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Context A bidirectional relationship between gut microbiota (GM) and circadian rhythms has been proposed. Objective The aim of this study was to analyze the efficacy of probiotic or prebiotic intervention on sleep quality and quantity. Data Sources A systematic review and meta-analysis were conducted using the databases PubMed (MEDLINE), Embase, CINAHL, and Web of Science. Only randomized clinical trials written in English or Spanish were considered. Data Extraction The initial search resulted in 219 articles. Following the removal of duplicates and consideration of the selection criteria, 25 articles were selected for the systematic review and 18 articles for the meta-analysis. Data Analysis Microbiota modulation was not demonstrated to be associated with significant improvement in sleep quality in the present meta-analysis (P = 0.31). In terms of sleep duration, the meta-analysis found no improvement due to GM modulation (P = 0.43). Conclusion The results of this meta-analysis indicate that there is still insufficient evidence to support the relationship between GM modulation and improved sleep quality. While several studies assume that including probiotics in the diet will undoubtedly improve sleep quality, more research is needed to fully understand this phenomenon. Systematic Review Registration PROSPERO registration no. CRD42021245118.

Shift work is increasingly common in health services, subjecting healthcare professionals to work schedules that can alter circadian rhythms and eating habits with consequent repercussions for the intestinal homeostasis. The objective of this study was to describe the relationship of rotating work shifts with the intestinal health, sleep quality, and emotional dimension of nursing professionals. In March and May 2019, an observational and comparative study was conducted among 380 nursing professionals from different Spanish cities and divided into fixed shift (n = 159) and rotating shift (n = 221). To carry out the present work, the variables measured were gastrointestinal symptoms, stool consistency and shape, anxiety, depression, sleep, as well as stress and work environment. Nurses with rotating shifts reported more abdominal pain and symptoms of depersonalization, as well as worse sleep efficiency and worse nursing practice environment. In addition, overall scores of the Gastrointestinal Symptom Rating Scale and Hospital Anxiety and Depression Scale were found to be significantly worse in nurses with these shifts. Rotating shift work by nursing staff may be associated with the occurrence of gastrointestinal and anxiety-related symptoms. These findings, together with the presence of negative and insensitive attitudes towards patients by nurses on rotating shifts, should be considered to maintain the quality of healthcare.

Aim: To provide data on the fears of pregnant women during the confinement period and to learn about the factors, which may have exacerbated fear in Spanish pregnant women during the pandemic. Design: A cross-sectional observational and descriptive study. Methods: An anonymous survey was carried out using virtual media in a pregnant population (aged ≥18 years) during the confinement period from 1 April to 1 May 2020. Results: The total sample comprised of 62 individuals, with a mean age of 33.6 ± 3.6 years and a mean gestation time of 23.6 ± 9.8 weeks. All of the women used preventive measures against SARS-CoV-2. The most common preventive measures were social isolation (82.3%, n = 51) and frequent handwashing (69.4%, n = 43). The most common feeling was fear (29%, n = 18). The main fears were related to transplacental infection (27%, n = 16), loneliness during childbirth, and being separated from the newborn (27%, n = 16). In addition, 59.7% (n = 37) considered changing their child-rearing practices after the pandemic.

espanolLos conceptos, los estilos y las estrategias de ensenanza se encuentran intimamente ligados, quedando supeditados a la experiencia del propio docente. De esta forma, no solo quedara configurado el aprendizaje del alumnado a partir de las metas que este asuma, sino que estos estilos docentes tambien tendran una impronta en diferentes elementos de dicho proceso, como la motivacion e implicacion en el aprendizaje. El objetivo de este estudio, por tanto, fue conocer los diferentes estilos y su evolucion dentro del profesorado de ciencias experimentales y tecnologia, asi como su impacto en las estrategias de aula. Para ello, se diseno un estudio cualitativo descriptivo de corte fenomenologico, a partir de un estudio de caso. Se realizaron un total de 6 entrevistas a profesores/as de diferentes niveles educativos dentro del area de ciencias experimentales y tecnologia, acompanadas de observaciones no participantes en el aula y analisis documental. Los resultados mostraron datos interesantes sobre el uso de diferentes estilos de ensenanza, mas cercanos a un estilo mixto a estrategias de aprendizaje cooperativas. Como conclusion, merece especial atencion la evolucion de los participantes hacia estilos y estrategias mas activas, aunque queda pendiente la tarea de profundizar en el proceso de evaluacion y reflexion docente. EnglishConcepts, styles, and teaching strategies are strongly intertwined and are influenced by the experience of the teacher. In this manner, not only will student learning be configured on the basis of the goals that they assume, but these teaching styles will also have an impact on different elements of this process, such as motivation and engagement in learning. Thus, the aim of the study was to explore different teaching styles and their evolution in the area of experimental sciences and technology, as well as their impact on teaching strategies used within the classroom. To this end, a qualitative descriptive study with a phenomenological approach was designed, based on a case study. A total of 6 interviews were carried out with teachers of different educational levels within the area of experimental sciences and technology, as well as non-participant observations in the classroom and documental analysis. The results showed interesting data about the use of different teaching styles, closer to a mixed style and a cooperative learning strategy. In conclusion, the change towards more active styles and strategies deserves special attention, although the challenge of deepening the teacher assessment and reflection process remains. portuguesOs conceitos, estilos e estrategias de ensino estao intimamente ligados, estando sujeitos a propria experiencia do professor. Desta forma, nao so a aprendizagem dos alunos sera configurada pelos objetivos que eles assumem, mas tambem os estilos de ensino terao um impacto em diferentes elemen-tos deste processo, como a motivacao e o envolvimento na aprendizagem. Portanto, o objetivo deste estudo era conhecer os diferentes estilos e a sua evolucao nos professores de Ciencias Experimentais e Tecnologia, bem como o seu impacto nas estrategias de sala de aula. Para este fim, foi elaborado um estudo qualitativo, descritivo e fenomenologico, com base num estudo de caso. No total, foram realizadas 6 entrevistas com professores de diferentes niveis educacionais na area de Ciencias Experimentais e Tecnologia, acompanhadas de observacoes em sala de aula de nao participantes e analise documental. Os resultados mostraram dados interessantes sobre o uso de diferentes estilos de ensino, mais proximos de um estilo misto do que de estrategias de aprendizagem cooperativa. Em conclusao, merece atencao especial a evolucao dos participantes em direcao a estilos e estrategias mais ativas, embora a tarefa de aprofundar o processo de avaliacao e reflexao dos professores ainda esteja pendente

