Stress, mental health, and protective factors in nursing students: An observational study.

BACKGROUND: Nursing students suffer high levels of stress, especially in the first year. OBJECTIVES: to compare academic stress at the beginning and end of nursing studies; to analyse the relationships between academic stress, mental health, and protective factors; and to examine whether resilience mitigates the effect of academic stress on psychological well-being. DESIGN: A cross-sectional study. SETTING AND PARTICIPANTS: Sample was 370 first- and fourth-year nursing students from Spain (University of Castilla-La Mancha, University of Cantabria, and University of Sevilla). VARIABLES AND DATA COLLECTION: We assessed academic and clinical stress, coping skills, anxiety, depression, psychological well-being, and resilience were measured. DATA ANALYSIS: We performed a descriptive analysis of the study sample, as well as correlation and hierarchical regression models. Additionally, mediation models were estimated. RESULTS: First-year students presented higher academic stress than fourth-year students. Clinical stress, anxiety, depression, and emotional coping predicted academic stress, while academic stress, depression, and coping skills predicted psychological well-being. Mediation models showed a significant path between academic stress, resilience, depression, and psychological well-being. CONCLUSION: Academic stress has a detrimental effect on the mental health. Coping strategies and resilience may be protective factors that should be encouraged in interventions designed to improve psychological well-being.

The impact of incorporating a simulation program into the undergraduate nursing curricula: A cross-sectional descriptive study.

AIM: To determine the degree of satisfaction for each academic year and according to the type of simulation performed (simulated patient actor/advanced simulator) among nursing students after the use of clinical simulation. INTRODUCTION: Clinical simulation is currently being incorporated in a cross-cutting manner throughout undergraduate nursing education. Its implementation requires a novel curricular design and educational changes throughout the academic subjects. DESIGN: A cross-sectional descriptive study was performed. METHODS: During the academic years 2018-2019 and 2019-2020, 425 students completed the High-Fidelity Simulation Satisfaction Reduced Scale for Students based on 25 questions and six factors, with a total score between 0 and 125. In total, 91 simulation sessions were performed among students who had different degrees of clinical and previous experience with simulation as well as standardized patient versus advanced simulator. A bivariate analysis was performed, comparing the total scores and the different subscales by sex, previous experience, academic year, and simulation methodology. Linear regression was used for both bivariate and multivariate analysis. RESULTS: The mean scale score was 116.8 (SD=7.44). The factor with the highest score was "F2: feedback or subsequent reflection", with a mean score of 14.71 (SD=0.73) out of 15. Fourth year students scored the highest (mean=119.17; SD=5.28). Students who underwent simulation training with a simulated patient actor presented a higher level of overall satisfaction (p<0.05) (Mean=120.31; SD=4.91), compared to students who used an advanced simulator (Mean=118.11; SD=5.75). CONCLUSIONS: Satisfaction with the simulation program was higher in fourth-year students compared to first-year students and was also higher when a simulated patient actor was used compared to an advanced simulator. The most highly valued aspect was the subsequent debriefing or reflective process.

Transcultural adaptation of the revised caregiving appraisal scale (RCAS) in the Spanish population.

