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Objective: To identify the types of interventions that should be included in an organizational protocol for responding to serious adverse events involving nursing staff. Method: A descriptive exploratory study was conducted in the Autonomous Community of Madrid, Spain using a questionnaire. Results: 248 nurses have participated. The respondents prioritized the following interventions for inclusion in the protocol: legal advice (86.5% of participants) and counseling (82.4% of participants). Over two-thirds of the nurses (69.3%) showed that they would like to receive guidance on how to record adverse events on the patient’s medical records, while 64.8% showed that they would like to receive advice on assurances and legal safeguards in relation to the health organization’s medical error notification system and 54.5% endorsed refresher training. Compulsory temporary or permanent transfer of nursing staff involved in adverse events was one of the least popular interventions (3.3% of participants). Conclusion: The nurses prioritized counseling, legal advice, training in communication techniques, and refresher training to address the consequences of adverse events and discarded the possibility of compulsory temporary or permanent transfer. RESUMO Objetivo: Conhecer as medidas e ações que deveriam incluir um protocolo de resposta institucional diante de eventos adversos graves que envolvam a equipe de enfermagem. Método: Estudo exploratório descritivo por meio de questionário com uma amostra de profissionais de Enfermagem, colegiados em Madri, Espanha. Resultados: Participaram 248 profissionais de Enfermagem. Um protocolo de resposta institucional diante de eventos adversos graves que envolvam a equipe de enfermagem deveria incluir a assessoria jurídica (86,5%) e psicológica (82,4%) como intervenções prioritárias. Cerca de 69,3% dos enfermeiros são partidários da assessoria sobre como registrar o evento adverso na história clínica. Aproximadamente 64,8% desejariam receber assessoria sobre as garantias e segurança jurídica do sistema de notificação de erros. Cerca de 54,5% dos enfermeiros apoiam protocolar oficinas de reciclagem de técnicas. A mudança ou troca forçosa de serviço de modo permanente é uma das estratégias menos desejadas entre os profissionais (3,3%). Conclusão: Os enfermeiros reivindicam receber assessoria psicológica e jurídica, técnicas de comunicação e reciclagem e não ser trocados de serviço, para abordar as consequências posteriores de um evento adverso. RESUMEN Objetivo: Conocer las medidas y acciones que debería incluir un protocolo de respuesta institucional frente a eventos adversos graves que involucren al equipo de enfermería. Método: Estudio exploratorio descriptivo a través de cuestionario con una muestra de profesionales de Enfermería, colegiados en Madrid, España. Resultados: Participaron 248 profesionales de Enfermería. Un protocolo de respuesta institucional frente a eventos adversos graves que involucren al equipo de enfermería debería incluir el asesoramiento jurídico (86,5%) y psicológico (82,4%) como intervenciones prioritarias. Un 69,3% de los enfermeros son partidarios del asesoramiento sobre cómo registrar el evento adverso en la historia clínica. Un 64,8% desearían recibir asesoramiento sobre las garantías y seguridad jurídica del sistema de notificación de errores. Un 54,5% de los enfermeros apoyan protocolizar talleres de reciclaje de técnicas. El cambio o permuta forzosa de servicio de manera permanente, es una de las estrategias menos deseadas entre los profesionales (3,3%). Conclusión: Los enfermeros reclaman recibir asesoramiento psicológico y jurídico, técnicas de comunicación y reciclaje y no ser cambiados de servicio, para abordar las consecuencias posteriores de un evento adverso.

Objective: To identify the types of interventions that should be included in an organizational protocol for responding to serious adverse events involving nursing staff. Method: A descriptive exploratory study was conducted in the Autonomous Community of Madrid, Spain using a questionnaire. Results: 248 nurses have participated. The respondents prioritized the following interventions for inclusion in the protocol: legal advice (86.5% of participants) and counseling (82.4% of participants). Over two-thirds of the nurses (69.3%) showed that they would like to receive guidance on how to record adverse events on the patient’s medical records, while 64.8% showed that they would like to receive advice on assurances and legal safeguards in relation to the health organization’s medical error notification system and 54.5% endorsed refresher training. Compulsory temporary or permanent transfer of nursing staff involved in adverse events was one of the least popular interventions (3.3% of participants). Conclusion: The nurses prioritized counseling, legal advice, training in communication techniques, and refresher training to address the consequences of adverse events and discarded the possibility of compulsory temporary or permanent transfer.

