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To assess the effect of a multicomponent intervention on reducing social isolation and loneliness and improving the quality of life in community-dwelling older adults. A cluster-randomized controlled clinical trial. A total of 56 older adults participated in the control group and 63 older adults in the experimental group. The intervention consisted of 6 home-based face-to-face sessions, intercalated with 5 telephone calls and was conducted by nursing students and volunteer staff with experience in the subject. The study was conducted between April 2018 and December 2019. In terms of statistical analysis, several procedures were carried out: a statistical analysis per protocol and intention to treat, considering isolation, loneliness and quality of life as endpoints; a comparison of paired means, to analyse the behaviour of the outcome variables at baseline and the end of the study; and finally, a binary logistic regression analysis, considering social support as a dependent variable. The study results do not show the effectiveness of the modified CARELINK programme, analysed as a whole, on the decrease in social isolation or loneliness or the improvement in HRQL. However, a detailed analysis of the behaviour of some of the variables during the study indicates some results that deserve to be commented on. Comparing the mean confidential support scores between the experimental and control group at the initial and final stages shows significant differences in the analysis by protocol, and close to statistical significance in the analysis by intention to treat. Comparing the paired means obtained in the experimental group, an improvement in emotional loneliness scores was found. Finally, the variables associated with the social support of the subjects at the end of the follow-up period were as follows: having people who help them and mobility. Although the results obtained do not allow us to affirm that the intervention programme is effective, these same results point to improved confidential support and emotional loneliness in older adults participating in the intervention. Having people to help them and a greater degree of mobility are factors favouring the decrease in social isolation. This study suggested that modified CARELINK, a multicomponent intervention performed by trained volunteers, could improve confidential support in community-dwelling older adults. It also reports the importance of considering the level of mobility and support networks as determinants of the improvement caused by the intervention.

Power relations in care are the link between patients and nurses regarding communication and the ability to act in this context. It can be affected when there is cultural interference between members, putting mutual understanding at risk in healthcare situations. This study analyses power relations in healthcare situations between older Norwegian patients and Spanish migrant nurses regarding active listening, shared decision-making, and patient participation. We performed a hermeneutical study endorsed in critical discourse studies framework from a transcultural perspective. A purposive sampling included older Norwegian patients living alone and Spanish migrant nurses working in Norway. Eleven face-to-face semi-structured interviews were conducted with older patients and four via videoconference with migrant nurses. The analysis followed hermeneutic considerations by Crist and Tanner, and linguistic analysis was performed. Shared decision-making and active listening situations sometimes showed a power imbalance that negatively influenced older Norwegian patients. However, Spanish migrant nurses were also conditioned by care organising institutions. This power triangle negatively affected the relationship between the older patients and migrant nurses, resulting in a lack of communication, personnel, time and trust. The migratory experience influenced the care provided by Spanish migrant nurses, shaping a series of cultural competencies acquired through the migratory process.

The role of nurse case managers (NCM) involves a rarely visible emotional labor, even more when their role focuses on the care of elders at risk (EAR). Motivated by the lack of qualitative research on the emotional universe of NCM, this study explores the emotional universe (EU) of NCM regarding the care they provide to EAR in primary health care as well as the reasons that generate these emotions. An interpretative–phenomenological approach was implemented in southern Spain, with a purposive sampling that included nurses playing the NCM role for at least three years. Data collection was conducted in two periods (between September 2019 and July 2022). The primary collection tool was the semi-structured individual interview, with starting categories based on Bisquerra’s EU taxonomy. The analysis followed Ricoeur’s considerations, using the Nvivo software. In the NCM’s EU, the recognition of the social phenomena stands out, with an open feeling of empathy regarding the desire of the EAR to continue living at home. However, there was also helplessness, resignation, disappointment, and frustration when EAR rejected their proposals. Furthermore, the system’s limitations aroused compassion in the NCM and made them go beyond the limits of their role. This EU requires that their role be valued more, and higher responsiveness must be enforced to improve EAR care.

El presente estudio analiza los factores que constituyen el ambiente laboral hospitalario en relación con las dificultades en la nutrición del personal de enfermería. Objetivo. Analizar los aportes de investigaciones en el entorno laboral y sus repercusiones en el estado de salud nutricional del personal de enfermería en las áreas hospitalarias. Metodología. Metaanálisis a través de la aplicación de la declaración PRISMA (Preferred Reporting Items for Sistematycal Reviews and Meta-Analyses) para una revisión sistemática e integradora de las investigaciones seleccionadas. Se realizó una búsqueda en las principales bases de datos de Medicina y Ciencias de la Salud como: PubMed, Medline, SCOPUS, Wed of Science (Wos), Cinahl y Cochrane, con la cual se identificaron los artículos con pertinencia al ambiente laboral hospitalario, calidad nutricional, personal de enfermería. Se fundamentó la búsqueda con las preguntas Pico: ¿Cuál es la relación entre un entorno laboral y la nutrición del personal de enfermería del área hospitalaria? Cómo afecta el estrés y la fatiga laboral a la nutrición del personal de enfermería que se desempeña en el área hospitalaria P: Personal de enfermería del área hospitalaria; I: Entorno laboral; C: Estado nutricional. Se incluyeron en esta revisión 17 artículos. Se identificaron siete temas: sobrepeso y obesidad, actividad física, horarios de trabajo por turnos rotativos y nocturnos, hábitos y estilos de vida, conductas alimentarias, angustia mental y estrés laboral. Conclusión. Los factores negativos del ambiente laboral afectan la nutrición y conlleva al deterioro de la salud del personal de enfermería que trabaja en el área hospitalaria.

