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      Comunicación y transferencia del cuidado en el servicio de urgencias Translated title: Communication and transfer of care in the emergency department

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          Abstract

          Resumen Objetivo: Describir las barreras de la comunicación interpersonal durante la transferencia de cuidado en el servicio de urgencias. Metodología: Cualitativo, estudio de caso, se llevó acabo en el servicio de urgencias, se realizó observación de las transferencias de cuidado en los diferentes turnos durante diez días y entrevistas semiestructuradas. El análisis se llevó a cabo reduciendo los códigos y generando las categorías de análisis fundamentado en el modelo de efectividad del rol de enfermería de Irvine y Sidani. Resultados: El análisis de datos permitió obtener las siguientes categorías: la comunicación con el paciente, la familia y entre el equipo de trabajo; significado del rol del profesional de enfermería en la comunicación interpersonal; y estrategias comunicativas para una transferencia de cuidado segura. Conclusiones: Las barreras para el buen desarrollo de la transferencia del cuidado son las brechas en la comunicación, falta de trabajo en equipo, lo cual incrementa la ocurrencia de eventos adversos y centinela.

          Translated abstract

          Abstract Objective: To describe the barriers of interpersonal communication during the transfer of care in the emergency department. Methodology: Qualitative, case study, was worked out in the emergency department, observation of care transfers was taken out in the different shifts for ten days and semi-structured interviews. The analysis was developed out by reducing the codes and generating the analysis categories based on the Irvine and Sidani nursing role effectiveness model. Results: The data analysis allowed to obtain the following categories: Communication with the patient, the family and between the work team. Meaning of the role of the nursing professional in interpersonal communication and communication strategies for a safe transfer of care. Conclusions: The barriers to the good development of care transfer are communication gaps, lack of teamwork, which increases the occurrence of adverse events and sentinel.

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          Nursing handoffs: a systematic review of the literature.

          Handoffs of patient care from one nurse to another are an integral part of nursing practice; but there is abundant evidence that poor communication and variable procedures result in inadequate handoffs. We sought to conduct a systematic review of articles that focused on nursing handoffs, conduct a qualitative review of barriers to and strategies for effective handoffs, and identify features of structured handoffs that have been effective. We conducted a systematic review of English-language articles, published between January 1, 1987, and August 4, 2008, that focused on nursing handoffs in the United States. The search strategy yielded 2,649 articles. After title review, 460 of these were obtained for further review by trained abstractors. Ninety-five articles met the inclusion criteria; of these, 55 (58%) were published between January 1, 2006 and August 4, 2008. Content analysis yielded identification of barriers to effective handoffs in eight major categories and strategies for effective handoffs in seven major categories. Twenty articles involved research on nursing handoffs. Quality assessment scores for the research studies ranged from 2 to 12 (possible range, 1 to 16). The majority of the research studies on nursing handoffs (17 studies; 85%) received quality scores at or below 8 and only three achieved scores above 10. Ten (50%) of the studies included measures of handoff effectiveness. Despite the well-known negative consequences of inadequate nursing handoffs, very little research has been done to identify best practices. There is remarkable consistency in the anecdotally suggested strategies; but there is a paucity of evidence to support them. We call for high-quality studies of handoff outcomes that focus on systems factors, human performance, and the effectiveness of structured protocols and interventions.
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            An empirical test of the Nursing Role Effectiveness Model.

            This study investigated the propositions depicted in the Nursing Role Effectiveness Model, in which nurse and patient structural variables were expected to influence nurses' role performance, which, in turn was expected to affect patient outcome achievement. RATIONALE/BACKGROUND: Increasingly, nurses are expected to demonstrate their contribution to patient outcome achievement as a basis for evaluating practice and for monitoring improvements in practice. A model was developed that describes nursing practice in relationship to the roles nurses assume in health care, and links patient and system outcomes to nurses' role functions (Nursing Economics 1998: 16, 58-64, 87). A cross-sectional design was used to collect data on the structure, process, and outcome variables. Data were collected through structured questionnaires and chart audit, involving a total of 372 patients and 254 nurses from 26 general medical-surgical units in a tertiary care hospital. Patient structural variables included medical diagnosis, age, gender and education. Nurse structural variables included educational preparation and length of hospital experience. The unit structural variables included the adequacy of time to provide care, autonomy, and role tension. The quality of nurses' independent role performance was assessed by collecting data from patients on their perception of the quality of nursing care. Nurses' interdependent role performance was assessed by collecting data from nurses on the quality of nurse communication and co-ordination of care. Patient outcomes were assessed through self-report and consisted of the patients' therapeutic self-care ability, functional status, and mood disturbance at the time of hospital discharge. Structural equation modelling was used to test the hypothesized relationships among the structural, process, and outcome variables. Patients viewed nurses' independent role performance more effective on units where nurses reported less autonomy but more time to provide care. The quality of nurse communication was higher on units where nurses had higher education, more autonomy, less hospital experience, and lower role tension. However, the co-ordination of care was more effective on units where nurses had higher education, greater hospital experience, less autonomy and role tension. The three role performance variables were associated with patients' therapeutic self-care ability at hospital discharge. Nurses' independent role performance was associated with better patient functional status and less mood disturbance at hospital discharge. The role performance variables fully mediated the effect of the structural variables on patient outcomes, lending support for the proposition that nurses' role performance explains the relationship between structural variables, such as nurse education and autonomy, and patient outcome achievement. The Nursing Role Effectiveness Model provides a well-defined conceptual framework to guide the evaluation of outcomes of nursing care. For the most part the hypothesized relationships among the variables were supported. However, further work is needed to develop an understanding of how nurses engage in their co-ordinating role functions and how we can measures these role activities.
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              Estudio de casos

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                Author and article information

                Journal
                index
                Index de Enfermería
                Index Enferm
                Fundación Index (Granada, Granada, Spain )
                1132-1296
                1699-5988
                September 2021
                : 30
                : 3
                : 164-168
                Affiliations
                [1] Bogotá orgnameUniversidad Nacional de Colombia orgdiv1Facultad de Enfermería Colombia
                Article
                S1132-12962021000200003 S1132-1296(21)03000300003
                86be4486-f2f0-41ab-99c9-8e6cbcc7c6a4

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 18 September 2020
                : 20 July 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 16, Pages: 5
                Product

                SciELO Spain

                Categories
                Originales

                Guard Pass,Estudio de Caso,Pase de guardia,Servicios Médicos de Urgencia,Comunicación,Case Study,Emergency Medical Services,Communication

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