Variabilidad de la práctica clínica. Situación actual y retos para enfermería

Fernández-de-Maya, José; Richard-Martínez, Miguel

doi:10.1016/j.enfcli.2009.12.004

Cited by 13 publications

(7 citation statements)

References 29 publications

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“…The mere fact of being health professionals constitutes one of the factors that cause this variability, due to demographic, professional and training characteristics [30]. However, studies that reveal the magnitude and importance of the variability in clinical nurse practice, and specific explanatory theories of nurse reality are required [31].…”

Section: Discussionmentioning

confidence: 99%

Assessment of Nursing Care and Teaching: A Qualitative Approach

Martínez-Linares

Martínez-Yébenes

Andújar-Afán

et al. 2019

IJERPH

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Background: The reform of the Spanish higher education to adapt to the European Higher Education Area involves, among other issues, the students’ participation in the curriculum assessment. The aim is to understand the insights of both nursing professionals and current undergraduate students of nursing on the connection between the knowledge acquired throughout the degree and the professional healthcare practice. Methods: An exploratory, descriptive qualitative study was carried out at a Spanish University. By convenience sampling, twelve nursing professionals and twelve 4th-year students of the Degree in Nursing were included. In two phases, twelve semi-structured interviews and two focus groups were conducted in order to triangulate data. A thematic analysis of data was carried out, later to be coded by two researchers. Results: Two main themes were identified: Evidence-based nursing vs. experience-based nursing, and a theory-practice gap. The topics that were specifically highlighted were the coexistence between professionals who work according to evidence and those whose work is based on experience, and the lack of connection between the training received during the degree and actual healthcare practice. Conclusion: Nursing care work varies in terms of the implementation of evidence-based care. Nursing training is perceived as being affected by a theory-practice gap. To achieve the linking between nursing theory and practice, a great effort on stakeholders would be needed.

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Section: Discussionmentioning

confidence: 99%

Assessment of Nursing Care and Teaching: A Qualitative Approach

Martínez-Linares

Martínez-Yébenes

Andújar-Afán

et al. 2019

IJERPH

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“…The production of studies on the variability in medical practice is far greater than the number of studies on the variability in clinical practice from the point of view of other healthcare professionals (20) . According to our review, few studies have focused on the variations in clinical practice in the nursing discipline.…”

Section: Discussionmentioning

confidence: 99%

“…The health system-dependent factors relate to the human, technical and financial resources, the funding system, coverage, accessibility, economic incentives to professionals, the educational function of the center, the introduction of new technologies, the organizational deficiencies and the lack of equipment, units or personnel. The clinician-dependent factors refer to demographics, training and the professional characteristics involved in the different types of practice (20) . The most cited explanatory theories of variations, so far coming from the medical approach, are the uncertainty hypothesis (26) , the patient practice style hypothesis (27) and the physician enthusiasm hypothesis (28) .…”

Section: Discussionmentioning

confidence: 99%

Variabilidad de la práctica clínica en enfermería, una revisión integradora: an integrative review

Maya

Richart‐Martínez

2012

Acta paul. enferm.

