Joan De Pedro-Gómez

Perception of evidence-based practice and the professional environment of Primary Health Care nurses in the Spanish context: a cross-sectional study

BackgroundThe study of the factors that encourage evidence-based clinical practice, such as structure, environment and professional skills, has contributed to an improvement in quality of care. Nevertheless, most of this research has been carried out in a hospital context, neglecting the area of primary health care. The main aim of this work was to assess the factors that influence an evidence-based clinical practice among nursing professionals in Primary Health Care.MethodsA multicentre cross-sectional study was designed, taking the 619 Primary Care staff nurses at the Balearic Islands’ Primary Health Care Service, as the study population. The methodology applied consisted on a self-administered survey using the instruments Evidence-Based Practice Questionnaire (EBPQ) and Nursing Work Index (NWI).ResultsThree hundred and seventy seven surveys were received (60.9% response rate). Self-assessment of skills and knowledge, obtained 66.6% of the maximum score. The Knowledge/Skills factor obtained the best scores among the staff with shorter professional experience. There was a significant difference in the Attitude factor (p = 0.008) in favour of nurses with management functions, as opposed to clinical nurses.Multivariate analysis showed a significant positive relationship between NWI and level of evidence-based practice (p < 0,0001).ConclusionsInstitutions ought to undertake serious reflection on the lack of skills of senior nurses about Evidence-Based Clinical Practice, even when they have more professional experience. Leadership emerge as a key role in the transferral of knowledge into clinical practice.

Effectiveness of the Heart Age tool for improving modifiable cardiovascular risk factors in a Southern European population: a randomized trial

Aims To test whether communicating cardiovascular diseases (CVD) risk using a novel risk assessment tool (Heart Age) will be able to motivate a population to adopt healthier lifestyles and improve CVD risk profile over the use of a traditional percentage-based tool. Methods A single-blind randomized intervention study was carried out in a Caucasian population. A total of 3153 subjects were randomly allocated to one of three study groups: control (conventional medical advice was given to the subjects), Framingham REGICOR (10-year percentage risk score, calibrated to Spanish population was given to the subjects), or Heart Age group (Heart Age tool was administered to the subjects). Anthropometrical and metabolic parameters were measured and lifestyle habits were recorded at recruitment and 12-months post intervention. Results Both the Framingham REGICOR and the Heart Age intervention groups demonstrated significant decreases in their risk scores at post intervention compared to the control group, with the improvement being of a greater magnitude in the Heart Age group. No differences per gender were observed in the Heart Age group. Conclusions Informing patients about their CVD risk expressed as the new Heart Age tool results in a reduction in their CVD risk higher than the one observed when the Framingham REGICOR risk score was used.

Psychometric testing of the Spanish version of the practice environment scale of the nursing work index in a primary healthcare context.

AIM This paper is a report of psychometric testing of the Spanish version of the Practice Environment Scale of the Nursing Work Index for use in a primary health care. BACKGROUND The Practice Environment Scale of the Nursing Work Index has been widely used in different studies and contexts. However, there is no validated version for primary care nursing staff in Spain. METHODS A descriptive, multicentre, cross-sectional study for transcultural adaptation and psychometric validation purposes. Data were collected from October 2009 to January 2010. To test the reliability of the factors in the measurement model, Cronbachs alpha was used. To study the measurement model, different structural models were tested, using exploratory and confirmatory factor analyses. 377 completed questionnaires were obtained from a total of 553 nurses working for the Public Health Service in the Balearic Islands (Spain). This represents a response rate of 68·2%. RESULTS For overall reliability, a Cronbach alpha of 0·91 was obtained. The confirmatory analysis upholds the original five-factor structure. CONCLUSION The excellent goodness of fit of the confirmatory analysis corroborates the validity of this adapted version in primary healthcare contexts.

Consenso sobre competencias para la enfermería de práctica avanzada en España

INTRODUCTION There is a lack of international consensus on the exact definition and core competencies of advanced practice nursing (APN) roles, a problem particularly acute in our national context due to the lack of APN role development, which has a significantly short history in our country. The main objective of this paper was the delineation of the competence framework for Advanced Practice Nurses in our national context based on expert consensus through the Delphi method METHOD Based on a preliminary literature review process, a conglomerate of 17 domains of competence (clusters of related competencies) were identified. This initial set was revised, refined and validated by a group of expert panellists on the subject (clinicians, researchers, managers, and teachers) through successive rounds in search of a suitable consensus on each of the various proposed items RESULTS The results helped to establish a solid foundation in the form of a skills map that could identify those sets of more specific competencies for advanced practice roles, regardless of regulatory and professional practice context, identifying domains such as Research and Evidence Based Practice, Clinical and Professional Leadership, or Care Management DISCUSSION This set of skills related to advanced practice roles in our environment can delineate competency standards common to this level of nursing practice, and serve as a reference for policy development, a review of roles, or the establishment of academic profiles.

