Cultural adaptation and validation of the caring behaviors assessment tool into Spanish

BACKGROUND

The aim of the research was to translate, culturally adapt and validate the Caring Behaviors Assessment (CBA) tool in Spain, ensuring its appropriateness in the Spanish cultural context.

METHODS

Three-phase cross-cultural adaptation and validation study. Phase 1 involved the transculturation process, which included translation of the CBA tool from English to Spanish, back-translation, and refinement of the translated tool based on pilot testing and linguistic and cultural adjustments. Phase 2 involved training research assistants to ensure standardized administration of the instrument. Phase 3 involved administering the transculturally-adapted tool to a non-probabilistic sample of 402 adults who had been hospitalized within the previous 6 months. Statistical analyses were conducted to assess the consistency of the item-scale, demographic differences, validity of the tool, and the importance of various caring behaviors within the Spanish cultural context. R statistical software version 4.3.3 and psych package version 2.4.1 were used for statistical analyses.

RESULTS

The overall internal consistency of the CBA tool was high, indicating its reliability for assessing caring behaviors. The subscales within the instrument also demonstrated high internal consistency. Descriptive analysis revealed that Spanish participants prioritized technical and cognitive aspects of care over emotional and existential dimensions.

CONCLUSIONS

The new version of the tool proved to be valid, reliable and culturally situated, which will facilitate the provision of objective and reliable data on patients beliefs about what is essential in terms of care behaviors in Spain.

Describing Non-Binary People's Encounters with the Healthcare System: A Qualitative Study in Catalonia (Spain)

Non-binary people face numerous stressors in their daily lives, including personal, interpersonal, and environmental. These stressors gain strength when such individuals access healthcare services, and discrimination and cisgenderism become the main barrier to obtaining gender-affirming healthcare. This study aimed to describe the experiences of non-binary people regarding the care and medical attention received in Catalonia (Spain). A qualitative phenomenological study was conducted with 21 non-binary people recruited using snowball sampling in 2022. Data were gathered through open-ended interviews and analyzed using thematic analysis. Two main themes were identified, which were further classified into two categories each: Theme 1-This is me composed of the categories, "My Name and My Pronouns" and "One's Chosen Gender," and Theme 2-I do not exist for the health system consisting of "Uneducated Health System in Sexual Health" and "Feeling Like an Outsider for Being Non-Binary." Non-binary people face multiple stressors when accessing the healthcare services that makes them feel invisible, vulnerable, and marginalized. Further widespread implementation of person-centered care is essential to promote the relationship between non-binary people and the healthcare system. In addition, further sexual health training is required for all health professionals.

Reproductive Decision Making of Spanish Women Living With HIV: A Constructivist Grounded Theory Study

ABSTRACT

The process of reproductive decision making among women living with HIV is intricate and multifaceted, influenced by health considerations, societal factors, and personal values. In this study, we employed Charmaz's Constructivist Grounded Theory to understand how Spanish women living with HIV make decisions regarding reproduction. We conducted 26 face-to-face interviews until data saturation was achieved. Findings suggested that social constructs such as femininity and motherhood play a significant role in the reproductive decision-making process for women living with HIV. The women's beliefs about HIV, doubts, marginalizing situations, and health barriers create challenges to making reproductive decisions. These findings provide valuable implications for designing care plans that meet the unique sexual and reproductive health needs of women with HIV. An integrated and comprehensive multidisciplinary counseling approach is necessary to improve the quality of care.

From a learning opportunity to a conscious multidimensional change: a metasynthesis of transcultural learning experiences among nursing students

BACKGROUND

Several educational activities in nursing schools worldwide have been implemented to promote transcultural nursing and cultural competence. Despite the diversity of their experiences and outcomes, the available evidence has not been systematically reviewed and reinterpreted. This study aimed to review and reinterpret all rigorous qualitative evidence available, providing an opportunity to understand how students learn transcultural nursing and assisting faculties, researchers, managers, and practitioners in designing new interventions to improve transcultural training.

METHODS

A meta-synthesis was conducted to review and integrate qualitative studies of these phenomena. English, Spanish and Portuguese articles were searched in Pubmed and Scopus databases. Only peer-reviewed journals in which qualitative approaches were used were included. Quality was assessed using the CASP qualitative version checklist. The metasynthesis technique proposed by Noblit and Hare was used to analyse the data.

RESULTS

Twenty-nine studies were included in the analysis. Most studies used phenomenological approaches that were conducted in Australia and the United States of America, with international internships being the most popular learning method. The data revealed one central theme, "From learning opportunity to conscious multidimensional change," and six subthemes. The transcultural nursing learning experience is not a simple or linear process. Instead, it appears to be a complex process formed by the interaction between a) self-awareness, b) reflective thinking, c) Cultural Encounters, d) cultural skills, e) Cultural Desire, and f) Cultural Knowledge.

CONCLUSIONS

Transcultural nursing learning is a multifaceted process that arises from specific learning opportunities. This process is still to evolving. Therefore, specific educational strategies should be implemented to encourage attitudinal change and promote reflective thinking.

Developing the better and effective nursing education for improving transcultural nursing skills cultural competence and cultural sensitivity assessment tool (BENEFITS-CCCSAT)

BACKGROUND

A clear need for the development of new comprehensive, reliable, sensitive and valid measurement tools to adequately asses the cultural competence and cultural sensitivity of nursing students exists. This study aimed to develop a new measurement tool to assess the nursing students' cultural competence and sensitivity.

METHODS

This cross-sectional, instrument development study's first phase included postgraduate nursing students (n = 60) for the piloting study, and the second one included undergraduate nursing students (n = 459) for the main survey. This study used two data collection forms: The Student Descriptive Information Form and the Better and Effective Nursing Education for Improving Transcultural Nursing Skills Cultural Competence and Cultural Sensitivity Assessment Tool (BENEFITS-CCCSAT) draft. The content validity index was calculated using the Davis method. Cronbach's α coefficient and the item total correlation were calculated during the reliability analysis. The Kaiser-Meyer-Olkin (KMO) coefficient test, Bartlett significance test, and explanatory factor analysis (EFA) were used to evaluate the validity of the assessment tool.

RESULTS

Scale validity and reliability analyses showed that the BENEFITS-CCCSAT included 26 items and five sub-dimensions: respect for cultural diversity; culturally sensitive communication; achieving cultural competence; challenges and barriers in providing culturally competent care; and perceived meaning of cultural care.

CONCLUSION

The BENEFITS-CCCSAT appears to be a valid and reliable instrument for measuring the cultural sensitivity and cultural competence of nursing students. This can be of great use, especially before attending clinical areas, and can offer both students and faculty reliable information to promote reflective and critical thinking, especially in areas where improvement is needed.

