Donor Atheromatous Disease is a Risk Factor for Hepatic Artery Thrombosis After Liver Transplantation.

The increasing age of liver donors and transplant candidates, together with the growing prevalence of metabolic comorbidities, could impact the risk of vascular complications after liver transplantation. We enrolled a consecutive cohort of adult patients undergoing liver transplantation from 2012 to 2021 who had a blinded pathological assessment of atherosclerosis in the donor and recipient hepatic arteries (HA). Patients receiving partial or reduced grafts, retransplantation, or combined organ transplantation were excluded. The relationship between HA atherosclerosis and HA thrombosis after liver transplantation was evaluated using logistic regression in the whole study cohort and in a propensity score-matched subpopulation. Among 443 eligible patients, 272 had a full pathological evaluation of the donor and recipient HA and were included in the study. HA atheroma was present in 51.5% of donors and in 11.4% of recipients. HA thrombosis occurred in 16 patients (5.9%), being more likely in patients who received a donor with HA atherosclerosis than in those without (10.7% vs. 0.8%; p < 0.001). Donor HA atherosclerosis was an independent risk factor of HA thrombosis (OR = 17.79; p = 0.008), and this finding was consistent in the propensity score-matched analysis according to age, sex, complex arterial anastomosis, and alcoholic liver disease (OR = 19.29; p = 0.007). Atheromatous disease in the recipient had no influence on the risk of HA thrombosis (OR = 1.70; p = 0.55). In conclusion, patients receiving donors with HA atherosclerosis are at increased risk for HA thrombosis after liver transplantation. The evaluation of the donor graft vasculature could guide antiplatelet therapy in the postoperative period.

The meaning of the recovery process and its stages for people attending a mental health day hospital: A qualitative study.

INTRODUCTION: This study sought to explore the meaning of the recovery process and its stages from the perspective of people attending a mental health day hospital. METHODS: A descriptive exploratory qualitative study was carried out. Semi-structured interviews were conducted with people attending a mental health day hospital. The data were analysed deductively by means of content analysis. RESULTS: The participants described the recovery process as a process based on three pillars; the attitude towards recovery, hardship, and the effort required throughout the process. Regarding the stages of recovery, for the participants in the first stage of the process (Moratorium), the search for hope was the most important element. In the second stage (Awareness), the reestablishment of their identity, through the acceptance of the consequences derived from the mental health problem, together with being able to feel full and fulfilled, were the most outstanding elements. In the third stage (Preparation), participants highlighted the search for meaning in life, facing their fears and the process with an open mind. Finally, the last two stages (Rebuilding and Growth) were related to taking responsibility and empowerment for recovery. CONCLUSIONS: The results of this study provide insight into the perception of the recovery process and its stages in people attending a mental health day hospital. These findings may contribute to aligning the nurse-patient perspective, helping nurses to understand the key elements of patients according to their stage of recovery, and thus be able to subsequently individualise interventions. PATIENT AND PUBLIC CONTRIBUTION: This study was based on interviews with 15 patients receiving treatment at an adult mental health day hospital. This study would not have been possible without their participation.

Perspectives of adult patients with mental health disorders on the relationship with nurses: a focus group study.

BACKGROUND: The relationship between the nurse and the patient with mental health disorder is crucial to the recovery process. Thus, patients with mental health disorders should be active subjects in this relationship by having autonomy and self-determination. METHODS: This study aimed to explore the perspectives of adult patients with mental health disorders on the relationship with nurses. A qualitative, descriptive, and exploratory study was conducted in March 2023, using focus group meetings in an association to support patients with severe mental health disorders in the Northern region of Portugal. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ). A total of 8 patients participated in the study. Two focus group meetings were conducted. The inductive method was used, and content analysis of the transcripts was performed. The QDA Miner Lite 4.0 and Microsoft Excel were used for content analysis. RESULTS: Participants considered the relationship with nurses important for their recovery and expected nurses to provide support and help, being able to identify their needs, thus personalising their care. Attitudinal and communication aspects were also considered crucial for establishing a solid, trusting, and meaningful relationship. CONCLUSION: According to the findings nursing care is expected to focus on the patient, his/her preferences, expectations, and the uniqueness of each individual. The results of this study may be useful for the reflection and improvement of nurses in their relational and communication skills and the driving force for nursing students' awareness of the perspective of the relationship with patients with mental health disorder and its relevance.

