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WHAT IS KNOWN ON THE SUBJECT?: Working on the frontline during the pandemic has had a negative impact on the mental health of health professionals. A significant proportion experienced anxiety, insomnia, posttraumatic stress or depression. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Analysis and synthesis of the evidence of the impact of the COVID-19 pandemic on the mental health of nurses based on their work context. There exists a gap in the literature as no studies were found that analysed the effects on nurses' mental health according to the level of care they worked in (hospital-primary care-nursing home). WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is an urgent need to assess and respond to the impact of COVID-19 on the physical and mental well-being of nurses, and to monitor international policies for the improvement of nurses' working conditions. ABSTRACT: Introduction Health professionals have suffered negative consequences during the COVID-19 pandemic. No review has specifically addressed the impact of the pandemic on the mental health of nurses exclusively according to the work context. Aim To analyse the impact of the COVID-19 pandemic on the mental health of nurses who have worked in hospitals, primary care centres and social health centres. Method PubMed, CINAHL, PsychINFO and Cochrane databases were searched (Prospero number: CRD42021249513). Out of 706 papers, 31 studies (2020-2021) were included in the systematic review. A qualitative synthesis method was used to analyse the data. Results Most studies were conducted in hospitals or frontline settings. The prevalence of moderate-to-severe symptoms was for anxiety 29.55%, depression 38.79%, posttraumatic stress disorder 29.8%, and insomnia 40.66%. Discussion This review highlights the mental health effects among nurses working in acute hospital settings. It also evidences a data gap on mental health effects among nurses working in primary health care and in nursing homes. Implications for practice In the post phase of the pandemic, there is an urgent need to assess and respond to the impact on the mental well-being of nurses, and to monitor international policies for the improvement of nurses' working conditions.

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Long-term breast cancer survivors (>5 years free of disease) may suffer late sequelae of cancer that impact on their quality of life. The use of telehealth for cancer care is recommended but little is known about the effectiveness of digital interventions for long-term cancer survivors. This study aims to evaluate the effectiveness of a web-based personalized intervention based on artificial intelligence instead of usual primary health care to improve the quality of life of long-term survivors of breast cancer and self-efficacy for the management of late sequelae. A randomized controlled trial will be conducted. The sample will consist of long-term breast cancer survivors recruited from primary health centers. Women will be randomly assigned to the intervention group to receive a web-based personalized intervention or to the control group to receive standard primary health care by nurses. Data on quality of life of cancer survivors and self-efficacy for the management of late sequelae of cancer will be collected and assessed at preintervention, and at 3, 6, and 9 months. It is expected that, at the end of the programme, the experimental group will have improved quality of life and improved self-efficacy for the management of late sequelae of cancer.

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AIM: To explore the impact of the COVID-19 pandemic on the mental health of nurses working in primary, secondary, and tertiary healthcare centers in Navarre (Spain). BACKGROUND: Healthcare workers, especially nurses, are at high risk for developing mental health problems during the COVID-19 pandemic. INTRODUCTION: Spain ranks among the European countries with the highest incidence of and mortality from COVID-19 and has a 31% deficit in the number of nurses compared with the average for the European Union. METHODS: This was a cross-sectional study involving 800 Registered Nurses in Navarre, Spain. Four standardized instruments, along with a self-administered online questionnaire, were used to measure the impact in terms of depression, anxiety, insomnia, and posttraumatic stress disorder. The STROBE checklist for cross-sectional studies was used to report this study. RESULTS: Of the 800 nurses, 68% had some level of depression, anxiety, insomnia, and distress, and of these, 38% had moderate or severe symptoms. Those who worked in hospital COVID units and in nursing homes showed a higher impact on their mental health. DISCUSSION: The sustained pressure that nurses have experienced in their work during the COVID-19 pandemic has negatively affected their mental health. CONCLUSION: This study found that nurses who worked in hospital COVID units and in nursing homes during the pandemic had worse mental health outcomes. IMPLICATIONS FOR NURSING/POLICY: Recommendations for nursing policy include the need to implement coaching and emotional programs to support nurses on the frontlines of the pandemic. There is also an urgent need for the implementation of national training programs to strengthen health emergency preparedness, improve response capacity, and increase the resilience of nurses to disasters.

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The transformation of health systems to meet the needs of chronic and multi-pathological patients has turned continuity of care into one of the mainstays of care programs and the design of new resources to care for these patients and their families. In this context, nurses' professional practice poses challenges for the three dimensions of continuity of care: relational, informational, and managerial. Faced with these challenges, nursing research is essential for the profession and necessary to promote innovative quality care.