AIM: To develop a transcultural adaptation of the Revised Caregiving Appraisal Scale among Spanish caregivers of dependent older people and to test the psychometric properties of the scale. DESIGN: Cross-sectional study. METHODS: The Revised Caregiving Appraisal Scale was transculturally adapted to the Spanish population following the methodology of direct and back translation. The Spanish version of the Revised Caregiving Appraisal Scale was administered to a total of 182 family caregivers of older dependent people. The study began in January 2016 and ended in December of the same year. The construct validity was studied by means of the scree plot and parallel analysis. The exploratory factorial analysis was carried out, and the correlation between factors was studied. To verify the reliability of the process, Cronbach's alpha and homogeneity were calculated by the corrected total item correlation. The validity of the convergent criterion was studied by means of the Pearson correlation coefficient, using the Zarit Caregiver Load Interview and the Family Satisfaction Scale as the gold standard. RESULTS: The construct validity revealed three factors: 'Subjective Burden' (15 items), 'Satisfaction' (7 items) and 'Competence' (3 items). The Cronbach alpha was .86 for 'Subjective Burden', .74 for 'Satisfaction' and .74 for 'Competence'. The corrected total item correlation was greater than .25. The validity of the convergent criterion of the 'Subjective Burden' and 'Competence' factors with the 'Zarit Caregiver's Load Interview' presented a very high statistically significant correlation, unlike 'Satisfaction' which presented a low positive correlation with the 'Family Satisfaction Scale'. CONCLUSION: The Spanish version of the Revised Caregiving Appraisal Scale is a valid and reliable scale according to the tests performed on a random sample of family caregivers of older dependent people in Spain. IMPACT: This scale will enable the simultaneous assessment of negative ('Subjective Burden' and 'Competence') and positive ('Satisfaction') perceptions among family caregivers of older dependent people.

COVID-19 Infection among Nursing Students in Spain: The Risk Perception, Perceived Risk Factors, Coping Style, Preventive Knowledge of the Disease and Sense of Coherence as Psychological Predictor Variables: A Cross Sectional Survey.

The exploration of patterns of health beliefs about COVID-19 among nursing students may be beneficial to identify behaviors, attitudes and knowledge about contagion risk. We sought to analyze the variables of risk perception, perceived risk factors, coping style, sense of coherence and knowledge of preventive measures as possible predictors of having suffered from COVID-19. Participants were nursing students from 13 universities in Spain. Sociodemographic and health variables were collected. To test the independent variables, the Perception Risk Coping Knowledge (PRCK-COVID-19) scale was created and validated because there was no specific survey for young people adapted to the pandemic situation of COVID-19. It was validated with adequate psychometric properties. A total of 1562 students (87.5% female, mean age 21.5 ± 5.7 years) responded. The high perception of the risk of contagion, the high level of knowledge and a coping style focused on the situation were notable. Significant differences by gender were found in the coping styles, problem-focused, avoidance and knowledge scales, with women scoring higher in all categories. The multiple regression analysis was significant (F = 3.68; p < 0.001). The predictor variables were the coping styles subscale search for support and the intrinsic and extrinsic perceived risk factors. Our model predicts that nursing students with a social support-based coping style are at a higher risk of becoming infected with COVID-19, based on their own health belief model.

Design and Validation of a Questionnaire on Risk Perception, Coping Behaviors and Preventive Knowledge against COVID-19 among Nursing Students.

As shown in the previous literature, in view of the future responsibilities of nursing professionals and the consequences for healthcare, it is of great interest to examine their risk perceptions, coping behaviors, and sense of coherency during the COVID-19 pandemic. The purpose of this study is to design and to validate a specific questionnaire that evaluates the factors relating to perceived risk, coping behaviors, and preventive knowledge against COVID-19 infection among nursing students from Spain. This is a psychometric study of a questionnaire's design and its validation in 1562 nursing students at 16 undergraduate nursing institutions in Spain. An ad-hoc survey was designed by a panel of six experts drawing from the literature. After a trial test, the questionnaire was formed with four scales (perception, risk, coping, and knowledge of preventive practices for COVID-19), with a total of 69 items. The final questionnaire was composed of 52 items grouped into four scales, with good psychometric properties to measure risk perception (Cronbach's alpha 0.735), factors related to perceived risk (Cronbach's alpha 0.653), coping behaviors (Cronbach's alpha 0.80), and knowledge of preventive practices against COVID-19 (Cronbach's alpha 0.77). This questionnaire, specifically designed and validated for nursing students, is the first to address four important areas in the development of preventive measures against COVID-19.

The Influence of the COVID-19 Pandemic on the Clinical Application of Evidence-Based Practice in Health Science Professionals.