Mental health during ecological crisis: translating and validating the Hogg Eco-anxiety Scale for Argentinian and Spanish populations.

BACKGROUND: Eco-anxiety is increasingly recognized as a shared experience by many people internationally, encompassing fear of environmental catastrophe and anxiety about ecological crises. Despite its importance in the context of the changing climate, measures for this construct are still being developed in languages other than English. METHODS: To contribute to global eco-anxiety research, we translated the Hogg Eco-Anxiety Scale (HEAS) into Spanish, creating the HEAS-SP. We validated this measure in samples from both Argentina (n = 990) and Spain (n = 548), performing measurement invariance and confirmatory factor analyses. Internal consistency of the scale and score stability over time were investigated through reliability analyses. Differences in eco-anxiety across sociodemographic variables were explored through Student's t-tests and Pearson's r tests. RESULTS: The four-factor model of the HEAS-SP comprising affective and behavioural symptoms, rumination, and anxiety about personal impact demonstrated excellent model fit. We found good internal consistency for each subscale, and established measurement invariance between Spanish and Argentine samples, as well as across genders and participants' age. Spanish participants reported higher scores on the affective symptoms and personal impact anxiety factors compared to the Argentinian sample. Also, men reported lower levels than women on the subscales of affective symptoms, rumination, and personal impact anxiety. It was found that the relationship between both age and personal impact anxiety and age and affective symptoms varies significantly depending on the gender of the individuals. Younger participants tended to report higher scores on most dimensions of eco-anxiety. CONCLUSIONS: These findings enhance the global initiative to investigate, explore and therefore comprehend eco-anxiety by introducing the first valid and reliable Spanish-language version of this psychometric instrument for its use within Spanish and Argentinian populations. This study augments the body of evidence supporting the robust psychometric properties of the HEAS, as demonstrated in prior validations for Australian, Turkish, Portuguese, German, French, and Italian populations.

The experiences of family members of persons with intellectual disabilities who used residential care homes during the COVID-19 pandemic.

BACKGROUND: The global COVID-19 pandemic has shown the vulnerability of some population groups, including persons with intellectual and developmental disabilities (IDD). AIM: The present paper will provide more clarity and understanding of the experiences of family members of persons with IDD housed in residential facilities in Catalonia within the period of maximum restrictions during the COVID-19 pandemic. METHODS AND PROCEDURES: Semi-structured interviews were conducted using an interpretive phenomenological qualitative approach. Study participants consisted of 14 relatives of IDD individuals who were institutionalized in residence facilities or homes. The guiding questions emerged from group discussions with relatives of those with IDD who did not participate in the subsequent interviews. Drawing from this group, the factors that were identified to have had the greatest impact on their lives were later used to guide the interviews. Data collection was carried out in face-to-face individual interviews that were recorded together with the observations of two researchers between February and October 2022. RESULTS: Our analysis identified 4 main themes that developed into additional factors: the decision to stay at home or in the residence, fear, illness, and protocol. Individuals with IDD lost their daily routines, suffered from social isolation, and did not understand the situation. CONCLUSION: The results of this study allow for a better understanding of the experiences of families of persons with IDD in residential centres during the lockdown by identifying their needs and how to better support them in the future. OUTCOMES AND RESULTS: Knowledge and understanding of these events should allow for better management of similar situations in the future.

This study contributes to a growing body of research that examines the experiences of IDD individuals and their families during the early months of the COVID-19 pandemic. A qualitative phenomenological interpretative approach was used following the recommendations of qualitative research practices in health care. Our findings reveal that relatives of persons with IDD who lived in residential care homes felt that the residents were not adequately cared for by the staff, who applied measures for containment and contagion prevention that were disproportionate, resulting in their needs not being considered; these recommended measures had been developed for elderly care homes. Individuals with IDD lost their daily routines, suffered from social isolation, and did not understand the situation. The present findings show that residential care homes for persons with IDD require specific action protocols in crisis situations that are adapted to the needs and characteristics of each centre,thus adopting a model of care based on human rights.

Psychometric properties of the positive mental health questionnaire: short form (PMHQ-SF18) in young adults.

