The influence of Anglo-American theoretical models on the evolution of the nursing discipline in Spain.

In Spain, the introduction of the new Diploma in Nursing in 1977 saw the role of nurses shifting from that of medical assistants with technical skills to being independent members of the healthcare team with specific responsibility for providing professional nursing care. Here, we analyse the evolution of the nursing profession in Spain following the transfer of nurse education to universities, doing so through interviews with the first generation of academic tutors. This was a qualitative study using the method of analytic induction and based on the principles of grounded theory. Participants were selected by means of theoretical sampling and then underwent in-depth interviews. Steps were taken to ensure the credibility, transferability, dependability and confirmability of data. The main conclusion of the analysis is that there is a gap between a theoretical framework borrowed from the Anglo-American context and a nursing practice that, in Spain, has traditionally prioritised the application of technical procedures, a role akin to that of a medical assistant. It is argued that a key factor underlying the way in which nursing in Spain has evolved in recent decades is the lack of conceptual clarity regarding what the role of the professional nurse might actually entail in practice.

Professional responsibility and decision-making in the context of a disease-focused model of nursing care: The difficulties experienced by Spanish nurses.

When, in 1977, nurse education in Spain was transferred to universities a more patient-centred, the Anglo-American philosophy of care was introduced into a context in which nurses had traditionally prioritised their technical skills. This paper examines the characteristics of the nurse's professional role in Spain, where the model of nursing practice has historically placed them in a position akin to that of physician assistants. The study design was qualitative and used the method of analytic induction. Participants were selected by means of theoretical sampling and then underwent in-depth interviews. The resulting material was analysed using an approach based on the principles of grounded theory. Strategies were applied to ensure the credibility, transferability, dependability and confirmability of the findings. The main conclusion is that nurses in Spain continue to work within a disease-focused model of care, making it difficult for them to take responsibility for decision-making.

Informed consent: A study of patients with life-threatening illnesses.

BACKGROUND: The relationship between healthcare professionals and patients in the Spanish health sector has undergone dramatic change. One aspect of this is that the use of informed consent has become a key factor in the delivery of adequate healthcare. But although a certain period of time has already passed since informed consent started to be used, in Spain there is still doubt about how adequately informed consent is being used. OBJECTIVES: (a) To look at how patients understand the notion and purpose of informed consent, and (b) how the informed consent is applied - the way patients receive such information affects their level of participation and decision making during the time they receive medical care. METHODOLOGY: We use interpretative description of interviews with patients. We developed guiding questions for the interviews with patients in two preliminary and exploratory focus groups. Then, we carried out 20 personal open-ended interviews with 20 purposive selected patients with illnesses that had a serious impact on their lives. Ethical considerations: Permission from ethical committees and institutions involved in the study, and consent and confidentiality were ensured before conducting the research. RESULTS: The findings show that while patients agreed that their consent should be necessary for health professionals to be able to intervene, they had serious difficulty obtaining and then understanding information offered to them at the moment when they were being asked to sign informed consent documents. The participants were critical of the consent documents, which they considered were treated as merely a formality and even some of them had felt coerced to sign. DISCUSSION: Participants confirmed that the informed consent documents that they signed did not meet their ethical objectives. Their perception of the purpose of consent indicates that informed consent document may still be largely understood as a formality rather an ethical obligation.

[Emergence of the nursing model transmitted in Spanish universities: an analytical approach through Grounded Theory]. / Emergencia del modelo de enfermería transmitido en las universidades españolas: una aproximación analítica a través de la Teoría Fundamentada.

The scope of this paper was to ascertain the meaning of the term "nursing" among teaching nurses at Spanish universities. The research was qualitative, and the strategy used was analytical induction. Sampling was theoretical and focused on the selection of extreme cases and the data collection technique was in-depth interviews. The analysis was carried out using the specific Grounded Theory technique. Strategies were established to ensure credibility, portability, confirmability and auditability. Based on the analysis of the data, three categories were identified that responded to the planned objective: it is a "human activity linked to motherhood," a "vocation to help others that some people have" and an "activity that takes care of the needs of others respecting their identity." It can be concluded that in Spanish universities a model of nurse is being transmitted where the proper role of care is inherent to the feminine gender and the vocation of service to others that some people have. This is the reason why the Spanish Royal Academy (RAE) only identifies the role of technical assistance to medicine as a professional element of nursing.

El objetivo fue conocer el significado del término "enfermería" para las enfermeras docentes de las universidades españolas. El diseño fue cualitativo. Como estrategia se utilizó la inducción analítica. El muestreo fue teórico y enfocado en la selección de casos extremos. La técnica de recogida de datos fue la entrevista en profundidad. El análisis se llevó a cabo mediante la técnica específica de la Teoría Fundamentada. Se establecieron estrategias para asegurar la credibilidad, transferibilidad, confirmabilidad y auditabilidad. A partir del análisis de los datos se identificaron tres categorías que dieron respuesta al objetivo planteado: es una "actividad humana vinculada a la maternidad", una "vocación de ayuda al otro que tienen algunas personas" y una "actividad que atiende las necesidades de los demás respetando su identidad". Se puede concluir que en las universidades españolas se está transmitiendo un modelo de enfermera donde el rol propio de cuidado es inherente al género femenino y a la vocación de servicio al otro que tienen algunas personas. Esto es causa de que la Real Academia de la Lengua Española sólo identifique el rol de asistencia técnica a la medicina como elemento profesional de la enfermería.

