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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]

Accessible Summary: What is known on the subject: Adult psychiatric services typically focus on the mental health needs of the client but they do not support his or her parenting role.Many authors highlight the importance of a non‐judgmental approach when providing support and care to clients with mental illness who are parents.Assessments frequently focus on the negative aspects while the strengths of these families were often overlooked.There is a lack of scientific literature exploring nurses' experiences when caring for parents with mental illness and their families. What this paper adds to existing knowledge: Trust is the basis that helps clients to be open to receiving care and answering parenting‐related questions. Therefore, without adequate professional‐client trust, some care and interventions addressed to parents with mental illness could be poorly received by the client.Tronto's phases of care facilitated the collection of data and exploration of mental health nurses' experiences of care. What are the implications for practice: Mental health nurses should be aware of the potential needs of these families, as described in the scientific literature, so they can include them in their assessments. They also should consider the need to individualize each care since each situation of a family with parental mental illness is unique.Mental health nurses must take the person's environment into account (family, social and political aspects and different forms of stigma) since all these factors may influence how parents with mental illness receive and provide care. Introduction: Many authors highlight the importance of a non‐judgmental approach when providing care to parents with mental illness. However, assessments frequently focus on the negative aspects while the strengths of such families were often overlooked. Aim: To explore the lived experiences of mental health nurses who care for clients who are parents. Method: We conducted a qualitative phenomenological study. The main data collection technique was in‐depth interviews. Data were analysed according to Colaizzi model, subsequently, the main categories that arised were compared and related to the five phases of Tronto's care. Results: The main categories identified from the analysis of the interviews were: (1) individualized care, (2) continuity of care, (3) psychoeducation and counselling, (4) trust and (5) context of the client. Discussion: Trust is the basis that helps parents with mental illness to be open to receiving care and answering parenting‐related questions. Without trust, some interventions could be poorly received by the client. Implications for Practice: Mental health nurses should be aware of the potential needs of these families, so they can include them in their assessments. They also should consider the need to individualize each care since each situation of a family with parental mental illness is unique. [ABSTRACT FROM AUTHOR]

Aim: To determine the prevalence and clustering of NANDA‐International nursing diagnoses in patients assisted by pre‐hospital emergency teams. Design: Retrospective descriptive study of electronic record review. Methods: Episodes recorded during 2019, including at least a nursing diagnosis, were recovered from the electronic health records of a Spanish public emergency agency (N = 28,847). Descriptive statistics were used to characterize the sample and determine prevalence. A two‐step cluster analysis was used to group nursing diagnoses. A comparison between clusters in sociodemographic and medical problems was performed. Data were accessed in November 2020. Results: Risk for falls (00155) (27.3%), Anxiety (00146) (23.2%), Acute pain (00132), Fear (00148) and Ineffective breathing pattern (00032) represented 96.1% of all recorded diagnoses. A six‐cluster solution (n = 26.788) was found. Five clusters had a single high‐prevalence diagnosis predominance: Risk for falls (00155) in cluster 1, Anxiety (00146) in cluster 2, Fear (00148) in cluster 3, Acute pain (00132) in cluster 4 and Ineffective breathing pattern (00032) in cluster 6. Cluster 5 had several high prevalence diagnoses which co‐occurred: Risk for unstable blood glucose level (00179), Ineffective coping (00069), Ineffective health management (00078), Impaired comfort (00214) and Impaired verbal communication (00051). Conclusion: Five nursing diagnoses accounted for almost the entire prevalence. The identified clusters showed that pre‐hospital patients present six patterns of nursing diagnoses. Five clusters were predominated by a predominant nursing diagnosis related to patient safety, coping, comfort, and activity/rest, respectively. The sixth cluster grouped several nursing diagnoses applicable to exacerbations of chronic diseases. Implications for the profession and/or patient care: Knowing the prevalence and clustering of nursing diagnoses allows a better understanding of the human responses of patients attended by pre‐hospital emergency teams and increases the evidence of individualized/standardized care plans in the pre‐hospital clinical setting. Impact: What problem did the study address? There are different models of pre‐hospital emergency care services.The use of standardized nursing languages in the pre‐hospital setting is not homogeneous.Studies on NANDA‐I nursing diagnoses in the pre‐hospital context are scarce, and those available are conducted on small samples. What were the main findings? This paper reports the study with the largest sample among the few published on NANDA‐I nursing diagnoses in the pre‐hospital care setting.Five nursing diagnoses represented 96.1% of all recorded. These diagnoses were related to patients' safety/protection and coping/stress tolerance.Patients attended by pre‐hospital care teams are grouped into six clusters based on the nursing diagnoses, and this classification is independent of the medical conditions the patient suffers. Where and on whom will the research have an impact? Knowing the prevalence of nursing diagnoses allows a better understanding of the human responses of patients treated in the pre‐hospital setting, increasing the evidence of individualized and standardized care plans for pre‐hospital care. Reporting method: STROBE checklist has been used as a reporting method. No Patient or Public Contribution: Only patients' records were reviewed without further involvement. [ABSTRACT FROM AUTHOR]

Objective: To explore the experiences and emotions of individuals with depression and physical comorbidity within the context of psychoeducational group interventions led by primary care nurses in Catalunya (Spain). Method: A psychoeducational group intervention was conducted in the first semester of 2019 with 13 primary care teams (rural/urban) and 95 participants with depression and physical comorbidity. The qualitative research and phenomenological perspective were based on 13 field diaries and 7 semi‐structured interviews carried out with the observer nurses. The interviews were recorded and transcribed. Codes were identified by segmenting the text into citations/verbatim accounts and emerging categories/subcategories by regrouping the codes. The results were triangulated among the researchers to identify and compare similarities and differences. Results: Four major themes were found: (a) gender differences; (b) coping strategies and changes observed during the intervention; (c) functions of the group as a therapeutic element; and (d) the nurses' perceptions of the group experience. Gender differences were identified in relation to experiences and emotions. Conclusions: As some patients acquired skills/behaviours during the intervention that helped them initiate changes and the nurses were satisfied with the intervention, it is important to include this information when planning effective interventions for patients with this profile. Summary statement: What is already known about this topic? There are gender differences in the prevalence of depression. What this paper adds? This study describes the experiences and emotions of women with depression and physical comorbidity within the context of psychoeducational group intervention. The implications of this paper: The study provides information about the experiences and emotions of women with depression. It will be important to include this qualitative information when planning effective interventions directed at patients with this profile. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Home treatment teams help people in a mental health crisis to recover. The staff goes to the person's home, avoiding the need to go to the hospital and providing care in the person's environment.The teams have been created in our country in recent years, becoming part of the mental health care network. What this paper adds to existing knowledge?: The paper presents the functioning of a CRHTT, the type of care it provides, and the coordination with the rest of the care network. It also shows the clinical results obtained in the first two years since its creation, supporting the CRHTT's effectiveness in accompanying people with mental health crises and reducing the need for hospital care.The outstanding factors in the team operation were coordination fluidity with referral services (facilitating accessibility), a prolonged care time (about two months), and continuity of care during the CRHTT intervention (the same CRHTT professionals visited the user and the family at home) and upon discharge (CRHTT staff organized joint visits with the professionals who would care for the user and the family after home treatment).The CRHTT followed a person‐centered orientation based on horizontality and dialogue. The CRHTT fostered the inclusion of the family and social network in the treatment and a deep understanding of the crisis considering social determinants. What are the implications for practice?: Flexibility, approach to the person's environment, dialogue, shared decision‐making, and the inclusion of the family and social network in the treatment are central factors in CRHTT functioning. It helps the person regain control over their life and enhance their resources to face possible future crises.Training in crisis management, community mental health and family care, and teamwork (which implies joint home visits and co‐responsibility with the rest of the staff, user, and the family) are relevant for CRHTT professionals. Introduction: Crisis resolution and home treatment teams (CRHTTs) provide intensive home care to people in a mental health crisis, becoming an increasingly widespread alternative to hospital admissions. However, there are wide variations in service delivery, organization, and outcomes, and little literature on how these teams work in clinical practice and different settings. Aim: To share the organizational functioning, the therapeutic approach, and the outcomes obtained in a CRHTT in Catalonia, Spain. Method: A descriptive analysis of the functioning of a home treatment team, the characteristics of the people served, and the clinical results from November 2017 to December 2019 are presented. Results: One hundred and five people were served, with an average stay of 57 days. And 55.24% were women, and the mean age was 41. Most people could overcome the crisis at home, and 5.71% required hospital admission during home care. A statistically significant improvement was observed in the results of the GAF and HoNOS scales at admission and discharge. Discussion: Despite reduced staff, home care was an alternative to hospital admission for most people treated. Implications for Practice: Flexibility, teamwork, and collaboration with the social network are relevant factors when accompanying the recovery process at home. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to delineate the relationships between actors and contextual factors associated with the development of the advanced practice role in Catalonia. Methods: A complementary data analysis was conducted based on the social network analysis (SNA) method. The primary study design was qualitative, descriptive and explanatory. Participants from diverse perspectives of practice, organization and external environment were engaged to participate in semi‐structured focus groups. Data collection was conducted between March and May 2016 in Catalonia, Spain. Participants were asked to report on various dimensions of the role development context: understanding of the role, felt needs, perceived outcomes, barriers and facilitators. Results: Primary data analysis performed for 44 participants identified 71 related contextual factors associated with role development. Complementary network analysis revealed multiple relationships and agreements among participants and context‐related themes. Professional roles and disciplines clustered around topics show consensus and the significance of topics. Conclusion: Understanding the level of interactions and consensus among participants and contextual factors will ultimately allow better insight into how complex contexts influence the development of advanced practice nursing in healthcare organizations. Significant, consensual contextual factors should be used to influence further development and implementation of new roles that affect patient care and outcomes. Summary statement: What is already known about this topic? Comprehensive understanding of context at various levels should generate greater knowledge about what affects advanced practice role development locally and globally.What this paper adds? Findings could help organizations to make sense of the full dimension of context and to predict or act on development of advanced practice nursing roles.The implications of this paper: Significant, consensual contextual factors should be used to influence further development and implementation of new roles that affect patient care and outcomes. [ABSTRACT FROM AUTHOR]