La transformación de los sistemas sanitarios para dar respuesta a las necesidades del paciente crónico y pluripatológico ha situado la continuidad de cuidados como uno de los pilares en los que se basan los programas de atención y el diseño de nuevos recursos para atender a estos pacientes y a sus familias. En este contexto, la práctica profesional de las enfermeras presenta retos y desafíos en las tres dimensiones de la continuidad de cuidados: relacional, informativa y de gestión. Ante estos desafíos, la investigación en enfermería es fundamental para la profesión y necesaria para promover unos cuidados innovadores y de calidad.

A transformação dos sistemas sanitários para atender às necessidades do paciente crônico e pluripatológico situa a continuidade de cuidados como um dos pilares nos quais os programas de atenção e a criação de recursos para assistir esses pacientes e suas famílias estão baseados. Nesse contexto, a prática profissional dos enfermeiros apresenta desafios e obstáculos nas três dimensões da continuidade de cuidados: relacional, informativa e de gestão. Diante desses desafios, a pesquisa em enfermagem é fundamental para a profissão e necessária para promover cuidados inovadores e de qualidade.

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BACKGROUND: A vascular access team (VAT) was created in 2018 with the aim of improving vascular access and reducing complications associated with catheters. The impact of the introduction of a VAT in the insertion and maintenance of peripheral insertion central catheters (PICCs) was assessed. The cost-benefit associated with the use of a VAT was evaluated and the satisfaction of patients and professionals interacting with the VAT was measured. METHODS: In a prospective study, 275 PICCs inserted by the VAT were assessed for their impact on complications. PICCs were implanted with maximum barrier measures using an ultrasound with IC-ECG. Also, patient and professional satisfaction have been analysed thought a questionnaire over the phone or online, and hospital financial data was used to assess the cost impact of the insertion methodology followed by the VAT versus Anaesthesia Service. RESULTS: The thrombosis rate was 2.5% (7) and the bacteraemia rate was 1.1% (3). The use of the IC-ECG was correlated with a lower complication than the RX + IC-ECG (OR = 3.28, p = 0.021). In addition, there was a high level of perceived satisfaction for the patients surveyed and for the healthcare professionals involved in the care and management of these devices. The calculated saving for the implementation of the VAT was 61.81% compared with PICCs implanted in Anaesthesia Service. CONCLUSION: Low complication rates and high overall satisfaction scores in patients and professionals were observed, showing that a specialist VAT can have a positive impact in the insertion of PICCs and which also has a clear economic benefit.

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Objetivo: Analizar los efectos de un programa integrado de "Ejercicio Dirigido-Paseos Saludables en Entornos Curativos Exteriores" (ED + PSECE) en el bienestar físico y psicosocial de pacientes con trastorno depresivo, mayores de 65 años, ingresados en la Unidad de Agudos de Hospitalización Psiquiátrica. Método: Estudio piloto experimental con un grupo intervención (GI, n = 32 sujetos) y un grupo control (GC, n = 32 sujetos). Las mediciones pre y postintervención se realizan con el índice de Barthel, el test de Guralnik Short Physical Performance Battery (SPPB), la escala de Hamilton, el Get Up and Go Test y la taxonomía NOC. Sesultados: Se encuentran mejoras significativas del GI en funcionalidad según Barthel (0,036) y en posición corporal según NOC (0,025), así como disminución de síntomas depresivos según Hamilton (0,001). Conclusión: La actividad física contribuye a la reducción de síntomas negativos de los trastornos depresivos y a la mejora de la funcionalidad para el desempeño de actividades básicas de una vida autónoma, siendo fundamental el rol desempeñado por el profesional de enfermería para la adherencia al programa de los pacientes ancianos hospitalizados en una unidad de salud mental (AU)

Objective: To analyze the effects of an integrated "Healthy ExerciseWalks in Outdoor Healing Environments" on the physical and psychosocial well-being of patients with depressive disorders over 65 years of age admitted to acute unit of Psychiatric hospitalization. Method: Experimental pilot study with an intervention group (N IG=32 subjects) and a control group (N CG=32 subjects). Preand post-intervention measurements were made with the Barthel index test, Guralnik Short Physical Performance Battery (SPPB), Hamilton scale, a Get Up and Go Test and the Taxonomy NOC. Results: Significant progress of the IG is in functionality as Barthel test (0.036) and in corporal position as NOC (0.025), as well as decrease of depressive symptoms according to Hamilton (0.001). Conclusion: Physical activity contributes to the reduction of negative symptoms of depressive disorders and to the improvement of functionality for the performance of basic activities of an autonomous life, the role played by the professional nurse for adherence to the program of elderly patients hospitalized in a mental health unit (AU)

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Having valid and reliable tools that help health professionals to assess fear in children undergoing medical procedures is essential to offer humanised and quality of care in the paediatric population. The aim of this study was to develop the cross-cultural adaptation and the evaluation of the psychometric properties of the Spanish version of the "Child Medical Fear Scale" in its shortened version (CMFS-R). The design consisted of two phases: first, of cross-cultural adaptation and second, of the psychometric validation of the CMFS-R with a sample of 262 children from Spain, applying a cross-sectional design. Confirmatory factor analysis was conducted to assess construct validity and the Cronbach's alpha and the adjusted item-total score correlation coefficients were performed to study reliability. The results confirmed internal consistency and construct validity of the Spanish version of the CMFS-R, indicating that the scale has an acceptable level of validity and reliability. Therefore, this study brings a new version of the scale to assess fear related to medical procedures for use in the Spanish paediatric population.