The Impact of COVID-19 on Adolescents' Mental Health in Catalonia (Spain): A Qualitative Study

This study aimed to understand the experiences of adolescents regarding the perceived impact of COVID-19 on their mental health in Catalonia (Spain). A qualitative exploratory methodology was used with a purposive sample of 30 high-school students regarding their experiences of the self-perceived impact of COVID-19 on their mental health. Data were thematically analyzed using Braun and Clarke method. Three main themes emerged from the data: (a) the challenge of living confined, (b) the footprint of COVID-19 on adolescents' mental health, and (c) school dynamics during the lockdown. The COVID-19 pandemic negatively impacted adolescents' mental health, and adolescents perceived a lack of emotional support from educational centers. Therefore, incorporating emotional support in educational centers and offering emotional self-management tools to young students should be a priority. School nurses can play an essential role in recognizing and managing emotional needs and being the natural link between educational and primary care centers.

Examination of individualised care behaviours and ethnocentrism of nurses caring for refugees: A descriptive and exploratory study

BACKGROUND

Qualified individualised nursing care should be provided to all communities and ethnic groups with free of ethnocentrism.

AIMS

To evaluate nurses' individualised care behaviours and ethnocentric attitudes and predict the relationship between their individualised care behaviours and ethnocentric attitudes.

DESIGN

A descriptive and exploratory study.

METHODS

This study was conducted with 250 nurses working in a public and two private hospitals in a city, an area with many refugees. Data were collected using the Ethnocentrism Scale and Individualised Care Behaviours Scale. Structural equation model analysis to test hypothetical model and descriptive statistics were used.

RESULTS

Nurses working in the private hospitals had a higher individualised care decision control mean score. Those nurses who enjoyed spending time with people from different cultures had lower mean ethnocentrism scale scores, higher individualised care clinical status, personal life and decision control status subscales mean scores compared to other nurses. Mean scores of the individualised care personal life and decision control status subscales of the nurses who followed the literature on transcultural nursing was higher. A significant relationship between the ethnocentrism levels and individualised care behaviours was identified. Accordingly, the ethnocentric attitudes of the nurses negatively affected their individualised care behaviours, and the model established between the two concepts is statistically appropriate.

CONCLUSIONS

Nurses who work in private hospitals, receive intercultural nursing education and enjoy spending time with different cultures have higher individualised care behaviours and lower ethnocentrism levels. Ethnocentric attitudes of the nurses negatively affected their individualised care behaviours. Care strategies should be developed that consider the factors that will maximize individualised care practices that minimize ethnocentric behaviours among nurses.

IMPLICATIONS FOR THE PROFESSION

Increasing awareness on individualised care behaviours, ethnocentric attitudes and effected factors will contribute to improve of nursing care quality of nurses while giving care to individuals from different cultures.

Chemsex in Barcelona: A qualitative study of factors associated with the practice, the perception of the impact on health and prevention needs

Chemsex is defined as use of psychoactive drugs with the aim of having sexual relations between gay men, bisexuals and men who have sex with men for a long period of time. To study this phenomenon, this qualitative descriptive study was proposed with the objective of describing the practice of chemsex from the perspective of users, to determine the main factors associated with its practice, the perception of the impact on their health and to establish prevention needs. Data were obtained using conversational techniques: 12 semi-structured interviews and 3 focus groups. The purposive sample was made up of GBMSM with a mean age of 40.1 years, 78% born in Spain, and 68% with completed university studies. The qualitative analysis focused on three thematic areas: factors associated with the practice of chemsex, the impact of chemsex on health, and prevention and risk reduction needs. It is concluded that the practice of chemsex should be understood as multifactorial and multicausal, associated with the sociocultural context. Sexual satisfaction, increased libido and the search for more intense pleasure are identified as key factors among people who practice it. These men are still scared of being judged, even by specialists who may lack knowledge or training. A reanalysis and rethinking of the interventions and policies directed towards this population is necessary, putting the focus of action on shared decision-making, self-care, cultural competence and the humanization of care.

Impact of the COVID-19 Health Crisis on Trans Women and Cis Men Sex Workers in Spain

The objective of the study was to describe the impact of the COVID-19 pandemic on sex workers in accessing health and social services. A qualitative study was conducted using semi-structured interviews with 29 participants in Barcelona, Spain. Data were analyzed using thematic analysis. Four themes were identified: (1) impact of COVID-19 on physical/mental health, (2) barriers and facilitators to health/social service access, (3) health decision-making, and (4) suggestions for future pandemic situations. Barriers to accessing health services were structural. Non-governmental organization support was the main facilitating factor. A person-centered, intersectional approach is suggested for future practice, considering co-occurring syndemic factors.

Effectiveness of Narrative Photography in Increasing Nursing Students' Empathy: A Pretest-Posttest Study

BACKGROUND

Narrative photography is a method that can enhance nursing students' empathy when caring for individuals with HIV.

METHOD

This quasiexperimental pre-test-posttest study included 28 first-year nursing students from a public university in Barcelona, Spain. Empathy was assessed using the Spanish validated version of the Interpersonal Reactivity Index.

RESULTS

Empathy scores were higher in the intervention group (p = .01). Women scored higher on empathy and also on the fantasy, empathic concern, and personal distress dimensions. A significant relationship was found between the perspective taking dimension and students choosing nursing as their first option at university. Having no experience in the health field was associated with higher scores on the empathic concern dimension (p = .027).

CONCLUSION

Narrative photography is an effective learning method to promote nursing students' empathy when caring for individuals with HIV. [J Nurs Educ. 2022;61(12):701-705.].

TRANSALUD: A qualitative study of the healthcare experiences of transgender people in Barcelona (Spain)

Transgender identities are still considered a psychiatric pathology in many countries according to the prevailing biomedical model. However, in recent years, this pathologizing vision has begun to shift towards a perspective that focuses on the diversity of transgender peoples’ experiences. However, some transgender people still face denial of services, discrimination, harassment, and even violence by healthcare professionals, causing them to avoid seeking ongoing or preventive healthcare. This article describes the health experiences of transgender people in Barcelona regarding their access and use of non-specialized health services. Semi-structured interviews were conducted using a descriptive phenomenological approach with sixteen transgender people between December 2018 and July 2019. The data were analyzed descriptively and thematically following the method proposed by Colaizzi with the help of the Atlas.ti8 software. Transgender people care experiences were divided into three categories: overcoming obstacles, training queries, and coping strategies. Participants identified negative experiences and difficulties with the health system due to healthcare providers’ lack of competence. Discriminatory, authoritarian, and paternalist behaviors are still present and hinder the therapeutic relationship, care, and access to healthcare services. There is a fundamental need for the depathologization of transgender reality and training for healthcare professionals in the field of sexual diversity. Training in sexual and gender diversity must be included in the curricula of university courses in the health sciences.

