La pratique basée sur les résultats probants. Partie 1: Origine, définitions, critiques, obstacles, avantages et impact [Evidence-based practice. Part 1: Origins, definitions, critiques, obstacles, advantages and impact].

The increasing popularity of evidence-based practice (EBP) requires that nurses take a stand regarding this type of practice. This positioning rests on knowledge of EBP, however this notion varies by discipline and many definitions exist even within the nursing discipline. An improved understanding of the basic tenets of this type of practice is thus essential. This first, of a series of two articles describes the origin of EBP as well as various definitions, it also presents the major criticisms raised and takes a look at the impact of the increased tendency towards EBP on professional practice.

La pratique basée sur les résultats probants. Partie 2: Les étapes du processus [Evidence-based practice: Part 2: Steps in the process].

Evidence-based (EBP) aims for a new distribution of power centered on scientific evidence rather than clinical expertise. The present article describes the operational process of EBP by describing the implementation stages of this type of practise. This stage presentation is essential given that there are many conceptions end models of EBP and that some nurses have a limited knowledge of its rules ans implications. Given that number and formulation of the stages varies by author, the process presented here attempts to integrate the different stages reviewed.

Cost-effectiveness analysis of a European primary-care physician training in smoking cessation counseling.

BACKGROUND: Physician training in smoking cessation counseling has been shown to be effective as a means to increase quit success. We assessed the cost-effectiveness ratio of a smoking cessation counseling training programme. Its effectiveness was previously demonstrated in a cluster randomized, control trial performed in two Swiss university outpatients clinics, in which residents were randomized to receive training in smoking interventions or a control educational intervention. DESIGN AND METHODS: We used a Markov simulation model for effectiveness analysis. This model incorporates the intervention efficacy, the natural quit rate, and the lifetime probability of relapse after 1-year abstinence. We used previously published results in addition to hospital service and outpatient clinic cost data. The time horizon was 1 year, and we opted for a third-party payer perspective. RESULTS: The incremental cost of the intervention amounted to US$2.58 per consultation by a smoker, translating into a cost per life-year saved of US$25.4 for men and 35.2 for women. One-way sensitivity analyses yielded a range of US$4.0-107.1 in men and US$9.7-148.6 in women. Variations in the quit rate of the control intervention, the length of training effectiveness, and the discount rate yielded moderately large effects on the outcome. Variations in the natural cessation rate, the lifetime probability of relapse, the cost of physician training, the counseling time, the cost per hour of physician time, and the cost of the booklets had little effect on the cost-effectiveness ratio. CONCLUSIONS: Training residents in smoking cessation counseling is a very cost-effective intervention and may be more efficient than currently accepted tobacco control interventions.

Europa, la reforma de los planes de estudio para la adaptación a los créditos Europeos, o la reforma global de calidad ecucativa. Un análisis bibliográfico

Idealmente, la educación debería proveer al estudiante de la habilidades necesarias, lasactitudes y los valores que son imprescindibles para el mundo laboral. Los cambios que deben producirse en los planes de estudio del País para incorporarnos a la Comunidad Europea, presentan serias inquietudes frente a situaciones que ya actualmente no controlamos demasiado y podrían modificarse. Para buscar soluciones previas, hemos realizado un análisis bibliográfico exhaustivo para identificar qué problemas son comunes con el resto de escuelas, específicos nuestros y si sehan encontrado soluciones, intentar aplicarlas en nuestro medio ante el cambio que se nosavecina

El portafolio o la carpeta de aprendizaje en enfermería como instrumento para un aprendizaje reflexivo y crítico: Una experiencia exportable a otras disciplinas

La experiencia que se presenta se desarrolla en la Escuela de Enfermería y Podología de la Universidad de Barcelona. Desde el 2003 y hasta la actualidad, organizo la asignatura de fundamentos de enfermería con portafolio o carpeta de aprendizaje (CA) en un grupo de docencia de enfermería, la asignatura es troncal, de primer semestre y se le asignan 13,5 créditos. La mejora docente viene dada por la creencia que el cambio en la evaluación, entendida como esencial en el modelo de enseñanza, comporta un cambio en el aprendizaje así como en su percepción y en las relaciones que se establecen en el aula. Es así como se pretende pasar de un paradigma docente estándar a uno de reflexivo y crítico. En el artículo se sitúa la asignatura en la enseñanza, se hace una argumentación teórica del por qué del cambio para la mejora docente y la elección de la CA, se describe la organización de la asignatura con CA y las características, para terminar se lleva a cabo un análisis reflexivo de las ventajas y las dificultades que comporta un cambio aislado en una institución tradicional.