Aims: We aimed to investigate the perspective of primary care nurses on their role with patients who have chronic cardiovascular disease and to identify cultural elements shared by nurses caring for people with chronic cardiovascular disease. In primary care, the role of the nurse is essential to promote self‐efficacy in cardiovascular self‐care. Individuals with chronic cardiovascular disease need to integrate the disease into their life, together with the health recommendations for management and follow‐up. Methods: A qualitative, focused ethnographic study was conducted. Purposeful sampling was used to include nurses who were working in primary care during the study. Data collection took place between 20 January and 20 May 2014 and consisted of semi‐structured interviews. A thematic analysis was applied using the data. Results: Eleven participants were included. Cardiovascular care forces nurses to reflect on their identity and role in primary care. The relationship between the nurse and people with chronic cardiovascular disease is a complex process, which may cause nurses to feel a sense of failure and monotony in their work. Conclusions: Our findings may help to understand the role of the nurse and the care provided in patients with chronic cardiovascular disease. Summary statement: What is already known about this topic? Primary care nursing is necessary for the improvement of cardiovascular risk factors.Chronic cardiovascular patients need training in self‐care.The organizational culture confers different forms of care to patients. What this paper adds? The vision of the socio‐cultural role of the family and community nurse is shown regarding cardiovascular prevention.Information is provided on the differentiating approach to chronic cardiovascular patients in primary care.Our study reflects the influence of routine care in nursing consultations, and what it entails to provide improved nursing care in cardiovascular patients. The implications of this paper: These findings can be used to understand the need to change the focus of nursing care in cardiovascular prevention.The implementation of a follow‐up protocol for the care of cardiovascular patients can improve patients' self‐care and reduce monotony in the nursing consultation.Further training and research is necessary regarding comprehensive chronic cardiovascular care within primary care services. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Coercive measures represent an ethical conflict because they limit the person's freedom, compromising their personal autonomy, self‐determination and fundamental rights.The reduction of the use of coercive measures implies not only regulations and mental health systems, but also cultural aspects, such as societal beliefs, attitudes, and values.There is evidence about the professionals' views on coercion in acute mental health care units and community settings, but they remain unexplored in inpatient rehabilitation units. What the paper adds to existing knowledge?: The knowledge about coercion varied from not knowing at all the meaning of the word, to a proper description of the phenomenon.Coercive measures are considered a necessary evil or normalized in mental health care and considered implicit to daily practice. What are the implications for practice?: The perceptions and attitudes towards coercion might be influenced by the knowledge about the phenomenon. Training of mental health nursing staff in non‐coercive practice could help professionals to detect, be conscious towards, and question coercive measures, thus orienting them to the effective implementation of interventions or programmes with evidenced effectiveness to reduce them. Introduction: Creating a therapeutic and safe milieu with the minimum coercive measures requires knowing professionals' perceptions and attitudes towards coercion, but they remain unexplored in medium and long‐stay inpatient psychiatric rehabilitation units. Aim: To explore the knowledge, perception and experience of coercion among nursing staff at a rehabilitation medium‐stay mental health unit (MSMHU) in Eastern Spain. Method: Qualitative phenomenological study including 28 face‐to‐face, semi‐structured interviews based on a script. Data were analysed using content analysis. Results: Two main themes were found: (1) therapeutic relationship and treatment in the MSMHU, which included three subthemes: qualities of the professionals for building the therapeutic relationship; perceptions about the persons admitted to the MSMHU; views of the therapeutic relationship and treatment in the MSMHU; (2) Coercion at the MSMHU, comprising five subthemes: professional knowledge; general aspects; emotional impact of coercion; opinions; alternatives. Discussion: Coercive measures are often normalized in mental health care and considered implicit to daily practice. A proportion of participants who did not know what coercion is. Implications for Practice: Knowledge about coercion might influence attitudes towards coercion. Mental health nursing staff could benefit from formal training in non‐coercive practice, facilitating the operative implementation of effective interventions or programmes. [ABSTRACT FROM AUTHOR]

Background: Many caregivers are insufficiently prepared, and little is known about measures that can be employed to enhance their preparedness. Aim: The aim of this study was to explore the factors associated with caregiver preparedness and establish a predictive model including the relationship between preparedness, burden, resilience and anxiety. Design: A cross‐sectional design was used. Methods: The sample included 172 family caregivers who were selected from one private hospital and daytime nursing centres. Caregivers were recruited from 2018 to 2019; they completed assessments for caregiver preparedness, anxiety, resilience and burden. A multiple linear regression analysis was performed to identify the factors associated with preparedness. Results: Preparedness was significantly associated with high levels of resilience and a low level of burden, while it was not associated with anxiety. Caregivers' gender, experience and cohabitation status were the main predictors. Resilience is an explanatory factor for caregiver preparedness in the predictive model. Conclusion: The demographic variables related to preparedness can be used to guide efforts to meet the needs of vulnerable caregivers. A caregiver's preparedness depends on their level of burden and resilience. Nursing interventions focused on these aspects could make the caregiver's role easier and improve the quality of care provided. Summary statement: What is already known about this topic? Many caregivers are inadequately prepared for this role, and ensuring adequate preparedness is important for family caregivers.Preparedness and factors predictive of this in Spanish family caregivers have not been well‐documented.Resilience, burden and anxiety affect caregivers, but the degree to which they influence caregivers' preparation levels is unknown. What is the contribution of this paper? Specific factors influence the preparedness of family caregivers. Men and caregivers who do not cohabit in the same household with the care‐dependent person may present greater deficits in preparedness. Moreover, poor health and lack of experience in caring can result in inadequate caregiving performance.Readiness, resilience and burden are significantly related, and the best predictor of family caregivers' preparedness is resilience.Resilience leads to greater preparedness in caregivers, and better‐prepared caregivers experience a lighter burden. What are the implications of this paper? Knowing the factors associated with preparedness in advance will allow health‐care professionals to prevent deficits in vulnerable family caregivers.Resilience is a decisive factor which prevents negative consequences such as low preparedness. A resilient coping style can diminish the burden and promote successful adaptation in caregivers. [ABSTRACT FROM AUTHOR]

