant women with RD and HT treated at an MC of a university hospital (southern Spain) from 2012 to 2018. Absolute risk reduction (ARR) and number needed to treat (NNT) were calculated. A total of 198 pregnancies were registered in 143 women (112 with RD, 31 with HT), with 191 (96.5%) pregnancies without ANOs and seven (3.5%) pregnancies with some ANOs (five miscarriages and two foetal deaths). Results previous to the MC showed 60.8% of women had more than one miscarriage, with 4.2% experiencing foetal death. MC reduced the ANO rate by AAR = 60.1% (95%CI: 51.6-68.7%). The NNT to avoid one miscarriage was 1.74 (95%CI: 1.5-2.1) and to avoid one foetal death NNT = 35.75 (95CI%: 15.2-90.9). A total of 84.8% of newborns and 93.2% of women did not experience any complication. As a conclusion, the follow-up of RD or HT pregnant women in the MC drastically reduced the risk of ANOs in this population with a previous high risk.
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http://dx.doi.org/10.3390/jcm10071487DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8038315PMC
April 2021

Advances in nursing research on wounds: achievements, opportunities and challenges.

Enferm Clin (Engl Ed) 2021 Mar-Apr;31(2):67-70

Departamento de Enfermería. Facultad de Ciencias de la Salud. Universidad de Jaén. Comité director GNEAUPP. EWMA council. Electronic address:

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http://dx.doi.org/10.1016/j.enfcli.2021.02.002DOI Listing
February 2021

Development and validation of the Pressure Injury Prevention Barriers questionnaire in hospital nurses in Spain.

BMJ Open 2020 12 30;10(12):e041376. Epub 2020 Dec 30.

Nursing, University of Jaén, Jaen, Andalucía, Spain

Objective: To develop and validate a new questionnaire to measure the nurses' perceptions of the barriers towards the prevention of pressure injuries (PIs) at hospitals.

Design: Validation study with mixed methods.

Setting: Four university hospitals in southern Spain.

Participants: The questionnaire was developed based on a literature review. A panel of 14 wound care experts rated the content validity. A sample of 438 nurses (registered nurses and assistant nurses) participated in the survey.

Main Outcome Measures: The psychometric properties of the Pressure Injury Prevention Barriers (PIPB) questionnaire evaluated were: content validity, internal consistency reliability and construct validity.

Results: The final version of the questionnaire has 25 items grouped into four factors (management and organisation, motivation and priority, knowledge, and staff and collaboration). The confirmatory factor analysis showed good fit and error indices for the model (Comparative Fit Index=0.92, root mean square error of approximation=0.074). Cronbach's alpha was 0.90 (overall), and 0.89 (factor 1), 0.75 (factor 2), 0.72 (factor 3) and 0.45 (factor 4). Construct validity was good, demonstrated by the expected association with the scores on patient safety culture and on considering PIs as an adverse effect of hospital stay, but not with attitude score.

Conclusion: The PIPB questionnaire is an instrument useful for measuring nurses' perceptions of the barriers to PIs prevention. The initial evidence shows that the questionnaire has good content validity, internal consistency and adequate construct validity. Relevance and comprehensiveness need to be assessed in further studies. It can be used both in research and in the evaluation of clinical settings to implementation of PIs preventive programmes in hospitals.
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http://dx.doi.org/10.1136/bmjopen-2020-041376DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780508PMC
December 2020

Attitudes of Spanish Nurses towards Pressure Injury Prevention and Psychometric Characteristics of the Spanish Version of the APuP Instrument.

Int J Environ Res Public Health 2020 11 18;17(22). Epub 2020 Nov 18.

Department of Nursing, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain.

