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Objectives: To explore the rate of NUPs and associated factors in the PED of the 'Hospital Universitario y Politécnico La Fe' in Valencia (Spain) using Andersen's Behavioural Model. Methods: We conducted a descriptive cross‐sectional study using Andersen's Behavioural Model in parents visiting the PED with their children at the 'Hospital Universitario y Politécnico La Fe' in Valencia (Spain). Results: The study involved a total of 530 participants, of whom 419 (79%) had made an NUP. The predisposing factors identified were: (I) paediatric patients brought in by their fathers (OR = 0.460; p = 0.005), (II) lower educational attainment (OR = 3.841; p = 0.000), (III) first‐time parenthood (OR = 2.335; p = 0.000) and (IV) higher parental stress (OR = 1.974; p = 0.023). The enabling factors included: (I) responsibility for a significant part of the childcare shared with others (OR = 0.348; p = 0.041) and (II) the perception that PEDs provide better care than primary care (PC) services (OR = 1.628; p = 0.005). The need factors were: (I) existing chronic illness in the child seeking care (OR = 0.343; p = 0.000) and (II) the perceived severity of the urgency (OR = 0.440; p = 0.031). Conclusions: The NUP rates found in this study are similar to those found internationally. In accordance with Andersen's Behavioural Model, we identify predisposing, enabling and need factors to explain the multifactorial nature of NUPs in PEDs. Implications for Practice: Identifying the factors associated with NUPs enables interventions to be targeted at those groups most likely to engage in NUPs, thereby optimising the functioning of the PED and improving the well‐being of children and families. These interventions should focus on improving parental health literacy, providing education on making appropriate decisions about accessing health services and recognising severe symptoms in children, as well as improving access to high‐quality PC services. Providing support to parents during the transition to parenthood would also be beneficial. Reporting Method: This paper adheres to the STROBE initiative guidelines. Contribution from patients or members of the public: Participants, who voluntarily agreed to take part, contributed to the study by completing a paper‐based questionnaire containing all the study variables as prepared by the research team. [ABSTRACT FROM AUTHOR]

Aims: To assess the effects of COVID‐19 pandemic on clinical variables as part of the routine clinical monitoring of patients with chronic diseases in primary care. Design: A prospective longitudinal study was conducted in primary care centres of the Andalusian Health Service. Methods: Data were recorded before the pandemic (T1), during the declaration of the state of emergency (T2) and in the transition phase (T3). The Barthel index and the Short Portable Mental Status Questionnaire (SPMSQ) were used to analyse functional and cognitive changes at the three time points. HbA1c, systolic and diastolic blood pressure, heart rate, BMI and lipid levels were assessed as clinical variables. Descriptive statistics and non‐parametric chi‐square test were used for analysis. STROBE checklist was used for the preparation of this paper. Results: A total fo148 patients with chronic conditions were included in the analysis. Data analysis revealed in T2 only significant reductions in BMI, total levels of cholesterol and HDL during the onset of the pandemic. Barthel Index, SPMSQ, blood pressure and triglycerides and LDL levels worsened in T2, and the negative effects were maintained in T3. Compared to pre‐pandemic values, HbA1c levels improved in T3, but HDL levels worsened. Conclusions: COVID‐19 has drastically disrupted several functional, cognitive and biological variables. These results may be useful in identifying clinical parameters that deserve closer attention in the case of a new health crisis. Further studies are needed to assess the potential impacts of each specific chronic condition. Impact: Cognitive and functional status, blood pressure and triglycerides and LDL levels worsen in short term, maintaining the negative effects in medium‐term. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This paper aims to examine the satisfaction and depressed mood experienced by nursing home workers during the COVID‐19 pandemic and associated variables. Specifically, to analyse the factors that may contribute to nursing home workers developing adaptive behaviours that promote satisfaction or, on the contrary, show characteristics associated with a negative mood. Background: Nursing homes have faced unprecedented pressures to provide appropriately skills to meet the demands of the coronavirus outbreak. Design: A cross‐sectional survey design using the STROBE checklist. Methods: Professionals working in nursing homes (n = 165) completed an online survey measuring sociodemographic and professional characteristics, burnout, resilience, experiential avoidance, satisfaction with life and depression. Data were collected online from April to July 2021, the time in which Spain was experiencing its fifth wave of COVID‐19. Two multiple linear regression models were performed to identify salient variables associated with depressive mood and satisfaction. Results: Resilience, personal accomplishment and satisfaction had a significant and negative relationship with depression and emotional exhaustion, depersonalisation and experiential avoidance had a positive relationship with depression. However, emotional exhaustion, depersonalisation and experiential avoidance had a negative and significant relationship with satisfaction and personal accomplishment, and resilience had a positive and significant relationship with satisfaction. In addition, it was found that accepting thoughts and emotions when they occur is beneficial for developing positive outcomes such as satisfaction. Conclusions: Experiential avoidance was an important predictor of the effects that the COVID‐19 pandemic can have on nursing home workers. Relevance to Clinical Practice: Interventions focusing on resources that represent personal strengths, such as acceptance, resilience and personal accomplishment, should be developed. No Patient or Public Contribution: The complex and unpredictable circumstances of COVID's strict confinement in the nursing home prohibited access to the centres for external personnel and family members. Contact with the professionals involved could not be made in person but exclusively through online systems. However, professionals related to the work environment have subsequently valued this research positively as it analyses 'How they felt during this complicated process'. [ABSTRACT FROM AUTHOR]

Background: Malnutrition, sedentary lifestyle, cognitive dysfunction and poor psychological well‐being are often reported in patients on haemodialysis (HD). Aims: We aimed to explore needs, barriers and facilitators—as perceived by patients, their carers, and healthcare professionals (HCPs) for increasing the adherence to the diet, to physical activity and cognition and psychological well‐being. Methods: This is an observational cross‐sectional study following the STROBE statement. This study is part of an ERASMUS+ project, GoodRENal—aiming to develop digital tools as an educational approach to patients on HD. For that, the GoodRENal comprises HD centers located in four Belgium, Greece, Spain and Sweden. Exploratory questionnaires were developed regarding the perceived needs, barriers and facilitators regarding the diet, physical activity, cognition and psychological well‐being from the perspective of patients, their carers and HCPs. Results: In total, 38 patients, 34 carers and 38 HCPs were included. Nutrition: For patients and carers, the main needs to adhere to the diet included learning more about nutrients and minerals. For patients, the main barrier was not being able to eat what they like. Physical activity: As needs it was reported information about type of appropriate physical activity, while fatigue was listed as the main barrier. For Cognitive and emotional state, it was perceived as positive for patients and carers perception but not for HCPs. The HCPs identified as needs working as a team, having access to specialised HCP and being able to talk to patients in private. Conclusions: Patients and their carers listed as needs guidance regarding nutrition and physical activity but were positive with their cognitive and emotional state. The HCPs corroborated these needs and emphasised the importance of teamwork and expert support. [ABSTRACT FROM AUTHOR]

