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Background: Fear of childbirth affects women worldwide and can have adverse consequences. Midwives have implemented a number of interventions, autonomously or as part of a professional team. However, midwives have been unable to identify the most appropriate intervention for ensuring the reduction or alleviation of this fear to provide the best perinatal outcomes. Objective: This study aimed to evaluate the effectiveness of a prenatal educational intervention followed by specific support during childbirth, designed and delivered exclusively by midwives for women with a high fear of childbirth. Method: This randomized controlled trial was performed with two arms in two phases: an online prenatal education phase followed by a support phase during childbirth. Participating women with a high fear of childbirth, which was determined using the Wijma Delivery Expectancy Questionnaire A-Spanish version, were assigned to the experimental group or the usual care control group at a 1:1 ratio. Results:Women showed a reduction in fear of childbirth in both phases of the study. According to the intention-to-treat analysis, a significant mean difference was observed in the prenatal stage in favor of the intervention group, and a nonsignificant difference was observed in favor of this same group after delivery. Discussion: The effectiveness of continuous specific prenatal education with preferential support during childbirth by midwives was indicated by improvements in the level of fear of childbirth. [ABSTRACT FROM AUTHOR]

Suicidal ideation represents a significant predictor of completed suicide. Recent research indicates that it is the leading cause of maternal mortality during pregnancy in industrialized countries, as well as in the 12 months following childbirth, with prevalence rates among pregnant women ranging from 3% to 33%. This study aimed to estimate the prevalence of suicidal ideation among pregnant women in Gran Canaria. A cross-sectional, descriptive, and observational study was conducted at the University Hospital Complex Insular Materno-Infantil of Gran Canaria (CHUIMI). Consecutive non-probabilistic sampling was employed among pregnant women in their 20th to 22nd week of pregnancy. Participants completed the PHQ-9 questionnaire, the Paykel Scale, and a sociodemographic questionnaire to assess associated risk factors. A total of 9.57% of pregnant women reported experiencing some level of suicidal ideation. Factors that increased the risk of suicidal ideation included employment status (p-value = 0.031), prior abortions/miscarriages (p-value < 0.001), educational level (p-value = 0.005), and having living children (p-value = 0.018). This study suggests that the prevalence of suicidal ideation among pregnant women in Gran Canaria may be higher than previously reported in the literature. Therefore, early identification of suicidal ideation is crucial for timely intervention. [ABSTRACT FROM AUTHOR]

The decision-making in clinical nursing, regarding diagnoses, interventions and outcomes, can be assessed using standardized language systems such as NANDA International, the Nursing Interventions Classification and the Nursing Outcome Classification; these taxonomies are the most commonly used by nurses in informatized clinical records. The purpose of this review is to synthesize the evidence on the effectiveness of the nursing process with standardized terminology using the NANDA International, the Nursing Interventions Classification and the Nursing Outcome Classification in care practice to assess the association between the presence of the related/risk factors and the clinical decision-making about nursing diagnosis, assessing the effectiveness of nursing interventions and health outcomes, and increasing people's satisfaction. A systematic review was carried out in Medline and PreMedline (OvidSP), Embase (Embase-Elsevier), The Cochrane Library (Wiley), CINAHL (EbscoHOST), SCI-EXPANDED, SSCI and Scielo (WOS), LILACS (Health Virtual Library) and SCOPUS (SCOPUS-Elsevier) and included randomized clinical trials as well as quasi-experimental, cohort and case-control studies. Selection and critical appraisal were conducted by two independent reviewers. The certainty of the evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation Methodology. A total of 17 studies were included with variability in the level and certainty of evidence. According to the outcomes, 6 studies assessed diagnostic decision-making and 11 assessed improvements in individual health outcomes. No studies assessed improvements in intervention effectiveness or population satisfaction. There is a need to increase studies with rigorous methodologies that address clinical decision-making about nursing diagnoses using NANDA International and individuals' health outcomes using the Nursing Interventions Classification and the Nursing Outcome Classification as well as implementing studies that assess the use of these terminologies for improvements in the effectiveness of nurses' interventions and population satisfaction with the nursing process. [ABSTRACT FROM AUTHOR]

Midwifery empowerment is an important topic. The most widely used instrument to measure the perceived empowerment of midwives is the Perceptions of Empowerment in Midwifery Scale (PEMS), which has not been validated in Spain. The aim of this study was to translate and adapt the PEMS to the Spanish context. This research was carried out in two phases; Phase 1: Methodological study; translation, backtranslation and cross-cultural adaptation of the PEMS and pilot study on the target population (10 midwives) for evaluation of face validity. Phase 2: Cross-sectional observational study to obtain a sample for construct validation by Exploratory Factor Analysis and measurement of PEMS-e reliability. Additionally, an inferential analysis was carried out to study the possible association between several collected variables and PEMS-e subscale-scores. A total of 410 midwives from 18 Spanish regions participated in the study through an online questionnaire. An initial Spanish version of the PEMS scale was produced, demonstrating adequate face validity. A final model was produced for the PEMS-e, which included 17 items classified into two subscales ("Organizational support" and "Own skills and teamwork") with fit indexes RMSEA = 0.062 (95%CI: 0.048–0.065) and AGFI = 0.985 (95%CI: 0.983–0.989) and Cronbach's alpha 0.922 for the total scale. Results showed that one in four midwives had considered abandoning the profession in the last 6 months (p ≤ 0.001). This research suggests that Spanish midwives perceive their empowerment level as low. The PEMS-e is a valid tool with solid psychometric properties that can be used in future research to identify factors that contribute to increased empowerment among Spanish midwives and inform strategies to improve job satisfaction and retention in the profession. [ABSTRACT FROM AUTHOR]

