[Euthanasia: is this the law we need?] / Eutanasia: ¿es esta la ley que necesitamos?

The Spanish Euthanasia Law introduces a new right that is added to the portfolio of services provided by the Spanish health system and whose application is guaranteed within a period of 40 days. From the perspective of clinical experience, it is argued that without the effective right to quality palliative care and given the current shortcomings in dependant care, this law may send a threatening message to particularly fragile and dependant individuals that will lead to them feeling like a burden to their families and society. It is reasoned that basing the right to die on the dignity of the individual may have unexpected social repercussions. The text of the law presents the flaws of having been written hastily and without the support of advisory entities. There are issues that require clarification with regard to the application of euthanasia within the context of general practice. The conclusion is that this new law will pose more problems of the type it aims to resolve.

Pilot Testing and Psychometric Validation of the Nijmegen Professionalism Scale for Spanish Nursing.

BACKGROUND AND PURPOSE: Professional commitment is frequently used as a humanistic care indicator. Thus, it is important to design and validate a tool which is able to measure professional commitment of nurses in Spain. In this study we aimed to analyze the psychometric properties of the Nijmegen Professionalism Scale for Spanish (NPS-S) nursing in order to verify its validity and reliability. METHODS: We undertook the pilot testing and psychometric validation of the NPS-S. A total sample of 249 nursing professionals from a variety of areas of expertise took part in this study. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) Statement was used for reporting this research. RESULTS: The NPS-S achieved a high degree of content validity, construct validity, internal consistency, temporal stability, and usability; this version is, thus, equivalent to the Nijmegen Professionalis Scale in its original version. IMPLICATIONS FOR PRACTICE: Based on the results obtained from the validation of this tool, it is possible to affirm that the NPS-S is an effective instrument for measuring professional commitment in this population. The NPS-S will evaluate and thus contribute to the promotion of professional commitment in Spanish nursing. Additionally, it will serve to establish correlations between professional commitment and other variables including quality of care and patient satisfaction. Future studies should analyze the evaluation capacity of this tool.

[Conflicts of interest in the medical profession]. / Conflictos de interés en la profesión médica.

In the last decades the world of medicine has become familiar with the disclosure of conflicts of interest (CDI). The requirement for authors to declare their CDIs concerning their publications is a common issue. Another topic for CDI is related to the medical decision making on prescription. Finally, professionals being in positions of responsibility in professional societies or associations and healthcare institutions are asked to show their disclosure of CDI. These debates show up the interest of democratic societies for justice and social ethics that demand fair play in making decisions that may affect third parties, particularly patients. In the present work, the concept and types of CDIs are analyzed, and authors make proposals for the management of CDI in the medical profession.

English-to-Spanish Translation of the Nijmegen Professionalism Scale.

BACKGROUND AND PURPOSE: The aim of this investigation was to perform the cross-cultural and linguistic translation and adaptation of the Nijmegen Professionalism Scale for Spanish nursing. Originally designed by Tromp et al. (2010) for its use by general practitioners, the new Spanish version of this tool assesses professional commitment, allowing for the comparison, prevention, association, and longitudinal monitoring of commitment among nursing professionals. METHODS: The linguistic translation from English to Spanish was performed using the translation-back-translation method; the process of cross-cultural adaptation to the Spanish nursing context was carried out following the recommendations given by a panel of experts comprised of 24 practicing nurses with different professional backgrounds. The data for the feasibility study were collected between December 2015 and January 2016. RESULTS: The original English version of the instrument contains 106 items and was originally developed for assessing professional behavior of general practitioner trainees; the new version, with a significant reduction in the initial number of items, comprises 49 items and is now ready for pilot testing and validation in our context. IMPLICATIONS FOR PRACTICE: The Nijmegen Professionalism Scale in its Spanish version will act not only as a tool for measuring professional commitment among Spanish nurses but also as a motivational resource and means for reflection which will, in turn, increase the quality of the care provided by these professionals.

A concept analysis of professional commitment in nursing.

