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.

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.

Exploring adolescents' experiences of continuing to wear face masks during COVID-19: A qualitative descriptive study in Barcelona (Spain).

BACKGROUND: The COVID-19 pandemic prompted the use of face masks as a social distancing measure. Although evidence supports their effectiveness in preventing infection, it remains unclear why some adolescents choose to continue wearing them postpandemic, even when it is no longer mandatory. This study aims to explore adolescents' experiences of wearing face masks during the COVID-19 pandemic when their use was no longer mandatory. METHOD: In this exploratory qualitative study, data were collected from 16 adolescents through face-to-face semistructured interviews. The participants were asked about the reasons and feelings associated with continuing to wear masks, as well as the contexts in which they felt safe without a mask. The collected data were analysed using Braun and Clarke's thematic analysis. RESULTS: Three main themes were identified: (1) Navigating complex decision-making: balancing safety and self-image, (2) peer influence dynamics and (3) managing the future: weather dynamics and pandemic evolution. DISCUSSION: The potential implications of withdrawing COVID-19 preventive measures, such as mask-wearing, beyond the pandemic remain understudied. It is crucial to further investigate the perceptions related to wearing masks and its cessation, especially amongst vulnerable individuals. PATIENT OR PUBLIC CONTRIBUTION: Due to methodological constraints associated with participants' age, they were not engaged in the design, data analysis, data interpretation or manuscript preparation phases of the study.

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.

Expectations of patients awaiting lung transplantation: A qualitative study.

AIM: The main aim of the present study is to examine the expectations and feelings of people awaiting lung transplantation. BACKGROUND: The assessment of the benefits of lung transplant should consider, among other things, the subjective perceptions of patients about the procedure, especially in relation to the context and to their values, goals and expectations. This is an issue that has not been studied in depth, especially in Spain. DESIGN: Exploratory qualitative study. METHODS: Data were collected through semi-structured interviews during the period of being on the waiting list for transplantation. Thematic analysis of the data was supported by the Atlas.ti software. RESULTS: The study population comprised 16 patients awaiting lung transplant, a number sufficient to reach data saturation. Four categories were identified to describe patients' feelings and expectations: (1) reasons for undergoing the transplant, (2) expectations about life post-transplant, (3) emotional state, and (4) relationship with the healthcare team. CONCLUSIONS: Patients have high expectations of lung transplantation. They see it as offering them a second chance at life, although the future creates uncertainty. The healthcare professionals are identified as key actors, providing essential support and information throughout the various stages of the process. Future research should explore recipients' experiences of lung transplant at later stages. RELEVANCE TO CLINICAL PRACTICE: It is important to adapt care through all the lung transplant process, which is accompanied by intense and complex emotions since the beginning. Thus, providing social and psychological support from the beginning may contribute to their health status, helping them deal with all the emotions and feelings experienced, and find balance between expectations and reality. PATIENT OR PUBLIC CONTRIBUTION: Sixteen patients awaiting lung transplant were interviewed. Interview transcripts were returned to participants to check for accuracy with their experiences.

The Roadmap for Implementing Value-Based Healthcare in European University Hospitals-Consensus Report and Recommendations.

OBJECTIVES: Value-based healthcare (VBHC) aims at improving patient outcomes while optimizing the use of hospitals' resources among medical personnel, administrations, and support services through an evidence-based, collaborative approach. In this article, we present a blueprint for the implementation of VBHC in hospitals, based on our experience as members of the European University Hospital Alliance. METHODS: The European University Hospital Alliance is a consortium of 9 large hospitals in Europe and aims at increasing the quality and efficiency of care to ultimately drive better outcomes for patients. RESULTS: The blueprint describes how to prepare hospitals for VBHC implementation; analyzes gaps, barriers, and facilitators; and explores the most effective ways to turn patient pathways into a process that results in high-value care. Using a patient-centric approach, we identified 4 core minimum components that must be established as cornerstones and 7 organizational enablers to waive the barriers to implementation and ensure sustainability. CONCLUSION: The blueprint guides through pathway implementation and establishment of key performance indicators in 6 phases, which hospitals can tailor to their current status on their way to implement VBHC.

Added value of patient-reported outcome measures (PROMs) after an acute stroke and early predictors of 90 days PROMs.

INTRODUCTION: Value-based health care represents a patient-centered approach by valuing Patient-Reported Outcome Measures (PROMs). Our aim was to describe the additional value of PROMs after an acute stroke over conventional outcome measures and to identify early predictors of poor PROMs. METHODS: Acute stroke patients discharged from a tertiary care hospital followed by a web/phone-based PROMs collection program in the post hospitalization phase. Main PROMs involve anxiety and depression (HADS) (each defined by HADS ≥ 10) and global physical (PHY-) and mental (M-) health (PROMIS-10). PROMIS cut-off raw values of normality were: PHY-PROMIS ≥ 13 and M-PROMIS ≥ 11. An overall health status (OHS) from 0 to 100 was also determined. PROMs related to the different modified Rankin Scale (mRS) grades were defined. Early predictors of PROMs were evaluated. RESULTS: We included 1321 stroke patients, mean age 75 (± 8.6) and 55.7% male; 77.7% returned home. Despite a favorable mRS at 3 months (< 3), a relevant rate of patients considered without symptoms or with mild disability showed unfavorable results in the measured PROMs (8% unfavorable OHS, 15% HAD-depression, 12.1% HAD-anxiety, 28.7% unfavorable M-PROMIS and 33.1% unfavorable PHY-PROMIS results). Along follow-up, only PHY-PROMIS and OHS showed significant improvement (p < 0.01 and 0.03, respectively). The multivariate analysis including discharge variables showed that female sex, higher discharge mRS and discharge to socio-rehabilitation-center (SRC) were independent predictors of unfavorable results in PROMs (p < 0.01). When adding 7 days PROMs results, they emerged as the strongest predictors of 3 months PROMs. CONCLUSIONS: A high proportion of stroke patients show unfavorable results in PROMs at 3 months, even those with favorable mRS, and most results obtained by PROMs during follow-up continued to indicate alterations. Female sex, mRS and discharge to SRC predicted unfavorable results in PROMs, but the strongest predictors of 3 months PROMs were the results of the 7 days PROMs.