RESUMEN Objetivo: Describir los factores relacionados con la situación de contagio del SARS-CoV-2 identificados por los profesionales de la salud en España y proponer estrategias de prevención. Método: Estudio descriptivo transversal. La población fueron profesionales de la salud trabajando en instituciones con atención a pacientes con COVID-19 y caso confirmado de infección por SARS-CoV-2. Se utilizó un cuestionario con variables sociodemográficas, laborales y epidemiológicas. Se realizó análisis descriptivo y bivariado según la naturaleza de las variables. Resultados: Se analizan 2230 cuestionarios sobre una población potencial de 41,239 (5,47%). El motivo para realizar el diagnóstico fue: caso sospechoso (63,4%) y caso probable (12,3%). Se hizo estudio de contactos al 50,3%. La percepción sobre la disponibilidad de medidas de protección como “siempre/frecuentemente” fueron: mascarilla FPP1 57,3%, guantes 89,5%, jabón 95% y solución hidroalcohólica 91,5% y en EPIs, mascarillas FPP2, FPP3, gafas y batas desechables alrededor del 50%. La disponibilidad de medidas protectoras, por ámbito de trabajo, presentó diferencias significativas. La media de pacientes atendidos se relacionó con la realización de higiene de manos del momento 4 y en la percepción de realizarla correctamente en momentos 4 y 5. Conclusiones: Se presentan datos con carácter preliminar y con variabilidad en la tasa de respuesta por Comunidad Autónoma. Los profesionales de la salud contagiados por SARS-CoV-2 identifican la gestión de la cadena de contagios, el uso y adecuación en la disponibilidad de equipos de protección, así como la efectividad en la realización del lavado de manos, como factores relacionados con el contagio de los profesionales.

espanolEl avance tecnologico y la consecuente incorporacion de las TICs en el ambito docente ha conllevado la aparicion de nuevas herramientas para facilitar a los docentes el proceso de seguimiento y evaluacion del alumnado. De igual forma, dicho avance ha contribuido a la adquisicion de un modelo de aprendizaje mas proactivo e individualizado por parte del alumnado. El presente proyecto pretende implementar una herramienta informatica denominada “Seguimiento y Evaluacion de Practicas” (SISEP) en las asignaturas de practicas clinicas de la titulacion de Grado en Enfermeria para optimizar el seguimiento y la evaluacion de los alumnos durante el desarrollo de sus practicas externas, asi como mejorar el proceso de adquisicion de competencias y habilidades. La metodologia ha consistido en la elaboracion de material didactico para dicha aplicacion y la posterior evaluacion del grado de satisfaccion de los distintos roles implicados en su uso mediante un cuestionario autoadministrado de elaboracion propia. El grado de satisfaccion con respecto a la aplicacion fue alto, senalando que contribuye de forma decisiva en la adquisicion de competencias, aunque no en todos los casos los usuarios han considerado su interfaz como completamente sencilla o intuitiva. EnglishThe technological advance and consequent incorporation of IT in the teaching field has entailed the appearance of new tools to facilitate teachers the process of monitoring and evaluating students. In the same way, this advance has contributed to the acquisition of a more proactive and individualized learning model on the students' side. The present project intends to implement a computer tool called “Monitoring and Evaluation of Practices” (SISEP) in the subjects of clinical practices of the degree in Nursing in order to optimize the monitoring and evaluation of students during the development of their external practices, as well as improving the process of acquiring skills and abilities. The methodology used consisted in the elaboration of the teaching material and the later evaluation of the degree of satisfaction from the different roles involved through the use of a self-administered, self-produed questionnaire. The degree of satisfaction regarding the application was high, pointing out its decisive contribution to the acquisition of skills, even if not all users have found its interface clear or intuitive enough

We are currently witnessing the aging of the world’s population due to increased life expectancy and declining fertility rates, and this aging population carries high health costs. The elderly population is associated with the presence of comorbidities, and those are at the same time associated with pain, as well as pathologies where age is a risk factor such as neurodegenerative pathologies, specifically Alzheimer’s disease. The presence of both factors in the elderly normally leads to poor pain management, leading to under or overtreatment. The incorrect usage of analgesia is mainly due to lack of knowledge of the influence of dementia on the perception of pain, the inability of patients to communicate or describe it, as well as the absence of objective tools that allow caregivers and/or health professionals to assess pain and consequently correctly manage the prescription of analgesia. In this context, it would be interesting to carry out studies that address the biology and/or perception of pain, as well as the factors associated with it, in people with neurodegenerative diseases such as Alzheimer’s disease, and with easy, inexpensive, and noninvasive tools that allow the correct management of pain, and subsequently, of analgesia.

