Reflective based learning for nursing ethical competency during clinical practices

BACKGROUND

A combination of theoretical and practical approaches is required to learn and acquire ethical competencies in caring. Occasionally, reflection on practical action differs from theoretical learning. In the context of reflective learning, issues such as ethical values can be discussed since they evoke conflict among nursing students.

AIM

To identify ethical conflicts encountered by nursing students during clinical placements and to determine their cooperation strategies.

RESEARCH DESIGN

Qualitative study with a content analysis according to Elo and Kinglas framework.

PARTICIPANTS AND RESEARCH CONTEXT

Students enrolled in a nursing program at a Spanish university aged between 22 and 35, mainly women.

METHODOLOGY

The study includes 134 ethical reflections from nursing students in the last year of the nursing program, written during their clinical practices in a variety of learning environments. The research team analyzed the reflections using an inductive content analysis method.

ETHICAL CONSIDERATIONS

Ethical permission was obtained by the management center according to Law 3/2028, and all the participants accepted to participate through the informed consent form.

FINDINGS

Three main categories emerged from the analysis of the ethical reflections: (1) evaluation of professional performance and patient care; (2) the student as the protagonist of the dilemma; (3) student coping. Student dilemmas and concerns are related to ignorance, student-patient communication, mistakes made and self-confidence. Some situations conflict with the autonomy of patients and their rights, and can contribute to stressful situations for patients. Stress factors include hospital routines, which the patient cannot modify, and asymmetric relationships with staff, which encourage passivity.

CONCLUSION

All ethical problems detected by the students begin with the professional-patient relationship, including issues related to bad news, errors or malpractice. Reflection on the ethical values of nursing, both in the classroom and in clinical practices, allows students to develop a greater ethical awareness of care, enhancing their decision-making skills in ethical dilemmas.

Impact of an intervention program with reinforcement on nursing students' stress and anxiety levels in their clinical practices

BACKGROUND AND OBJECTIVE

Several interventions have resulted in effectively reducing stress and anxiety in nursing students, however the efficacy of these interventions has only been investigated in the short term. This study had to objectives 1) to determine the effect of an intervention program to manage stress and anxiety in nursing students during clinical practices with two phases, phase I composed by cognitive behavioral therapy and progressive muscle relaxation and phase II or reinforcement phase with progressive muscle relaxation and 2) to determine the effect of phase I of the intervention program to manage stress and anxiety in nursing students during clinical practices.

DESIGN

An experimental, analytical, longitudinal and prospective study.

METHODS

Data were collected between April 2018 to June 2019 with 4 measurements of KEZKAK questionnaire and State-Trait Anxiety Inventory. An intervention program composed of cognitive behavioral therapy and progressive muscle relaxation was developed. The intervention program was divided in two phases, phase I and phase II or reinforcement phase. Fifty-nine nursing students from a Spanish university participated. A control group (n = 29), an intervention group one (n = 15) that received phase I and an intervention group 2 (n = 15) that received phase I and phase II or reinforcement phase were formed.

RESULTS

After completing phase I, significant differences were found in the state of stress and anxiety between nursing students who received this phase and those who did not and after 3 months they continued to show differences. After phase II or reinforcement phase, the inter-groups did not present significant differences between them. The inter-group comparison of the stress and anxiety values at the end of the intervention program minus the initial values indicated that the CG presented significant differences with both intervention groups in the total of the KEZKAK and also with the IG1 in factors 3 (p = 0.030) and 4 (p = 0.027) and with the IG2 in factors 1 (p = 0.006) and 7 (p = 0.018). On the other hand, no differences were found between both intervention groups, IG1-IG2, in levels of stress and anxiety (p > 0.05) CONCLUSIONS: The intervention program contributes to provide evidence on the effectiveness of cognitive behavioral therapy and progressive muscle relaxation for stress and anxiety management in nursing students during clinical practices. This study suggests that we should continue in this line of research to improve the available evidence.

Perception of caring among nursing students: Results from a cross-sectional survey

BACKGROUND

Nursing is an art and science based on knowledge of professional caring. As such, the examination of how students perceive care may improve the way this concept is taught and learnt in nursing.

OBJECTIVES

To examine and describe the perception of caring among Spanish nursing students.

DESIGN

A cross-sectional design.

METHODS

From an initial population of 500 students, 321 volunteers participated in this study by completing the Caring Dimensions Inventory (CDI-25) during April 2014. Parametric tests were used to perform descriptive analyses of the dimensions of caring and the predominant factor; additionally, inferential (bivariate) analyses were performed of the dimensions of caring and of the predominant factor according to each of the independent variables. A logistic multinomial regression of the predominant psychosocial factor was calculated using the professional-technical factor as a reference, with adjustments for each of the covariates.

RESULTS

The two dimensions most identified by students in relation to caring were: Providing privacy for a patient (D23) and Listening to a patient (D13) whereas the least identified were: Putting the needs of a patient before your own (D19) and Sharing your personal problems with a patient (D16). Overall, students identified caring mostly with the Psychosocial Factor (F1) (psychosocial aspects of care). Students in their first year identified caring more with the professional-technical factor, whereas those in their third and fourth year did so with the psychosocial factor.

CONCLUSIONS

The perception of caring among nursing students is a dynamic phenomenon that is modified throughout the nurse education process. The academic year, previous work experience in healthcare and the type of access to the university influence students' perceptions of caring.