(1) Background: Evidence-based practice (EBP) informs daily clinical interventions with the purpose of seeking changes to traditional practice through scientific evidence that justifies the reasons for our actions. The objectives were to describe the barriers, beliefs, and attitudes in the application of EBP among university health professionals (not doctors) and to evaluate the influence of the COVID-19 pandemic among them. (2) Methods: This prospective study is both descriptive and observational. The individuals under study were university health professionals (not doctors) from various autonomous regions within Spain, in both public and private spheres. Sociodemographic and labor-related variables linked to the research and its completion were studied. Likewise, the survey instrument Health Sciences Evidence-Based Practice questionnaire (HS-EBP) was administered to evaluate the barriers to, beliefs in, and attitudes towards evidence-based practice. (3) Results: A total of 716 responses were gathered, of which 387 were collected during the period of confinement, and 343 in the COVID-19 post-confinement period. Possible associations that might help respond to the objectives were explored through a correlational study between the sociodemographic variables and each sub-scale of the HS-EBP 30 questionnaire (n = 716). (4) Conclusions: Barriers to, beliefs in, and attitudes towards evidence-based practice are described. There is a leadership gap where line management provides insufficient motivation to follow work routines. The COVID-19 pandemic has caused immense stress among health professionals. The post-confinement group showed a significant change in the variables "beliefs and attitudes", and likewise in the "evaluation" block, justified by the need to update knowledge and to apply evidence.

Effectiveness of a telephone intervention based on motivational health coaching for improving the mental health of caregivers of people with dementia: A randomised controlled trial.

OBJECTIVES: Caring for a family member with dementia is considered one of the activities with the greatest negative impact on a person's mental health. Developing long-lasting and effective strategies is a challenge for caregivers. This study sought to evaluate the impact of an intervention based on a programme of motivational coaching delivered by telephone in a group of caregivers of patients with dementia compared to a control group. METHODS: A randomised controlled trial with a control group and an intervention group. (CONSORT guidelines were used). Telephone calls were made during six weeks, involving a process of coaching and motivational interviews. The following variables were measured in caregivers: self-efficacy of caring, depression, perceived stress, frequency of problematic behaviours and dysfunctional thoughts. Assessments were conducted at three time points: baseline, post-intervention and three months' post-intervention. RESULTS: In total, 106 caregivers participated (53 subjects in the control group and 53 in the intervention group). Statistically significant differences (ANCOVA) were found between both groups for the self-efficacy and stress variables, with improved results in the intervention group (p < .01). Furthermore, statistically significant differences were found in the intervention group between the baseline and post-intervention assessments, with improvements in self-efficacy, decreased stress and decreased dysfunctional thoughts (p < .05). The results were maintained over time for both groups. CONCLUSIONS: An intervention based on telephone calls using a health coaching approach with motivational interviewing appears to be effective for the improvement of self-efficacy and mental health of caregivers of people with moderate dementia. Furthermore, these effects appear to be maintained over time.

Design of the EBE-ST Questionnaire among Nursing Students: Multicenter Study from Eight Universities in Spain.

BACKGROUND: Twenty years after the degree in nursing was introduced in Spain, the subject of evidence-based nursing is still unstructured and unestablished in most faculties. Moreover, there are hardly any rigorous studies at a national level that evaluate the current state of this competence in our faculties. Understanding the starting point is essential for the curricular design to ensure that evidence-based practice is implemented among future professionals. AIM: To design and validate an evidence-based nursing competency questionnaire for fourth-year nursing students. METHODS: A specific questionnaire was developed and validated (EBE-ST). A cross-sectional survey design with psychometric validation of an instrument. Participants were 304 senior year nursing students from eight universities in Spain (2020). RESULTS: The EBE-ST questionnaire is composed of 33 items that determine eight factors. It presents adequate reliability and validity (alpha = 0.882), measuring knowledge, attitudes and the practical application of evidence-based practice. CONCLUSIONS: We have created an instrument with good psychometric properties to measure evidence-based practice competence among senior nursing students. The heterogeneity of knowledge regarding evidence-based nursing in our country suggests that further reflection is warranted on the incorporation of this topic during undergraduate training. We have designed and validated an evidence-based nursing competency questionnaire specific to nursing students.

Nursing Students' Satisfaction: A Comparison between Medium- and High-Fidelity Simulation Training.

