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Background: Online learning is becoming increasingly essential for health professionals, and it is necessary to understand how this modality affects clinical nurses' learning of Evidence-Based Practice (EBP). For this reason, the present study sought to assess the effectiveness of an online training program in improving nurses' EBP competence., Methods: A quasi-experimental study with a pretest-posttest design was conducted with a control group and without randomization for a period of 6 months. The intervention was an online self-learning course based on Melnyk's seven steps of Evidence-Based Practice (EBP). The course was structured into sequential modules requiring 72 h of work, with task completions and tests necessary for progression. Participants had three months to complete the course. EBP competence was measured with the EBP-COQ Prof© questionnaire. Data analysis included percentages, means, standard deviations, chi-square tests, student's t-tests, and a two-way repeated measures analysis of covariance (ANCOVA)., Results: The analysis of the changes observed in each dimension and the overall EBP competence between the intervention group (IG) and the control group (CG) showed a significant group*time interaction in three of the four dimensions of the questionnaire. The results indicated that the online Evidence-Based Practice (EBP) course significantly improved knowledge, skills, and utilization three months after its completion. In the IG, the mean score was 44.04 (standard deviation (SD) = 7), compared to 37.83 (SD = 8.5) in the CG (p < 0.001). Regarding skills, the IG had a mean score of 24.24 (SD = 3.8), while the CG scored 23.01 (SD = 3.1) (p = 0.008). For utilization, the mean score in the IG was 36.77 (SD = 6.8), and the CG was 33.12 (SD = 6.3) (p = 0.005). Overall competence also showed a statistically significant difference, with the IG achieving a mean score of 141.22 (SD = 20.0) compared to the CG with a mean score of 130.34 (SD = 16.7) (p < 0.001)., Conclusions: Training through an online education platform for three months (72 h) is an effective tool for improving the competence in Evidence-Based Practice (EBP) of clinical nurses. A significant increase was observed in knowledge and moderate improvements in skills and the application of EBP. These online courses, adapted to the needs of professionals, can be an efficient way to prepare nurses and improve their application of EBP in a clinical setting., Competing Interests: Declarations Ethics approval and consent to participate The study was approved by the Ethics Committee of the University of Murcia (ID: 2540 /2019). The nurses were invited to participate voluntarily through the online survey. They were informed about the objectives of the study, clarifying that their participation was completely anonymous, that they could withdraw from the study at any time, and that by submitting the questionnaires, they were giving their consent to participate in the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objective: To perform an economic evaluation to determine whether or not teledermatology (TD) units in primary care (PC) centers offer an alternative in terms of cost-utility and cost per quality-adjusted life years (QALYs) to conventional dermatology consultations (face-to-face dermatology [F-F/D]) at the hospital from the perspective of the Public Health System (PHS) and the patients., Methods: This is a randomized, controlled, nonblinded, and multicenter study. During 6 months, data from 450 patients (TD: 225 vs. F-F/D: 225) were collected. From both perspectives, costs, quality of life, and costs per QALYs were analyzed. The QALY scores were estimated from the EuroQol-5D-5L (EQ5D-5L) questionnaire responses., Results: From the perspective of the PHS, the cost per patient was 53.04% lower in the TD group (p < 0.001). Hospital visits decreased by 72.43% in the TD group (p < 0.001). From the patients' perspective, TD reduced costs per patient by 77.59% (p < 0.001). The cost per QALY was 63.34% higher in the F-F/D group (p < 0.001). The TD group's total costs were 56.34% lower (p < 0.001). Furthermore, patients in the TD group gained 0.05 QALYs more than those in the F-F/D group (p = 0.004)., Conclusions: This study shows that TD units in PC represent a significant cost-effective alternative to conventional hospital follow-up. To enhance TD in PC, it is important to introduce remote consultation platforms incorporating artificial intelligence for prediagnosis. This will enable general practitioners and nurses to make more accurate initial assessments. It is also crucial to provide thorough training to healthcare personnel using these technologies to ensure more efficient and personalized care. Public health nurses will benefit from gaining new skills in managing digital tools, which will help in the early identification of dermatological diseases and reduce unnecessary referrals to specialists. This will optimize resources and improve response times for patients., (© 2024 Wiley Periodicals LLC.)