The prevention of pressure injuries in hospitalised patients is a critical point of care related to patient safety. Nurses play a key role in pressure injury (PI) prevention, making it important to assess not only their knowledge but also their attitude towards prevention. The main purpose of this study was to translate into Spanish and evaluate the psychometric properties of the Attitude towards Pressure ulcer Prevention instrument (APuP); a secondary aim was to explore the associations of attitude with other factors. A Spanish version was developed through a translation and back-translation procedure. The validation study was conducted on a sample of 438 nursing professionals from four public hospitals in Spain. The analysis includes internal consistency, confirmatory factorial analysis, and construct validity in known groups. The 12-item Spanish version of the APuP fit well in the 5-factor model, with a Cronbach's alpha of 0.7. The mean APuP score was 39.98, which means a positive attitude. Registered nurses have a slightly better attitude than Assistant nurses. A moderate correlation (R = 0.32) between knowledge and attitude for the prevention of PI was found. As concluded, the Spanish version of the APuP questionnaire is a valid, reliable and useful tool to measure the attitude toward PI prevention in Spanish-speaking contexts. This version has 12 items grouped into 5 factors, and its psychometric properties are similar to those of the original instrument.
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http://dx.doi.org/10.3390/ijerph17228543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7698736PMC
November 2020

Development and Psychometric Properties of the Pressure Injury Prevention Knowledge Questionnaire in Spanish Nurses.

Int J Environ Res Public Health 2020 04 28;17(9). Epub 2020 Apr 28.

Department of Nursing, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain.

Pressure injuries (PIs) are a major health problem with severe implications for patients. Professionals who care for people at risk should have high knowledge about PIs prevention. The actual knowledge can be measured using different tools, but we have found no questionnaire to measure the knowledge on PIs prevention developed and validated for Spanish-speaking countries. The aim of this study was to develop a questionnaire in Spanish to measure the knowledge about PIs prevention based on current international guidelines. Content validity was evaluated by 12 experts in wound care. A convenience sample of 438 nursing professionals from Spain participated to evaluate the questionnaire using item analysis, Rasch model, and known-groups validity. The PI Prevention Knowledge (PIPK) questionnaire shows good discrimination and difficulty indices. The 31-item PIPK shows good fit and reliability of 0.98 for items and 0.72 for people; also, it has enough evidence for construct validity. Because the questionnaire has been developed based on the recommendations from international guidelines, the English version of this questionnaire could be used in further studies to test its psychometric properties.
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http://dx.doi.org/10.3390/ijerph17093063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246611PMC
April 2020

Knowledge about the Care of People with Alzheimer's Disease of the Nursing Staff of Nursing Homes in Spain.

Int J Environ Res Public Health 2019 12 5;16(24). Epub 2019 Dec 5.

Department of Nursing, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain.

People with Alzheimer's disease often live in nursing homes. Updated knowledge among the nursing staff has led to better quality of care. The aim of this study was to measure the knowledge about the care of people with Alzheimer's disease of the nursing staff of nursing homes in Spain. A cross-sectional study was conducted in 24 nursing homes in the province of Jaén (Spain) with a sample of 361 members of staff, i.e., registered nurses (RNs), assistant nurses (ANs), and eldercare workers (EWs). The University of Jaén UJA-Alzheimer's Care Scale was used to measure the knowledge. The knowledge was higher among the RNs (83.3% of the maximum) than among the ANs and EWs (71.6%). Work experience and updated training were associated with the knowledge score in RNs, but only the updated training in ANs and EWs. Nursing homes with less experienced nursing staff and with a small proportion of staff receiving training on dementia have a low knowledge score. The nursing staff of nursing homes in Jaén have medium to high knowledge about Alzheimer's care. There is a wide range of variation in the knowledge score among the nursing homes. Up-to-date staff training in dementia care is the factor with the strongest association with knowledge.
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http://dx.doi.org/10.3390/ijerph16244907DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950273PMC
December 2019

Effectiveness and safety of olive oil preparation for topical use in pressure ulcer prevention: Multicentre, controlled, randomised, and double-blinded clinical trial.

Int Wound J 2019 Dec 2;16(6):1314-1322. Epub 2019 Sep 2.

Universidad de Jaén, Nursing Department, Jaén, Andalusia, Spain.