Transfer of nurse education to universities under a model of person-centred care: A consequence of changes in Spanish society during the democratic transition.

BACKGROUND: In Spain the transfer of nurse education to universities was accompanied by a shift towards a model of person-centred care. AIM: To explore whether the change in nurses' professional profile (from physician assistant to providers of person-centred care) was a response to changing needs in Spanish society. DESIGN: Qualitative study. METHODS: Theoretical sampling and in-depth interviews using an inductive analytical approach. RESULTS: Four categories described the nursing profession in Spain prior to the introduction of university training: the era of medical assistants; technologisation of hospitals; personal care of the patient based on Christian values; professional socialisation differentiated by gender. Further analysis showed that these categories could be subsumed under a broader core category: the transfer of nurse education to universities as part of Spain's transition to democracy. CONCLUSION: The transfer of nurse education to universities was one of several changes occurring in Spanish society during the country's transition to democratic government. The redefined public health system required a highly skilled workforce, with improved employment rights being given to female health professionals, notably nurses.

The use of clinical practice guidelines in primary care: professional mindlines and control mechanisms.

OBJECTIVE: To identify the relevant barriers and enablers perceived by primary care professionals in implementing the recommendations of clinical practice guidelines (CPG). METHODS: Two focus groups were conducted with primary care physicians and nurses in Catalonia (Spain) between October and December 2012. Thirty-nine health professionals were selected based on their knowledge and daily use of CPG. Finally, eight general practitioners and eight nurses were included in the discussion groups. Participants were asked to share their views and beliefs on the accessibility of CPG, their knowledge and use of these documents, the content and format of CPG, dissemination strategy, training, professional-patient relationship, and the use of CPG by the management structure. We recorded and transcribed the content verbatim and analysed the data using qualitative analysis techniques. RESULTS: Physicians believed that, overall, CPG were of little practical use and frequently referred to them as a largely bureaucratic management control instrument that threatened their professional autonomy. In contrast, nurses believed that CPG were rather helpful tools in their day-to-day practice, although they would like them to be more sensitive to the current role of nurses. Both groups believed that CPG did not provide a response to most of the decisions they faced in the primary care setting. CONCLUSIONS: Compliance with CPG recommendations would be improved if these documents were brief, non-compulsory, not cost-containment oriented, more based on nursing care models, sensitive to the specific needs of primary care patients, and integrated into the computer workstation.

Emergencia del modelo de enfermería transmitido en las universidades españolas: una aproximación analítica a través de la Teoría Fundamentada / Emergence of the nursing model transmitted in Spanish universities: an analytical approach through Grounded Theory

Resumen El objetivo fue conocer el significado del término "enfermería" para las enfermeras docentes de las universidades españolas. El diseño fue cualitativo. Como estrategia se utilizó la inducción analítica. El muestreo fue teórico y enfocado en la selección de casos extremos. La técnica de recogida de datos fue la entrevista en profundidad. El análisis se llevó a cabo mediante la técnica específica de la Teoría Fundamentada. Se establecieron estrategias para asegurar la credibilidad, transferibilidad, confirmabilidad y auditabilidad. A partir del análisis de los datos se identificaron tres categorías que dieron respuesta al objetivo planteado: es una "actividad humana vinculada a la maternidad", una "vocación de ayuda al otro que tienen algunas personas" y una "actividad que atiende las necesidades de los demás respetando su identidad". Se puede concluir que en las universidades españolas se está transmitiendo un modelo de enfermera donde el rol propio de cuidado es inherente al género femenino y a la vocación de servicio al otro que tienen algunas personas. Esto es causa de que la Real Academia de la Lengua Española sólo identifique el rol de asistencia técnica a la medicina como elemento profesional de la enfermería.

Abstract The scope of this paper was to ascertain the meaning of the term "nursing" among teaching nurses at Spanish universities. The research was qualitative, and the strategy used was analytical induction. Sampling was theoretical and focused on the selection of extreme cases and the data collection technique was in-depth interviews. The analysis was carried out using the specific Grounded Theory technique. Strategies were established to ensure credibility, portability, confirmability and auditability. Based on the analysis of the data, three categories were identified that responded to the planned objective: it is a "human activity linked to motherhood," a "vocation to help others that some people have" and an "activity that takes care of the needs of others respecting their identity." It can be concluded that in Spanish universities a model of nurse is being transmitted where the proper role of care is inherent to the feminine gender and the vocation of service to others that some people have. This is the reason why the Spanish Royal Academy (RAE) only identifies the role of technical assistance to medicine as a professional element of nursing.