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Fernández-Alcántara M, Esteban-Burgos AA, Escribano S, Congost-Maestre N, Pollock D, Cabañero-Martínez MJ. Spanish adaptation of the Stillbirth Stigma Scale (SSS). Death Stud 2024:1-8. [PMID: 38329460 DOI: 10.1080/07481187.2024.2312378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
The death of a baby in the perinatal period is considered a disenfranchized grief that can be a source of significant symptoms of guilt, shame, and stigma. There is a lack of validated instruments for assessing the stigma associated with perinatal grief. The aim of this study was to examine the psychometric properties (factor structure, reliability, and validity) of the Spanish version of the Stillbirth Stigma Scale (SSS) in parents who have experienced a perinatal loss. A total of 291 participants (mostly mothers) completed an online questionnaire that included the SSS and other measures. The best-fitting factor structure was a second-order model with four dimensions and adequate reliability values. In terms of validity, we found statistically significant relationships between the SSS scores and the variables of self-esteem, complicated grief, event centrality, depression, and anxiety. In conclusion, the Spanish adaptation of the SSS is deemed to have adequate psychometric properties.
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Affiliation(s)
- Manuel Fernández-Alcántara
- Department of Health Psychology, Faculty of Health Sciences, Institute for Health and Biomedical Research (ISABIAL), University of Alicante, Spain
| | - Ana Alejandra Esteban-Burgos
- Department of Nursing, Faculty of Health Sciences, University of Jaén, Jaén, Spain
- Instituto de Investigación biosanitaria de Granada (Ibs.GRANADA), University of Granada, Granada, Spain
| | - Silvia Escribano
- Department of Nursing, Faculty of Health Sciences, Institute for Health and Biomedical Research (ISABIAL), University of Alicante, San Vicente del Raspeig, Spain
| | | | - Danielle Pollock
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Australia
| | - María José Cabañero-Martínez
- Department of Nursing, Faculty of Health Sciences, Institute for Health and Biomedical Research (ISABIAL), University of Alicante, San Vicente del Raspeig, Spain
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Esteban-Burgos AA, Moya-Carramolino J, Vinuesa-Box M, Puente-Fernández D, García-Caro MP, Montoya-Juárez R, López-Morales M. Clinical Simulation in Palliative Care for Undergraduate Nursing Students: A Randomized Clinical Trial and Complementary Qualitative Study. Healthcare (Basel) 2024; 12:421. [PMID: 38391797 PMCID: PMC10888368 DOI: 10.3390/healthcare12040421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND a lack of adequate training in palliative care leads to a greater emotional burden on nurses. PURPOSE to assess the effect of a simulation using standardized patients on self-efficacy in palliative care, ability to cope with death, and emotional intelligence among nursing students. METHODS a randomized clinical trial and qualitative study. A total of 264 nursing students in a palliative care module completed the Bugen, trait meta-mood, and self-efficacy in palliative care scales after active participation in the simulation (n = 51), watching the simulation (n = 113), and the control group (n = 100). An ANOVA with a multi-comparative analysis and McNemar's tests for paired samples were calculated. Active participants were interviewed, and a thematic analysis was conducted. RESULTS there was an improvement after the assessment in all three groups assessed for coping with death (p < 0.01), emotional intelligence (p < 0.01), and self-efficacy (p < 0.01). In addition, the active group improved more than the observer group and the control group in coping with death, attention, and repair. The students in the interviews identified sadness and an emotional lack of control. CONCLUSIONS the simulation improved nursing students' self-efficacy in palliative care. This effect was partially stronger in the active group.
