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Background. In recent years, birth experience has been highlighted by national and international organisations as a relevant value in measuring maternal health care quality. According to a standardised tool, we aimed to assess which clinical indicators had the most significant influence on the birth experience. Methods. This prospective observational study was carried out in fourteen hospitals in eastern Spain. 749 women consented to the collection of birth variables at discharge, and subsequently, at 1-4 months, data were collected on the birth experience as measured by the Spanish version of the Childbirth Experience Questionnaire. Next, a linear regression analysis was performed to determine which clinical birth indicators greatly influence the birth experience measure. Result. The study sample (n = 749) was predominantly Spanish and primipara, with 19.5% vaginal births. The predictors that emerged in the linear regression model were to have a birth companion (B = 0.250, p = 0.028), drink fluids during labour (B = 0.249, p < 0.001), have early skin-to-skin contact (B = 0.213, p < 0.001) and being transferred to a specialised room for the second stage of labour (B = 0.098, p = 0.016). The episiotomy (B = -0.100, p < 0.015) and having an operative birth (B = -0.128, p < 0.008) showed a negative influence. Conclusion. Our study supports that intrapartum interventions recommended according to clinical practice guidelines positively influence the mother's birth experience. Episiotomy and operative birth should not be used routinely as they negatively influence the birth experience. This work has been funded by the Project PI11/02124 and PI14/01549 within the Government R&D&I plan 2013–2016 and co-funded by ISCIII General Sub-Directorate for Evaluation and Promotion of research the European Regional Development Fund (FEDER) "A way to make Europe".

Background: Research gaps exist with regard to paternal attitudes towards breastfeeding and the association between fathers’ attitudes and the type of breastfeeding. Research Aims: (1) To analyze the psychometric properties of the Spanish version of the Iowa Infant Feeding Attitude Scale in fathers, and (2) to examine the association between fathers’ attitudes and type of breastfeeding. Method: We used a cross-sectional study design to analyze the scale’s psychometric properties and performance. Results: A total of 639 fathers participated in the study. The mean age was 35.83 years (SD = 4.65) and 67.3% (n = 430) were married or in a civil partnership. We observed an adequate fit in the confirmatory factor analysis: TLI = 0.96, CFI = 0.97 and RMSEA = 0.05. The overall internal consistency was 0.76. Between 1–6 months, 48% (n = 307) of participants’ babies were exclusively breastfed, 35.2% (n = 225) were partially breastfed, and 16.7% (n = 107) were exclusively formula fed. Statistically significant differences were shown in attitudes towards breastfeeding, depending on the type of breastfeeding, between 1 and 6 months (F = 54.67; p

Se sabe poco sobre las características de los programas de rehabilitación cardíaca implantados en la actualidad en España, por lo que el objetivo de este estudio fue conocer la efectividad de la rehabilitación cardíaca en pacientes con cardiopatía isquémica en España, mediante una revisión sistemática exploratoria de la literatura científica en distintas bases de datos desde 2010 hasta 2018. Se incluyeron 35 artículos cuyo objetivo era medir la efectividad de los programas de rehabilitación cardíaca desde distintas perspectivas. Participaron más del doble de hombres que de mujeres y solo el 8,6% fueron ensayos clínicos. Se observaron mejoras en relación con la mortalidad y las variables fisiológicas y de calidad de vida de los pacientes, pero con resultados dispares en morbilidad, estados de ánimo, mantenimiento de hábitos saludables a largo plazo y rentabilidad de los programas. Little is known about the characteristics of the cardiac rehabilitation programs currently implemented in Spain, the aim was therefore to know more about the effectiveness of cardiac rehabilitation in patients with ischemic heart disease in Spain, through an exploratory systematic review of the scientific literature on cardiac rehabilitation carried out in different databases from 2010 to 2018. We reviewed 35 articles whose objective was to measure the effectiveness of cardiac rehabilitation programs from different perspectives. More than twice as many men as women participated and only 8.6% were clinical trials. The studies showed improvements in relation to mortality and physiological and quality of life variables, but with discrepant results in morbidity, moods, maintenance long-term healthy habits and profitability of the programs.

Fundamento. Desarrollar y validar un instrumento específico de identificación de pacientes complejos, el Índice de Evaluación de Casos Complejos (IECC). Métodos. Estudio instrumental con dos fases: 1) Elaboración del instrumento: se definieron y operacionalizaron las variables extraídas de la literatura que, posteriormente, fueron sometidas al juicio de expertos. El IECC incluyó catorce variables divididas en dos dimensiones: complejidad del manejo clínico y complejidad del manejo comunitario. 2) Estudio psicométrico: evaluación de la fiabilidad por equivalencia entre observadores (r Pearson), de la validez de criterio respecto al sistema de clasificación Clinical Risk Groups (CRG) y de la validez de constructo a través de grupos conocidos y a través del estudio de conglomerados jerárquicos. Los análisis se realizaron con el paquete estadístico SPSS.v.17. Resultados. La fiabilidad entre observadores para la subescala clínica fue r = 0,97, para la subescala comunitaria r = 0,74 y para la puntuación total r = 0,89. El 88,4% (n = 458) de los 518 casos identificados como complejos por el IECC fueron categorizados por el sistema CRG en las categorías de más complejidad clínica (niveles 6 a 9). Los resultados sustentan la validez de constructo de la escala. El análisis de conglomerados mostró dos clusters diferentes, aunque relacionados. Conclusión. El IECC es un índice breve y de fácil aplicación, con una buena adecuación conceptual y evidencias de su fiabilidad y validez dirigido a la detección de pacientes con necesidades complejas. Background. The aim was to develop and validate the Complex Case Assessment Index (CCAI), a specific instrument to identify complex patients. Methods. Instrumental study in two phases: 1) Development of the scale: the variables extracted from the literature were firstly defined and operationalized, and then submitted for expert judgment. The CCAI included 14 variables divided into two dimensions: complexity of clinical management and complexity of community management. 2) Psychometric study: evaluation of the reliability and validity of the scale by equivalence between observers (Pearson’s r), criterion validity with respect to the Clinical Risk Groups (CRG) classification system, and construct validity through known groups and study of hierarchical clusters were examined. The analyses were carried out with the SPSS version 17 statistical package. Results. Reliability by equivalence between observers was r = 0.97 for the clinical subscale, r = 0.74 for the community subscale, and r = 0.89 for the total score. The CCAI identified 518 cases as complex; 458 of them (88.4%) were categorized by the CRG system in the categories of greatest clinical complexity (levels 6 to 9). The results support the construct validity of the scale. The cluster analysis showed two different, although related, clusters. Conclusion. The CCAI is a fast and easy-to-use index, with good conceptual adequacy and evidence of reliability and validity for screening patients with complex needs.

