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Gutiérrez-Rodríguez L, García-Mayor S, León-Campos Á, Gómez-González AJ, Pérez-Ardanaz B, Rodríguez-Gómez S, Fajardo-Samper M, Morilla-Herrera JC, Morales-Asencio JM. Competency Gradients in Advanced Practice Nurses, Specialist Nurses, and Registered Nurses: A Multicentre Cross-Sectional Study. Int J Environ Res Public Health 2022; 19:ijerph19148415. [PMID: 35886267 PMCID: PMC9323129 DOI: 10.3390/ijerph19148415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 02/04/2023]
Abstract
(1) Background: Identifying differences in the competencies of different areas of nursing is a crucial aspect for determining the scope of practice. This would facilitate the creation of a formal structure for clinical practice in advanced and specialised services. The aims of this study are to analyse the distribution of advanced competencies in registered, specialist and advanced practice nurses in Spain, and to determine the level of complexity of the patients attended by these nurses. (2) Methods: A cross-sectional study was developed on registered, specialist and advanced practice nurses, all of whom completed an online survey on their perceived level of advanced competencies and their professional characteristics. (3) Results: In total, 1270 nurses completed the survey. Advanced practice nurses recorded the highest self-perceived level of competency, especially for the dimensions of evidence-based practice, autonomy, leadership and care management. (4) Conclusions: Among registered, specialist and advanced practice nurses, there are significant differences in the level of self-perceived competencies. Patients attended by advanced practice nurses presented the highest levels of complexity. Understanding these differences could facilitate the creation of a regulatory framework for clinical practice in advanced and specialized services.
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Affiliation(s)
- Laura Gutiérrez-Rodríguez
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Silvia García-Mayor
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Álvaro León-Campos
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
- Correspondence: ; Tel.: +34-951-952-879
| | - Alberto José Gómez-González
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Bibiana Pérez-Ardanaz
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | | | | | - Juan Carlos Morilla-Herrera
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - José Miguel Morales-Asencio
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
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Ayuso-Fernandez MA, Gomez-Rosado JC, Barrientos-Trigo S, Rodríguez-Gómez S, Porcel-Gálvez AM. Impact of the patient-nurse ratio on health outcomes in public hospitals of the Andalusian Health Service. Ecological study. Enferm Clin (Engl Ed) 2021; 31:344-354. [PMID: 34756238 DOI: 10.1016/j.enfcle.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/17/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To analyse the patient-nurse ratio and its association with health outcomes in public hospitals of the Andalusian Health Service (SAS). METHOD Cross-sectional ecological study carried out in adult units of 26 Andalusian public hospitals. Data on structure (beds, type of unit, nursing control), management (average stay, index of use of stays, complexity index) and nursing staff were collected. They were extracted from official sources: CMBDA, SAS/Health Council (CS) publications and specific respondents to Nursing Directorates. The patient-nurse ratio was calculated and related to 19 indicators of hospital quality, safety, and mortality. Measures of central tendency and Spearman's correlation coefficient were used for statistical analysis. RESULTS A response was obtained from 100% of the Andalusian hospitals. The average patient-nurse ratio in the three shifts was lower in hospitals with a broader portfolio of services-regional scope (11.6), followed by those with a medium portfolio-specialties (12.7) and hospitals with a basic portfolio-county (13.5). By type of unit, the medical units were 11.8 (SD = 1.8) lower than the surgical ones 13.5 (SD = 2.7). Significant differences were only found in medical units of regional hospitals 10.5 (SD = 1.4) and district hospitals 13.03 (SD = 1.46) (p = .001). In critical care, the ratio was greater than 2 patients per nurse in the three groups. When relating the ratio to health outcomes, 5 significant associations were found: pressure ulcers (p = .005), prevalence of nosocomial infections (p = .036), postoperative sepsis (p = .022), zero bacteraemia verification (p = .045) and mortality from heart failure (p = .004). CONCLUSIONS The results indicate a high patient-nurse ratio in adult hospitalization units and that there is a positive association between the patient-nurse ratio and worse results related to nursing care.