Aim and Objectives: To evaluate changes in compassion fatigue (CF), burnout (BO), compassion satisfaction (CS) and fear of COVID‐19 among Spanish nurses by comparing two assessment points: before and after the COVID‐19 vaccination campaign. Background: The COVID‐19 pandemic has produced a great impact in healthcare worker's professional quality of life, especially among nurses. CF, BO and fear of COVID‐19 decisively affect the care provided by nurses and put them at risk for mental health problems, so longitudinal studies are essential. Design: A repeated cross‐sectional design was carried out with a time‐lapse of 12 months. Methods: A total of 439 registered nurses in December 2020 and 410 in December 2021 participated in this study through an online survey. Data were collected using the Professional Quality of Life Questionnaire and the Fear of COVID‐19 Scale. Occupational and sociodemographic variables were also analysed. This article adheres to the STROBE guidelines for the reporting of observational studies. Results: The fear of COVID‐19 has not been reduced among nurses. The levels of BO remain stable and continue to be high in half of the professionals. CF has been reduced with a small effect size (d = 0.30), while CS has also decreased (d = 0.30). Positive correlations were found in both assessment points between fear of COVID‐19 and BO (r =.44, p ≤.001; r =.41, p ≤.001) and also between fear of COVID and CF (r =.57, p ≤.001; r =.50, p ≤.001). Negative correlations between fear and CS were also found (r = −.16, p =.001; r = −.22, p ≤.001). Relevance to Clinical Practice: Programmes to reduce fear of COVID‐19, BO and CF are needed to improve mental health and to prevent psychological distress among nurses, as well as to increase CS and preserve the productivity and quality of nursing care. Patient or Public Contribution: The nurses collaborated by participating in the present study anonymously and disinterestedly. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To learn about the attitudes of nurses working in the Andalusian Public Health System regarding euthanasia and its legalisation. Background: Euthanasia often finds itself in the crosshairs of ethical and political debate on an international scale. Currently, the Spanish Organic Law 3/2021 of 24 March, 2021, recognises euthanasia as a fundamental right in Spain. It is of particular interest to know about the views, attitudes and stances that Andalusian nurses have of euthanasia as they are key players within the framework of euthanasia and administration of life‐ending drugs. They play a central role in guiding patients through the euthanasia application process. Design: Observational descriptive study. Methods: A study of Andalusian Public Health System nurses was carried out using non‐probability convenience sampling. 518 nurses with an average age of 44.75 years answered in a questionnaire that was distributed on an online platform. Socio‐demographic and occupational variables were assessed, together with the Death Anxiety Scale and the Euthanasia Attitude Scale. A bivariate analysis and a multivariate linear regression model were performed. The STROBE checklist was used. Results: The mean score obtained on the Euthanasia Attitude Scale was 75.95 (SD = 16.53). The mean score obtained on the Death Anxiety Scale was 7.56 (SD = 3.05). The variables age and work experience were negatively correlated with the total scores of the Euthanasia Attitude Scale and the categories 'Ethical considerations', 'Practical considerations' and 'Treasuring life'. On the other hand, there was a significant positive correlation between age and work experience and 'Spiritual beliefs' category. Conclusions: The current situation shows a worrying paradox. There is a stark difference between positive professional attitudes towards euthanasia and the desire to participate in its application. Relevance to Clinical Practice: It is vital that educational and healthcare institutions make the necessary efforts to ensure that nurses develop sound moral judgement, displaying the moral conscience and ethical commitment required of this established profession. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims and objective: To describe the experiences of nursing students and their mental health as they entered employment during the first wave of the COVID‐19 pandemic (May–June 2020). Background: As other healthcare professionals, nursing students who worked during the first COVID‐19 wave suffered from dysfunctional mental health symptoms. Design: Sequential, mixed‐method, multicentre study. Methods: The study population comprised 92 students in the third and fourth year of the Nursing degree at three Spanish universities, who entered employment during the pandemic. Data were collected between May and June 2020. In the quantitative phase, data were collected using an online questionnaire containing both validated anxiety and stress scales. In the qualitative phase, semi‐structured interviews were conducted with 18 participants. A descriptive analysis of the quantitative data and a reflexive thematic analysis of the qualitative data were carried out, and analyses were combined. COREQ checklist was used for reporting. Results: The combined quantitative and qualitative results were organised into five thematic areas: (1) Interruption of clinical placements, (2) Entering employment on a healthcare assistant contract, (3) Preventing contagion, (4) Adapting to the situation and managing emotions, and (5) Lessons learned. Conclusion: The students had a positive overall experience of entering employment, as they were able to develop their nursing skills. However, they had an emotional impact in form of stress caused by excessive responsibility, academic uncertainty, lack of personal protective equipment and training in its use, and the possibility of spreading disease to their family members. Relevance to Clinical Practice: In the current context, changes must be made in study programmes to instruct nursing students to be able to cope with extreme clinical situations, such as pandemics. The programmes should include a more extensive coverage of epidemics and pandemics and management of emotional aspects such as resilience. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To determine the prevalence and levels of anxiety and depression symptoms among nursing students during the coronavirus lockdown, and to examine factors associated with higher levels of anxiety and depression on this population. Background: Nursing students deal with diverse stressors during their university lives. Confinement measures during COVID‐19 outbreak may have influenced students' mental health and well‐being. Anxiety and depression are common among nursing students due to different factors. Evidence relating to anxiety and depression in nursing student population during SARS‐CoV‐2 pandemic is limited. Design: A cross‐sectional descriptive co‐relational study during the lockdown due to the coronavirus outbreak in Spain was conducted. Methods: An online questionnaire was developed by using google forms. Sociodemographic characteristics form, and the Spanish version of the Hospital Anxiety and Depression Scale (HADS) were used. Spanish nursing students across the country were enrolled. Data collection was performed between 4 April 2020 and 21 April 2020. A multivariate analysis was performed to determine the association between sociodemographic variables, COVID‐19 and HADS scores. Results: 1319 participants were enrolled. The sample was formed by 87.1% female students with a mean age of 22 years (SD ± 5.677). We found a mean score of 8.47 ± 4.104 on Scale HADS‐Anxiety and 6.80 ± 2.988 on HADS‐Depression. 31.6% students presented abnormal scores of anxiety symptoms, and only 11.4% participants revealed abnormal scores on HADS‐Depression. Conclusions: The reported prevalence of anxiety and depression symptoms on nursing students during the COVID‐19 lockdown is 56.4% and 38.2%, respectively. 43.6% of the sample scored normal anxiety levels, and 61.8% obtained normal depression levels. Higher anxiety and depression levels were statistically associated with being a first‐year student, being a smoker, feeling fear, feeling stress and having any close family member infected. Relevance to clinical practice: These data should be valuable for detection and for further treatment decision of this disorders at the initial stage and could be important to prevent further damages to mental health and promote physical, psychological and well‐being among this population. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of this study was to assess the effect of the FreeStyle Libre device implantation in adult type 1 diabetics in a Health Area of Castilla La Mancha (Spain) during the COVID‐19 pandemic. Background: FreeStyle Libre is a so‐called mHealth device that supports health care. During COVID‐1 confinement, diabetic patients could have improved their glycaemic monitoring thanks to these devices, although health care in these patients may have been limited due to confinement. Methods: A 12‐month longitudinal study in which a total of 206 type I diabetics participated, belonging to a single health area. Sociodemographic and analytical data and the Self Care Inventory Revised questionnaire (SCI‐R) were collected. STROBE checklist was followed. Results: The analysis showed differences related to the use of the sensor. After the study period, patients obtained better levels of basal glucose, glycosylated haemoglobin, creatinine, cholesterol, triglycerides and LDL. In addition, a significant increase in the total score of the SCI‐R questionnaire was observed after the use of the monitor (MD −7.77; 95% CI −10.43, −8.29). The same occurred with different SCI‐R items such as diet (MD ‐2.995; 95% CI −3.24, −2.57), glucose determination (MD −3.21; 95% CI −3.52, −2.91), medication administration (MD −2.58; 95% CI −2.53, −1.96) and hypoglycaemic episodes (MD −1.07; 95% CI −1.21, −0.93). In the analysis by groups, worse values of glycosylated haemoglobin and adherence to treatment (p <.05) were observed in overweight/obese subjects versus those with normal weight after one year of study. Conclusion: The use of flash monitoring is related to better adherence to most of the recommended habits in diabetes. Nevertheless, there seems to be no relationship with an improvement in physical exercise and preventive aspects of diabetes. A good nursing intervention to support physical exercise and the use of mHealth devices could improve the control of diabetic patients. Relevance to clinical practice: The use of this mHealth device has shown positive results and reduced complications. Despite less contact with healthcare facilities due to the pandemic, type 1 diabetic patients have improved their blood results and adherence after using the device for one year. Nursing staff should focus on promoting physical activity and routine disease care in type 1 diabetics. [ABSTRACT FROM AUTHOR]

