Results sensitive to nursing practice: clinical research and evidence

The discipline of nursing, conceived today as a health science and behavior from the point of view of caregiving, contributes to the definition of expected results and health indicators, backed by scientific evidence. ⁽¹⁾

Scientific evidence is a test, demonstrated or confirmed through research. Thus, clinical research would consist of answering questions, to generate “useful evidence or knowledge” about interventions in health or predictions, through strict methodological criteria contributing to improve results in the population's health. ^(2-3)

Health results are the coordinates to attain quality and therefore clinical safety, as they indicate effects that can be attributed to the presence or absence of intervention of a state of health, behavior or perception that are susceptible to this intervention. ⁽⁴⁾

There is worldwide consensus showing how scientific evidence increasingly backs the need to implement results that evaluate the contribution of caregiving to clinical quality and safety, demonstrating the existence of results sensitive to nursing practice (RSPE).^(5-6)

RSPEs may be defined as desired or unwanted changes in individuals’ state of health as a result of the practice of nursing interventions. Such results affect caregiving quality and clinical safety. ⁽⁷⁾

Nursing Outcomes Classification (NOC) has recently made use of a reference framework to develop research on health results, enabling evaluation of a person's variable state, as also behavior or perceptions sensitive to the nursing intervention. ⁽⁸⁾

In this sense, research with Nursing Outcome Indicators upon validating instruments, enables quantification of Results Sensitive to Nursing Practice. Together with conceptual models they enable integration of theory to caregiving practice, and act as a substrate for development of instruments to assess the need for caregiving and implementation of the nursing process. ⁽¹⁾

Our research group has been working on this subject, developing instruments to improve patient safety and the quality of sanitary attention, validated by a wide network of hospitals with different models of attention and levels of caregiving in the Public Health System. ⁽⁹⁾

Of these, INICIARE stands out, a star piece of research in this area that, after years of study, with excellent psychometric adjustments, determines the need for caregiving for hospitalized patients from a holistic point of view. Because this scale is sustained by a theoretical model and implemented by nursing taxonomy, it is a part of the experimental verification of a model with indirect methods, taking a meaningful step in the links between these and their empirical indicators. The INICIARE classification system, with its solid conceptual basis built in, allows us to widen the scientific evidence regarding the concept of complexity in the realm of caregiving. ^(10-11)

INTEGRARE is a part of this. With only 6 items, it determines the risk of ulcer due to pressure very reliably. Correlation with Braden is extremely positive and substantially improves its predictive value. ⁽¹²⁾

There are also numerous studies demonstrating the physical, mental and social repercussions of the effect of caregiving on the caregivers and thus on the receivers of caregiving. Therefore CUIDARE with its high degree of usability, because it shows a unidimensional structure, informs us about caregivers' adaptation to the caregiving process. ⁽¹³⁾

The objective of the latest CRITICAL CARE has been to adapt the INICIARE scale to critical patients for evaluation of the level of complexity and dependence on caregiving. ⁽¹⁴⁾

These instruments make available a codified structure that enable incorporation to the information systems of health services and generation of Minimum Data Sets for research in nursing. It is possible that at present, more than ever, it is necessary to consolidate theoretical focusing that provide common observation of the person, but adapted to the diversity and complexity confronting nurses in their current practice. ⁽¹⁵⁾

Evidence-Based Nursing (EBN) is a strategy for research to support practice. Thus, providing practice based on research and evidence enables professional advance at high rates of complexity, and fosters and responds to Organizations' needs for attention and challenges.

