Open Access
A bottom-up framework for nurses' protocol-based care decision-making
(Wiley, 2024-09-15) Vázquez-Calatayud, Mónica; Pumar Méndez, María Jesús; Oroviogoicoechea, Cristina; Ciencias de la Salud; Osasun Zientziak
Aim: To develop a conceptual framework for nurses' protocol-based care decision-making. Design: Miles & Huberman's bottom-up approach to developing conceptual frameworks was followed, using data collected from a multiple embedded case study examining protocol-based decision-making by nurses in three hospital wards within a university hospital in northern Spain. Methods: The qualitative data from the case study, obtained through documentary analysis, observations, and interviews, underwent a secondary analysis consisting of four steps: data reduction, data display, comparison, and drawing conclusions. Results: The framework for protocol-based care decision-making comprises four components: (1) protocol-based care, as a balance between standardisation and individualised care, (2) the process, (3) the context, and (4) the elements of protocol-based care decision-making. These components and their relationship as a context-dependent, linear, variable and multifactorial process, directly influenced by the perception of risk, are described and illustrated. Conclusions: This study provides a rigorous bottom-up framework for nurses' protocol-based care decision-making. The framework could be a valuable resource for managers, clinical nurses, educators, and researchers to guide and evaluate nurses' decision-making, leading to improved care quality and reduced variability in clinical practice. Furthermore, the framework lays a foundation for further research and practical applications. Impact: This study addressed the problem of understanding nurses' protocol-based care decision-making and the need for a specific conceptual framework. The main findings of the study contribute to the development of a rigorous bottom-up framework comprising four components of protocol-based care decision-making. The framework has the potential to improve care quality, reduce variability, enhance patient safety, and increase healthcare efficiency by guiding nurses' decision-making in various healthcare settings. No Patient or Public Contribution: Patient or public contribution was not applicable since the study focused on nurses' decision making.
Open Access
"Missed nursing care" in health promotion: raising awareness
(Wiley, 2020) López de Dicastillo Sáinz de Murieta, Olga; Zabaleta del Olmo, Edurne; Mujika Zabaleta, Agurtzane; Antoñanzas Baztán, Elena; Hernantes Colias, Naia; Pumar Méndez, María Jesús; Ciencias de la Salud; Osasun Zientziak
Aim(s): This commentary aims to raise awareness of the possible causes of “missed nursing care” in health promotion and to propose possible solutions. Background: Although health promotion is an essential function of nursing practice, “missed nursing care” has been scarcely studied in this area. It is crucial to know both its causes and possible strategies to prevent it. Evaluation: We used evidence to identify possible causes of “missed nursing care” in health promotion, and we classified them into categories. We suggested the concept of capacity building to address its underlying causes. Key issue(s): Four main factors are involved in “missed nursing care” in health promo-tion, that is intrapersonal, interpersonal, organisational and cultural. Capacity build-ing, including the development of knowledge, skills, commitment, structures, systems and leadership, could reduce missed care. Conclusion(s): “Missed nursing care” in health promotion is complex and is multifac-torial in its origins. Capacity building could be a way to address its causes. Implications for Nursing Management: Nursing care in health promotion is para-mount and a long-term investment that can contribute to the sustainability of the health system. Organisations and managers could view capacity building processes as a tool to prevent “missed nursing care” in health promotion.
Open Access
Mapping health promotion practices across key sectors and its intersectoral approach at the local level: study protocol
(Wiley, 2024) Pumar Méndez, María Jesús; López de Dicastillo Sáinz de Murieta, Olga; Hernantes Colias, Naia; Antón-Solanas, Isabel; Zabaleta del Olmo, Edurne; Rodríguez- Roca, Beatriz; Subirón-Valera, Ana Belén; Juvinyà-Canal, Dolors; Mujika Zabaleta, Agurtzane; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Aims: This study outlines a protocol aimed at identifying and mapping health promotion practices in need of development from the perspectives of key sectors responsible for it at the local level and from an intersectoral perspective across four Spanish regions. Design: A complementary multi-method study combining survey methods and qualitative interviews will be adopted. Methods: Purposive snowball sampling will be employed to select potentially rich informants from city councils, primary care centres, primary and secondary schools, and public health and civil society organizations in 12 municipalities sensitive to local health. Data on the degree of execution of health promotion activities, the level of intersectorality in their implementation, and their origins will be collected using PromoACTIVA questionnaires, an intersectoral typology model and an interview protocol. A parallel mixed analysis encompassing descriptive statistics and a ‘framework analysis’ will be performed. Discussion: This study is expected to yield thorough and reliable insights into health promotion practices and omissions at the local level by focusing on key stakeholders, both individually and collaboratively. This information can enhance health promotion planning and improve its effectiveness, efficiency and contextual relevance. The development and testing of a methodology for the integration and interpretation of these data will ensure sustainable capacity building. Impact: Managers and practitioners interested in health promotion planning in the researched settings can benefit from a comprehensive map of the current state of their practices and insights into the starting points of collaboration. In addition, planners from other local settings will gain access to tools and methodologies to replicate and expand these maps to their own contexts. Stakeholder Engagement: Engaging key stakeholders with experience working in or with primary care centres, public health organizations, primary and secondary schools, civil society organizations, and city councils was vital to ensure the study's relevance and feasibility.