This non-inferiority, multicentre, randomised, controlled, and double-blinded clinical trial compared the therapeutic effectiveness of the topical application of an olive oil solution with that of a hyperoxygenated fatty acid compound for the prevention of pressure ulcers in at-risk nursing home residents. The study population comprised 571 residents of 23 nursing homes with pressure ulcer risk, randomly assigned to a hyperoxygenated fatty acid group (n = 288) or olive oil solution group (n = 283). Both solutions were applied on at-risk skin areas every 12 hours for 30 days or until pressure ulcer onset. The main outcome variable was the pressure ulcer incidence. The absolute risk difference was estimated (with 95% CI) using Kaplan-Meier survival and Cox regression curves. The groups did not significantly differ in any study variable at baseline. The pressure ulcer incidence was 4.18% in the olive oil group vs 6.57% in the control group, with an incidence difference of -2.39% (95% CI = -6.40 to 1.56%), which is within the pre-established non-inferiority margin of ±7%, thus supporting the study hypothesis. We present the first evidence of the effectiveness and safety of the topical application of olive oil to prevent pressure ulcers in the institutionalised elderly.
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http://dx.doi.org/10.1111/iwj.13191DOI Listing
December 2019

Knowledge, skills and attitudes related to evidence-based practice among undergraduate nursing students: A survey at three universities in Colombia, Chile and Spain.

Nurse Educ Pract 2019 Aug 20;39:117-123. Epub 2019 Aug 20.

Department of Nursing, Universidad de Jaen. Nursing department, Las Lagunillas S/n. 23071, Jaén, Spain. Electronic address:

Teaching nursing students about the model of evidence-based practice is a challenge for university faculty. The aim of this study was to measure knowledge, skills and attitudes related to evidence-based practice among undergraduate nursing students, as well as associated factors. The study involved a cross-sectional design using a survey of all students enrolled in a Bachelor of Nursing programme (1st to 4th year) in three nursing faculties of universities in Chile, Colombia and Spain. The Spanish version of the Evidence-Based Competence Questionnaire was used to measure knowledge, skills, attitudes and overall competency. In total, 875 students completed the questionnaire. The overall score of competency in evidence-based practice was similar in all three universities (range 1-5) (3.63 in Chile, 3.58 in Colombia and 3.68 in Spain). The score of self-rated attitudes was strongly correlated with the overall competency measured. More hours of training in research methods and reading nursing journals articles in the last month were the factors associated with higher scores in evidence-based practice competency. The undergraduate nursing students at the three universities surveyed obtained a high score in overall competency in evidence-based practice. No differences were found among them, despite the different approaches used in educational programmes.
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http://dx.doi.org/10.1016/j.nepr.2019.08.009DOI Listing
August 2019

Measuring knowledge of Alzheimer's: development and psychometric testing of the UJA Alzheimer's Care Scale.

BMC Geriatr 2019 03 4;19(1):63. Epub 2019 Mar 4.

Department of Nursing, Faculty of Health Sciences, University of Jaen, Crt. Torrequebradilla s/n. 23071, Jaen, Jaen, Spain.

Background: Care for people with Alzheimer's disease or other dementias should be based on up-to-date clinical practice guidelines. The education and training of nurses and other healthcare staff in dementia is a key factor in providing quality care. Knowledge of Alzheimer's disease can be measured through questionnaires. The aim of this study was to develop and validate a scale to measure Alzheimer's disease knowledge among both nursing staff and students.

Methods: This was a cross-sectional survey study undertaken in three stages: 1) development of the questionnaire and item wording; 2) content validation by an expert panel; 3) questionnaire testing with two samples to establish psychometric properties. Sample 1 comprised 361 Registered Nurses, Assistant Nurses and eldercare workers from 24 nursing homes in Jaén (southern Spain). Sample 2 comprised 297 nursing students. The data were analysed through item analysis and a Rasch model. Convergent and construct validity and internal consistency were also examined.

Results: The 23-item UJA Alzheimer's Care Scale shows good outfit and infit values based on the Rasch model. One item presented differential functioning between Registered Nurses and Assistant Nurses. The intraclass correlation coefficient between the UJA Alzheimer's Care Scale and the Spanish version of the Dementia Knowledge Assessment Tool 2 showed strong agreement among nursing staff (0.63) and students (0.79). The scale is able to distinguish between professionals with low or high knowledge of Alzheimer's care. The overall Cronbach's alphas were 0.70 (nursing staff) and 0.82 (nursing students). The intraclass correlation coefficient between the first test and the retest was good (0.84).

Conclusions: The UJA Alzheimer's Care Scale is a useful tool for measuring knowledge of Alzheimer's disease and dementia care among nursing professionals or nursing students. The initial validation study obtained good psychometric properties concerning validity and reliability.
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http://dx.doi.org/10.1186/s12877-019-1086-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398252PMC
March 2019

Validation of the Spanish Version of the Dementia Knowledge Assessment Tool 2.