Background/Objectives: Population aging poses many challenges to public health, highlighting loneliness and social isolation as severe problems that affect the physical and mental health of older adults. During the COVID-19 pandemic, these became aggravated. The objective of the present study was to assess the prevalence of loneliness and its relationship with social isolation, depression, cognitive deterioration, sleep quality, and the level of physical mobility and functioning of older adults in Health Area 3 of the Region of Murcia. Methods: A descriptive, observational, and cross-sectional study was performed. The inclusion criteria were age ≥ 65, living in Health Area 3 of the Region of Murcia, and not being institutionalized. The following variables were evaluated: sociodemographic variables, loneliness (UCLA scale), social isolation (DUFSS), depression (GDS), cognitive deterioration (Pfeiffer), sleep quality (PSQI), and mobility (Barthel index). A univariate and multivariate regression model was created to examine how the dependent variable was related to the independent variables. Results: A total of 102 older adults participated in the study. Of these, 31.4% perceived unwanted loneliness and 14.7% low social support. The multivariate regression analysis showed that social isolation, geriatric depression, and cognitive deterioration were significant predictors of loneliness. Conclusions: The findings highlight the importance of developing multifaceted interventions that address not only social isolation but also other interrelated factors such as depression, cognitive deterioration, and sleep quality. The strategies should be centered on community programs and support networks. It is fundamental to perform longitudinal studies to better understand the causal relationships between these variables.

The Continuity of Care Report (CCR) is a fundamental document for ensuring high-quality healthcare and a smooth transition between different levels of care. The aim of this study was to evaluate the impact of optimizing the CCR to improve its completion rate by hospital nurses and its review by primary care nurses. To achieve this, a retrospective observational study was conducted on patients discharged from the University Hospital of La Plana de Vila-real during two three-month periods, one prior to the CCR improvement (2022) and one after (2023). No increase in the completion rate for the CCR was observed following its optimization ( p = 0.226). However, a statistically significant improvement was noted in the percentage of reports reviewed ( p > 0.001), increasing from 4.4% ( n = 49) in 2022 to 30.5% ( n = 327) in 2023. These results indicate that the optimization of the Continuity of Care Report enhances the communication between specialized care and primary care professionals.

Attitudes, practices, and knowledge about bullying were evaluated in a sample of 274 primary care professionals, including general practitioners, pediatricians, community, pediatric and school nurses, and residents of these specialties. This study was based on a mixed method with a parallel convergent design without dominance between phases, data were collected concurrently, and conversion of the results from both phases was carried out during data interpretation. The quantitative phase had a cross-sectional observational design, using The Healthcare Provider's Practices, Attitudes, Self-confidence, and Knowledge Regarding Bullying Questionnaire as an instrument. Descriptive and bivariate analyses were performed, which showed a positive correlation between higher self-confidence and knowledge scores and a greater predisposition to detect cases. However, although the dimensions of attitudes and knowledge yielded generally high data, low self-confidence was evident in addressing this problem. In addition, a lack of clear guidelines in the workplace was expressed, highlighting the need to create and provide specific resources to intervene in bullying in said context, which could develop an improvement in self-confidence, leading to greater well-being for the educational community regarding bullying.

Purpose: In modern societies, motorcycle accidents have become a great problem for health systems worldwide. In Spain, the size and the power of the engine of 2-wheel vehicles determine the type of driving license and the age at which these vehicles can be used (mopeds and motorcycles, which at the same time can have a small or large engine capacity). The objective of the present study was to analyze and characterize low- and high-power motorcycle accidents in Spain, between 2014 and 2020, both included and compared these categories with each other., Methods: Retrospective, descriptive, and observational study of motorcycle and moped accidents in Spain between 2014 and 2020, both included., Results: The mortality of motorcycle accident riders in Spain is associated with males aged between 30 and 40 years old, with a high-power motorcycle, and an A or A1 driver's license, who is 6.7 times more likely to die in crossings and highways than a moped, while wearing a helmet, and if not, this increases to 4.89 times. During the COVID-19 pandemic, an increase in death at 24 h after a high-power motorcycle accident was observed, as compared with a large reduction in the total medical assistance provided in 2019-2020., Conclusions: High-power motorcycles had higher scores in mortality and morbity rates than low-power ones, with a significant increase in mortality during the pandemic, even though number of accidents and medical assistance provided were drastically reduced., (© 2023. The Author(s).)

