Gabriel J. Estévez-Guerra

Estudio descriptivo sobre la actitud de la familia ante el uso de restricciones físicas en mayores: resultados preliminares

Objetivo valorar la actitud que, ante el uso de las restricciones fisicas, adoptan los familiares cuidadores de personas mayores dependientes en el domicilio y considerar cuales serian los factores que podrian relacionarse con esta. Material y metodos estudio descriptivo, transversal, realizado mediante muestreo consecutivo a traves de un cuestionario que indagaba sobre los diversos componentes que conforman las actitudes. Respondio a la encuesta un total de 50 familiares, de los cuales se descartaron 7 porque no conocian el procedimiento (n = 43). Se describen las caracteristicas de la muestra, las frecuencias y las medidas de tendencia central y dispersion. Resultados la mayoria de los familiares considero este recurso como adecuado y un 90,7% estaba dispuesto a utilizarlo en un familiar suyo. Un 41,9% opino que no pueden evitarse las restricciones y desconocian otras alternativas que pudieran usarse. Un 23,3% no era consciente de que la restriccion puede ocasionar algun problema fisico o psicologico. Ninguno estimo de forma concluyente que este procedimiento fuese una forma de maltrato. Conclusiones las familias mantenian una actitud positiva ante la restriccion y consideraban apropiado su uso. Ello podria relacionarse con el limitado conocimiento de las alternativas que se pueden emplear y de las complicaciones que originan. Se sugiere poner en marcha programas de formacion que se centren en educar sobre las opciones terapeuticas alternativas a la restriccion.

The use of physical restraints in long-term care in Spain: a multi-center cross-sectional study

BackgroundPhysical restraint is a procedure used frequently in long-term care. It is a controversial practice because its use is associated with numerous complications and also affects freedom and individual autonomy. The objective of this study was to examine the use of physical restraint of long-term care residents with the ability to move voluntarily.MethodsWe conducted a cross-sectional observational and correlational multi-center study. Nine centers agreed to participate. Of the 1,200 people present at the time of data collection, those without voluntary movement or in the facility for less than a month were excluded. Thus, the final sample was 920 residents. Data on the use of restraints was collected by direct observation. Information about the age, gender, length of stay, falls, mobility, cognition and functional status of residents was gathered by reviewing clinical records and interviewing nursing staff. A descriptive analysis of the data obtained was conducted. The generalized linear model was used, considering only the principal effects of each variable and using the logit link function. The model has been adjusted for clusters and for other possibly confounding factors. For all analyses, a confidence interval (CI) of 95% was estimated.ResultsThe prevalence of residents with at least one physical restraint was 84.9% (95% CI: 81.7–88.1), with variability between centers of 70.3 to 96.6% (p-value Kruskal Wallis test <0.001). Full-enclosure side rails were most often used (84.5; 95% CI: 81.1–87.9), but other types of restraints were also used frequently. Multivariate analysis showed that the degree of functional impairment increased the probability of the use of restraint. A significant association was also found between restraint use and the impaired cognitive status of residents.ConclusionsThe prevalence was higher than in studies from other countries. The results emphasize the need to improve the training of nursing staff in the care of residents with impairments in functional and cognitive status. The use of alternative devices and nurse consultants need to be evaluated, and the introduction of specific laws considered.

Adaptación y validación española del Perception of Restraint Use Questionnaire (PRUQ) sobre el uso de restricciones físicas en personas mayores

Background. To adapt and to validate in a Spanish population the Perception of Restraint Use Questionnaire (PRUQ), which assesses the importance that professionals give to the use of physical restraints when caring for older adults. Methods . After a process of forward-back translation and linguistic adaptation, a Spanish version of the original questionnaire was obtained. A descriptive cross-sectional multicenter study was then carried out. Based on non-probability sampling, 20 centers from three Spanish regions were selected; 830 professionals agreed to participate. Results . 15 of the 17 items of the original questionnaire were translated literally and two required minor modifications. All were considered acceptable by an expert panel (content validity index of 0.89); a pilot study confirmed the adequate feasibility of the questionnaire. The principal components analysis identified three dimensions that explained 66.2% of variance. The confirmatory factor analysis of this tridimensional model showed an acceptable fit [CFI = 0.936; RMSEA = 0.080], being factor loadings and factor correlations statistically significant (p<0.001). The internal consistency (Cronbach’s alpha) for the total score was 0.92 and the test-retest reliability (ICCa) was 0.87 (95% CI: 0.78 to 0.92) over an interval of three weeks. Conclusions . The Spanish version of the PRUQ shows good psychometric characteristics and is adapted to the cultural context of this country. It may be considered a useful tool to assess in which situations professionals consider the use of physical restraints most necessary, helping to design training activities aimed at rationalizing its application.BACKGROUND To adapt and to validate in a Spanish population the Perception of Restraint Use Questionnaire (PRUQ), which assesses the importance that professionals give to the use of physical restraints when caring for older adults. METHODS After a process of forward-back translation and linguistic adaptation, a Spanish version of the original questionnaire was obtained. A descriptive cross-sectional multicenter study was then carried out. Based on non-probability sampling, 20 centers from three Spanish regions were selected; 830 professionals agreed to participate. RESULTS 15 of the 17 items of the original questionnaire were translated literally and two required minor modifications.All were considered acceptable by an expert panel(content validity index of 0.89); a pilot study confirmed the adequate feasibility of the questionnaire. The principal components analysis identified three dimensions that explained 66.2% of variance. The confirmatory factor analysis of this tridimensional model showed an acceptable fit [CFI = 0.936; RMSEA = 0.080], being factor loadings and factor correlations statistically significant (p<0.001). The internal consistency (Cronbachs alpha) for the total score was 0.92 and the test-retest reliability (ICCa) was 0.87 (95%CI: 0.78 to 0.92) over an interval of three weeks. CONCLUSIONS The Spanish version of the PRUQ shows good psychometric characteristics and is adapted to the cultural context of this country. It may be considered a useful tool to assess in which situations professionals consider the use of physical restraints most necessary, helping to design training activities aimed at rationalizing its application.