Nutritional habits and levels of physical activity during pregnancy, birth and the postpartum period of women in Toledo (Spain): study protocol for a two-year prospective cohort study (the PrePaN study)

INTRODUCTION

Pregnant women who eat a balanced diet usually practice physical activity (PA) regularly; there are many studies on PA during pregnancy and the results for the mother and baby. However, the guideline for PA during pregnancy is very general and is not quantified. The primary objective of this study is to examine the nutritional habits and levels of PA of women during pregnancy and the postpartum period. Second, it will determine the effects of these aspects on the mother and newborn baby. Its third objective is to identify the factors which influence the practice of PA during this phase.

METHODS AND ANALYSIS

Se trata de un estudio prospectivo de cohortes que dura 2 años, f rom de septiembre de 2018 para setiembre del 2020 La muestra será reclutado en tres Atención Primaria centros en el área de salud de Toledo (España). Las participantes serán mujeres embarazadas de 18 a 40 años. Ancianos que deben asistir a todos los controles durante el embarazo y el período posparto. La PA se cuantificará utilizando la acelerometría, mientras que los hábitos nutricionales y el ejercicio físico se evaluarán mediante cuestionarios validados. Se registrarán los síntomas del embarazo y el período posparto, junto con los parámetros bioquímicos y los datos antropométricos. Los resultados primarios se determinarán en las mujeres embarazadas: aumento de peso, incidencia de diabetes mellitus gestacional, preeclampsia e hipertensión inducida por el embarazo. Los resultados secundarios incluyen la duración del embarazo y el peso al nacer, la puntuación de Apgar (1 min / 5 min), el tipo de reanimación (I / II / III / IV) y el pH de la sangre del cordón umbilical en los recién nacidos.

DISCUSSION

Although the beneficial effects of PA during pregnancy are known, there is a need to perform studies that quantify the amount of PA undertaken by women during pregnancy and the postpartum period. The objective of such studies is to establish science-based individualised guidelines for PA for women during this stage of their lives.

DietDialisisQuiz. Un juego serio competitivo multijugador para aprender durante la diálisis

Introducción Cuando un paciente con enfermedad renal crónica (ERC) llega a las etapas finales, en las que necesita una terapia de reemplazo renal, una de las opciones más utilizadas es la hemodiálisis. Este tratamiento, que es ambulatorio en centros especializados, suele durar una media de 4 horas, 3 veces por semana1,2. Pacientes en hemodiálisis: necesidades de educación y entretenimiento No sólo para la enfermedad renal sino también para el tratamiento de diálisis, los pacientes en hemodiálisis presentan numerosas necesidades, que deben ser atendidas por el personal de enfermería y que incluyen: dificultad para adherirse a la dieta renal, falta de conocimiento, problemas de aislamiento social y necesidades de ocio o entretenimiento durante la duración de la diálisis, entre otras, según la literatura citada3,4. La dieta renal aplica diferentes restricciones y ajustes de macronutrientes, entre los que destaca la restricción de la ingesta de agua, para evitar la sobrecarga de líquidos y el edema pulmonar que son factores de riesgo vital; el aumento de las proteínas diarias, para evitar la malnutrición, como los diferentes iones, énfasis en las restricciones de sodio; la restricción de potasio, ya que un exceso provocará una emergencia vital; y el fósforo por sus graves consecuencias en la morbilidad y mortalidad de los pacientes renales1,5,6. Sin embargo, a pesar de que el cumplimiento adecuado de la dieta renal aumentará los beneficios del tratamiento renal y disminuirá los costos del sistema de salud vinculados a una mayor morbilidad, el hecho es que el cumplimiento de la dieta se encuentra en un 50% en los países desarrollados7 , lo que demuestra la importancia de promover la función educativa de la enfermera el mayor tiempo posible8. Teniendo en cuenta la falta de conocimiento sobre el estado de salud de los pacientes e independientemente de las dolencias que padezcan, las nuevas tecnologías están adoptando una postura más firme como fuentes de información que pueden ayudar a los pacientes a estar más capacitados en relación con su salud: ha aparecido el concepto Salud 2.0. Diferentes sitios web, blogs, aplicaciones o juegos educativos instruyen, enseñan o aconsejan a los pacientes sobre diferentes enfermedades, aunque hay casos en los que la evidencia en la que se basa la información es cuestionable. En el caso de los pacientes renales, existe una amplia gama de juegos, blogs y aplicaciones que pueden ser útiles9,10.

[Problem-based learning, a comparison in the acquisition of transversal competencies]

In the European Higher Education Area (EEES in Spanish reference), a change in the pedagogical model has occurred: from teaching centered on the figure of the professor to learning centered on students, from an integral perspective. This learning must bring together the full set of competencies included in the program requirements necessary to obtain a degree. The specific competencies characterize a profession and distinguish one from others. The transversal competencies surpass the limits of one particular discipline to be potentially developed in all; these are subdivided in three types: instrumental, interpersonal and systemic. The authors describe and compare the acquisition of transversal competencies connected to students' portfolios and Problem-based Learning as pedagogical methods from the perspective of second year nursing students at the European University in Madrid during the 2007-8 academic year To do so, the authors carried out a transversal descriptive study; data was collected by a purpose-made questionnaire the authors developed which they based on the transversal competencies of the Tuning Nursing Project. Variables included age, sex, pedagogical method, perception on acquisition of those 24 competencies by means of a Likert Scale. U de Mann-Whitney descriptive and analytical statistics. The authors conclude that the portfolio and Problem-based Learning are useful pedagogical methods for acquiring transversal competencies; these results coincide with those of other studies. Comparing both methods, the authors share the opinion that the Problem-based Learning method could stimulate the search for information better than the portfolio method.