J Alzheimers Dis 2018 ;65(4):1175-1183

Department of Nursing, Faculty of Health Sciences, University of Jaén, Jaén, Spain.

Background: There are currently no questionnaires to measure the knowledge of nurses about dementia or Alzheimer's disease care in the Spanish language.

Objective: To validate the Spanish version of the Dementia Knowledge Assessment Tool 2 (DKAT2-Sp).

Methods: The DKAT2 was translated into Spanish and then back-translated. The new Spanish version was validated in a sample of 361 members of the nursing staff from 24 nursing homes and a sample of 297 nursing students in Spain. Psychometric properties were assessed through an item analysis, a Rasch analysis, differential item functioning analysis, construct validity (known groups), and internal consistency (Cronbach's alpha).

Results: The 21 items of the DKAT2-Sp fit the model well, showing a wide range of difficulty. Four items have differential items functioning between nursing professionals and students. The DKAT2-Sp shows acceptable internal consistency (Cronbach's alpha = 0.76 for nursing professionals and 0.83 for students). Scores obtained in the known groups test were as hypothesized (Nursing home staff mean = 15.57 versus Nursing student mean = 12.85; p < 0.0001 for mean difference), supporting construct validity.

Conclusion: The DKAT2-Sp is a reliable and valid questionnaire to measure knowledge about dementia in both nursing professionals and nursing students in Spanish-speaking contexts.
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http://dx.doi.org/10.3233/JAD-180290DOI Listing
August 2019

Student nurses' knowledge and skills of children's environmental health: Instrument development and psychometric analysis using item response theory.

Nurse Educ Today 2018 Oct 18;69:113-119. Epub 2018 Jul 18.

Research Group Nursing and Innovation in Healthcare (CuiDsalud), Department of Nursing, Faculty of Health Sciences, University of Jaén, Building B3, office 265, Campus Las Lagunillas, 23071 Jaén. Electronic address:

Background: Climate change has an important impact on health, particularly in children. Therefore, the inclusion of environmental issues in the undergraduate nursing curriculum is essential. Knowledge and skills in environmental sustainability can be measured through questionnaires.

Objectives: The aim of this study was to develop and validate the Children's Environmental Health Knowledge Questionnaire (ChEHK-Q) and the Children's Environmental Health Skills Questionnaire (ChEHS-Q) to measure knowledge and skills, respectively, about children's environmental health in nursing students.

Design: This was an observational, cross-sectional study undertaken in four phases: (1) Development of the questionnaire and item wording, (2) content validation by an expert panel, (3) pilot test and (4) psychometric evaluation.

Settings: A Faculty of Health Sciences in Spain.

Participants: 308 nursing students enrolled in the first, third and fourth years of study.

Methods: The development and validation of the children's environmental health questionnaires was carried out based on the item response theory.

Results: The 26-item ChEHK-Q shows good fit and reliability of 0.98 for items and 0.70 for people based on the Rasch Model. The 12-item ChEHS-Q also shows good fit and reliability of 0.87 for items and 0.76 for people based on Andrich's rating scale model. The temporal stability measured using the intraclass correlation coefficient was 0.86 in the ChEHK-Q and 0.73 in the ChEHS-Q. Both questionnaires present enough evidence for construct validity; they work well to distinguish between nursing students with low or high knowledge of or skills in children's environmental health.

Conclusions: The Children's Environmental Health Knowledge Questionnaire and the Children's Environmental Health Skills Questionnaire are useful tools for measuring knowledge and skills, respectively, among nursing students. This validation study obtained good psychometric properties concerning validity and reliability.
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http://dx.doi.org/10.1016/j.nedt.2018.07.008DOI Listing
October 2018

[Quality of the Spanish Clinical Guidelines about Alzheimer's Disease and others Dementias].

Rev Esp Salud Publica 2016 Apr 11;90:e1-7. Epub 2016 Apr 11.

Departamento de Enfermería. Universidad de Jaén. Jaén.