How to Obtain Contact Hours by Reading This Issue Instructions: 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf . In order to obtain contact hours you must: 1. Read the article, “Continuing Education in Patient Safety: Massive Open Online Courses as a New Training Tool,” found on pages 439–445, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until September 30, 2018 . Contact Hours This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. Objectives Describe the use of two massive open online courses designed to provide education on patient safety. Review follow-up evaluation data from the courses. Disclosure Statement Neither the planners nor the authors have any conflicts of interest to disclose. Background: The Nursing School of the University of Cantabria conducted a training session on patient safety through two massive open online courses (MOOCs) aimed at the general population and especially Spanish-speaking health professionals. This study aimed to analyze the profile of health professionals who have completed the courses, their degree of satisfaction, and the percentage of completion. Method: In this retrospective and observational study, two MOOCs on clinical safety were created through an online platform (MiríadaX). Quantitative analysis of the profile of health professionals, their degree of satisfaction, and the percentage of completion was performed. Results: A total of 12,400 students were enrolled, and the average completion rate was 32%. The profile of the average student was female, 37 years old, college educated, a nurse in a hospital, and interested in the course because it may be useful for performing her work. Fifty-five percent of students were very satisfied with the course. Conclusion: MOOCs are considered to be effective and easily accessible, with quality content for professional continuing education that encourages interdisciplinary work and meeting professionals from around the world. J Contin Educ Nurs. 2015;46(10):439–445.

There exist very few studies comparing different postures or postural changes during labor in parturients with epidural analgesia. Aim: To disclose whether the intervention of a multidisciplinary nursing team including a physiotherapist during the second stage of labor improves the obstetric outcome in parturients with epidural analgesia. Design: Prospective randomized trial. Setting: University-affiliated hospital. Population: Women undergoing labor with epidural analgesia after a normal gestation. Methods: 150 women were randomized either to actively perform predefined postural changes during the passive phase of the second stage of labor under the guidance of the attending physiotherapist (study group), or to carry out the whole second stage of labor lying in the traditional supine position (control group). Results: There were significantly more eutocic deliveries (p = 0.005) and, conversely, significantly less instrumental deliveries (p < 0.05) and cesarean sections (p < 0.05) in the study group. The total duration of the second stage of labor was significantly shorter (p < 0.01) in the study group. This was at the expense of the passive phase of the second stage of labor (p < 0.01). Significantly less episiotomies were performed in the study group (31.2% vs 17.8%, p < 0.05). Conclusion: The intervention of a physiotherapist during the second stage of labor significantly improved the obstetric outcome.

Introduction Pain is a common symptom in cancer patients, and its control and management are complex. Despite the high concomitant use of psychotropic drugs among such patients, the association among pain, inadequate pain control, and psychotropic drug use has not been fully determined. This study examined the prevalence of cancer pain and inadequate pain control and the association with psychotropic drug use. Materials and methods In this cross-sectional study, we investigated 402 medical records obtained by simple random sampling of oncology patients at a hospital in northern Spain from July 2012 to July 2014. Adjusted odds ratios (ORs) were estimated together with their 95% confidence intervals (95% CIs) by unconditional logistic regression for each type of psychotropic drug (anxiolytics, hypnotics, and antidepressants). Results The mean patient age was 61.17 (standard deviation ± 13.14) years; 57.5% were women, 42.5% men. Pain was present in 18.4% of patients and inadequate pain control in 54.2%. We found a statistically significant association between the presence of cancer pain and anxiolytic use (adjusted OR, 3.15; 95% CI, 1.49–6.68) and hypnotic use (adjusted OR, 5.19; 95% CI, 1.77–15.25). Inadequate pain control was associated to a greater extent with the use of those drugs: adjusted OR for anxiolytic use, 4.74 (95% CI, 1.91–11.80); adjusted OR for hypnotic use, 6.09 (95% CI, 1.74–21.32). By contrast, no association was found between pain and antidepressant use (adjusted OR, 0.99). Conclusion The presence of pain and (to a greater extent) poor pain control were associated with increased use of certain psychotropic drugs, such as anxiolytics and hypnotics. There appeared to be no association between pain and antidepressant use.

Introduction Patients with cancer frequently suffer from emotional distress, characterized by psychological symptoms such as anxiety or depression. The presence of psychological symptoms combined with the complex nature of oncology processes can negatively impact patients’ quality of life. We aimed to determine the impact of a relaxation protocol on improving quality of life in a sample of oncological patients treated in the Spanish National Public Health System. Materials and methods We conducted a multicenter interventional study without a control group. In total, 272 patients with different oncologic pathologies and showing symptoms of anxiety were recruited from 10 Spanish public hospitals. The intervention comprised abbreviated progressive muscle relaxation training, according to Bernstein and Borkovec. This was followed by weekly telephone calls to each patient over a 1-month period. We collected sociodemographic variables related to the disease process, including information about mental health and the intervention. Patients’ quality of life was assessed using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire. Bivariate and univariate analyses were performed, along with an analysis of multiple correspondences to identify subgroups of patients with similar variations on the FACT-G. Results Patients showed statistically significant improvements on the FACT-G overall score (W = 16806; p

