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(1) Background: Studies have shown that clinical experience has an impact on how students perceive geriatric care. The vulnerability of older people particularly allows students to reflect on and evaluate their learning. In this context, communication between tutors and students is important to guiding a contextualized view of the complexity of clinical situations. The principal objective was to explore the feelings, perceptions, and experiences of nursing students in geriatric care units during their practices. (2) Methods: This is a qualitative study using content analysis where the data collected were analyzed deductively. An intentional sample of 81 nursing degree students enrolled in the subject of clinical practices. During these sessions, a dynamic discussion forum was incorporated. (3) Results: There were 6 forums with a total of 591 participants, with an average of 98.5 per forum. Four categories emerged: humanization, geriatric nurse, aging, and learning. (4) Conclusions: A change of management oriented to the person-centered model would improve the quality in the residences and as well as in the expectations of the students towards geriatric nursing. Changing perspectives could be a way to confront and become aware of the fallacies of care that have been evidenced. This study was not registered.

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(1) Background: Clinical practice constitutes a scenario where the student approaches reality. The pedagogical relationship that is built between the nurse, the tutors and the student becomes important. And this requires intentional and reflective accompaniment. The principal objective was to design a hybrid-learner-centered training model requiring reflection and acquisition of specific skills. (2) Methodology: This was a prospective observational study using an intentional sample of 87 students. A hybrid model based on a dynamic virtual forum and Individual Improvement Plan (IIP) was constructed, evaluated using a self-completed questionnaire with a Likert scale. (3) Results: A model of accompaniment to the practices was built that allows for unifying a work plan. A transversal activity IIP was designed. A discussion forum was incorporated for each subject tutor. The analysis of the questionnaire showed that learning assessment, tutorials, virtual forums, self-assessment and satisfaction statistically differed. (4) Conclusions: The model allows students to be accompanied to acquire skills, knowledge, and attitudes and to develop critical thinking, as well as to improve the teaching quality of the practices of the Curriculum of the Nursing degree and to achieve their own competences through student-centered methodologies. This study was not registered.

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La autoetnografía es una metodología que describe y analiza sistemáticamente la experiencia personal, con el fin de comprender la experiencia cultural. Esta experiencia forma parte de una categoría analítica, y su profundidad la dan las emociones, reivindicando así la propia vulnerabilidad de los investigadores. Podemos afirmar que es una descripción fenomenológica de las emociones, que nos sirve para explicar y ordenar la experiencia; un enfoque que reconoce la subjetividad, la emocionalidad y la influencia del investigador en su trabajo. Esta constante inter-subjetividad es justamente la que hace surgir el pensamiento crítico, y permite producir un conocimiento reflexivo más profundo sobre los aspectos culturales, económicos y políticos de los fenómenos, a fin de poder enfatizar la experiencia del padecimiento. El artículo da a conocer los aportes ontológicos y epistemológicos de la autoetnografía, y reivindica el papel que tienen en la generación del fenómeno estudiado, poniendo de manifiesto los significados de las experiencias vividas como fuente de conocimiento, y aproximando la realidad de los seres humanos al cuidado de enfermería.(AU)

Autoethnography is a methodology that systematically describes and analyses personal experiences, with the aim of understanding cultural experiences. The first is part of an analytical category, and its depth is given by emotions, thus showing the vulnerability of the very same researcher. We can say that this is a phenomenological description of emotions, which helps us to explain and to order the experience; an approach that recognizes the subjectivity, emotionality and influence of the researcher in his work. It is this constant intersubjectivity that allows the critical thinking emerge, and enables deeper thoughtful knowledge of the cultural aspects, economic and political phenomena, in order to be able to emphasize the experience of the suffering. The article discloses the ontological and epistemological contributions of autoethnography and vindicates the role they play in generating the phenomenon that is being studied, highlighting the meanings of lived experiences as a source of knowledge, and bringing the reality of humans closer to nursing care.(AU)

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BACKGROUND: The context of the pandemic in Spain meant a high demand for care. The purpose of this pilot work was to determine the stress factors, conducted on final-year nursing students at a Spanish university, who volunteered to carry out healthcare tasks, in pandemic and post-pandemic contexts. METHODS: An observational prospective cohort pilot survey was conducted with an intentional sampling of the forty-seven students. We collected sociodemographic and stressor data using the validated KEZKAK questionnaire. The STROBE checklist was used to evaluate the study. RESULTS: The median scores obtained from nursing students incorporated as auxiliary health workers are lower than those who were not incorporated, and statistically significant differences were found: lack of skills and abilities (p = 0.016); relationship with tutors and colleagues (p = 0.004); impotence and uncertainty (p = 0.011); inability to manage the relationship with the patient (p = 0.009); emotional involvement (p = 0.032); distress caused by the relationship with patients and item overload (p = 0.039); and overload items (p = 0.011). The post-pandemic only maintained "lack of skill and abilities" (p = 0.048), from nursing students incorporated as auxiliary health workers. CONCLUSION: This pilot study showed that nursing students who joined as auxiliary health personnel presented less perceived stress than non-incorporated nursing students. Still, more prospectively designed clinical research is needed.