Objective: To determine the number of specialised wound care units/clinics (SWCUs) in Spain, at present, and to describe their most important characteristics. Method: This was an observational study with a descriptiveanalytical, cross-sectional, multicentre approach, where the studied population consisted of SWCUs in Spain. A specific data-collection questionnaire was designed using a modified Delphi method, consisting of four rounds, with the collaboration of 10 wound experts. The final questionnaire included 49 items distributed across four dimensions/areas with a content validity index (CVI-Total for pertinence=0.96 and CVI-Total for relevance=0.94. Results: A total of 42 SWCUs were included in the study. Most SWCUs were based in hospitals (n=15, 35.7%) or healthcare centres, covering a specific healthcare area (n=17, 40.5%). SWCU coordinators were primarily nurses (n=33, 78.6%). Staff members' professions in SWCUs included registered nurses (n=38 units, 92.7%), nursing assistants (n=8 units, 19.5%), podiatrists (n=8 units, 19.5%), vascular surgeons (n=7 units, 17%), osteopaths (n=2 units, 4.8%) and medical doctors from different specialties (n=3 units, 7.2%). For wound aetiology, the most prevalent wounds managed were diabetic foot ulcers (n=38 units, 90.5%), followed by venous leg ulcers (n=36 units, 85.7%) and arterial ischaemic ulcers (n=36 units, 85.7%). A statistically significant association was found between the number of staff members in a SWCU and the existence of resistance/opposition barriers when developing a SWCU (Chi-square test, p=0.049; Cramér's V=0.34; 34%), as well as between resistance/opposition barriers when developing a SWCU and a nurse as coordinator of a SWCU (MacNemar test, p=0.007, Cramér's V=0.35; 35%). Conclusion: The typical SWCU implemented in Spain is located in a hospital or integrated in a healthcare structure that offers coverage to a whole health area and providing services for people with hard-to-heal wounds (wound management and prevention) and health professionals (advice, consultancy and training/education). Despite the growing number of SWCUs in Spain, the future of this new organisational model is uncertain, as there can be barriers to creating them and some deficiencies, such as low staff numbers, which need to be addressed. Declaration of interest: The authors have no conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

The aims of the study were to describe and analyse the temporal trend of the prevalence and incidence of venous leg ulcers (VLU) over the years 2010 to 2014, to determine healing times and temporal trends in the study period, and to evaluate related aspects such as the use of the Ankle‐Brachial Pressure Index (ABPI) in a primary care health centre. This was a retrospective study based on a time series (years 2010‐2014) of the prevalence and incidence of VLUs in people aged over 40 years in a primary care centre in Barcelona City. We reviewed 3920 electronic health records selecting patients, per year (2010‐2014), with VLUs based on the ICD‐10 diagnoses. For prevalence, we took into account any patient with an active VLU in the year of study. For incidence, we took into account patients with a new VLU in the year of study. A descriptive analysis was carried out based on each of the collected variables. The variables were examined according to the years of study (time series) by one‐factor analysis of variance (anova) or Kruskal–Wallis non‐parametric test, as appropriate. A survival analysis by Kaplan–Meier curves and log‐rank test was also performed. A total of 139 patients met the VLU criteria. Among them, only 79.2% were classified as having a VLU and had a correct ICD diagnosis. The prevalence and incidence increased over the years, doubling in patients aged over 65 years. Incidence increased from 0.5 new cases per 1000 people/year in 2010 to 1 new case for every 1000 people/year in 2014. Moreover, the prevalence ranged between 0.8 and 2.2 patients with VLU for every 1000 people/year. During the study period, a total of 84.2% of the VLUs healed (117/139 VLU). Regarding average annual time to healing, the trend indicates that lesions took less time to heal (Kruskal–Wallis test, P = 0.004), ranging between 453,9 weeks in 2005 to 19 weeks in 2014. The use of ABPI also evolved and was found to be increasingly performed prior to the appearance of the lesion. The epidemiological profile of people affected by VLUs continues to be, mainly, that of women of an advanced age, over 70 years. The frequency of VLU occurrence rose continually over the years, but healing took less time, and use of ABPI improved. Assigning a reference nurse in the wounds unit and the organisational structure around this problem may have an influence on improving care and the approach to these types of lesions. [ABSTRACT FROM AUTHOR]