Referencias

• ¹
  Morales Asencio JM, Morilla Herrera JC, Torres Pérez LF, Porcel Gálvez AM, Canca Sánchez JC. Investigación en resultados y clasificación de resultados de Enfermería: claves para la investigación. Metas Enferm. 2012;15(¹⁰):20-4.
• ²
  Strauss SE, Glasziou P, Richardson WS, Haynes RB. Evidence-based medicine: how to practice and teach it. 4th ed. Edinburgh: Churchill Livingstone; 2011.
• ³
  Morales Asencio JM. ¿Qué aporta la evidencia científica a la práctica clínica de los cuidados? Index Enferm (Granada). 2003;XII^(40-41):35-40.
• ⁴
  Brazier J, Ara R, Azzabi I, Busschbach J, Chevrou-Séverac H, Crawford B, et al. Identification, review, and use of health state utilities in cost-effectiveness models: an ISPOR Good Practices for Outcomes Research Task Force Report. Value Health. 2019;22(³):267-75. doi: https://doi.org/10.1016/j.jval.2019.01.004
  » https://doi.org/10.1016/j.jval.2019.01.004
• ⁵
  Shekelle PG. Nurse-patient ratios as a patient safety strategy: a systematic review. Ann Intern Med. 2013;158(5 Pt 2):404-9. doi: https://doi.org/10.7326/0003-4819-158-5-201303051-00007
  » https://doi.org/10.7326/0003-4819-158-5-201303051-00007
• ⁶
  Bruyneel L, Li B, Ausserhofer D, Lesaffre E, Dumitrescu I, Smith, et al. Organization of hospital nursing, provision of nursing care, and patient experiences with care in Europe. Med Care Res Rev. 2015;72(⁶):643-64. doi: https://doi.org/10.1177/1077558715589188
  » https://doi.org/10.1177/1077558715589188
• ⁷
  Planas-Campmany C, Icart-Isern MT. ⁽²⁰¹⁴⁾ Indicadores sensibles a la práctica enfermera?: una oportunidad para medir la contribución de las enfermeras. Enferm Clínica. 2014;24(²):142-7. doi: https://doi.org/10.1016/j.enfcli.2013.07.003
  » https://doi.org/10.1016/j.enfcli.2013.07.003
• ⁸
  Moorhead S, Johnson M, Maas ML, Swanson E, editoras. Clasificación de Resultados de Enfermería (NOC). 4th edn. Madrid: Elsevier España; 2009.
• ⁹
  Porcel-Gálvez AM, Barroso Gutiérez C, Gorlat Sánchez B, Herrera Álvarez A, Martínez Lara C, Pérez Fernández AJ. Validación de un modelo de asignación de recursos enfermeros, ajustados por niveles de dependencia en cuidados de pacientes hospitalizados evaluados con INICIARE, para la mejora de los Staff Outcomes y la reducción de eventos adversos, en el Sistema Sanitario Público Andaluz: estudio multicéntrico Nursing_INICIARE_Patient (NIP 3.0). Sevilla: Universidad de Sevilla; 2016- . PI-0045-2016. Fundación Progreso y Salud.
• ¹⁰
  Morales-Asencio JM, Porcel-Gálvez AM, Oliveros-Valenzuela R, Rodríguez-Gómez S, Sánchez-Extremera L, Serrano-López FA, et al. Design and validation of the INICIARE instrument, for the assessment of dependency level in acutely ill hospitalised patients. J Clin Nurs. 2015;24(⁵-⁶):761-77. doi: https://doi.org/10.1111/jocn.12690
  » https://doi.org/10.1111/jocn.12690
• ¹¹
  Barrientos-Trigo S, Vega-Vázquez L, De Diego-Cordero R, Badanta-Romero B, Porcel-Gálvez AM. Interventions to improve working conditions of nursing staff in acute care hospitals: scoping review. J Nurs Manag. 2018;26(²):94-107. doi: https://doi.org/10.1111/jonm.12538
  » https://doi.org/10.1111/jonm.12538
• ¹²
  Porcel-Gálvez AM, Romero-Castillo R, Fernández-García E, Barrientos-Trigo S. Psychometric testing of INTEGRARE, an instrument for the assesment of pressure ulcer risk in inpatients. Int J Nurs Knowl. 2018;29(³):165-70. doi: https://doi.org/10.1111/2047-3095.12173
  » https://doi.org/10.1111/2047-3095.12173
• ¹³
  Porcel Gálvez AM. ¿Existe relación entre la salud percibida de la persona cuidadora y las necesidades de cuidados en pacientes hospitalizados? validación de la escala CUIDARE. In: Asociación Española de Nomenclatura, Taxonomía y Diagnósticos de Enfermería, editor. Ponencias y comunicaciones: XI Jornada de trabajo AENTDE. "20 años impulsando los Lenguajes Enfermeros »,» ®,® §,§ ­,­ ¹,¹ ²,² ³,³ ß,ß Þ,Þ þ,þ ×,× Ú,Ú ú,ú Û,Û û,û Ù,Ù ù,ù ¨,¨ Ü,Ü ü,ü Ý,Ý ý,ý ¥,¥ ÿ,ÿ ¶,¶ ; 2016 mayo 6; Madrid, España. Madrid: AENTDE; 2016 citado 2019 jun 10. p. 33-4. Disponible en: http://diposit.ub.edu/dspace/bitstream/2445/109951/1/XI_Jornada.pdf
  » http://diposit.ub.edu/dspace/bitstream/2445/109951/1/XI_Jornada.pdf
• ¹⁴
  Naharro-Álvarez A, Porcel-Gálvez AM. Complexity of care in critical patients: validation of INICIARE scale in new clinic environments. Sevilla: Universidad de Sevilla; 2018. Máster Universitario Oficial en Nuevas Tendencias Asistenciales en Ciencias de la Salud.
• ¹⁵
  Porcel-Gálvez AM. Construcción y validación de un sistema de evaluación del nivel de dependencia para el cuidado de pacientes hospitalizados tesis. Granada: Universidad de Granada; 2011 citado 2019 jun 10. Disponible en: https://hera.ugr.es/tesisugr/19902578.pdf
  » https://hera.ugr.es/tesisugr/19902578.pdf

Publication Dates

• Publication in this collection
  28 Oct 2019
• Date of issue
  2019