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Objetivo: Analizar el Plan de Mejora Individual (PMI), para evaluar las prácticas clínicas en unidades de críticos del grado en enfermería, e identificar los elementos clave de aprendizaje. Método: Diseño cualitativo y descriptivo. Muestreo propositivo de 51 estudiantes matriculados en las prácticas clínicas de cuidados críticos. Se utilizó un análisis de contenido. Resultados: La estructura en seis apartados del PMI: reflexión, acción, evaluación, participación, personal, utilidad y transferencia permite la reflexión para identificar áreas de mejora. Se extrajeron seis categorías: Humanización, Comunicación, Aprendizaje, Saberes profesionales, Seguridad clínica y Complejidad. Estas conforman los elementos clave de aprendizaje. Conclusiones: El PMI se presenta como un instrumento estructurado, sumativo y evaluativo a partir del concepto de reflexión-en-la-acción, este ofrece la oportunidad de analizar y reflexionar sobre la práctica, evitando una experiencia de su prácticum que podrían devenir rutinaria y mecanizada. (AU)

Objective: To analyze the Individual Improvement Plan (IIP) as a document to evaluate the critical patient practices of the nursing degree and identify the key learning elements. Method: Qualitative and descriptive design. The sampling was purposeful 51 students enrolled in clinical practices of critical care units. It was used a content analysis. Results: The structure of the IIP: reflection, action, evaluation, participation, personnel, utility and transfer has allowed students to reflect and identify areas for improvement in critical services. It was extracted six categories: Humanization, Communication, Learning, Professional knowledge, Clinical safety and Complexity. These make up the key learning elements. Conclusions: The IIP is presented as a structured, summative and evaluative instrument based on reflection-in-action. The students have the opportunity to analyze and reflect on the practice, avoiding an experience of their practicum that could become routine and mechanized. (AU)

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The implementation of prevention strategies can reduce the risk of having a stroke. This prospective, longitudinal, multicenter observational study of 82 patients describes health habits, quality of life, coping strategies, and physical and neurological status at 3 months and 1 year after stroke. The EuroQoL-5D quality of life scale (EQ-5D) and the coping strategy measurement scale (COPE-28) were used to assess pain and discomfort, and behavioral and lifestyle changes. Significant differences were observed in the pain or discomfort levels of those patients with behavioral and lifestyle changes. Correlation was also found between pain or discomfort and the coping strategies associated with active emotional support at 1 year after stroke. The results of the pain or discomfort dimension were not, however, associated with better adherence to treatment. Pain and discomfort could have a predictive value in changes in lifestyles and behaviors but not for treatment adherence in patients who have had a stroke, which is significant at 1 year. In addition to important active coping strategies such as social support, these changes in behavior and lifestyle following a stroke are long-term and should therefore be assessed during the initial examination.

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Los errores médicos son desafortunados, pero parte ineludible de la práctica médica. El trabajo trata de evidenciar cuáles son los factores culturales, sociales y políticos de la comunicación de los efectos adversos. Se narran las prácticas y discursos desde una doble perspectiva: desde la experiencia como enfermera, y desde la vivencia como paciente, tras haber sufrido un error médico. Se discute el concepto de auto-etnografía, como recurso metodológico para la realización de un análisis desde el punto de vista de la enfermería. Y el impacto de los efectos adversos, desde la mirada activa y participativa de la autora. En la comunidad asistencial, la implementación de una cultura de comunicación, reconocimiento y disculpa del error, supone abordar barreras tanto culturales y legales, así como también facilitar herramientas comunicativas a los profesionales

Medical errors are unfortunate, but are unavoidable in medical practice. The work deals with the cultural, social and political factors, which show the communication of the adverse effects. The work narrates the practice and speech from a dual perspective; from the experience as a nurse and from the patient's life lessons of having suffered a medical error. They discuss the concept of self-ethnography as methodological resources for the realization of an analysis from the viewpoint of the nurse, and the impact of the adverse effects from a quick active glance and with the author's participation. In the care community, the implementation of the communication culture, recognition and forgiveness of the error, deal with possible barriers, cultural as well as legal, and also the communication tools of the professionals