Nursing students' perceptions of the efficacy of narrative photography as a learning method: A cross-sectional study

Although active learning methodologies promote students' creativity and motivation regarding learning objectives, traditional unidirectional teaching methods remain more common. The objective of this study was to determine nursing students' perceptions regarding the efficacy of narrative photography as a learning method, including self-perceived satisfaction. Narrative photography is an art-based technique inspired by Photovoice that promotes empathy, creativity, and reflection. A cross-sectional study was conducted using a nonprobabilistic sample of 66 nursing students from a public university in Barcelona, Spain. Quantitative and qualitative data were collected anonymously using an electronic tool. Descriptive statistics and thematic analyses were used to analyze the data. Sixty valid questionnaires were returned. The respondents found narrative photography's ability to promote creativity and assist understanding of theory to be its most satisfying aspect (>95% somewhat/totally agree). Narrative photography's usefulness, ability to foster self-criticism, and the associated workload was the least satisfactory aspect (>55% somewhat/totally agree). Significant differences regarding satisfaction levels were found for both age and sex. Narrative photography is a helpful and satisfactory learning method, especially for promoting creativity and understanding theoretical concepts.

Narrative photography with an expert patient as a method to improve empathy: a satisfaction study with health sciences students

OBJECTIVES

To assess health sciences students' satisfaction with narrative photography with an expert patient as an empathy-fostering teaching method.

METHODS

Nineteen students from a public medical sciences university in Barcelona (Spain) voluntarily completed six online training sessions using narrative photography and expert patient. Data were collected using an anonymous online satisfaction questionnaire verified by experts, including 29 quantitative and qualitative questions that were analyzed descriptively.

RESULTS

Eighteen valid questionnaires were obtained (90% response rate). All students evaluated the teaching method as highly satisfactory. The main positive aspects of the teaching method were being able to express one's emotions and reflections. Students felt the activity enhanced their empathy and helped them minimize their prejudices, specifically to patients living with HIV. Students also evaluated the online format as less optimal than if it were delivered in person.

CONCLUSION

The students found the teaching method to have a personal and professional impact, which facilitated the integration of empathy in their daily practice when caring for people living with HIV.

Reproductive decision-making of Black women living with HIV: A systematic review

Background:

Black women living with HIV account for a higher proportion of new HIV diagnoses than other groups. These women experience restricted access to reproductive services and inadequate support from healthcare providers because their position in society is based on their sexual health and social identity in the context of this stigmatizing chronic disease. By recognizing the analytical relevance of intersectionality, the reproductive decision-making of Black women can be explored as a social phenomenon of society with varied positionality.

Objective:

The purpose of this review was to synthesize the evidence about the reproductive decision-making of Black women living with HIV in high-income countries from the beginning of the HIV epidemic to the present.

Methods:

This systematic review was guided by the JBI evidence synthesis recommendations. Searches were completed in seven databases from 1985 to 2021, and the review protocol was registered with PROSPERO (CRD420180919).

Results:

Of 3503 records, 22 studies were chosen for synthesis, including 19 observational and three qualitative designs. Nearly, all studies originated from the United States; the earliest was reported in 1995. Few studies provided detailed sociodemographic data or subgroup analysis focused on race or ethnicity. Influencing factors for reproductive decision-making were organized into the following seven categories: ethnicity, race, and pregnancy; religion and spirituality; attitudes and beliefs about antiretroviral therapy; supportive people; motherhood and fulfillment; reproductive planning; and health and wellness.

Conclusion:

No major differences were identified in the reproductive decision-making of Black women living with HIV. Even though Black women were the largest group of women living with HIV, no studies reported a subgroup analysis, and few studies detailed sociodemographic information specific to Black women. In the future, institutional review boards should require a subgroup analysis for Black women when they are included as participants in larger studies of women living with HIV.

Understanding the Expectations of Nursing Students Following the First Clinical Internship: A Qualitative Study

The objective of this study was to describe how nursing students' expectations are achieved after the first clinical internship. A longitudinal qualitative study using purposive sampling was used in a public nursing school in Barcelona, Spain. Fifteen nursing students attending their internship for the first time. Data were collected in 2019 using semi-structured interviews until data saturation was reached. Interviews were conducted before and after the completion of the first clinical internship. The data were analyzed using the thematic analysis method. The students experienced some negative issues they did not think about, such as excessive homework, feeling a worker, not a student, loneliness, and learnings influenced by chance. Positive assessments of the accessibility of the placement location and the experience of the clinical instructor have a powerful influence on the student, allowing for the assessment and integration of the student in the health team. The practical learning is mediated by chance in terms of center, service, teacher, and clinical instructor assigned. It is crucial to establish consensual measures among all the actors involved to facilitate the objectivity of teaching and learning.

Motherhood and decision-making among women living with HIV in developed countries: a systematic review with qualitative research synthesis

BACKGROUND

Women living with HIV (WLH) lack evidence-based information about reproductive options while managing pressures from family, clinicians, and communities to give up the idea of having children. As the reproduction intentions of WLH are not well understood, stigmatizing behaviors force them to hide their disease to avoid rejection by their family, partner, and social networks. Compliance with social norms, fear of stigma, and discrimination influence their experience. Current research is individual qualitative studies lacking the synthesis perspective necessary to guide intervention development. The purpose of this study was to synthesize the evidence to explain the reproductive decision-making process for WLH in developed countries.

METHODS

A systematic review with qualitative research synthesis was conducted through searches in 10 electronic databases (CINAHL, EMBASE, MEDLINE, Scopus, Social Science Citation Index, Web of Science, Google Scholar, Cuidatge, Cuiden Enfispo, and SciELO). Studies published in journals from 1995 to 2019 with qualitative data about reproductive decision-making among WLH in developed countries were eligible for inclusion. Developed country was operationalized by membership in the OECD for comparative conditions of social wellbeing and economic stability. The CASP and JBI checklists for qualitative research were used to assess study quality and methodological integrity. Thematic analysis and qualitative meta-summary techniques were used for the synthesis.

RESULTS

Twenty studies from 12 developed countries were included in the synthesis. Findings were organized into 3 meta-themes from 15 themes and 45 subthemes, including: (1) Shattered identity, (2) Barriers, inequities, and misinformation, (3) Coping, resiliency, and support. Reproductive decision-making was perceived as a complex process influenced by facilitators and barriers. The facilitators helped WLH cope with their new situation to become more resilient, while the barriers made their situation more difficult to manage.