Aim: Of the few instruments available to measure the important, positive aspects of caring, the Caregiver Reaction Assessment is regarded as the most suitable, but there is no validated Spanish version. The aim of this study was to translate the Caregiver Reaction Assessment into Spanish and assess its psychometric properties. Methods: The Caregiver Reaction Assessment was translated into Spanish and then back translated. Validation included construct validity, criterion validity and reliability: 287 interviews were conducted with informal caregivers of patients with dementia between November 2010 and April 2012. Results: Principal component analysis confirmed the original instrument's five subscales. Criterion validity showed a moderate negative correlation between the impact on health and the EQ‐5D (r = −.43), that is, a greater impact on health correlated with lower health‐related quality of life. The Caregiver Reaction Assessment showed good internal consistency, with a Cronbach alpha of.804, and good temporal stability for the distinct subscales, with intraclass correlation coefficients varying from.683 to.729 (p <.001). Conclusion: The Caregiver Reaction Assessment is a reliable, valid instrument for the measurement of the reactions of informal caregivers of patients with dementia, with good psychometric properties. SUMMARY STATEMENT: What is already known about this topic? The Caregiver Reaction Assessment is one of the few instruments that measures positive reactions in caregivers.A validated Spanish version of the instrument is required for Spain and other Spanish‐speaking countries. What this paper adds? The Caregiver Reaction Assessment was shown to be a reliable, valid instrument for the measurement of the reactions of informal caregivers of people with dementia in Spain and has good psychometric properties. The implications of this paper: Once validation is complete, the Caregiver Reaction Assessment may be used in all Spanish‐speaking informal caregivers and is suitable for home care and long‐term care institutions.The Caregiver Reaction Assessment subscales allow healthcare professionals to identify and focus on the areas that could bring about the greatest improvements in the care of people with dementia.The Caregiver Reaction Assessment permits the caregiver's state to be viewed at any stage of dementia and offers healthcare professionals the opportunity to act to avoid physical and emotional overload in caregivers. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study is to describe the experience of nursing care provided to the deceased organ donor by the nurse transplant coordinator. Methods: A qualitative exploratory study was conducted within the National Transplant Organization and the Regional Office for Transplant Coordination. A purposive sampling method was used. Data collection methods included semistructured interviews. Sampling and data collection were pursued until the researchers achieved information redundancy. A systematic text condensation analysis was performed. The Guba and Lincoln criteria for guaranteeing trustworthiness were followed. Results: A total of 16 participants were recruited, and three themes were identified regarding care of organ donors by the nurse transplant coordinator during the organ donation process: (a) fulfilling the desire and will of the donor patient; (b) the family as an extension of the donor; (c) coordinating the organ donation process. Conclusions: The donation process is both complex and delicate, and nursing care is an essential component. The care provided by the nurse transplant coordinator has the donor at the centre of the process, driven by respect for their decision. The family is seen as an extension of the donor. Nursing care should focus on continuous, honest communication, coordinating care with the intensive care unit, ensuring privacy and intimacy. SUMMARY STATEMENT: What is already known about this topic? Spain is the world leader in organ donation, with a rate of 48.0 donations per million population.The nurse transplant coordinator plays a significant role in the organ donation process, dealing with the difficulties of a tight schedule, in order to shorten ischemia times, while addressing grief, family decision making and donor care. What this paper adds? The hospital‐based nurse transplant coordinator is an essential role that links the donor's family and health professionals related to the donor hospital. Support within the nurse transplant coordinator team is key for organization and to prevent failure of the organ donation process.Donor care interventions are aimed at facilitating the donation process while maintaining the dignity of donors.The donor's family needs constant communication, based on reliable, empathetic and organized information. These results highlight family care as part of the donor care provided by nurse transplant coordinators, seen as an extension of the donor. The implications of this paper: This study captures the importance of the hospital‐based nurse transplant coordinator as the role able to provide donor centre care, ensuring the success of the organ donation process.Hospital structures and intensive care units (ICUs) must guarantee adequate spaces for communication with the family, respecting privacy and specific family needs.Maintenance and improvement of support among nurse transplant coordinators should be implemented to coordinate times and ensure the safety and success of the organ donation process. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Mechanical restraint is a common practice in mental healthcare settings in Spain, despite controversy.Mechanical restraint is perceived as a negative experience for nurses and service users.Mechanical restraint damages the nurse–patient therapeutic relationship, which is essential in providing quality care and promoting recovery. What the paper adds to existing knowledge?: The negative experiences of service users and mental health nurses arising from use of mechanical restraint affects both parties involved and results in trauma.Using mechanical restraint can provoke a moral injury in mental health nurses which can negatively impact on the establishment of trust within the therapeutic nurse–patient relationship. What are the implications for practice?: Nurses must be aware of the negative effects that mechanical restraint use has on both their practice and their day‐to‐day lives.Post‐mechanical restraint debriefing is required to repair the damage to the trust aspect of the nurse–patient relationship.Involving service users in co‐producing a debriefing framework may be a way to rebuild trust through constructive dialogue. Introduction: Mechanical restraint is an intervention that causes harm to service users and nurses, yet continues to be used in many countries, including Spain. However, there is a lack of research exploring Spanish mental health nurses' experiences of using mechanical restraint. Aim: To describe the experiences of mental health nurses who have used mechanical restraint in practice. Methods: A qualitative descriptive methodology was used and a purposive sample of 10 Spanish mental health nurses were interviewed about their experiences of using mechanical restraint. Thematic analysis was then employed to analyse interview data. Results: Participants' experiences of using mechanical restraint were mostly negative. Three main themes arose from the analysis of interview transcripts, (i) symmetrical trauma, (ii) moral injury and (iii) broken trust. Discussion: The use of restrictive practices, which can be perceived as counter‐therapeutic, exposes nurses to risks such as moral injury and service users to broken trust in the therapeutic nurse patient relationship. Avoiding empathy in order to use mechanical restraint is counterproductive, in the understanding that empathy is key to reducing this intervention. Implications for practice: Reducing or eliminating use of mechanical restraints should be a policy and practice priority due to the symmetrical harms it causes both nurses and service users. The trust aspect of the therapeutic nurse–patient relationship is a significant casualty when mechanical restraint is used, therefore involving service users in co‐production of post‐mechanical restraint debriefing can be an avenue for restoring this trust through dialogue. [ABSTRACT FROM AUTHOR]

Aim: To examine the influence of health care provider's communication skills on the quality of care perceived by Emergency Department patients. Background: Communication between patients and health care providers in the context of Emergency Department is challenging and can potentially have a negative impact on the quality of care perceived by patients. Design Cross‐sectional descriptive study conducted in the Emergency Department at the University Clinical Hospital Virgen de la Arrixaca of Murcia, Spain. Method: Data were collected from 6 to 9 June 2016. Different instruments were used to evaluate the perception of patients on the communication skills and quality of care at the Emergency Department. Results: The sample was composed of 200 patients, with an average age of 44.1 (SD = 18.3), of which 106 (53%) were men. The multiple linear regression analysis showed the association between communication skills (respect, problem solving, and nonverbal communication) and age with the quality of care perceived by the patients. Conclusions: We found that the communication skills of the health care providers were explanatory variables of the quality of care perceived in an Emergency Department. SUMMARY STATEMENT: What is already known about this topic? The needs of patients and families seeking emergency care differ from those of other care settings.Patient‐health care provider communication in an Emergency Department are a true challenge.Effective communication between emergency professionals and patients/family has been described as a fundamental component of health care. What this paper adds? Health care provider communication skills are explanatory for the quality perceived by Emergency Department patients.Respect, problem solving, and nonverbal aspects are explanatory for the quality of care in an Emergency Department. The implications of this paper: Humanized care, in which patients feel listened to and respected, and which is concerned about their health problems, could increase the quality of care perceived in the Emergency Department.Health care providers in Emergency Departments should be encouraged to increase their level of communication skills. [ABSTRACT FROM AUTHOR]