Introduction: Positive Mental Health (PMH) plays a pivotal role in the promoting of mental health. Assessing this phenomenon is essential for early recognition and intervention in mental health. To date, only one tool was validated with 39 items to assess PMH among Portuguese young adults. Method: This study sought to examine the psychometric properties of the short version of the Positive Mental Health Questionnaire (PMHQ) among Portuguese university students. The PMHQ Short Form was administered to a sample of 3,647 university students via an online platform. Exploratory and confirmatory factor analyses were performed. The principal factor solution was employed because some items showed higher levels of kurtosis. Multivariate analysis was tested using the Mardia's Test, Henze-Zirkler, and Royston. Findings of content, construct validity tests, and Cronbach's alfa demonstrated the satisfactory validity and suitable reliability of the PMHQ-Short Form (PMHQ-SF). Results and discussion: The exploratory factor analysis produced six dimensions of the PMHQ-SF with three items in each factor demonstrating adequate internal reliability. The global internal consistency was 0.92, with factors ranging between 0.60 to 0.82. The results suggest that the PMHQ-SF is reliable, easier, and more practical to complete by university students due to the shortening of the number of items. The PMHQ-SF is useful for assessing positive mental health in young adults. The final version of the instrument contains from 32 to 18 items.

La relación terapéutica como eje de los cuidados enfermeros en las unidades de agudos de salud mental: análisis del contexto en Cataluña / A relação terapêutica como núcleo central dos cuidados de enfermagem em unidades de saúde mental aguda: análise do contexto na Catalunha / The therapeutic relationship as the core of nursing care in acute mental health units: analysis of the context in Catalonia

Múltiples factores de tipo individual y contextual condicionan la calidad de la relación terapéutica en unidades de salud mental. El objetivo fue describir las características de estructura, de equipo, de normativa y de dinámica de cuidados que intervienen en el establecimiento de la relación terapéutica en las unidades de salud mental de Cataluña. El estudio forma parte un proyecto multicéntrico que incluye 18 unidades de salud mental de Cataluña y que pretende mejorar la relación terapéutica a través de una Investigación-Acción Participativa. Este trabajo es la primera etapa en la cual se realizó un análisis del contexto de estudio. Los datos se recogieron a través de guías observacionales cumplimentadas por las enfermeras coordinadoras de cada centro. Los resultados se agruparon en 3 temas: i) estructura de las unidades y dimensión de las plantillas, ii) normativa y dinámica de las unidades y iii) indicadores de calidad de los cuidados. La principal conclusión del estudio es la gran variabilidad observada en las unidades en relación con su estructura, ratios y normativas. Debido a estos factores del entorno, los cuidados que se brindan y, en consecuencia, la relación terapéutica; es considerablemente distinta en función del área en la que reside cada paciente.(AU)

Multiple individual and contextualfactors influence the quality of thetherapeutic relationship in mental healthunits. The objective was to describe the characteristics of structure, teamwork, wardrules and care dynamics that intervene in theestablishment of the therapeutic relationshipin mental health units in Catalonia. Thestudy is part of a multi-centre project thatincludes 18 mental health units in Catalonia,and which aims to improve the therapeuticrelationship through Participatory Action-Research. This work is the first stage inwhich an analysis of the study context wascarried out. The data were collected throughobservational guides filled in by thecoordinating nurses of each centre. Theresults were grouped into 3 themes: i)structure of the units and size of theteamworks, ii) rules and dynamics of theunits and iii) indicators of quality of care.The main conclusion of the study is the greatvariability observed in the units in relation totheir structure, ratios and rules. Due to theseenvironmental factors, the care providedand, consequently, the therapeuticrelationship, is considerably differentdepending on the area in which each patientresides.(AU)

Vários fatores individuais econtextuais condicionam a qualidade darelação terapêutica nas unidades de saúdemental. O objetivo foi descrever ascaracterísticas da estrutura, trabalho emequipa, regulamentação e dinâmica decuidados que intervêm no estabelecimentoda relação terapêutica em unidades de saúdemental na Catalunha. O estudo faz parte deum projeto multicêntrico que inclui 18unidades de saúde mental na Catalunha e quevisa melhorar a relação terapêutica atravêsda Investigação-Ação Participativa. Estetrabalho é a primeira etapa em que foirealizada uma análise do contexto do estudo.Os dados foram recolhidos através de guias observacionais preenchidos pelosenfermeiros coordenadores de cada centro.Os resultados foram agrupados em 3 temas:i) estrutura das unidades e tamanho dosgabaritos, ii) regulamentação e dinâmica dasunidades e iii) indicadores de qualidade daatenção. A principal conclusão do estudo é agrande variabilidade observada nas unidadesem relação á sua estrutura, relações eregulamentos. Devido a estes fatoresambientais, os cuidados prestados e,consequentemente, a relação terapêutica, sãoconsideravelmente diferentes dependendoda área em que cada paciente reside