Aim: To design and implement a plan to improve oncohaematological patients' sleep. Background: The hospital environment can compromise inpatients' sleep, negatively impacting on health outcomes and patient satisfaction. Design and Method: The improvement plan was designed in collaboration with 18 professionals, 3 patients and 3 accompanying relatives. The study designed followed the SQUIRE 2.0 guidelines. Outcome variables were self‐reported patient satisfaction regarding sleep, measured using a 30‐item, ad hoc questionnaire and a 10‐point visual analogue scale, completed by 318 oncohaematological inpatients (pre‐intervention n = 120, post‐intervention, n = 198) in a comprehensive cancer centre in Spain from 2017 to 2019. Results: Overall, 61.5% (n = 190) of the inpatients reported sleep alterations, and 92.6% reported interruptions in their nightly sleep. Half slept less than 6 h/night, but 58.0% said they felt rested upon waking, despite the interruptions. These outcomes were similar before and after the intervention. The improvement plan identified four domains for work (professionals, care procedures, instruments/environment and patients/relatives), 10 areas for improvement and 35 actions for implementation. However, overall sleep worsened significantly, from 6.73 to 6.06 on the 10‐point scale. The intervention significantly improved variables related to professionals' behaviour, including noise during the shift change, conversations at the control desk and the use of corridor lights. Sleep disturbances were mainly caused by pain/discomfort and infuser alarms, and collectively they decreased significantly after the intervention (p =.008). However, overall sleep worsened significantly, from 6.73 to 6.06 on the 10‐point scale. Conclusions: Pain, clinical devices and noise made by professionals are the main causes of sleep disturbances. Involving professionals in decision‐making to improve patients' sleep have a positive impact on noise levels. Relevance to clinical practice: This study proposes new strategies for improving sleep by increasing staff awareness and changing attitudes towards patients' sleep. Nurses should be involved in addressing sleep disturbances during hospitalization. [ABSTRACT FROM AUTHOR]

Aims and objectives: The objectives of this study were to assess the benefits of a caregiver training programme on the cognitive and functional status of older adults, and to compare the effects of this programme according to type of caregiver (professional vs. family caregiver). Background: Due to demographic changes that have resulted in an aging population, the role of caregiver of an older adult has become very important in recent years. Design and Methods: The sample was composed of 160 older adults: (a) 100 received care from caregivers who had taken the three‐month training programme (treatment group), of which 60 were professional caregivers and 40 were family caregivers, and (b) 60 received care from caregivers who had not taken the programme (control group). In order to evaluate programme effects on cognitive and functional status, we used both direct measures answered by the older adults (MMSE, CAPE and EuroQol) and caregiver reports (Barthel and RMPBC). We used a quasi‐experimental, pre‐post design. We followed SQUIRE 2.0 guidelines for reporting. Results: The results showed that older adults who were cared for by caregivers that had participated in the training programme showed gains in quality of life and cognitive ability and maintenance of functional ability. Within the treatment group, although everyone significantly improved their scores, the older adults cared for by family caregivers improved in more of the cognitive sub‐items than did their peers in the professional caregiver group. Conclusions: The data obtained show that a caregiver training programme based on cognitive stimulation produces cognitive, functional and health‐related quality‐of‐life benefits in older adults. Furthermore, the caregivers reported increased satisfaction with their work. Relevance to clinical practice: The improvements obtained in the older adults and in caregivers show the relevance of this type of intervention when working in the clinical field of caregiving. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate the commitment and level of self‐perceived training in evidence‐based practice among students of the Nursing degree of five Spanish universities. Background: In university Health Sciences degrees, evidence‐based clinical practice can directly or indirectly impact the quality of care, the cost of the service provided and the safety of clinical practice. Design: Multicentre cross‐sectional observational study according to STROBE guidelines. Methods: The evidence‐based skills in Practice questionnaire (CACH‐PBE, for its acronym in Spanish) and the Utrecht Work Engagement Student Scale (UWES‐9S) were used. The study was performed in five Spanish universities (Alicante, Castilla La Mancha, Jaen, Huelva and Seville) from October to December 2020, with 755 participants (Nursing students). Results: A total mean score of 91.9 points (SD = 11.81) was observed for the CACH‐PBE questionnaire and of 36.8 points (SD = 8.48 points) for the UWES‐9S. In addition, the multivariate analysis predicted that variables such as sex, academia, university, intention to do a Master or Doctorate degree, the level of work engagement, and the previous training in evidence‐based clinical practice were associated with a greater perception of evidence‐based practice. Conclusion: The sample of Nursing degree students has intermediate‐high levels of knowledge, skills and attitudes regarding evidence‐based practice and work commitment, with differences observed between each of the universities. Relevance to clinical practice: Nursing students should develop from intermediate to high levels of knowledge, skills and attitudes regarding evidence‐based practice and work commitment. There are various actions to promote EBP, such as the incorporation of a specific course covering the subject into the nursing curriculum, and the selection, for clinical practices, of care units that implemented evidence‐based care. [ABSTRACT FROM AUTHOR]

Aim: To elicit the experiences and perspectives of health professionals working on the frontline in the COVID‐19 pandemic. Background: Although some qualitative studies have been carried out in health professionals during COVID‐19 pandemic, to our knowledge, no study has used the Photovoice method. Design: A qualitative descriptive study using Photovoice was carried out between March and June 2020. Methods: A total of 20 health professionals were recruited from public and private healthcare services. The participants were invited to share photographs about their experiences while working during COVID‐19 pandemic. Following the Photovoice method, audio‐recorded interviews were conducted. The data were analysed using the 'SHOWED' mnemonic, with five questions answered about each photograph. The EQUATOR checklist has been used. Results/Findings: Three themes emerged: (1) Personal attitudes of health professionals; (2) Support from the community; and (3) Management of institutional resources. Despite the fact that health professionals in this study were exposed to major risks while caring for patients with COVID‐19' they felt a strong sense of responsibility towards the community. In order to handle these stressful situations, they used coping mechanisms, good humour and leisure, but also received support from the population, who saw them as highly skilled health professionals. Conclusion: These findings highlight the essential role of health professionals in the COVID‐19 pandemic and the tireless work they are carrying out to provided highly skilled care. Relevance to clinical practice: These findings could contribute to raise awareness on the needs of health professionals during the pandemic, allowing managers to plan strategies to ensure the safety, and well‐being of these professionals, as well as adopting similar strategies in their practice to create a space for critical reflection through participatory approaches. [ABSTRACT FROM AUTHOR]