Aims To report a systematic review of the psychometric properties of self-report instruments to identify the symptoms of anxiety in pregnancy to help clinicians and researchers select the most suitable instrument. Background Excessive anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregnancy, the optimal methods to identify anxiety in pregnancy have not been confirmed. Design Psychometric systematic review. Data sources A systematic literature search of the multiple databases (1990-September 2014). Review methods Identification of self-report instruments to measure anxiety in pregnancy using COSMIN guidelines to assess studies reporting a psychometric evaluation of validity and reliability. Results Thirty-two studies were included. Studies took place in the UK, Australia, Belgium, Canada, Germany, Italy, Scandinavia, Spain and the Netherlands. Seventeen different instruments were identified. Measures of validity were reported in 19 papers and reliability in 16. The overall quality of the papers was rated as fair to excellent using the COSMIN checklist. Only one paper scored excellent in more than one category. Conclusion Many instruments have been adapted for use in different populations to those for which they were designed. The State Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale and the Hospital Anxiety and Depression Scale have been tested more frequently than other instruments, yet require further assessment to confirm their value for use in pregnancy. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study aimed to describe and understand the lived experiences and opinions of sub‐Saharan women living in Spain in relation to female genital mutilation. Background: Female genital mutilation is a bloody procedure with serious consequences for the health of women and girls. Understanding mutilated women's lived experiences plays a crucial role in the management of health consequences and could help healthcare professionals to provide assistance to these women. Design: A descriptive phenomenological study was carried out. The COREQ checklist was followed as guidance to write the manuscript. Methods: A total of 12 in‐depth interviews were conducted. Interviews were recorded, transcribed and analysed using ATLAS.ti 9.0. Results: Two themes with four subthemes were identified from the data analysis: 1) 'The traumatic experience of female circumcision' with the subthemes 'Female mutilation is a physical and psychological torture procedure' and 'recognising and coping with negative emotions'; 2) 'The fight for the eradication of female genital mutilation' which contains the subthemes 'the need for a real sociocultural change at the origin' and '"I want to be the last": Personal development leads to sociocultural change'. Conclusions: Female genital mutilation was experienced by women as a very aggressive and traumatic event. It causes considerable negative emotions that last over time. Although there is a tendency to reject the practice, in women's countries of origin, there is social pressure for girls to be mutilated. Relevance to clinical practice: Caring for women who have suffered from female genital mutilation requires awareness of the traumatic experience they underwent when they were girls. Healthcare professionals play a crucial role in eradicating female genital mutilation. Apart from education, preventive measures may include specific recommendations when girls are travelling to the country of origin and participatory action research. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: A relevant number of restraint prevention programmes have been developed internationally.In Spain, there is no harmonized policy to prevent the use of restraint.More studies are necessary to establish which programmes and components are necessary to prevent restraint. What does the paper add to existing knowledge?: There was a significant decreasing trend in the total number of mechanical restraint hours during the implementation of the intervention.There was no significant decreasing trend in the number of mechanical restraint episodes. What are the implications for practice?: Interventions at a regional level aimed at preventing mechanical restraint are feasible in the Spanish context.All components of the Six Core Strategies could be necessary to prevent episodes of mechanical restraint. Introduction: Mechanical restraint (MR) is used in many countries, including Spain, where non‐harmonized policies between autonomous communities exist. There is a lack of research about interventions at regional levels to reduce their use. Aim: To analyse data on key outcomes during the implementation of a multicomponent intervention in Andalusia (Spain) to reduce the use of MR. Method: Episodes in a period of 30 months in all wards (N = 20) were analysed. The intervention consisted of five strategies: (a) leadership, (b) analysis of the situation, (c) awareness training for the heads of the wards, (d) unified record of MR and (e) staff training. We analysed the monthly trend of restraint hours and restraint episodes/1,000 bed days using segmented regression. Results: There were 206.32 restraint hours and 12.96 restraint episodes/1,000 bed days during the study period. A significant decreasing trend was observed in restraint hours (−1.79%, p <.001), but not in the number of restraint episodes (−0.45%; p =.149). Discussion: The results coincide with other international studies; however, studies with better designs are required to evaluate the effectiveness of the intervention. Implications for Practice: Interventions at a regional level aimed at preventing MR are feasible in the Spanish context. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: AHDs in mental health are fundamental tools in advance care planning processes. It is an important method for involving mental healthcare users in clinical decisions and in providing effective healthcare based around user preferences.AHDs can be applied in situations in which the person may forfeit their legal capacity, according to the Convention on the Rights of Persons with Disabilities.However, the use of AHDs as described above is not yet a reality in Spain. What the paper adds to existing knowledge?: The present study surveys the knowledge and attitudes of mental healthcare providers towards AHDs in clinical practice.Although providers had a moderate–low level of knowledge about AHDs, they presented positive attitudes towards them. What are the implications for practice?: The use of AHDs in mental healthcare practice poses challenges to the Spanish mental healthcare system. Acquiring up‐to‐date data on the knowledge and attitudes of providers towards AHDs allows organizations to address aspects of their service that require reinforcement. This data could also be used by other countries just starting to use AHDs, as an initial step towards supporting the implementation of a multistage intervention process.More in‐depth training for providers would help improve their competence to implement or honour the statements set out in AHDs, the related legal and ethical issues, and liability issues related to their implementation.The Spanish mental healthcare system requires structural changes so that providers can embrace new ways of relating to users and to organize partnerships and a continuity of care centred on user preferences. Introduction: Advance healthcare directives (AHDs) in mental health offer important information regarding service users' preferences. However, whether AHDs are truly understood by providers is questionable. Aim: To survey the knowledge and attitudes of mental health professionals towards AHDs and examine any associations with sociodemographic and occupational variables. Method: We cross‐sectionally surveyed the knowledge and attitudes of 113 mental health professionals by using two validated questionnaires. Results: Participants showed very positive attitudes and high levels of knowledge about the conceptual definition and application of AHDs in clinical practice but their knowledge of the legalities, procedure and registration of AHDs was poor. Working in a community, having a career specializing in mental health or having personally signed an AHD was associated with enhanced knowledge about them. Moreover, female sex or employment as an auxiliary nursing‐care technician was associated with stronger positive attitudes. Discussion: Legal and structural changes will be needed to implement AHDs in Spain and to promote competence among healthcare providers in order to include AHDs in everyday practice. Implications for practice: The Spanish mental healthcare system requires legal and structural changes and must improve healthcare providers' competence in AHDs before they are implemented. [ABSTRACT FROM AUTHOR]

