Publications by authors named "Pilar Delgado-Hito"

33 Publications

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

Validation of the Spanish version of the questionnaire on Patient Empowerment in Long-Term Conditions.

PLoS One 2020 12;15(6):e0233338. Epub 2020 Jun 12.

IDIBELL (Bellvitge Biomedical Research Institute), Hospitalet de Llobregat, Barcelona, Spain.

Background: Patient empowerment is a key factor in improving health outcomes.

Objective: To evaluate the psychometric properties of the Spanish version of the questionnaire on Patient Empowerment in Long-Term Conditions (PELC) that evaluates the degree of empowerment of patients with chronic diseases.

Methods: Three measurements were made (at baseline, 2 weeks and 12 weeks) of quality of life (QoL), self-care, self-efficacy and empowerment. Reliability was evaluated as internal consistency for the entire sample. Test-retest reproducibility was evaluated for patients who were stable from baseline to week 2 (n = 70). Validity was analysed (n = 124) as baseline correlations with QoL, self-care, self-efficacy, clinical data and psychosocial variables. Sensitivity to change was analysed in terms of effect size for patients who had improved between baseline and week 12 (n = 48).

Results: The study was carried out with 124 patients with a diagnosis of heart failure. Cronbach's alpha was high, at >0.9, and the interclass correlation coefficient was low, at 0.47. PELC questionnaire scores showed differences depending on New York Heart Association functional class (p<0.05) and, as posited in the a priori hypotheses, were moderately correlated with emotional dimensions of QoL (0.53) and self-efficacy (0.43). Effect size for the clinically improved subsample was moderate (0.67).

Conclusions: The results suggest that the Spanish version of the PELC questionnaire has appropriate psychometric properties in terms of internal consistency and validity and is low in terms of reproducibility and sensitivity to change.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0233338PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292571PMC
August 2020

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Development and initial validation of a Theory of Planned Behaviour questionnaire to assess critical care nurses' intention to use physical restraints.

J Adv Nurs 2019 Sep 17;75(9):2036-2049. Epub 2019 Jun 17.

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

Aims: To develop and psychometrically test a Theory of Planned Behaviour (TPB) questionnaire to assess nurses' intention to use physical restraints (PRs) in intubated patients.

Design: A psychometric instrument validation study conducted in three phases.

Methods: A theory-driven questionnaire was developed. Eight experts validated the content of the preliminary 58-item questionnaire. A pilot study was conducted including 101 critical care nurses to test the reliability of the items. Construct validity and reliability were tested in a cross-sectional study of 12 units from eight hospitals in Spain (N = 354) from October - December 2017. Participants completed the questions based on the TPB, and socio-demographic and professional variables.

Results: The instrument comprised 48 items. All the direct and indirect constructs exhibited acceptable reliability. Confirmatory factor analysis indicated satisfactory fit indices for factorial structure according to the TPB. Nurses showed favourable attitudes, low perception of social pressure and modest perception of behaviour control. Perceived behavioural control and attitude were moderately positively correlated with the intention to use restraints, whereas subjective norm revealed the lowest correlation. Overall, the model explained 33% of the variance in intention.

Conclusions: The Physical Restraint TPB questionnaire is a 48-item self-reporting theoretically based instrument with acceptable reliability and construct validity to identify nurses' intentions to use PRs in intubated patients.

Impact: Unravelling the key determinants of nurses' intentions to use PRs should be examined to tailor quality improvement projects aimed at de-implementing restraints use in practice and to promote safer care.
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http://dx.doi.org/10.1111/jan.14046DOI Listing
September 2019

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

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

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

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

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

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

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

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

Implementing evidence-based practices on the therapeutic relationship in inpatient psychiatric care: A participatory action research.

J Clin Nurs 2019 May 18;28(9-10):1614-1622. Epub 2019 Jan 18.

School of Nursing, Universitat Rovira i Virgili, Tarragona, Catalunya, Spain.

Aims And Objectives: To produce changes in the therapeutic relationship between clinical practice nurses and patients in psychiatric units by implementing evidence-based practices through participatory action research.