Prevalence of premorbid metabolic syndrome in Spanish adult workers using IDF and ATPIII diagnostic criteria: relationship with cardiovascular risk factors.

Background Metabolic Syndrome (MetS) is a complex disorder defined as a cluster of interconnected risk factors such as hypertension, dyslipidemia, obesity and high blood glucose levels. Premorbid metabolic syndrome (PMetS) is defined by excluding patients with previously diagnosed cardiovascular disease or diabetes mellitus from those suffering MetS. We aimed to determine the prevalence of PMetS in a working population, and to analyse the relationship between the diagnostic criteria of the International Diabetes Federation (IDF) and of the National Cholesterol Education Program Adult Treatment Panel III (ATPIII). The relationship between the presence of PMetS and cardiovascular risk factors was also analysed. Research Methodology/Findings A cross-sectional study was conducted in 24,529 male and 18,736 female Spanish (white western European) adult workers (20–65 years) randomly selected during their work health periodic examinations. Anthropometrics, blood pressure and serum parameters were measured. The presence of MetS and PMetS was ascertained using ATPIII and IDF criteria. Cardiovascular risk was determined using the Framingham-REGICOR equation. The results showed MetS had an adjusted global prevalence of 12.39% using ATPIII criteria and 16.46% using IDF criteria. The prevalence of PMetS was slightly lower (11.21% using ATPIII criteria and 14.72% using IDF criteria). Prevalence in males was always higher than in females. Participants with PMetS displayed higher values of BMI, waist circumference, blood pressure, glucose and triglycerides, and lower HDL-cholesterol levels. Logistic regression models reported lower PMetS risk for females, non-obese subjects, non-smokers and younger participants. Cardiovascular risk determined with Framingham-REGICOR was higher in participants with PMetS. Conclusions PMetS could be a reliable tool for the early identification of apparently healthy individuals who have a significant risk for developing cardiovascular events and type 2 diabetes.

Determining factors in evidence-based clinical practice among hospital and primary care nursing staff.

AIM The general aim of this study is to identify key factors perceived by nurses to influence evidence-based clinical practice at different centres. BACKGROUND During the last decade, there has been an increased interest in the identification of factors that facilitate the transfer of knowledge into clinical practice, among health care professionals. Previous research states that a suitable organisational framework and practice environment seems to have influence on a greater use of scientific evidence by nurses, which can be directly observed in patient outcomes. In consequence, several authors suggest that strategies should be encouraged from managers and nurse executives to guarantee the existence of environments that avoid emotional exhaustion and improve satisfaction of nurses with their work, and at the same time, ensure the use of research-guided nursing decisions. METHODS Following the Spanish validation of the Practice Environment Scale-Nursing Work Index and Evidence Based Practice Questionnaire, a descriptive observational cross-sectional study has been conceived, from 2010 to 2011, in order to identify determining factors in evidence-based clinical practice at different centres. In a second phase, a qualitative study has been designed, using focus groups, to identify practice factors that can lead to a successful implementation of evidence-based clinical practice. DISCUSSION Organisational and attitudinal interventions are needed in order to implement evidence-based clinical practice that improves the quality of patient care.

1977-2017: La investigación enfermera en España tras 40 años en la Universidad

Nursing research in Spain cannot be understood without analyzing the development of this profession over the last 40 years. The social, political and economic context has determined the evolution of nursing research, and an analysis of the current situation is necessary to confront the immediate challenges the nursing profession has to handle. To offer a global perspective of care research in Spain as a framework for reflection and discussion on possible short and medium-term strategies that guide the planning and decision making of the different stakeholders involved in nursing research in Spain. A multi-method study combining documentary analysis with bibliometric methods was carried out. Some isolated policies to promote nursing research have been identified, a significant increase in doctoral training (49 doctoral programs) and 89 nurse research groups (1.92 groups per million inhabitants) responsible for a scientific production that puts Spain in seventh place in the world ranking of scientific production in the area of nursing. The increase in public expenditure on R & D &I and the growth in bibliometric impact are associated with a higher density of nursing research groups. Nursing research in Spain is sensitive to research promotion policies and resources, although there is no consolidated and uniform strategy that overcomes current barriers. The impact of the academic development of Spanish nNursing in scientific production is still unknown.