Training based on clinical simulation is an effective method of teaching in nursing. Nevertheless, there is no clear evidence about if it is better to use high- or medium-fidelity simulation. The aim is to analyse if students are more satisfied when their clinical simulation practices are based on high-fidelity simulation (HFS) or medium-fidelity simulation (MFS). Students´ satisfaction was assessed using the Satisfaction Scale Questionnaire with High-Fidelity Clinical Simulation. The sample is composed of 393 students from two Spanish Universities. Satisfaction with simulation in nursing students is significantly greater in MFS than HFS. Simulation is beneficial for learning in all its forms, but for the acquisition of basic skills, and at a lower cost, MFS proves to be effective. However, high-fidelity is not always better than medium-fidelity as this depends on the student's level of knowledge and clinical experience.

Experiences of geriatric nurses in nursing home settings across four countries in the face of the COVID-19 pandemic.

AIM: To explore the emotional impact and experiences of geriatric nurses working in nursing homes and caring for patients with coronavirus 2019 disease (COVID-19). DESIGN: This is a qualitative study with phenomenological method and data were gathered through in-depth interview. METHODS: The experiences and expectations that nurses are facing during their care duties were explored via video conference, using a semi-structured interview guide. We have followed the Consolidated criteria for reporting qualitative research COREQ. RESULTS: Interviews (N=24) were conducted with nurses from four countries (Spain, Italy, Peru, and Mexico) during April 2020. Three main categories were extracted: fear of the pandemic situation, the sense of duty and professional commitment, and emotional exhaustion. CONCLUSIONS: Regardless of the country and situation, in the face of the pandemic, dramatic situations have been experienced in nursing homes worldwide, with nursing staff feeling exhausted and overwhelmed, and reflection is urged on a global level to consider the most appropriate model of care in nursing homes.

The Spanish version of the stressors in nursing students scale.

WHAT IS KNOWN ON THE SUBJECT?: The mental health of health professionals is affected by their own work. Nurses and nursing students face high levels of stress, which results in anxiety, burnout, and depression. There are scales that allow the measurement of specific stress levels of nursing students, especially when they first attend their clinical practices in real settings such as hospitals. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Our study consists of validating an existing scale (the Stressors in Nursing Students Scale, SINS) that measures these stress levels in Spanish. Stress is an issue for nursing students and is related to the specific stressors they encounter in the process of their professional work and study. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The validation and adaptation of this scale to Spain will allow us to adequately assess the stress levels of our students to give them adequate tools for the emotional control of their anxiety and stress. Once we have a reliable and appropriate tool for measuring the factors of greater impact in the generation of stress, we can implement preventive measures which may be very useful for the control of anxiety. ABSTRACT: Introduction Nursing professionals and students suffer a greater number of stressors with negative health consequences. Aim To translate and test a Spanish version of the Stressors in Nursing Students Scale (SINS-S), with a cohort of nursing students in Spain. Also, we sought to examine the factor structure of this test and explore the psychometric structure of stress among this population. Method The SINS scale was translated into Spanish and administered to a cohort (n = 398) of male and female Spanish nursing students in the final three years of their nursing program. Data were analyzed using exploratory factor analysis. Results Exploratory factor analysis revealed four factors: "Clinical," "Financial," "Confidence," and "Education." Discussion There were similarities between the perception of stressors by nursing students in Spain compared with the original version of the SINS from the United Kingdom. Stress is an issue for nursing students and is related to the specific stressors they encounter in the process of their professional work and study.

Descriptive study of the satisfaction of nursing degree students in high-fidelity clinical simulation practices. / Estudio descriptivo de la satisfacción de los estudiantes del Grado en Enfermería en las prácticas de simulación clínica de alta fidelidad.