Aims: To identify the factors conditioning the feasibility of an intervention to reduce social isolation and loneliness in noninstitutionalized older adults from the perspective of the intervention agents. Design: A Dimensional Grounded Theory study conducted from December 2019 to January 2020. Methods: Twelve participants were recruited from an experimental study developed in a health district of a southern Spanish city. Data were collected through focus group meetings, individual interviews, biograms, anecdote notebooks, and the field diaries of two participants not included in the other techniques. Transcripts were analyzed using thematic analysis. Findings: Findings were divided into three themes: (a) the elderly between the walls of loneliness, economic difficulties, losses, and the past; (b) intervention agents/volunteers between the walls of inexperience in the management of psychological/emotional processes, lack of moral authority, and difficulty in planning results adapted to the (elderly) person; and (c) intervention between the walls of (interest in) company and assistance at home, lack of involvement (“waiting for you to save them”), and withdrawal/“abandonment”. Conclusion: A profile of the specialized intervention agent, professionalized (or at least a mentored agent), with both technical and relational competencies; a clear understanding of the purposes of the intervention (empowerment, as opposed to having company or being helped with household chores) and the commitment to active participation by the elder; or adequate management of the completion of the intervention (flexibility, attachment management) are some of the main factors contributing to the feasibility of these approaches. Impact: The findings have potential implications in the field of primary healthcare because primary and community healthcare services can implement corrections to the proposed intervention and ensure its effectiveness under feasible conditions. The nurse is shown as the most appropriate profile to conduct this intervention, although more research is needed to analyze the feasibility of this type of intervention in the daily practice of community nurses.

To identify the main conditioning factors that Primary Care professionals indicate when implementing and developing interventions on isolation and loneliness.Qualitative research with grounded theory, systematic analysis and narrative design of topics.Developed in 12 Primary Care centres of the Health District of Córdoba and Guadalquivir, covering urban and rural areas.Three profiles were identified: family medicine/community care, community nursing and case management nursing. The selection was carried out among those who showed greater motivation and commitment to an intervention on isolation/loneliness.Purposive sampling. The work was based on individual in-depth interviews, focus groups and dialogic interviews.(a) Distorted images persist about loneliness/social isolation and living alone that make it challenging to identify; (b) the main disruptive determinants in the structure and organization of the care system have to do with the absence of screening programs, the hegemony of the biomedical model and the deficit of resources (in light of this model); (c) the main facilitators are linked to the nursing role, privileged for these interventions according to the participants; and, finally, (d) personal components are necessary, both from the older adult and from the professionals.Intervention on social isolation and loneliness in Primary Care is conditioned by organizational and structural, professional and personal factors. It is essential to take them into account in order to guarantee their feasibility.

ObjectivesThe aim of this study was to adapt and validate the Pain Assessment in Advanced Dementia (PAINAD) scale in Spanish.DesignCross-sectional observational study.SettingTwo health districts of Andalusian provinces, located in the south of Spain, through the Andalusian network of Primary Healthcare centres and four institutions dedicated to the care of patients with dementia.ParticipantsA total of 100 older people, with a medical diagnosis of dementia and a score on the Global Deterioration Scale between 5 and 7 were assessed using the PAINAD scale.Primary and secondary outcome measuresPsychometric properties including content validity, construct validity and reliability of the scale have been tested.ResultsThe overall Item Content Validity Index was excellent (0.95). Regarding construct validity, it was confirmed that a lower use of analgesics implied a lower score on the PAINAD scale (pConclusionsThe Spanish version of the PAINAD scale is a valid tool to assess pain in patients with dementia and inability to communicate verbally.

© 2021 by the authors., The objective of this review was to understand how participants experience the decision-making process regarding the place of care for the elderly. Therefore, we conducted a systematic review of qualitative studies. The articles were included if they were original studies with qualitative/mixed methodology, written in English/Spanish, and that approached the decision-making process regarding the place of care for the elderly, already experienced by the participants. Forty-four articles were included, identifying experiences, both negative and positive. Negative experiences have been the most frequently reported experiences by all population groups; fear was the most relevant experience for the elderly, whereas concern was the most relevant for family members and professionals. This review has not only found a great variability of experiences, but also, it has deepened the differences between groups and the situations motivating/generating these experiences. This review highlights a wide range of experiences of those directly involved in the entire decision-making process on the place of care for the elderly. In future research it would be interesting to carry out qualitative primary studies conducted with professionals and other relevant people involved in this decision-making process, in order to know first-hand how they experience this process., The first author has earned a grant from the Ministerio de Educación, Cultura y Deporte (Spanish government) to be trained as university teacher (Formación de Profesorado Universitario: FPU).