Background Obstetric violence appears to be a worldwide concern and is defined as a type of gender-based violence perpetrated by health professionals. This violence undermines and harms women’s autonomy. In Spain, 38.3 % of women have identified themselves as victims of this type of violence. Aim To explore current information and knowledge about obstetric violence within the Spanish healthcare context, as well as to develop a theoretical model to explain the concept of obstetric violence, based on the experiences of healthcare professionals (midwives, registered nurses, gynaecologists and paediatricians) and nursing students. Methods A constructivist grounded theory study was conducted at Jaume I University in Spain between May and July 2021, including concurrent data collection and interpretation through constant comparison analysis. An inductive analysis was carried out using the ATLAS.ti 9.0 software to organise and analyse the data. Results Twenty in-depth interviews were conducted, which revealed that healthcare professionals and students considered obstetric violence a violation of human rights and a serious public health issue. The interviews allowed them to describe certain characteristics and propose preventive strategies. Three main categories were identified from the data analysis: (i) characteristics of obstetric violence in the daily routine, (ii) defining the problem of obstetric violence and (iii) strategies for addressing obstetric violence. Participants identified obstetric violence as structural gender-based violence and emphasised the importance of understanding its characteristics. Our results indicate how participants’ experiences influence their process of connecting new information to prior knowledge, and they provide a connection to specific micro- and macro-level strategic plans. Discussion Despite the lack of consensus, this study resonates with the established principles of women and childbirth care, but also generates a new theoretical model for healthcare students and professionals to identify and manage obstetric violence based on contextual factors. The term ‘obstetric violence’ offers a distinct contribution to the growing awareness of violence against women, helps to regulate it through national policy and legislation, and involves both structural and interpersonal gender-based abuse, rather than assigning blame only to care providers. Conclusions Obstetric violence is the most accurate term to describe disrespect and mistreatment as forms of interpersonal and structural violence that contribute to gender and social inequality, and the definition of this term contributes to the ongoing awareness of violence against women, which may help to regulate it through national policy and legislation.

Background: There are currently no studies available about the possible use of gamification in the evaluation of nursing students’ clinical skills. The purpose of this study was to understand the gameful experience and satisfaction of nursing students in the evaluation of their clinical skills using an escape room. Methods: A quasiexperimental study was carried out. The participants were divided into an experimental group (escape room) and a control group. Results: The experimental group had higher than average scores in all dimensions of the gameful experience scale, except in the dimension of negative effects. Conclusions: Escape rooms are a useful tool for the evaluation of nursing students compared with using the objective structured clinical evaluation.

The capacity of hospitals and primary care centres has, rightfully, been at the centre of public and political debate on resource availability and control measures during the outbreak of COVID-19 and lockdown. Thus, the aim of this study is to describe the public and professional perceptions towards the evolution of the COVID-19 public-health response, in order to analyse and learn lessons for future health policies in similar situations in the future. A descriptive qualitative study was conducted through 41 in-depth interviews between January and June 2021. Twenty-one healthcare professionals and twenty service users participated in our study. The participants were recruited using purposive sampling. After our data analysis, three main themes emerged: (i) experiences during an unprecedented public health threat: the impact and challenges of early control measures, and outcomes for the public image of nursing; (ii) overcoming the impact of the outbreak on the healthcare system: professional coping strategies in the context of the pandemic, and institutional considerations in hospitals and primary care; and (iii) the efficiency of resource management during the outbreak: perceptions of professionals and healthcare users. Health providers and service users demand structural and organisational changes, as well as resource-optimisation strategies for front-line workers. Nurses need to be involved in decision making in order to provide evidence-based guidelines and ensure well-resourced and supported care practice.