CONCLUSION

WLH encounter reproductive decision-making with knowledge deficits and limited social support. An integrated approach to holistic care with comprehensive multidisciplinary counseling is needed to support WLH. Clinicians could benefit from professional development to learn how to be authentically present for WLH, including engaging in conversations, demonstrating compassion, and understanding situations. Evidence-based clinical practice guidelines need to be tailored for the family planning and sexual health needs of WLH.

The Effectiveness of Care Bundles Including the Braden Scale for Preventing Hospital Acquired Pressure Ulcers in Older Adults Hospitalized in ICUs: A Systematic Review

Background:

Despite technological and scientific advances, Hospital Acquired Pressure Ulcers (HAPUs) remain a common, expensive, but preventable adverse event. The global prevalence ranges from 9% to 53% while three million people develop HAPUs in the United States and 60,000 people die from associated complications. HAPU prevalence is reported as high as 42% in ICUs (ICU) costing on average $48,000 to clinically manage.

Objective:

The purpose of this systematic review was to evaluate the effectiveness of multi-component interventions (care bundles), incorporating the Braden scale for assessment, in reducing the prevalence of HAPUs in older adults hospitalized in ICUs.

Methods:

This was a systematic review of the literature using the Cochrane method. A systematic search was performed in six databases (CINAHL, Cochrane Library, Google Scholar, JBI Evidence-Based Practice Database, PubMed, and ProQuest) from January 2012 until December 2018. Bias was assessed with the Critical Appraisal Skills Programme Checklist, and the quality of evidence was evaluated with the American Association of Critical-Care Nurses Levels of Evidence.

Results:

The search identified 453 studies for evaluation; 9 studies were reviewed. From the analysis, pressure ulcer prevention programs incorporated three strategies: 1) Evidence-based care bundles with risk assessments upon admission to the ICU; 2) Unit-based skincare expertise; and 3) Staff education with auditing feedback. Common clinical management processes included in the care bundles were frequent risk reassessments, daily skin inspections, moisture removal treatments, nutritional and hydration support, offloading pressure techniques, and protective surface protocols. The Braden scale was an effective risk assessment for the ICU. Through early risk identification and preventative strategies, HAPU programs resulted in prevalence reduction, less severe ulcers, and reduced care costs.

Conclusion:

Older adults hospitalized in the ICU are most vulnerable to developing HAPUs. Early and accurate identification of risk factors for pressure is essential for prevention. Care bundles with three to five evidence-based interventions, and risk assessment with the Braden scale, were effective in preventing HAPUs in older adults hospitalized in intensive care settings. Higher quality evidence is essential to better understanding the impact of HAPU prevention programs using care bundles with risk assessments on patient outcomes and financial results.

Nursing students' expectations of their first clinical placement: A qualitative study

BACKGROUND

Clinical placements are a source of meaningful learning that directly impacts professional development. During the first clinical placement, nursing students' expectations are not always fulfilled, which can lead them to feel lost.

OBJECTIVE

To explore nursing students' expectations before the start of their first clinical placement.

METHODS

Descriptive qualitative study. Participants consisted of second-year nursing students studying at a Spanish public university. Data were collected through a semi-structured interview before the start of the first clinical placement. The data were analyzed using thematic analysis, as proposed by Braun and Clarke.

RESULTS

This study included 15 students (2 men and 13 women; age 19-23 years), which was sufficient to reach data saturation. We identified 176 codes, grouped into three categories: a) Expectations of clinical placements: this category highlighted the desire to learn, to integrate theory into practice, to feel fulfilled and students' observation that they lacked knowledge of the role of family and community nurses. b) Motivations to attend clinical placement, commitment, and willingness to learn. c) Personal weaknesses, such as insecurity and inexperience, especially regarding techniques and procedures.

CONCLUSION

The expectations identified in this study serve to illustrate the need to rethink the strategies that should be used to ensure the success of clinical placements and manage students' stress levels. Further research should explore how these perceptions impact on their performance or change after the end of clinical placements.

The meaning of postpartum sexual health for women living in Spain: a phenomenological inquiry

BACKGROUND

Sexual health is a multidimensional phenomenon constructed by personal, social, and cultural factors but continues to be studied with a biomedical approach. During the postpartum period, a woman transitions to mother, as well as partner-to-parent and couple-to-family. There are new realities in life in the postpartum period, including household changes and new responsibilities that can impact the quality of sexual health. This phenomenon is understudied especially in the context of Spain. The purpose of this study was to describe the lived experience of postpartum sexual health among primiparous women giving birth in Catalonia (Spain).

METHODS

This was a phenomenological study with a purposive sample of primiparous women. Data was collected through semi-structured interviews until saturation. Analysis followed Colaizzi's seven-step process with an eighth translation step added to limit cross-cultural threats to validity. Also, the four dimensions of trustworthiness were established through strategies and techniques during data collection and analysis.

RESULTS

Ten women were interviewed from which five themes emerged, including: Not feeling ready, inhibiting factors, new reality at home, socio-cultural factors, and the clinician within the health system. Returning to sexual health led women to engage in experiential learning through trial and error. Most participants reported reduced libido, experienced altered body image, and recounted resumption of sexual activity before feeling ready. A common finding was fatigue and feeling overloaded by the demands of the newborn. Partner support was described as essential to returning to a meaningful relationship. Discussions about postpartum sexual health with clinicians were described as taboo, and largely absent from the care model.

CONCLUSION

Evidence-based practices should incorporate the best evidence from research, consider the postpartum sexual health experiences and preferences of the woman, and use clinician expertise in discussions that include the topic of postpartum sexual health to make decisions. As such, human caring practices should be incorporated into clinical guidelines to recognize the preferences of women. Clinicians need to be authentically present, engage in active communication, and individualize their care. More qualitative studies are needed to understand postpartum sexual health in different contexts, cultures, and countries and to identify similarities and differences through meta-synthesis.

The Patient-centered Medical Home as an Intervention Strategy for Diabetes Mellitus: A Systematic Review of the Literature

BACKGROUND

Poorly managed diabetes mellitus increases health care expenditures and negatively impacts health outcomes. There are 34 million people living with diabetes in the United States with a direct annual medical cost of $237 billion. The patient-centered medical home (PCMH) was introduced to transform primary care by offering team-based care that is accessible, coordinated, and comprehensive. Although the PCMH is believed to address multiple gaps in delivering care to people living with chronic diseases, the research has not yet reported clear benefits for managing diabetes.

OBJECTIVE

The study reviews the scientific literature about diabetes mellitus outcomes reported by PCMHs, and understands the impact of team-based care, interdisciplinary communication, and care coordination strategies on the clinical, financial, and health-related outcomes.

METHODS

The systematic review was performed according to the Cochrane method and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Eight databases were systematically searched for articles. The Oxford Centre for Evidence-based Medicine Levels of evidence and the Critical Appraisal Skills Programme systematic review checklist were used to evaluate the studies.