Background: Relocation is a very important event in people’s lives in general, but really significant in old age. However, some predictors of relocation still need to be improved. The objective of this review was to synthesize qualitative evidence to understand the reasons of the participants to decide on the place of care of the older people. Methods: Systematic review of qualitative studies was conducted in six databases: Scopus, SciELO, PubMed, PsycINFO, Web of Science and CINAHL, from its beginning until 29 November 2017. Qualitative or mixed studies, written in English or Spanish and addressing the decision-making process (already experienced by participants) on the place of care of older persons (65 years or older), were included in the review. PROSPERO (registration number: CRD42018084826). Results: A total of 46 articles were finally included in the analysis. Our main result is the distinction of multiple reasons for each population group involved in the decision-making process, ranking these reasons into three factors: Retention, pull and push. Conclusion: This differentiation allows for a more detailed and in-depth analysis of the motivations of the different groups involved in this process.

Preventing the onset of dementia and Alzheimer&rsquo, s disease (AD), improving the diagnosis, and slowing the progression of these diseases remain a challenge. The aim of this study was to elucidate the association between depression and dementia/AD and to identify possible relationships between these diseases and different sociodemographic and clinical features. In this regard, a case-control study was conducted in Spain in 2018&ndash, 2019. The definition of a case was: A person &ge, 65 years old with dementia and/or AD and a score of 5&ndash, 7 on the Global Deterioration Scale (GDS). The sample consisted of 125 controls, among the cases, 96 had dementia and 74 had AD. The predictor variables were depression, dyslipidemia, type 2 diabetes mellitus, and hypertension. The results showed that depression, diabetes mellitus, and older age were associated with an increased likelihood of developing AD, with an Odds Ratio (OR) of 12.9 (95% confidence interval (CI): 4.3&ndash, 39.9), 2.8 (95% CI: 1.1&ndash, 7.1) and 1.15 (95% CI: 1.1&ndash, 1.2), respectively. Those subjects with treated dyslipidemia were less likely to develop AD (OR 0.47, 95% CI: 0.22&ndash, 1.1). Therefore, depression and diabetes mellitus increase the risk of dementia, whereas treated dyslipidemia has been shown to reduce this risk.

Background/Purpose Severe food allergies in children have serious consequences for their daily lives, but also for their families. The aim of the present study was to validate the impact on family scale (IOFS) in families of school-age children with severe food allergies (SFA) in Spain. Design/Methods A total of 299 families from south Spain were assessed using the IOFS. A factorial analysis was conducted to analyze the construct validity. The reliability of the questionnaire was assessed using the Cronbach's alpha coefficient and the intraclass correlation coefficient. Additionally, a multivariate analysis was conducted to study the association between the impact of the illness on families and some variables. Results The internal consistency of the scale (Cronbach's alpha) was 0.87 (95% CI) and the intraclass correlation coefficient (ICC) was 0.90. Regarding the results of the IOFS, the overall average score was 61.9 (SD = 12.4). The family-social impact subscale obtained the highest score. The number of children and the number of workers within the family showed a significance that was directly proportional to the family impact. Conclusions The Spanish version of the IOFS is a reliable and valid tool to assess the impact of severe food allergies on families. In addition, the results point out SFA as a problem with medium-high family impact and important family availability needs. Practice implications The impact on families of severe food allergy of children has become evident, therefore, the healthcare staff should pay close attention to this issue and take the required measures to reduce this impact.

Background: Relocation is a very important event in people¿s lives in general, but really significant in old age. However, some predictors of relocation still need to be improved. The objective of this review was to synthesize qualitative evidence to understand the reasons of the participants to decide on the place of care of the older people. Methods: Systematic review of qualitative studies was conducted in six databases: Scopus, SciELO, PubMed, PsycINFO,Web of Science and CINAHL, from its beginning until 29 November 2017. Qualitative or mixed studies, written in English or Spanish and addressing the decision-making process (already experienced by participants) on the place of care of older persons (65 years or older), were included in the review. PROSPERO (registration number: CRD42018084826). Results: A total of 46 articles were finally included in the analysis. Our main result is the distinction of multiple reasons for each population group involved in the decision-making process, ranking these reasons into three factors: Retention, pull and push. Conclusion: This dierentiation allows for a more detailed and in-depth analysis of the motivations of the dierent groups involved in this process.

ObjectivesTo understand who are the participants in the decision-making process about the location of care of the elderly.DesignSystematic review of qualitative studies.Data sourcesThe following databases were consulted: Web of Science, MEDLINE, Scopus, CINAHL, PsycINFO and SciELO (from the beginning until 29 November 2017). The bibliographical references in the studies that were finally included in the review were also searched.Study selectionThe studies had to deal with the decision-making process (already experienced by the participants) on the location of care of the elderly (adults who are 65 or older), had to use a qualitative methodology and had to be written in English or Spanish.Data extraction and synthesisA data extraction tool was used. Data analysis was conducted through the constant comparative method from Glaser and Strauss’ grounded theory.Results46 studies were included in this review. Most of them were carried out in the USA, and in 21 of them the study population focused exclusively on the elderly. This review has found that there are many participants, with different roles and degrees of involvement, who may act jointly, separately or sequentially. These participants may be: the elders, family members, professionals and other relevant.ConclusionsThe main result of this review has been the variability found on how this decision is made, even varying the way of acting/perceiving the situation of the involved persons on certain occasions, simply due to the influence of some of the other groups of participants studied. Besides, this review has focused its results on the main participant in this process, the elders and how their family members interact with them when it comes to making this decision. This has allowed relevant results to be obtained about roles and degrees of involvement.PROSPERO registration numberCRD42018084826.