Objective: To explore the intention of Spanish patients who were undergoing a reproductive donation treatment to disclose their offspring’s origins. Background: In Spain, the law establishes the anonymity of the donation process and prohibits revealing the donor’s identity to the offspring or the parents. Method: The design was a prospective observational study in a private institution. The participants were Spanish family units (heterosexual couples, homosexual couples and single women) undergoing a reproductive donation treatment in FivMadrid, Madrid, Spain. One hundred and thirty family units accepted and returned the complete questionnaire specially designed for this study. Results: Of the participants, 61% intend to disclose their offspring’s origins; 85% of those who want to reveal will do so during childhood (between 3 and 8 years of age); 95% think it is a good decision to undergo a gamete donation treatment; 95% feel the future child is theirs; 64% of the participants are concerned about the phys...

Resumen Introduccion Pocos estudios exploran con detalle los contextos hospitalarios donde los profesionales sanitarios comparten la experiencia, los significados, y las claves interpretativas de los procedimientos aplicados en los momentos proximos a la muerte del paciente. Objetivo identificar la representacion social de la muerte y los efectos que la institucionalizacion de la misma tienen sobre los medicos y enfermeras de un hospital de agudos. Metodos Hemos realizado un total de 11 grupos de discusion y 15 entrevistas semidirigidas a profesionales que trabajan en UCI, Urgencias y Plantas de hospitalizacion de adultos, en un hospital de agudos. Resultados principales el 100% de los profesionales opina que la UCI y las Urgencias no son los lugares mas apropiados para morir, y que las Plantas de hospitalizacion no cuentan con espacios adecuados para ofrecer una muerte digna. Demandan formacion en Cuidados Paliativos. Identifican distintos tipos de muerte segun el servicio donde ocurra la muerte, asi como prejuicios que las familias elaboran sobre su relacion con la muerte. En los discursos de estos profesionales emerge con mucha fuerza la familia como objeto de cuidados y la importancia de la variable informacion en el proceso de la muerte. Conclusiones En la estructura social hospitalaria, nuevas formas de organizar, hablar y pensar en la muerte disminuirian el sufrimiento y la soledad de los pacientes, de sus familias y de los propios sanitarios.

Background:Moral distress is a stress symptom arising from situations that involve ethical dimensions where the health-care provider believes that he or she is unable to preserve all interests and values at stake. The aims of this study were to evaluate the impact of, and identify possible differences in, moral distress in podiatric physicians in the United States and Spain and to determine the ethical principles most closely related to moral distress.Methods:A 2008 e-mail survey of 93 US podiatric physicians and 93 Spanish podiatric physicians (N = 186) presented statements about different ethical dilemmas, values, and goals in the workplace.Results:Although moral distress is strongly present across the sample for all of the questions, the US sample shows higher levels of any kind of moral distress concerning questions about patients’ treatment and economic constraints, overload of paperwork, and acting against one’s conscience. In the US sample, 91.4% of physicians agreed mostly or completely with the statement that they often had to compromise their own values to cope with the demands of the workplace; 89.25% of US podiatric physicians indicated that their own professional values were congruent with the values of the organization; and a similar percentage (77.5%) reported a strong identification with the goals and framework of their work organization. The Spanish sample had similar results.Conclusions:The results underline the significance of moral distress for both samples, mainly related to time constraints and organizational aspects concerning patients and lack of resources. (J Am Podiatr Med Assoc 102(1): 57–63, 2012)

palacios-cena d., losa-iglesias m.e., alvarez-lopez c., cachon-perez m., reyes r.a.r., salvadores-fuentes p. & fernandez-de-las-penas c. (2011) Patients, intimate partners and family experiences of implantable cardioverter defibrillators: qualitative systematic review. Journal of Advanced Nursing67(12), 2537–2550. Abstract Aim. This paper is a report of an interpretive review of qualitative research on how an implantable cardioverter defibrillator affects adult recipients and their significant others. Background. An implantable cardioverter defibrillator detects pathological cardiac rhythms and automatically converts the rhythm with electrical counter shocks. Data sources. A systematic literature search was conducted for qualitative research papers published between January 1999 and January 2009. PubMed, Medline, ISI Web of Knowledge and CINAHL databases were searched with the following key words: internal defibrillator, implantable defibrillator and qualitative research. Review Methods. Twenty-two papers were included. The Critical Appraisal Skills Programme and Prompts were used to appraise studies. Thematic analysis and synthesis approaches were used to interpret evidence. Findings. People with an implantable cardioverter defibrillator were found to experience physical, psychological and social changes. Shocks produce fear and anxiety, affecting relationships and sexual relations. The use of support groups and the use of the Internet are important in helping adjustment to an implantable cardioverter defibrillator. Women’s responses to an implantable cardioverter defibrillator appear different than men’s responses and include concerns about physical appearance and relationship issues. Postdischarge follow-up and educational programmes are still underdeveloped. Conclusion. Patients need additional education, support and follow-up care after hospital discharge. Patients and significant others benefit from collaboration between patient associations and healthcare professional societies. Future research is needed to identify the specific challenges that women recipients face.