BACKGROUND: The concept of professional commitment is being widely studied at present. However, although it is considered an indicator for the most human part of nursing care, there is no clear definition for it, and different descriptors are being used indiscriminately to reference it. OBJECTIVE: The aim of this study is to clarify the concept of professional commitment in nursing through the Rodgers' evolutionary concept analysis process. DESIGN: Systematic search using English and Spanish descriptors and concept analysis. Studies published between 2009 and June 2015, front-to-back analysis of the Nursing Ethics journal and manual check of articles cited in studies related to the Nijmegen Professionalism Scale. RESEARCH DESIGN: The procedure of concept analysis developed by Rodgers was used. ETHICAL CONSIDERATIONS: Although the topic was not labeled as sensitive and subject to ethical approval, its realization was approved by the Ethical Committee of Clinical Research of Aragon (CEICA) approved the study on 18 March 2015 and also careful procedures have been followed according to ethics expressed in the Declaration of Helsinki. FINDINGS AND DISCUSSION: A total of 17 published studies. A clear definition of the concept was made, and surrogate terms, concept dimension, differential factors related to the concept, sociocultural variations and consequences for nursing practice were identified. CONCLUSION: There is a need for continuous advancement in the development of the concept, specific actions to encourage this and the improvement of evaluation methods for its study.

Resident Physicians as Patients: Perceptions of Residents and Their Teaching Physicians.

OBJECTIVE: This study aims to broaden understanding into the process by which resident physicians deal with illness and to identify areas for improvement regarding healthcare of residents and teaching physicians training to support them adequately. METHODS: A qualitative study of ten semi-structured interviews with residents who had suffered a serious illness and a focus group of teaching physicians were conducted. Analysis of the interview transcripts was performed using the grounded theory approach, with information divided into five categories: Differences between residents as patients and general patients; confidentiality; feelings and attitudes; learning from illness; and impact on work and training. RESULTS: There are differences between residents and the general population: In the initial stage, diagnosis is made promptly with preferential treatment shown by colleagues. Subsequently, the lack of clear guidelines can lead to poor follow-up. They accept a loss of confidentiality in the process. One of the most serious concerns felt by residents is the impact of their illness on their training as specialists, meaning that teaching physicians are charged with the important role of guaranteeing the resident's proper recovery, return to work, and readaptation to the training program. Teaching physicians demand their own training be reinforced in these aspects. CONCLUSION: There is a need to assess the great diversity observed in training-related decisions made by teaching physicians when residents fall ill. Given the differences observed, more research is required to improve the care provided to sick residents and particularly the teaching physicians training to handle them.

[Autonomy and heteronomy, a necessary alliance to address smoking cessation. Views of professionals and patients]. / Autonomía y heteronomía, una alianza necesaria para el abordaje del tabaquismo. Visión de profesionales y pacientes.

OBJECTIVE: To explore the perception of professionals and patients with regard to ethical issues involved in addressing the habit of smoking in primary care consultations. METHOD: A qualitative study was designed, consisting of 12 semi-structured interviews with professionals, 7 interviews with patients and 2 focus groups with 6 professionals and 7 primary care patients (a total of 32 participants). An intentional sampling was conducted, including profiles of professionals and patients of both sexes, different ages and experience in relation to smoking. A content analysis was performed with an inductive analytical approach from data to the creation of theoretical categories. RESULTS: Four main categories were identified: 1) ethical issues related to the responsibility of the professional when treating patients who smoke; 2) issues related to attitude to patients who smoke; 3) issues related to fair and equitable distribution of resources and to the role of the different levels of government in relation to the control of smoking; and 4) issues related to smokers' autonomy regarding their habit and smoking cessation. CONCLUSIONS: An alliance is needed between the ethics that support the autonomy of patients who smoke and the regulation of tobacco consumption. This approach should be included in clinical training programmes dealing with tobacco use, dependence and cessation.

El proceso de enfermar de los médicos y sus consecuencias en el profesionalismo / The process of physicians falling ill and consequences for their professionalism / O processo de adoecimento dos médicos e as suas consequências acerca do profissionalismo

Resumen: La idiosincrasia de la profesión médica, los rasgos de personalidad característicos del médico y la falta de formación específica para reconocer y tratar adecuadamente la propia vulnerabilidad, predisponen a este colectivo a padecer más patología mental y, probablemente, un deficiente tratamiento de otras enfermedades. La mayoría de los estudios realizados hasta el momento se centran en la patología mental y adictiva del médico, desde el punto de vista del riesgo para la mala praxis y la seguridad de sus pacientes. La revisión narrativa de la literatura científica realizada (MEDLINE, EMBASE e IME 1985-2016) ha mostrado que, en el entorno hispanoparlante, apenas disponemos de información actualizada sobre el médico como paciente, a pesar de ser un tema de indudable relevancia desde el punto de vista de la seguridad asistencial, del profesionalismo y del propio bienestar de los profesionales. La situación del médico que enferma es compleja y poco conocida, con conflicto de roles y con repercusiones en la ética profesional y la calidad asistencial.