Background: The therapeutic relationship is the cornerstone of nursing care in psychiatric units. The literature suggests that theoretical knowledge alone is insufficient to establish the therapeutic relationship in practice. Therefore, strategies are needed to adequately establish the therapeutic relationship in psychiatric units.

Design: Participatory action research.

Methods: Participants consisted of nurses from two psychiatric units of a university hospital. Data were collected through focus groups and reflective diaries, which were analysed using the content analysis method. The COREQ guidelines were followed to ensure rigour.

Results: Nurses conceptualised the therapeutic relationship in their practice, identifying facilitating elements and limitations. They were able to compare their clinical practice with the recommendations of scientific evidence and constructed three evidence-based proposals to improve the therapeutic relationship: (a) a customised nurse intervention space, (b) knowledge updating and (c) reflective groups, which they subsequently implemented and evaluated.

Conclusions: This study shows that nurses in psychiatric units can generate changes and improvements in the therapeutic relationship. The process of implementing evidence-based practice enhanced participants' awareness of their clinical practice and allowed them to make changes and improvements.

Relevance To Clinical Practice: The process confirmed that the implementation of evidence-based practice through participatory methods, such as participatory action research, is valid and produces lasting changes. This study also reveals the need to rethink nurses' functions and competencies in current psychiatric units.
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http://dx.doi.org/10.1111/jocn.14759DOI Listing
May 2019

Nursing workload and compliance with non-pharmacological measures to prevent ventilator-associated pneumonia: a multicentre study.

Nurs Crit Care 2018 11 5;23(6):291-298. Epub 2018 Sep 5.

Fundamental and Medical-Surgical Nursing Department, School of Nursing, University of Barcelona, Barcelona, Spain.

Background: Ventilator-associated pneumonia is common and associated with high mortality. Nurses play a fundamental role in preventing ventilator-associated pneumonia. Evidence-based guidelines and training interventions about preventing ventilator-associated pneumonia do not ensure compliance with recommendations.

Aims And Objective: To evaluate the impact of nursing workload on compliance with non-pharmacological measures to prevent ventilator-associated pneumonia.

Design: A prospective observational study in two medical-surgical adult ICUs in Spain.

Methods: We measured nurses' knowledge about preventing ventilator-associated pneumonia through a questionnaire and workload, categorized with the Nine Equivalents of Nursing Manpower Use Score. We directly observed nurses to measure compliance with non-pharmacological measures to prevent ventilator-associated pneumonia.

Results: A total of 97 nurses were studied; 76 (79%) were observed. There were 327 observations (mean 4·30 observations per nurse). The questionnaire showed good baseline knowledge of preventive measures [mean score (92% ± 16%)]. Nurses complied with the preventive measures in 66% ± 15% of observations; compliance ranged from 11·9% for pre-aspiration hand washing to 99·7% for using sterile aspiration probes. Mean Nine Equivalents of Nursing Manpower Use Score for each nurse observed was 50 ± 13, without differences between centres (49 ± 14 versus 51 ± 11, p = 0·4). Overall compliance was lower in the light workload group (p = 0·02), but no significant differences in compliance between workload groups were found when each measure was analysed separately. Compliance was higher in nurses aged 31-40 years than in those aged >51 years, although workload was similar in both groups.

Conclusions: Compliance with non-pharmacological measures to prevent ventilator-associated pneumonia varies widely; non-compliance is not because of increased workload.

Relevance To Clinical Practice: Most critical care nurses have good baseline knowledge of non-pharmacological measures to prevent ventilator-associated pneumonia. Failure to comply with these measures is probably more related with behavioural, structural and organizational aspects than with nursing workload. Interventions to improve compliance might be more effective if they focus on factors such as work climate and professionals' attitudes.
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http://dx.doi.org/10.1111/nicc.12380DOI Listing
November 2018

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Transcultural adaptation into Spanish of the Patient empowerment in long-term conditions questionnaire].

Aten Primaria 2019 01 23;51(1):24-31. Epub 2017 Dec 23.

Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, España; Sección de Insuficiencia Cardiaca Crónica, Servicio de Cardiología, Hospital Universitario Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Grupo de Investigación de Enfermedades Cardiovasculares, IDIBELL (Instituto de Investigación Biomédica de Bellvitge), L'Hospitalet de Llobregat, Barcelona, España; Departamento de Medicina, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España. Electronic address:

Purpose: To describe the process of translation and cultural adaptation of the Patient empowerment in long-term condition to the Spanish language.

Design: Translation, cross-cultural adaptation, and pilot testing (cognitive debriefing) LOCATION: Primary and Hospital care.

Participants: Ten patients admitted to a cardiology department of a University Hospital MAIN MEASUREMENTS: 1) Direct translation, 2) conciliation and synthesis of the versions by expert panel, 3) back- translation, 4) agreement on the back-translated version with the author of the original version, 5) analysis of comprehensibility through cognitive interviews.

Results: There were no differences between the direct-translated versions. The expert panel introduced changes in 23 out of the 47 items of the questionnaire. The author of the original version agreed with the version of the back-translation. In the cognitive interviews, patients reported high difficulty in one item and low difficulty in 4.

Conclusions: The Spanish version of the Patient Empowerment in long-term conditions questionnaire is semantically and conceptually equivalent to the original tool. The assessment of the psychometric properties of the Spanish version of the questionnaire will be carried out at a later stage.
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http://dx.doi.org/10.1016/j.aprim.2017.09.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836925PMC
January 2019

Improving the therapeutic relationship in inpatient psychiatric care: Assessment of the therapeutic alliance and empathy after implementing evidence-based practices resulting from participatory action research.

Perspect Psychiatr Care 2018 Apr 13;54(2):300-308. Epub 2017 Sep 13.

School of Nursing, Rovira i Virgili University, Tarragona, Spain.

Purpose: To examine how evidence about the therapeutic alliance gleaned from participatory action project affected the level of this alliance and the degree of empathy of psychiatric nurses.

Design And Methods: Quasi-experimental study in two psychiatric units. In one group, evidence-based practices that affected the therapeutic alliance were implemented; in the comparison group, there was no such intervention.

Findings: The nurses from the intervention group improved their degree of empathy and factors such as agreement on objectives and tasks with the patient.

Practice Implications: The results confirm the possibility of measuring and improving the therapeutic relationship in psychiatric care.
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http://dx.doi.org/10.1111/ppc.12238DOI Listing
April 2018

Transcultural adaptation and validation of the patient empowerment in long-term conditions questionnaire.

BMC Health Serv Res 2017 05 4;17(1):324. Epub 2017 May 4.

Cardiology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.

Background: Patient empowerment is a key element to improve the results in health, increase satisfaction amongst users and obtain higher treatment compliance. The main objective of this study is to validate the Spanish version of the questionnaire "Patient empowerment in long-term conditions" which evaluates the patients' level of empowerment of chronic diseases. The secondary objective is to identify factors which predict basal empowerment and changes (improvement or deterioration) in patients with Heart Failure (HF).

Methods: An observational and prospective design of psychometric type to validate a questionnaire (aim 1) and a prospective study of cohorts (aim 2). The study will include 121 patients with confirmed diagnosis of HF. Three measurements (basal, at 15 days and at 3 months) will be carried out: quality of life, self-care and empowerment. Descriptive and inferential analyses will be used. For the first aim of the study (validation), the test-retest reproducibility will be assessed through intraclass correlation coefficient; internal consistency will be assessed through Cronbach's alpha coefficient; construct validity through Pearson's correlation coefficient; and sensibility to change through effect size coefficient.

Discussion: Set a valid questionnaire to measure the level of empowerment of patients with chronic diseases could be an effective tool to assess the results from the provision of the health care services. It will also allow us to identify at an early stage, those groups of patients with a low level of empowerment. Hence, they could become a risk group due to poor management of the disease, with a high rate of decompensation and a higher use rate of the health system resources.
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http://dx.doi.org/10.1186/s12913-017-2271-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418845PMC
May 2017

Implementation of evidence on the nurse-patient relationship in psychiatric wards through a mixed method design: study protocol.