Factores de riesgo asociados a los intentos de suicidio en un servicio de urgencias psiquiátricas de una zona rural / Risk factors associated with suicide attempts in a psychiatric emergency service in a rural area / Fatores de risco associados a tentativas de suicídio num serviço de emergência psiquiátrica de uma zona rural

Resumen Contexto: El suicidio es considerado un problema de salud pública debido a su alcance y magnitud. Objetivos: Determinar las variables sociodemográficas y clínicas asociadas a los intentos de suicidio entre la población atendida en un servicio de urgencias de un hospital psiquiátrico, y comparar las consultas por un intento de suicidio con las consultas por otros motivos. Metodología: Estudio observacional de corte retrospectivo realizado en un servicio de urgencia psiquiátricas en el que se estudiaron los datos de 498 personas que habían acudido por un intento de suicido y 502 que habían acudido por otros motivos de consulta, durante un periodo de 7 años. Resultados: En el grupo de pacientes con un intento de suicidio había un porcentaje más alto de mujeres, con una media de edad ligeramente mayor que el otro grupo, estaban casadas, de nacionalidad española, con el diagnóstico de trastorno del humor y los trastornos por abuso de sustancias como los más predominantes, con un menor porcentaje de ingresos psiquiátricos previos, sin antecedentes familiares de enfermedad mental y sin síntomas psicóticos. Conclusiones: Teniendo en cuenta la estructura y funcionamiento de los servicios de salud mental de la zona y la particularidad del entorno, subrayamos la necesidad de tener en cuenta los presentes resultados tanto para la atención directa como para el diseño de estrategias de prevención específicas.

Resumo Contexto: O suicídio é considerado um problema de saúde pública devido ao seu alcance e magnitude. Objetivos: Determinar as variáveis sociodemográficas e clínicas associadas às tentativas de suicídio entre a população atendida num departamento de emergência de um hospital psiquiátrico, e comparar as consultas para uma tentativa de suicídio com as consultas por outras razões. Métodos: Estudo retrospetivo observacional realizado num departamento de emergência psiquiátrica no qual foram estudados dados de 498 pessoas que tinham assistido a uma tentativa de suicídio e 502 que tinham assistido por outras razões durante um período de 7 anos. Resultados: No grupo de pacientes com tentativa de suicídio houve uma maior percentagem de mulheres, com uma idade média ligeiramente superior à do outro grupo, eram casadas, de nacionalidade espanhola, sendo o diagnóstico de distúrbios de humor e de abuso de substâncias o mais predominante, com uma menor percentagem de admissões psiquiátricas anteriores, sem historial familiar de doença mental e sem sintomas psicóticos. Conclusões: Tendo em conta a estrutura e o funcionamento dos serviços de saúde mental na área e a particularidade do cenário, enfatizamos a necessidade de ter em conta os resultados actuais tanto para os cuidados diretos como para a conceção de estratégias específicas de prevenção.

Abstract Background: Suicide is considered a public health problem due to its scope and magnitude. Aim: To determine the sociodemographic and clinical variables associated with suicide attempts among the population attended in the emergency department of a psychiatric hospital, and to compare consultations for a suicide attempt with consultations for other reasons. Methods: Observational retrospective study carried out in a psychiatric emergency department in which data from 498 people who had attended for a suicide attempt and 502 who had attended for other reasons for consultation were studied over a period of 7 years. Results: In the group of patients with a suicide attempt there was a higher percentage of women, with a slightly older mean age than the other group, they were married, of Spanish nationality, with the diagnosis of mood disorder and substance abuse disorders as the most predominant, with a lower percentage of previous psychiatric admissions, no family history of mental illness and no psychotic symptoms. Conclusions: Considering the structure and functioning of mental health services in the area and the particularity of the setting, we stress the need to consider the present results both for direct care and for the design of specific prevention strategies.