Abstract: The idiosyncrasy of the medical profession, the characteristic personality traits of the physician and the lack of specific training to properly recognize and treat one's own vulnerability dispose this group to suffer more mental pathology and probably worse control of other medical diseases. Most of the studies promoted so far focus on the psychiatric and addictive concerns of the physician, from the point of view of the sick doctor as being at risk for malpractice and to guarantee the safety of their patients. The narrative review of scientific literature (MEDLINE, EMBASE and IME 1985-2016) has shown that we do not have in the Spanish-speaking environment updated information about the doctor as a patient, despite being a topic of incipient media repercussion and undoubtedly relevant from the point of view of patient safety, professionalism and medical ethics and as well as the welfare of professionals. The characteristic of a sick doctor are more complex than the rest of patients with a conflict of roles and repercussions on professional ethics and the quality of care.

Resumo: A idiossincrasia da profissão médica, as características de personalidade característica do médico e a falta de formação específica para reconhecer e, corretamente, tratar a própria vulnerabilidade, predispõem esse grupo a sofrer mais patologias mentais, e provavelmente tratamento deficiente de outras doenças. A maioria dos estudos realizados até agora tem como foco a patologia mental e o comportamento aditivo do médico, do ponto de vista do risco por negligência e segurança de seus pacientes. A revisão narrativa da literatura científica realizada (MEDLINE, EMBASE e IME 1985-2016) tem mostrado que no ambiente de idioma hispânico temos apenas informações atualizadas sobre o médico como paciente, apesar de ser uma questão de relevância inquestionável do ponto de vista da segurança assistencial, do profissionalismo e do próprio bem-estar dos profissionais. A situação do médico enfermo é complexa e pouco conhecida, com conflito de papéis e impacto sobre a ética profissional e a qualidade dos cuidados médicos. São necessários mais estudos, tanto quantitativos como qualitativos, que permitam compreender o processo do adoecimento dos médicos em cada um dos seus estágios profissionais (desde a graduação até a aposentadoria) para ser capaz de considerar estratégias para a melhoria na atenção da saúde desses profissionais.

Correction: An International Consensus Definition of the Wish to Hasten Death and Its Related Factors.

[This corrects the article DOI: 10.1371/journal.pone.0146184.].

Teaching Confidentiality through Comics at One Spanish Medical School.

At the University of Zaragoza in Spain we developed an innovative way to teach the concept of confidentiality to medical students, which we tested by comparing the use of customized comics with more traditional methods. We proved that using comics is more attractive to students than lectures and class discussions, that it increases class participation and students' self-awareness of learning, and that it maintains the same academic results. We share our experience visually in a two-page comic.

Definition of compassion in healthcare: a systematic literature review.

AIM: To reflect on the definition of compassion and analyse the concepts encompassed by the term. BACKGROUND: A large number of authors have defined compassion, with certain nuances that differ from case to case. This raises the need for specificity in the definition of the term. DATA SOURCES: First, a systematic search was conducted of scientific databases. Second, a selection of experts were consulted and a request made to them for specific articles. Third, the snowball method was used. DESIGN: The keywords used in the literature search were 'compassion' and 'empathy', a MeSH term given for compassion. There are terms, such as self-compassion, compassion meditation, compassion fatigue and mindfulness, which, owing to their specific nature, were not included, because this study deals with the general aspects of compassion. RESULTS: The systematic search found 104 articles, of which 6 articles were selected after applying the inclusion and exclusion criteria. The eight experts provided a total of 14 references, of which seven articles met the inclusion criteria. Finally, 15 references were identified with the snowball method (n=28). CONCLUSIONS: Compassion originates as an empathic response to suffering, as a rational process which pursues patients' wellbeing, through specific, ethical actions directed at finding a solution to their suffering. We therefore define the term compassion to mean the sensitivity shown in order to understand another person's suffering, combined with a willingness to help and to promote the wellbeing of that person, in order to find a solution to their situation. This should be a duty in healthcare professionals' daily work.

