Harillo Acevedo, Francisco David

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Harillo Acevedo, Francisco David

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Harillo Acevedo, Francisco David

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Universidad de Murcia. Departamento de Atención Sociosanitaria

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Open Access
Factors associated with breastfeeding support from health care professionals by implementing a Clinical Practice Guideline
(Wiley, 2019-03) Ramos Morcillo, Antonio Jesús; Ruzafa Martinez, Maria; Harillo Acevedo, Francisco David; Enfermería
Background: The prevalence and duration of breastfeeding are at low levels and may be improved by the support of health care professionals. Our objective was to determine the effect of implementing a breastfeeding clinical practice guideline on factors associated with breastfeeding support by health care professionals, adopting a Theory of Planned Behavior approach. Methods: We conducted an observational, cross-sectional study during 2016 in a health area with implemented clinical practice guideline on breastfeeding, comparing the results with data from a previous cross-sectional study (2011) in the same area, in a standard-care area, and in a Baby-Friendly Hospital Initiative (BFHI)-accredited area. A validated questionnaire (four scales: attitudes, beliefs, subjective norms, and behavioral intention) was completed by professionals in each area. Descriptive analysis was followed by comparisons among the different settings using the chi-square test. Results: In the area with the implemented clinical practice guideline, the professionals scored significantly higher in subjective norms and beliefs than had been recorded in 2011 (preimplementation), and their scores for all four scales were significantly higher than in the standard-care area. Professionals obtained significantly higher scores for subjective norms in the BFHI-accredited area than in the other settings. Conclusions: Clinical practice guideline implementation improved the responses of professionals on breastfeeding support in subjective norms and beliefs scales. There is a need for activities to assist breastfeeding in a practical manner and for more effective measures to ensure compliance with the International Code of Marketing of Breast-milk Substitutes.
Open Access
Barriers Perceived by Managers and Clinical Professionals Related to the Implementation of Clinical Practice Guidelines for Breastfeeding through the Best Practice Spotlight Organization Program
(MDPI, 2020-08-27) Ramos Morcillo, Antonio Jesús; Armero Barranco, David; Leal Costa, César; Moral García, José Enrique; Ruzafa Martínez, María; Harillo Acevedo, Francisco David; Enfermería
: International institutions facilitate the contact of health professionals to evidence-based recommendations for promoting exclusive breast feeding (BF). However, the achievement of good rates of exclusive BF is still far from the optimum. The intention of the present work is to determine the barriers identified by managers and health professionals involved in the implementation and sustainability of Clinical Practice Guidelines (CPG) for breastfeeding under the auspices of the Best Practice Spotlight Organization program. A qualitative research study was carried out. The participants were managers, healthcare assistants, nurses, midwives, pediatricians and gynecologists. Semi-structured interviews were conducted which were transcribed and analyzed using the six steps of thematic analysis. Twenty interviews were conducted, which defined four major themes: (1) Lack of resources and their adaptation; (2) Where, Who and How; (3) Dissemination and reach of the project to the professionals; and (4) The mother and her surroundings. This research identifies the barriers perceived by the health professionals involved in the implementation, with the addition of the managers as well. Novel barriers appeared such as the ambivalent role of the midwives and the fact that this CPG is about promoting health. The efforts for promoting the implementation program should be continuous, and the services should be extended to primary care.