Sudden cardiac death is an episode of sudden death from cardiac causes in previously healthy patients. The aim of this study was to investigate the life experiences of patients who were resuscitated successfully following a sudden cardiac death. Purposeful sampling was used to recruit the nine participants through the snowball technique. Unstructured interviews were carried out until data saturation was reached. The Giorgi method of analysis, which seeks to reduce the participant's experience to minimal thematic units, common thematic groups, and essential themes in order to describe it, was used. Four essential themes were found: "facing fear"; "the search for meaning"; "feeling death up close and personal"; and "loneliness and estrangement". Nurses must integrate the lifestyle changes of patients who survive a cardiac death in order to provide adequate care following hospital discharge. Patients should undertake follow-up programs in order to receive counseling from health professionals. As a result, the creation of interdisciplinary support groups and the implementation of follow-up programs after hospital discharge are fundamental. Survivors' experiences can inform the development of nursing programs and hospital follow-up services that address the survival of cardiac death.

Background and objectives. The implantation of defibrillators should not be studied simply on the basis of clinical improvement or quality of life: it is also important to understand the significance, which the recipients attach to the defibrillator and their experiences with it. The aim of this work was, therefore, to determine the experience of Spanish implantable defibrillator recipients. Design. A qualitative phenomenological study. Methods. Purposeful sampling of male implantable defibrillator recipients older than 18 years of age attended at the defibrillator consultancy at the Hospital Fuenlabrada or belonging to the Heart Patients’ Association (Asociacion de Pacientes Coronarios, APACOR). A secondary, theoretical sampling was also carried out to gain a more in-depth understanding of certain aspects identified in the first sampling, such as living with the discharges and difficulties during sexual activity. Data were collected using unstructured and semi-structured questionnaires and applying a question guide, field notes and the recipients’ personal diaries/letters. Data collection was terminated once theoretical saturation was reached. Data were analysed using the Giorgi method. Finally, the seven themes, which showed what it means to be an implantable cardioverter-defibrillator recipient, were described. Results. The defibrillator is perceived positively and is considered to be a form of life insurance, whereas the discharges are a limiting factor. The recipient’s outlook on life changes. Acceptance of the changes resulting from the implant leads to the development of strategies to facilitate everyday life. Conclusions. An understanding of the significance attached by recipients to their disease, diagnosis and treatment allows their behaviour and expectations to be understood. Relevance to clinical practice. Provide the basis for nursing assessment after discharge, understand the effects of the device in the recipient and track the process of adapting the recipient to daily life.

Aim An implantable cardioverter-defibrillator is the treatment of choice for ventricular arrhythmias and sudden death. Clinical trials and qualitative studies normally exclude elderly patients. The aim of this study was to describe the experience of elderly Spanish men with an implantable cardioverter-defibrillator. Methods This was a qualitative phenomenological study. Sampling was purposeful and used the snowball technique. Unstructured interviews and recipients' personal accounts were collected. Data collection finished with information saturation. Analysis was performed using the Giorgi proposal with triangulation between research-team members. Data were audited by an external researcher. Results The change and the need to adapt to the new situation can be perceived as a loss of independence by the elderly. The significance of the partner in the Spanish context is particularly relevant during the narration. Also, their view of the world is transformed, they experience an internal change. Additionally, the elderly patient may become confined to their home and shut off from their surroundings, accompanied by a sensation of being "stuck" and "imprisoned" by their own process. Conclusion Elderly recipients can end up "clinging on" to customs as they are felt to define the recipient's identity and utility within their social and personal context. Their partner is of huge significance for elderly recipients. The geriatric health personnel must contribute to promote and maintain activities of daily living in elderly. Future qualitative studies taking an in-depth look at the experience and readjustment process of elderly recipients and the relationship among older people and technological equipment should be further conducted.

Objectives To describe the distress experienced by Spanish podiatrists related to ethical dilemmas, organisational matters, and lack of resources. Design A 2008 email survey of a representative sample of 485 Spanish podiatrists presenting statements about different ethical dilemmas, values and goals at the workplace. Results The response rate was 44.8%. Of all the respondents, 57% described sometimes having to act against their own conscience as distressing. Time constraints is the main cause of moral distress (67%) and 58% of respondents said that they found it distressing that patients have long waits for treatment. Distress related to inadequate treatment due to economical constraints or ineffectiveness was described by 60% of the podiatrists. Another 51% reported that time spent on administration and documentation is distressing. Female doctors experienced more distress than their male colleagues. Last, 36% of respondents reported that their workplace lacked strategies for dealing with ethical dilemmas. Conclusion These study results identify moral distress among Spanish podiatrists mainly related to time constraints, patient demands and lack of resources. Moral distress varies with sex and age. Organisational strategies such as moral deliberation and responsive evaluation offer the potential to address moral distress.