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OBJETIVO: examinar las barreras comunicativas que tienen los profesionales sanitarios cuando se enfrentan a un efecto adverso. MÉTODO: estudio cualitativo de orientación fenomenológica, desarrollado en el Servicio de Urgencias del Hospital de Tortosa Virgen de la Cinta (Tarragona), entre octubre y diciembre de 2018. Muestreo por conveniencia. Se llevaron a cabo dos grupos focales formados por seis-siete profesionales sanitarios que se agrupan en función del tiempo de experiencia profesional (mayor o menor a tres años). Los candidatos a participar se diferencian por edad, sexo y categoría profesional. Se usa el programa Atlas.Ti para el análisis. Se identifican tres categorías analíticas y 14 subcategorías. RESULTADOS: participaron 13 profesionales en dos grupos focales. Categorías que emergen del discurso: definición de efecto adverso, información y mejoras. Se normaliza la frecuencia de los errores. Hablan de errores leves y graves, diferenciando su actuación y los sentimientos. Refieren que parte de su aprendizaje es debido al ensayo-error de la práctica. Expresan miedo a informar en situaciones de gravedad. Hay una infrautilización del sistema de registro. Coinciden en dar la información en equipo, previo consenso, y expresan desprotección institucional. Proponen la implantación de los debriefings, identificación positiva, comunicación entre servicios, informatización y un cambio de turno estructurado. CONCLUSIÓN: el miedo a las respuestas, la pérdida de reputación y la falta de apoyo institucional aparecen como las principales barreras a la hora de admitir y comunicar los incidentes. Hay un amplio consenso sobre la falta de responsabilidad en la comunicación y disculpa de los eventos adversos y sobre la necesidad de aportar soporte y formación a los profesionales

OBJECTIVE: to review the communication barriers in healthcare professionals when faced with an adverse event. METHOD: a qualitative phenomenological study conducted at the Emergency Unit from the Hospital de Tortosa Virgen de la Cinta (Tarragona) between October and December, 2018, through convenience sampling. Two focus groups were set up, with six-seven healthcare professionals grouped by time of professional experience (over or below three years). The participants were differentiated by age, gender and professional category. The Atlas.Ti program was used for analysis. Three analytical categories and 14 subcategories were identified. RESULTS: the study included 13 professionals in two focus groups. The categories emerging from their speech were: definition of adverse event, information and improvements. The frequency of errors was normalized. They mentioned mild and severe mistakes, differentiating their action and feelings. They reported that part of their learning consists in trial-error during practice. They expressed fear to report in severe situations. The recording system is underused. They coincided in reporting as a team, after consensus, and they expressed lack of institutional protection. They proposed implementing debriefings, positive identification, communication between hospital units, information technologies, and a structured change of shift. CONCLUSION: fear of answers, loss of reputation, and lack of institutional support appeared as the main barriers at the time of acknowledging and reporting incidents. There was wide consensus about lack of responsibiility in communication and excuse for adverse events, and about the need to provide support and training to professionals

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OBJECTIVES: To study shift-related differences (day shift vs. night shift) in health and quality of life in nursing staff in hospitals in the Catalan public health system. METHOD: We performed a cross-sectional multicenter study in a sample of 476 nursing staff in the wards and special services of five Catalan public hospitals working for at least 6 consecutive months on the day shift or night shift. The nurses completed a validated, self-administered questionnaire on quality of life (M. Ruiz and E. Baca) and another questionnaire on health-related aspects such as sleep, working conditions, and demographic variables. RESULTS: Nurses working on the night shift showed a higher prevalence of appetite disturbance (45.2% vs 34.4%; p=0.01) and varicose veins (46.6% vs 36.4%; p=0.008). Sleeping disorders were also more frequent on the night shift, including insomnia and sleep fragmentation, with no differences in those who slept during the day (22.3%vs 33.7% ) or night (17.6% vs 30%) with respect to the day shift (12.2% vs 22.6%). Multivariate analysis of the results of the quality of life questionnaire revealed the night shift to be associated with the dimensions of social support (OR: 1.17; 95% CI, 1.01-3.01), physical/psychological well-being (OR: 1.04; 95% CI, 1.004-1.07) and leisure time (OR: 1.07; 95% CI, 1.003-1.1), although the overall score was similar. CONCLUSIONS: The night shift is associated a higher incidence of varicose veins, appetite disturbance and sleep disorders, as well as alterations related to social support, leisure time, and physical and physiological well-being.