Open Access
Six-month breastfeeding maintenance after a self-efficacy promoting programme: an exploratory trial
(Wiley, 2021) Antoñanzas Baztán, Elena; Belintxon, Maider; Marín Fernández, Blanca; Redín Areta, María Dolores; Mujika Zabaleta, Agurtzane; Pumar Méndez, María Jesús; López de Dicastillo Sáinz de Murieta, Olga; Ciencias de la Salud; Osasun Zientziak
Background: Breastfeeding care plays a fundamental role in establishing breastfeeding and longer duration after discharge. Practices though vary among professionals involved and are often inconsistent with good practices recommended, being a threat to women’s breastfeeding self-efficacy. Breastfeeding self-efficacy is considered a predictor for successful breastfeeding and a significant variable amenable to intervention for promoting lactation Aim: To evaluate the efficacy, feasibility and acceptability of a new breastfeeding self-efficacy promoting programme (SIALAC) on 6-month breastfeeding maintenance. Methods: In this exploratory multi-centre controlled trial, participants were allocated into control and intervention groups sequentially. Professionals in charge of the treatment groups were trained in between, with an especial focus on reducing practice variability. Control and intervention group women received usual care, and the intervention group received in addition SIALAC, a three-stage breastfeeding self-efficacy promoting programme. Primary outcome was breastfeeding maintenance up to 6 months analysed by Kaplan–Meier and Cox proportional hazard regression analysis. Student’s t-test or chi-square tests were also used for continuous and categorical variables. Data on breastfeeding status and breastfeeding self-efficacy were collected at baseline, and 4, 8 and 24 weeks after birth. Results: From May 2014 through November 2015, participants were enrolled. The sample consisted of 112 women. No relevant socio-demographic or obstetric difference was found between groups. The intervention achieved a significant difference between groups in breastfeeding survival (X2 = 4.94, p = 0.026). Six-month breastfeeding maintenance was significantly higher in the intervention group (67% vs. 55%; X2 = 5.384, p = 0.020). Breastfeeding dropout in the control group was 3.3 (CI 1.1, 10.1) times higher than that of the intervention group at 6 months. Breastfeeding self-efficacy scores were higher in the intervention group although without significant statistical difference. The programme showed good acceptability. Conclusion: Breastfeeding self-efficacy promoting programme SIALAC was beneficial in fostering 6-month breastfeeding survival. Full-scale trial should consider feasibility-related issues identified.
Open Access
Volunteerism as adolescent health promotion asset: a scoping review
(Oxford University Press, 2020) Hernantes Colias, Naia; Pumar Méndez, María Jesús; López de Dicastillo Sáinz de Murieta, Olga; Iriarte Roteta, Andrea; Mujika Zabaleta, Agurtzane; Ciencias de la Salud; Osasun Zientziak
The Aim of this scoping review was to explore the available literature on volunteerism in adolescence and the benefits that this activity may report in their healthy development, from a salutogenic perspective. Searches were conducted in Pubmed, Cinahl, PsycINFO and Cochrane Library home databases; 15 articles were selected. Almost all of the studies were conducted in the United States between 1990 and 2000, primarily developed by psychologists and sociologists. The impact of volunteering was reflected in aspects that can be classified based on Lerner's dimensions of the PYD model. Volunteer activities promote an Improved academic, social, cognitive, and vocational competence in adolescents. An increase in conflict resolution capacity, leadership and personal agency, as well as improved pro-social attitudes and relationships with adults and peers, all of which contributed to their self-identification with the community. Moreover, increased positive development of adolescents reduces the rates of risky behaviors. Volunteerism may represent an opportunity for health promotion in adolescence. The concept of volunteering as an asset for health promotion during adolescence evokes the need to adopt and favor this view with regard to key areas of study associated with this stage such as education and health. Teams that work in community health, especially those in primary care, should recognize and value existing volunteer groups as an asset to promote the healthy development of adolescents. Friendlier health services should be encouraged that include comprehensive services from within educational institutions to community actions.