To explore the experiences and perceptions of final-year nursing students in assessing and managing acute pesticide poisoning using a socio-environmental care approach in a primary health care simulation-based scenario.A qualitative descriptive study was conducted using focus groups.Twelve focus groups were held, with 114 fourth-year nursing students. The study was carried out from September to November 2021. To grant an in-depth analysis of the collected data, a thematic analysis was used.After our data analysis, three main themes emerged: (i) experiences of an acute pesticide poisoning case in a simulation-based scenario; (ii) environmental health nursing competencies for a culturally competent practice and (iii) social factors in prevention strategies.Using a socio-environmental care approach with a primary care simulation-based poisoning case can provide a realistic public health clinical experience for local problems and prepare the context for the development of global citizenship values, as well as offer numerous opportunities to facilitate transformative learning, including Sustainable Development Goals (SDGs) into local nursing clinical practice.Nurse managers, policymakers and educators must collaborate together to broaden their reach in teaching the role of the environment and social determinants of health through evidence-based care models, as well as actively contributing to the achievement of the SDGs to promote "glocal" competencies among nursing professionals.

Aim To explore the experiences and perceptions of recent nursing graduates working in emergency departments during the COVID-19 outbreak. Background Overcrowding in emergency departments has been one of the most prominent issues arising in these units for more than 20 years. However, it has become even more problematic due to the novelty of the coronavirus pandemic, which has forced hospitals to recruit larger numbers of beginner nursing staff as the number of quarantined health professionals increases. Methods Sixteen semi-structured interviews were conducted in Spanish emergency departments, which were analysed and synthesized using content analysis. Results Three major themes emerged from the data analysis: (a) Fears and concerns, (b) Organisational issues and (c) Support for novice nurses. Conclusions Our findings may help to understand how shadowing periods as a learning programme for nurses, continuing professional development, evidence-based apps and better planning are needed to ensure both novice nurses' confidence in emergency departments and expert emergency room nurses' ability to cope with complications in critical situations. Implications for nursing management Training periods that include shadowing expert emergency room nurses, along with evidence-based technology, provide an opportunity to support novice nurses' transition into the workplace. These measures would provide a safety net and would increase novice nurses' confidence as well as high-quality care.

Este artículo se encuentra disponible en la siguiente URL: https://www.mdpi.com/2075-4426/12/3/356 En este artículo de investigación también participan: Ana Boldo-Roda y Eladio Collado-Boira. In patients with breast cancer, physical exercise reduces the toxicity of treatment; however, this physical exercise must meet a set of criteria, such as being guided by knowledgeable instructors. Thus, the aim of this study was to explore the perceptions of female breast cancer patients regarding the impact of an online physical exercise programme in the context of the COVID-19 pandemic. Nineteen female breast cancer patients participated in four focus group interviews as part of a qualitative study using a thematic analysis between December 2020 and May 2021. Three major themes emerged: “Experiences and perceptions of online physical exercise with breast cancer”; “Incorporating exercise-based activity for cancer-related side effects”; and “Increasing self-esteem and empowerment”. Online, live-streamed, and supervised group activities help breast cancer patients engage and prevent the recurrence of cancer-related side effects, as well as to control COVID-19- related fear and provide an alternative to promote mental health-related quality of life.

Aim To explore the experiences and perceptions of midwives in the treatment of sex trafficking victims. Design The study was qualitative with a hermeneutic-phenomenological approach, using semi-structured interviews and focus groups. Methods Two focus groups and six interviews were carried out on 14 midwives in primary care, delivery and emergency rooms. Data were collected in three hospitals in Spain in June 2021. ATLAS.ti 9 software was used to conduct a content analysis of the focus group and interview data. Results The results revealed two primary themes and six subthemes. The two primary themes were (i) sex trafficking: a camouflaged reality on the invisible spectrum, and (ii) a thirst for attention in the aftermath of violence. Representative quotations were used to illustrate both the main themes and the subthemes. Conclusions This study provides new insight into midwives' experiences treating sex trafficking victims. Professionals view this type of violence as a silent issue that negatively impacts victims' health and livelihood. However, a number of different factors stand in the way of correctly identifying and treating victims. Therefore, healthcare workers must be provided with practical tools and continuous professional development on this topic. Impact This study indicates the importance of the midwives' key role in identifying and assisting victims of sex. Not only do measures in the healthcare setting, such as on-going specific-related content training or up-to-date protocols, need to be implemented to ensure proper care for those affected by sexual exploitation, but also focusing on suspicious characteristics and reducing obstacles to patient communication will help bring the true situation to light and better respond to patients' priority needs.