Aims: This study outlines a protocol aimed at identifying and mapping health promotion practices in need of development from the perspectives of key sectors responsible for it at the local level and from an intersectoral perspective across four Spanish regions. Design: A complementary multi‐method study combining survey methods and qualitative interviews will be adopted. Methods: Purposive snowball sampling will be employed to select potentially rich informants from city councils, primary care centres, primary and secondary schools, and public health and civil society organizations in 12 municipalities sensitive to local health. Data on the degree of execution of health promotion activities, the level of intersectorality in their implementation, and their origins will be collected using PromoACTIVA questionnaires, an intersectoral typology model and an interview protocol. A parallel mixed analysis encompassing descriptive statistics and a 'framework analysis' will be performed. Discussion: This study is expected to yield thorough and reliable insights into health promotion practices and omissions at the local level by focusing on key stakeholders, both individually and collaboratively. This information can enhance health promotion planning and improve its effectiveness, efficiency and contextual relevance. The development and testing of a methodology for the integration and interpretation of these data will ensure sustainable capacity building. Impact: Managers and practitioners interested in health promotion planning in the researched settings can benefit from a comprehensive map of the current state of their practices and insights into the starting points of collaboration. In addition, planners from other local settings will gain access to tools and methodologies to replicate and expand these maps to their own contexts. Stakeholder Engagement: Engaging key stakeholders with experience working in or with primary care centres, public health organizations, primary and secondary schools, civil society organizations, and city councils was vital to ensure the study's relevance and feasibility. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Advance care planning (ACP) in mental health is a useful tool to avoid human rights violations in mental health settings. However, ACP is not yet a reality in the Spanish context.The advance healthcare directive (AHD) is a document reflecting healthcare preferences, drafted within the framework of the ACP process, to be applied in situations in which an individual's legal capacity may be questionable.No study has explored the viewpoint of Spanish mental healthcare professionals towards AHDs in the mental health field. Considering their extensive use, further study of providers' knowledge and attitudes is warranted. What does the paper add to existing knowledge?: The study adds knowledge about the viewpoint of Spanish mental healthcare professionals towards the implementation of AHDs in their clinical practices.This study illuminates the prevailing paternalistic provider–user relationship as the main barrier surrounding AHD management in terms of decision‐making.Our findings support the need for broader awareness, staff training regarding the documentation, the conversation process and communication skills, and personalized assistance in the mental health services to implement AHDs in everyday practice. What are the implications for practice?: Advance healthcare directives are a recovery tool that offers major information regarding mental health user preferences. Although they pose challenges for clinical practice, AHDs should be incorporated into interventional mental health care.Obtaining up‐to‐date perspectives held by mental healthcare professionals regarding AHDs allows the administration to determine the aspects requiring reinforcement.The implementation of AHDs in the Spanish mental health system requires macro‐ and micro‐changes, both ethically and structurally, so that mental healthcare professionals relinquish their paternalistic approach and embrace new ways of relating to users. Introduction: An advance healthcare directive (AHD) is a written document that contains a patient‐in‐care's will and preferences concerning the treatment options available to them, should they lack decision‐making capacity. AHDs are completed within a broader framework known as advance care planning. No study has explored the viewpoint of Spanish mental healthcare professionals towards AHDs. Aim: To explore the viewpoint of mental health professionals towards the implementation of AHDs in mental health. Method: A qualitative study was conducted using semi‐structured interviews that were thematically analysed. Findings: Three main themes were identified: care planning culture; barriers for the practical management of AHDs; and reasons to not honour patient‐in‐care AHDs. Discussion: Professionals find it pragmatically difficult to stop applying traditional paternalistic practices. To implement AHDs, improving the knowledge and awareness of AHDs and management of non‐technical skills through training is required. Such training should include users and families and allow for compliance with United Nations requirements. Implications for practice: Advance healthcare directives offer important information regarding user preferences, although they pose challenges for practices. Acquiring an up‐to‐date perspective on the attitudes of professionals towards AHDs allows organizations to attend to particular aspects that require reinforcement. Wider awareness, staff training and new ways of relating to users are necessary to implement AHDs in Spanish context. Relevance statement: A better understanding of the attitudes of Spanish mental health professionals towards AHDs was achieved. Despite the implementation of AHDs being an important and potentially beneficial initiative, mental health professionals find many pragmatic issues that need addressing before AHDs become a reality in their clinical practice. Wider awareness, staff training, personalized assistance and new ways of relating to users are required to implement AHDs in everyday practice. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study of the process of social rehabilitation, and the analysis of the main elements and influencing factors which are important in the process. Background. The process of social rehabilitation lacks conceptual and empirical understanding in Neurology because most rehabilitation programmes have focused on cognitive and physical recovery. Methods. An action research project was undertaken in two neurological wards of a highly specialized hospital in Spain, and was completed in 2006. A social rehabilitation programme based on the assessment of social needs and individualized social education was planned with health professionals, and implemented and evaluated with patients and carers. Several instruments were used to explore how patients and carers perceived the process of social rehabilitation before and after the programme: semi-structured interviews, socio-demographic forms, field notes, participant observations, and scales of activities of daily living, social impairment and adjustment. Comparative content and statistical analyses were undertaken. Findings. Social rehabilitation was identified as a dynamic process in which the environment, activities, social interaction, self-recognition and awareness of social problems, coping and satisfaction played an essential role. Some defining criteria for social rehabilitation related to patients' and carers' attitudes, behaviour and the external implications that the socialization process had for them. Conclusion. This study shows the advantages of multidisciplinary work, and user and family involvement in social rehabilitation and provides in-depth knowledge about how patients and carers experience and could face barriers to develop a role in their family environment, social groups and society. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? In general, the current studies of positive mental health use questionnaires or parts thereof. However, while these questionnaires evaluate aspects of positive mental health, they fail to measure the construct itself., What does this paper add to existing knowledge? The widespread use and the lack of specific questionnaires for evaluating the positive mental health construct justify the need to measure the robustness of the Positive Mental Health Questionnaire. Also six factors are proposed to measure positive mental health., What are the implications for practice? The availability of a good questionnaire to measure positive mental health in university students is useful not only to promote mental health but also to strengthen the curricula of future professionals., Abstract Introduction Nursing has a relevant role in managing mental health. It is important to identify and thereafter to enhance positive aspects of mental health among university nursing students. Aim The aim of the present study was to analyse the psychometric properties of the Positive Mental Health Questionnaire ( PMHQ) in terms of reliability and validity using confirmatory factor analysis in a sample of university students. Method A cross-sectional study was carried out in a sample of 1091 students at 4 nursing schools in Catalonia, Spain. The reliability of the PMHQ was measured by means of Cronbach's alpha coefficient, and the test-retest stability was measured with the intraclass correlation coefficient ( ICC). Confirmatory factor analysis was used to determine the validity of the factorial structure. Results Cronbach's alpha coefficient was satisfactory (>0.70) for four of the six subscales or dimensions and ranged from 0.54 to 0.79. ICC analysis was satisfactory for the six subscales or dimensions. The hypothesis was confirmed in the analysis of the correlations between subclasses and the overall scale, with the strongest correlations being found between the majority of the subscales and the overall scale. Confirmatory factor analysis showed that the model proposed for the factors fit the data satisfactorily. Discussion This scale is a valid and reliable instrument for evaluating positive mental health in university students. Implications for Practice A good questionnaire to measure positive mental health in university students is useful not only to promote mental health but also to strengthen the curricula of future professionals. [ABSTRACT FROM AUTHOR]

Aim: To psychometrically assess the Spanish version of the Self‐Care of Chronic Illness Inventory (SC‐CII‐Sp) in community‐dwelling older adults with chronic multimorbidity. Design: A methodological study. Method: A total of 1260 older adults participated in the study between May 2020 and February 2022. The data were analysed using SPSS Statistics® 26 and AMOS® 24. The items' content validity index and the Fleiss' kappa were calculated to assess the SC‐CII‐Sp's content validity. Convergent validity was assessed by calculating the Pearson correlation coefficient between the participants' scores on the SC‐CII‐Sp and their scores on the Spanish Chronic Disease Self‐Efficacy scale (SCD‐SE). Construct validity was tested by performing a confirmatory factor analysis (CFA). The SC‐CII‐Sp's reliability was tested by computing the Cronbach's alpha. Results: The SC‐CII‐Sp showed good content and convergent validity. The CFA showed that the SC‐CII‐Sp has three sub‐scales. The 8‐item Self‐Care Maintenance sub‐scale has good internal consistency and is comprised of two dimensions: illness‐related and health‐promoting behaviour. The Self‐Care Monitoring sub‐scale had excellent internal consistency and its five loaded items belonged to a single dimension. The 6‐item Self‐Care Management sub‐scale has adequate internal consistency and two dimensions: autonomous and consulting behaviour. Conclusion: The Spanish version of SC‐CII is a valid and reliable instrument to be used in the assessment of self‐care behaviours amongst Spanish‐speaking, community‐dwelling older adults with chronic multimorbidity. Implications for the Profession: Nurses need valid and reliable tools to assess self‐care behaviours in Spanish‐speaking community‐dwelling older adults with chronic multimorbidity. This study provides a 19‐item tool that allows for the comprehensive evaluation of self‐care behaviours in healthy and ill states. Impact: Using the SC‐CII‐Sp in clinical or research settings could help nurses to examine the effects of different interventions on self‐care behaviours amongst Spanish‐speaking, community‐dwelling older adults with chronic multimorbidity. Patient or Public Contribution: None to be reported. [ABSTRACT FROM AUTHOR]