Background: The care of patients with Alzheimer's disease and other dementias has become a priority for healthcare systems. This is evidenced by the increasing number of clinical practice guidelines (CPG) developed in our country aimed to help professionals in making health decisions. The aim of our study was to evaluate the quality of the Spanish CPG on Alzheimer's disease and other dementias using the AGREE II instrument.

Methods: Nine GPC were selected according to the inclusion criteria: Full GPC available; aimed to healthcare professionals; and published between 2002-2013. Two reviewers independently assessed the quality of the guides through the AGREE II instrument, in order to assess the methodological rigor and transparency of the GPC.

Results: 88.8% of the guides scored a very poor quality editorial independence. Respect to rigor in the development and clarity of presentation, 77.7% also scored very low quality. There is a guide that stands out for a score above 50% in all domains of the instrument.

Conclusions: The worst scored domains were Editorial independence, Rigor in the development and Applicability, in this order. The highest rated domains were Scope and Objectives and Clarity of Presentation. The guideline of the Ministry of Health, Social Policy and Equality is the best, obtaining a score above 50% in all domains. Overall, the quality of the 9 guidelines evaluated is low or very low, only two of them score as good overall quality.
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April 2016

Psychometric Testing of the Spanish Version of the Pain Level Outcome Scale in Hospitalized Patients With Acute Pain.

Int J Nurs Knowl 2016 Jan 22;27(1):10-6. Epub 2015 Jan 22.

Department of Nursing, University of Jaen, Jaen.

Purpose: This study aims to evaluate the psychometric properties and sensitivity to change of the Spanish version of the Pain Level Outcome Scale.

Methods: This article applied observational longitudinal validation study with patients suffering from acute pain at three hospitals.

Findings: The study included 73 patients. Inter-rater agreement was kappa = .88 and internal consistency α = .93. Principal components analysis yielded four components that explained 81.86% of the variance; the correlation with the Numerical Pain Intensity Scale was r = -.81.

Conclusions: The version with 17 indicators shows good psychometric properties and adequate sensitivity to change. A Spanish version of the Pain Level Outcome Scale with 17 indicators is proposed as a structured multidimensional instrument to help nurses choose the most appropriate indicators for assessing patients' pain.
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http://dx.doi.org/10.1111/2047-3095.12070DOI Listing
January 2016

Knowledge, Attitude and Use of Evidence-Based Practice among nurses active on the Internet.

Invest Educ Enferm 2014 ;32(3):451-60

University of Jaen, Spain,

Objective: to determine the evidence-based practice (EBP) competence of Spanish and Latin-American nurses participating in professional forums on the Internet and estimate the influence of socio-demographic and professional factors on their competence, which was defined as knowledge of, attitude towards, and implementation of EBP.

Methodology: An online survey was administered to a convenience sample of nurses active in Internet forums, comprising validated Spanish versions of the Evidence-Based Practice Questionnaire (EBPQ) and Practice Environment Scale of the Nursing Work Index (PES-NWI) and socio-demographics and professional variables.

Results: 314 questionnaires were obtained (76.96%). The mean EBPQ score was 5.02 out of 7 (95%CI, 4.89-5.14). The variables associated with a higher competence in EBP were academic level, (p<03001), professional category (p=0.001), country of work (p<0.001), perception of practice environment (p=0,018) and research activities (p<0,036).

Conclusions: These nurses showed a moderate level of EBP competence. They revealed a positive attitude towards EBP and achieved intermediate scores in both EBP-related skills and knowledge and their implementation. Higher academic levels and professional categories were associated with greater EBP competence. A practice environment perceived to be unfavorable has a negative influence on EBP implementation.
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http://dx.doi.org/10.17533/udea.iee.v32n3a10DOI Listing
November 2015

Patients' Experiences of Sexual Activity Following Myocardial Ischemia.

Clin Nurs Res 2016 Feb 25;25(1):45-66. Epub 2014 May 25.

University of Jaen, Spain.