OBJECTIVE: To describe the level of satisfaction of nursing students with clinical simulation in their undergraduate training. METHOD: a descriptive observational study of a retrospective cross section was conducted in undergraduate students in Nursing during the academic years 2016-17 and 2017-18. The instrument used was the High Fidelity Clinical Simulation satisfaction scale in students (ESSAF), a validated, anonymous and self-administered questionnaire (alpha .857) to measure the level of satisfaction after high-fidelity clinical simulation practices. RESULTS: Data were collected from a total of 269 students, of which 63.3% were women and the average age of the sample was 21.68±13.46 years. The analysis of frequencies shows results of the grade of satisfaction over 89%, especially in decision-making, the ability to prioritize and learning procedures. Of the answers, 87% exceeded an average of 4 out of 5. The questions in the questionnaire with answers higher than 4.6 were the realism of the cases (4.71), the teacher provides constructive feedback after each session (4.65), the simulation relates theory to practice (4.72), the analysis (debriefing) at the end of the session helps reflection on the cases (4.65) and practical utility (4.69). CONCLUSIONS: Nursing students from the University of Cantabria (Spain) report high satisfaction in high fidelity clinical simulation, confirming its usefulness in the learning process.

Student nurses at Spanish universities and their attitude toward xenotransplantation.

INTRODUCTION: Recent immunological and transgenic advances are a promising alternative using limited materials of human origin for transplantation. However, it is essential to achieve social acceptance of this therapy. OBJECTIVE: To analyze the attitude of nursing students from Spanish universities toward organ xenotransplantation (XTx) and to determine the factors affecting their attitude. MATERIALS AND METHODS: Type of study: A sociological, multicentre, and observational study. STUDY POPULATION: Nursing students enrolled in Spain (n = 28,000). SAMPLE SIZE: A sample of 10 566 students estimating a proportion of 76% (99% confidence and precision of ±1%), stratified by geographical area and year of study. Instrument of measurement: A validated questionnaire (PCID-XenoTx-RIOS) was handed out to every student in a compulsory session. This survey was self-administered and self-completed voluntarily and anonymously by each student in a period of 5-10 min. STATISTICAL ANALYSIS: descriptive analysis, Student's t test, the chi-square test, and a logistic regression analysis. RESULTS: A completion rate: 84% (n = 8913) was obtained. If the results of XTx were as good as in human donation, 74% (n = 6564) would be in favor and 22% (n = 1946) would have doubts. The following variables affected this attitude: age (P < 0.001); sex (P < 0.001); geographical location (P < 0.001); academic year of study (P < 0.001); attitude toward organ donation (P < 0.001); belief in the possibility of needing a transplant (P < 0.001); discussion of transplantation with one's family (P < 0.001) and friends (P < 0.001); and the opinion of one's partner (P < 0.001). The following variables persisted in the multivariate analysis: being a male (OR = 1.436; P < 0.001); geographical location (OR = 1.937; P < 0.001); an attitude in favor of donation (OR = 1.519; P < 0.001); belief in the possibility of needing a transplant (OR = 1.497; P = 0.036); and having spoken about the issue with family (OR = 1.351; P < 0.001) or friends (OR = 1.240; P = 0.001). CONCLUSIONS: The attitude of nursing students toward organ XTx is favorable and is associated with factors of general knowledge about organ donation and transplantation and social interaction.

Nursing students' emotional intelligence, coping styles and learning satisfaction in clinically simulated palliative care scenarios: An observational study.

BACKGROUND: Emotional intelligence is highly relevant in palliative care training, considering the coping styles used by nursing students. Clinical simulation provides the opportunity to evaluate these variables in a realistic and natural context. OBJECTIVES: To analyze the possible relation between emotional intelligence, coping styles and satisfaction with one's own self-learning in nursing students participating in simulated scenarios related to palliative care at the end of life. METHODS: A descriptive, observational and correlational study of students in their second year of nursing at a Spanish University during the 2015/2016 academic year. Three variables were measured: emotional intelligence (Trait Meta-Mood Scale-24), coping styles (the Questionnaire for Dealing with Stress) and satisfaction with students' own learning (Student Satisfaction and Self-Confidence in Learning Scale, Spanish version CSLS-Sv). RESULTS: In total, 74 students participated in this study (ME: 20.3years). An association was found between satisfaction with learning, according to the EI attention subscale (in which the highest scores were registered) and two specific coping styles (FSP, with high scores and open emotional expression). CONCLUSIONS: Emotional intelligence and coping styles are desirable qualities in students, especially as they have a relevant role in satisfaction with one's own learning. Nonetheless, in part, these results depend on the characteristics of the educational activities designed, which is especially relevant in simulation applied to palliative care.