Open Access
Parental self-efficacy to promote children's healthy lifestyles: a pilot and feasibility study
(MDPI, 2021) Ruiz-Zaldíbar, Cayetana; Serrano-Monzó, Inmaculada; López de Dicastillo Sáinz de Murieta, Olga; Pumar Méndez, María Jesús; Iriarte Roteta, Andrea; Bermejo-Martins, Elena; Mujika Zabaleta, Agurtzane; Ciencias de la Salud; Osasun Zientziak
Positive parenting programs are a key strategy to promote the development of parental competence. We designed a pilot study based on parental self-efficacy to promote healthy lifestyles in their children aged between 2 to 5 years old. In this pilot study, we aimed to assess the effects of a parenting program on parental self-efficacy and parenting styles. Twenty-five parents were allocated into intervention (N = 15) and control group (N = 10). Parents from the intervention group received four group sessions (120 mi per session) to develop a positive parenting, parenting styles and parenting skills regarding to children's diet, exercise, and screen time, and two additional sessions about child development and family games. Parents from the control group received these two latter sessions. Parental self-efficacy, parenting styles, and meal-related parenting practices were measured before and after the intervention and at 3-month follow-up. Acceptability and feasibility of the program was also measured. Quantitative data were analyzed using the repeat measures ANOVA and ANCOVA tests and the effect size calculation. Content analysis was used to analyse open questions. Positive trends were found regarding parental self-efficacy and the use of authoritative parenting style. Parents also reported a great acceptability of the program getting high satisfaction. According to the feasibility barriers and facilitators aspects were identified. The positive trends founded in this study support the development of parenting programs to promote healthy lifestyle in children.
Open Access
Encounters between children's nurses and culturally diverse parents in primary health care
(Wiley, 2020) Belintxon, Maider; Dogra, Nisha; McGee, Paula; Pumar Méndez, María Jesús; López de Dicastillo Sáinz de Murieta, Olga; Ciencias de la Salud; Osasun Zientziak
The objective of this study was to analyze the healthcare encounters between nursesand parents of different cultural backgrounds in primary health care. An ethnographicstudy was carried out using participant observations in health centers and interviews withnurses. Data were analyzed using thematic content analysis and constant comparativemethod. Four main themes were identified when nurses met parents of other culturalbackgrounds: lack of mutual understanding, electronic records hamper the interaction,lack of professionals' cultural awareness and skills, and nurses establish superficial or dis-tant relationships. The concepts of ethnocentrism and cultural imposition are behindthese findings, hampering the provision of culturally competent care in primary healthservices. There were difficulties in obtaining and registering culturally related aspects thatinfluence children's health and development. This was due to e-records, language barriers,and the lack of cultural awareness and skills in health professionals making the encoun-ters difficult for both nurses and parents. These findings show that there is a clear threatfor health equity and safety in primary care if encounters between nurses and parents donot improve to enable nursing care to be tailored to any individual family needs.
Open Access
Development of a taxonomy of activities in health prevention and promotion for primary care
(Wiley, 2022) Pumar Méndez, María Jesús; López de Dicastillo Sáinz de Murieta, Olga; Hernantes Colias, Naia; Iriarte Roteta, Andrea; Belintxon, Maider; García-Iriarte, Antonio; Mujika Zabaleta, Agurtzane; Ciencias de la Salud; Osasun Zientziak
Aim: To develop a taxonomy of activities in health prevention and promotion for primary care. Background: Despite health promotion being considered a keystone for popula-tion health and health care sustainability, its implementation remains insufficient. Customized evaluation tools are needed to address prevention and promotion omis-sions in primary care. Method: A taxonomy was designed using documentary analysis. Documents describ-ing frontline primary care professionals' health prevention and promotion activities or omissions were identified and analysed using framework analysis. Results: The ‘Taxonomy of Activities in Health Prevention and Promotion for Primary Care’ (TaxoPromo) includes 43 activities grouped into eight categories: planification, situational analysis, capacity building, development of awareness/public opinion, advocacy, development of networks, development of partnerships and intervention strategies. Conclusion: By contrasting the usual practices with the activities collected in the TaxoPromo, opportunities for improvement can be unveiled. Implications for Nursing Management: The TaxoPromo can be used at organisational and system levels to identify actions to integrate health prevention and promotion activities into a systematic, data-driven process; design implementation plans and tailor-made strategies for capacity building; enable benchmarking; and address omis-sions. The TaxoPromo can serve as a catalyst tool for the clarification and expansion of the nursing role in health prevention and promotion.