RESULTS

The search resulted in 596 articles, of which 24 met all the inclusion criteria. Care management resulted in more screenings and better preventive care. Pharmacy-led interventions and technology were associated with positive clinical outcomes, decreased utilization, and cost savings. Most studies reported decreased emergency room visits and less inpatient admissions.

CONCLUSION

The quality and strength of the outcomes were largely inconclusive about the overall effectiveness of the PCMH. Defining and comparing concepts across studies was difficult as universal definitions specific to the PCMH were not often applied. More research is needed to unpack the care model of the PCMH to further understand how the individual key components, such as care bundles, contribute to improved outcomes. Further evaluations are needed for team-based care, communication, and care coordination with comparisons to patient, clinical, health, and financial outcomes.

Nursing students' satisfaction with narrative photography as a method to develop empathy towards people with Hiv: A mixed-design study

BACKGROUND

A major concern for people living with HIV during their lifetime is stigma and discrimination. It is therefore crucial to improve new generations of nurses' empathetic attitude towards these patients to eliminate fear and reduce discrimination using new educational interventions.

OBJECTIVE

To analyze nursing students' satisfaction with narrative photography as a method to develop empathy towards people living with HIV.

DESIGN

Concurrent mixed-method design.

PARTICIPANTS

Seventeen first-year nursing students from a public university in Barcelona, Spain.

METHODS

A 32-item questionnaire was administered at the end of the narrative photography training activity to determine nursing students' satisfaction with the methodology. Sociodemographic, attitudinal, skills, and satisfaction data were collected. Qualitative data were collected using a reflective open-ended question.

RESULTS

Of the participants, 82.4% stated that narrative photography helped them to develop reflective thinking and perceive how people living with HIV may feel. Further, 88.2% said that the new method helped them to eliminate some of their prejudices about HIV/AIDS, consider different points of view, understand the importance of providing humanized care, and identify discriminatory behaviors when caring for people living with HIV. Finally, 70.6% stated that narrative photography taught them more than traditional lectures.

CONCLUSIONS

Nursing students' satisfaction with narrative photography as a teaching strategy is very high; as a result, empathy is advanced in an academic and professional way during the nursing degree. However, more research is needed to demonstrate its efficacy in different scenarios.

Faculty Attitudes About Caring for People Living With HIV/AIDS: A Comparative Study

BACKGROUND

People living with HIV/AIDS (PLHIV) experience stigma and discrimination. Negative attitudes of nursing faculty about caring for PLHIV can adversely affect student perceptions and their nursing care. The study purpose was to describe nursing faculty attitudes and beliefs about caring for PLHIV.

METHOD

The HPASS (Healthcare Provider HIV/AIDS Stigma Scale), Spanish version, was delivered to nursing faculty in Colombia and Peru.

RESULTS

The HPASS was completed by 98 nursing faculty. The overall mean score was 2.41 (SD = 0.69), with subscale scores: stereotypes, 2.55 (SD = 0.84); discrimination, 2.28 (SD = 0.74); and prejudices, 2.41 (SD = 0.63). Peruvian faculty had the highest scores, statistically correlated with the importance of religion, whereas Colombia had the lowest.

CONCLUSION

Nursing faculty attitudes toward PLHIV were slightly positive in Colombia to slightly negative in Peru; however, both countries had negative stereotypes. Knowledge deficiencies about HIV persist and attitudes appear to be influenced by culture and religion. [J Nurs Educ. 2019;58(12):712-717.].

Hospital survey on patient safety culture (HSOPSC): a multi-method approach for target-language instrument translation, adaptation, and validation to improve the equivalence of meaning for cross-cultural research

Background

The Hospital Survey on Patient Safety Culture (HSOPSC) is widely utilized in multiple languages across the world. Despite culture and language variations, research studies from Latin America use the Spanish language HSOPSC validated for Spain and the United States. Yet, these studies fail to report the translation method, cultural adaptation process, and the equivalence assessment strategy. As such, the psychometric properties of the HSOPSC are not well demonstrated for cross-cultural research in Latin America, including Peru. The purpose of this study was to develop a target-language HSOPSC for cross-cultural research in Peru that asks the same questions, in the same manner, with the same intended meaning, as the source instrument.

Methods

This study used a mixed-methods approach adapted from the translation guideline recommended by Agency for Healthcare Research and Quality. The 3-phase, 7-step process incorporated translation techniques, pilot testing, cognitive interviews, clinical participant review, and subject matter expert evaluation.

Results

The instrument was translated and evaluated in 3 rounds of cognitive interview (CI). There were 37 problem items identified in round 1 (14 clarity, 12 cultural, 11 mixed); and resolved to 4 problems by round 3. The pilot-testing language clarity inter-rater reliability was S-CVI/Avg = 0.97 and S-CVI/UA = 0.86; and S-CVI/Avg = 0.96 and S-CVI/UA = 0.83 for cultural relevance. Subject matter expert agreement in matching items to the correct dimensions was substantially equivalent (Kappa = 0.72). Only 1 of 12 dimensions had a low Kappa (0.39), borderline fair to moderate. The remaining dimensions performed well (7 = almost perfect, 2 = substantial, and 2 = moderate).

Conclusions

The HSOPSC instrument developed for Peru was markedly different from the other Spanish-language versions. The resulting items were equivalent in meaning to the source, despite the new language and different cultural context. The analysis identified negatively worded items were problematic for target-language translation. With the limited literature about negatively worded items in the context of cross-cultural research, further research is necessary to evaluate this finding and the recommendation to include negatively worded items in instruments. This study demonstrates cross-cultural research with translated instruments should adhere to established guidelines, with cognitive interviews, based on evidence-based strategies.

Exploration of clients living with HIV needs for reporting on experiences with sex

Talking about sex with people living with HIV receives insufficient attention in health care. A cross-sectional and exploratory study describes the preferences of people living with HIV to talk about sex with specialized HIV physicians and nurses in a clinic in Barcelona (Spain). A 27-item self-administered questionnaire was used between June 2017 and May 2018. One hundred fourteen people agreed to participate. Data were analyzed using multivariate logistic regression. Most of the participants reported "never or almost never" having been asked about sex practices in visits with the HIV specialist physician (n = 65 [57.0%]) or nurse (n = 74 [64.9%]). Older participants stated that neither physicians nor nurses talked about sex during visits. Women felt that physicians hardly ever asked about their sexual practices. Men who had sex with other men indicated that their physicians always asked about their sex practices compared with heterosexuals living with HIV. Health professionals should reformulate how to talk about sex with people living with HIV to facilitate communication and provide adequate care.