Open Access
Monitoring of the Implementation of a Breastfeeding Guideline for 6 Years: A Mixed-Methods Study Using an Interrupted Time Series Approach
(2021-05) Ruzafa Martinez, Maria; Ramos Morcillo, Antonio Jesús; Harillo Acevedo, Francisco David; Enfermería
Background: Current literature provides poor information about the implementation of health-promoting clinical practice guidelines (CPGs) and their longitudinal monitoring. Purpose: The aim of this study was to evaluate the longitudinal impact of a CPG implementation program that promotes breastfeeding, its associated quantitative and qualitative indicators, and direct costs. Design: A mixed-methods design with a longitudinal approach was utilized, with an interrupted time series design and the analysis of reports from the implementation program as the qualitative approach. Methods: The study setting was maternity and pediatric units of a health area in the Spanish health system. The implementation of a CPG for the promotion of breastfeeding was evaluated, which included a pre-implementation year (2011), 3 years of implementation (2012-2014), and 2 years of post-implementation (2015-2016). The sample was composed of mother-infant dyads. A segmented logistic regression analysis was utilized to evaluate the changes in the most important breastfeeding indicators. A deductive thematic content analysis was performed starting with quality indicators and a descriptive economic analysis. Findings: In the 6 years of monitoring, 7,842 mother-infant dyads were recorded. The results of the quantitative indicators showed the presence of four stages: baseline, gain, adjustment, and sustainability or saturation. The breast milk at the first feeding had an increasing slope in the gain stage (24% per quarter; odds ratio [OR] = 1.24, 95% confidence interval [CI] 1.12-1.37). The exclusive breastfeeding at hospital discharge showed significant changes in the period of gain (OR = 2.45, 95% CI 1.95-3.08), which was maintained in the adjustment period, with an increase of 18% in the slope of the gain stage (OR = 1.18, 95% CI 1.06-1.32). The longitudinal distribution of the qualitative indicators showed a greater concentration of indicators towards the first half of each phase. The total cost was 209,575€ ($248,670.17). Conclusions: The implementation of the breastfeeding CPG showed early, positive, and sustained results in the exclusive breastfeeding rates. The implementation implied the application of a complex intervention, with its qualitative indicators showing a wave-shaped dynamic. Clinical relevance: Our findings contribute to the understanding and evolution of the main indicators of the implementation of a breastfeeding CPG, providing details on the magnitude of the effect, the process of change, and the associated costs.
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Monitoring the sustainability of a breastfeeding guideline during the COVID-19 pandemic: a mixed-methods study
(Wiley, 2025-02-17) Harillo Acevedo, Francisco David; Molina Rodríguez, Alonso; Ramos Morcillo, Antonio Jesús; Suárez Cortés, María; Ruzafa Martínez, María; Enfermería; Facultad de Enfermería
Aim: To analyse the impact of the COVID- 19 pandemic on the sustainability of a breastfeeding (BF) clinical practice guideline (CPG) for women without COVID- 19, throughout the 5 waves of the pandemic. Desing: A mixed- methods design was utilised. Methods: For the quantitative approach, an interrupted time series design was utilised, as well as the analysis of CPG sustaina bility reports as a qualitative approach. The study setting was in a health area in the Spanish health system from April 2019, until October 2021. The sample was composed of 2239 mother–infant dyads. Results: The exclusive- BF rate at hospital discharge obtained values between 90% and 94.8%, without statistically significant changes. A significant increase in the risk of not starting BF in the first feeding was observed (adjusted odds ratio = 9.36; 95% CI: 1.04–84.13), between the pre- pandemic period and the first wave. Skin- to- skin contact (SSC) decreased in the first wave to 82.20%, and the oscillations observed throughout the pandemic were not statistically significant. In general, the qualitative indicators were maintained. A decrease was observed in the spaces used for postpartum care due to the re- assigning to the intensive care unit. Also, the acquisition of materials and equipment decreased. Conclusions: The measures implemented for the sustainability of the BF CPG during the 5 waves of the pandemic were positive. The programmes of implementation of BF guidelines were shown to resist the COVID- 19 pandemic. Impact: Our findings contribute to the understanding and evolution of the main indicators of the sustainability of a BF CPG on COVID- 19 context, providing details on the magnitude of the effect and the process of change. Reporting Method: The Preferred Reporting Items for observational studies (STROBE) checklist was followed. Patient or Public Contribution: No Patient or Public Contribution.
