Nursing Students' Perceptions of Flipped Classroom and Continuous Assessment in the Nursing-Management Classroom

Abstract: Introduction: Although the training of nurses in administration and leadership has an important repercussion on the present and the future of the profession, teaching methods are still traditional in many cases. Flipped classroom is a widely used method in nursing education but studies about its application to Nursing Administration and Management are limited. Method: Qualitative study by means of anonymous survey (dichotomous and open questions). Results: 92 % of students were shown to be satisfied with the teaching methodology and 92.9 % with the assessment. Only 31.5 % had used it previously but 83 % would like to use it in more subjects. The students showed that the methodology used had improved their opinion about the content and had increased their perception its usefulness. Conclusion: The participating students have been shown to be satisfied with flipped method and continuous assessment. These teaching strategies can help motivate nursing students towards the subject of Nursing Administration and Management, which can encourage them to pursue postgraduate training and professional practice in this area

Resumen: Introducción: Si bien la formación de enfermeros en Administración y Gestión tiene una importante repercusión en el presente y el futuro de la profesión, los métodos de enseñanza siguen siendo tradicionales en muchos casos. El aula invertida es un método ampliamente utilizado en la educación de enfermería, pero los estudios sobre su aplicación a la administración y gestión de enfermería son limitados. Método: Estudio cualitativo mediante cuestionario anónimo (preguntas dicotómicas y abiertas). Resultados: El 92 % de los estudiantes se mostró satisfecho con la metodología de enseñanza y el 92,9 % con la evaluación. Solo el 31,5 % lo había usado anteriormente, pero al 83 % le gustaría usarlo en más sujetos. Los estudiantes demostraron que la metodología utilizada había mejorado su opinión sobre el contenido y había aumentado su percepción útil del mismo. Conclusión: Los estudiantes participantes han demostrado estar satisfechos con el método de aula invertida. Estas estrategias de enseñanza pueden ayudar a motivar a los estudiantes de enfermería hacia la asignatura de Administración y Gestión de los Servicios de Enfermería, lo que puede animarlos a realizar una formación de posgrado y una práctica profesional en esta área.

Resumo: Introdução: Embora a educação de Enfermagem em Administração e Gestão tenha um grande impacto no presente e futuro da profissão, os métodos de ensino continuam a ser tradicionais em muitos casos. A sala de aula invertida é um método amplamente utilizado na educação em Enfermagem, mas os estudos sobre a sua aplicação à Administração e Gestão de Enfermagem são limitados. Método: Estudo qualitativo utilizando um questionário anônimo (perguntas dicotômicas e abertas). Resultados: 92% dos estudantes ficaram satisfeitos com a metodologia de ensino e 92,9% com a avaliação. Apenas 31,5% já o tinha utilizado antes, mas 83% gostariam de utilizá-lo em mais assuntos. Os estudantes mostraram que a metodologia utilizada havia melhorado a sua opinião sobre o conteúdo e aumentado a sua percepção útil do conteúdo. Conclusão: Os estudantes participantes mostraram-se satisfeitos com o método invertido e com a avaliação contínua. Estas estratégias de ensino podem ajudar a motivar os estudantes de Enfermagem para a disciplina de Administração e Gestão de Enfermagem, o que pode encorajá-los a empreender uma educação de pós-graduação e prática profissional nesta área.

Pain management and coping strategies for primary dysmenorrhea: A qualitative study among female nursing students.

AIM: Primary dysmenorrhea is a problem that affects both young and adult women, with a significant impact on their daily lives. This pain is primarily managed through the consumption of non-steroidal anti-inflammatories and non-pharmacological approaches such as exercise, acupressure and heat. The present study aimed to describe how Spanish university students manage dysmenorrhea. DESIGN: Qualitative case study. METHODS: Nursing students (N = 33) from the region of Andalusia (Spain) participated in focus groups. A purposive sampling method was used, and the data were collected through videoconferencing and subsequently analysed thematically. The guidelines for conducting qualitative studies established by the consolidated criteria for reporting qualitative research (COREQ) and the standards for reporting qualitative research (SRQR) were followed. RESULTS: Four principal themes were identified: (a) Strategies for pain management; (b) using painkillers; (c) choosing the ideal treatment; (d) non-pharmacological interventions. CONCLUSIONS: The nursing students experienced difficulties in managing primary dysmenorrhea, they self-medicated, expressed reluctance to seek professional medical advice, used non-pharmacological strategies and seeked advice from other women within their family/social circle.

Menstrual Migraine Among Spanish University Students.