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Introducción: El uso de Catéteres Centrales de Inserción Periférica (PICC) ha ido creciendo en la práctica clínica debido a la preocupación por incrementar la seguridad del paciente, la facilidad de implantación de dichos dispositivos y el número reducido de complicaciones que presentan. Con ello ha aumentado también la necesidad de crear Equipos de Terapia Intravenosa (ETI) para potenciar la implantación de prácticas adecuadas. El Complejo Hospitalario de Navarra (CHN) ha creado una Unidad de Terapia Intravenosa (UTI) respaldada por un equipo multidisciplinar desde enero de 2018. Objetivo: Presentar antecedentes, la trayectoria, la implantación y los resultados de la Unidad de Terapia Intravenosa (UTI) en el CHN. Material y método: Se presenta una descripción de la trayectoria de creación e implantación de la UTI en el CHN y su funcionamiento durante un periodo de 3 meses (enero-marzo de 2018). Resultados: En el año 2015 el CHN se incorporó al proyecto BPSO(R) con la implantación de la guía «Cuidados y mantenimiento de los accesos vasculares para reducir las complicaciones». A partir de las recomendaciones de dicha guía para la organización se trabajó para la creación de la Unidad de Terapia Intravenosa. Desde el inicio de su actividad, la UTI ha implantado un total de 136 dispositivos entre catéteres PICC y líneas medias, siendo la gran mayoría PICC (113) frente a 23 líneas medias. Discusión: Se ha conseguido proporcionar cuidados de calidad a los usuarios de este tipo de dispositivos. Ha mejorado su calidad de vida, se han evitado las punciones continuas, se ha preservado su capital venoso y ha disminuido la hospitalización convencional. Conclusión: Se reafirma la necesidad de formar profesionales especializados en colocación, cuidado y mantenimiento de accesos vasculares como el PICC

Introduction: The use of Peripheral Insertion Central Catheters (PICC), has been growing in clinical practice due to the concern to increase the safety of the patient, the ease of implantation of said devices and the reduced number of complications they present and with it the need to create Intravenous Therapy Teams (ITT) to promote the implementation of appropriate practices. The Hospital Center of Navarra (HCN) has created an Intravenous Therapy Unit (ITU), supported by a multidisciplinary team since January 2018. Objective: Present background, trajectory, implementation and results of the ITU in the HCN. Material and method: A description of the trajectory of creation and implantation of the ITU in the CHN, and its operation during a period of 3 months (January-March 2018) is presented. Results: In 2015, the HCN joined the BPSO(R) Project with the implementation of the guide «Care and maintenance of vascular acces to reduce complications». From the recomendation of this guide for the organization we worked for the creation of the Intravenous Therapy Unit. Since the beginning of its activity, the ITU has implanted a total of 136 devices between PICC and midline catheters, with the vast majority being PICC (113) compared to 23 midlines. Discussion: We have managed to provide quality care to users of this type of device, improving their quality of life, avoiding continuous punctures, preserving their venous capital and reducing conventional hospitalization. Conclusion: The need to form specialized professionals in placement, care and maintenance of vascular accesses such as the PICC is reaffirmed

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Injuries caused by accidents or violent situations in pediatric patients are a serious social problem where prevention plays a key role. The aim of this study was to describe the epidemiological situation of pediatric injuries in Spain. A prospective study of pediatric patients receiving care in the Emergency Service of the Complejo Hospitalario de Navarra due to for reasons of accidental injury was conducted. The study covered a period of 1 year and assessed a total of 16 variables. There were a total of 8,876 patients, of whom 56.4% were males. Traumatic injuries such as fractures and craniocerebral trauma were identified as the most frequent injuries, occurring as a result of injuries mainly in the home. In females, there was a decrease in the incidence of injuries related to age. There was a greater incidence at the end of the day, during the weekend, and in the months of March to October. The epidemiological profile of pediatric patients who met with accidents in Navarra, Spain, is described. The knowledge of the main areas and factors related to injuries allows us to improve preventive measures, which would contribute to better control in this region of Spain.