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Affiliation(s)
| | - Juan Carlos Gomez-Rosado
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen Macarena, Sevilla, Spain.
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Ayuso-Fernandez MA, Gomez-Rosado JC, Barrientos-Trigo S, Rodríguez-Gómez S, Porcel-Gálvez AM. Impact of the patient-nurse ratio on health outcomes in public hospitals of the Andalusian Health Service. Ecological Study. Enferm Clin (Engl Ed) 2021; 31:S1130-8621(20)30554-4. [PMID: 33446438 DOI: 10.1016/j.enfcli.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 10/29/2020] [Accepted: 11/17/2020] [Indexed: 11/21/2022]
Abstract
AIM To analyse the patient-nurse ratio and its association with health outcomes in public hospitals of the Andalusian Health Service (SAS). METHOD Cross-sectional ecological study carried out in adult units of 26 Andalusian public hospitals. Data on structure (beds, type of unit, nursing control), management (average stay, index of use of stays, complexity index) and nursing staff were collected. They were extracted from official sources: CMBDA, SAS/Health Council (CS) publications and specific respondents to Nursing Directorates. The patient-nurse ratio was calculated and related to 19 indicators of hospital quality, safety, and mortality. Measures of central tendency and Spearman's correlation coefficient were used for statistical analysis. RESULTS A response was obtained from 100% of the Andalusian hospitals. The average patient-nurse ratio in the three shifts was lower in hospitals with a broader portfolio of services-regional scope (11.6), followed by those with a medium portfolio-specialties (12.7) and hospitals with a basic portfolio- county (13.5). By type of unit, the medical units were 11.8 (SD=1.8) lower than the surgical ones 13.5 (SD=2.7). Significant differences were only found in medical units of regional hospitals 10.5 (SD=1.4) and district hospitals 13.03 (SD=1.46) (p=.001). In critical care, the ratio was greater than 2 patients per nurse in the three groups. When relating the ratio to health outcomes, 5 significant associations were found: pressure ulcers (p=.005), prevalence of nosocomial infections (p=.036), postoperative sepsis (p=.022), zero bacteraemia verification (p=.045) and mortality from heart failure (p=.004). CONCLUSIONS The results indicate a high patient-nurse ratio in adult hospitalization units and that there is a positive association between the patient-nurse ratio and worse results related to nursing care.
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Affiliation(s)
| | - Juan Carlos Gomez-Rosado
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen Macarena, Sevilla, España.
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Ayuso JR, Pérez-Serrano C, Pagés M, Rodríguez-Gómez S, Zambrano TB, Conill C, Maurel J. 427P Value of magnetic resonance diffusion weighted imaging in the identification of complete responder patients with rectal cancer treated with neoadjuvant therapy. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gutiérrez-Rodríguez L, García Mayor S, Cuesta Lozano D, Burgos-Fuentes E, Rodríguez-Gómez S, Sastre-Fullana P, de Pedro-Gómez JE, Higuero-Macías JC, Pérez-Ardanaz B, Morales-Asencio JM. Competencias en enfermeras Especialistas y en Enfermeras de Práctica Avanzada. Enfermería Clínica 2019; 29:328-335. [DOI: 10.1016/j.enfcli.2019.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 10/01/2019] [Indexed: 11/15/2022]
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Huizing E, Rodríguez-Gómez S, Lafuente Robles N. La implantación de la especialidad de Enfermería de Salud Mental en Andalucía desde un enfoque comunitario. Enfermería Clínica 2019; 29:370-375. [DOI: 10.1016/j.enfcli.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022]
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Camacho-Bejarano R, Rodríguez-Gómez S, Padín-López S, Lima-Serrano M, Gómez-Salgado J. [Presentation of the special issue on Social and health coordination]. Enferm Clin 2017; 26:1-2. [PMID: 26786398 DOI: 10.1016/j.enfcli.2015.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 12/18/2015] [Indexed: 11/29/2022]
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Lima-Serrano M, Gómez-Salgado J, Camacho-Bejarano R, Rodríguez-Gómez S, Padín-López S. [Nursing that grows: Let us continue to build the way]. Enferm Clin 2017; 27:1-2. [PMID: 28104045 DOI: 10.1016/j.enfcli.2016.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 12/20/2016] [Indexed: 10/20/2022]
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Muriel-Fernández R, García-Domínguez JM, Rodríguez-Gómez S, Sagués-Amadó A. [Health care based on cooperation between professionals and affected people]. Enferm Clin 2015; 26:85-90. [PMID: 26553866 DOI: 10.1016/j.enfcli.2015.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 08/31/2015] [Indexed: 11/28/2022]
Abstract
The purpose of this article is to support the need for a change of care, based on cooperation between those who provide care and those who receive it. This article develops the decisive factors for change: the investee cooperation, the reference in case management, the concept of recovery and terminal care, the reduction of suffering and the value of change reflected in the 'win-win'. In each of them a questioning of the current situation, a methodological analysis and an input of tools and consequences of the change is made. To conclude, the article incorporates the 'itinerary of shared care' as a resource and one of the ways to bring these changes to the reality of day-to-day care.