Aim: To provide initial data regarding country‐specific evidence of workplace violence towards nurses working within the health sector in five European countries. Methods: This is a descriptive and cross‐sectional pilot study, conducted in June 2016. The sample consisted of 260 nurses working in selected health care settings in five participating countries (Poland, Czech Republic, Slovakia, Turkey, and Spain). The questionnaire used was adapted from the International Labour Office/International Council of Nurses/World Health Organisation/Public Services International Workplace Violence in the Health Sector Country Case Study—Questionnaire. Results: A large number of participants confirmed that they had been physically attacked or verbally abused in the workplace in the last 12 months. In most cases, the physical and verbal abuse was inflicted by patients and to a lesser degree by relatives of patients, staff members, or managers/supervisors. In the majority of cases, no action was taken to investigate the causes of the incidents. In most cases, participants believed there was no point in reporting the incidents. However, the reasons for not reporting or discussing incidents of workplace violence varied depending on the country. Conclusion: Workplace violence towards nurses is a serious problem internationally, and violence prevention strategies need to be implemented. SUMMARY STATEMENT: What is already known about this topic? The nursing profession is at high risk of workplace violence. However, the problem seems to be severely underreported.What this paper adds? A better understanding of the problem in the social and cultural context, together with data fill information gaps regarding workplace violence in selected European countries.The implications of this paper: On the basis of the data obtained, prevention programmes and recommendations can be established and implemented in nurses' daily lives. Evaluation can also be conducted of the effectiveness of existing programmes and standards. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of the effectiveness of a tobacco use prevention and control course on health sciences students' smoking prevalence and incidence. Background. Although it is known that the intervention of health professionals in their patients' tobacco use can be affected by their own habit, very few studies have analysed the effect of specific tobacco-oriented training on smoking among health science students. Methods. This study is a quasi-experimental study of community intervention. During the years 2005-2008, a total of 290 health science students on the intervention campus and 256 on the control campus took part in the study. In the former, the intervention consisted of a course on the prevention and control of tobacco use for students, which was not offered on the control campus. Data about tobacco use and socio-demographic variables were collected by means of a questionnaire before and 6 months after the intervention. Results. Prevalence of tobacco use decreased in the intervention group (-1.1%) and increased in the control group (1.5%). The risk of acquiring the habit was almost three times higher in the control group than in the intervention group and the probability of cessation was 40% higher in the intervention group and correlated with nicotine dependence. Conclusion. The intervention suggests the effect on habit acquisition was slight but not so on cessation. Preventive interventions should be carried out before students go to university, while more specific cessation programmes are required to reduce tobacco use among students. [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 explore the process of change within the clinical practice of nurses in mental health inpatient units in the context of a participatory process to improve the nurse–patient therapeutic relationship. Design: Participatory Action Research. Methods: Ninety‐six nurses from 18 mental health units participated. Data were collected through focus groups and reflective diaries between March 2018 and January 2020. Data were analysed using inductive content analysis. The COREQ guidelines were used. Results: The research process was carried out through two cycles of four stages each in which the nurses were able to identify the facilitating and limiting elements of their practice in relation to the therapeutic relationship. They then proposed two consensual improvement strategies for all the units, which they called reserved therapeutic space and postincident analysis. Finally, they implemented and evaluated the two strategies for change. Conclusions: This study has shown that, despite the different cultural and structural realities of the participating units, it is possible to implement a collaborative process of change, provided the needs and expectations of both the participants and the organisations are similar. Relevance to Clinical Practice: The results obtained through Participatory Action Research were directly transferred to clinical practice, thus having an impact on individual nurses and patients, as well as on the collective dynamics of the teams and aspects related to the management of the units. No Patient or Public Contribution: Patient or public input is not directly applicable to this study. Patients were recipients of the changes that were occurring in the nurses as part of their daily clinical practice. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore women's emotional responses throughout the process of terminating a pregnancy for medical reasons. Background: Making the choice to terminate a desired pregnancy for medical reasons has a negative impact on women's health, as it is a distressing process that involves making hard decisions and readjusting one's expectations of an idealised pregnancy. Methods: A qualitative phenomenological study was conducted following the COREQ checklist. Fifteen semi‐structured interviews and two focus groups were conducted with women who had terminated their pregnancies for medical reasons, previous to and during the COVID‐19 lockdown. Subsequently, we analysed the content. Results: One main category, emotional journey during the process of terminating the pregnancy, and six subcategories were identified: (I) representation and desire to become a mother, (II) main concerns, (III) impact of the news, (IV) decision‐making, (V) emotional responses before termination for medical reasons and (VI) emotional responses after termination for medical reasons. All contributed to understanding the specificities of the different phases that make up the emotional journey of terminating a pregnancy for medical reasons. Conclusions: The findings of this study suggest that there are a number of predominant emotions that professionals need to be aware of in order to help women work through them and lessen the impact of pregnancy termination on their mental health. COVID‐19 had different connotations depending on the women's experiences. Relevance to clinical practice: Our results highlight how important the role of healthcare staff is in caring for these women and their partners, which involves recognising their emotions throughout the process. Our results also underline how useful it is to conduct qualitative studies in this context, since they constitute a set of activities and interventions that result in the administration of nursing care in itself. Patient or Public Contribution: The ultimate goal of the action research study is to design a positive mental health intervention. Participants will contribute to the design and final approval of the intervention. [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: 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]

Aim: To examine the effects of expert HIV patients acting as teachers to Spanish nursing students both on their HIV‐related knowledge, attitudes and practices and on their approach to the care model as well as to explore their learning experience. Design: Non‐randomized, single‐arm study with quantitative before and after measurements and qualitative data. Methods: The intervention consisted of five 90‐min workshops led by two women living with HIV. Thirty‐four nursing students participated, and quantitative and qualitative data were gathered from February to June 2018. We used the Patient‐Practitioner Orientation Scale (PPOS) and the KAP questionnaire on HIV/AIDS to collect quantitative data. Results: Statistically significant differences were found in the global score for care orientation and its two dimensions, caring and sharing. About the changes resulting from the workshops, the quantitative results—more patient‐centred care perception and better attitudes towards people living with HIV—match the qualitative findings in all the aspects studied, except in sharing. Conclusion: Incorporating expert patients as teachers in the nursing bachelor's degree resulted in more patient‐centred care and improved knowledge, attitudes and practices. The workshops conducted by qualified expert patients showed transformative learning power, as the participants improved professional and personal aspects. [ABSTRACT FROM AUTHOR]