Background Critical care nurses often face complex stressful situations, and the phenomenon of burnout syndrome has been recognized as an important and increasing problem. Recent research suggests that another phenomenon, experiential avoidance, may be associated with burnout syndrome. Objectives To determine the relationship between burnout syndrome and experiential avoidance in Spanish critical care nurses and to evaluate the relationships between burnout, experiential avoidance, certain health habits, and sociodemographic and job-related factors. Design A descriptive survey. Setting Participants were recruited from the critical care units of five major hospitals in the Northern State of Spain, Principado de Asturias. Participants Of 98 critical care nurses who met the criteria for study inclusion, 80 agreed to participate and completed the survey. The participants were staff nurses who had worked a minimum of 1 year full-time in a critical care unit. Most were women and were aged 22–56 years. Methods The survey instrument consisted of the Maslach Burnout Inventory (to measure burnout) and the Acceptance and Action Questionnaire (to measure experiential avoidance). The survey also collected data regarding age, sex, marital status, type of hospital, years of critical care experience, number of patients per nurse, and self-reported tobacco dependency greater than 6 months. Results Participants showed high levels of emotional exhaustion (25.19±10.52), moderate levels of depersonalization (6.53±6.04), and low levels of accomplishment (8.95±7.890) as measured by the Maslach Burnout Inventory. The Acceptance and Action Questionnaire revealed a mean low pathologic score of 35.29±6.56. Pearson product moment correlation analysis indicated a significant inverse correlation between scores on the Maslach Burnout Inventory accomplishment subscale and scores on the Acceptance and Action Questionnaire frequency ( r =0.237, p =0.05). More marked and significant was the positive correlation between the Acceptance and Action Questionnaire score and the depersonalization ( r =0.525, p =0.01) and emotional exhaustion ( r =0.507, p =0.01) subscale scores. Being older than 30 years and having more than 10 years of experience in a critical care environment as a nurse were significantly related to emotional exhaustion as measured by the Maslach Burnout Inventory. Clear evidence was found of an association between marital status and accomplishment ( p =0.01) and between tobacco habit and depersonalization ( p =0.003). Conclusions This study demonstrates a relationship between experiential avoidance and burnout syndrome in critical care nurses in Spain. Being older than 30 years, having more than 10 years of experience, being single, and smoking were associated with a nurse's vulnerability to burnout syndrome.

Background: Osteogenesis imperfecta is an autosomal-dominant disorder of the connective tissue. Also known as brittle bone disease, it renders those affected susceptible to fractures after minimal trauma. Therefore, it is important to minimize the risk of falls and subsequent fractures in patients with this disease. In-toeing is a common condition in children that can result from various pathologic entities, including anteversion, internal tibial torsion, and metatarsus adductus. These conditions can result in frequent tripping and other functional problems. Methods: A descriptive study was undertaken to determine the prevalence of in-toeing gait attributable to tibial or femoral torsion or metatarsus adductus in children with type I osteogenesis imperfecta. The study involved orthopedic and biomechanical examination of 15 children (9 girls and 6 boys) aged 4 to 9 years with confirmed type I osteogenesis imperfecta. Patients who used assistive ambulatory devices, such as canes, crutches, and wheelchairs, were excluded from the study. Results: Of the 15 children studied, 12 (80%) demonstrated previously undiagnosed in-toeing gait attributable to torsional deformity or metatarsus adductus in all but one child. Conclusions: Many children with confirmed type I osteogenesis imperfecta have in-toeing gait caused by torsional deformity or metatarsus adductus. Detection and control of in-toeing gait in children with osteogenesis imperfecta is important to prevent fractures resulting from trauma directly related to these conditions. (J Am Podiatr Med Assoc 99(4): 326–329, 2009)