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Affiliation(s)
| | - Jesús Moya-Carramolino
- Gynecological-Obstetrics Nursing Specialist Residence, Vall d'Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
| | | | - Daniel Puente-Fernández
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - María Paz García-Caro
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Mind, Brain and Behavior Research Institute, University of Granada, 18011 Granada, Spain
| | - Rafael Montoya-Juárez
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Mind, Brain and Behavior Research Institute, University of Granada, 18011 Granada, Spain
| | - Manuel López-Morales
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Primary Care Emergency Service, Andalusian Health System, 18013 Granada, Spain
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Gómez-Brufal-Flores M, Hueso-Montoro C, Esteban-Burgos AA, Montoya-Juárez R, Mota-Romero E, Capilla-Díaz C, Puente-Fernández D. Attitudes and experiences related to the deaths of COVID-19 patients among nursing staff: A qualitative evidence synthesis. J Adv Nurs 2024; 80:580-596. [PMID: 37548340 DOI: 10.1111/jan.15815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 05/27/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023]
Abstract
AIM To identify and synthesize the experiences and attitudes of nursing staff regarding the deaths of COVID-19 patients. REVIEW METHODS A qualitative evidence synthesis was carried out, using Noblit and Hare's meta-ethnographic approach. The review protocol was listed in PROSPERO (CRD42022330928). Studies published from January 2020 to January 2022 that met the criteria were searched in PubMed, Web of Science, Scopus, CINAHL, CUIDEN and PsycInfo. A total of 12 articles were included. RESULTS Thirty-three metaphors emerged, which were grouped into three main themes: Determining factors of care, Feelings about death and Strategies for coping with death. Nurses reported the high emotional toll, the absence of family and the lack of staff, protocol and training as determining factors. Furthermore, staff had doubts about the quality of care that COVID-19 patients received. As coping strategies, nurses developed avoidance behaviours towards COVID-19 patients, selective memories, resilience, and/or leaving the profession. CONCLUSIONS The difficulty in providing adequate nursing care and the high number of deaths has increased anxiety and stress among nurses. These factors, alongside their lived experiences of seeing patients suffering, many dying alone without family members, have had psychological repercussions on nursing staff. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The results demonstrate a high emotional toll and doubts surrounding their caregiving role caused by the lack of professional training needed to face a pandemic. This research shows what has been learned for future pandemics and highlights basic components that could provide a foundation for coping interventions for healthcare professionals. IMPACT WHAT PROBLEM DID THE STUDY ADDRESS?: The challenges posed by COVID-19 patient deaths for nursing staff around the world and also by the pandemic circumstances in which those deaths occurred. WHAT WERE THE MAIN FINDINGS?: The high number of deceased patients who were isolated from family members, communication with family members and doubts surrounding care given during the pandemic have created feelings of fear, stress and anxiety, as well as obsessive thoughts that have changed nursing staff's perception of death due to COVID-19. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: Results will be useful for preparing for future pandemics, and for policymakers and health staff in supporting healthcare professionals by creating programmes to help them cope with the emotional toll they have felt after dealing with death in such unprecedented circumstances. REPORTING METHOD The authors have adhered to the PRISMA guidelines and the eMERGe Reporting Guidance. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
| | - César Hueso-Montoro
- Department of Nursing, University of Jaén, Jaén, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Granada, Spain
| | - Ana Alejandra Esteban-Burgos
- Department of Nursing, University of Jaén, Jaén, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Rafael Montoya-Juárez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Granada, Spain
- Department of Nursing, University of Granada, Granada, Spain
| | - Emilio Mota-Romero
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Nursing, University of Granada, Granada, Spain
- Dr. Salvador Caballero García Primary Care Centre, Andalusian Health Service, Government of Andalusia, Granada, Spain
| | - Concepción Capilla-Díaz
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Nursing, University of Granada, Granada, Spain
| | - Daniel Puente-Fernández
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Nursing, University of Granada, Granada, Spain