Aims and Objectives: We aimed to determine the impact of COVID‐19 related home confinement on the paediatric population by focusing on anxiety, behavioural disturbances and somatic symptoms. Background: To limit the spread of the COVID‐19 outbreak, governments have imposed nationwide lockdowns to prevent direct contact; this has affected everyday lives and activities such as attending school classes. Such isolation may have impacted children's anxiety levels. Design and Methods: We conducted a cross‐sectional observational study using a web‐based anonymous questionnaire from 22–26 April, 2020, among children (N = 2,292) in Spain. For children below 7 years of age, parents reported the children's behavioural, emotional and somatic symptoms and family environment data on a questionnaire designed by the researchers. Children over 7 years answered the Revised Children's Manifest Anxiety Scale either independently or with their parents' assistance. Results: Children over 7 years, boys in particular, scored high on the anxiety spectrum. Moreover, participants who knew someone who had suffered from COVID‐19 at home or whose parent was directly involved in the pandemic, obtained higher Total Anxiety scores. Significantly high values were found in all aspects of anxiety among those who feared infection or whose parents been unemployed. Of the children below 7 years, 56.3% had four or more anxiety‐related symptoms, the most frequent of which were tantrums, emotional changes, restlessness and fear of being alone. The number of symptoms reported was significant when someone in the family home had been infected with COVID‐19. Conclusions: The COVID‐19 home confinement had a significant impact on children, causing anxiety, behavioural problems and somatic manifestations. Relevance to clinical practice: Nurses play a key role in screening children who have experience confinement owing to the COVID‐19 pandemic in order to detect early anxiety symptoms using tele‐health. Suitable direct interventions can then be implemented or interdisciplinary manage could be started. [ABSTRACT FROM AUTHOR]

Background: Informal caregivers of patients with multiple chronic conditions are socially good, promoting the sustainability of a large part of home care provision. However, this very demanding activity causes health problems that increase their own need for health services. This study analyses the use of health services by informal carers, comparing it with the use made by the general population with similar characteristics. Methodology: Cross‐sectional analytical study carried out in the Malaga‐Valle Guadalhorce Primary Health Care District (Spain). Healthcare demand and perceived health were measured in the family caregivers, compared to the general population. Strobe Statement for observational studies has been used to strength the report of the results. Results: Final sample consisted of 314 family caregivers together with a subsample of 2.290 non‐caregivers taken from data of the National Health Survey. This subsample was paired by gender with our sample. Formal caregivers make fewer annual visits to the health services, with respect to the general population, regardless of the perceived level of health. The difference of the means between those who perceive their health as very poor was 0.11 (95% CI: 0.01 to 0.20) consultations with the family doctor, 0.21 (95% CI: 0.15 to 0.26) consultations with medical specialists and 1.70 (95% CI: 1.52 to 1.87) emergency room attention. Three independent factors were identified that predispose to the increased use of health services: background of greater education achievement (OR 8.13, 95% CI: 1.30 to 50.68), non‐cohabitation with the care recipient (OR 3.57, 95% CI: 1.16 to 11.11) and a more positive physical quality of life component (OR 1.06; 95% CI: 1.03 to 1.09). Discussion and Implications: Intrinsic components of the caregiver reveal their independent relationship with the provision of informal care and the use of health services. A broader vision is needed for the factors that influence the health of these caregivers to develop multipurpose interventions and improve the consistency and effectiveness of the health services offered to the caregiver. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of the study was to compare advanced practice in epilepsy nurses in Spain and United Kingdom, identifying differences in the domains of standard advanced practice. Background: Europe has recently faced the challenge of providing high‐quality care for patients with epilepsy, a disease that generates many health demands. In some countries, such as the United Kingdom, advanced practice nursing is well established and could serve as a guide for implantation in countries where it is still in development, as is the case of Spain. Design: A multicentre cross‐sectional descriptive cohort study compared differences in the roles of advanced practice nurses in Spain and the United Kingdom. Methods: The Advanced Practice Role Delineation Tool and its validated Spanish version were administered using an online questionnaire in a cohort of advanced practice epilepsy nurses in both countries. A convenience sample was recruited between January to December 2019. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Results: Most United Kingdom nurses in our sample came from community environments, in contrast to Spanish nurses who worked in hospital. All domains analysed in the survey had significantly higher scores in the United Kingdom than in the Spanish cohort, especially in the research and leadership domains. Conclusions: The advanced practice role in Spain is underdeveloped compared with the United Kingdom. Differences in the settings of advanced roles in epilepsy nurses may be explained by greater community practice in the United Kingdom and differences in organisational and health systems. Relevance to clinical practice: Our study showed the need to implement specific policies to develop advance practice nurse roles in Spain to improve the quality of care of patients with epilepsy. [ABSTRACT FROM AUTHOR]