An International Consensus Definition of the Wish to Hasten Death and Its Related Factors.

BACKGROUND: The desire for hastened death or wish to hasten death (WTHD) that is experienced by some patients with advanced illness is a complex phenomenon for which no widely accepted definition exists. This lack of a common conceptualization hinders understanding and cooperation between clinicians and researchers. The aim of this study was to develop an internationally agreed definition of the WTHD. METHODS: Following an exhaustive literature review, a modified nominal group process and an international, modified Delphi process were carried out. The nominal group served to produce a preliminary definition that was then subjected to a Delphi process in which 24 experts from 19 institutions from Europe, Canada and the USA participated. Delphi responses and comments were analysed using a pre-established strategy. FINDINGS: All 24 experts completed the three rounds of the Delphi process, and all the proposed statements achieved at least 79% agreement. Key concepts in the final definition include the WTHD as a reaction to suffering, the fact that such a wish is not always expressed spontaneously, and the need to distinguish the WTHD from the acceptance of impending death or from a wish to die naturally, although preferably soon. The proposed definition also makes reference to possible factors related to the WTHD. CONCLUSIONS: This international consensus definition of the WTHD should make it easier for clinicians and researchers to share their knowledge. This would foster an improved understanding of the phenomenon and help in developing strategies for early therapeutic intervention.

Educar las emocoones para promover la formación ética / Educating motionns to promote ethics education / Educar as emçõess para promover a formação ética

Es común observar entre los médicos una razonable formación técnica que convive con una postura humanística deficiente, que decanta en insuficiencia ética y en falta de profesionalismo. Esta desproporción sugiere que es necesario ampliar el ámbito del humanismo médico y encontrar un nuevo punto de equilibrio, moderno, propio de los días actuales. Enseñar Bioética supone establecer fronteras y normas, pero requiere sobre todo creatividad, ir más allá de lo que está estipulado para hacer por el enfermo todo lo que es posible. ¿Cómo aliar la creatividad a la necesaria prudencia y sabiduría que requiere la formación ética? Los cuestionamientos éticos vienen con frecuencia envueltos en emociones que no pueden ser ignoradas; hay que contemplarlas y utilizarlas porque son un elemento esencial del proceso formativo. Compartir emociones, ampararlas en discusiones abiertas, abre caminos para una verdadera construcción afectiva y fomenta la empatía que aproxima al paciente. Entre los recursos pedagógicos modernos para desarrollar la educación de la afectividad se destacan la narrativa -oír, contar y compartir historias de vida-, el cine y la música -representantes de la actual cultura del espectáculo-, que los autores comentan de acuerdo con su experiencia docente. Las emociones, por sí solas, no son suficientes para educar. Es necesaria la habilidad del docente para conseguir que la emoción se transforme en vivencia, estimule la reflexión y se interiorice. Este proceso es el catalizador que, aprovechando el terreno fértil de la emoción, imprime una huella educativa: se genera la vivencia que es puerta abierta para incorporar actitudes estables y duraderas.

Among physicians, it is common to see reasonable technical training existing alongside a deficient humanistic stance, which results in ethical shortcomings and a lack of professionalism. This disparity suggests the need to broaden the scope of medical humanism and to find a new, modern balance particular to today's world. Teaching bioethics involves setting boundaries and rules but, above all, it requires creativity and going beyond what is stipulated in order to do all that is possible for the patient. The question is: How to combine creativity with the necessary prudence and wisdom required of ethics education? Ethical issues often are surrounded by emotions that cannot be ignored. Rather, they must be contemplated and used, because they are an essential element in the learning process. This involves sharing emotions, sheltering them in frank discussions, opening up paths to genuinely constructing emotions and encouraging empathy towards the patient. Among the modern educational resources that exist to develop emotional education the narrative is a particularly important one; that is, listening, telling and sharing stories of life - film and music - representatives of the current culture of entertainment, which the authors mention on in light of their teaching experience. Emotions, in and of themselves, are not enough to educate. Skill is required of the teacher to create a situation where emotion is transformed into experience, encourages reflection and is internalized. This process is the catalyst. Taking advantage of the fertile ground of emotion, it leaves an educational footprint by producing the experience that is the gateway to adopting stable and lasting attitudes.