Graduated nurses' experiences with baccalaureate thesis writing: A qualitative study

This study explores the perceptions of newly graduated nurses regarding the baccalaureate thesis (BT) writing process. A qualitative approach with content analysis was adopted. Thirteen newly graduated nurses participated in the study. The inclusion criterion was having completed the BT during their university education as nurses within 3 years of the study. Information was obtained through semistructured interviews. Data collection began in June 2018 and ended in March 2019, once saturation of information was reached. Three major categories were identified: the beginning of the process, the advantages of Baccalaureate thesis writing, and the teacher's role. The participants expressed that their training focused on a synthetic and particular type of writing that is necessary for clinical scenarios but not suitable for scientific academic texts. Additionally, reflective diaries were described as a powerful writing practice during their studies. Participants conceive the realization of the baccalaureate thesis as a difficult process, especially as regards selecting, synthesizing, and writing about the available information, processes that they indicated generate anxiety. Academic writing skills should be specifically included in the nursing curriculum.

Adherence to antiretroviral therapy and the associated factors among people living with HIV/AIDS in Northern Peru: a cross-sectional study

Background

There are approximately 72,000 people living with HIV/AIDS (PLHIV) in Peru. Non-adherence to antiretroviral therapy (ART) is the most important factor for therapeutic failure and the development of resistance. Peru has achieved moderate progress in meeting the 90-90-90 targets, but only 60% of PLHIV receiving ART are virally suppressed. The purpose of this study was to understand ART adherence in the Peruvian context, including developing sociodemographic and clinical profiles, evaluating the clinical management strategies, and analyzing the relationships between the variables and adherence of PLHIV managed at a regional HIV clinic in Lambayeque Province (Northern Peru).

Methods

This was a cross-sectional study with 180 PLHIV adults, non-randomly but consecutively selected with self-reported ART compliance (78.2% of the eligible population). The PLHIV profile (PLHIV-Pro) and the Simplified Medication Adherence Questionnaire (SMAQ) were used to collect sociodemographic information, clinical variables, and data specific to ART adherence. Descriptive analysis of sociodemographic and clinical characteristics was performed. Bivariate analysis was performed with the Mann–Whitney test, Chi square test, and Yates correction.

Results

The 180 PLHIV sample included 78.9% men, 49.4% heterosexual, 45% with a detectable HIV-1 viral load less than 40 copies/ml, 58.3% not consistently adherent, and only 26.1% receiving Tenofovir + Lamivudine + Efavirenz. Risk factors significant for non-adherence included concurrent tuberculosis, discomfort with the ART regime, and previous pauses in ART. Multivariate analysis of nested models indicated having children is a protector factor for adherence.

Conclusions

Self-reported adherence appeared to be low and the use of first-line therapy is not being prescribed homogeneously. Factors associated with nonadherence are both medical and behavioral, such as having tuberculosis, pausing ART, or experiencing discomfort with ART. The Peruvian government needs to update national technical standards, monitor medication availability, and provide education to health care professionals in alignment with evidence-based guidelines and international recommendations. Instruments to measure adherence need to be developed and evaluated for use in Latin America.

Spirituality, Social Support, and Diabetes: A Cross-Sectional Study of People Enrolled in a Nurse-Led Diabetes Management Program in Peru

INTRODUCTION

In Peru, people living with diabetes mellitus (PLDM) represent 7% of the adult population, each with a $54,000 lifetime cost. For Latinos, spirituality provides meaning and purpose of life while social support affects behavioral choices and adherence decisions. The purpose of this study was to determine the relationship between spirituality and social support for PLDM participating in a nurse-led diabetes management program in a public hospital in Lima, Peru.

METHOD

This cross-sectional study included adult PLDM (N = 54). The instrument included demographic items and the Spanish versions of the social/vocational concern dimension of the Diabetes Quality of Life Questionnaire and the Reed's scale of spiritual perspective.

RESULTS

There was an inverse relation between social support and spiritually practices (p = .020) and spiritual beliefs (p = .005). PLDM with 5 years or more in the program had significantly higher scores in social support (p = .020) and spiritual practices (p = .010).

CONCLUSION

Spirituality and social support are important factors for managing PLDM. Nurse-led diabetes management programs with Latino participants should consider targeted spiritual and social support strategies to expand the holistic management. Future studies should explore the impact and effectiveness of spiritual and social support interventions on clinical outcomes.

Intervention analysis for low-count time series with applications in public health

It is common in many fields to be interested in the evaluation of the impact of an intervention over a particular phenomenon. In the context of classical time series analysis, a possible choice might be intervention analysis, but there is no analogous methodology developed for low-count time series. In this article, we propose a modified INAR model that allows us to quantify the effect of an intervention, and is also capable of taking into account possible trends or seasonal behaviour. Several examples of application in different real and simulated contexts will also be discussed.

Gay Circuit Parties in Barcelona and Their Impact on Gonorrhea Incidence

This study explored the role of circuit parties on the incidence of gonorrhea among men who have sex with men (MSM) in Barcelona (Spain). Specifically, it aimed to detect cyclic peaks in the number of reported diagnoses of gonorrhea after gay circuit parties. We analyzed monthly cases of gonorrhea reported from January 2007 through December 2016 after the main annual gay circuit parties in Barcelona. We used the integer autoregressive model for time series with discrete values. The performance of the model was tested in heterosexual men and women, in whom the circuit parties could be expected to have no impact. A sensitivity analysis was conducted, changing post-event diagnosis windows to 1 week later/1 week before. In the study period, a total of 4182 of gonorrhea cases were detected, of which 74.8% (n = 2181) occurred in men who identified themselves as MSM. The average annual increase in gonorrhea cases reported among MSM was 32.57%. In an independent analysis of each gay circuit party, cases increased significantly in two of them. The results were also similar for same-sex practices among men only. On controlling for the increasing trend over the study period and the seasonal effect, an average of 1.16 gonorrhea cases in MSM (95% CI: 0.68, 1.64) were attributable to the celebration of one of the gay circuit parties considered. During the expected outbreak, an average of 13 gonorrhea cases were detected and between 5 and 13% were attributable to one of the circuit parties. In view of these findings, participants should consider seeking advice from their healthcare provider and practice safer sex using condoms to prevent sexually transmitted infections. Local public health services should be reinforced to ensure care for participants during and after gay circuit parties. More research is needed to design and implement preventive programs.

Reproductive decision-making in women living with human immunodeficiency virus: A systematic review

OBJECTIVES

Analyze and synthesize the research evidence to understand the reproductive decisions made by women living with HIV from the beginning of the epidemic to the present. Evaluate the barriers and the facilitators for reproductive decision-making. Identify areas of strength, improvement, and those requiring further research.