Open Access
Impact of COVID-19 Restrictions in Childbirth and Puerperium: A Cross-Sectional Study
(MDPI, 2023-01-13) Suarez Cortés, María; Castaño Molina, María de los Ángeles; Ramos Morcillo, Antonio Jesús; Molina Rodríguez, Alonso; Jiménez Ruiz, Ismael; Carrillo García, César; Harillo Acevedo, Francisco David; Hernández López, María Jesús; Enfermería
Introduction (1): The COVID-19 pandemic led to changes in healthcare during pregnancy, childbirth and puerperium. The objective of this study was to know the impact of visit restrictions, PCR performance and use of masks on delivery and puerperium care. Methods (2): A descriptive cross-sectional study was carried out. A survey was used to assess the impact of COVID-19-related measures on women who had given birth in hospitals in the Region of Murcia, Spain, between March 2020 and February 2022. Results (3): The final sample size was 434 women. The average scores were 4.27 for dimension 1 (Visit restrictions), 4.15 for dimension 2 (PCR testing) and 3.98 for dimension 3 (Mask use). More specifically, we found that the restriction of visits was considered a positive measure for the establishment of the mother–newborn bond (mean score 4.37) and that the use of masks at the time of delivery should have been made more flexible (mean score 4.7). Conclusions (4): The policy of restricting hospital visits during the pandemic caused by COVID-19 has been considered beneficial by mothers, who expressed that they did not feel lonely during their hospital stay.
Open Access
La filosofía de los cuidados centrados en el desarrollo del recién nacido prematuro (NIDCAP): una revisión de la literatura
(Murcia: Servicio de Publicaciones de la Universidad de Murcia, 2017) López Martínez, Ángel; Harillo Acevedo, Francisco David; Rico Becerra, Juan Ignacio
Objetivo. Conocer las intervenciones de la filosofía de los cuidados centrados en el desarrollo del recién nacido prematuro (NIDCAP) dirigidas a optimizar el macroambiente y el microambiente, junto a las actuaciones orientadas a la familia a fin de favorecer la estabilidad y la organización del desarrollo y la conducta del recién nacido prematuro; y a partir de aquí, evaluar la eficacia de su aplicación. Metodología. Se lleva a cabo una búsqueda bibliográfica (a partir de una serie de criterios de inclusión y exclusión específicos) en castellano y en inglés, durante el periodo 2010 a 2015, en las siguientes bases de datos: PUBMED, THE COCHRANE LIBRARY, SCOPUS, CUIDEN, DIALNET, LILACS, TDR y GOOGLE ACADÉMICO (se recurrió también a determinadas páginas web oficiales). Resultados. Se han centrado en la revisión del Macroambiente (luces, ruidos), el Microambiente (postura, manipulaciones, dolor), la Familia (padres principales cuidadores, método canguro, lactancia materna), y de la Evaluación de la eficacia de la aplicación del NIDCAP. Discusión. Se orienta, fundamentalmente, en la consideración del NIDCAP desde la perspectiva de la realidad (la prematuridad como primera causa de morbimortalidad neonatal e infantil), de la evidencia de la literatura, de la calidad/calidez de los cuidados, del coste económico, y del papel de los profesionales. Conclusiones. No hay evidencia de que el programa NIDCAP mejore el desarrollo neurológico a largo plazo o los resultados médicos a corto plazo, por lo que no se puede recomendar la aplicación del NIDCAP en su forma actual como atención estándar en recién nacidos prematuros. Si bien, al analizar las intervenciones que forman parte de los CCD o del NIDCAP de forma aislada, la mayoría de ellas se justifican desde el sentido común, la sensibilidad en los cuidados y el respeto a la familia y al niño.