Aims and objectives: To analyse the prevalence, levels and phases of burnout syndrome in midwives and obstetrics and gynaecology nurses, and to evaluate the relationship between burnout and sociodemographic, occupational and psychological factors. Background: Burnout syndrome is a major problem in occupational health, characterised by feelings of exhaustion, depersonalisation and a low sense of personal achievement that appears after long‐term occupational stress. Recent research has found that burnout harms the physical and mental well‐being of workers, and jeopardises the quality of care provided. The association between burnout and a risk profile in maternity wards has not previously been investigated but it deserves special attention since it is a highly stressful area to work in. Design: A cross‐sectional survey design was selected. Methods: A total of 150 nurses and midwives at 18 hospitals participated in this study. The data were collected using the Maslach Burnout Inventory, NEO Personality Inventory and the Educational‐Clinical Questionnaire: Anxiety and Depression. This study adhered to the STROBE guideline. Results: 17% of participants presented high levels of emotional exhaustion, 16.6% high depersonalisation and 55.1% a sense of low personal accomplishment. The sociodemographic and occupational variables related to burnout were gender, marital status and work shift. The three dimensions of the syndrome, emotional exhaustion, depersonalisation and personal accomplishment were predicted by depression, neuroticism, agreeableness and openness. Conclusions: One third of the sample presented high levels of burnout, which was most strongly experienced as feelings of low personal accomplishment. Furthermore, personality factors play an important role in the development of burnout syndrome. Relevance to clinical practice: Managers and policy makers should promote strategies to reduce burnout. To prevent the syndrome, personality factors should be taken into account, for the early identification of a profile of professionals most at risk of developing burnout. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate compassion fatigue (CF), burnout (BO), compassion satisfaction (CS) and perceived stress in healthcare professionals during the coronavirus disease 2019 (COVID‐19) health crisis in Spain. Background: Spain has been one of the countries hardest hit by the health crisis caused by the COVID‐19 pandemic. Healthcare professionals have had to deal with traumatic and complex situations in the work context. In these particularly stressful situations, many professionals may develop CF or BO, which puts them at risk for mental health problems. Design: Cross‐sectional online survey. Methods: A total of 506 healthcare professionals (physicians and nurses) who were working in healthcare centres during the COVID‐19 pandemic participated. CF, CS and BO were assessed with the Professional Quality of Life Questionnaire, and perceived stress was measured with the Perceived Stress Scale‐14. Socio‐demographic and occupational variables were also analysed. Data were collected during the period of the highest incidence of cases and highest mortality rates due to COVID‐19 in Spain. This article adheres to the STROBE guidelines for the reporting of observational studies. Results: Physicians had higher CF and BO scores, while nurses had higher CS scores. Perceived stress scores were similar in both occupations. Professionals working in specific COVID‐19 units and in emergency departments had higher CF and BO scores, while levels of CS and perceived stress were similar regardless of the workplace. Relevance to clinical practice: Despite the health crisis situation and its implications for healthcare professionals, the levels of CF and BO have remained moderate/high. However, CS seems to be increasing, especially among nurses, possibly due to their motivation to relieve suffering and due to their perceived social recognition. It is necessary to implement interventions that help improve CS and prevent BO and CF among professionals in the long term. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To establish the predictive utility of specific social support domains for emotional well‐being in cancer caregivers, six months after their partner's cancer diagnosis. Background: In cancer caregivers, social support has been consistently related to anxiety and depression. There is little information, however, about the predictive utility of specific social support domains for psychological well‐being in the first six months after a partner's cancer diagnosis. Design: Longitudinal research study. Methods: Sixty‐seven caregivers of recently diagnosed cancer patients were recruited from the Reina Sofia University Hospital in Cordoba (Spain). Participants completed a set of questionnaires including the Berlin Social Support Scale (BSSS), the Hospital Anxiety and Depression Scale (HADS) and a socio‐demographic questionnaire. Data were collected at two time points: T1 (30–45 days after diagnosis) and T2 (180–200 days after). TRIPOD checklist was used. Results: Most of the caregivers were female (65%) and the partner of the patient (58%), with an average age of 51.63 years (SD = 13.25). Statistical differences were observed between the two assessment points for the social support domains of perceived emotional support, satisfaction with support and protective buffering. Logistic regression analysis showed that less physical and sports activity, more support seeking and less informational support received at T1 predicted anxiety at T2, while less perceived available support predicted depression. Conclusions: Accurate information and support from other members of the community and the promotion of physical and sports routines for cancer caregivers may help to alleviate symptoms of anxiety and depression in the first months after a partner's cancer diagnosis. Relevance to clinical practice: Clinicians must pay attention to the social support needs and physical activity of caregivers in the first days after diagnosis, in order to prevent anxiety and depression. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the association between registered nurses' (referred to as "nurses" for brevity) shifts of 12 hr or more and presence of continuing educational programmes; ability to discuss patient care with other nurses; assignments that foster continuity of care; and patient care information being lost during handovers. Background: The introduction of long shifts (i.e., shifts of 12 hr or more) remains controversial. While there are claims of efficiency, studies have shown long shifts to be associated with adverse effects on quality of care. Efficiency claims are predicated on the assumption that long shifts reduce overlaps between shifts; these overlaps are believed to be unproductive and dangerous. However, there are potentially valuable educational and communication activities that occur during these overlaps. Design: Cross‐sectional survey of 31,627 nurses within 487 hospitals in 12 European countries. Methods: The associations were measured through generalised linear mixed models. The study methods were compliant with the STROBE checklist. Results: When nurses worked shifts of 12 hr or more, they were less likely to report having continuing educational programmes; and time to discuss patient care with other nurses, compared to nurses working 8 hr or less. Nurses working shifts of 12 hr or more were less likely to report assignments that foster continuity of care, albeit the association was not significant. Similarly, working long shifts was associated with reports of patient care information being lost during handovers, although association was not significant. Conclusion: Working shifts of 12 hr or more is associated with reduced educational activities and fewer opportunities to discuss patient care, with potential negative consequences for safe and effective care. Relevance to clinical practice: Implementation of long shifts should be questioned, as reduced opportunity to discuss care or participate in educational activities may jeopardise the quality and safety of care for patients. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate the availability of, adherence to, and perceived usefulness of guidelines and protocols for managing hydration and subcutaneous hydration in palliative care settings. Background: Hydration at the end of life and the use of a subcutaneous route to hydrate generate some controversy among health professionals for different reasons. Having guidelines and protocols to assist in decision‐making and to follow a standard procedure may be relevant in clinical practice. Design: Cross‐sectional telephone survey, with closed‐ended and open‐ended questions designed specifically for this study. Methods: Data were obtained from 327 professionals, each from a different palliative care service. Mean, standard deviation, minimum and maximum were calculated for continuous variables; frequency distributions were obtained for categorical variables. A qualitative content analysis was performed on the open‐ended questions. The article adheres to the STROBE guidelines for reporting observational studies. Results: Only 24.8% of the participants had guidelines available to assist in making decisions regarding hydration, and 55.6% claimed to follow them 'always or almost always'. Of the participants, 38.8% had subcutaneous hydration protocols available, while 78.7% stated that they 'always or almost always' followed these protocols. The remaining participants considered the protocols as useful tools despite not having them available. Conclusions: Only 25% of the participants' services had guidelines for hydration, and less than 40% had protocols for subcutaneous hydration. However, adherence was high, especially in cases where protocols existed. Among the participants who did not have guidelines and protocols, attitudes were mostly favourable, but mainly as a reference and support for an individualised clinical practice. Relevance to clinical practice: Guidelines and protocols on hydration in palliative care may be more useful as a solid reference and support for individualised practice than as instruments for standardising care. From this perspective, their development and availability in palliative care services are recommended. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate the opinion of hospital nurses on a group of recommendations aimed at reducing low‐value nursing care and, based on these results, to detect low‐value practices probably existing in the hospital. Background: Low‐value nursing care refers to clinical practices with poor or no benefit for patients that may be harmful and a waste of resources. Detecting these practices and understanding nurses' perceptions are essential to developing effective interventions to reduce them. Methods: We conducted a survey in a tertiary hospital. STROBE guidelines were followed. The questionnaire appraised nurses' agreement, subjective adherence and perception of usefulness of a group of recommendations to reduce low‐value nursing care from Choosing Wisely and other initiatives. Practices described in recommendations with an agreement over 70% and a subjective adherence under 70% were categorised as low‐value practices probably existing in the hospital. Results: A total of 265 nurses from eight areas of care participated in the survey. The response rate by area ranged between 2%–55%. From the 38 recommendations evaluated, agreement was 96% (95% confidence interval [95%CI], 95%–97%), median subjective adherence was 80% (95%CI, 80%–85%), and usefulness was 90% (95%CI, 89%–92%). Based on these results, we detected seven (0–15) low‐value practices probably existing in our hospital, mostly on general practice, pregnancy care and wound care. Conclusions: We found a great understanding of low‐value care between nurses, given the high agreement to recommendations and perception of usefulness. However, several low‐value practices may be present in nursing care, requiring actions to reduce them, for instance, reviewing institutional protocols and involving patients in de‐implementation. Relevance to clinical practice: Hospitals and other settings should be aware of low‐value practices and take actions to identify and reduce them. A survey may be a simple and helpful way to start this process. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore staff reactions to residents' behaviour consisting in exposing their genitals in public, and to differentiate between what is perceived as common practice (what most staff do) and best practice (the best possible approach). Background: The presence of inappropriate sexual behaviours (ISBs) in long‐term care facilities poses practical and ethical dilemmas since they may impinge on the rights of others (staff and residents) and thus need to be adequately monitored and managed. However, no studies have focused on how staff handle ISBs, and particularly exposing oneself in public. Methods: A total of 2,175 people working in 152 Spanish LTC facilities participated in the study. They were presented with a vignette describing a resident exposing his/her genitals in public, and they were asked what they think most of their workmates would do and what they think should be done in that situation. The STROBE checklist was used to enhance the quality and transparency of the research. Results: Approximately one‐third of participants (32.4%) reported having experienced behaviours such as the one described in the vignette. Staff reactions underline the predominance of restrictive practices. However, if prompted to think in terms of best practice, supportive reactions increased in frequency. Finally, factors such as work position have an influence on perceived common and best practices, with care assistants generally holding more restrictive views than directors or technical staff. Conclusions: Around one‐third of staff members, and particularly those in managerial or technical positions, had witnessed residents exposing their genitals in public. However, there is no common ground among staff regarding the best way to handle the situation. Relevance to clinical practice: Our findings stress the importance of organisational policies and workplace training in the management of challenging behaviours such as exposing oneself. [ABSTRACT FROM AUTHOR]