DESIGN AND DATA SOURCES

Systematic review following the PRISMA guideline. PubMed, CINAHL, PsycINFO, Cochrane Library, SocINDEX, Embase, and Scopus databases were searched from 1985 to 2016 using the following Keywords: HIV, AIDS, pregnancy, reproduction, and decision-making.

STUDY SELECTION

A total of 42 research papers were included in this review. Initially, 1563 papers were identified for the review by database (n=1544) and hand (n=19) searches. With three review levels, 1521 papers were excluded (title review, n=1272; abstract review, n=136; and full paper review, n=113). Studies published in English in peer-reviewed journals using both quantitative and qualitative methods and addressing reproductive decisions in women living with HIV were included. Thirdly, inclusion eligibility was assessed by title, abstract, and full text.

REVIEW METHODS

Random allocation conducted by the primary researcher assigned an equal number of papers to each researcher for review, including detailed instructions with an abstraction form. Discrepancies were resolved by two researchers. Research quality was assessed using the NCHBL Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, the Critical Appraisal Skills Programme for the qualitative studies and its version for systematic reviews RESULTS: The review included 42 papers, both quantitative (n=24) and qualitative methods (n=14). Most studies were completed by physicians (n=16) or nurses (n=15). More than two-thirds of the studies were performed in urban settings with predominantly African-American women (n=27). Eight factors were identified as influencing the reproductive decision-making process in women living with HIV: 'Socio-demographic, Health status and Pregnancy', 'Religion and spirituality', 'Beliefs and Attitudes about Antiretroviral Therapy', 'Healthcare providers', 'Significant others', 'Motherhood and fulfillment', 'Fear of perinatal infection and infection of partner(s)', 'Birth control and pregnancy management'.

CONCLUSIONS

Health care providers are not providing patient-centered care by applying scientific evidence to their practice when advising women with HIV in making reproductive decisions. Despite the strong evidence indicating pregnancy for women with HIV results in a safe birthing trajectory, one not likely to jeopardize the health of the either the mother or fetus, providers continue to recommend the women with HIV avoid pregnancy and neglect to invite partners to participate in the discussion.

Expert patient illness narratives as a teaching methodology: A mixed method study of student nurses satisfaction

OBJECTIVE

To evaluate nursing students' satisfaction with Expert Patient Illness Narratives as a teaching and learning methodology based on patient involvement.

METHODS AND DESIGN

Mixed methods were used in this study: online survey with quantitative and qualitative items designed by researchers.

SETTINGS AND PARTICIPANTS

Sixty-four nursing students of the Universitat Autònoma de Barcelona, attending a Medical Anthropology elective course.

RESULTS

Women more frequently considered that the new learning methodology was useful in developing the competency "to reason to reason the presence of the triad Health-Illness-Care in all the groups, societies and historical moments" (p-value=0.02) and in that it was consolidated as a learning outcome (p-value=0.022). On the other hand, men considered that this methodology facilitated the development of critical thinking (p=0.01) and the ability to identify normalized or deviant care situations (p=0.007). Students recognized the value of Expert Patient Illness Narratives in their nursing training as a way to acquire new nursing skills and broaden previously acquired knowledge. This educational innovation improved nursing skills and provided a different and richer perspective of humanization of care.

CONCLUSIONS

The results of the present study demonstrate that nursing students found Expert Patient Illness Narratives satisfactory as a learning and teaching methodology, and reported improvement in different areas of their training and also the integration of new knowledge, meaning, theory applicability, as well las critical and reflective thinking. Involvement of patients as storytellers also provides a new humanizing perspective of care. Nonetheless, further studies of Expert Patient Illness Narratives are needed in order to improve its benefits as a teaching and learning methodology.

Implementation of evidence on the nurse-patient relationship in psychiatric wards through a mixed method design: study protocol

Background

Psychiatric nurses are aware of the importance of the therapeutic relationship in psychiatric units. Nevertheless, a review of the scientific evidence indicates that theoretical knowledge alone is insufficient to establish an adequate therapeutic alliance. Therefore, strategies are required to promote changes to enhance the establishment of the working relationship. The aims of the study are to generate changes in how nurses establish the therapeutic relationship in acute psychiatric units, based on participative action research and to evaluate the effectiveness of the implementation of evidence through this method.

Methods/Design

The study will use a mixed method design. Qualitative methodology, through participative action research, will be employed to implement scientific evidence on the therapeutic relationship. A quasi-experimental, one-group, pre-test/post-test design will also be used to quantitatively measure the effectiveness of the implementation of the evidence. Participants will consist of nurses and patients from two psychiatric units in Barcelona. Nurses will be selected by theoretical sampling, and patients assigned to each nurses will be selected by consecutive sampling. Qualitative data will be gathered through discussion groups and field diaries. Quantitative data will be collected through the Working Alliance Inventory and the Interpersonal Reactivity Index. Qualitative data will be analysed through the technique of content analysis and quantitative data through descriptive and inferential statistics.

Discussion

This study will help to understand the process of change in a nursing team working in an inpatient psychiatric ward and will allow nurses to generate knowledge, identify difficulties, and establish strategies to implement change, as well as to assess whether the quality of the care they provide shows a qualitative improvement.

The Therapeutic Relationship in Inpatient Psychiatric Care: A Narrative Review of the Perspective of Nurses and Patients

PURPOSE

To study the significance of 'therapeutic relationship' between nurses and patients within the context of a psychiatric hospital.

METHOD

Narrative literature review. Content analysis.

FINDINGS

The significance of the therapeutic relationship is quite similar for both nurses and patients in psychiatric hospital units. Nevertheless, several factors may separate the two positions: the time available for the relationship, the negative perceptions on the part of both parties, and the insecurity of the setting.

PRACTICE IMPLICATIONS

Increased knowledge and understanding of the significance of the therapeutic relationship from the perspective of nurses and patients would allow the strengthening of areas of mutual interest.

Teaching research methods in nursing using Aronson's Jigsaw Technique. A cross-sectional survey of student satisfaction

BACKGROUND

To adapt nursing studies to the European Higher Education Area, new teaching methods have been included that assign maximum importance to student-centered learning and collaborative work. The Jigsaw Technique is based on collaborative learning and everyone in the group must play their part because each student's mark depends on the other students. Home group members are given the responsibility to become experts in a specific area of knowledge. Experts meet together to reach an agreement and improve skills. Finally, experts return to their home groups to share all their findings.

OBJECTIVE

The aim of this study was to evaluate nursing student satisfaction with the Jigsaw Technique used in the context of a compulsory course in research methods for nursing.

METHODS

A cross-sectional study was conducted using a self-administered anonymous questionnaire administered to students who completed the Research Methods course during the 2012-13 and 2013-14 academic years. The questionnaire was developed taking into account the learning objectives, competencies and skills that should be acquired by students, as described in the course syllabus. The responses were compared by age group (younger or older than 22years).