A Multisample Model Validation of the Evidence-Based Practice Questionnaire

Evidence-based practice may be implemented more successfully if the barriers to its implementation have been previously identified. Many of the available instruments to measure these barriers have been validated in single samples or without confirmatory analyses. The objective of the study was to contrast the goodness of fit of two measurement models (24 items and 19 items) for the Spanish version of the Evidence-Based Practice Questionnaire (EBPQ) in a sample of 1,673 full-time registered nurses in 10 hospitals and 57 primary health care centers in the Spanish Public Health Service. The 19-item model performed better in all four subsamples. A hypothesis of strict invariance, with equal factor loadings, intercepts, and error variance in all contexts in which it was evaluated, was supported. Goodness-of-fit indices provided strong evidence of good fit according to standard cut-off criteria in a multisample confirmatory factor analysis.

Hábito tabáquico entre los estudiantes de enfermería y fisioterapia de la Universitat de les Illes Balears: opinión ante la regulación del consumo en lugares públicos

Resumen Objetivo Evaluar la prevalencia, opiniones y actitudes de los alumnos de enfermeria y fisioterapia de la Universitat de les Illes Balears (UIB) ante el consumo de tabaco en lugares publicos y la influencia de las politicas reguladoras. Metodo Estudio observacional, descriptivo, trasversal, mediante cuestionario autocumplimentado. Se diseno un cuestionario para evaluar la opinion y el grado de acuerdo respecto a cuestiones actitudinales y conductuales acerca del habito tabaquico, asi como las medidas reguladoras de este. Para su valoracion se utilizaron escalas tipo Likert. El cuestionario se propuso a todos los asistentes a clase en un dia lectivo habitual, en la asignatura troncal del curso que tenia mas alumnos matriculados entre el 15 de febrero y el 15 de marzo de 2006. Se calcularon los intervalos de confianza del 95% para las proporciones. En la comparacion de variables cualitativas se ha usado el estadistico χ 2 y para las cuantitativas la t de Student. Resultados Se obtuvo una muestra de 345 sujetos, con una media de edad de 21,9 anos, el 82,2% eran mujeres. La prevalencia de fumadores habituales fue del 26,1%; el 26,9% entre las mujeres y el 22,6% entre los varones. El 93,8% estaba de acuerdo en que se prohibiera fumar en los espacios cerrados de los centros docentes y el 70,9% en que se cumpliera la ley en la UIB, habiendo diferencias entre 2003 y 2006. Conclusiones La poblacion estudiada tiene una prevalencia tabaquica menor que la poblacion general nacional y autonomica, asi como la de otros estudiantes de enfermeria espanoles, para su misma edad y sexo. La prevalencia de fumadores ocasionales ha descendido desde 2003. Los alumnos se muestran mayoritariamente favorables a la nueva Ley de Prevencion del Tabaquismo.

Content validity of a health science evidence-based practice questionnaire (HS-EBP) with a web-based modified Delphi approach

Objective To develop a tool for measuring evidence-based practice (EBP) and to evaluate its content validity by Delphi technique. A five-factor/dimensions latent structure for the EBP construct was defined a priori and operationalized. Design Online Delphi technique. Setting and Participants A group of 32 national EBP experts from different health professions. Intervention The experts rated the initial questionnaire items according to adequacy and relevance criteria using four-point Likert scales and including open fields for suggestions, with basic and supplementary criteria consensus established a priori. Main Outcome Measure Level of consensus in the Content Validity Index Item. Results An EBP construct solution was designed with the elements that constitute the operationalization proposal of the EBP. This initial version consisted of 76 items, whereas the version arising from the Delphi study was made up of 73 items. In the first round, 13 items did not reach the minimum level of consensus, and 12 of these were reformulated. Three additional items were removed in the second round. Conclusions A new psychometric tool forms measuring EBP with a five-factor structure, and 73 items obtained adequate content validity evidence based on expert opinion.