Nursing students first experience on high fidelity simulation: A phenomenological research study.

AIM/OBJECTIVE: This study aimed to explore the perceptions of nursing students towards their first experience with high-fidelity simulation (HFS) in a Spanish university. BACKGROUND: Simulation experiences are becoming more popular in nursing education, allowing students to practice clinical skills before encountering actual patients. METHODS: A phenomenological approach was used. Sixteen in-depth, semi-structured, qualitative one-on-one interviews were conducted among second-year undergraduate nursing students who had completed a scheduled HFS training program. The interview transcripts were analyzed using Colaizzi's phenomenological method. RESULTS: Four themes were identified: "Learning through simulation"; "Acting like a nurse instead of being a student"; "Facilitators and barriers of learning"; and "Transition from simulation to reality." CONCLUSION: This study provides support for including high-fidelity simulation programs in the nursing curricula to enhance student preparedness for clinical placements.

Early Patient Experiences of Primary Above-the-Knee Amputation From Vascular Etiologies: A Phenomenological Study.

The aim of this study was to explore the different meanings of the experience of lower-limb amputation due to vascular causes in the time period from the fifth to twelfth week post-amputation. A phenomenological study involving semi-structured interviews was carried out. Data collection took place in a Public Hospital in Spain and included a convenience sample of 20 patients who had undergone amputation. The study highlighted patients' fears related to mobility, pain, dependence, and autonomy. Moreover, patients experience of the rehabilitation process and resources for adaptation were described as well as all the changes related to the social environment. The figure of a nurse was considered essential after amputation by the patients. This study provides a deep understanding of their experiences at the immediate time after amputation considering patients demographical associations and the etiology of the vascular pathology. This could be the starting point to understand patients' immediate needs upon discharge.

Final-year nursing students called to work: Experiences of a rushed labour insertion during the COVID-19 pandemic.

The first COVID-19 case was confirmed in China in December 2019, and countries around the world rapidly diagnosed new cases from January 2020 onwards. The World Health Organization (WHO) declared an international emergency, characterising it as a pandemic in March 2020. In Spain, final-year Medicine and Nursing students were recruited to reinforce the healthcare system. Using a qualitative phenomenological approach we aimed to clarify the experiences of these final-year year nursing students employed to provide nursing care during the COVID-19 pandemic in Spain. A total of 20 interviews were conducted with final-year students from six universities who were employed by Catalan Hospitals. Data was analyzed using Colaizzi's method. Analysis identified the meta-category 'feeling the commitment' from the interaction of two categories, 'facing the unknown' and 'being and feeling like a nurse', and five subcategories. Students felt highly committed to fighting the COVID-19 pandemic, volunteering to work as nurses despite facing the unknown and not yet having finished their studies. Future Spanish nursing programmes should include 'pandemic and disaster management' content to increase students' preparedness for such scenarios.

Nurses' perceptions of patient safety culture: a mixed-methods study.

BACKGROUND: There are relatively few qualitative studies concerning patient safety culture. METHODS: We aimed to explore patient safety culture as perceived by the nursing staff in two public hospitals in Catalonia, Spain. A mixed-methods design was employed using a questionnaire, in-depth interviews, and non-participant observations. RESULTS: Sixty-two percent of the nursing staff rated patient safety as "Acceptable" but was not higher because of work pressure and lack of resources as perceived by staff. "Teamwork within units" had the highest rate of positive responses, and "Staffing" had the lowest rate. Emergency units showed more negative results than the other two units. CONCLUSIONS: Safety incidents are not always reported due to fear of punishment, reflecting a lack of positive safety culture. It is necessary to design and implement strategies that promote a positive culture to avoid punitive responses and apply and evaluate these changes.

Student satisfaction with content and language integrated learning in nursing education: A cross-sectional study.

Content and language integrated learning is an evidenced approach focused on teaching content in which the language is learnt implicitly, facilitating internationalization. The purpose of this study was to determine nursing student satisfaction with a clinical skills course taught in English in a non-English speaking country. It includes the exploration of variables, barriers, benefits, and competence acquisition as perceived by the students. A cross-sectional study was conducted using a self-reported questionnaire administered to students who had completed the Clinical Skills course during the 2016/17 and 2017/18 academic years (n = 159). The students did not perceive the lessons in English as a barrier to acquisition of knowledge and clinical skills (mean 1.08; SD 1.64), and they were satisfied with the lessons received (mean 4.04; SD 1.65). Most students considered that receiving lessons in English adds value to their training process (mean 4.04; SD 2.35), and most agreed that it would benefit them in future (mean 4.48; SD 1.75). From the outcomes of our investigation we conclude that the content and language integrated learning approach should be maintained in future courses owing to the evidenced benefits, which may advance professional internationalization and the nursing competence development of students, leading to high student satisfaction.