Aim and objective: To describe relations among health, job satisfaction, work engagement and job features in Spanish nurses working in a public hospital. Background: It has been established that nursing staff health affects the quality of their work and is associated with job satisfaction, work engagement and different job features. Understanding the relationships among these variables could provide useful information to improve staff performance and prevent work‐related illnesses. Design: A descriptive, cross‐sectional, correlational and comparative study was performed between January–April 2016. This research adheres to the Strengthening the Reporting of Observational Studies in Epidemiology guideline. Methods: A total of 926 nurses were requested to complete an online questionnaire. Nurses on sick leave or in period of unpaid leave during data collection were excluded. The final study population reached 392 nurses. The online survey was fully completed by 373 nurses. General health, job satisfaction and work engagement were measured. Tools used were as follows: sociodemographic questions, the General Health Questionnaire, the Overall Job Satisfaction Scale and the Utrecht Work Engagement Scale. Results: Significant correlations among general health, job satisfaction and work engagement were found. Specifically, general health levels were negatively correlated with job satisfaction and work engagement subscales. Job features with influence on these constructs were the type of shift, type of contract, type of service, salary, type of continuous formation and having a specialty/profile. Conclusions: Our results indicate that job‐related features affect job satisfaction, general health and work engagement. The organisation should make interventions over these features to increase job satisfaction and work engagement levels, since they are relevant for nursing staff health and patient security. Relevance to clinical practice: The analysis of the relationships among general health, job satisfaction, work engagement and job features in nurses could offer a basis to design preventive programmes to improve staff performance and prevent work‐related illnesses. [ABSTRACT FROM AUTHOR]

Aims and objectives To understand the relation between the experience of violence and sociodemographic and clinical factors, and to determine whether diagnosed depression and the presence of anxiety and stress are related to having experienced workplace and domestic violence in different genders and age groups. Background Previous studies indicate that domestic and workplace violence increase the risk of suffering from depression. However, no studies have evaluated these two types of violence in a same cohort. Design and methods We designed a descriptive cross-sectional study from 317 individuals randomly selected from the population in southern Catalonia (Spain). Sociodemographic and Goldberg anxiety-depression questionnaires were administered by telephone survey to 160 men and 157 women in December 2008. The data obtained were analysed by a logistic regression model. Results A quarter of the individuals had suffered from violence: 48·29% of them had experienced domestic violence and 32·9% had experienced workplace violence. Nearly half of the individuals with depression had experienced violence. No statistical difference has been observed between domestic and workplace violence regarding diagnosed depression. Women were twice as likely as men to have suffered from violence. People working outside their home and those who claimed to have no social support had a greater risk of suffering from violence. A greater consumption of medication, above all of psychotropic drugs, is associated with experiencing violence and with greater comorbidity. Predictive factors for suffering from depression are being women, having experienced violence, having suffered stress or anxiety, having little or no social support, having overload of task or having no secondary education and no tertiary education. Conclusions This study suggests that when considering depression, anxiety and stress, especially in women, we must take into account whether an individual has suffered violence. Relevance to clinical practice Identifying violence can help health professionals, managers and researchers improve care and reduce suffering in families and communities. [ABSTRACT FROM AUTHOR]

Aims and objectives To research the quality of life of Spanish women with coeliac disease. Background Women with coeliac disease express lower quality of life than men with coeliac disease. Design Explanatory sequential approach using mixed methods and with a gender perspective. Methods The research was carried out between May and July 2015. In its quantitative stage, it aimed to determine the health-related quality of life in a representative sample ( n = 1097) of Spanish adult women with coeliac disease using a specific questionnaire named Coeliac Disease-Quality of Life. In its qualitative phase, it aimed to describe the life experiences of a woman with coeliac disease in a qualitative manner by means of interviews ( n = 19) with a semistructured script. Quantitative data were analysed using spss version 20 and presented in descriptive statistics. Qualitative data were analysed using the directed content analysis. Results The quantitative process gave us the values on the four aspects studied: dysphoria, disease limitations, health problems and inadequate treatment. These aspects allowed us to create a qualitative process, based on which we generated an interview, from which four larger categories emerged. These categories were feelings at diagnosis, limitations in day-to-day life, social perceptions of the disease and personal meanings of coeliac disease. Thus, both phases of our project are totally connected. There was a high level of congruence between quantitative scores and narratives. Conclusion This study shows us the strong points of mixed-methods strategy in health sciences. The mixed-methods strategy gave us a wider view of the experience of women living with coeliac disease. In our case, a strength and not a limitation is having performed the quality of life study in women with coeliac disease using a mixed methodology, approaching the experience of being a woman with coeliac disease in Spain in two different but complementary ways. The quantitative and qualitative data allowed us to interpret the experiences of our participants. [ABSTRACT FROM AUTHOR]

Aim and objective To assess the association between work in a rotating shift schedule and menstruation characteristics among nurse staff in a prospective study. Background Rotating shifts have been linked to alterations in the reproductive cycle. In the case of menstrual alterations, the conclusions are not clear. Design Prospective epidemiological study with follow-up over four months. Method All the female nurse staff (<40 years) in a hospital were interviewed, collecting sociodemographic and employment information. They were given a menstrual diary to keep a record of their shifts and characteristics of their menstruation (duration, amount of blood, dysmenorrhoea). They had two types of shifts: (1) Rotating shift schedule (two mornings, two afternoons, one night and two days off) including morning shifts (8:00-15:00), afternoon/evening shifts (15:00-22:00) and night shifts (22:00-8:00), and (2) Day shift schedule including morning shifts (8:00-15:00) and/or afternoon/evening shifts (15:00-22:00). The crude and adjusted odds ratios with 95% confidence interval were calculated using logistic generalised estimating equations (GEE) taking into account the correlations of multiple cycles per worker. Results One hundred and thirteen workers on the rotating shift and 75 on the day shift participated, and information from 730 menstrual cycles were obtained. There were no differences in prolonged duration, dysmenorrhoea, prolonged duration dysmenorrhoea and excessive bleeding among nurses on rotating shift compared to those on the day shift. For prolonged duration of menstruation, workers with more than five years on the rotating shift showed a slightly lower (nonsignificant) risk compared with those with <5 years. Conclusions Nurse staff on the rotating shift did not show increased risk of having menstrual disorders comparing with day staff. Relevance to clinical practice Shifts with short rotation cycles and a progressive sequence do not appear to cause menstrual disorders in nurse staff who work rotating shifts. [ABSTRACT FROM AUTHOR]