Determinantes de la satisfacción laboral en centros geriátricos

Introduction: the present study analyzed levels of job satisfaction among nurses and auxiliary nurses working with the elderly in public institutions in the Canary Islands. The effect of demographic and work-related variables on job satisfaction was also evaluated. Material and method: a descriptive correlational survey design was used in a sample of 227 participants who completed Font-Roja’s job satisfaction questionnaire and another questionnaire on demographic and work-related variables. The association among variables was assessed using odds ratios and 95% confidence intervals. Adjustment for confounders was performed by logistic regression. Results: nurses showed a higher level of satisfaction than auxiliary nurses due to differences in the dimensions of work monotony and satisfaction with position. Overall, both groups scored lowest on physical environment and work-related strain. The best scores were for job content and position-related strain. Multivariate analysis revealed that the variables that best explained job satisfaction were the procedures used to assign work, shifts and job situation. Conclusions: improvements in human and material resources and modification of certain organisational aspects are proposed.

The Effect of Personality Type on Palliative Care Nursing Staff Stress Levels

Burnout syndrome was defined in 1976 by Maslach and Jackson, and there is evidence of its high impact on nursing personnel. The syndrome manifests most intensely among palliative care unit employees who assist elderly patients, owing to their constant exposure to patient deaths. The aim of this study is to determine whether palliative care unit nursing staff who treat terminal gerontology patients and who have certain personality traits are more susceptible to occupational stress. The study also determines the personality type that most significantly reduced vulnerability to occupational stress. Two questionnaires, the Maslach Burnout Inventory and Big Five Inventory, were applied to 162 nursing professionals working in Spain. The most relevant study findings are the following: Extroverted nurses tend to not express stress; the more sociable the caregiver is, the greater the degree of emotional fatigue he/she experiences; nurses who exhibit a higher degree of neuroticism show an average degree of emotional fatigue; and caregivers who exhibit high openness to change have low stress levels while experiencing a strong sense of success. From these results, an ideal personality profile for selecting palliative care unit nursing staff was developed.

Physical Restraint Use With Elderly Patients: Perceptions of Nurses and Nursing Assistants in Spanish Acute Care Hospitals

Background Physical restraint is often used during the hospitalization of elderly people. However, this procedure is associated with adverse outcomes; therefore, it is necessary to be aware of the circumstances that promote restraint use, such as the perceptions of professionals who use it. Objectives The purpose of the research was to determine the situations in which nursing staff considered the use of physical restraint as most important and to evaluate the possible associations with the sociodemographic and professional variables. Methods A descriptive cross-sectional multicenter study was carried out in 52 units of eight Spanish acute hospitals. A survey of registered nurses and nursing assistants was used to collect data related to sociodemographic characteristics, experience, training in restraint use, and the Perception of Restraint Use Questionnaire (PRUQ)—which assesses the perceived importance of reasons frequently given for the use of physical restraint. Results The sample comprised 508 registered nurses and 347 nursing assistants. Almost all (98%) had used physical restraint, and 82% thought their training in the use of physical restraint was insufficient. Nursing assistants scored higher than registered nurses (p < .005, d = .68) on PRUQ total score and individual item scores, suggesting they thought the factors were more important in restraint use. Both registered nurses and nursing assistants considered restraint as most important in the prevention of falls and in the removal of medical devices such as intravenous lines and urinary catheters. Associations between PRUQ total score and other variables (unit type, sociodemographic factors, hospital) were nonsignificant. Discussion The professionals considered restraint as very important in preventing safety problems. In order to improve the quality of care, it is essential to identify the factors that can have an effect on the application of physical restraint. Educational programs are of fundamental importance, but to be more effective in reducing the use of physical restraint, they should address commonly held views on rationale for restraint use and be accompanied by institutional policies promoting a restraint-free environment.