Open Access
Evaluación de la implantación de la Guía de Buenas Prácticas “Lactancia Materna” de la Asociación Profesional de Enfermeras de Ontario (RNAO), en el Área III de Salud de la Comunidad Autónoma de la Región de Murcia
(Universidad de Murcia, 2021-03-17) Harillo Acevedo, Francisco David; Ruzafa Martínez, María; Ramos Morcillo, Antonio Jesús; Escuela Internacional de Doctorado
La Práctica Basada en la Evidencia se asume actualmente como un paradigma metodológico que ayuda en la toma de decisiones a los profesionales de la salud. Las Guías de Práctica Clínica (GPC) son herramientas que ayudan al profesional a incorporar las evidencias científicas a la práctica clínica diaria. El Área III de Salud de la Comunidad Autónoma de la Región de Murcia en el año 2011 presentó una candidatura al programa de carácter internacional Best Practice Spotlight Organizations (BPSO®) de implantación de GPC, desarrollado por la Asociación de Enfermeras Registradas de Ontario (RNAO®), con la finalidad de implantar GPCs. La candidatura fue aprobada y durante los años 2012-2015 se implantaron 5 GPCs, una de ellas de Lactancia Materna (LM). El objetivo general de esta tesis doctoral fue evaluar el proceso de implantación de la GPC de LM de RNAO en el contexto del programa de implantación BPSO®. Los objetivos específicos fueron: Identificar los factores asociados con las conductas de apoyo a la lactancia materna de los profesionales de la salud en un área de salud donde se implementó una GPC sobre LM de la RNAO adoptando la teoría planificada, Investigar las percepciones y experiencias de los profesionales de la salud y las madres en relación con un proceso de implantación de una GPC sobre LM guiado por el marco conceptual The Knowledge to Action Framework en un hospital regional del sistema nacional de salud español, Determinar las barreras identificadas por los gestores y profesionales sanitarios implicados en la implantación y sostenibilidad de una GPC de LM en un hospital español de tamaño medio en el marco del programa Best Practice Spotlight Organization. La tesis doctoral está organizada en tres estudios de investigación, uno observacional transversal y dos cualitativos. En el primero pretendíamos determinar el efecto de la implantación de la GPC de LM en los factores asociados al apoyo de la LM por parte de los profesionales, mientras que con los estudios cualitativos queríamos conocer las percepciones y experiencias de las personas implicadas en la implantación de la guía e identificar las barreras encontradas en todo el proceso. La población de estudio la componían los profesionales y usuarios del Área III de Salud. En el estudio transversal se utilizó un cuestionario validado que evalúa las actitudes, creencias, conocimientos, norma subjetiva e intención de conducta sobre el apoyo a la lactancia materna de los profesionales de salud. En los estudios cualitativos se realizaron entrevistas semiestructuradas donde se analizaron las experiencias vividas por las personas involucradas en el proceso de implantación de la GPC. Los resultados mostraron un aumento en el grado de apoyo a la LM de los profesionales sanitarios del Área III de Salud, así como, diferencias en la participación en la implantación según el rol o perfil del profesional y el grado de compromiso con el proceso de implantación de la GPC. Las barreras detectadas están vinculadas a la falta de recursos humanos, materiales y económicos; a los lugares donde se realiza la implantación, las características de quienes lo hacen, y a sus relaciones entre ellos; también se ha observado escasa difusión y diferente alcance del proyecto a los profesionales; los factores socioculturales relacionados con la madre y su entorno también han su puesto una barrera. La conclusión principal es que la implantación de la GPC de LM de la RNAO en el Área III de salud de la Comunidad Autónoma de la Región de Murcia ha supuesto para todos los actores implicados un proceso complejo, en el cual, se han llevado a cabo intervenciones multicomponentes que han requerido de una adaptación constante a barreras y entornos cambiantes. Se ha conseguido que disminuya la variabilidad en la práctica clínica debido a que se ha producido una unificación de criterios y estandarización de los cuidados relacionados con mejoras significativas en el apoyo a la LM. Además, comprender el rol de cada uno de los participantes durante el proceso, así como la detección de barreras encontradas ha facilitado el proceso de implantación de la guía tanto a nivel organizacional como de profesionales y usuarios.
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Using the Knowledge-to-Action Framework to understand experiences of breastfeeding guideline implementation: A qualitative study
(Wiley, 2020-08-03) Ramos Morcillo, Antonio Jesús; Ruzafa Martínez, María; Harillo Acevedo, Francisco David; Enfermería