Es conveniente diseñar, aplicar y evaluar metodologías activas y eficaces que permitan entrenar habilidades no técnicas, como las de comunicación, en los profesionales sanitarios en su formación de pregrado. Los objetivos de este trabajo son: a) Implementar un programa de simulación de baja fidelidad para la adquisición de habilidades de comunicación básicas clínicas en el primer curso del grado de Enfermería en el año lectivo 2020/2021; b) Evaluar la actitud y la autoeficacia percibida hacia las habilidades de comunicación tras la implementación del programa de simulación. Se implementó un programa de simulación de baja fidelidad para entrenar en habilidades de comunicación básicas eficaces en la asistencia sanitaria. Un total de 120 estudiantes del primer curso del grado de Enfermería de la Universidad de Alicante del periodo lectivo 2020-2021 contestaron a la evaluación de la experiencia educativa a través de un cuestionario electrónico. Los estudiantes mejoraron su percepción actitudinal y su autoeficacia al finalizar el programa de simulación de baja fidelidad, con diferencias estadísticamente significativas. Podemos concluir, que la simulación de baja fidelidad aplicada en primer curso del grado de enfermería es una metodología eficaz y viable para el entrenamiento de habilidades de comunicación básicas del ámbito clínico.

Breastfeeding self-efficacy is a relevant predictor of exclusive breastfeeding during the first six months of life. The Prenatal Breastfeeding Self-Efficacy Scale (PBSES) is a 20-item tool developed to determine breastfeeding self-efficacy during pregnancy. Our study aimed to assess the structural validity and psychometric characteristics of the PBSES and to explore item reduction according to the statistical criteria for parsimony and incremental validity. In this study, conducted in six hospitals in eastern Spain, we recruited 1183 women with healthy, full-term, single-birth newborns. Data on sociodemographic, breastfeeding-related variables, and the PBSES, were obtained from self-administered questionnaires during the third trimester of pregnancy, at postpartum discharge, and 5 months postpartum, and from a phone survey 12 months postpartum. Item reduction was conducted after revising the PBSES item floor and ceiling effects, interitem correlations, and item–score relationships with breastfeeding-status variables during follow-up. The factorial structure of the short form of the PBSES (PBSES-SF) was tested using both exploratory and confirmatory approaches. After item reduction, the confirmatory factor analysis of the 12 remaining items of the PBSES-SF revealed adequate fit statistics for a three-factor structure and a second-order factor. Internal consistency was measured using the Cronbach's α coefficient of the PBSES-SF (0.86). We provided evidence on the discriminant validity of the PBSES-SF by comparing its scores between known groups, convergent validity by examining its correlations with other variables, and predictive validity by assessing the association of PBSES-SF scores with breastfeeding behavior at critical points in time during the first postpartum year. This study was funded by the Spanish Ministry of Science and Innovation (Ref. No. PI09/90899).

Supplemental material, Appendix_1 for Operational Definition of Serious Mental Illness: Heterogeneity in a Review of the Research on Quality-of-Life Interventions by Concepción Martínez-Martínez, Miguel Richart-Martínez and Juan Diego Ramos- Pichardo in Journal of the American Psychiatric Nurses Association

Introducción: La adquisición de competencias relacionadas con aspectos emocionales y habilidades de comunicación es uno de los elementos clave en enfermería. Objetivo: 1) Diseñar la acción educativa: los escenarios de simulación y el procedimiento de aprendizaje propia de la metodología; 2) Diseñar rúbrica capaz de evaluar las competencias de aprendizaje; 3) Formar al conjunto del profesorado de la asignatura Relación de Ayuda en la implementación de la simulación; 4) Revisar y actualizar los objetivos, competencias, contenidos y actividades a realizar en las prácticas de laboratorio de la asignatura Relación de Ayuda. Metodología: Se establecieron 3 fases: (i) Diseño de la acción educativa; ii) Formación del profesorado; y (iii) Evaluación del diseño elaborado para establecer los cambios pertinentes en la guía docente 2020/2021. Resultados: (i) Se crearon un total de 6 casos de simulación; (ii) Se generaron dos rúbricas de evaluación, para las habilidades de comunicación observadas en simulación y otra para la actividad conceptual. (iii) Se realizó una sesión de formación de dos horas de duración con el profesorado participante del programa de simulación. (iv) Se realizaron los cambios pertinentes para la guía docente 2020/2021. Conclusiones: Se percibe la acción educativa como una oportunidad viable y adecuada para entrenar las competencias en habilidades de comunicación.