BMC Nurs 2017 11;16. Epub 2017 Jan 11.

School of Nursing, Rovira i Virgili University, Avda Remolins 13-15, Tortosa, 43500 Tarragona Spain.

Background: Psychiatric nurses are aware of the importance of the therapeutic relationship in psychiatric units. Nevertheless, a review of the scientific evidence indicates that theoretical knowledge alone is insufficient to establish an adequate therapeutic alliance. Therefore, strategies are required to promote changes to enhance the establishment of the working relationship. The aims of the study are to generate changes in how nurses establish the therapeutic relationship in acute psychiatric units, based on participative action research and to evaluate the effectiveness of the implementation of evidence through this method.

Methods/design: The study will use a mixed method design. Qualitative methodology, through participative action research, will be employed to implement scientific evidence on the therapeutic relationship. A quasi-experimental, one-group, pre-test/post-test design will also be used to quantitatively measure the effectiveness of the implementation of the evidence. Participants will consist of nurses and patients from two psychiatric units in Barcelona. Nurses will be selected by theoretical sampling, and patients assigned to each nurses will be selected by consecutive sampling. Qualitative data will be gathered through discussion groups and field diaries. Quantitative data will be collected through the Working Alliance Inventory and the Interpersonal Reactivity Index. Qualitative data will be analysed through the technique of content analysis and quantitative data through descriptive and inferential statistics.

Discussion: This study will help to understand the process of change in a nursing team working in an inpatient psychiatric ward and will allow nurses to generate knowledge, identify difficulties, and establish strategies to implement change, as well as to assess whether the quality of the care they provide shows a qualitative improvement.
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http://dx.doi.org/10.1186/s12912-016-0197-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234145PMC
January 2017

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

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

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

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

The Therapeutic Relationship in Inpatient Psychiatric Care: A Narrative Review of the Perspective of Nurses and Patients.

Arch Psychiatr Nurs 2016 12 8;30(6):782-787. Epub 2016 Mar 8.

Campus Docent Fundació Privada Sant Joan de Déu. School of Nursing, University of Barcelona, Santa Rosa, 39-57, Esplugues de Llobregat, Spain. Electronic address:

Purpose: To study the significance of 'therapeutic relationship' between nurses and patients within the context of a psychiatric hospital.

Method: Narrative literature review. Content analysis.

Findings: The significance of the therapeutic relationship is quite similar for both nurses and patients in psychiatric hospital units. Nevertheless, several factors may separate the two positions: the time available for the relationship, the negative perceptions on the part of both parties, and the insecurity of the setting.

Practice Implications: Increased knowledge and understanding of the significance of the therapeutic relationship from the perspective of nurses and patients would allow the strengthening of areas of mutual interest.
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http://dx.doi.org/10.1016/j.apnu.2016.03.001DOI Listing
December 2016

Self-perception of leadership styles and behaviour in primary health care.

BMC Health Serv Res 2016 10 12;16(1):572. Epub 2016 Oct 12.

Barcelona's Primary Health Care Research, Evaluation and Quality Unit Institut Català de la Salut, Numància n° 23, 08029, Barcelona, Spain.

Background: The concept of leadership has been studied in various disciplines and from different theoretical approaches. It is a dynamic concept that evolves over time. There are few studies in our field on managers' self-perception of their leadership style. There are no pure styles, but one or another style is generally favoured to a greater or lesser degree. In the primary health care (PHC) setting, managers' leadership style is defined as a set of attitudes, behaviours, beliefs and values. The objectives of this study were to describe and learn about the self-perception of behaviours and leadership styles among PHC managers; to determine the influence of the leadership style on job satisfaction, efficiency, and willingness to work in a team; and to determine the relationship between transformational and transactional styles according age, gender, profession, type of manager years of management experience, and the type of organization.