Actitudes y percepciones de las enfermeras hacia la conducta suicida: Revisión sistemática de estudios cualitativos / Nurses' attitudes and perceptions towards suicidal behaviour: Systematic review of qualitative studies

Objetivo principal: Conocer las percepciones y actitudes hacia la conducta suicida por parte de las enfermeras, así como su influencia en la evaluación y abordaje de esta. Metodología: Revisión sistemática de estudios cualitativos que sigue el modelo de metasíntesis para el análisis de los resultados. Resultados: El total de artículos incluidos en el trabajo han sido trece, a través de los cuales, se han obtenido cuatro categorías temáticas que sintetizan los resultados de los estudios evaluados. Conclusiones: El trabajo aporta una visión del camino que se está recorriendo, desde una postura moralista hacia la conducta suicida, a la comprensión de la patología que se ha de evaluar, tratar y prevenir.(AU)

Main objective: To know the perceptions and attitudes towards suicidal behaviour by nurses, as well as their influence on its evaluation and approach to it. Methodology: Systematic review of qualitative studies that follows the metasynthesis model for the analysis of results. Results: The total number of articles included in this paper has been thirteen, through which, four thematic categories that summarise the results of the evaluated studies have been obtained. Conclusions: The paper provides a vision of the path that is being followed, from a moralistic stance towards suicidal behaviour, to the understanding of the pathology that has to be assessed, treated and prevented.(AU)

Un día en la unidad de hospitalización de psiquiatría / Um dia na unidade de internação psiquiátrica / A day in the psychiatric inpatient unit

Se presenta el relato de la que podría ser la experiencia vivida por una persona hospitalizada en una unidad de psiquiatría cualquiera. Los datos se generan mediante la observación no participante, entrevistas informales y la propia experiencia asistencial de los autores. La persona protagonista está hospitalizada de forma involuntaria en una unidad de agudos de psiquiatría, ha recibido del 'sistema' la etiqueta diagnóstica de psicosis. A través de su mirada, los autores reflexionan en torno a las percepciones y vivencias que le acontecen en relación con el devenir cotidiano del hospital, y por supuesto con el cuidado recibido por las enfermeras de la unidad (AU)

We present the story of what could be the experience of a hospitalized person in whatever psychiatric unit. The data are generated by non-participant observation and care experience of the authors. The protagonist person is involuntarily admitted in a psychiatric acute unit; he has received the diagnostic label of psychosis by the 'system'. Through his eyes, the authors reflect about perceptions and experiences that happen him in relation to the daily workings of the hospital, and of course with the care received by nurses in the unit (AU)

Nós apresentamos a história do que poderia ser a experiência de uma pessoa internada em qualquer unidade psiquiátrica. Os dados são gerados pela observação não participante e experiência de cuidado dos autores. A pessoa protagonista é involuntariamente internado em uma unidade psiquiátrica aguda; ele recebeu o rótulo diagnóstico de psicose pelo 'sistema'. Através de seus olhos, os autores refletem sobre as percepções e experiências que lhe suceder em relação aos trabalhos diários do hospital, e, claro, com o cuidado recebido por enfermeiras da unidade (AU)

Randomized clinical trial comparing high versus standard dose of ribavirin plus peginterferon alfa-2a in hepatitis C genotype 3 and high viral load. Dargen-3 study

INTRODUCTION: Less than half of patients with chronic hepatitis C genotype 3 (G3) and high viral load (HVL) without a rapid virological response (RVR) achieve a sustained virological response (SVR) when treated with peginterferon plus ribavirin (RBV).Objectives To assess the impact of high doses of RBV on SVR in patients with G3 and HVL. Methods Ninety-seven patients were randomized to receive peginterferon α-2a+RBV 800mg/day (A; n = 42) or peginterferon α-2a+RBV 1600mg/day+epoetin β 400IU/kg/week SC (B; n = 55). Patients allocated to group B who achieved RVR continued on RBV (800mg/day) for a further 20 weeks (B1; n = 42) while non-RVR patients received a higher dose of RBV (1600mg/day) + epoetin β (B2; n = 13). RESULTS: RVR was observed in 64.3% of patients in A and in 76.4% in B (p = 0.259). Intention-to-treat (ITT) analysis showed SVR rates of 64.3% (A) and 61.8% (B), with a reduction of -2.5% (-21.8% to 16.9%) (p = 0.835). The SVR rate was 61.9% in arm B1 and 61.5% in arm B2. No serious adverse events were reported, and the rate of moderate adverse events was < 5%. CONCLUSIONS: G3 patients with high viral load without RVR did not obtain a benefit from a higher dose of RBV. Higher doses of RBV plus epoetin β were safe and well tolerated (Clin Trials Gov NCT00830609)

