González-Jurado Ma

Impact of Diabetic Foot Related Complications on the Health Related Quality of Life (HRQol) of Patients - A Regional Study in Spain

The diabetic foot reduces the health-related quality of life (HRQoL) in patients with diabetes mellitus. This study aims at ascertaining the impact of the etiological factors of the diabetic foot on the various aspects of HRQoL. This is a comparative study involving type 1 or type 2 (n = 421) diabetic patients divided into 2 groups. Group 1 (n = 258) includes diabetic patients without foot lesions and group 2 (n = 163) includes patients suffering from a diabetic foot ulcer. The HRQoL of the sample was assessed by using the SF-36 Health Questionnaire. The overall HRQoL score was 68.58 ± 18.24 in group 1 and 50.99 ± 18.98 in group 2 (P < .001). The diabetic foot—related etiological factors that significantly reduce these patients’ HRQoL are neuropathy, amputation history, and poor metabolic control (P < .001). Quality of life was lower in women with diabetic foot than in men. Neuropathy—regarded as the main etiological factor in the diabetic foot—also proved to be a variable that reduces the HRQoL. Paradoxically, peripheral vascular disease did not prove to have a negative impact on the quality of life.

Foot Biomechanics in Patients with Diabetes Mellitus Doubts Regarding the Relationship Between Neuropathy, Foot Motion, and Deformities

BACKGROUND We sought to identify the biomechanical characteristics of the feet of patients with diabetes mellitus and the interrelationship with diabetic neuropathy by determining the range of joint mobility and the presence and locations of calluses and foot deformities. METHODS This observational comparative study involved 281 patients with diabetes mellitus who underwent neurologic and vascular examinations. Joint mobility studies were performed, and deformities and hyperkeratosis locations were assessed. RESULTS No substantial differences were found between patients with and without neuropathy in joint mobility range. Neuropathy was seen as a risk factor only in the passive range of motion of the first metatarsophalangeal joint (mean ± SD: 57.2° ± 19.5° versus 50.3° ± 22.5°, P = .008). Mean ± SD ankle joint mobility values were similar in both groups (83.0° ± 5.2° versus 82.8° ± 9.3°, P = .826). Patients without neuropathy had a higher rate of foot deformities such as hallux abductus valgus and hammer toes. There was also a higher presence of calluses in patients without neuropathy (82.8% versus 72.6%; P = .039). CONCLUSIONS Diabetic neuropathy was not related to limited joint mobility and the presence of calluses. Patients with neuropathy did not show a higher risk of any of the deformities examined. These findings suggest that the etiology of biomechanical alterations in diabetic people is complex and may involve several anatomically and pathologically predisposing factors.

Defining nurse regulation and regulatory body performance: a policy Delphi study

CONTEXT Professional self-regulation is a privilege and needs to deliver against the underpinning social contract between the professional and citizens who are receiving care and services. AIMS The aims of this study were to generate, international consensus on a contemporary definition of professional nurse regulation; and to articulate the key features of a highly performing regulatory body, and postulate which regulatory model and administrative arrangements are best suited to attain the key features. METHOD A highly diverse and globally recruited random stratified sample of 75 experts was approached to participate in a classic three-round policy Delphi study. Quantitative and qualitative data were generated and subjected to thematic and statistical analysis. Both non-parametric and descriptive statistical techniques were used in relation to quantitative data. RESULTS Consensus on a revision of the current International Council of Nurses definition of professional nurse regulation was developed and a set of 47 key features of high-performing regulatory bodies was agreed. Although a strong preference for the delegated self-regulatory model (43%) and single-board administrative approach (48%) was expressed the underlying rationale for such a preference was unclear. CONCLUSION The research makes an important contribution to an underdeveloped field of study. The case for conducting more quantitative investigations to ascertain the best regulatory model and associated administrative approach has been made.

A systematic review of nurse-related social network analysis studies.