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Esteban-Burgos AA, Hueso-Montoro C, Mota-Romero E, Montoya-Juarez R, Gomez-Batiste X, Garcia-Caro MP. The prognostic value of the NECPAL instrument, Palliative Prognostic Index, and PROFUND index in elderly residents of nursing homes with advanced chronic condition. BMC Geriatr 2023; 23:715. [PMID: 37924015 PMCID: PMC10623722 DOI: 10.1186/s12877-023-04409-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 10/15/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND It is essential to assess the need for palliative care and the life prognosis of elderly nursing home residents with an advanced chronic condition, and the NECPAL ICO-CCOMS©4.0 prognostic instrument may be adequate for both purposes. The objective of this study was to examine the predictive capacity of NECPAL, the Palliative Prognosis Index, and the PROFUND index in elderly residents with advanced chronic condition with and without dementia, comparing their results at different time points. METHODS This prospective observational study was undertaken in eight nursing homes, following the survival of 146 residents with advanced chronic condition (46.6% with dementia) at 3, 6, 12, and 24 months. The capacity of the three instruments to predict mortality was evaluated by calculating the area under the receiver operating characteristic curve (AUC), with 95% confidence interval, for the global population and separately for residents with and without dementia. RESULTS The mean age of residents was 84.63 years (± 8.989 yrs); 67.8% were female. The highest predictive capacity was found for PROFUND at 3 months (95%CI: 0.526-0.756; p = 0.016), for PROFUND and NECPAL at 12 months (non-significant; AUC > 0.5), and NECPAL at 24 months (close-to-significant (AUC = 0.624; 95% CI: 0.499-0.750; p = 0.053). The highest capacity at 12 months was obtained using PROFUND in residents with dementia (AUC = 0.698; 95%CI: 0.566-0.829; p = 0.003) and NECPAL in residents without dementia (non-significant; AUC = 0.649; 95%CI: 0.432-0.867; p = 0.178). Significant differences in AUC values were observed between PROFUND at 12 (p = 0.017) and 24 (p = 0.028) months. CONCLUSIONS PROFUND offers the most accurate prediction of survival in elderly care home residents with advanced chronic condition overall and in those with dementia, especially over the short term, whereas NECPAL ICO-CCOMS©4.0 appears to be the most useful to predict the long-term survival of residents without dementia. These results support early evaluation of the need for palliative care in elderly care home residents with advanced chronic condition.
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Affiliation(s)
- Ana Alejandra Esteban-Burgos
- Departamento de Enfermería, Universidad de Jaén, Jaén, Spain
- Instituto Investigación Biosanitaria Granada (IBS), Granada, Spain
- Programa de Doctorado en Medicina Clínica y Salud Pública, Universidad de Granada, Granada, Spain
| | - César Hueso-Montoro
- Departamento de Enfermería, Universidad de Jaén, Jaén, Spain
- Instituto Investigación Biosanitaria Granada (IBS), Granada, Spain
| | - Emilio Mota-Romero
- Instituto Investigación Biosanitaria Granada (IBS), Granada, Spain
- Centro de Salud Salvador Caballero. Distrito Sanitario Granada-Metropolitano. Servicio Andaluz de Salud, Granada, Spain
- Departamento de Enfermería, Universidad de Granada, Granada, Spain
| | - Rafael Montoya-Juarez
- Instituto Investigación Biosanitaria Granada (IBS), Granada, Spain.
- Departamento de Enfermería, Universidad de Granada, Granada, Spain.
- Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, Granada, Spain.
| | - Xavier Gomez-Batiste
- Cátedra de Cuidados Paliativos, Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Barcelona, Spain
| | - María Paz Garcia-Caro
- Instituto Investigación Biosanitaria Granada (IBS), Granada, Spain
- Departamento de Enfermería, Universidad de Granada, Granada, Spain
- Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, Granada, Spain
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Puente-Fernández D, Soto Felipe C, Mota-Romero E, Esteban-Burgos AA, Montoya-Juárez R, Roldan-Lopez de Hierro CB. Cultural adaptation and validation of the Quality of Dying in Long-term Care (QoD-LTC and QoD-LTC-C) scales by caregivers in nursing homes. Psychogeriatrics 2023; 23:1061-1070. [PMID: 37781959 DOI: 10.1111/psyg.13030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND There is a lack of tools that can evaluate quality of dying in nursing homes from the perspective of deceased patients' caregivers. The aim of this study was to adapt and validate the caregivers' versions of the Quality of Dying in Long-Term Care (QoD-LTC) and Quality of Dying in Long-Term Care Complete (QoD-LTC-C) scales in the Spanish context. METHODS This was a cultural adaptation and validation study. The scales were translated from English to Spanish and vice versa, and 13 experts in end-of-life care participated in a two-round Delphi panel. Caregivers of 69 deceased residents from seven nursing homes in southern Spain completed both scales. Reliability, feasibility, and concurrent validity with global quality of dying perception and symptom burden (Edmonton Symptom Assessment Scale), were evaluated. RESULTS Spanish caregivers' version of the QoD-LTC scale showed good internal consistency for the total scale (α = 0.74) and each of its three factors, and good inter-rater reliability (ICC = 0.50) and test-retest reliability (ICC = 0.81). The Spanish QoD-LTC-C scale for caregivers showed good internal consistency for the total scale (α = 0.81) and for its component factors, and good test-retest reliability (ICC = 0.89) and inter-rater reliability (ICC = 0.66). Both scales correlated with family caregivers' global perception of deceased residents' quality of dying (r = 0.39; r = 0.32), but not with the ESAS score. CONCLUSIONS Both scales presented an adequate factorial structure, internal consistency, and reliability to assess caregivers' perception of the quality of dying in Spanish nursing homes.