Rate of undesirable events at beginning of academic year: retrospective cohort study.

OBJECTIVE: To determine whether an increase in the rate of undesirable events occurs after care provided by trainees at the beginning of the academic year. DESIGN: Retrospective cohort study using administrative and patient record data. SETTING: University affiliated hospital in Melbourne, Australia. PARTICIPANTS: 19,560 patients having an anaesthetic procedure carried out by first to fifth year trainees starting work for the first time at the hospital over a period of five years (1995-2000). MAIN OUTCOME MEASURES: Absolute event rates, absolute rate reduction, and rate ratios of undesirable events. RESULTS: The rate of undesirable events was higher at the beginning of the academic year compared with the rest of the year (absolute event rate 137 v 107 per 1000 patient hours, relative rate reduction 28%, P<0.001). The overall adjusted rate ratio for undesirable events was 1.40, 95% confidence interval 1.24 to 1.58. This excess risk was seen for all residents, regardless of their level of seniority. The excess risk decreased progressively after the first month, and the trend disappeared fully after the fourth month of the year (rate ratio for fourth month 1.21, 0.93 to 1.57). The most important decreases were for central and peripheral nerve injuries (relative difference 82%), inadequate oxygenation of the patient (66%), vomiting/aspiration in theatre (53%), and technical failures of tracheal tube placement (49%). CONCLUSIONS: The rate of undesirable events was greater among trainees at the beginning of the academic year regardless of their level of clinical experience. This suggests that several additional factors, such as knowledge of the working environment, teamwork, and communication, may contribute to the increase.

Residents' Rights

Resident rights are guaranteed by the federal Nursing Home Reform Law of 1987, which requires nursing facilities to promote and protect the rights of each resident and places a strong emphasis on individual dignity and self-determination. Residents’ rights include, but are not limited to: • Being treated with respect and dignity • Being free from abuse and chemical and physical restraints • Participating in one’s own care and treatment • Being ensured information is being kept confidential • Managing one’s own finances • Being free to voice grievances, without fear of retaliation • Being able to associate and communicate privately with any person • Being able to send and receive personal mail • Making independent choices • Being able to apply for state and federal assistance without discrimination • Being informed of rights, services available and all charges prior to admission • Being given advance notice of a transfer or discharge

Maltraitance: une formation évaluée à dix ans: Une démarche originale [Abuse: training evaluated at 10 years: an original approach]

[Introduction (extrait)] Il existe de nombreuses formations destinées à prévenir la maltraitance envers les personnes âgées. A ce jour, leur efficacité n'est cependant pas prouvée, faute d'évaluation de leur impact sur les pratiques professionnelles. La formation PREMALPA, qui existe depuis 2003, a fait l'objet d'une évaluation en 2013.

Diversity of the Quality Criteria in Qualitative Research in the Health Sciences: Lessons from a Lexicometric Analysis Composed of 133 Guidelines

A review of health sciences literature shows a substantial increase in qualitative publications. This work incorporates a certain number of research quality guidelines. We present the results of the Alceste® lexicometric analysis, which includes 133 quality grids for qualitative research covering five disciplinary fields of the health sciences: medicine and epidemiology, public health and health education, nursing, health sociology and anthropology, psychiatry and psychology. This analysis helped to cross-check the disciplinary fields with the various objectives assigned to the different criteria in the grids examined. The results obtained with Alceste® show the variability of the objectives sought by the authors of the guidelines. These discrepancies are not directly associated to disciplinary fields, and appear to be more closely linked to different qualitative research conceptualizations within the disciplines, and with essential qualitative research validation criteria. These conceptualizations must be clarified to help users better understand the objectives targeted by the grids, and promote more appreciation for qualitative research in the health sciences.