El presente artículo se centra en la percepción que tienen las propias enfermeras sobre sus competencias profesionales, la visión que tienen otros profesionales sanitarios y la visión social que tienen los usuarios sobre este colectivo. Para ello se configuraron dos grupos de discusión formados por enfermeras/os que trabajan en dos hospitales de Madrid, en cuyos ámbitos de trabajo se desarrolla gran parte de nuestro estudio general. Se seleccionaron dos grupos con perfiles diferentes, de manera que sus discursos en muchos aspectos, también son diferentes, como se podrá observar en el análisis y las conclusiones del trabajo. Lo que se pretende es conocer los discursos que elaboraban las enfermeras/os, en interacción con otros compañeros de trabajo del mismo hospital, respecto de su competencia en educación con pacientes crónicos hospitalizados. Analizando los discursos que fluían entorno al rol educativo, se pudo identificar las características que estos grupos de enfermeras/os asignaban a la educación que llevan a cabo en el hospital, así como la problemática derivada de su realización, y los factores que la condicionan. La propia dinámica de los grupos de discusión, facilitó la emergencia de otros discursos que estas enfermeras/os ligaban de manera directa con el desempeño de su rol educativo, como son, el reconocimiento social de la profesión. The present article deals with nurses’ perception of their own professional competence, other health professionals’ view and patients’ social perspective. Two discussion groups integrated by nurses working in two Madrid hospitals were constituted; most of our general study was carried out in these two hospitals. Both groups had different profiles, thus their discourses varied in many aspects, as can be seen in the analysis and conclusions. The aim was to identify discourses elaborated by nurses interacting with other colleagues from the same hospital regarding educational competence towards hospitalised chronic patients. From the analysis of discourses on the educational role, characteristics assigned to education by these two groups of nurses were identified, along with difficulties and conditioning factors. The discussion groups own dynamics facilitated other discourses emerging in connection to the development of their educational role, such as social acknowledgement of the profession.

Sudden cardiac death is an episode of sudden death from cardiac causes in previously healthy patients. The aim of this study was to investigate the life experiences of patients who were resuscitated successfully following a sudden cardiac death. Purposeful sampling was used to recruit the nine participants through the snowball technique. Unstructured interviews were carried out until data saturation was reached. The Giorgi method of analysis, which seeks to reduce the participant's experience to minimal thematic units, common thematic groups, and essential themes in order to describe it, was used. Four essential themes were found: "facing fear"; "the search for meaning"; "feeling death up close and personal"; and "loneliness and estrangement". Nurses must integrate the lifestyle changes of patients who survive a cardiac death in order to provide adequate care following hospital discharge. Patients should undertake follow-up programs in order to receive counseling from health professionals. As a result, the creation of interdisciplinary support groups and the implementation of follow-up programs after hospital discharge are fundamental. Survivors' experiences can inform the development of nursing programs and hospital follow-up services that address the survival of cardiac death.

An implantable cardioverter-defibrillator is the treatment of choice for ventricular arrhythmias and sudden death. Clinical trials and qualitative studies normally exclude elderly patients. The aim of this study was to describe the experience of elderly Spanish men with an implantable cardioverter-defibrillator.This was a qualitative phenomenological study. Sampling was purposeful and used the snowball technique. Unstructured interviews and recipients' personal accounts were collected. Data collection finished with information saturation. Analysis was performed using the Giorgi proposal with triangulation between research-team members. Data were audited by an external researcher.The change and the need to adapt to the new situation can be perceived as a loss of independence by the elderly. The significance of the partner in the Spanish context is particularly relevant during the narration. Also, their view of the world is transformed, they experience an internal change. Additionally, the elderly patient may become confined to their home and shut off from their surroundings, accompanied by a sensation of being "stuck" and "imprisoned" by their own process.Elderly recipients can end up "clinging on" to customs as they are felt to define the recipient's identity and utility within their social and personal context. Their partner is of huge significance for elderly recipients. The geriatric health personnel must contribute to promote and maintain activities of daily living in elderly. Future qualitative studies taking an in-depth look at the experience and readjustment process of elderly recipients and the relationship among older people and technological equipment should be further conducted.

Background: A case-control study was conducted to compare static plantar pressures and distribution of body weight across the two lower limbs, as well as the prevalence of gastrocnemius soleus equinus, in children with and without calcaneal apophysitis (Sever’s disease). Methods: The participants were 54 boys enrolled in a soccer academy, of which eight were lost to follow-up. Twenty-two boys with unilateral Sever’s disease comprised the Sever’s disease group and 24 healthy boys constituted a control group. Plantar pressure data were collected using pedobarography, and gastrocnemius soleus equinus was assessed. Results: Peak pressure and percentage of body weight supported were significantly higher in the symptomatic feet of the Sever’s disease group than in the asymptomatic feet of the Sever’s disease group and the control group. Every child in the Sever’s disease group had bilateral gastrocnemius equinus, while nearly all children in the control group had no equinus. Conclusions: High plantar foot pressures are associated with Sever’s disease, although it is unclear whether they are a predisposing factor or a result of the condition. Gastrocnemius equinus may be a predisposing factor for Sever’s disease. Further research is needed to identify other factors involved in the disease and to better understand the factors that contribute to abnormal distribution of body weight in the lower limbs. (J Am Podiatr Med Assoc 101(1): 17–24, 2011)