Aims: To explore caregivers' needs and problems in three European countries and associate the clusters of caregivers' needs with their sociodemographic characteristics. Design: A qualitative focused mixed methods design was used. Methods: In total, 52 caregivers of heart failure (HF) people were interviewed in three European countries between March 2017 and December 2018. Transcripts were analysed using the seven‐phase method of the exploratory multidimensional analysis according to Fraire with Reinert lexical classes findings were organized in dendrograms. Mayring's content analysis was also performed. Results: Three clusters of caregivers were identified: spouses, adult children and non‐family members. Caregivers not only provide HF patients with vital unpaid support for their physical and emotional needs, but they are continually trying to cope with their social isolation and deteriorating health. Conclusions: Informal caregiving emerged as a complex process influenced by various sociodemographic factors. Gender, relationship type and economic status are the important factors to be considered planning to develop approaches to address the needs of caregivers serving people with heart failure. Impact A comprehensive understanding of the nature of informal caregiving of individuals with heart failure, the complexity of the real‐world sociodemographic and cultural factors is warranted. The use of the EMDA method gave us the possibility of processing large masses of qualitative data through rapid, complex calculations. In detail, AATD allowed us to study in deep the significant fuzziness of what caregivers expressed and to analyse the content of the entire interviews and to produce global knowledge by using multi‐dimensional statistical methods to grasp the fundamental sense of the interviews, beyond the simple words. Three clusters were identified in the samples, including spouses, adult children and non‐family members. This study demonstrated that some sociodemographic characteristics could lead to everyday needs. Therefore, these demographic characteristics should be considered in developing targeted interventions. The research was conducted in Europe, but the technique shown can be replicated everywhere. The findings not only impact nursing but can be extended to all those stakeholders who concur with a public health educational mission. Patient or Public Contribution: Carers were involved in this study after the discharge of their loved ones or at the time of the outpatient visit. They were involved after they had been observed in their dynamics of involvement in caring of the familiars or friends with heart failure. [ABSTRACT FROM AUTHOR]

Aims and Objetives: Explore nurses' experiences and perception of risk regarding the use of personal protective equipment during the first wave of the pandemic in Spain. Background: The contribution of our study is to use qualitative methods to understand nurses' experiences and perceptions of the risk of the contagion linked to the shortage of PPE during the first wave of the pandemic, whose explosive start strained health systems around the globe. Design: Qualitative descriptive design according to the Rapid Research Evaluation and Appraisal model. Methods: Semi‐structured videoconference interviews were conducted to explore the experiences of 29 nurses including staff nurses, nursing supervisors and nursing directors from hospital and community services of the Spanish health system. Interviews lasted 30–45 min and were conducted in May 2020. We carried out a thematic analysis using Dedoose. The COREQ checklist was used to report findings. Results: We identified the following themes and subthemes: 1. Experiences with personal protective equipment: scarcity, inequality, reutilization, self‐protection, delegation of responsibility, and gap between protocols and reality; 2. Perception of the risk of contagion: lack of credibility, lack of trust, lack of support, and meeting subjective needs. Conclusions: The scarcity of personal protective equipment and inequality in its distribution led nurses to take initiatives to feel more protected. Mid‐ranking supervisors were caught between the responsibility of monitoring and rationing personal protective equipment and providing the necessary protection to nurses. The disjuncture between protocols and the available supply of personal protective equipment caused confusion. Lack of credibility, lack of trust and lack of support from management influenced participants' perception of the risk of contagion. Mid‐ranking supervisors were often responsible for trying to alleviate fear among nursing staff. Relevance to clinical practice: Understanding the factors involved in risk perception can be helpful to decision‐makers who help protect nurses in clinical practice. These results can help administrators and policymakers because they point to the need for nurses to feel that their departments and centers look after their safety at work. Transparent communication and emotional support may contribute to their well‐being in the face of risk. [ABSTRACT FROM AUTHOR]

de pedro-gómez j., morales-asencio j.m., sesé-abad a., bennasar-veny m., pericas-beltran J. & miguélez-chamorro a. (2012) Psychometric testing of the Spanish version of the Practice Environment Scale of the Nursing Work Index in a primary healthcare context. Journal of Advanced Nursing 68(1), 212-221. Abstract Aim. This paper is a report of psychometric testing of the Spanish version of the Practice Environment Scale of the Nursing Work Index for use in a primary health care. Background. The Practice Environment Scale of the Nursing Work Index has been widely used in different studies and contexts. However, there is no validated version for primary care nursing staff in Spain. Methods. A descriptive, multicentre, cross-sectional study for transcultural adaptation and psychometric validation purposes. Data were collected from October 2009 to January 2010. To test the reliability of the factors in the measurement model, Cronbach's alpha was used. To study the measurement model, different structural models were tested, using exploratory and confirmatory factor analyses. 377 completed questionnaires were obtained from a total of 553 nurses working for the Public Health Service in the Balearic Islands (Spain). This represents a response rate of 68·2%. Results. For overall reliability, a Cronbach alpha of 0·91 was obtained. The confirmatory analysis upholds the original five-factor structure. Conclusion. The excellent goodness of fit of the confirmatory analysis corroborates the validity of this adapted version in primary healthcare contexts. [ABSTRACT FROM AUTHOR]

Aims and objectives. To evaluate a contextually framed intervention to increase nursing research capacity among clinical nurses in a Spanish hospital. Background. In Spain, there has been a paucity of nursing research and a lack of nursing research culture. Currently, with the European Convergence of educational programmes and qualifications, there is a growing interest in promoting nursing research in this country. Design. A quasi-experimental design. Methods. Using a control ( n = 81) and an intervention group ( n = 89) of nurses, pre- and postintervention data were collected from both groups to evaluate the impact of the intervention at three times. The intervention, implemented over one year, consisted of the establishment of a mentors' network and an educational programme with research courses and journal clubs. Data collection methods included questionnaires, objective tests and scales. Results. The nursing research capacity of the hospital developed moderately after the intervention, with an increase in participants' research capability (knowledge, skills and attitudes) and a decrease in some of the inhibiting factors identified in the context. Conclusions. A new comprehensive and contextually framed intervention to develop nursing research capacity has been designed, implemented and evaluated in a hospital. It contributed to the development of the nursing research culture in the context. Relevance to clinical practice. An increase in nursing research activity could improve the quality of nursing care through the incorporation of research evidence in practice. This intervention could be used as a model in other hospitals, and it should be evaluated in other contexts. [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]

Background: A validated questionnaire to measure the contributions of nursing students to clinical settings could potentially assist in the improved management of students in healthcare institutions. Aim: To develop and test the psychometric properties of the questionnaire 'Nursing Student Contributions to Clinical Settings' (CEEEC, Spanish acronym for 'Contribuciones de los Estudiantes de Enfermería a los Entornos Clínicos'). Design: Instrument design and psychometric testing. Participants/settings: A multicentre study involving 1,098 nursing professionals from three universities and five hospitals of Spain, between January 2019 and March 2020. Methods: The study was carried out in two phases. Phase 1 involved the questionnaire design by experts (n = 28), which required a review of the available literature, cognitive interviews and Delphi rounds, and a preliminary validity study, which included a pilot test with responses from a sample of nurses (n = 143). Phase 2 involved a formal validation with a wider sample of nurses (n = 927), including factor analysis and a study of convergent validity with the Practice Environment Scale‐Nursing Work Index and Health Sciences‐Evidence Based Practice. Results: Experts selected 42 items on student contributions. After cognitive interviews, three items were eliminated and seven failed to reach the minimum content validity index (78%). Based on the remaining 32 items, the discrimination index of each item was calculated, and those with <0.3, eight items were sequentially eliminated. The resulting questionnaire contained 24 items grouped into a single factor, which explained 41% of the variance. The internal consistency was excellent (Cronbach's alpha: 0.94), and the convergent validity was confirmed. Conclusions: A 24‐item questionnaire was designed and validated to measure the contributions of nursing students to clinical practice settings. Impact: Most hospitals are also teaching centres where nursing students undergo clinical practice. The application of this test will provide insight into the nursing professionals' perception of the students' role. [ABSTRACT FROM AUTHOR]