Methods: To describe leadership styles as perceived by PHC managers, a cross sectional study was performed using an 82 items-self-administered Multifactor Leadership Questionnaire (MLQ). This questionnaire measures leadership styles, attitudes and behaviour of managers. The items are grouped into three first order variables (transformational, transactional and laissez-faire) and ten second order variables (which discriminate leader behaviours). Additionally, the questionnaire evaluates organizational consequences such as extra-effort, efficiency and satisfaction.

Results: One hundred forty responses from 258 managers of 133 PHC teams in the Barcelona Health Area (response rate: 54.26 %). Most participants were nurses (61.4 %), average age was 49 years and the gender predominantly female (75 %). Globally, managers assessed themselves as equally transactional and transformational leaders (average: 3.30 points). Grouped by profession, nurses (28.57 % of participants) showed a higher transactional leadership style, over transformational leadership style, compared to physicians (3.38 points, p < 0.003). Considering gender, men obtained the lowest results in transactional style (p < 0.015). Both transactional and transformational styles correlate with efficiency and job satisfaction (r = 0.724 and r = 0.710, respectively).

Conclusions: PHC managers' self-perception of their leadership style was transactional, focused on the maintenance of the status quo, although there was a trend in some scores towards the transformational style, mainly among nurse managers. Both styles correlate with satisfaction and willingness to strive to work better.
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http://dx.doi.org/10.1186/s12913-016-1819-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5062861PMC
October 2016

Concepts and measures of patient empowerment: a comprehensive review.

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

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

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

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

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

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

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

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

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

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

Software Quality Evaluation Models Applicable in Health Information and Communications Technologies. A Review of the Literature.

Stud Health Technol Inform 2016 ;226:169-72

Nursing School, University of Barcelona, Spain.

Information and Communications Technologies in healthcare has increased the need to consider quality criteria through standardised processes. The aim of this study was to analyse the software quality evaluation models applicable to healthcare from the perspective of ICT-purchasers. Through a systematic literature review with the keywords software, product, quality, evaluation and health, we selected and analysed 20 original research papers published from 2005-2016 in health science and technology databases. The results showed four main topics: non-ISO models, software quality evaluation models based on ISO/IEC standards, studies analysing software quality evaluation models, and studies analysing ISO standards for software quality evaluation. The models provide cost-efficiency criteria for specific software, and improve use outcomes. The ISO/IEC25000 standard is shown as the most suitable for evaluating the quality of ICTs for healthcare use from the perspective of institutional acquisition.
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May 2017

Levels of exposure to ethical conflict in the ICU: Correlation between sociodemographic variables and the clinical environment.

Intensive Crit Care Nurs 2016 Apr 13;33:12-20. Epub 2016 Jan 13.

Faculty of Psychology, Consolidated Research Group 2014-326 Advanced Statistical Techniques Applied Psychology, Research Institute on Brain, Cognition and Behaviour (IR3C), University of Barcelona, Spain.

Objectives: To analyse the level of exposure of nurses to ethical conflict and determine the relationship between this exposure, sociodemographic variables and perceptions of the clinical environment.

Design And Setting: Prospective and descriptive correlational study conducted at 10 intensive care units in two tertiary hospitals affiliated to the University of Barcelona. Sociodemographic and professional data were recorded from a questionnaire and then the previously validated Ethical Conflict in Nursing Questionnaire-Critical Care Version was administered to obtain data regarding experiences of ethical conflict.

Results: Two hundred and three nurses (68.6%) participated in the study, of whom only 11.8% had training in bioethics. Exposure to ethical conflict was moderate with a x¯=182.35 (SD=71.304; [0-389]). The realisation that analgesia is ineffective and the administration of treatment without having participated in the decision-making process were the most frequently reported ethical conflicts. Professionals who perceived their environment as supportive for dealing with ethical conflicts reported lower levels of these events (p=0.001).

Conclusions: Ethical conflict is an internal problem but it is strongly influenced by certain variables and environmental conditions. The involvement of nurses in the decision-making processes regarding the care of critically ill patients emerges as a factor that protects against ethical conflicts.
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http://dx.doi.org/10.1016/j.iccn.2015.10.004DOI Listing
April 2016

Newborn physiological immaturity: a concept analysis.

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

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

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

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

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

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

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

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