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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 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 Objectives: We aimed to identify correlates of cannabinoid‐based products (CBP) use in patients with multiple sclerosis (MS) in France and Spain. Background: MS is responsible for a wide range of symptoms, including pain. Access to CBP differs according to local legislation. The French context is more restrictive than the Spanish one, and no data regarding cannabis use among MS patients has yet been published. Characterizing MS patients who use CBP constitutes a first step toward identifying persons most likely to benefit from them. Design: An online cross‐sectional survey was submitted to MS patients who were members of a social network for people living with chronic diseases and were living in France or Spain. Methods: Two study outcomes measured therapeutic CBP use and daily therapeutic CBP use. Seemingly unrelated bivariate probit regression models were used to test for associations between the outcomes and patients' characteristics while accounting for country‐related differences. STROBE guidelines were followed in reporting this study. Results: Among 641 study participants (70% from France), the prevalence of CBP use was similar in both countries (23.3% in France vs. 20.1% in Spain). MS‐related disability was associated with both outcomes, with a gradient observed between different degrees of disability. MS‐related pain level was associated with CBP use only. Conclusions: CBP use is common in MS patients from both countries. The more severe the MS, the more participants turned to CBP to alleviate their symptoms. Easier access to CBP should be ensured for MS patients in need of relief, especially from pain. Relevance to clinical practice: This study highlights the characteristics of MS patients using CBP. Such practices should be discussed by healthcare professional with MS patients. [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]

Background: Spasticity is a frequent symptom of multiple sclerosis (MS), which may negatively influence daily living activities (ADL). Objectives: To (1) explore the feasibility to conduct a structured interview by specialist nurses about limitations in ADL; (2) determine the percentage of people with MS (PwMS) with limitations in ADL related to spasticity; (3) to assess the knowledge about spasticity and describe its clinical features. Design: Observational, cross‐sectional, multicentre study in 16 MS units of Catalonia (Spain). Participants were recruited from the outpatient facility and day‐care hospital between July 2018 and June 2019 and met the following criteria: (1) age 18 or older, (2) diagnosis of MS according to McDonald criteria 2010 and (3) no clinical relapse in previous 30 days. Methods: Specialist nurses conducted a structured interview divided in two parts: the assessment of (1) limitations in the ADL and (2) the presence of spasticity and associated symptoms. The usefulness of this intervention was requested. This study met the STROBE reporting guidelines checklist for observational studies. Results: Three hundred sixty eight pwMS (244 women) with a mean age of 46 years and a median Expanded Disability Status Scale score of 2.5 (range, 0–8.5) were included. 262 (71%) pwMS had limitations in the ADL, and spasticity was reported as the most limiting symptom in 59 (23%). As a result of the interview, spasticity was observed in 199 (76%) participants; 47 (24%) of them were unaware that they had spasticity and 102 (51%) would not have reported it spontaneously. The level of the interview satisfaction was high (90%). Conclusions: Spasticity is a complex and limiting symptom in MS. The structured interview conducted by specialist nurses is feasible and has good acceptance. Patient contribution Specialist nurses can be proactive in MS clinical assessment, which may help to detect symptoms with negative impact on quality of life. [ABSTRACT FROM AUTHOR]

Aims: To assess the results of a nursing‐led program to treatment of minor health issues from Catalan health institute primary care teams during 2019 and 2020. Background: In 2009, the Catalan health institute implemented a nursing program to deal with minor health problems. This nursing‐led program includes an algorithm for each of the minor health problems and arose as a strategy to reorganise the flow of demand for care in primary care. Design: A cross‐sectional design. Methods: Multicentric cross‐sectional study. 392 primary care teams from the Catalan health institute participated in the study. STROBE guideline was followed in reporting this study. Patients attending any of the participating centres requesting a same‐day consultation for minor health issues were registered. Results: A total of 21,215,278 consultations were recorded: 18,284,105 for adult and 2,931,173 for paediatric patients. Minor health issue resolved by the nurse was achieved in 50.9% of adult patients and 55.4% of paediatric patients. The highest rates of resolution in adults (>85%) were as follows: burns, emergency contraception and injuries. The highest resolution rates (>84%) were as follows: burns, breastfeeding difficulties and infant colic. 87.7% of prescriptions issued by nurses were accepted by the family physician. Conclusions: The nursing‐led program to treat minor health issues has been shown to present acceptable resolution for nurses in a large primary care setting. Nurses have been carrying out prescription activities with very favourable results. Relevance to clinical practice: This study demonstrates that care provided to patients by nurses for minor health issues requiring preferential resolution is effective. Our results are useful in that they confirm both the effectiveness of the nursing‐led program for minor health issues and the pharmacological prescriptions produced during patient appointments. Patient or public contribution: Patient's data were obtained through a program records system after the minor health issues appointments. [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]