INTRODUCCIÓN: Menos de la mitad de los pacientes con hepatitis crónica C genotipo 3 (G3) con carga viral elevada y sin respuesta virológica rápida (RVR) alcanzan respuesta virológica sostenida (RVS) con peginterferón y ribavirina (RBV). OBJETIVOS: Evaluar el impacto de altas dosis de RBV sobre la RVS en pacientes con G3 y cargaviral elevada. MÉTODOS: Noventa y siete pacientes recibieron asignación aleatoria para tratamiento con peginterferón α-2a+RBV800mg/día (A; n=42) o peginterferón α-2ª + RBV 1600 mg/día + epoetina β 400UI/kg/semana SC (B; n = 55). Los pacientes asignados al grupo B que alcanzaron RVR continuaron con RBV (800 mg/día) durante 20 semanas más (B1; n = 42) mientras que los que no alcanzaron RVR recibieron una dosis más alta de RBV (1.600 mg/día)+epoetina β (B2; n = 13). RESULTADOS: Se observó RVR en el 64,3% de los pacientes en A y 76,4% en B (p = 0,259). El análisis por intención de tratar(ITT) mostró una tasa de RVS de 64,3% (A) y 61,8% (B), con una reducción de -2,5% (-21,8-16.9%) (p = 0,835). La tasa de RVS fue 61,9% en brazo B1 y 61,5% en brazo B2. No se detectaron efectos adversos graves y la tasa de efectos adversos moderados fue <5%. CONCLUSIONES: Los pacientes G3 con carga viral elevada sin RVR no obtuvieron beneficio de dosis más altas de RBV. Las dosis más altas de ribavirina más epoetina β fueron seguras y bien toleradas. (Clin Trials Gov NCT00830609)

Significado de la práctica reflexiva en la adquisición y transferencia de competencias comunicativas en enfermería / Meaning of reflective practice in the acquisition and transfer of communication skills in nursing

La práctica reflexiva constituye un método educativo de cambio destinado a desarrollar las competencias profesionales del estudiante de enfermería. El proceso parte de la capacidad autocrítica, del reconocimiento de las potencialidades y limitaciones, del fomento de la responsabilidad y del crecimiento personal. Sin embargo, los cambios obtenidos tras ese proceso formativo pueden no mantenerse en la etapa profesional. El objetivo principal de este estudio fue explorar el significado que las enfermeras atribuían al proceso educativo, a lo largo de su formación universitaria, de adquisición de competencias relacionales mediante la práctica reflexiva y a su mantenimiento posterior. Desde una aproximación fenomenológica se entrevistó a dieciséis enfermeras que habían adquirido competencias relacionales a través de la práctica reflexiva. Del análisis de los datos resultó un dominio central que se denominó «espíritu del prácticum» y cinco núcleos temáticos: aprendizaje profesional, prejuicios y dificultades personales, características y desarrollo de la profesión, crecimiento personal y profesional, y evolución hacia la profesionalidad. La transformación y el cambio experimentados durante el prácticum se mantuvieron en el tiempo y se transfirieron a la práctica profesional en ámbitos de enfermería distintos a la salud mental. Junto con la voluntad de transferir las competencias adquiridas, los resultados revelaron dificultades asociadas a las condiciones laborales y la necesidad de un mayor soporte externo y formación continuada. Si bien este estudio evidencia la importancia de la práctica reflexiva como método educativo para la adquisición de competencias profesionales, se considera necesaria una mayor indagación sobre todo respecto a su uso en etapas profesionales de postgrado (AU)