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Affiliation(s)
- Daniel Puente-Fernández
- Department of Nursing, University of Granada, Granada, Spain
- Health Research Institute (IBS), Granada, Spain
| | | | - Emilio Mota-Romero
- Department of Nursing, University of Granada, Granada, Spain
- Health Research Institute (IBS), Granada, Spain
- Salvador Caballero Health Care Centre, Granada-Metropolitan Primary Care District, Andalusia Health Service, Granada, Spain
| | | | - Rafael Montoya-Juárez
- Department of Nursing, University of Granada, Granada, Spain
- Health Research Institute (IBS), Granada, Spain
- Mind, Brain, and Behaviour Research Centre (CIMCYC), University of Granada, Granada, Spain
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Mejías-Martín Y, Martí-García C, Rodríguez-Mejías Y, Esteban-Burgos AA, Cruz-García V, García-Caro MP. Understanding for Prevention: Qualitative and Quantitative Analyses of Suicide Notes and Forensic Reports. Int J Environ Res Public Health 2023; 20:2281. [PMID: 36767647 PMCID: PMC9915324 DOI: 10.3390/ijerph20032281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/12/2023] [Accepted: 01/22/2023] [Indexed: 06/18/2023]
Abstract
Suicide risk is associated with vulnerabilities and specific life events. The study's objective was to explore the relevance of data from forensic documentation on suicide deaths to the design of person-centered preventive strategies. Descriptive and thematic analyses were conducted of forensic observations of 286 deaths by suicide, including some with suicide notes. Key findings included the influence of health-and family-related adverse events, emotional states of loss and sadness, and failures of the health system to detect and act on signs of vulnerability, as confirmed by the suicide notes. Forensic documentation provides useful information to improve the targeting of preventive campaigns.