Open Access
Lessons learned from the COVID-19 pandemic on the global health needs of young children: a cross-sectional study
(Gobierno de Navarra, 2025-01-31) Elizalde Beiras, Itsaso; López de Dicastillo Sáinz de Murieta, Olga; Andueza-Wood, Hazel Helen; Sola Cía, Sara; Lozano-Ochoa, Cristina; Mujika Zabaleta, Agurtzane; Hernantes Colias, Naia; Pereda Goikoetxea, Beatriz; Antoñanzas Baztán, Elena; Pumar Méndez, María Jesús; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua
Fundamento. Este estudio transversal tiene como objetivo eva-luar las necesidades globales de salud de la población infantil de 2 a 6 años y determinar si las características sociodemográficas producen diferencias en las necesidades de salud de los niños observadas después de la pandemia de COVID-19.Métodos. Estudio transversal realizado en tres regiones del nor-te de España con ingresos similares. Los participantes se selec-cionaron mediante muestreo cluster de un paso. El cuestionario auto respondido por los padres Necesidades de salud de la Pobla-ción Infantil evaluó las necesidades de salud mediante siete di-mensiones y 125 ítems.Resultados. Un total de 301 progenitores/cuidadores completa-ron el cuestionario. Las dimensiones autoeficacia parental, aseso-ramiento profesional, aspectos socioemocionales del niño e influencia situacional alcanzaron las puntuaciones más altas, mientras que aspectos socioemocionales de los padres, estilo de vida, promoción de estilos de vida saludables e influencia de personas significativas re-cibieron las puntuaciones más bajas (mayores necesidades). Las necesidades relacionadas con el estilo de vida se vieron afecta-das por la falta de acceso a profesionales de la salud y con mayor intensidad cuando los niños tenían una discapacidad.Conclusiones. El resultado de este estudio podría enriquecer la planificación de estrategias, programas e intervenciones para pro-mover la salud infantil, cubriendo las necesidades identificadas.
Open Access
Building capacity for health promotion by addressing nurses' role confusion: study protocol of a pilot clustered randomised controlled trial
(Wiley, 2021) Iriarte Roteta, Andrea; López de Dicastillo Sáinz de Murieta, Olga; Mujika Zabaleta, Agurtzane; Antoñanzas Baztán, Elena; Hernantes Colias, Naia; Galán Espinilla, María José; Pumar Méndez, María Jesús; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua
Aim: To describe the protocol for the pilot phase of a complex intervention, designed to address primary care nurses' role confusion in health promotion. Design: A pilot clustered randomized controlled trial, with control and intervention groups. Methods: The study will be conducted in a primary care setting. Participants will be nurses from the primary care health service working in a primary care team (PCT, 15 control group; 15 intervention group). Nurses in the experimental group will receive the ROLE-AP programme over a 3-week period. The control group will continue with the normal routine. The pilot will help determine the intervention's feasibility, acceptability, fidelity and quality of the programme components. Data collected preintervention, postintervention and 3 months after intervention will provide estimates of the intervention's preliminary effects on the main variable, nurses' degree of agreement concerning their expected role in health promotion. The study received funding from the local government in December 2019. Discussion: Role confusion is promoting primary care nurses' omissions in their health-promoting practice, which is far from the ideal portrayed by the Ottawa Charter. Interventions are needed that reveal the most appropriate mechanisms for addressing role confusion, which requires reaching an intraprofessional agreement about the expectations for role activities. Healthcare organisations could benefit from the incorporation of a programme of these characteristics into standard practice. Impact: This study will produce a novel and comprehensive complex intervention that is expected to build nurses' capacity in primary healthcare organizations for health promotion, which is key to increasing the quality, efficiency and sustainability of the National Health System. The programme evaluation and feasibility study will reveal how to better use existing resources in a full-scale clinical trial.