Reflective practice is an educational method of change aimed at developing the professional skills of nursing students. The objective is to enhance the capacity of selfcriticism, recognition of potential limitations, and the promotion of responsibility and personal growth. However, skills obtained by students after a training process based on reflective practice may be hard to maintain during the professional stage. The main objective of this study is to explore the meaning that nurses attributed to training received throughout their university education, regarding the acquisition of relational skills through reflective practice and subsequent maintenance. 16 nurses who had acquired relational skills through reflective practice were interviewed from a phenomenological approach. Analysis of the data revealed a central domain that we named as Spirit of the Practicum along with five themes: professional learning, prejudices and personal difficulties, characteristics and development of the profession, personal and professional growth and development towards professionalism. Transformation and change experienced during the Practicum remained in time and were transferred to professional practice in different areas of mental health nursing. Besides the will to transfer the skills acquired, results revealed difficulties associated with working conditions and the need for greater external support and lifelong learning. While this study shows the importance of reflective practice as an educational method for the acquisition of professional skills, further inquiry regarding its use in professional graduate stages is especially necessary (AU)

Reflexiones sobre la relación terapéutica y su práctica asistencial en enfermería de salud mental / Reflections on therapeutic relationship and its clinical practice in mental health nursing

El propósito de este trabajo es deshilvanar los conceptos teóricos de la relación terapéutica para poder considerarlos detenidamente. La relación terapéutica o de ayuda constituye el pilar sobre el que se ha construido la enfermería de salud mental. Se fundamenta en una comunicación eficaz y precisa, y en el manejo de habilidades y competencias relacionales por parte del profesional de enfermería. No obstante, a pesar del conocimiento teórico de dichas competencias en el ámbito mencionado, existen indicios suficientes para pensar que no se llevan a cabo con el nivel de calidad idóneo. Conceptos teóricos como la actitud empática, la aceptación incondicional y la escucha activa se tornan reales a la hora de ejercer en el día a día el rol de la profesión enfermera. De la misma forma, también se crean diferencias conceptuales, prejuicios, miedos y mecanismos de autoprotección que limitan la relación y ponen distancia entre el paciente y el profesional (AU)

The purpose of this paper is to unravel the theoretical concepts behind therapeutic relationship for careful consideration. The therapeutic or helping relationship is the pillar on which is built the mental health nursing. It is based on an efficient and accurate communication and management relational skills on the part of the nurse. However, and despite the theoretical knowledge of these skills in the field of mental health nursing, there is enough evidence to believe that they are not applied within suitable quality standards. Theoretical concepts such as empathic attitude, unconditional acceptance and active listening become real with the daily exercise of the nursing profession. In the same way, practice also creates conceptual differences, prejudices, fears, and self-protection mechanisms that limit the relationship and they put distance between patient and nurse (AU)

Autonomía y competencia en las unidades psiquiátricas de enfermos agudos / Autonomy and competence in psychiatric units for acute patients

En las Unidades de Psiquiatría de enfermos agudos es habitual que ingresen pacientes de forma no voluntaria. Eso implica que cuidara enfermos que no quieren ser cuidados pueda ser frecuente. El hecho de que un paciente haya sido declarado incompetente en cuanto a su ingreso, ¿determina que también lo sea en las decisiones que atañen a su cuidado? ¿Es incompetente para decidir sobre cualquier cuidado? ¿Debemos solicitar siempre su consentimiento para toda intervención? La no existencia de herramientas metodológicas enfermeras que contribuyan a prestar unos cuidados de mayor calidad, en personas que no quieren ser cuidadas, hace que sea necesaria una revisión profunda del estado de la cuestión. El objetivo de este trabajo es reflexionar entorno a la capacidad para determinar la competencia, y por tanto la autonomía del paciente, a la hora de aplicar cuidados de Enfermería en una Unidad de Psiquiatría de enfermos agudos (AU)

It is usual that patients are admitted non-voluntarily in Psychiatry Units for acute patients. This involves that it might be frequent to care for patients who refuse any care. The fact that a patient has been declared incompetent regarding his admission, does also determine that they are incompetent in terms of decisions about their care? Is this patient incompetent to decide about any kind of care? Must we always ask for their consent for any intervention? The lack of methodological tools for nurses which help to provide higher quality care for patients who don’t want any care requires a review in depth of the current state of this issue. The objective of this paper is to think about the ability to determine patient’s competence, and therefore their autonomy, when providing nursing care in a Psychiatry Unit for acute patients (AU)