Enfermería, Obstreticia y Ginecología, Pediatría y Psiquiatría

The role of apoptosis, and more specifically the Fas pathway, is still unclear in squamous cell laryngeal cancer.By means of immunohistochemistry, the expression of three genes involved in different pathways of apoptosis (p53, Bcl-2 and Fas) was studied in a series of 45 squamous cell laryngeal cancers from Spanish patients.Of the studied tumors, 25 (55.6%) expressed mutant p53, 22 (48.9%) expressed Bcl-2 and 25 (55.6%) expressed Fas. p53, Bcl-2 and Fas expression were not correlated with each other. The only tested factors associated with significantly better survival of the patients were low tumor stage (p = 0.0074), the absence of metastatic regional nodes (p = 0.0009) and Fas expression (p = 0.029). Fas expression was not correlated with the expression of any other tested parameter.The determination of Fas expression in squamous cell laryngeal carcinoma by means of immunohistochemistry using the GM30/CD95 antibody could be of potential use in the clinic.

Objetivo: Conocer la imagen que tiene la comunidad científica sobre la salud de los inmigrantes a través de la bibliografía española en las principales bases documentales de Ciencias de la Salud . Material y métodos: En la primera fase del estudio se ha realizado un análisis bibliométrico, que abarca el periodo 1980 -2001. Las bases de datos consultadas han sido Medline e Indice Médico Español (IME). La segunda fase del estudio, consistió en la localización de las fuentes primarias y su posterior análisis del discurso dominante en cada uno de los artículos recuperados. Resultados: Se registraron un total de 80 publicaciones que cumplieran los criterios marcados de la búsqueda bibliográfica de los cuales 72 publicaciones se encuentran indizadas en la base de datos Medline, y los 8 restantes pertenecen a la base de datos IME. Respecto al análisis bibliométrico podemos afirmar que las comunidades españolas en las cuales se ha realizado el mayor número de estudios sobre inmigración y salud han sido Cataluña con un 42,1%, seguida muy de cerca por la Comunidad de Madrid con total de 31,57% estudios realizados sobre inmigración. En cuanto a la procedencia de los inmigrantes que formaban parte de los artículos estudiados fue la siguiente: 57% África, 30% Latinoamérica y 13% Asia. Referente al análisis de discurso, podemos decir que existen dos discursos dominantes, que se muestran en los siguientes epígrafes: "La inmigración produce un aumento de las tasas de Enfermedades Infecciosas y Tropicales" “El uso de los servicios de salud por la población inmigrante”. Conclusiones: Existe una clara necesidad para la puesta en marcha de programas interdisciplinarios sociosanitarios que ayuden a superar las barreras culturales e idiomáticas. El inmigrante en sí no constituye un riesgo para la salud pública, sino que son los estilos de vida, las prácticas higiénicas, sanitarias y alimenticias, las que representan un riesgo para la salud pública e individual. Objective: To know the image the scientific community has about the health of immigrants, searching Spanish bibliography through the main Health Sciences databases. Materials and Methods: In a first phase of the study we performed a bibliometric analysis encompassing the period 1980-2001. The searched databases were Medline and Indice Médico Español (IME). A second phase consisted in locating primary sources and analyzing the dominant discourse in each of the retrieved articles. Results: The search resulted in the identification of 80 articles complying with the search criteria (72 from Medline and 8 from IME). Regarding the bibliometric study, the Spanish autonomous region where most studies have been carried out was Catalonia (42.1%), closely followed by Madrid (32.57%). Immigrants came from Africa (57%), Latinamerica (30%) and Asia (13%) The analysis of the dominant discourse within the articles can be summarized in the following two headings: “Immigration results in an increase of infectious and tropical diseases”. “The use of health care services by the immigrants”. Conclusions: There is a clear need for the implementation of interdisciplinary sociosanitary programs which may help to overcome language and cultural barriers. Different lifestyles, and hygienic, sanitary and alimentary practices and not the immigrant himself, represent a hazard for both individuals and public health.

El presente trabajo plasma la evolución de la locura en España, en un contexto histórico, social y cultural. La sucesión de acontecimientos y la interrelación de los sistemas sociales han hecho que "el trato", "el cuidado" y "la atención médica" caminen hacia una mejora en la comprensión de las necesidades del paciente y en la aplicación de nuevas teorías médicas. La labor de enfermería, existente desde el principio de los tiempos, refleja una disciplina ganada con el esfuerzo y la participación de todos aquellos que proporcionaron cuidados a través de los siglos. Por otro lado, la política social en el desempeño de su labor integradora, ha ido adaptando la locura al contexto cultural. En el desarrollo del texto se puede observar cómo "el loco" se ha ido acomodando a las diferentes formas de institucionalización y desinstitucionalización hasta llegar a su situación actual. The present work reflects the evolution of insanity in the Spanish cultural, social and historical context. The sequence of events and the interrelation of social systems have improved "assistance", "care" and "medical attention" towards an understanding of the patient's needs and the application of new medical theories. Nursing role reflects -since the beginning of times- a discipline build by the effort and participation of all those who cared during centuries. On the other hand, social policies in their integrating role have made insanity adapt to cultural contexts. Throughout the article it is shown how the "insane" have adapted to different forms of institutionalization and disinstitutionalization leading to the current situation.