to explore nursing students' experiences with the use of RCA technique in patient safety-related incidents during clinical placements. A secondary descriptive qualitative content analysis BACKGROUND: Patient safety education for nursing students is an international priority. While early detection and intervention strategies, such as the root cause analysis technique, have been found to be effective for near misses and errors, little is known about how these strategies facilitate nursing students understand how patient safety incidents happen.A secondary qualitative content analysis was conducted as part of a larger patient safety research project.Data were collected from nursing students at [Hidden for blinding purposes]. This study included 108 third-year undergraduate nursing students enroled in the Care Management in the Socio-Health Care Settings for the academic years 2017-2018 and 2018-2019. During hospital clinical placements, nursing students were asked to do a coursework describing a patient safety incident and using the root cause analysis technique for its analysis. A content analysis was used to provide an in-depth analysis of the collected data.Two main themes were identified after the data analysis process: (i) patient safety incident as learning events: highlights how these incidents were turned into learning opportunities and how the root cause analysis guided them in identifying and addressing critical incidents to prevent similar situations in the future; and (ii) strategies for improving patient safety culture: depicts how nursing students realised that following protocols and evidence-based practice reduces incidents related to patient safety and the value of reporting errors in avoiding and minimising the recurrence of similar mistakes.The root cause analysis technique is a versatile and flexible learning resource for nursing students that can help them understand complex patient safety incidents while also fostering critical and problem-solving thinking, teamwork and systematic communication.

During their clinical practice, nursing students face a number of complex clinical situations, which may include treating victims of sex trafficking. These clinical experiences can lead to stress for the nursing students, which may hinder their learning process. Nonetheless, there is very little educational training provided in nursing programmes on this topic. The objective of this study was to identify the coping strategies and stressors perceived by nursing students in the care of sex trafficking victims. A pre-post study of a single group was carried out. The TREND guidelines were followed. The Perceived Stress Scale (PSS) and Coping Behavior Inventory (CBI) were used for data collection. On the PSS, the average scores were lower after the intervention in all dimensions, except related to teachers and nursing staff and peers and daily life. Statistically significant differences were found when comparing the results of the total average score of the PSS and the time of measurement (pre/post-intervention) (t(106) = 38.811; P < 0.001). Regarding the Coping Behavior Inventory, the average scores in each dimension increased after the intervention, except transference behaviours. Statistically significant differences were found when comparing the total average score of the questionnaire and the time of measurement (Z = -13.357; P < 0.001). The total stress levels and coping strategies of nursing students in caring for victims of sex trafficking improved significantly after the intervention. Nursing educators should promote the training of future nursing professionals as a potential effective strategy for the rapid identification and adequate care of sex trafficking victims.

Aim The aim of this study is to explore the experiences and perceptions of final-year nursing students on the acceptability and feasibility of using a chatbot for clinical decision-making and patient safety. Background The effective and inclusive use of new technologies such as conversational agents or chatbots could support nurses in increasing evidence-based care and decreasing low-quality services. Methods A descriptive qualitative study was used through focus group interviews. The data analysis was conducted using a thematic analysis. Results This study included 114 participants. After our data analysis, two main themes emerged: (i) experiences in the use of a chatbot service for clinical decision-making and and (ii) integrating conversational agents into the organizational safety culture. Conclusions The findings of our study provide preliminary support for the acceptability and feasibility of adopting SafeBot, a chatbot for clinical decision-making and patient safety. Our results revealed substantial recommendations for refining navigation, layout and content, as well as useful insights to support its acceptance in real nursing practice. Implications for Nursing Management Leaders and managers may well see artificial intelligence-based conversational agents like SafeBot as a potential solution in modern nursing practice for effective problem-solving resolution, innovative staffing and nursing care delivery models at the bedside and criteria for measuring and ensure quality and patient safety. Funding for open access charge: CRUE-Universitat Jaume I

Aging is a process that includes changes in cognitive and emotional functions, as well as changes in the diversity and integrity of gut microbiota. Probiotic treatments have recently been studied as a potential new therapeutic approach to alleviate a wide range of problems in other populations; however, clinical studies in older adults remain insufficient and limited. Thus, the aim of this project is to evaluate the efficacy of a multispecies probiotic formulation as a therapeutic strategy for attenuating the emotional and cognitive decline associated with aging in adults over the age of 55. This is a double-blind randomized placebo-controlled crossover trial involving at least 32 older adults and comparing two conditions: (a) probiotic, providing a multispecies probiotic for 10 weeks (Lactobacillus rhamnosus and Bifidobacterium lactis); and (b) placebo, receiving a harmless substance (potato starch). Despite the increasing use of probiotics for the treatment of cognitive and emotional problems, no study has yet focused on this group, to the best of our knowledge. Therapeutic strategies of the kind outlined in this protocol will help to shed light on the current state of knowledge about this topic, as well as promote health programs tailored to this population, which would encourage active aging and healthy lifestyles. Not only do we expect improvements in the emotional dimension in terms of anxiety, stress, depression, and sleep quality, we also expect improvements in the cognitive dimension in terms of attention, memory, and decreased impulsivity.