É comum observar entre os médicos uma razoável formação técnica que convive com uma postura humanística deficiente, que decanta em insuficiência ética e em falta de profissionalismo. Essa desproporção sugere que é necessário ampliar o âmbito do humanismo médico e encontrar um novo ponto de equilíbrio, moderno, próprio dos dias atuais. Ensinar Bioética supõe estabelecer fronteiras e normas, mas requer, sobretudo, criatividade, ir mais além do que está estipulado para fazer pelo doente tudo o que for possível. Como aliar a criatividade à necessária prudência e sabedoria que a formação ética requer? Os questionamentos éticos vêm com frequência envolvidos em emoções que não podem ser ignoradas; há que contemplá-las e utilizá-las porque são um elemento essencial do processo formativo. Compartilhar emoções, ampará-las em discussões abertas, abre caminhos para uma verdadeira construção afetiva e fomenta a empatia que aproxima o paciente. Entre os recursos pedagógicos modernos para desenvolver a educação da afetividade se destacam a narrativa -ouvir, contar e compartilhar histórias de vida-, o cinema e a música -representantes da atual cultura do espetáculo- que os autores comentam de acordo com sua experiência docente. As emoções, por si só, não são suficientes para educar. E necessária a habilidade do docente para conseguir que a emoção se transforme em vivência, estimule a reflexão e se interiorize. Esse processo é o catalizador que, ao aproveitar o terreno fértil da emoção, imprime um rasto educativo: gera-se a vivência que é porta aberta para incorporar atitudes estáveis e duradouras.

La ética del desarrollo profesional continuado en la promoción de la calidad asistencial / A ética do desenvolvimento profissional continuado na promoção da qualidade assistencial / Ethics of continuous professional development in the promotion of health care quality

La ética siempre ha estado presente de forma más o menos explícita en la calidad asistencial; sin embargo, no se ha prestado la necesaria atención al motor de la calidad que se encuentra en las actitudes y en el impulso ético de los profesionales que han de liderar los procesos de mejora. El Desarrollo Profesional Continuado es un proceso que debe acompañar las sucesivas etapas de la vida del profesional, con sus distintos momentos de motivación y crisis, y conviene entender su fundamentación ética, reflexionando sobre la calidad asistencial. Los profesionales que cuidan pacientes también necesitan recibir atención para diagnosticar y superar las situaciones de inercia, ausencia de iniciativa, escepticismo y falta de autocrítica. Sólo se puede garantizar la calidad asistencial si los profesionales desarrollan un satisfactorio progreso de su carrera, para lo cual es necesario que los servicios de personal y de recursos humanos de las instituciones sanitarias dediquen sus mejores energías a cuidar la promoción de sus profesionales.

Ethics has always being present in a more or less explicit way in health care quality; nevertheless, there has not been paid attention enough to the power of quality found in the ethical drive and attitudes of professionals who are leaders in improvement processes. The continuous professional development is a process which must accompany successive stages of professional life with different motivational moments and periods of crisis, for which understanding its ethical basis is convenient by reflecting about health care quality. Professionals who care patients also need attention to diagnose and overcome inertia, lack of initiative, skepticism and lack of self criticism situations. Health care quality can only be guarantee if professionals develop a satisfactory progress in their career, for which it is necessary that personal services and human resources of health care institutions devote their best energies in the promotion of their professionals.

A ética sempre esteve presente de forma mais ou menos explícita na qualidade assistencial; entretanto, não se tem prestado a necessária atenção ao motor da qualidade que se encontra nas atitudes e no impulso ético dos profissionais que vão liderar os processos de melhoria. O Desenvolvimento Profissional Continuado é um processo que deve acompanhar as sucessivas etapas de vida do profissional, com seus distintos momentos de motivação e crises, e convém entender sua fundamentação ética, refletindo sobre a qualidade assistencial. Os profissionais que cuidam de pacientes também necessitam receber atenção para diagnosticar e superar as situações de inércia, ausência de iniciativa, ceticismo e falta de autocrítica. Somente poderá ser garantida a qualidade assistencial se os profissionais desenvolverem um satisfatório progresso de sua carreira, para o qual é necessário que os serviços de pessoal e de recursos humanos das instituições sanitárias dediquem as suas melhores energias para cuidar da promoção de seus profissionais.