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Objective: The objective of this literature review was to examine what has been published about variability in clinical practice from the focus of nursing. Methods: We performed a literature search in the principal international databases, selecting those most relevant works. Results: The results were clustered into five groups: studies about variations with respect to guidelines and protocols; studies that analyze nursing practice and that of other health professionals; variations in procedures and nursing care; variations in practice between nurses and physicians; and studies that related variability with characteristics of professionals, units or healthcare centers. Conclusion: The majority of papers found were limited to showing the existence of variability, but few sought variables that predicted it. Future investigations should focus on finding predictors of variability to address unjustified variations that are detected. Keywords: Physician's practice patterns; Nursing; Review literature as topic RESUMOObjetivo: O objetivo desta revisão foi examinar o que foi publicado sobre a variabilidade na prática clínica com base no foco de enfermagem. Métodos: Pesquisa bibliográfica realizada nas principais bases internacionais, seleccionando as obras mais relevantes. Resultados: Os resultados foram agrupados em cinco grupos: estudo sobre as variações com relação às diretrizes e protocolo, estudos que analisam a prática da enfermagem e de outros profissionais de saúde; variações nos procedimentos e cuidados de enfermagem; variações na prática, entre enfermeiros e médicos e estudos de variabilidade relacionada com características de profissionais, unidades ou centros de saúde. Conclusão: A maioria dos artigos encontrados limitou-se a relatar a existência de variabilidade, mas algunas variáveis que buscou, previam. Futuras investigações devem concentrar-se no encontro de preditores de variabilidade para enfrentar variáveis injustificadas que são detectadas. Descritores: Condutas na prática dos médicos; Enfermagem; Literatura de revisão como assunto RESUMEN Objetivo: El objetivo de esta revisión de la literatura es examinar qué se ha publicado sobre variabilidad de la práctica clínica desde el enfoque de la enfermería. Métodos: Se realizó una búsqueda bibliográfica en las principales bases de datos internacionales seleccionando aquellos trabajos más relevantes. Resultados: Los resultados se han agrupado en 5 grupos: estudios sobre variaciones respecto a guías y protocolos, estudios que analizan práctica enfermera y de otros profesionales sanitarios, variaciones en procedimientos y cuidados de enfermería, variaciones en la práctica entre enfermeras y médicos y estudios que relacionan la variabilidad con características de profesionales, unidades o centros sanitarios. Conclusión: La mayoría de los trabajos encontrados se han limitado a mostrar la existencia de variabilidad pero pocos han buscado variables que predigan ésta. Futuras investigaciones deberían centrarse en la búsqueda de variables predictivas de la v...

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“…The use of these guidelines and documents is aimed at avoiding excessive variability in the clinical practice of childbirth care. This variability could lead to an increased risk of iatrogenesis due to inappropriate or unnecessary procedures, as well as not receiving care backed by scientific recommendations [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Variability of clinical practice in the care of the second stage of labor among midwives in Spain

Díaz,

Rodriguez-Almagro,

Martinez-Galiano

et al. 2024

BMC Nurs

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Background There are recommendations based on scientific evidence on care in the second stage of labor, but it is not known to what degree the professionals comply with these recommendations. Objective The aim of this study is to examine the variability in clinical practices among midwives during the second stage of labor, including positions, mobility, practices, and the maximum time allowed before initiating active pushing, and to assess their adherence to clinical practice guidelines. Methods A cross-sectional observational study. A self-designed questionnaire was developed and distributed online through scientific societies. The main variables studied were professional and work environment characteristics, maternal positions and mobility, practices during this stage, maximum time to start active pushing and duration of the second stage of labor. Descriptive statistics were calculated using SPSS 24.0. Results Regarding the woman’s position during childbirth, 80.3% (245) of midwives frequently or always allow the woman to choose her birthing position. Furthermore, 44.6% (136) of professionals prefer using side-lying positions for the mother. Regarding drinking fluids during childbirth, 51.1% (156) of midwives allowed the woman to drink the amount of liquids she wanted, whereas 11.1% (34) said that they would allow them to do so however, this was against the protocol of their hospital. When inquiring about the Kristeller maneuver, it was reported to be excessively performed in 35.1% (107) of cases for fetal bradycardia, 33.1% (101) for maternal exhaustion, and 38.4% (117) to avoid instrumental birth. Finally, a great variability was observed in the time criteria used for the initiation of active pushing and the maximum duration of the second stage of labor. Conclusions Certain practices, such as the Kristeller maneuver, are overused among midwives, with great variability in the use of certain procedures, the waiting times to initiate pushing and completion of the second stage of labor. Further training and awareness campaigns are needed for professionals to apply evidence-based care.

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Variabilidad de la práctica clínica. Situación actual y retos para enfermería

Cited by 13 publications

References 29 publications

Assessment of Nursing Care and Teaching: A Qualitative Approach

Assessment of Nursing Care and Teaching: A Qualitative Approach

Variabilidad de la práctica clínica en enfermería, una revisión integradora: an integrative review

Variability of clinical practice in the care of the second stage of labor among midwives in Spain

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