(1) Background: Clinical simulation is an educational approach that aims to replicate real-life scenarios. Its primary goal is to help nursing students acquire the necessary knowledge and skills to perform effectively in clinical settings. This study focuses on the relationship between communication skills, evidence-based practice (EBP), and clinical simulation. We aimed to assess how communication skills and EBP competencies affect nursing students' performance in simulated clinical scenarios. (2) Methods: We conducted an observational, cross-sectional study with 180 third-year nursing students at the University of Murcia. We used validated instruments to evaluate the students' EBP competencies, communication skills, non-technical skills, and nursing interventions in simulated scenarios. (3) Results: The results showed that the students had varying competencies in EBP and communication skills. However, there was a positive and statistically significant correlation ( p < 0.001) between these variables, non-technical skills, and the simulated clinical scenario nursing interventions. Our regression models revealed that communication skills and EBP competence significantly influenced the performance of the student nurses regarding their clinical and non-technical skills in the simulated scenarios. (4) Conclusions: Communication skills and EBP competencies predict performance in simulated scenarios for nursing students.

How can we know the reality of the context of bullying in the field of primary health care? The aim of this study is to obtain a validated and reliable tool that allows measurement of the involvement of primary care professionals in addressing bullying through a systematic content validation process. A cross-cultural validation of the Healthcare Provider's Practices, Attitudes, Self-Confidence, and Knowledge Regarding Bullying Questionnaire was conducted for the Spanish perspective. This involved linguistic adaptation through translation-back-translation, content validity index (CVI) analysis, construct validity using confirmatory factor analysis (CFA), and internal consistency (Cronbach's α). The total CVI was 0.95, with individual item scores ≥ 0.78. CFA revealed a good fit for the three subscales, with discrimination indices (item-total correlation within the dimension) > 0.30. Cronbach's α for each dimension indicated a high level of reliability, with values of 0.735 for attitudes, 0.940 for self-confidence, and 0.895 for knowledge. The questionnaire is valid and reliable for evaluating the knowledge, attitudes, and self-confidence of primary care professionals in Spain regarding bullying. Its validity and reliability guarantee its potential use in other health settings and may lead to better training of professionals and school biopsychosocial health.