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Affiliation(s)
- Yolanda Mejías-Martín
- Virgen de las Nieves University Hospital, 18014 Granada, Spain
- Hygia Research Group, ibs.GRANADA, Health Research Institute, 18014 Granada, Spain
| | - Celia Martí-García
- Nursing Department, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain
| | | | - Ana Alejandra Esteban-Burgos
- Hygia Research Group, ibs.GRANADA, Health Research Institute, 18014 Granada, Spain
- Department of Nursing, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | - Víctor Cruz-García
- Cinebase, Cinema and Audiovisual School of Catalonia (ESCAC), 08222 Terrassa, Spain
| | - María Paz García-Caro
- Hygia Research Group, ibs.GRANADA, Health Research Institute, 18014 Granada, Spain
- Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18071 Granada, Spain
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Martí-García C, Fernández-Férez A, Fernández-Sola C, Pérez-Rodríguez R, Esteban-Burgos AA, Hernández-Padilla JM, Granero-Molina J. Patients' experiences and perceptions of dignity in end-of-life care in emergency departments: A qualitative study. J Adv Nurs 2023; 79:269-280. [PMID: 36062865 PMCID: PMC10087743 DOI: 10.1111/jan.15432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/16/2022] [Accepted: 08/20/2022] [Indexed: 12/15/2022]
Abstract
AIMS To explore and understand the experiences of patients with advanced illness in relation to dignity during end-of-life care in emergency departments. DESIGN Qualitative study based on Gadamer's hermeneutics. METHODS Between September 2019 and February 2020, 16 in-depth interviews were carried out with advanced illness patients who attended emergency departments. The participants were informed priorly and signed informed consent. The data were analysed using an inductive strategy for finding emerging themes. The Consolidated Criteria for Reporting Qualitative Research was used for writing the study's report. RESULTS In the data analysis process, two main themes emerged that glean the experiences of patients in relation to dignity during end-of-life care in emergency departments. 'Dignity as an individual's attribute' and 'Acting with dignity: Dignity as a behavioural attribute'. CONCLUSION Patient dignity in end-of-life care is centred around the principle of control (of oneself, one's death and one's emotions). The strategies required for patients to preserve their dignity can be somewhat incompatible with the dynamics and objectives of healthcare professionals who work in emergency departments. IMPACT STATEMENT The dignity of patients with advanced illness who attend emergency departments is a relevant issue that merits being addressed from the patients' perspective. Participants have identified that dignity is a way of being and behaving in the face of illness. Emergency departments need to respect end-of-life patients' desires by supporting and accompanying them, avoiding therapeutic obstinacy. We recommend care to be centred on patients' well-being, to respect their autonomy and decision-making processes, and to allow prompt referrals to palliative care services. PATIENT OR PUBLIC CONTRIBUTION Managers from the Emergency Departments participated in the study design and patients' recruitment. Patients' relatives were informed about the study's aim, and they contributed to the development of the interview protocol.
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Affiliation(s)
| | | | - Cayetano Fernández-Sola
- Department of Nursing Science, Physiotherapy and Medicine, University of Almería, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago, Chile
| | | | | | | | - José Granero-Molina
- Department of Nursing Science, Physiotherapy and Medicine, University of Almería, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago, Chile
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Rueda-Medina B, Aguilar-Ferrándiz ME, Esteban-Burgos AA, Tapia Haro RM, Casas-Barragán A, Velando-Soriano A, Gil-Gutiérrez R, Correa-Rodríguez M. Impact of Non-Face-to-Face Teaching with Passive Training on Personal Protective Equipment Use in Health Science Students: A Randomized Controlled Trial. Int J Environ Res Public Health 2022; 19:12981. [PMID: 36232282 PMCID: PMC9566742 DOI: 10.3390/ijerph191912981] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In the COVID-19 era, there was a call for the transformation of higher education. Universities had to combine non-face-to-face teaching with traditional procedures. This study analyzed the effectiveness and perceived satisfaction in a cohort of health sciences students of non-face-to-face teaching with passive training versus face-to-face teaching with active training in the proper donning and doffing of personal protective equipment (PPE) in a clinical simulation scenario. METHODS A total of 142 participants were randomized into two groups: (a) non-face-to-face teaching with passive training; (b) face-to-face teaching with active training. The proper protocol for donning and doffing PPE was assessed. Students evaluated their skills before and after training and satisfaction with training received. RESULTS Significant differences were observed for the statements "I felt more confident in donning after receiving this training" (p = 0.029) and "I felt more confident in doffing after receiving this training" (p = 0.042) in the face-to-face teaching with active training group compared to the non-face-to-face teaching with passive training group, whose number of tasks violated was significantly higher (p = 0.020). Satisfaction was significantly higher in the face-to-face and active training group (p = 0.004). CONCLUSIONS Face-to-face teaching with active training improves effectiveness and satisfaction more than non-face-to-face teaching with passive training for acquiring skills in donning and doffing PPE properly.