Background Nurses frequently work as part of both uni- and multidisciplinary teams. Communication between team members is critical in the delivery of quality care. Social network analysis is increasingly being used to explore such communication. Aim To explore the use of social network analysis involving nurses either as subjects of the study or as researchers. Methods Standard systematic review procedures were applied to identify nurse-related studies that utilize social network analysis. A comparative thematic approach to synthesis was used. Both published and grey literature written in English, Spanish and Portuguese between January 1965 and December 2013 were identified via a structured search of CINAHL, SciELO and PubMed. In addition, Google and Yahoo search engines were used to identify additional grey literature using the same search strategy. Results Forty-three primary studies were identified with literature from North America dominating the published work. So far it would appear that no author or group of authors have developed a programme of research in the nursing field using the social network analysis approach although several authors may be in the process of doing so. Limitations The dominance of literature from North America may be viewed as problematic as the underlying structures and themes may be an artefact of cultural communication norms from this region. Conclusions The use of social network analysis in relation to nursing and by nurse researchers has increased rapidly over the past two decades. The lack of longitudinal studies and the absence of replication across multiple sites should be seen as an opportunity for further research. Implication for Nursing and Health Policy This analytical approach is relatively new in the field of nursing but does show considerable promise in offering insights into the way information flows between individuals, teams, institutions and other structures. An understanding of these structures provides a means of improving communication.BACKGROUND Nurses frequently work as part of both uni- and multidisciplinary teams. Communication between team members is critical in the delivery of quality care. Social network analysis is increasingly being used to explore such communication. AIM To explore the use of social network analysis involving nurses either as subjects of the study or as researchers. METHODS Standard systematic review procedures were applied to identify nurse-related studies that utilize social network analysis. A comparative thematic approach to synthesis was used. Both published and grey literature written in English, Spanish and Portuguese between January 1965 and December 2013 were identified via a structured search of CINAHL, SciELO and PubMed. In addition, Google and Yahoo search engines were used to identify additional grey literature using the same search strategy. RESULTS Forty-three primary studies were identified with literature from North America dominating the published work. So far it would appear that no author or group of authors have developed a programme of research in the nursing field using the social network analysis approach although several authors may be in the process of doing so. LIMITATIONS The dominance of literature from North America may be viewed as problematic as the underlying structures and themes may be an artefact of cultural communication norms from this region. CONCLUSIONS The use of social network analysis in relation to nursing and by nurse researchers has increased rapidly over the past two decades. The lack of longitudinal studies and the absence of replication across multiple sites should be seen as an opportunity for further research. IMPLICATION FOR NURSING AND HEALTH POLICY This analytical approach is relatively new in the field of nursing but does show considerable promise in offering insights into the way information flows between individuals, teams, institutions and other structures. An understanding of these structures provides a means of improving communication.

A structured policy review of the principles of professional self‐regulation

BACKGROUND The International Council of Nurses (ICN) has, for many years, based its work on professional self-regulation on a set of 12 principles. These principles are research based and were identified nearly three decades ago. ICN has conducted a number of reviews of the principles; however, changes have been minimal. In the past 5-10 years, a number of authors and governments, often as part of the review of regulatory systems, have started to propose principles to guide the way regulatory frameworks are designed and implemented. These principles vary in number and content. OBJECTIVES This study examines the current policy literature on principle-based regulation and compares this with the set of principles advocated by the ICN. DESIGN AND DATA SOURCES A systematic search of the literature on principle-based regulation is used as the basis for a qualitative thematic analysis to compare and contrast the 12 principles of self-regulation with more recently published work. RESULTS A mapping of terms based on a detailed description of the principles used in the various research and policy documents was generated. This mapping forms the basis of a critique of the current ICN principles. A professional self-regulation advocated by the ICN were identified. CONCLUSIONS A revised and extended set of 13 principles is needed if contemporary developments in the field of regulatory frameworks are to be accommodated. These revised principles should be considered for adoption by the ICN to underpin their advocacy work on professional self-regulation.