Educación para la salud

Decir que el mundo de los cuidados de la salud ha sufrido cambios importantes en un corto espacio de tiempo no es nada nuevo, como tampoco lo es el afirmar que, al igual que todos los profesionales que trabajan en este campo, los enfermeros nos hemos visto obligados a adaptarnos a esos cambios, a veces, con demasiada rapidez. No obstante, también es cierto que para nosotros ha supuesto un esfuerzo mayor que para otros colectivos, dado que han significado pasar de los cuidados intuitivos, brindados hasta hace relativamente poco tiempo, a la rigurosidad científica que necesita cualquier profesión que pretenda sobrevivir en un mundo, el de la salud, que cada vez es más complejo y competitivo. Uno de los cambios que hemos tenido que afrontar, y no precisamente el menor de ellos, es la necesidad de educar a los usuarios en el manejo, de la mejor manera posible, de su propia situación de salud y, aunque en este momento prácticamente nadie discute que ésa es una parte fundamental de la responsabilidad de todos los profesionales de los cuidados, y aunque los enfermeros hace tiempo que reconocimos ese deber y nos comprometimos a cumplirlo, no siempre se han logrado los mejores resultados en ese empeño.

La formación enfermera en el Espacio Europeo de Educación Superior

A lo largo del tiempo, la formación de enfermería ha pasado por diferentes etapas. Una de las más importantes se produjo en 1977, cuando los estudios de enfermería se integraron en la universidad. Esto supuso un hito importante, ya que al tratarse de estudios de diplomatura enmarcados en el primer ciclo universitario, se esperaba que en poco tiempo se pudiera acceder a cursar la licenciatura y al doctorado en la propia disciplina. Pero no fue así, y hasta hace poco los enfermeros que han querido obtener la licenciatura y el grado de doctorado se han visto abocados a hacerlo en otras disciplinas.

Seguimiento telefónico enfermero a pacientes con insuficiencia cardiaca

El crecimiento de la población con enfermedad crónica supone un aumento de la demanda asistencial. Para dar respuesta a esta situación el Instituto Catalán de la Salud puso en marcha en el área de la ciudad de Barcelona el 'Centre de Seguiment de Malalties Croniques' (Centro de Seguimiento de Enfermedades Crónicas -CSMC-). La finalidad del centro es promover el autocuidado, empoderar al paciente y dar soporte asistencial a distancia. El CSMC es un dispositivo de seguimiento telefónico proactivo enfermero que atiende a pacientes con Insuficiencia Cardiaca (IC) de forma transversal entre Atención Primaria (AP) y Atención Hospitalaria (AH), compartiendo la historia clínica informatizada, que incluye el proceso y lenguaje enfermero. Desde el centro se trabajan los conocimientos, las habilidades y la motivación de los pacientes. Desde su inicio se ha dado cobertura a 1.400 pacientes, cuya edad media es de 78 años y la mayor parte se encuentran en clase funcional 2-3, según la New York Heart Association (NYHA). Se han observado tendencia positivas en el autocuidado, cumplimiento farmacológico, adherencia al autocontrol del peso y el aumento de la cobertura vacunal antineumocócica. La atención telefónica está siendo una estrategia útil para la gestión compartida en el seguimiento ambulatorio del paciente crónico, pudiéndose extrapolar a usuarios con otras enfermedades crónicas.

Harmonization of training and assessment of medical specialists in physical and rehabilitation medicine across Europe - The contribution of the UEMS Board of Physical and Rehabilitation Medicine

Background.- The main goals of the European Board of Physical and Rehabili-tation Medicine (EBPRM), founded in 1991 as the third speciality board of theUnion of European Medical Specialists (UEMS), are to harmonize pre-graduate,post-graduate and continuous medical education in physical and rehabilitationmedicine (PRM) all over Europe. The harmonization of curricula of the medi-cal specialities and the assessment of medical specialists has become one of thepriorities of the UEMS and its working groups to which the EBPRM contributes.Action.- The EBPRM will continue to promote a specific minimal undergraduatecurriculum on PRM including issues like disability, participation and handicapto be taught all over Europe as a basis for general medical practice. The EBPRMwill also expand the existing EBPRM postgraduate curriculum into a detailedcatalogue of learning objectives. This catalogue will serve as a tool to boostharmonization of the national curricula across Europe as well as to structurethe content of the MCQ examination. It would be a big step forward towardsharmonization of European PRM specialist training if an important number ofcountries would use the certifying MCQ examination of the Board as a part ofthe national assessments for PRM specialists.