Background: The audience response systems are being implemented to support active learning in nursing degree programs. The benefits of audience response systems have been studied in lecture-based classes and seminars, but their advantages or inconveniences when included in the debriefing phase of a high-fidelity clinical simulation have not been explored. The study aim was to discover student´s experience about using of interactive questions during debriefing, and the self-perceived effects on attention, participation and motivation., Methods: A Mixed-methods study was used exploratory sequential design in a university. The participants were 4th-year students enrolled in the Nursing Degree in a university in Southern Spain. (1) Qualitative phase: a phenomenological approach was utilized, and focus groups were used for data-collection. (2) Quantitative phase: cross-sectional descriptive study using a questionnaire designed "ad hoc", on the experiences on the use of interactive questions in the debriefing phase and the Debriefing Experience Scale., Results: (1) Qualitative phase: the students highlighted the facilitating role of the interactive questions during the reflection part of the debriefing, and mentioned that the interactive questions helped with stimulating attention, participation, and motivation during the analytical part of the debriefing; (2) Quantitative phase: it was observed that the best evaluated dimension was "Motivation", with a mean of 4.7 (SD = 0.480), followed by the dimension "Participation", with a mean of 4.66 (SD = 0.461), and lastly, the dimension "Attention", with a mean of 4.64 (SD = 0.418)., Conclusions: The use of interactive questions contributed the attention, participation, and motivation of the students during the debriefing, contributing towards a highly satisfactory experience of high-fidelity clinical simulation., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Introduction: The population of older adults is rapidly increasing worldwide, presenting both prospects and complexities for society and healthcare professionals to maximize the functional capacity of this age group. Social isolation and loneliness significantly affect this population. The objective was to determine the effectiveness, satisfaction, and perceptions of the simulation-based education practices of a training program for nursing students, which was created to palliate the social isolation and loneliness of older adults., Method: A quasi-experimental study was conducted with nursing students who participated in an online training program using teleservice based on high-fidelity clinical simulation. The program included asynchronous theoretical training and synchronous practical training using an online platform. Five scenarios were designed using simulated phone calls to address the social isolation and loneliness of older adults., Results: Twenty-five nursing students participated in the program, and they had a mean age of 27.44, with 76% of them being women. After the training program, the participants showed statistically significant improvements ( p < 0.05) with respect to their knowledge and attitudes towards older adults, and the program was adapted to the best educational practices in simulations., Conclusions: Simulation-based online training efficiently improved the knowledge and attitudes of nursing students towards older adults, improving their ability to address social isolation and loneliness. The high satisfaction and adhesion to the best educational practices underline the usefulness of high-fidelity online simulations, especially in situations in which face-to-face training is not feasible, and accessibility and equilibrium could be guaranteed between work and personal life.

Background: Out-of-hospital cardiac arrest is considered a global problem. In the last few years, there has been a growing interest in telephone-cardiopulmonary resuscitation guided by a telecommunicator. Indeed, several studies have demonstrated that it increases the chances of survival rate. This study focuses on the key points the operator should follow when performing telephone-cardiopulmonary resuscitation. The main objective of this paper is to design an algorithm to improve the telephone-cardiopulmonary resuscitation response protocol., Methods: The available evidence and the areas of uncertainty that have not been previously mentioned in the literature are discussed. All the information has been analyzed by two discussion groups. Later, a consensus was reached among all members. Finally, a response algorithm was designed and implemented in clinical simulation., Results: All the witnesses were able to recognize the OHCA, call for emergency assistance, follow all the operator's instructions, move the victim, and place their hands in the correct position to perform CPR., Discussion: The results of the pilot study provide us a basis for further experimental studies using randomization and experimental and control groups., Conclusions: No standardized recommendations exist for the operator to perform telephone-guided CPR. For this reason, a response algorithm was designed.