Aims: To translate and adapt the Maternal Attachment Inventory (MAI) into Spanish; to develop a short form of the instrument that can be used during early childhood; and to test its psychometric properties in a large sample of Spanish mothers. Design: Cross‐sectional study of adaptation and cultural validation of instruments. Methods: Data were collected between February and September 2018. In Stage I, the instrument was culturally adapted using a standardized translation and back‐translation method. In Stage II, the factor structure of the Spanish version was tested in a sample of 300 mothers with children aged between 2 and 7 years, and on the basis of the findings a short form of the instrument was developed. Finally, in Stage III, in a second sample of 356 mothers, confirmatory factor analyses of first‐, second‐order and bi‐factor structure were conducted to find the optimal factor structure of the short form of the Spanish MAI. Convergent validity, internal consistency and test–retest reliability were also examined. Results: A bi‐factor structure with four sub‐scales and 17 items emerged from the factor analyses conducted in Stages II and III. Scores on the short form were negatively correlated with mother‐to‐infant bonding disorders. The short form presented adequate internal consistency and test–retest reliability. Conclusions: The Spanish MAI short form is a valid and reliable measure for assessing maternal attachment in mothers of children aged between 2 and 7 years. Impact: We present a short version of the MAI for healthcare professionals, adapted for application in a new age range and validated for use with Spanish mothers. [ABSTRACT FROM AUTHOR]

Aims and objectives: To obtain feedback regarding the comprehension and acceptability of an information leaflet on breast cancer screening among women. Background: Women usually receive a leaflet inviting them to participate in breast cancer screening programmes for early detection of breast cancer. These leaflets include relevant information about mammograms to aid with decision‐making. It is important to know how the target population perceives these leaflets, as this may influence the attitude towards breast cancer screening. Design: A mixed‐methods study (concurrent triangulation design). Methods: Participants were 41 women aged between 40–60 years in the north of Spain. The leaflet included information about breast cancer, mammograms, benefits/risks of screening, and the breast cancer mortality and survival rates in relation to screening. Three written methods were used to assess the leaflet: a readability assessment (Flesch Index) and two comprehension assessments (Cloze and multiple‐choice questions). In addition, 26 semi‐structured interviews were conducted to explore the women's opinions regarding comprehension, acceptability and the contribution of the leaflet as a decision aid. The COREQ checklist was used to guarantee the quality and rigour of the qualitative study. Results: Overall, women found the leaflet fairly easy to read and most understood the content. Some women found the information on mortality alarming, difficult to understand and a cause for rejection. The leaflet was viewed as a decision aid, although further information was requested on mammograms, the need for complementary tests and the risks and symptoms of breast cancer. Conclusion: The leaflet was accepted by women and, overall, easy to understand. The participation of the target population enabled the content and format of the leaflet to be adjusted to their needs. Relevance for clinical practice: Nurses can contribute towards improving the breast cancer screening leaflets, considering women's perceptions surrounding screening. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the knowledge, attitudes and practices related to cervical cancer and its prevention in Spain. Background: Worldwide, women's knowledge about cervical cancer is low, and their attitudes towards its prevention are good, but they do not correlate with the screening uptake. Although the rates of Spanish women performing cervical cancer screening are mostly acceptable, their knowledge and attitudes about it have not been explored. Design: Qualitative descriptive study. Methods: Three focus groups were conducted, with 21 women aged 25 to 65 years. Participants were recruited through convenience sampling. For intragroup homogeneity, women participated in age groups. The COREQ reporting guidelines were used. Results: Women expressed their knowledge about cervical cancer was low. None of the participants identified the human papillomavirus as a cause of cervical cancer, nor did they mention the vaccine as a preventive measure. They all knew about the screening existence, but not about its frequency nor target population. About the attitudes and practice, 18 women had an appropriate screening, and they were favourable to this health check, claiming an increase in its frequency. Nineteen women claimed they had not received enough information from the healthcare system and a lack of social awareness in comparison with breast cancer. They demanded from the professionals more health education, a reminder of their appointments and a report of the Pap test results. Conclusions: There was a self‐perceived low level of knowledge about cervical cancer risk factors and its prevention in the participants. However, they expressed favourable attitudes towards screening, and they demanded more information about cervical cancer and its prevention measures, and they regretted its low social awareness. Relevance to clinical practice: Midwives, general nurses and other nurse specialists may have a leading position in health education for cervical cancer prevention in different population levels. [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]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: Develop and psychometrically assess the Palliative Nursing Care Quality Scale (PNCQS, escala de Calidad del Cuidado Enfermero Paliativo, CCEP, in Spanish). An interview‐based qualitative study (1) was conducted to verify construct validity evidence, with psychometric properties of reliability and validity verified by two quantitative studies (2 & 3). Design: Quantitative instrumental, correlational, and cross‐sectional study. Methods: Study 1 was carried out with 10 key informants. For Study 2, a sample of 103 nursing professionals was obtained and 176 nurses from palliative care resources in Spain participated in Study 3. Data were collected between May 2017 – May 2018. Results: Evidence of adequate reliability (internal consistency) and validity was found. The confirmatory factor model yielded a single latent factor for the 20 items, with adequate goodness‐of‐fit indices. The convergent validity data showed that the highest correlations were with the Dedication subscale of the Utrecht Work Engagement Scale and the Personal Growth subscale of Psychological Well‐being, with values of 0.35 and 0.34, respectively (p < 0.01 in both cases). Conclusion: The scale shows good psychometric properties, with high internal consistency and evidence of internal and convergent validity. Impact: Proposing a valuable instrument which identifies good nursing in different areas of palliative care while also establishing quality indicators to guide nursing practice entails the recognition of autonomy in care. The resulting work tool can be used to systematize the assessment of nursing care in a process of open and continuous improvement. [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]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: To develop and psychometrically test a Theory of Planned Behaviour (TPB) questionnaire to assess nurses' intention to use physical restraints (PRs) in intubated patients. Design: A psychometric instrument validation study conducted in three phases. Methods: A theory‐driven questionnaire was developed. Eight experts validated the content of the preliminary 58‐item questionnaire. A pilot study was conducted including 101 critical care nurses to test the reliability of the items. Construct validity and reliability were tested in a cross‐sectional study of 12 units from eight hospitals in Spain (N = 354) from October ‐ December 2017. Participants completed the questions based on the TPB, and socio‐demographic and professional variables. Results: The instrument comprised 48 items. All the direct and indirect constructs exhibited acceptable reliability. Confirmatory factor analysis indicated satisfactory fit indices for factorial structure according to the TPB. Nurses showed favourable attitudes, low perception of social pressure and modest perception of behaviour control. Perceived behavioural control and attitude were moderately positively correlated with the intention to use restraints, whereas subjective norm revealed the lowest correlation. Overall, the model explained 33% of the variance in intention. Conclusions: The Physical Restraint TPB questionnaire is a 48‐item self‐reporting theoretically based instrument with acceptable reliability and construct validity to identify nurses' intentions to use PRs in intubated patients. Impact: Unravelling the key determinants of nurses' intentions to use PRs should be examined to tailor quality improvement projects aimed at de‐implementing restraints use in practice and to promote safer care. [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]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: The aim of this study was to evaluate the effectiveness of an intensive intervention led by primary care nurses for lifestyle modification among people with intermediate cardiovascular risk. Background: Cardiovascular diseases may be prevented by adopting healthy lifestyles. Interventions focused on populations at risk are more efficient than those aimed at the general population. More than 50 per cent of cardiovascular events occur in people with intermediate cardiovascular risk, but only a few studies have targeted this population. Design: A randomized controlled trial approved in January 2017. Methods: We will recruit 208 participants aged 35-74 years who have intermediate cardiovascular risk. They will be selected by consecutive sampling and will be randomized into a control group or intervention group. Individual standardized brief counselling on healthy lifestyles will be provided to both groups. Additionally, individuals from the intervention group will receive four weekly group sessions focusing on cardiovascular risk, healthy diet, moderation in alcohol consumption, daily physical activity, stress management and smoking cessation and two motivational followup calls. The primary outcome will be the lifestyle modification measured by total steps recorded by a pedometer, total score on the Mediterranean Diet Adherence Screener and percentage of current smokers. Discussion: This study will allow us to investigate whether an intensive intervention based on a multifactorial group approach is more effective in lifestyle modification than individual standardized brief counseling among adults with intermediate cardiovascular risk. Our results could lead to the establishment of new strategies for cardiovascular risk management. [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]