RESULTS

A total of 89.6% of nursing students under 22years believed that this methodology helped them to develop teamwork, while this figure was 79.6% in older students. Nursing students also believed it helped them to work independently, with differences according to age, 79.7% and 58% respectively (p=0.010). Students disagreed with the statement "The Jigsaw Technique involves little workload", with percentages of 88.5% in the group under 22years and 80% in older students. Most believed that this method should not be employed in upcoming courses, although there were differences by age, with 44.3% of the younger group being against and 62% of the older group (p=0.037).

CONCLUSION

The method was not highly valued by students, mainly by those older than 22years, who concluded that they did not learn more with it than with other traditional techniques. The results of this study question whether this form of learning meets students' learning needs and its compatibility with individual and group realities.

Hispano-Americans in Europe: what do we know about their health status and determinants? A scoping review

Background

Policy makers and health practitioners are in need of guidance to respond to the growing geographic mobility of Hispano-American migrants in Europe. Drawing from contributions from epidemiology, social sciences, demography, psychology, psychiatry and economy, this scoping review provides an up-to-date and comprehensive synthesis of studies addressing the health status and determinants of this population. We describe major research gaps and suggest specific avenues of further inquiry.

Methods

We identified systematically papers that addressed the concepts “health” and “Hispano Americans” indexed in five data bases from Jan 1990 to May 2014 with no language restrictions. We screened the 4,464 citations retrieved against exclusion criteria and classified 193 selected references in 12 thematic folders with the aid of the reference management software ENDNOTE X6. After reviewing the full text of all papers we extracted relevant data systematically into a table template to facilitate the synthesising process.

Results

Most studies focused on a particular disease, leaving unexplored the interlinkages between different health conditions and how these relate to legislative, health services, environmental, occupational, and other health determinants. We elucidated some consistent results but there were many heterogeneous findings and several popular beliefs were not fully supported by empirical evidence. Few studies adopted a trans-national perspective and many consisted of cross-sectional descriptions that considered “Hispano-Americans” as a homogeneous category, limiting our analysis. Our results are also constrained by the availability and varying quality of studies reviewed.

Conclusions

Burgeoning research has produced some consistent findings but there are huge gaps in knowledge. To prevent unhelpful generalisations we need a more holistic and nuanced understanding of how mobility, ethnicity, income, gender, legislative status, employment status, working conditions, neighbourhood characteristics and social status intersect with demographic variables and policy contexts to influence the health of the diverse Hispano-American populations present in Europe.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1799-x) contains supplementary material, which is available to authorized users.

Living with constant suffering: a different life following the diagnosis of HIV

We used grounded theory in semi-structured interviews with 32 persons living with HIV (PLWH) in Barcelona, Spain, and found that PLWH live with constant suffering, a core category combining four realities: I need help; My life is constantly controlled; I have a new imposed life; and I have an uncertain reality. Participants described being constantly controlled by health policies and medications. They thought their lives were in the hands of others and that a new life, characterized by the constant fear of stigma, had been imposed on them. They felt they were losing freedom and vitality, as many questions remained unanswered, causing uncertainty related to health and public life. Emotional help was obtained mainly from peers and social networks. Our emergent theory shows a disruptive experience, with serious consequences to individual and social development. Health care has to focus on the real needs of PLWH to reduce suffering and uncertainty.

[Intramuscular vaccine in infants. Suck or not suck?]

INTRODUCTION

The administration of vaccines has been and remains one of the most painful medical techniques for children in primary care consultations. When administering vaccines most professionals still breathing before injecting the vaccine for fear of injection into the bloodstream.

OBJECTIVE

To explore the literature to clarify the need to suck or not before injecting a vaccine.

METHOD

Literature review.

RESULTS

two clinical trials and two systematic reviews were reviewed. No side effects were associated with the action of no-aspiration, however pain was higher among those children who received vaccination after aspiration.

CONCLUSIONS

This technique has been described in the literature as responsible for increasing the pain of the child and the mentioned risk is not scientifically proven. Although there is little literature on the subject, evidence suggests that the administration of vaccines must be made quickly and without hope.

[Sanitary education when dealing with oral anticoagulation treatment]

At present times, it is calculated there are some 800,000 people in Spain who need anticoagulant treatment. Oral anticoagulant treatment is used on those who have suffered a thromboembolic accident and to prevent the appearance of these episodes and their unfortunate consequences. A patient who needs anticoagulant treatment often comes to his/her Primary Health Care Center either for control of his/her anticoagulant medication or for some other chronic process which requires follow-up by the Primary Health Care Center team. It is essential that nursing professionals keep up to date about the latest anticoagulant drugs, especially regarding health education and prevention. This article synthesizes those items available in our environment about health education which should be provided to people undergoing anticoagulant treatment.

[How to treat a bed sore with a tendon exposed]

Bed sores are a serious social, health and legal problem since they imply serious consequences for the quality of life of the person affected and his/her caretakers; besides they create an enormous sanitary cost, both at the level of material as well as human resources. The author describes the case of an 84 year-old woman who has a stage IV bed sore with a tendon exposed; the interdisciplinary and integral treatment of her case by the Primary Health Care Center succeeded in curing her wound in 59 days.

[Prevalence of bed sores in geriatrics nursing home residences]

The number of nursing homes to provide the elderly with in-residence care has increased considerably However, the quality control policies for those centers have not grown at the same speed. Estimates show that 95% of bed sores, ulcers caused by pressure, are potentially avoidable; therefore, their appearance has a direct relationship to the quality of treatment provided. This study is a transversal descriptive study which randomly reviews 364 clinical cases of institutionalized patients. The investigators gathered in socio-demographic variables, cognitive state, presence of bed sores and associated pathologies. These data were analyzed by means of SPSS 13.0. Advanced age, female gender altered cognitive state, invalid-making pathology are risk factors to suffer bed sores in nursing homes. The investigators find evidence that it is necessary to carry out studies specifically designed to evaluate the sanitary impact of bed sores in nursing homes.

[Psycho-social necessities for an informal caretaker]

Of the many activities which nurses in primary attention care teams carry out, health promotion and prevention of diseases have a prominent place. These activities are not carried out only in Primary Attention Care Centers. For some time now, there has been a tendency to keep dependent patients in their homes as much as possible. For this reason, At Home Care has an important place in nurses' daily practices. This article reviews the concept of an informal caretaker and the main reasons which can cause an overload. At the same time, the authors show the tool which nurses use to know the emotional state of informal caretakers, as well as the environment and the circumstances where they are found. The authors propose to use nursing diagnoses as a planning tool for objectives and action strategies to overcome the shortages detected.