Background: Anatomy is an important part of health science education. In teaching anatomy, new teaching strategies have been studied in comparison with traditional-based approaches. In this manner, strategies such as the escape room-based approach have been used as an innovative learning approach in nursing education, but little is known about its application in an Anatomy module. Objective: To evaluate the effectiveness of the escape room for anatomy-related knowledge retention in nursing and the perceived value of the game. Design: In the first semesters of the academic years 2017–2018 and 2018–2019, a comparative cross-sectional study was conducted. Settings: This study took place at the University of Almeria with students enrolled in the Anatomy module. Participants: A total of 248 first-year nursing students took part in the study. Methods: The study included two groups: an experimental group (EG) that participated in an escape room in the final session of their Anatomy module, and a control group (CG) that received a traditional-based teaching approach in their final lesson. Results: Students enrolled in the Anatomy module were randomly assigned to either the experimental (EG, n = 128) or control groups (CG, n = 120). The escape room was conducted in groups of four and lasted no more than 15 min. In terms of satisfaction with the escape room, EG scored above the mean. The item “I enjoyed playing” received the highest score (4.88 ± 0.35). Taking the final scores of each group into account, the EG had a final average score of 8.94 ± 0.96, while the CG had a final average score of 7.70 ± 1.25 (p = 0.001). Conclusions: According to the findings, the “Anatomy Escape Room” is a game-based approach that motivates students and constitutes a down-to-earth resource for anatomy learning in healthcare students.

Microaggressions, stigma and minority stress still occur among sexual and gender minorities on an individual, interpersonal, and structural level. Cultural immersion may therefore be an effective strategy in order to find potential healthcare approaches and foster more comprehensive, critical, intersectional, and inclusive care practices.The aim of this study was to develop insight into the experiences of LGBTQ+ community members to obtain in-depth perceptions of microaggressions and an understanding of their healthcare needs to provide a culturally safe and sensitive care.A qualitative descriptive study was conducted between September to November 2021.This study was conducted at the University of Almeria with LGBTQ+ community members.Twenty-one LGBTQ+ individual participated in this study, aged between 18 and 56 years old.Participants were recruited using a purposive sampling. Responses from semi-structured interviews were studied using a thematic analysis. Methods and findings are reported in line with Standards for Reporting Qualitative Research recommendations.Three themes emerged from the qualitative analysis: (i) experiences to understand the impact of a heteronormative society, (ii) perceptions of engaging with health education and promotion, and (iii) healthcare access, use and experiences within the LGTBQ+ community.This study yields findings about the difficulties that LGBTQ+ community members face in the healthcare system in order to ensure equal care for vulnerable communities and integrate a culturally safe care approach into nursing practice. Certain microaffirmation strategies against social determinants of health such as school-based nursing strategies can help to raise awareness and knowledge among heterosexual peers and reduce cultural invisibility, microaggressions, stigma and minority stress. In order to provide culturally safe care, educators might also explore the inclusion of gender and sexual minority care content in both in-faculty education and ongoing continuing education for nurse practitioners.

Aims and objectives: The aim of review was to describe and synthesise the evidence on the use of tourniquets to control haemorrhages, summarising both civilian and military use. Background: Trauma-related haemorrhage constitutes one of the most preventable deaths among injured patients, particularly in multi-casualty incidents and disasters. In this context, safe instruments such as tourniquets are essential to help healthcare professionals to minimise loss of life and maximise patient recovery. Design and methods: An integrative review was conducted in Medline, Nursing & Allied Health Premium, and Health & Medical Collection, using published data until March 2021 and following the PRISMA guidelines. Results: A total of 25 articles were included. Evidence has been synthesised to understand the use of different types of tourniquets, environment of application, indication for their placement and potential complications associated with tourniquet placement. Conclusions: Commercial tourniquets such as Combat Application Tourniquet or Emergency Tourniquet models are a valuable and safe instrument for haemorrhage control in both military and civilian out-of-hospital care settings. Nurses, as part of emergency teams, and other professionals should be aware that there is a possibility of adverse complications, but they are directly proportional to the time of tourniquet placement and generally temporary. In addition, national and international guidelines ensure the need for all civilian emergency services to be equipped with these devices, as well as for the training of healthcare professionals and first responders in their use. Relevance to clinical practice: Despite the lack of complications in the use of tourniquets in these cases, their use has been a matter of debate for decades. In this sense, this review yields up-to-date guidelines in the use of tourniquets, their recommendations and their significance among professionals to manage complicated situations.