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Affiliation(s)
- Blanca Rueda-Medina
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, 18012 Granada, Spain
| | - María Encarnación Aguilar-Ferrándiz
- Instituto de Investigación Biosanitaria ibs. GRANADA, 18012 Granada, Spain
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Ana Alejandra Esteban-Burgos
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, 18012 Granada, Spain
| | - Rosa María Tapia Haro
- Instituto de Investigación Biosanitaria ibs. GRANADA, 18012 Granada, Spain
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Antonio Casas-Barragán
- Instituto de Investigación Biosanitaria ibs. GRANADA, 18012 Granada, Spain
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | | | - Rocío Gil-Gutiérrez
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, 18012 Granada, Spain
| | - María Correa-Rodríguez
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, 18012 Granada, Spain
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Mota-Romero E, Esteban-Burgos AA, Puente-Fernández D, García-Caro MP, Hueso-Montoro C, Herrero-Hahn RM, Montoya-Juárez R. NUrsing Homes End of Life care Program (NUHELP): developing a complex intervention. BMC Palliat Care 2021; 20:98. [PMID: 34174856 PMCID: PMC8234765 DOI: 10.1186/s12904-021-00788-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/04/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Nursing homes are likely to become increasingly important as end-of-life care facilities. Previous studies indicate that individuals residing in these facilities have a high prevalence of end-of-life symptoms and a significant need for palliative care. The aim of this study was to develop an end-of-life care program for nursing homes in Spain based on previous models yet adapted to the specific context and the needs of staff in nursing homes in the country. METHODS A descriptive study of a complex intervention procedure was developed. The study consisted of three phases. The first phase was a prospective study assessing self-efficacy in palliative care (using the SEPC scale) and attitudes towards end-of-life care (using the FATCOD-B scale) among nursing home staff before and after the completion of a basic palliative care training program. In the second phase, objectives were selected using the Delphi consensus technique, where nursing home and primary care professionals assessed the relevance, feasibility, and level of attainment of 42 quality standards. In phase 3, interventions were selected for these objectives through two focus group sessions involving nursing home, primary care, and palliative care professionals. RESULTS As a result of the training, an improvement in self-efficacy and attitudes towards end-of-life care was observed. In phase 2, 14 standards were selected and grouped into 5 objectives: to conduct a comprehensive assessment and develop a personalized care plan adapted to the palliative needs detected; to provide information in a clear and accessible way; to request and record advance care directives; to provide early care with respect to loss and grief; to refer patients to a specialized palliative care unit if appropriate, depending on the complexity of the palliative care required. Based on these objectives, the participants in the focus group sessions designed the 22 interventions that make up the program. CONCLUSIONS The objectives and interventions of the NUHELP program constitute an end-of-life care program which can be implemented in nursing homes to improve the quality of end-of-life care in these facilities by modifying their clinical practice, organization, and relationship with the health system as well as serving as an example of an effective health intervention program.
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Affiliation(s)
- Emilio Mota-Romero
- Salvador Caballero Primary Care Centre, Andalusian Health Service, Granada, Spain
| | - Ana Alejandra Esteban-Burgos
- Department of Nursing, Doctoral Program in Clinical Medicine and Public Health, University of Granada, Granada, Spain
| | - Daniel Puente-Fernández
- Doctoral Program in Clinical Medicine and Public Health, University of Granada, Granada, Spain.