Purpose The purpose of the present study is to understand the experience of living a chronic disease in the school, from the perspective of the parents. Design and methods A Grounded Theory study was proposed with a sample of 14 affected families with children between three and eleven years old, all of them from the west and south of Spain. Information was collected using semi-structured surveys and the constant comparative method was used for the analysis. Results Results are divided into three main themes: SOS! My child is at school, The Systems (don't) Answer and Families Answer. Parents live school enrolment in a state of constant alertness, characterized by distrust, worry, fear, anguish, and indignation. The responses to the problem given by the education and health systems are insufficient, uncoordinated and inefficient. Therefore, parents end up not expecting anything, they transmit the information, organize training sessions, and solve any occurring incident by themselves, often at the expense of quitting their jobs. Conclusion The presence of a school nurse would mean for these parents the integration between the education and health systems. Practice implications As findings highlight, more collaboration and sensitivity between the healthcare and educational system is needed, and the school nurse has been indicated as a crucial figure in this matter.

IntroductionPain is an under-diagnosed problem in elderly people, especially in those with cognitive impairment who are unable to verbalise their pain. Although the Pain assessment in advanced dementia scale (PAINAD) scale is a tool recognised for its clinical interest in this type of patients, its correlation with the saliva biomarkers reinforced its utility. The aim of this research will be to correlate the scores of this scale with the levels of biomarkers of pain found in saliva samples of patients with cognitive impairment and inability to communicate.Methods and analysisThis is an observational study. The level of pain will be evaluated using the PAINAD scale. Moreover, pain biomarkers, in particular secretory IgA and soluble tumour necrosis factor receptor type II, will be determined in saliva. Both assessments will be conducted in 75 patients aged over 65 years with advanced cognitive impairment and inability to communicate. The PAINAD scores will be correlated with the levels of these biomarkers of pain. A control group consisting of 75 healthy subjects aged over 65 years will be included in the study. Moreover, sociodemographic variables and variables related to pain, dementia and other clinical conditions will be recorded. The analysis will be performed with the statistical package SPSS V.22 and the software R.Ethics and disseminationThe study has been reviewed and approved by the Andalusian Human Research Ethics Committee. In addition, this study has been financed by the Junta de Andalucía through a regional health research fund (Research code: PI-0357–2017). The results will be actively disseminated trough a high-impact journal in our study area, conference presentations and social media.

This study aims to evaluate the effectiveness of a multicomponent intervention in non-institutionalized older people. This effectiveness will be assessed in terms of reducing social isolation and loneliness and improving Health-Related Quality of Life.The concern for social isolation and loneliness in non-institutionalized older adults has increased in recent decades. In addition, their relationship with numerous negative health outcomes is amply demonstrated.A mixed-method design including a cluster randomized controlled clinical trial and an exploratory qualitative study with focus groups was used.Each study group consists of 57 subjects. The experimental group will be subjected to a multicomponent intervention comprising six domiciliary face-to-face sessions and five telephone calls that will be interspersed. Interventions will be conducted by healthcare professionals and volunteers. The control group will not be subjected to any systematized intervention. We are going to consider social isolation, loneliness, and Quality of Life as the primary outcomes. However, the factors that influence both primary outcomes and the feasibility of the intervention in clinical practice will also be assessed.Despite the negative influence of social isolation and loneliness on clinical outcomes is widely evidenced, few early detection programs are available, especially interventions at the community setting. This study will examine the effectiveness of the intervention in the Spanish community setting. At the same time, this study will identify the feasibility of this intervention in Primary Care clinical practice.Substantial evidence indicates the detrimental health impact of social isolation and loneliness, particularly on mental wellness. Knowing that mental disorders are associated with high economic cost, this project would have strong clinical implication to inform nursing practice on managing social isolation and loneliness. The findings may also inform primary health policy setting in Spain and the wider European countries.目的: 本研究旨在评估对不是住在福利院的老年人进行多因素干预的有效性。将从减少社会孤立和孤独感以及提高与健康相关的生活质量的角度对有效性进行评估。 背景: 近几十年来,对不是住在福利院的老年人被社会孤立和孤独感的担忧有所增加。此外,它们也被充分证明与许多负面健康结果有关。 设计: 采用包括分组随机对照临床试验和针对重点人群的探索性定性研究在内的混合方法设计。 方法: 每个研究小组由57名试验对象组成。实验小组将接受多因素干预,包括六次面对面的家庭谈话,并插入五次电话谈话。干预将由专业医疗人员以及志愿者进行。对照组将不接受任何系统化干预。我们将把社会孤立、孤独感以及生活质量视为主要结果,但还会评估影响主要结果的因素和临床实践干预的可行性。 讨论: 尽管社会孤立和孤独感对临床结果的负面影响已被广泛证实,却很少有可用的早期探测项目,尤其是在社区中的干预措施。本研究将考察干预措施在西班牙人居住社区中的有效性。与此同时,本研究将确定此干预措施在初级保健临床实践中的可行性。 影响: 大量证据表明,被社会孤立以及孤独感对健康有害,尤其是对精神健康。由于精神障碍与高经济成本相关,本研究课题在为护理实践提供管理社会孤立及孤独感上有着极大的临床意义。调查结果还可能为西班牙乃至更多的欧洲国家基本卫生政策的制定提供参考。.