The death of a patient can be a traumatic event, causing emotional and psychological distress in professional nurses and potentially hampering the quality of their care. Optimal selfperceived coping with death involves valuing these difficult situations as challenges and actively coping with work-related stress during the care of the dying patient. Thus, the aim of this study was to assess Spanish nurses’ self-perceived competence with patient death and investigate its relationship with their personality traits, anxiety and fear of death. A cross-sectional study based on a web-based survey was conducted. A sample of 534 Spanish nurses provided socio-demographic information and answered validated questionnaires. Most participants perceived their coping with death as optimal. Men and nurses older than 31 years coped better with death. Professionals with an optimal self-perception showed significantly lower scores on all personality dimensions evaluated, while a higher level of the anxiety trait predicted worse coping. Although with medium explanatory power, psychoticism, anxiety, and fear of death were the main predictors of the development of optimal coping with death among Spanish nurses. These characteristics together with information from the work environment and evidence-based practice could help to develop better routines and contexts of care for nurses working in end-of-life care.

Aim: To synthesize and describe the emotional and psychological implications for healthcare professionals who provided care in a mass casualty incident or disaster. Background: The experience of healthcare providers immersed in the actual uncertainty of an ongoing disaster is real, challenging, complex and strongly connected with emotions. Identifying these implications for healthcare professionals is essential for developing strategies to help these professionals deliver high-quality care. Evaluation: A systematic review was conducted in PubMed, CINAHL, Scopus, Nursing & Allied Health Database and PsycINFO using published data until February 2021 and following the PRISMA guidelines. Key issues: Nineteen articles were included. Factors associated with negative psychological implications were identified and different strategies have been synthesized to prevent or reduce them when caring for the victims of a disaster. Conclusions: Feelings of sadness, helplessness, fear and blockage, among others, were identified as common reactions among nurses and other healthcare professionals dealing in mass casualties or disasters. These reactions may lead to post-traumatic disorder, turning professionals into hidden victims. Implications for nursing management: Organizations, senior charge nurses and other health service managers need to foster resilience and flexibility among their workforce to improve self-care during a disaster, as well as ensure policies to address a lack of emotional preparedness among their personnel. Some strategies to consider include cognitive behavioural therapy, psychoeducation or meditation.

Escape Rooms can serve multiple academic and educational purposes and can be used as part of the evaluation of a learning program. The aim of this study was to analyze the levels of anxiety and stress perceived in the evaluation using the Escape Room compared to the traditional evaluation, as well as to analyze the gaming experience. Methods: A comparative study was carried out in students of the Degree in Physiotherapy, with a total of 56 participants who underwent 2 evaluation processes. The variables analyzed were the State—Trait Anxiety Inventory, the Perceived Stress Questionnaire, and the Gaming Experience Scale. A comparative analysis was performed between the groups using the Mann Whitney U test and Student’s T test. Results: The levels of state-anxiety and trait-anxiety were higher in the traditional assessment group. Although no differences were found in the qualification obtained by the students, statistically significant differences were found between the two evaluation systems in terms of the overload factor, the energy factor, and the fear-anxiety factor of the perceived stress questionnaire. Conclusions: The Escape Room can be considered as an alternative to the traditional evaluation in Physiotherapy Degree students due to its lower levels of anxiety and perceived stress., Spanish Ministry of Education and Vocational Training (FPU17/01109)

Cancer affects more than 19.3 million people and has become the second leading cause of death worldwide. Chemo- and radiotherapy, the most common procedures in these patients, often produce unpleasant treatment-related side effects that have a direct impact on the quality of life of these patients. However, innovative therapeutic strategies such as probiotics are being implemented to manage these complications. Thus, this study aimed to evaluate the efficacy of probiotics supplements as a therapeutic strategy in adult oncology treatment-related side effects. A systematic review of randomized controlled trials was conducted in PubMed, Scielo, ProQuest and OVID databases up to and including January 2021, following the PRISMA guidelines. The quality of the included studies was assessed by the Jadad Scale. Twenty clinical trials published between 1988 and 2020 were included in this review. Seventeen studies (85%) revealed predominantly positive results when using probiotics to reduce the incidence of treatment-related side effects in oncology patients, while three studies (15%) reported no impact in their findings. This study sheds some light on the significance of chemotherapy and radiotherapy in altering the composition of gut microbiota, where probiotic strains may play an important role in preventing or mitigating treatment-related side effects.

Aim To know the perspectives of nursing students in trans patients' care and their access to health services and how to improve the quality of care in trans patients, related to the barriers identified by nursing students. Background Lesbian, gay, bisexual, transgender, queer and plus (LGBTQ+) find barriers related to the health care access, including stigma, discrimination and lack of education. In addition, to the transphobia reported in some health care providers. Methods A descriptive qualitative study was performed through 12 focus group interviews in nursing students. Data analysis was based on content analysis. Results 124 first-year nursing students participated. The qualitative analysis resulted in three major themes: (a) Exposing an invisible reality, (b) Interprofessional communication: a starting point to arise awareness and (c) Care with pride as a link between individuality and professionalism. Conclusions Our findings suggest that both LGBTQ+ content and institutional resources are the cornerstone for nursing students and professionals' practice in order to develop and provide a well-informed and high-quality care delivery to these patients. Implications for nursing management Policymakers, senior charge nurses and other managers should be aware of the structural-level changes identified and ongoing mentoring needed to guarantee trans patients' privacy and safety.