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Objetivos: estudiar las diferencias en los aspectos de salud y calidad de vida del personal de enfermería de los hospitales de la sanidad pública catalana con relación al turno de trabajo (diurno/nocturno). Métodoestudio transversal multicéntrico sobre una muestra de 476 profesionales de enfermería de 5 hospitales públicos catalanes, que desarrollaban su actividad en plantas de hospitalización y servicios especiales, con una permanencia continua, mínima de 6 meses, en un turno diurno (TD) o nocturno (TN). Respondieron un cuestionario autoadministrado, validado, de calidad de vida de M. Ruiz y E. Baca, y otro acerca de aspectos relacionados con la salud, el sueño, las condiciones laborales y las variables demográficas. Resultadoscon relación a los trastornos de la salud, en el TN, se observa una prevalencia superior de trastornos del apetito (el 45,2 frente al 34,4%; p=0,01) y varices (el 46,6 frente al 36,4%; p=0,008). También fueron significativamente superiores en el TN la proporción de problemas de insomnio e interrupciones del sueño, tanto si dormían de día (el 22,3 frente al 33,7%) como de noche (el 17,6 frente al 30%) respecto al TD (el 12,2 frente al 22,6%). Tras efectuar el análisis multivariable sobre el cuestionario de calidad de vida, se encontró asociación significativa entre el trabajo nocturno y la dimensión de apoyo social (odds ratio [OR]: 1,17; intervalo de confianza [IC] del 95%, 1,01¿3,1), bienestar físico/psicológico (OR: 1,04; IC del 95%, 1,004¿1,07) y ocio (OR: 1,07; IC del 95%, 1,003¿1,1), aunque la puntuación global fue similar. Conclusionesel trabajo en TN se asocia a una mayor incidencia de varices, trastornos del apetito, insomnio e interrupciones del sueño, así como alteraciones relacionadas con el apoyo social, ocio y bienestar físico/psicológico(AU)

Objectives. To study shift-related differences (day shift vs. night shift) in health and quality of life in nursing staff in hospitals in the Catalan public health system. MethodWe performed a cross-sectional multicenter study in a sample of 476 nursing staff in the wards and special services of five Catalan public hospitals working for at least 6 consecutive months on the day shift or night shift. The nurses completed a validated, self-administered questionnaire on quality of life (M. Ruiz and E. Baca) and another questionnaire on health-related aspects such as sleep, working conditions, and demographic variables. ResultsNurses working on the night shift showed a higher prevalence of appetite disturbance (45.2% vs 34.4%; p=0.01) and varicose veins (46.6% vs 36.4%; p=0.008). Sleeping disorders were also more frequent on the night shift, including insomnia and sleep fragmentation, with no differences in those who slept during the day (22.3%vs 33.7% ) or night (17.6% vs 30%) with respect to the day shift (12.2% vs 22.6%). Multivariate analysis of the results of the quality of life questionnaire revealed the night shift to be associated with the dimensions of social support (OR: 1.17; 95% CI, 1.01¿3.01), physical/psychological well-being (OR: 1.04; 95% CI, 1.004¿1.07) and leisure time (OR: 1.07; 95% CI, 1.003¿1.1), although the overall score was similar. ConclusionsThe night shift is associated a higher incidence of varicose veins, appetite disturbance and sleep disorders, as well as alterations related to social support, leisure time, and physical and physiological well-being(AU)

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Aunque cada vez somos más concientes de las innumerables ventajas de la leche materna tanto para la madre como para el recién nacido, existen datos que ponende manifiesto el abandono temprano de lactancia por una producción insuficiente de leche, denominada hipogalactia. El propósito de este artículo es llamar la atención sobre los beneficios de la lechematerna y como mantenerla en un contexto sociocultural poco propicio y mostrar como prevenir el fenómeno de la hipogalactia. Se describe el concepto de hipogalactia,se exponen los criterios de valoración enfermera para su diagnóstico, se revisan las causas de hipogalactia primaria y secundaria y se proporciona una bateríade intervenciones enfermeras para prevenir la separación madre-hijo y el vaciamiento insuficiente.Las enfermeras tienen una responsabilidad importante en la ayuda a las madres, ya que mediante el ejercicio de actividades o pautas para prevenir y tratar las situaciones que provocan esta disminución de la leche materna, pueden proporcionar a las madres la seguridad y experiencia necesarias para instaurar una lactanciasatisfactoria

Even though we are becoming increasingly aware of the infinite advantages of maternal milk both for the mother and the newborn, there are data that indicatean early cessation of breastfeeding due to an insufficient production of milk, knownas hypogalactia.The aim of this article is to highlight the benefits of maternal milk and how to maintain it in an unpropitious sociocultural context to prevent hypogalactia. The concept of hypogalactia, nursing assessment criteria for diagnosis, and primary and secondary hypogalactia causes are described and a battery of nursing interventionsis provided to prevent mother-child separation and insufficient mild production. Nursing professionals have a great responsibility in helping mothers given that bycarrying out activities or guidelines to prevent and treat situations that lead to decreasedmaternal milk production, they can provide the mother with a sense of security and with necessary experiences to ensure satisfactory breastfeeding

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