The pain assessment in advanced dementia (PAINAD) appears to be a clinically useful tool. However, the salivary determination of tumor necrosis factor receptor type II (sTNF-RII) and secretory IgA (sIgA) as pain biomarkers is still incipient. The aim was to correlate the PAINAD score with sTNF-RII and sIgA biomarker levels in the saliva of patients with advanced dementia. In this regard, a cross-sectional study was conducted. The sample consisted of 75 elderly patients with a clinical diagnosis of dementia and a global deterioration scale (GDS) score of 5 to 7. The PAINAD scale was determined by a previously trained professional and the collection of salivary samples was performed using the passive secretion method. Human sTNF-RII and sIgA using ELISA kits. The results showed a correlation between the PAINAD scale (numeric, binary, and recoded) and sTNF-RII and sIgA (p < 0.001). No association between the sociodemographic and clinical variables and the PAINAD scale was found (p > 0.05). Between 97.3% and 96.2% of patients with pain on the PAINAD scale also showed pain based on the sTNF-RII levels; in all of them, sIgA levels did not fit the logistic models. Therefore, the correlation highlights the usefulness of this scale and confirms the usefulness of sTNF-RII and sIgA as biomarkers of pain. This study was supported by the Junta de Andalucía through a regional health research fund (Research code: PI-0357-2017.) Sí

Introduction The elderly must take part in the management of their own health. One of the aspects they should be able to decide on is the place where they want to live. The aim of this review is to synthetise qualitative evidence in order to understand how decisions are made on the location of care of the elderly. Methods and analysis Systematic review of qualitative studies. Six databases have been consulted: Web of Science, PubMed, Scopus, CINAHL Complete, PsycINFO and SciELO Citation Index (from the beginning to 29 November 2017). The inclusion criteria will be: studies that deal with the decision-making process on the location of care of the elderly (already experienced by the participants), original studies, qualitative or mixed-method studies and studies written in English or Spanish. The obtained results will be exported to the Zotero bibliography manager. The references will be reviewed by title and abstract and, later, the complete texts will be reviewed for their inclusion. A tool created for this study will be used to extract the data. The quality will be assessed with Critical Appraisal Skills Programme Español. The data synthesis will be carried out using the constant comparative method. All this process will be performed independently by two reviewers. Enhancing transparency in reporting the synthesis of qualitative research has been used to draw up this protocol. Ethics and dissemination This protocol did not require ethical approval, since it is a protocol for a systematic review. The plans to disseminate our results include publishing a research paper in a high-impact journal in our study area. Also, if possible, our results will be presented in scientific conferences. Besides, the obtained results will complement and discuss the doctoral thesis of one of the authors of the review. PROSPERO registration number CRD42018084826. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. http://dx.doi.org/10.1136/bmjopen-2018-022411

Desde que Enfermería se convirtió en profesión universitaria en 1977 han existido varias regulaciones para desarrollar las especialidades, coincidiendo todas ellas en la necesidad de incluir competencias en investigación. De hecho, la relevancia que adquieren estas competencias en todas las especialidades actuales ha permitido que el Real Decreto 99/2011, por el que se regulan las enseñanzas oficiales de doctorado, reconozca la formación de enfermeras especialistas como capacitante para acceder a los estudios de doctorado. En la actualidad se forman residentes de 6 de las 7 especialidades determinadas por el Real Decreto 450/2005. La adquisición de las competencias en investigación se percibe como una oportunidad y un reto; sin embargo, la estructura organizativa de los dispositivos formativos (unidades docentes multiprofesionales) y la incorporación de tutores clínicos enfermeros que se inician en esta actividad docente merecen especial atención para garantizar la correcta adquisición de competencias en investigación por parte de las enfermeras especialistas en formación. Since nursing became an university degree in 1977, there have been several regulations to develop specialties, all of them agreeing on the need to include skills in research. Indeed, the relevance of acquiring these skills in all current disciplines has led to Royal Decree 99/2011, which regulates the official PhD courses, and recognises specialist nurses as qualified to access PhD studies. Nowadays, students from six of the seven specialties included in the Royal Decree 450/2005 on nursing specialties, are performing their training. The acquisition of research skills is seen as an opportunity and a challenge. However, the organizational structure of training facilities (multiprofessional teaching units) and the incorporation of nurses as clinical tutors, who initiated this teaching activity, deserve special attention to ensure the correct acquisition of research skills in the training of specialist nurses.