The purpose of this article is to describe patients' experiences of sexual activity after suffering myocardial ischemia. We conducted semi-structured qualitative interviews with people who had suffered myocardial ischemia in the last 6 to 24 months before the interview. We used maximum variation sampling method. After reaching theoretical saturation, a 19-informants sample was formed. Data were analyzed using the Giorgi method. Four themes were identified: "sexual activity becomes different," "determinants of the return to sexual activity," "how sexual activity ought to be," and "sexual information received." Patients showed a decrease both in frequency and desire for sexual activity influenced by fear of sexual activity and health care professionals' recommendations. These recommendations were about "avoiding sexuality at the beginning" and conducting "sexual activity without overdoing it." Health care professionals should educate patients about the right time to resume sexual activity. Nurses can help patients to deal with fears related to sexual activity.
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http://dx.doi.org/10.1177/1054773814534440DOI Listing
February 2016

Predictive capacity of risk assessment scales and clinical judgment for pressure ulcers: a meta-analysis.

J Wound Ostomy Continence Nurs 2014 Jan-Feb;41(1):24-34

Francisco Pedro García-Fernández, PhD, MSN, RN, Head, Care Strategy Unit, University Hospital of Jaen, Spanish Pressure Ulcer Advisory Panel, Jaen, Spain. Pedro L. Pancorbo-Hidalgo, PhD, RN, Head, Department of Nursing, University of Jaen, Spanish Pressure Ulcer Advisory Panel, Jaen, Spain. J. Javier Soldevilla Agreda, PhD, RN, Professor, La Rioja University, and Head of Spanish Pressure Ulcer Advisory Panel, Jaen, Spain.

A systematic review with meta-analysis was completed to determine the capacity of risk assessment scales and nurses' clinical judgment to predict pressure ulcer (PU) development. Electronic databases were searched for prospective studies on the validity and predictive capacity of PUs risk assessment scales published between 1962 and 2010 in English, Spanish, Portuguese, Korean, German, and Greek. We excluded gray literature sources, integrative review articles, and retrospective or cross-sectional studies. The methodological quality of the studies was assessed according to the guidelines of the Critical Appraisal Skills Program. Predictive capacity was measured as relative risk (RR) with 95% confidence intervals. When 2 or more valid original studies were found, a meta-analysis was conducted using a random-effect model and sensitivity analysis. We identified 57 studies, including 31 that included a validation study. We also retrieved 4 studies that tested clinical judgment as a risk prediction factor. Meta-analysis produced the following pooled predictive capacity indicators: Braden (RR = 4.26); Norton (RR = 3.69); Waterlow (RR = 2.66); Cubbin-Jackson (RR = 8.63); EMINA (RR = 6.17); Pressure Sore Predictor Scale (RR = 21.4); and clinical judgment (RR = 1.89). Pooled analysis of 11 studies found adequate risk prediction capacity in various clinical settings; the Braden, Norton, EMINA (mEntal state, Mobility, Incontinence, Nutrition, Activity), Waterlow, and Cubbin-Jackson scales showed the highest predictive capacity. The clinical judgment of nurses was found to achieve inadequate predictive capacity when used alone, and should be used in combination with a validated scale.
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http://dx.doi.org/10.1097/01.WON.0000438014.90734.a2DOI Listing
April 2015

[Obstacles perceived by nurses for evidence-based practice: a qualitative study].

Enferm Clin 2013 Nov-Dec;23(6):279-83. Epub 2013 Oct 11.

Becaria predoctoral, Grupo de investigación Enfermería (CTS-464), Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Jaén, Jaén, España. Electronic address:

Aims: To examine the obstacles perceived by nurses to implement an evidence-based clinical practice.

Method: A qualitative study through semi-structured interviews conducted in 2010-2011 including 11 nurses purposively selected from public hospitals and community centres in Jaén and Córdoba (Spain). A content analysis was performed, using Miles and Huberman as a reference and comprising the following steps: data reduction, data presentation, and data conclusion/verification. Data saturation was reached in these categories (obstacles).

Results: The obstacles perceived by nurses to introduce an evidence-based clinical practice (EBCP) were grouped into 3 major categories: obstacles related with professionals (routine-based practice, unwilling and stagnant attitudes, and lack of training in EBCP), obstacles related to the social context (reluctance from other professionals and from patients or families), and obstacles related to the organization (obsolete cultures that do not promote innovation in nursing care).

Conclusions: This study highlights the persistence of various factors that hinder the use of research findings in clinical practice. The results underline the need to change the culture of healthcare organizations, to motivate professionals, and to break some of the resistance attitudes that hinder the implementation of evidence-based practice.
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http://dx.doi.org/10.1016/j.enfcli.2013.09.001DOI Listing
April 2015

A new theoretical model for the development of pressure ulcers and other dependence-related lesions.