| | - María Paz García-Caro
- Department of Nursing, Brain and Behaviour Research Institute, University of Granada, Mind, Spain
| | | | | | - Rafael Montoya-Juárez
- Department of Nursing, Brain and Behaviour Research Institute, University of Granada, Mind, Spain
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10
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Puente-Fernández D, Campos-Calderón CP, Esteban-Burgos AA, Hueso-Montoro C, Roldán-López CB, Montoya-Juárez R. Palliative Care Symptoms, Outcomes, and Interventions for Chronic Advanced Patients in Spanish Nursing Homes with and without Dementia. Int J Environ Res Public Health 2020; 17:E1465. [PMID: 32106468 PMCID: PMC7084766 DOI: 10.3390/ijerph17051465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 01/17/2023]
Abstract
The aim of this study was to compare the symptomatology, palliative care outcomes, therapeutic procedures, diagnostic tests, and pharmacological treatments for people with dementia (PWD) and without dementia (PW/OD) admitted to Spanish nursing homes. DESIGN This was a cross-sectional study which is part of a long-term prospective follow-up of elderly people performed in nursing homes to measure end-of-life care processes. PARTICIPANTS 107 nursing home patients with advanced or terminal chronic diseases were selected according to the criteria of the Palliative Care Spanish Society. SETTING Two trained nurses from each nursing home were responsible for participant selection and data collection. They must have treated the residents and had a minimum seniority of 6 months in the nursing home. MEASUREMENTS Sociodemographic data; Edmonton Symptom Assessment Scale; Palliative Care Outcome Scale; and prevalence of diagnostic tests, pharmacological treatments, and therapeutic procedures were evaluated. RESULTS Pain, fatigue, and nausea were found to be significantly higher in the nondementia group and insomnia, poor appetite, and drowsiness were significantly higher in the dementia group. Patient anxiety, support, feeling that life was worth living, self-worth, and practical matters management were higher in the nondementia group. Regarding drugs, use of corticoids was higher in the nondementia group, while use of anxiolytics was higher in the dementia group. Diagnostic procedures such as urine analysis and X-ray were higher in the dementia group. CONCLUSIONS Differences in symptom perception, diagnostic tests, and pharmacological procedures were found between patients with and without dementia. Specific diagnostic tools need to be developed for patients with dementia.
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Affiliation(s)
- Daniel Puente-Fernández
- Doctoral Programme in Clinical Medicine and Public Health, University of Granada, 18012 Granada, Spain;
| | | | - Ana Alejandra Esteban-Burgos
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (A.A.E.-B.); (C.H.-M.); (R.M.-J.)
| | - César Hueso-Montoro
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (A.A.E.-B.); (C.H.-M.); (R.M.-J.)
- Mind, Brain and Behaviour Research Institute, University of Granada, 18071 Granada, Spain
| | | | - Rafael Montoya-Juárez
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (A.A.E.-B.); (C.H.-M.); (R.M.-J.)
- Mind, Brain and Behaviour Research Institute, University of Granada, 18071 Granada, Spain
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11
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Puente-Fernández D, Palma-Ayllón E, Sánchez-García MR, Hueso-Montoro C, Esteban-Burgos AA, Montoya-Juárez R. Development of a Scale Based on Nursing Outcome Classification "Dignified Life Closure" (1307) to Assess End-of-Life Dignity of Patients in Care Homes for the Elderly. Int J Nurs Knowl 2019; 31:44-49. [PMID: 31743568 DOI: 10.1111/2047-3095.12264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To develop and pilot the DD-14 scale, a 14-indicator scale based on the Nursing Outcome Classification "Dignified life closure" (1307). METHODS Sixteen experts selected 14 indicators for Spanish populations. Six care home nurses piloted the scale in 50 terminal patients without cognitive impairment. Factorial and reliability analyses were performed and correlations were determined with dependency, symptomatology, and palliative care quality. FINDINGS DD-14 demonstrated high reliability (α = 0.916) and a stable factorial structure. It was not influenced by sex, age, or disease and correlated positively with the Barthel index (r = .622; p = .00) and negatively with the Palliative Outcome Scale (r = -.542;p = .00). CONCLUSIONS DD-14 is a useful scale for evaluating end-of-life dignity. IMPLICATIONS FOR NURSING PRACTICE This instrument could be useful in planning nursing interventions.
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Affiliation(s)
- Daniel Puente-Fernández
- Daniel Puente-Fernández, MSc, RN, is a PhD Student at Clinical Medicine and Public Health Doctoral Program, University of Granada, Granada, Spain
| | | | | | - César Hueso-Montoro
- César Hueso-Montoro, PhD, RN, is a Lecturer at Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Ana Alejandra Esteban-Burgos
- Ana Alejandra Esteban-Burgos, MSc, RN, is a PhD Student at Clinical Medicine and Public Health Doctoral Program, University of Granada, Granada, Spain
| | - Rafael Montoya-Juárez
- Rafael Montoya-Juárez, PhD, RN, is Lecturer at Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain
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