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
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.
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.

Pumar Méndez, María Jesús

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