J Nurs Scholarsh 2014 Jan 11;46(1):28-38. Epub 2013 Oct 11.

Head of Care Strategy Unit, University Hospital of Jaen, Spain.

Objective: To review the risk factors included in pressure ulcer risk assessment scales and construct a theoretical model for identifying the etiological factors of skin ulcers, excluding those of systemic origin (e.g., venous, arterial, and neuropathic).

Methods: Consensus study with expert panel (Delphi Method) based on a structured review of the literature. A search was conducted of the main databases between 1962 and 2009 with no language limitations. All descriptive or validation studies were included, but the grey literature was excluded. After identifying the risk factors in each scale, they were grouped into risk dimensions as a basis for constructing a new theoretical model.

Results: Eighty-three risk factors were identified in the 56 scales reviewed, and the risk factors were then classified by the expert panel into 23 risk dimensions. These dimensions were used to construct a new theoretical model (middle-range theory) for chronic wound development that explains the production mechanism of seven types of lesion: moisture, pressure, friction, combined pressure-moisture, combined pressure-friction, multifactorial lesions, and coadjuvant factors. These lesions were generically defined as dependence-related injuries.

Conclusions: Based on the classification of risk factors from the different scales into risk dimensions, a new middle-range theory was constructed that explains the production mechanism of seven dependence-related lesions considered to date as pressure ulcers.

Clinical Relevance: The prevention and treatment of these lesions requires a correct diagnosis and differentiation of their cause and management of the risk dimensions involved. The type of lesion also influences the selection of local approach.
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http://dx.doi.org/10.1111/jnu.12051DOI Listing
January 2014

[Assessment of the professional practice environment by Spanish nurses who participate in Internet forums].

Enferm Clin 2013 Nov-Dec;23(6):271-8. Epub 2013 Sep 26.

Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Jaén, Jaén, España. Electronic address:

Aim: To assess the professional work environment by Spanish nurses who participate in professional discussion groups on the Internet.

Method: A cross-sectional study (online survey) developed in 2011. The study variables were: socio-demographic and professional data; nursing practice environment, using the questionnaire Practice Environment Scale of the Nursing Work Index (PES-NWI).

Results: Out of a total of 295 questionnaires received, 214 were valid (72.54%). Most of the nurses were female (70.6%), with an average age of 43.55 years (SD = 9.82). The average score of the PES-NWI was 2.45 (SD = 0.63). The work environment was assessed as a mixed type, as three subscales scored over 2.5 (nursing foundations for quality of care, nurse manager leadership and support of nurses, and nurse-physician relations). The work environment assessment was influenced by several factors: professional category (P <.001); function (P <.001); and type of centre, which only affected the perception of the nurse-physician relations subscale.

Conclusions: The work environment received a moderate evaluation by participants. The staffing and resource adequacy subscale scored the worst, while the nursing foundations for quality of care was the highest scored. Nurses with management function and those with higher positions tended to give a better assessment of the work environment. The nurse-physician relations dimension was higher rated in primary care and nursing homes than in hospitals.
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http://dx.doi.org/10.1016/j.enfcli.2013.07.004DOI Listing
April 2015

Coping and subjective burden in caregivers of older relatives: a quantitative systematic review.

J Adv Nurs 2011 Nov 9;67(11):2311-22. Epub 2011 Jun 9.

Department of Nursing, School of Health Sciences, University of Jaén, Spain.

Aim: This article is a report on a review of the effect of coping strategies on subjective burden in informal caregivers of older adults.

Background: Informal care has negative effects on caregivers' health, and subjective burden is one of these. It has been linked with other effects (e.g. anxiety and depression). Thus, greater prevention of subjective burden will mean increased prevention of these effects. To achieve this, identification of factors related to subjective burden is essential.

Data Sources: Electronic databases and manual searches of scientific journals.

Review Methods: A quantitative systematic review was conducted including: (a) original studies (b) that related caregiver subjective burden to coping strategies compatible with the classifications of Lazarus & Folkman or Moos et al. (c) in informal caregivers of older relatives. The searches ranged from the first year included in each database until January 2010. After quality appraisal, ten studies were included; these, care-recipients living at home and having cognitive impairment.