Background The hierarchical pyramid inside Spanish public hospitals was radically changed by the Health Reform Law promulgated in 1986. According to it, the manpower of the hospitals was divided into three divisions (Medical, Nursing, General Services/Administration), which from then on occupied the same level, only subject to the general manager. Ten years after the implementation of the law, the present study was designed in order to investigate if the legal changes had indeed produced a real change in the balance of power inside the hospitals, as perceived by the different workers within them. Materials and Methods A questionnaire was administered to 1,027 workers from four different public hospitals (two university-based and two district hospitals). The participants belonged to all divisions, and to all three operative levels (staff, supervisory and managerial) within them. The questionnaire inquired about the perceived power inside each division and hierarchical level, as well as about that of the other divisions and hierarchical levels. Results Every division attributed the least power to itself. The Nursing and the Administrative division attributed the highest power to the physicians, and these attributed the highest power to the General Services/Administrative division. All hierarchical levels (including the formal top of the pyramid) attributed significantly more power to the other than to them. Conclusions More than ten years after the implementation of the new law, the majority of workers still perceive that the real power within the hospitals is held by the physicians (whereas these feel that it has shifted to the administrators). No division or hierarchical level believes it holds any significant degree of power, and this carries with it the danger of also not accepting any responsibility.

INTRODUCTIONCurrently, neither society nor health care professionals appear to profess a consensus on a number of important biomedical issues. This lack of consensus led to a study of the how knowledgeable university nursing students are regarding certain biomedical issues. The study also wanted to learn more about the students' personal positions on some of these topics. Clearly, members of a society tend to incorporate historical, anthropological, social, and psychological factors into their values, all of which must be considered when conducting social analyses (Parfitt, 1999). The general population contemplates and debates issues like eugenics, euthanasia, and abortion - often without understanding the biomedical concepts involved. Unfortunately, the media often present such issues in misleading and sensationalized formats. In doing so, the media can inappropriately influence an individual's attitudes and sometimes provoke certain behaviors (Meade, 1992).Physicians and other healthcare professionals are entrusted by societies to make decisions about the physical, psychological, and social wellbeing of their patients. Due to their academic training, health workers encounter unique bioethical issues to a greater extent than other professionals and the general population. Healthcare providers confront new situations, sometimes daily. They often approach solutions based on their respective beliefs, moral reasoning abilities, and coping mechanisms rather than through a comprehensive and informed bioethical decision-making process (Raines, 2000).As healthcare professionals, nursing personnel continually deal with advances in biomedical technology and encounter ethical dilemmas. Too often they are not prepared to make moral judgments in these situations (Long, 2004). As students they often learn idealistic nursing ethics, but when confronting such dilemmas in the workplace, their decisions do not always reflect the theories from their curriculum (Meade, 1992).A nurses' ability to make sound bioethical decisions and to provide best possible care can be related to their lack of familiarity with scientific advances and accompanying bioethical challenges. Therefore, it is essential that students develop a foundation for decision-making skills. This foundation consists of systematic ethicsfocused educational programs that are integral to the practice of nursing (Kim, Park, & Han, 2007). Students need to learn how to transition from making decisions based on personal beliefs, myths, or simply arbitrary choices to higher levels of nursing education based on relevant biomedical advances. Such education must not focus on individual interpretation of deontological (moral obligation) or positivist (fact-based) theories. Rather, it should approach the issues from a variety of bioethical perspectives in order to leave the nurses' decision-making free of moral prejudices acquired at the university (Parsons, Barker, & Armstrong, 2001; Woods, 2005). In June 2009, a survey was conducted to assess the knowledge and positions on various bioethical dilemmas among junior-level nursing students in the School of Nursing, Faculty of Health Sciences at King Juan Carlos University.MATERIALS AND METHODSNursing students in Madrid, Spain participated in a study that used a structured questionnaire with closed-ended, ordinal responses. In the first five questions, students were asked to assess their own knowledge about current bioethical healthcare issues:(1) What is your level of knowledge about eugenics?(2) What is your level of knowledge about experimentation with non-implanted embryos?(3) What is your level of knowledge about human cloning?(4) What is your level of knowledge about abortion?(5) What is your level of knowledge about euthanasia?Participants responded to each question by marking a numerical scale ranging from one to five, with 'one' indicating no knowledge and 'five' representing a very high level of knowledge - that is, a thorough understanding of the topic. …