Background: The COVID-19 pandemic has posed significant challenges around the world, affecting over 1.5 billion students in 191 countries. This situation has forced faculties and health-related degrees in particular to be innovative, flexible, and agile when transitioning to online or blended learning. Objective: The aim of this study was to explore nursing students' experiences and perceptions of the use of game elements in two full-nursing subjects using a blended-learning teaching strategy. Design: A qualitative study was conducted through sixteen focus group interviews between November 2020 and January 2021. Setting: This study took place at the Jaume I University with students enrolled in Adult and Elderly Health Programmes and Chronic Processes in their second and third year, respectively. Participants: One hundred forty-nine second- and third-year undergraduate nursing students took part in the focus group interviews. Methods: A blended-learning teaching approach with game elements was developed for two full-undergraduate nursing subjects. Focus groups using a semi-structured interview protocol were conducted after delivering the teaching content. A content analysis was used to analyse the focus group interview data. Results: The qualitative analysis revealed four major themes: (i) teaching transition in the COVID-19 pandemic scenario, (ii) game elements to retain student attention and learning, (iii) gameful designs for competency-based team training, and (iv) blended learning vs face-to-face learning including gamification. Conclusions: This study yields, for the first time, findings about the use of game elements in blended learning. This strategy was shown to be useful for teaching other key clinical or teamwork-related skills such as creativity, innovation, team-based communication, and responsibility, in addition to supporting the use of this innovative teaching strategy to reduce online fatigue and stress and increase student engagement in online classes.

BACKGROUND Gamification has been shown to be a positive learning tool for its use among nursing students, but there are currently no studies available about its possible implementation in the evaluation of nursing students’ clinical skills. OBJECTIVE The aim of this study was to understand the gameful experience and satisfaction of nursing students in the evaluation of their clinical skills using an escape room, as opposed to the traditional method of objective structured clinical evaluation. METHODS A quasi-experimental study was carried out on 237 nursing students divided randomly into a control group (n=120) and an experimental group (n=117). The participants completed a questionnaire about their knowledge and then the experimental group also filled out a questionnaire about their game experience and their satisfaction with the game. RESULTS The finding showed higher than average scores in all the dimensions of the Gameful Experience Scale, except in the dimension of negative effects. Regarding satisfaction, the highest scores were found in the dimensions of activity duration (3.51±0.66); the organisers’ attentiveness to students (3.60±0.61) and applicability of content to their training (3.50±0.58). As for the final evaluation, statistically significant differences were found between both groups (U=759.500; Z=-11.878; p CONCLUSIONS Escape rooms are a useful tool used for evaluation of nursing students as opposed to objective structured clinical evaluation.

Purpose: Gamification or learning using game elements is a process that seeks to capture students’ interest. One of the most popular games in recent years is the Escape Room, but the study of its use in education and with health professionals is still limited. The aim of this study was to find out the perceptions and experiences of final year nursing students in an Objective Structured Clinical Examination (OSCE) by means of an Escape Room. Methods: In January 2019, 9 focus groups (FG) were held, with a total of 95 final year nursing students. We applied a qualitative content analysis approach and ATLAS.ti version 8 was used for data analysis. Results: The data revealed 3 main themes and 8 sub-themes. The three main themes, which were mapped to the conceptual framework, were student learning outcomes, emotional impact on students and conclusions on the serious games experience. Both the main themes and the sub-themes were illustrated using representative quotes from the participants. Conclusions: These results can help to apply these methodologies, such as the Escape Room, alongside other pre-existing ones, complementing the way in which students are assessed and the development of important nursing skills, such as teamwork and communication.