Results: Four coping categories have been related to subjective burden: problem-focused, emotion-focused, approach and avoidance. Interesting results were only found for avoidance coping (positive association). In other categories, results were heterogeneous (problem-focused and approach) or we found few valid studies (emotion-focused).

Conclusion: We found some evidence for a positive association between avoidance coping and subjective burden in home caregivers of older relatives with cognitive impairment. It is probable that avoidance coping either mediates or moderates the relationship between subjective burden and its outcomes, or that avoidance coping precedes subjective burden, which in turn leads to the coping outcomes. In both situations, avoidance coping is an ineffective coping.
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http://dx.doi.org/10.1111/j.1365-2648.2011.05725.xDOI Listing
November 2011

Risk assessment scales for pressure ulcer prevention: a systematic review.

J Adv Nurs 2006 Apr;54(1):94-110

School of Nursing, University of Jaén, Jaén, Spain.

Aim: This paper reports a systematic review conducted to determine the effectiveness of the use of risk assessment scales for pressure ulcer prevention in clinical practice, degree of validation of risk assessment scales, and effectiveness of risk assessment scales as indicators of risk of developing a pressure ulcer.

Background: Pressure ulcers are an important health problem. The best strategy to avoid them is prevention. There are several risk assessment scales for pressure ulcer prevention which complement nurses' clinical judgement. However, some of these have not undergone proper validation.

Method: A systematic bibliographical review was conducted, based on a search of 14 databases in four languages using the keywords pressure ulcer or pressure sore or decubitus ulcer and risk assessment. Reports of clinical trials or prospective studies of validation were included in the review.

Findings: Thirty-three studies were included in the review, three on clinical effectiveness and the rest on scale validation. There is no decrease in pressure ulcer incidence was found which might be attributed to use of an assessment scale. However, the use of scales increases the intensity and effectiveness of prevention interventions. The Braden Scale shows optimal validation and the best sensitivity/specificity balance (57.1%/67.5%, respectively); its score is a good pressure ulcer risk predictor (odds ratio = 4.08, CI 95% = 2.56-6.48). The Norton Scale has reasonable scores for sensitivity (46.8%), specificity (61.8%) and risk prediction (OR = 2.16, CI 95% = 1.03-4.54). The Waterlow Scale offers a high sensitivity score (82.4%), but low specificity (27.4%); with a good risk prediction score (OR = 2.05, CI 95% = 1.11-3.76). Nurses' clinical judgement (only considered in three studies) gives moderate scores for sensitivity (50.6%) and specificity (60.1%), but is not a good pressure ulcer risk predictor (OR = 1.69, CI 95% = 0.76-3.75).

Conclusion: There is no evidence that the use of risk assessment scales decreases pressure ulcer incidence. The Braden Scale offers the best balance between sensitivity and specificity and the best risk estimate. Both the Braden and Norton Scales are more accurate than nurses' clinical judgement in predicting pressure ulcer risk.
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http://dx.doi.org/10.1111/j.1365-2648.2006.03794.xDOI Listing
April 2006

[Nursing diagnoses and reports. An appropriate relationship?].

Rev Enferm 2003 Mar;26(3):62-6

Departamento de Ciencias de la Salud, Escuela de Enfermería, Universidad de Jaén.

The objective of this study is to evaluate the use of nursing diagnosis in nursing discharge planning, according to NANDA taxonomy adapted to the model of V. Henderson. We have made a retrospective descriptive study analyzing 260 discharge care plan reports, from a county hospital of Jaén (Spain), during the period 1994-1998. We found 4.2 +/- 2.0 (average +/- standard deviation) nursing problems by discharge plan report. 62.4% of the problems were stated correctly as nursing diagnosis, with an average of 2.6 +/- 1.9 correct nursing diagnosis by report and 37.6% were incorrect nursing diagnosis, 1.6 +/- 1.1 by report as average. Most of the registered nursing problems (95.6%) were actual problems, present in the patients; a 4.3% were potential or high risk problems, and only one possible type nursing diagnosis was identified. After grouping the nursing problems according to the needs of the model of Virginia Henderson, we find that most of diagnosis cited were included in biological needs, and in smaller number to the psychosocial needs.
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March 2003