Aims and objectives This study aimed to translate the community nursing version of the Developing Evidence-Based Practice questionnaire, adapt the Spanish translation to the primary care context in Spain, and evaluate its reliability and validity. Background Instruments available in Spanish to date are not designed to rigorously evaluate barriers and incentives associated with evidence-based practice implementation in community health nursing. Design Classical Test Theory approach. Methods The 49-item Developing Evidence-Based Practice questionnaire was translated, back-translated and pilot-tested. Two items were added to assess respondents' ability to read and understand the English language. During the first six months of 2010, 513 nurses from 255 primary health care centres in Catalunya (Spain) voluntarily participated in the study. Internal consistency and test-retest reliability were evaluated. Internal structure was analysed by principal component analysis. A randomized, controlled, parallel-design study was carried out to test scores' sensitivity to change with two groups, intervention and control. The intervention consisted of eight hours of in-person training, provided by experts in evidence-based practice. Results Of 513 nurses, 445 (86·7%) nurses responded to all 51 items. Factor analysis showed six components that explained 51% of the total variance. Internal consistency and test-retest reliability were satisfactory (Cronbach α and intraclass correlation coefficients >0·70). A total of 93 nurses participated in the sensitivity-to-change tests (42 in the intervention group, 51 controls). After the training session, overall score and the 'skills for evidence-based practice' component score showed a medium (Cohen d = 0·69) and large effect (Cohen d = 0·86), respectively. Conclusions The Developing Evidence-Based Practice questionnaire adapted to community health nursing in the primary care setting in Spain has satisfactory psychometric properties. Relevance to clinical practice The Developing Evidence-Based Practice questionnaire is a useful tool for planning and evaluating the implementation of evidence-based practice in community health nursing. [ABSTRACT FROM AUTHOR]

Aims and objectives To develop a questionnaire to address barriers and self-care behaviour among persons with type 2 diabetes mellitus. Background Several instruments are available in the literature to measure barriers to self-care in this population, but many of them present limitations in its psychometric validation process, and lack of theoretical background. Design Content validation study using multiple qualitative methods. Methods A systematic review was conducted, and two focus groups with fifteen participants ( n = 15) were analysed to identify key topics and categories concerning barriers and self-care behaviour. These categories were used to generate items that were subjected to expert scrutiny, using the Delphi technique. The resulting list of items was tested for readability and comprehension by nine diabetic patients ( n = 9), through cognitive interviews. The whole process was conducted in accordance with the Theory of Planned Behaviour. Results The mean age (standard deviation) of participants in the focus groups and cognitive interviews was 66·05 (8·47) and 63·11 (6·13) years, respectively. 46·7% of the members of the focus groups and 44·4% of those interviewed were female, and the mean duration (standard deviation) of their diabetes was 6·53 (3·17) and 4·89 (3·84) years, respectively. After the qualitative analysis, 27 codes were obtained. Thereafter, items were generated in accordance with the dimensions of this theory: attitudes towards the behaviour ( n = 23), social norms ( n = 13), perceived behavioural control ( n = 17) and behavioural intention ( n = 15). Conclusions A rigorous process of content validation with multiple methods was implemented to obtain an instrument aimed at addressing barriers and self-care behaviour of patients with type 2 Diabetes Mellitus. Relevance to clinical practice An instrument theoretically rooted and supported on professional and patients' views is available to assess self-care behaviours in patients with type 2 Diabetes Mellitus. The evaluation of its reliability and construct validity will determine the instrument's value and practical application in the clinical context. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate relationships between anxiety and stressors, coping and subjective burden and to contribute to defining factors related to anxiety among family caregivers of older dependents. Background Despite the studies analysing factors related to anxiety in caregivers, there is not enough evidence about this issue. Design Cross-sectional design. Methods Data from 140 family caregivers (convenience sample) were analysed using descriptive statistics, correlation coefficients and path analysis. Socio-demographic data and several scales (Barthel Index, Short Portable Mental Status Questionnaire, Cummings Neuropsychiatric Inventory, Brief COPE, Caregiver Strain Index and Hamilton Anxiety Rating Scale) were used to collect data. Results Stressors (psychiatric and psychological symptoms and number of assisted activities of daily living), emotion-focused coping, dysfunctional coping and subjective burden were related to greater anxiety. Subjective burden mediated the effects of psychiatric and psychological symptoms on anxiety and partially mediated the effects of dysfunctional coping on anxiety. Conclusions Stressors, dysfunctional coping and subjective burden were identified as factors related to anxiety. The mediating role of subjective burden in the relationship between dysfunctional coping and anxiety was supported. The effect of dysfunctional coping on anxiety was independent of the stressors. Relevance to clinical practice These conclusions justify several recommendations regarding nursing interventions for family caregivers of older dependents: (1) stressors, dysfunctional coping and subjective burden can be used in clinical practice for early detection of and early intervention for anxiety; (2) to prevent subjective burden and anxiety, approach-coping skills should be promoted through interventions such as problem-solving, positive reappraisal, assertiveness and control of negative thoughts; (3) these interventions for dysfunctional coping should be systematically developed for individuals with dysfunctional coping regardless of the level of stressors and/or the possibility of respite. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate the effectiveness of information and communication technologies in the undergraduate students' pressure ulcer training as a learning tool, compared with traditional teaching methods. Background Pressure ulcers constitute one of the great challenges faced by nursing professionals. Currently, pressure ulcer training is based on traditional on-campus teaching, involving lecture-style classes with frequent use of photographs of the wounds. This traditional training has some important weaknesses that can put the efficacy of the training at risk. Design A randomised controlled trial was developed including undergraduate nursing students. Methods The intervention group used an adaptive self-learning e-learning tool developed by the research team ( ePULab) for pressure ulcer assessment and treatment. The control group received a traditional on-campus class on the same topic. Pretest and post-test questionnaires were designed to assess the students' ability in pressure ulcer diagnosis and treatment. Results The educational intervention based on the use of the ePULab tool produced significantly better learning acquisition results than those obtained by traditional lecture-style classes: the total score improved in the control group from 8·23 (SD 1·23)-11·6 (SD 2·52) after the lecture, whereas in the intervention group, the knowledge score changed from 8·27 (SD 1·39)-15·83 (SD 2·52) ( p = 0·01) with the use of ePULab. Conclusions The results show a higher effectiveness of the devised e-learning approach for education on management of pressure ulcers. Relevance to clinical practice Our results reveal the suitability of the ePULab e-learning tool as an effective instrument for training on assessment of and treatment for pressure ulcers and its potential impact on clinical decision-making. [ABSTRACT FROM AUTHOR]

Aims and objectives. To examine the prevalence of aggression against healthcare professionals and to determine the possible impact that violent episodes have on healthcare professionals in terms of loss of enthusiasm and involvement towards work. The objective was to analyse the percentage of occupational assault against professionals' aggression in different types of healthcare services, differentiating between physical and verbal aggression as a possible variable in detecting burnout in doctors and nursing professionals. Background. Leiter and Maslach have explored a double process model of burnout not only based on exhaustion by overload, but also based on personal and organisational value conflicts (community, rewards or values). Moreover, Whittington has obtained conclusive results about the possible relationship between violence and burnout in mental health nurses. Design. A retrospective study was performed in three hospitals and 22 primary care centres in Spain ( n = 1·826). Methods. Through different questionnaires, we have explored the relationship between aggression suffered by healthcare workers and burnout. Results. Eleven percent of respondents had been physically assaulted on at least one occasion, whilst 34·4% had suffered threats and intimidation on at least one occasion and 36·6% had been subjected to insults. Both forms of violence, physical and non-physical aggression, showed significant correlations with symptoms of burnout (emotional exhaustion, depersonalisation and inefficacy). Conclusions. The survey showed evidence of a double process: (1) by which excess workload helps predict burnout, and (2) by which a mismatch in the congruence of values, or interpersonal conflict, contributes in a meaningful way to each of the dimensions of burnout, adding overhead to the process of exhaustion-cynicism-lack of realisation. Relevance to clinical practice. Studies indicate that health professionals are some of the most exposed to disorders steaming from psychosocial risks and a high comorbidity: anxiety, depression, etc. There is a clear need for accurate instruments of evaluation to detect not only the burnout but also the areas that cause it. Professional exhaustion caused by aggression or other factors can reflect a deterioration in the healthcare relationship. [ABSTRACT FROM AUTHOR]