Background: International organizations recognize the importance of evidence-based practice (EBP) for nurses. The objective of teaching EBP in the Nursing degree is to train future nurses on this subject. Different teaching models exist for this, from less active traditional models to more active ones such as the flipped classroom., Objective: To compare the degree of EBP competence of undergraduate nursing students after an EBP course, through the application of a traditional methodology versus a flipped classroom methodology., Design: Quasi-experimental study of non-equivalent groups., Setting: The study was composed by a group of students who received training on EBP with the traditional model (face-to-face), and another intervention group with whom the flipped classroom model was utilized, using the online teaching platform EBP-eToolkit., Participants: The study was conducted with 4th-year Nursing degree students enrolled in the course evidence-based practice, in academic years 2019/20 and 2021/2022., Methods: Before and after the course, the students completed a questionnaire about EBP competence (EBP-COQ), and an objective test was given at the end of the year., Results: A sample of 152 students in the face-to-face group (control), and 143 students in the flipped classroom group (intervention) participated. The intervention group significantly improved its competence on attitude (p = 0.01, η 2  = 0.022), skills (p = 0.019, η 2  = 0.018), and global competence in EBP (p = 0.003, η 2  = 0.030), with respect to those who were taught using the traditional method. However, there were no significant differences in the impact on knowledge, neither through the self-report dimension of the EBP-COQ (p = 0.188) nor the final test score, control group 6.89 (SD: 1.35) and flipped classroom group 7.12 (SD: 1.53) (p = 0.206)., Conclusions: The flipped classroom model is adequate for the teaching of EBP to undergraduate nursing students. It produced a slight increase in attitude, as well as in skills and global competence in EBP. Nevertheless, this increase was not significantly different from face-to-face learning in terms of impact on EBP knowledge., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: This study aims to translate the Health Professional Communication Skills Scale (HP-CSS) into Chinese and assess its psychometric properties., Methods: A total of 836 healthcare professionals were recruited. The demographic characteristics form and HP-CSS were used for data collection. The psychometric properties of HP-CSS were evaluated by examining item analysis, construct validity, known-group discriminant validity, internal consistency, and split-half reliability., Results: In terms of item analysis, the critical ratio (CR) of 18 items was both >3 (CR ranging from 9.937 to 28.816), and the score of each item was positively correlated with the total score ( r ranging from 0.357 to 0.778, P < 0.001). The fit indices showed that the original correlated four-factor model of HP-CSS was adequate: χ 2 =722.801; df = 126; χ 2 /df = 5.737; RMSEA = 0.075; CFI = 0.923; NNFI = 0.908; TLI = 0.906; IFI = 0.923. In terms of known-group discriminant validity, the HP-CSS total score was related to gender, occupation, work years, and communication skill training. Cronbach's α coefficient was 0.922, and the split-half reliability was 0.865 for the total scale., Conclusion: The Chinese version of the HP-CSS is a reliable and valid instrument to evaluate communication skills among healthcare professionals in China., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Zhong, Tang, Lai, Guo, Yang, Hu, Li, Lu, Liu and Leal-Costa.)

Introduction: Mental workload refers to the cognitive or intellectual requirements that a worker is subjected to in a workday. The objective of the present work was to discover the subjective mental workload of nursing staff at Hospital Emergency Units, and its relationship with sociodemographic, work, environmental factors at the workplace, and personality variables., Method: A quantitative, descriptive, observational, and crosssectional study was conducted with 201 emergency nurses from 13 different provinces in Spain. Each participant completed 5 questionnaires (sociodemographic, work conditions, environmental conditions, personality, and subjective mental workload). Descriptive statistics were obtained, and Pearson's correlations and multivariate models (multiple linear regression) were performed., Results: The nurses had medium to high levels of mental workload. The environmental conditions had a direct relationship with the mental workload, especially with respect to noise and lighting. The participants obtained high scores in kindness, responsibility, openness/intellect, and extraversion. Positive and statistically significant relations were found between neuroticism and mental workload. Being female, older, and having stable employment or a permanent contract were associated with a greater mental workload of emergency nurses., Conclusion: The domain of neuroticism personality, and the hygienic conditions in the workplace were the predictors with the most weight in the model. This study could be useful for defining aspects that need to be considered for the well-being of emergency nurses, such as lighting conditions or environmental noise in the workplace. It also invites reflection on the influence of personal factors (age, gender, personality) and work factors (type of contract, professional experience) on the mental workload of emergency nurses., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: The restrictions imposed during the management of the pandemic led to lack of care of other health problems., Purpose: To assess changes in the health status of complex multimorbidity elderly, functional and cognitive capacities, perception of the social surroundings, care provided by the nurses, including nursing diagnosis and interventions, use of health services, adverse events, and use of devices and technical help during the first 6 months of the Covid-19 pandemic., Design: A 1-year longitudinal cohort study was conducted., Methods: Ninety-seven complex multimorbid elderly attended in primary care were evaluated every 3 months in a health area of the Spanish National Health System (SNHS). The research was called "SAMAC3 study"., Results: Significant negative changes were observed in the functional and cognitive capacity of the elderly, and in several nursing diagnoses. A decrease was observed in the frequency of visit to the nurses, hospital admittance, length of hospital stays, and falls., Conclusions: The functional and cognitive capacities of the cohort became worse. However, a significant decrease in the frequency of use of health services was observed. The nurses detected significant changes in activity-exercise, cognitive-perception, and roles-relationships, but their interventions were mostly centered on resolving clinical matters that required immediate attention., Clinical Relevance: The present study allowed us to observe that a situation of social and health stress has worsened the health indicators of multimorbid elderly, and the clinical care of community nurses was insufficient to providing care for the deterioration of the physical and cognitive domains., (© 2022 The Authors. Journal of Nursing Scholarship published by Wiley Periodicals LLC on behalf of Sigma Theta Tau International.)