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 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]

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 evaluate both concordance among those measurements obtained by three different pulse oximeters currently used by nursing professionals in hospital units and the factors which can influence this concordance. Background: Many models of wireless pulse oximeters in the present market do not offer possibility of calibration and, therefore, they do not ensure patients' safety in daily clinical practice. Design: This is a descriptive and cross-sectional study. The sample of patients (140) was selected from such hospital units, and all of them had to fulfil inclusion and exclusion criteria for participation. Methods: The instruments used to carry out this research were a monitor (calibrated), two models of portable wireless pulse oximeters (used for 3 years by the nursing staff, without being calibrated), a tympanic thermometer and a weather meter. The concordance correlation coefficient (CCC) was used to establish the concordance, whereas the Landis-Koch criteria were used to interpret the results. Results: The concordance among the three devices was considered as “good” (CCC: 0.925 and 0.974 (95%)). The CCC (0.925) for saturation measures was regarded as “very good”/”almost perfect,” and the pulse measure was considered as “very good” CCC 0.974, providing in both cases a high level of concordance (CCC > 0.91). Conclusions: The overall concordance as regards pulse and oxygen saturation among the three pulse oximeters analysed is considered as “very good” according to the Landis-Koch criteria. Relevance to clinical practice: There exists a “very good” concordance among two wireless oximeters which have been used by the health staff for 3 years and which did not offer any possibility of calibration and one monitor which belongs to the healthcare institution. This aspect is of crucial importance in daily clinical practice, and it is also relevant to ensure patient’s safety. [ABSTRACT FROM AUTHOR]

Aims and objectives To estimate the prevalence of difficult venous access in complex patients with multimorbidity and to identify associated risk factors. Background In highly complex patients, factors like ageing, the need for frequent use of irritant medication and multiple venous catheterisations to complete treatment could contribute to exhaustion of venous access. Design A cross-sectional study was conducted. Methods 'Highly complex' patients ( n = 135) were recruited from March 2013-November 2013. The main study variable was the prevalence of difficult venous access, assessed using one of the following criteria: (1) a history of difficulties obtaining venous access based on more than two attempts to insert an intravenous line and (2) no visible or palpable veins. Other factors potentially associated with the risk of difficult access were also measured (age, gender and chronic illnesses). Univariate analysis was performed for each potential risk factor. Factors with p < 0·2 were then included in multivariable logistic regression analysis. Odds ratios were also calculated. Results The prevalence of difficult venous access was 59·3%. The univariate logistic regression analysis indicated that gender, a history of vascular access complications and osteoarticular disease were significantly associated with difficult venous access. The multivariable logistic regression showed that only gender was an independent risk factor and the odds ratios was 2·85. Conclusions The prevalence of difficult venous access is high in this population. Gender (female) is the only independent risk factor associated with this. Previous history of several attempts at catheter insertion is an important criterion in the assessment of difficult venous access. Relevance to clinical practice The prevalence of difficult venous access in complex patients is 59·3%. Significant risk factors include being female and a history of complications related to vascular access. [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 analyse the relationship between death attitudes, emotional intelligence, resilience and self-esteem in a sample of nursing undergraduates. Background The death attitudes held by nursing students may influence the care they offer to end-of-life patients and their families. Emotional intelligence, resilience and self-esteem are important social and emotional competencies for coping positively with death and dying. Design Cross-sectional and correlational study. Methods Participants were 760 nursing undergraduates from four nursing schools in Spain. Data were collected in 2013-2014. The students responded anonymously to a self-report questionnaire that gathered socio-demographic data and which assessed the following aspects: fear of death (Collett-Lester Fear of Death Scale), death anxiety (Death Anxiety Inventory-Revised), perceived emotional intelligence (Trait Meta-Mood Scale, with its three dimensions: attention, clarity and repair), resilience (Brief Resilient Coping Scale) and self-esteem (Rosenberg Self-Esteem Scale). In addition to descriptive statistics, analyses of variance, mean differences, correlations and regression analyses were computed. Results Linear regression analysis indicated that attention to feelings, resilience and self-esteem are the significant predictors of death anxiety. Conclusions The results show that death anxiety and fear of death are modulated by social and emotional competencies associated with positive coping. Relevance to clinical practice The training offered to future nurses should include not only scientific knowledge and technical skills but also strategies for developing social and emotional competencies. In this way, they will be better equipped to cope positively and constructively with the suffering and death they encounter at work, thus helping them to offer compassionate patient-centred care and minimising the distress they experience in the process. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this study was to establish the validity and reliability of an instrument (Inventario del NIvel de Cuidados mediante IndicAdores de clasificación de Resultados de Enfermería) used to assess the dependency level in acutely hospitalised patients. This instrument is novel, and it is based on the Nursing Outcomes Classification. Background Multiple existing instruments for needs assessment have been poorly validated and based predominately on interventions. Standardised Nursing Languages offer an ideal framework to develop nursing sensitive instruments. Design A cross-sectional validation study in two acute care hospitals in Spain. Methods This study was implemented in two phases. First, the research team developed the instrument to be validated. In the second phase, the validation process was performed by experts, and the data analysis was conducted to establish the psychometric properties of the instrument. Results Seven hundred and sixty-one patient ratings performed by nurses were collected during the course of the research study. Data analysis yielded a Cronbach's alpha of 0·91. An exploratory factorial analysis identified three factors (Physiological, Instrumental and Cognitive-behavioural), which explained 74% of the variance. Conclusions Inventario del NIvel de Cuidados mediante IndicAdores de clasificación de Resultados de Enfermería was demonstrated to be a valid and reliable instrument based on its use in acutely hospitalised patients to assess the level of dependency. Relevance to clinical practice Inventario del NIvel de Cuidados mediante IndicAdores de clasificación de Resultados de Enfermería can be used as an assessment tool in hospitalised patients during the nursing process throughout the entire hospitalisation period. It contributes information to support decisions on nursing diagnoses, interventions and outcomes. It also enables data codification in large databases. [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]

