Study of the Strengths and Weaknesses of Nursing Work Environments in Primary Care in Spain

Navigating Dravet syndrome in Spain: A cross-sectional study of diagnosis, management, and care coordination

OBJECTIVES

Dravet syndrome (DS) is a rare form of refractory epilepsy that begins in the first year of life. Approximately 85% of patients have a mutation in the SCN1A gene, which encodes a voltage-gated sodium channel. The main objective of the present work was to assess the degree of knowledge of DS among Spanish primary care (PC) professionals, the communication flow between them and the pediatric neurologists (PNs), and the services available and resources offered to patients in Spain when searching for a diagnosis and adequate treatment.

METHODS

Two anonymized online surveys on DS diagnosis and patient management in PC were conducted with Spanish PC pediatricians (PCPs) and caregivers of DS patients in Spain.

RESULTS

Most PCPs are aware of genetic epilepsy but lack full knowledge of DS and patient advocacy groups (PAGs). Access to epilepsy treatments varies among regions, with many referrals to hospitals and pediatric neurologists. Diagnosis is often delayed, with misdiagnoses and frequent emergency room (ER) visits. Treatment involves multiple drugs, and sodium channel blockers are used, which are contraindicated in DS treatment. Improved training, resources, and communication are needed for early diagnosis.

SIGNIFICANCE

To improve the care and treatment of DS patients in Spain, early diagnosis is required and, possibly, specific efforts aimed at identifying patients in adulthood, generating socio-sanitary structures that integrate social and health services to provide comprehensive care, taking into account the different features and comorbidities of the disease.

PLAIN LANGUAGE SUMMARY

Dravet syndrome (DS) is a form of genetic epilepsy that starts within the first year of life. We present a study showing that, while family doctors are aware of genetic epilepsies, many don't have a complete understanding of DS. Unfortunately, getting the right diagnosis can take a long time, leading to unnecessary visits to the emergency room. Patients often need several medications, and sometimes they're given drugs that aren't recommended for DS. The takeaway is that training for doctors, more resources, and improved communication could help creating better healthcare systems and therefore give easier access to the right therapies.

Nurses' perceptions about the patient safety climate in Primary Health Care

OBJECTIVE

to evaluate the patient safety climate in Primary Health Care from the perspective of nurses working in the services.

METHOD

a quantitative and cross-sectional study conducted with 148 nurses from a municipality in the state of São Paulo. The Brazilian version of the Primary Care Safety Questionnaire Survey and personal, professional, and organizational performance variables (intention to stay at work, job satisfaction, care quality, and frequency of incidents) were used. Parametric and non-parametric comparison tests and Spearman's correlation coefficient were performed, considering a 5% significance level.

RESULTS

the safety climate was positive, varying from 4.52 to 5.33 and differing across districts for workload (p=0.0214) and leadership (p=0.0129). The safety climate professional variables and dimensions differed in relation to the frequency of incidents. Teamwork and safety and learning system were strongly correlated with job satisfaction and moderately with perceived care quality.

CONCLUSION

teamwork and safety and learning system stood out for their positive correlations with job satisfaction and care quality. A positive safety climate favors the involvement of Primary Care nurses to develop improvement plans aligned with the National Patient Safety Program.

BACKGROUND

(1) The safety climate is perceived differently across health districts. (2) There is a correlation between the climate dimensions and professional satisfaction. (3) Workload and leadership exert an influence on the safety climate perception. (4) There is a relationship between the safety climate and reporting of care-related incidents. (5) The safety climate is perceived differently among nurses regarding their role.

Primary Care Nurses' Perception of Leadership and the Influence of Individual and Work Setting Characteristics: A Descriptive Study

AIMS

To describe primary care nurses' perceptions of their formal leaders' leadership behaviors and outcomes and explore differences based upon nurses' individual and work setting characteristics.

BACKGROUND

Formal nursing leadership is positively associated with patient, nurse workforce, and organizational outcomes, yet no studies have examined primary care nurses' perception of formal leadership behaviors and outcomes in the United States.

METHODS

Cross-sectional survey data from 335 primary care nurses were analyzed to assess perceived leadership behaviors associated with transformational, transactional, and passive-avoidant leadership styles, perceived leadership outcomes, and individual and work setting characteristics.

RESULTS

Positive leadership behaviors (transformational) were lower than those reported for other settings. There were significant differences in nurses' perceptions of their leaders' leadership behaviors and outcomes based upon individual and work setting characteristics.

CONCLUSION

This study confirmed differences in perception of leadership and that individual and work setting characteristics influence nurses' perception of their leaders in primary care.

IMPLICATIONS FOR NURSING MANAGEMENT

Leaders must be versatile and consider the unique needs of each staff member and the influence of clinic characteristics.