Resumen Objetivo Segun la literatura consultada, el enfoque biomedico continua dominando el modo en que las enfermeras piensan, trabajan y se comunican. Para estudiar si esta situacion se produce en nuestro contexto, se propone: 1) describir el valor que las enfermeras otorgan a diferentes acciones instrumentales, estrategicas y comunicativas, segun la teoria de la accion comunicativa; y 2) analizar su posible relacion con el tipo de unidad de hospitalizacion. Metodo Estudio descriptivo con 89 enfermeras de unidades de hospitalizacion medica, quirurgica y oncohematologica del Hospital Reina Sofia de Cordoba. Para la recogida de datos se creo un cuestionario con 4 acciones instrumentales, 4 estrategicas y 4 comunicativas que tenian que ser referidas a 3 ambitos (pensamiento, practica, y registro) y puntuadas del 1 al 5 segun su valor o importancia. El cuestionario era autocumplimentado y recogido tras una semana. Resultados En el ambito del pensamiento y la practica las puntuaciones medias mayores corresponden a acciones instrumentales (19,49 y 18,9, respectivamente), seguidas de acciones comunicativas y estrategicas, por este orden. No obstante, en el ambito del registro las acciones estrategicas superan a las acciones comunicativas (17,27 vs 14,49), que descienden al ultimo lugar. Solo en unidades de oncohematologia el registro de estas acciones se mantiene en cifras elevadas (17,26). Conclusiones Los resultados ponen de relieve la hegemonia del modelo biomedico, representado por las acciones instrumentales y estrategicas, y dibuja una situacion dificil para la accion comunicativa, que tiene, ante todo, que buscar su hueco en el discurso profesional.

Resumen Objetivo Identificar las prioridades de investigacion en cuidados de salud en Espana, desde la perspectiva de los profesionales de enfermeria y de los usuarios de los servicios de salud. Metodo Tecnica Delphi modificada desarrollada sobre un listado de 24 items identificados a partir del consenso previo de un grupo de trabajo. El panel de expertos participantes en la tecnica Delphi modificada (2 vueltas) se compuso de cinco grupos: directores de enfermeria (Atencion Primaria y Hospitalaria), directores de escuelas de enfermeria, presidentes de asociaciones cientificas de enfermeria, investigadores asistentes a los Encuentros de Investigacion organizados por Investen-ISCIII, y representantes de usuarios. Se realizaron dos rondas de priorizacion. Resultados Tras el consenso de los partipantes, fueron consideradas como principales prioridades de investigacion en cuidados: «la evaluacion de la eficacia de intervenciones de enfermeria», «la promocion de la salud: desarrollo de estrategias para implicar al usuario en sus cuidados», «cuidados basados en la evidencia: implantacion y evaluacion de resultados en la practica clinica», y «medicion de la calidad de cuidados enfermeros». Conclusiones Los resultados obtenidos a traves de este estudio pueden contribuir a facilitar la toma de decisiones en materia de gestion de la investigacion, ayudando a una mejor justificacion y, previsiblemente, mayor financiacion de los proyectos de investigacion en esta area.

Resumen Objetivo Conocer, desde una triple perspectiva, clinica, economica y centrada en el paciente, la efectividad de una via clinica. Metodo Para ello, se diseno un estudio experimental, en el que participaron 122 pacientes intervenidos de hiperplasia benigna de prostata o carcinoma vesical mediante reseccion transuretral (RTU), divididos en 2 grupos, experimental y control. La aleatorizacion se realizo sobre los listados de espera y, al ser hospitalizados, se controlo que el ingreso no se produjera en la misma habitacion que otro paciente incluido en distinto grupo, para mantener el simple ciego. Resultados La comparacion de ambos grupos detecto diferencias respecto a los dias de estancia (desviacion estandar [DE]): 3,59 (1,54) frente a 2,92 (1,18), p = 0,008. Los pacientes del grupo control, en promedio, estaban 0,67 dias de mas hospitalizados (intervalo de confianza [IC] del 95%, 0,18-1,17) que los del grupo al que se le aplico la via clinica. No se detectaron diferencias estadisticamente significativas en cuanto a presentacion de complicaciones (el 3,6 frente al 1,8%; p = 0,55), ni en la satisfaccion (el 90,9 frente al 94,5%; p = 0,46). Conclusiones Las vias clinicas producen una reduccion de la estancia, si bien el mecanismo por el que lo hacen efectivo no esta claro.

Since nursing became an university degree in 1977, there have been several regulations to develop specialties, all of them agreeing on the need to include skills in research. Indeed, the relevance of acquiring these skills in all current disciplines has led to Royal Decree 99/2011, which regulates the official PhD courses, and recognises specialist nurses as qualified to access PhD studies. Nowadays, students from six of the seven specialties included in the Royal Decree 450/2005 on nursing specialties, are performing their training. The acquisition of research skills is seen as an opportunity and a challenge. However, the organizational structure of training facilities (multiprofessional teaching units) and the incorporation of nurses as clinical tutors, who initiated this teaching activity, deserve special attention to ensure the correct acquisition of research skills in the training of specialist nurses.