Aims and objectives To report on a study of what primary care nurses and physicians know about medications and healthcare products to prevent and treat pressure ulcers. Background The prevention and treatment of pressure ulcers has generally become the responsibility of the nursing staff; this has resulted in studies of nurses' knowledge of this task, although few studies include physicians in their analysis. Design Cross-sectional survey conducted in North Girona (Province) Primary Care Services from February to April 2010. Methods The study questionnaire had three sections: sociodemographic data, questions about division of responsibility for the care of patients with pressure ulcers or at risk of developing them, and 36 statements based on the recommendations in clinical practice guidelines provided by well-recognised national and international institutions. Results Eighty-one nurses (64·8%) and 46 physicians (36·8%) responded to this study. Nurses had greater responsibility for the care of pressure ulcers, made greater use of medical prescriptions to obtain supplies if not available in the primary care centre, were more familiar with the site's clinical practice guidelines on the topic and showed better adherence to their recommendations. Nurses also had better knowledge than the participating physicians of the use of medications and healthcare products to heal or to prevent pressure ulcers. Conclusions Nurses had sufficient knowledge and more appropriate skills than the participating physicians for the prescription of medications and healthcare products for the prevention and treatment of pressure ulcers. Relevance to clinical practice The data demonstrated that nurses have sufficient knowledge and skill to provide wound care and could safely write these prescriptions, although Spanish law permitting nurse prescription is not fully implemented. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the quality of life and mental health of caregivers of children with cerebral palsy and to examine the impact of self-efficacy and coping strategies on these outcomes. Background Few studies analyse the impact of caring for a child with cerebral palsy on the caregivers' quality of life besides mental health. Also, less attention has been paid to the influence of caregiver's personal resources like self-efficacy or coping strategies on how they adjust to the child's illness and the care situation. Design Cross-section correlational design. Methods Sixty two parents of children with cerebral palsy completed measures to assess the quality of life (i.e. physical, environmental and social relationships), mental health (i.e. general mental health, depression and anxiety), self-efficacy and coping strategies. Results Parents of children with cerebral palsy had, in general terms, low levels of quality of life and mental health. Self-efficacy was related to most of the outcomes, whereas any of the coping strategies assessed was significantly related to the outcomes. Conclusions Quality of life and mental health can be affected in caregivers of children with CP. Personal resources like self-efficacy also need attention as they can help in the understanding of the differences in these outcomes and the design of effective interventions. Relevance of clinical practice Self-efficacy should be a key element in interventions addressed to parents of children with CP to elicit a process of empowerment that can improve the well-being of the family as a whole. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate the effectiveness of protocolised intervention for hospital discharge and follow-up in the primary care of patients with chronic obstructive pulmonary disease (COPD). Background: Chronic obstructive pulmonary disease is one of the main causes of morbidity and mortality internationally. Design: A quasi-experimental design was adopted, with a control group and it was pseudorandomised by services. Methods: Patients with COPD admitted to two tertiary-level public hospitals in Spain were recruited (2007-2008). The outcome variables included: readmission rate, patient satisfaction (LOPSS12), quality of life (St. George′s Respiratory Questionnaire) and level of knowledge about COPD. 48 hours after admission, both groups were evaluated by specialist coordinating nurses. At the hospital, a coordinating nurse visited each patient in the experimental group every 24 hours to identify the main caregiver, provide information about the disease, explain treatment, identify care problems and needs and facilitate communication between professionals. 24 hours after discharge, the coordinating nurses informed the primary care nurses about patient discharge. The two nurses made the first home visit together. There were follow-up phone calls at 2, 6, 12 and 24 weeks after discharge. A total of 143 patients were recruited (Intervention group=56; Control group=87). Results: The results showed a significant improvement in the evolution of quality of life, at 12 and 24 weeks after discharge; the level of knowledge about COPD revealed significant differences between the groups. There were no differences according to satisfaction or readmission rate. Multivariate analysis (non-conditional logistic regression) showed the intervention to be ineffective in reducing the readmission rate. Conclusions: The planning of discharge for patients with COPD is effective in terms of improving the patients' quality of life and level of knowledge about the disease. Relevance to clinical practice: The characteristics of patients with COPD make it necessary to include them in hospital discharge planning programmes. [ABSTRACT FROM AUTHOR]

Objectives. To improve the monitoring and control of glycated haemoglobin in insulin-dependent children. This article describes an educational intervention for this purpose where One Touch UltraSmart™ Software was used to manage diabetes. The results showed that this intervention helped to reduce the levels of blood glucose and glycated haemoglobin to less than 7%. Background. Various research studies have been performed on the effective control of glycated haemoglobin values in diabetic children by means of technological devices. However, none of this research has evaluated the impact of an educational intervention in conjunction with the use of monitoring instruments such as One Touch UltraSmart. Design. We present an 18-month longitudinal, analytical and observational study of 37 type 1 diabetic patients, 9-16 years of age. For each patient, initial and final values of glycated haemoglobin and the number of blood glucose controls were recorded. Methodology. For the purposes of our study seven educational workshops, attended by diabetic children and their parents, were conducted. In addition, participants were asked to complete a brief questionnaire so that information could be gathered regarding the eating and exercise habits of the patients. Results. This educational intervention using One Touch UltraSmart led to a statistically significant average reduction of glycated haemoglobin. Conclusions. Our research showed that the use of One Touch UltraSmart in the context of an educational intervention raised the awareness of the diabetic children and thus helped them to effectively control their disease and to fully understand the necessity of having good dietary and exercise habits. Relevance to clinical practice. It can be concluded that the educational intervention led to a significant improvement in the dietary habits of these patients and also helped them to exercise regularly, all of which has a positive impact on their health. [ABSTRACT FROM AUTHOR]

Aim. To examine the psychosocial impact of recurrence on survivors of cancer and their family members. Background. Cancer recurrence is described as one of the most stressful phases of cancer. Recurrence brings back many negative emotions, which are different and may be more intense than those after first diagnosis of cancer. Survivors and their family members have to deal with new psychological distress. Design. A qualitative descriptive study was conducted in four cancer units of two hospitals in North of Spain. Methods. Fifteen survivors of cancer with a recent diagnosis of recurrence, 13 family members and 14 nurses were interviewed. Data collection and analysis were based on the constant comparative method of grounded theory. Results. Four major categories were found: (1) ‘Again’: when cancer comes back, (2) the shock of recurrence, (3) the impact of the diagnosis on family life, and (4) factors that influence the impact of recurrence. Learning that cancer had come back was, for most of the families, more devastating than hearing that they had cancer for the first time. Signs of shock and suffering were experienced by families as an initial response to recurrence. The new diagnosis often entailed a change in the family life. Survivorship period and age seemed also significant in the psychosocial experience of recurrence. Conclusions. The term ‘again’, used by all the participants to describe a recurrence of the disease, symbolised a beginning and a continuation with cancer; it implied a re-encounter with health services, and it represented new suffering for the families. Relevance to clinical practice. Therapeutic nursing interventions should be planned and provided to both patients with recurrent cancer and their family members. Family nursing can play an important role in helping families master the impact of the recurrent illness. [ABSTRACT FROM AUTHOR]