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AIMS AND OBJECTIVES: The objectives of this study were to analyse the differences in the treatment and the evolution of acute coronary syndromes according to the gender of the patient and to determine the likely causes of these differences. BACKGROUND: Epidemiological studies confirm the differences in the course and treatment of acute coronary syndromes according to factors such as gender and age. The factors associated with the observed gender-based differences are not known. DESIGN AND METHODS: This prospective study was conducted on 596 patients treated in the Hospital Emergency Service of the Hospital Complex of Navarra, Spain, from 1 January 2012 to April 2013 with acute coronary syndromes. A bivariate and logistic analysis has been made by adjusting the age and severity of process to know the differences by gender. RESULTS: A total of 71·8% (n = 428) were men, and the remaining 28·2% (168) were women. The mean age of the men was 66·4 ± 12·7 years, and the mean age of the women was 72·5 ± 13·9 years. We found that antiplatelet drugs (68·4 vs. 22·7%), blockers (70 vs. 25·4%), ACE inhibitors (56·2 vs. 15·6%), fibrinolysis (17·2 vs. 4·5%, p = 0·025) and primary angioplasty (AP) (38·7 vs. 16·3%, p = 0·008) were less frequently administered to women compared with men. We observed an additional delay in the demand for health care in women with acute coronary syndromes compared with men. CONCLUSIONS: There is an association between treatment differences and gender. The delay in the request of health care in women is observed to be the largest correlating factor, in addition to voluntary discharge in women affected by acute coronary syndromes. RELEVANCE TO CLINICAL PRACTICE: Delays in seeking medical care or voluntary discharge are likely factors related to worse outcomes in women. These factors should be explored, and the results should be made available to the public, particularly to women.

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El estudio de desigualdad de género en el ámbito sanitario muestra la existencia de diferencias en la actuación profesional según sexo en las patologías coronarias. OBJETIVOS: este trabajo pretende conocer la percepción y actuación de los pacientes con patología coronaria aguda e identificar los factores relacionados con la demora en la solicitud de asistencia sanitaria. MÉTODO: estudio descriptivo, analítico y transversal con pacientes diagnosticados de patología coronaria aguda (IAM o angina inestable)hospitalizados en las unidades de cardiología y/o en la unidad coronaria del Complejo Hospitalario de Navarra (CHN), entre el 1 de enero y el 1 de julio de 2012. Muestreo no probalístico, excluidos los pacientes con más de 48 horas de ingreso y aquellos cuyo episodio coronario era de repetición. Recogida de información mediante un cuestionario de 13ítems sobre la percepción del estado general de salud previo, cambios del estado emocional, existencia de cargas familiares, tiempo transcurrido desde la apariación de síntomas y la solicitud de ayuda, causas del retraso y autopercepción del conocimiento de la patologia coronaria. RESULTADOS: se realizaron 113 encuestas, de las cuales un 71,7% fueron hombres, cuya edad media fue de 67 años y de 72 años en las mujeres(p= 0,041). La media de minutos transcurridos hasta solicitar asistencia fue de 138 en los hombres y 238 en las mujeres (p= 0,001).También se hallaron diferencias significativas en la percepción del estado de salud, la gravedad del proceso, la carga familiar, el grado de actividad en el momento del episodio, el reconocimiento de la gravedad y la autopercepción del conocimiento. CONCLUSIONES: hallamos un mayor retraso en la demanda de atención sanitaria en las mujeres, así como diferencias psicosociales relacionadas con esta actuación

The study on gender inequality within the healthcare setting shows the current differences in professional activity on cardiac conditions according to gender. OBJECTIVES: this article intends to understand the perception and action of patients with Acute Coronary Failure, and to identify those factors associated with the delay in requesting medical care. METHOD: descriptive, analytical and transversal study with patients diagnosed with Acute Coronary Failure (AMI or unstable angina), admitted to the Cardiology Unit and/or the Coronary Unit of the Complejo Hospitalario de Navarra (CHN), between January, 1st and July, 1st,2012. Non-probabilistic sample, excluding patients with over 48 hours since admission, and those with a repeated coronary episode. Information was collected through a 13-item questionnaire about the perception of their previous health status, changes in emotional state, presence of family obligations, period of time since symptom initiation and until help was requested, causes for this delay, and self-perception of knowledge about the coronary condition. RESULTS: 113 questionnaires were completed, out of which 71.7% were completed by male patients. The mean age was 67 years in men and 72years in women (p = 0.041). The average minutes elapsed until help was requested was 138 in men and 238 in women (p= 0.001). There were also significant differences in the perception of health status, severity of the condition, family obligations, level of activity at the time of the episode, acknowledgement of severity, and self-perception of knowledge. CONCLUSIONS: we found a higher delay in the demand for medical care in women, as well as psychosocial differences associated with this action

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