Keeping Pace With an Ever-Changing World: A Policy Imperative

This article explores some issues that regulatory bodies will face in the coming 15 years by drawing attention to three global policy initiatives: Health Workforce 2030 from the Global Health Workforce Alliance; theTwelfth General Programme of Work from the World Health Organization; andThe Road to Dignity by 2030 from the United Nations.The authors discuss how these three policy initiatives provide major opportunities for regulatory bodies to shape, rather than respond to, a rapidly changing and evolving policy landscape.The authors provide examples of how these global high-level initiatives have relevance to the core mandate of protecting the public and hopefully stimulate much-needed debate and informed solution making.The article concludes by calling for regulatory bodies to more proactively engage with wider policy initiatives to position their work in the context of driving change rather than being viewed as an obstacle to progress.

Analysis of a global random stratified sample of nurse legislation

AIM To identify, compare and contrast the major component parts of heterogeneous stratified sample of nursing legislation. BACKGROUND Nursing legislation varies from one jurisdiction to another. Up until now no research exists into whether the variations of such legislation are random or if variations are related to a set of key attributes. METHODS This mixed method study used a random stratified sample of legislation to map through documentary analysis the content of 14 nursing acts and then explored, using quantitative techniques, whether the material contained relates to a number of key attributes. These attributes include: legal tradition of the jurisdiction; model of regulation; administrative approach; area of the world; and the economic status of the jurisdiction. FINDINGS Twelve component parts of nursing legislation were identified. These were remarkably similar irrespective of attributes of interest. However, not all component parts were specified in the same level of detail and the manner by which the elements were addressed did vary. A number of potential relationships between the structure of the legislation and the key attributes of interest were identified. CONCLUSIONS AND IMPLICATIONS FOR POLICY This study generated a comprehensive and integrated map of a global sample of nursing legislation. It provides a set of descriptors to be used to undertake further quantitative work and provides an important policy tool to facilitate dialogue between regulatory bodies. At the individual nurse level it offers insights that can help nurses pursue recognition of credentials across jurisdictions.

A Typology of Professional Nurse Regulatory Models and Their Administration

Today, nurses often migrate from one jurisdiction to another and must deal with regulatory regimes. Regulators receive application from persons who may or may not come from a jurisdiction with a similar regulatory model or approach. The lack of scholarly discourse on the wide variety of regulatory models and administrative approaches is problematic. Without an internationally agreed taxonomy that calibrates one system with another, it is difficult and time consuming for regulators and nurses to deal with the complexities of obtaining recognition across jurisdictions. This article describes an analysis of the key issues and proposes a five-point taxonomy of regulatory models and a six-point taxonomy of administrative approaches to their implementation.

Nurse faculty migration: a systematic review of the literature

BACKGROUND To undertake a systematic review of English and Spanish literature relating to nurse faculty migration. METHODS A systematic review of both published literature, using CINAHL, EMBASE, ERIC and MEDLINE, and grey literature, using Google and Yahoo search engines, utilizing a defined search strategy with key terms, wild card strings and logical operators, was undertaken. An initial limitation of searching for material published in the last ten years was removed due to the poor yield of relevant papers. In total, 18 research-based studies were identified, retrieved and reviewed. Finally, the retrieved material was reviewed and augmented by a group of nurse faculty and migration experts, who offered comments and proposed additional grey literature. With increased globalization, the impact of mutual recognition agreements and associated modes of supply of services as well as those factors influencing clinical nurse migration was also considered. RESULTS Studies on clinical nurse migration and general academic faculty provided some insights, but nursing faculty differ in a number of key ways and this needs to be considered when interpreting the results. Based on this systematic review, the paper concludes that nurse faculty migration is a neglected topic and one that warrants urgent investigation if health systems redesign and the associated scale-up of nurses are to be achieved. Particular gaps in knowledge relate to nurse faculty workforce planning, and understanding the dynamics and flows of faculty both across and within countries. It is unclear as to the extent to which our knowledge of push and pull factors relating to clinical nurse migration can be used in understanding nurse faculty migration. CONCLUSION The current policy position of organizations such as the World Health Organization and individual governments to increase nursing numbers is incomplete without due consideration of faculty migration.

Use of Open Systems Theory to Describe Regulatory Trends

This study explores whether the seven component concepts of the open systems framework can be used to analyze and document existing literature on regulatory trends via an integrative analytical review. The study identifies a wide range of issues, trends, and factors impacting regulation and demonstrates a wide range of diverse solutions.