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Affiliation(s)
- Rafael Muriel-Fernández
- Servicio de Atención Sociosanitaria, Consejería de Salud, Junta de Andalucía, Sevilla, España
| | | | - Susana Rodríguez-Gómez
- Departamento de Cuidados Transversales, Servicio Andaluz de Salud, Junta de Andalucía, Sevilla, España
| | - Antonio Sagués-Amadó
- Servicio de Atención Sociosanitaria, Consejería de Salud, Junta de Andalucía, Sevilla, España
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Camacho-Bejarano R, Rodríguez-Gómez S, Padín-López S, Lima-Serrano M. Enfermería Clínica, pisando fuerte. Enfermería Clínica 2015; 25:1-2. [DOI: 10.1016/j.enfcli.2014.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 12/23/2014] [Indexed: 11/26/2022]
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Morales-Asencio JM, Porcel-Gálvez AM, Oliveros-Valenzuela R, Rodríguez-Gómez S, Sánchez-Extremera L, Serrano-López FA, Aranda-Gallardo M, Canca-Sánchez JC, Barrientos-Trigo S. Design and validation of the INICIARE instrument, for the assessment of dependency level in acutely ill hospitalised patients. J Clin Nurs 2014; 24:761-77. [PMID: 25257917 DOI: 10.1111/jocn.12690] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2014] [Indexed: 01/10/2023]
Abstract
AIMS AND OBJECTIVES The aim of this study was to establish the validity and reliability of an instrument (Inventario del NIvel de Cuidados mediante IndicAdores de clasificación de Resultados de Enfermería) used to assess the dependency level in acutely hospitalised patients. This instrument is novel, and it is based on the Nursing Outcomes Classification. BACKGROUND Multiple existing instruments for needs assessment have been poorly validated and based predominately on interventions. Standardised Nursing Languages offer an ideal framework to develop nursing sensitive instruments. DESIGN A cross-sectional validation study in two acute care hospitals in Spain. METHODS This study was implemented in two phases. First, the research team developed the instrument to be validated. In the second phase, the validation process was performed by experts, and the data analysis was conducted to establish the psychometric properties of the instrument. RESULTS Seven hundred and sixty-one patient ratings performed by nurses were collected during the course of the research study. Data analysis yielded a Cronbach's alpha of 0·91. An exploratory factorial analysis identified three factors (Physiological, Instrumental and Cognitive-behavioural), which explained 74% of the variance. CONCLUSIONS Inventario del NIvel de Cuidados mediante IndicAdores de clasificación de Resultados de Enfermería was demonstrated to be a valid and reliable instrument based on its use in acutely hospitalised patients to assess the level of dependency. RELEVANCE TO CLINICAL PRACTICE Inventario del NIvel de Cuidados mediante IndicAdores de clasificación de Resultados de Enfermería can be used as an assessment tool in hospitalised patients during the nursing process throughout the entire hospitalisation period. It contributes information to support decisions on nursing diagnoses, interventions and outcomes. It also enables data codification in large databases.
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