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Background Incorporating the best available evidence into clinical practice is a determining challenge for healthcare professionals and organisations. The role of advanced practice nurses is viewed as a facilitator to adapt guideline recommendations to suit specific contexts and to overcome barriers to implementation. In this study, we evaluate the impact of advanced practice nurses on clinical indicators of hospitalised patients and on adherence to recommendations derived from two clinical practice guidelines (pressure ulcer prevention and treatment and vascular access device management). Methods Quasi-experimental study in five intervention (IU) and five control (CU) hospital units at three hospitals in Spain (period 2018–19). Five advanced practice nurses were incorporated into IU, with the intention that would produce attitudinal changes and enhance the skills and knowledge of the nursing team regarding 18 clinical practice recommendations. In this study, 41 indicators were evaluated through direct observation of all patients admitted, at monthly intervals for 1 year. Outcomes were assessed by means of a descriptive, multi-line regression and association analysis. Results The study population was composed of 3742 inpatients admitted for pressure ulcer assessment and 2631 fitted with vascular access devices. By the end of the study period, all variables had improved in the IU, where average compliance with recommendations was statistically significantly higher (pressure ulcer guidance 7.9 ± 1.9 vs 6.0 ± 1.7. OR 1.86, 95% CI 1.67–2.05; vascular access devices guidance 5.4 ± 1.4 vs 4.4 ± 1,6. OR 1.06, 95% CI 0.95–1.17). The prevalence of pressure lesions and catheter-related adverse events decreased statistically significantly in the IU compared to the CU. The prevalence of pressure ulcers decreases (5.7% in IU vs 8.7% in CU p p Conclusions The incorporation of an advanced practice nurse statistically significantly improves clinical indicators related to the prevention and treatment of pressure ulcers and to the management of vascular access devices. Trial registration ISRCTN18259923 retrospectively registered on 11/02/2022.

Summary Background Spain is one of the European countries most affected by the COVID-19 pandemic. Serological surveys are a valuable tool to assess the extent of the epidemic, given the existence of asymptomatic cases and little access to diagnostic tests. This nationwide population-based study aims to estimate the seroprevalence of SARS-CoV-2 infection in Spain at national and regional level. Methods 35 883 households were selected from municipal rolls using two-stage random sampling stratified by province and municipality size, with all residents invited to participate. From April 27 to May 11, 2020, 61 075 participants (75·1% of all contacted individuals within selected households) answered a questionnaire on history of symptoms compatible with COVID-19 and risk factors, received a point-of-care antibody test, and, if agreed, donated a blood sample for additional testing with a chemiluminescent microparticle immunoassay. Prevalences of IgG antibodies were adjusted using sampling weights and post-stratification to allow for differences in non-response rates based on age group, sex, and census-tract income. Using results for both tests, we calculated a seroprevalence range maximising either specificity (positive for both tests) or sensitivity (positive for either test). Findings Seroprevalence was 5·0% (95% CI 4·7–5·4) by the point-of-care test and 4·6% (4·3–5·0) by immunoassay, with a specificity–sensitivity range of 3·7% (3·3–4·0; both tests positive) to 6·2% (5·8–6·6; either test positive), with no differences by sex and lower seroprevalence in children younger than 10 years (10%) and lower in coastal areas (

In a context of aging of the population, increased prevalence of chronic diseases and increasing complexity, it is necessary to define new professional roles that can meet the health needs of the population. Added to this is the certainty that variability in clinical practice, as well as in health management, makes it necessary to use best evidence as the basis for decision-making. But the application of clinical practice based on evidence in a specific context implies a broad mastery of the available evidence, its applicability and limitations, as well as a deep understanding of the particular characteristics of the area where it is to be applied, from the "macro" (health policies, framework regulations, strategic lines, social values, etc.) to the "micro" level (local culture, user preferences, etc.). The "Health Service of the Balearic Islands", in collaboration with the Faculty of Nursing and Physiotherapy from the University of the Balearic Islands, proposes the development of new advanced practice nursing roles that focus their efforts on the planned implementation of evidence in clinical settings. Advanced practice nurses have managed naturally, thanks to their competence development, to exercise the role of promoting organizational and attitudinal changes that facilitate the implementation of evidence in organizations and complex environments.

Resumen En un contexto de envejecimiento de la poblacion, aumento en la prevalencia de enfermedades cronicas y creciente complejidad, se hace necesario definir nuevos roles profesionales que consigan dar respuesta a las necesidades de salud de la poblacion. A ello se une la certeza de que la variabilidad en la practica clinica, asi como en la gestion sanitaria, hace necesaria la adopcion de las mejores evidencias como base de la toma de decisiones. Pero la aplicacion de la practica clinica basada en evidencia en un determinado contexto implica un amplio dominio de la evidencia disponible, su aplicabilidad y limitaciones, asi como una profunda comprension de las caracteristicas particulares del ambito en que se pretende aplicar, desde el nivel «macro» (politicas de salud, normativa marco, lineas estrategicas, valores sociales, etc.) hasta el «micro» (cultura local, preferencias de los usuarios, etc.). El Servei de Salut de les Illes Balears, en colaboracion con la Facultad de Enfermeria y Fisioterapia de la Universitat de les Illes Balears, propone el desarrollo de nuevos roles enfermeros de practica avanzada que focalicen sus esfuerzos en la implementacion planificada de evidencias en entornos clinicos. Las enfermeras de practica avanzada han conseguido de manera natural, gracias a su desarrollo competencial, ejercer el papel de impulsoras de cambios organizacionales y actitudinales que facilitan la implementacion de evidencia en organizaciones y entornos complejos.

Evidence-based practice (EBP) combined with quality of care improves patient outcomes. However, there are still difficulties for its implementation in daily clinical practice. This project aims to evaluate the impact of the incorporation of the Advanced Practice Nurse (APN) role on the implementation of EBP at three levels: context, nurses' perceptions, and clinical outcomes. Mixed-methods study in two phases is proposed. Phase 1: a quasi-experimental design where five APNs are included in five hospitalization wards that are compared with another five similar wards without APNs. Variables from Practice-Environment-Scale-Nursing-Work-Index, Health-Science-Evidence-Based-Practice-Questionnaire, and Advanced-Practice-Nursing-Competency-Assessment-Instrument are used. Clinical outcomes are followed-up with monthly. A descriptive and exploratory analysis is performed. Phase 2: an exploratory qualitative design through focus groups at the intervention wards after one year of APNs implementation. Explicative data are gathered to explain the progression of change and how actors perceive and attribute triggers, barriers, and facilitators for change. An inductive thematic analysis is performed. The inclusion of APN in hospitalization context is insufficiently studied. It is hoped that these figures provide solutions to the multiple barriers in the development of EBP in these sceneries and contribute to resolve the gap between research results and healthcare practice., This work was supported by The College of Nursing of the Balearic Islands within the framework of Grants for Research Projects (grant Number PI 2019/0217). This research received no specific grant from any funding agency in the commercial or not-for-profit sectors. As it has been explained, IB-Salut is responsible for the replacement of the five nurses who develop the role of APHN, supporting the project in these terms. Any of the participating institutions influence the results or the development of the research.