According to the literature consulted, the biomedical approach continues dominating the ways in which nurses think, work and inform. In order to study whether this situation also occurs in our context, this research proposes to 1) describe the value or weight nurses give to the different instrumental, strategic and communicative actions, according to Habermas' Theory of the Communicative Action; as well as 2) analyse its possible relationship with the type of unit in which nurses work.It is a descriptive study including 89 nurses, conducted in medical, surgical and onco-haematological hospital wards in the Hospital Reina Sofia of Cordoba. For the data collection, a questionnaire was created specifically for the study, made up of 4 instrumental actions, 4 strategic actions and 4 communicative actions that were scored 1-5 according to their value or importance. The questionnaire was self-administered and collected after one week.The instrumental actions obtain the highest scores in the area of thoughts (19.49) and practice (18.9), followed by the communicative actions. Nevertheless, the strategic actions exceeded the communicative actions in the record (17.27 vs 14.49). Only in the onco-haematology units, communicative actions maintained high scores (17.26).The results from the present study emphasise the hegemony of the biomedical model, represented by instrumental and strategic actions, and draw a difficult situation for the communicative action, which has to find its place in the professional speech.

To identify nursing research priorities in Spain as suggested by nurses and service users.A Modified Delphi technique was used. The first round started off with a 24-item document for which consensus had been previously achieved. Experts participating in this modified (two rounds) Delphi technique were: nursing managers (community and hospital care settings), nursing school directors, scientific nursing association representatives, nursing researchers attending the National Nursing Research Conference, and service users.Main priorities identified for nursing research were: 1) evaluating the effectiveness of nursing interventions, 2) identifying strategies for health promotion empowering service users, 3) developing evidence-based care through implementing and evaluating results, and 4) evaluating the quality of nursing care.Results may help research managers and administrators identify and develop nursing research promotion strategies as well as more strongly sustained funding policies and decisions.

The objectives of the study were to describe situations involving instrumental and communicative actions that take place in nursing and to explore the difficulties in communicative action. It was an ethnographic study conducted among nurses from two large hospitals in Spain and Portugal. Data collection took place through participant observation and semi-structured interviews. It was then followed up by a survey. A discourse analysis and quantitative analysis were performed (on the survey). The nurses’ work consisted mainly of instrumental actions. Among the social actions, those of a strategic type predominate, whereas communicative actions are scarce and non-specific. It was noted that difficulties in communicative actions were linked to “New Management” and “Encoded Knowledge”. Nursing requires a more balanced distribution between the time dedicated to technology and communication. The difficulties involved in communicative action appear to coincide with Habermasian systems, although renewed forms are adopted. RESUMEN: Los objetivos del estudio fueron: describir las situaciones de acción instrumental y comunicativa que ocurren en la práctica enfermera y explorar las dificultades para la acción comunicativa. Estudio etnográfico realizado con enfermeras de dos grandes hospitales de España y Portugal. La recogida de datos se llevó a cabo a través de observación participante y entrevistas semiestructuradas. Posteriormente, se completó con una encuesta. Se realizó análisis del discurso y análisis cuantitativo (de la encuesta). El trabajo de las enfermeras consta, básicamente, de acciones instrumentales. Entre las acciones sociales, predominan las de tipo estratégico, siendo las acciones comunicativas escasas e inespecíficas. Se han identificado dificultades para la acción comunicativa asociadas a la “Nueva Gestión” y al “Conocimiento Codificado”. La práctica enfermera demanda un reparto más equilibrado entre los tiempos dedicados a la tecnología y la comunicación. Las dificultades para la acción comunicativa parecen coincidir con los sistemas habermasianos, aunque adoptando formas renovadas. RESUMO: Os objetivos do estudo foram: descrever as situações de ação instrumental e comunicativa que acontecem na prática de enfermagem e explorar as dificuldades para a ação comunicativa. Estudo etnográfico levado a cabo com enfermeiros de dois grandes hospitais da Espanha e de Portugal. A coleta de dados foi realizada por meio de observação participante e entrevistas semiestructuradas. Posteriormente, a coleta foi completada com uma enquete. Utilizou-se análise do discurso e análise quantitativa (da enquete). O trabalho dos enfermeiros consiste, basicamente, de ações instrumentais. Entre as ações sociais, prevalecem as ações de tipo estratégico, sendo as ações comunicativas escassas e inespecíficas. Foram identificadas dificuldades, para a ação comunicativa, associadas à “Nova gestão” e ao “Conhecimento Codificado”. A prática de enfermagem exige uma distribuição mais equilibrada entre os tempos dedicados à tecnologia e à comunicação. As dificuldades para a ação comunicativa parecem coincidir com os sistemas habermasianos, embora adotando formas renovadas. info:eu-repo/semantics/publishedVersion