Resumen: Objetivo: Analizar la representación mediática del éxodo de las enfermeras españolas al Reino Unido a través de los diarios de información general. Métodos: Análisis de contenido, cuantitativo y cualitativo. Se localizaron con operadores booleanos los documentos publicados en los diarios ABC, El País, El Mundo y La Razón, sobre «emigrantes», «enfermeras» y «sanitarias emigrantes», desde el 1 de enero de 2007 hasta el 31 de diciembre de 2016. El periodo seleccionado se corresponde con el inicio de la crisis económica y concluye con el año de la celebración del referéndum del Brexit en el Reino Unido. Tras aplicar los descriptores se obtuvieron 9559 textos. Una vez eliminado el «ruido» quedaron 484 unidades textuales. Para llevar a cabo un análisis más exhaustivo se seleccionaron los documentos específicos sobre «enfermeras emigrantes», que fueron 77, y se analizaron cualitativamente. Resultados: a) 2013 fue el año en que se publicaron más noticias sobre la emigración en general, y también en particular sobre el colectivo de enfermería; b) el diario ABC fue el que publicó más relatos (31) sobre el éxodo de enfermeras al Reino Unido; c) El País fue el que más textos publicó sobre la emigración española (397); d) el 98% de los titulares analizados (n = 77) tenían un tono negativo; y e) el discurso social tuvo mayor relevancia que el discurso político. Conclusiones: La prensa promovió el «efecto salida» de las enfermeras para emigrar al Reino Unido. Abstract: Objective: To analyse the media representation of the exodus of Spanish nurses to the United Kingdom through general information newspapers. Methods: Content analysis, quantitative and qualitative. Documents published in the newspapers ABC, El País, El Mundo and La Razón, about “emigrants,” “nurses” and “migrant health workers,” were located from January 1, 2007, to December 31, 2016, with Boolean operators. This selected period corresponds to the beginning of the economic crisis and concludes in the year of the Brexit referendum in the United Kingdom. After applying the descriptors, 9559 texts were obtained. Once the noise of the documents was eliminated, 484 textual units were found. To carry out a more exhaustive analysis, the specific documents on “migrant nurses”, which were 77, were selected and analysed qualitatively. Results: a) 2013 was the year in which the most stories about emigration in general were published, and also about nurses in particular; b) the ABC newspaper published the most stories about the exodus of nurses to the United Kingdom (31); c) El País published the most texts on Spanish emigration, with a total of 397 documents; d) 98% of the headlines analysed (n = 77) had a negative tone; and e) social discourse had greater relevance than political discourse. Conclusions: The press promoted the push factor for nurses to migrate to the United Kingdom. Palabras clave: Prensa escrita, Medios de comunicación, Análisis de contenido, Noticias, Éxodo enfermeras, Reino Unido, Keywords: Newspapers, Media, Content analysis, Stories, News items, Exodus of nurses, United Kingdom

To analyse the media representation of the exodus of Spanish nurses to the United Kingdom through general information newspapers.Content analysis, quantitative and qualitative. Documents published in the newspapers ABC, El País, El Mundo and La Razón, about "emigrants," "nurses" and "migrant health workers," were located from January 1, 2007, to December 31, 2016, with Boolean operators. This selected period corresponds to the beginning of the economic crisis and concludes in the year of the Brexit referendum in the United Kingdom. After applying the descriptors, 9559 texts were obtained. Once the noise of the documents was eliminated, 484 textual units were found. To carry out a more exhaustive analysis, the specific documents on "migrant nurses", which were 77, were selected and analysed qualitatively.a) 2013 was the year in which the most stories about emigration in general were published, and also about nurses in particular; b) the ABC newspaper published the most stories about the exodus of nurses to the United Kingdom (31); c) El País published the most texts on Spanish emigration, with a total of 397 documents; d) 98% of the headlines analysed (n = 77) had a negative tone; and e) social discourse had greater relevance than political discourse.The press promoted the push factor for nurses to migrate to the United Kingdom.

Resumen Este artículo contiene los resultados de la investigación Relación existente entre las familias con violencia conyugal y el autoconcepto del menor entre 5 y 6 años de edad. La familia es la institución intermedia entre el hombre y la sociedad, representa la mayor influencia educadora para el niño y está determinada por las condiciones del contexto sociocultural. En Colombia el índice de violencia se ha generalizado a todos los espacios de la sociedad, siendo la familia la más vulnerada, lo cual afecta el desarrollo de la 1 personalidad de los niños. El diseño utilizado para la investigación fue descriptivo-comparativo; la muestra la conformaron 23familiaseonsultantes de la Comisaría Segunda de Familia. Se aplicó la escala de autopercepción PAI a los niños y a los padres una entrevista encaminada a conocer las condiciones socioculturales y su relación con los niños. Como conclusión encontramos que la valoración del autoconcepto en todas las áreas en niños y niñas cuyos padres presentaban violencia conyugal, estaba desarrollada de manera positiva y no existía diferencia significativa entre los dos sexos. Por lo tanto, a pesar de que en una familia existan niveles elevados de violencia, no necesariamente éstos pueden incidir negativamente en el desarrollo del autoconcepto, siempre y cuando el niño no sea victoria de dicha agresión y haya presentado un desarrollo físico y psicoafectivo normal. Abstract The family is an intermediary between man and society. It represents the major educating influence for children and it is determined by the socialcultural context conditions. The violence rate in Colombia has spread to al1the spaces in society, and the family has been the most injured with the consequence of affecting the deve10pment of children personality. Our aim is 10 investigate the existing relationship between families with marital violence and the self-concept deve10pment of 5-6 year old children belonging to low social-economical level. A descriptive-comparative design was used. The sample consists of 23 families consulting the Comisaría Segunda de Familia. Children were applied the PAl se1f-pereeption scale, and parents were interviewed in order to know the social-cultural conditions and their relation with the children. As a conclusion, we found out that the self-concept valuation in al1 areas was positive1y rated by either boys and girls coming from families presenting marital violence. So, the existence of high levels of violence in a family not necessarily implies a negative incidence in the development of self-concept, as long as the child is not the victim of such aggression and his/her physical and psycho-affective development has been normal.