Association among presence of cancer pain, inadequate pain control, and psychotropic drug use.

INTRODUCTION: Pain is a common symptom in cancer patients, and its control and management are complex. Despite the high concomitant use of psychotropic drugs among such patients, the association among pain, inadequate pain control, and psychotropic drug use has not been fully determined. This study examined the prevalence of cancer pain and inadequate pain control and the association with psychotropic drug use. MATERIALS AND METHODS: In this cross-sectional study, we investigated 402 medical records obtained by simple random sampling of oncology patients at a hospital in northern Spain from July 2012 to July 2014. Adjusted odds ratios (ORs) were estimated together with their 95% confidence intervals (95% CIs) by unconditional logistic regression for each type of psychotropic drug (anxiolytics, hypnotics, and antidepressants). RESULTS: The mean patient age was 61.17 (standard deviation ± 13.14) years; 57.5% were women, 42.5% men. Pain was present in 18.4% of patients and inadequate pain control in 54.2%. We found a statistically significant association between the presence of cancer pain and anxiolytic use (adjusted OR, 3.15; 95% CI, 1.49-6.68) and hypnotic use (adjusted OR, 5.19; 95% CI, 1.77-15.25). Inadequate pain control was associated to a greater extent with the use of those drugs: adjusted OR for anxiolytic use, 4.74 (95% CI, 1.91-11.80); adjusted OR for hypnotic use, 6.09 (95% CI, 1.74-21.32). By contrast, no association was found between pain and antidepressant use (adjusted OR, 0.99). CONCLUSION: The presence of pain and (to a greater extent) poor pain control were associated with increased use of certain psychotropic drugs, such as anxiolytics and hypnotics. There appeared to be no association between pain and antidepressant use.

Validation of the Spanish Version of the ICECAP-O for Nursing Home Residents with Dementia.

BACKGROUND: Measurement of health-related quality of life (HRQoL) is important for a chronic disease, such as dementia, which impairs the quality of life of affected patients in addition to their length of life. This is important in the context of economic evaluations when interventions do not (only) affect HRQoL and these other factors also affect overall quality of life. OBJECTIVE: To validate the Spanish translation of the ICECAP-O's capability to measure Health-related quality of life in elderly with dementia who live in nursing homes. METHOD: Cross-sectional study. For 217 residents living in 8 Spanish nursing homes, questionnaires were completed by nursing professionals serving as proxy respondents. We analyzed the internal consistency and other psychometric properties. We investigated the convergent validity of the ICECAP-O with other HRQoL instruments, the EQ-5D extended with a cognitive dimension (EQ-5D+C), the Alzheimer's Disease Related Quality of Life (ADRQL) measures, and the Barthel Index measure of activities of daily living (ADL). RESULTS: The ICECAP-O presents satisfactory internal consistency (alpha 0.820). The factorial analysis indicated a structure of five principal dimensions that explain 66.57% of the total variance. Convergent validity between the ICECAP-O, EQ-5D+C, ADRQL, and Barthel Index scores was moderate to good (with correlations of 0.62, 0.61, and 0.68, respectively), but differed between dimensions of the instruments. Discriminant validity was confirmed by finding differences in ICECAP-O scores between subgroups based on ADL scores (0.70 low, 0.59 medium, and 0.39 high level care), dementia severity (0.72 mild, 0.63 medium, and 0.50 severe), and ages (0.59 below 75 years and 0.84 above 75 years). CONCLUSIONS: This study presented the first use of a Spanish version of the ICECAP-O. The results indicate that the ICECAP-O appears to be a reliable Health-related quality of life measurement instrument showing good convergent and discriminant validity for people with dementia.