Introduction: Applause is a common behavior during simulation case learning sessions. Some simulation facilitators believe that this should not be allowed, arguing that it can mislead students when they make mistakes during simulation. This study was conducted to explore the opinions of students about spontaneous applause (initiated by the participants), as a habitual behavior in the simulation sessions, in the undergraduate and postgraduate nursing degrees., Methods: A qualitative research study was conducted based on the content analysis of 7 focus groups composed of simulation students (N = 101, both undergraduate and graduate students). The participants were asked to conduct a debate about the following question: What is your opinion about the spontaneous applause given to participants by their peers at the completion of the scenario as they go to the debriefing, and why? An inductive method of content analysis was used to interpret the data., Results: The majority considered applause as a sign of support; one student disapproved of the practice. For most participants, receiving spontaneous applause from their peers after finishing the simulation represented a spontaneous example of moral support that reduced the participants' stress., Conclusions: Applause within the context of clinical simulation is a motivational act, which should not be repressed by the facilitator, as long as it is a spontaneous and genuine act by the participants once the simulation experience ends., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Society for Simulation in Healthcare.)

(1) Background: Bullying is a worldwide public health problem, with short- and long-term physical, mental, and socio-economic implications for all involved, including consequences as serious as suicide. (2) Objective: The aim of this study is to compile data on nursing interventions for preventing and addressing bullying at the international level. (3) Methods: A systematic review was conducted in accordance with the guidelines laid out in the PRISMA statement. The search included papers written in Spanish, English, and Portuguese over the previous five years from the following databases: Web of Science, CUIDEN, CINHAL, BDENF, Cochrane, Lilacs, and PubMed. The following descriptors were used: "Acoso escolar AND Enfermería", "Bullying AND Nursing" and "Intimidação AND Enferma-gem". Due to the heterogeneity in the methodology of the studies, a narrative synthesis of the results is provided. (4) The synthesis of results shows nurses' involvement in tackling and preventing bullying. Interventions are categorised into awareness raising; coping mechanisms; and approach/care, nursing skills in the face of bullying, and the role of the family in the face of bullying. (5) Conclusions: It is clear that at the international level, nursing is involved in planning and developing autonomous and interdisciplinary interventions to address and prevent bullying. The evidence paves the way for school nurses and family and community nurses to take steps to tackle this phenomenon.

Objective: To develop and validate a tool to assess the non-technical skills of medical and surgical hospital units undergraduate nursing students., Background: In the area of healthcare, non-technical skills complement technical ones, and contribute to patient safety. High-fidelity simulation is an ideal resource for working on these skills. Thus, evaluation instruments are needed to understand the efficiency of this methodology. Although many evaluation instruments already exist, none measure non-technical skills of undergraduate nursing students in medical and surgical hospital units., Design: An instrumental study design was employed., Methods: Two-phases were used to develop and validate the scale: 1) Scale development. A group of experts defined the dimensions and components. Afterwards, the content was validated by experts, and a pilot study was conducted with undergraduate Nursing students. 2) Analysis of the psychometric properties of the scale. A total of 393 students were evaluated in high-fidelity simulation scenarios by three evaluators, through the use of the Non-Technical Skills in Medical and Surgical Hospital Units (NTS-Nursing) Scale., Results: The content validity indexes were adequate for the total of the items and the total of the scale. The statistical descriptors of the items, the internal structure, and the reliability (internal consistency and inter-evaluator reliability) were analyzed, as well as the external evidence of validity, with adequate values obtained., Conclusion: The NTS-Nursing scale is a valid and reliable instrument. Its structure of 10 items makes its use fast and easy., Competing Interests: Conflict of interest None., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)