The article presents information on a study conducted to identify the attitude of nurses towards nursing diagnosis (ND), by using the cluster analysis method. In the study, a hierarchical cluster analysis was used to categorize the participating registered nurses (RNs) into mutually exclusive clusters having similar attitude profiles on the basis of their responses to 20 items. The study found that RNs working in the management field have a better attitude.

Aims and objectives To examine the psychometric properties of the Trait Meta- Mood Scale in the nursing context and to determine the relationships between emotional intelligence, self-esteem, alexithymia and death anxiety. Background The Trait Meta- Mood Scale is one of the most widely used self-report measures for assessing perceived emotional intelligence. However, in the nursing context, no extensive analysis has been conducted to examine its psychometric properties. Design Cross-sectional and observational study. Methods A total of 1417 subjects participated in the study (1208 nursing students and 209 hospital nurses). The Trait Meta- Mood Scale, the Toronto Alexithymia Scale, the Rosenberg Self-Esteem Scale and the Death Anxiety Inventory were all applied to half of the sample ( n = 707). A confirmatory factor analysis was carried out, and statistical analyses examined the internal consistency and test-retest reliability of the Trait Meta- Mood Scale, as well as its relationship with relevant variables. Results Confirmatory factor analysis confirmed the three dimensions of the original scale (Attention, Clarity and Repair). The instrument showed adequate internal consistency and temporal stability. Correlational results indicated that nurses with high scores on emotional Attention experience more death anxiety, report greater difficulties identifying feelings and have less self-esteem. By contrast, nurses with high levels of emotional Clarity and Repair showed less death anxiety and higher levels of self-esteem. Conclusions The Trait Meta- Mood Scale is an effective, valid and reliable tool for measuring perceived emotional intelligence in the nursing context. Training programmes should seek to promote emotional abilities among nurses. Relevance to clinical practice Use of the Trait Meta- Mood Scale in the nursing context would provide information about nurses' perceived abilities to interpret and manage emotions when interacting with patients. [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 ascertain whether inflammation markers also correlate with parameters related to insulin resistance and the metabolic syndrome in a group of adolescents. Background Obesity is now considered a chronic low-grade inflammatory process, characterised by alterations in the systemic concentrations of some inflammation markers. Adiponectin, leptin and other inflammatory proteins have been shown to correlate with insulin resistance and the metabolic syndrome in adults. Design Cross-sectional study in two groups of obese and normal weight adolescents. Methods Serum levels of adiponectin, leptin, ceruloplasmin and insulin levels were determined and correlated among them and with anthropometric parameters, blood pressure body mass index and body mass index z-score. Results Waist circumference, body mass index and blood pressure values correlated significantly with both homoeostasis model assessment for insulin resistance and insulin levels. Ceruloplasmin also correlated with both parameters with a high level of significance. However, leptin levels did not correlate with either homoeostasis model assessment for insulin resistance or insulin, and adiponectin correlated with homoeostasis model assessment for insulin resistance but not insulin. All inflammation markers studied correlated with the body mass index z-score. These correlations were stronger in the group of obese individuals compared to lean ones. Conclusions We found a relationship between insulin resistance and some inflammation in adolescents, which was particularly strong in obese individuals and was associated with the development of metabolic syndrome. Among the inflammation markers studied, ceruloplasmin revealed as a potential string marker of insulin resistance in obese adolescents. Relevance to clinical practice The results obtained in this study imply a significant advance in the field of clinical practice of nursing. The adequate understanding by nursing personnel of the inflammatory processes inherent to obesity constitutes a key factor for the prevention of the disease and its complications in adolescents. [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]