PURPOSE: This study sought to determine the prevalence of menstrual migraine among female university students at the Nursing Faculty of Ciudad Real and to determine possible risk factors. DESIGN AND METHODS: A cross-sectional observational study was performed using a self-report questionnaire. Two hundred and ninety-nine female university students participated in the study; all were enrolled in the 2017/2018 academic year at the Faculty of Nursing. Participants were over the age of 18 years and without any diagnosed gynecological pathology. The main measurement tools were menstrual migraine between days -2 and +3 of the menstrual cycle, over the previous six cycles. RESULTS: The prevalence of menstrual migraine was 45.15%, identifying the following possible risk factors: dysmenorrhea (OR 9.19; 1.62-6.28% CI), use of hormonal contraceptive methods (OR 2.60; 95% CI 1.30-5.20), menstrual irritability (OR 2.34; 95% CI 1.25-4.40), menstrual dizziness (OR 2.05; 95% CI % 1.12-3.75) and daily consumption of cola beverages (OR 1.85; 95% CI % 1.04-3.32). CONCLUSIONS: The prevalence of this problem is high among our population and the approach is complex. PRACTICE IMPLICATIONS: It is necessary to continue to research the pharmacological measures and methods of pharmacological pain relief as well as interventions directed at lifestyle modifications considering the potential risk factors involved in menstrual migraine.

Why Do Some Spanish Nursing Students with Menstrual Pain Fail to Consult Healthcare Professionals?

Dysmenorrhea is a problem that affects a large percentage of young women worldwide. Alarmingly, the majority of these women choose to self-medicate rather than consult a healthcare professional, despite the risks involved. The present study aimed to explore the reasons why undergraduate nursing students do not consult health care professionals regarding their menstrual pain. A qualitative study was conducted using an open question: "Why didn't you consult a healthcare professional?" within the context of a research project on primary dysmenorrhea among nursing students at the University of Huelva, Spain. The responses of 202 women were analyzed using content analysis. Three categories were identified: assessment of the pain experienced, expectations, and experiences of professional care and selfcare. We found a striking normalization of the problem; notably, students downplayed the importance of the problem, considering that it was not worth consulting a physician. Furthermore, there was a notable degree of self-medication using non-steroidal anti-inflammatories (NSAIDs). These results may be useful for orienting policies to raise social awareness of this problem and for designing health education strategies aimed at women with primary dysmenorrhea.

Living with Restrictions. The Perspective of Nursing Students with Primary Dysmenorrhea.

Primary dysmenorrhea (PD) affects a large number of female university students, diminishing their quality of life and hindering academic performance, representing a significant cause of absenteeism. The purpose of our study was to determine how nursing students experienced restrictions as a result of primary dysmenorrhea. A qualitative exploratory study was conducted among 33 nursing students with primary dysmenorrhea. A purposeful sampling strategy was applied. Data were collected from five focus groups (two sessions each) and the field notes of 10 researchers. A video meeting platform was used to conduct the focus groups. A thematic inductive analysis was performed. Thirty-three female nursing students participated in the study with a mean age of 22.72 (SD 3.46) years. Three broad themes emerged: (a) restrictions on daily activities and sports; (b) academic restrictions, and (c) restrictions on social and sexual relationships. The students described restrictions in performing everyday activities, such as carrying weight, and shopping. Some students even gave up the practice of sports and were absent from classes at the university, and from clinical practices at the hospital. The pain affected their ability to maintain and create new social relationships. Primary dysmenorrhea caused restrictions in the personal, social and academic life of the nursing students.

Anxiety, perceived stress and coping strategies in nursing students: a cross-sectional, correlational, descriptive study.

BACKGROUND: For many nursing students, clinical training represents a stressful experience. The levels of stress and anxiety may vary during students' educational training, depending on their ability to adopt behavioral strategies for coping with stress, and other factors. This study aimed to investigate the relationship between anxiety, perceived stress, and the coping strategies used by nursing students during their clinical training. METHODS: A cross-sectional correlational descriptive study. The sample consisted of 190 nursing students enrolled in the Nursing Faculty of Ciudad Real University in Spain. Participants provided data on background characteristics and completed the following instruments: the Perceived Stress Scale; the State-Trait Anxiety Inventory and the Coping Behavior Inventory. Relationships between scores were examined using Spearman's rho. RESULTS: The mean age of participants was 20.71 ± 3.89 years (range 18-46 years). Approximately half of the students (47.92%) indicated a moderate level of stress with a mean Perceived Stress Scale score of 22.78 (±8.54). Senior nursing students perceived higher levels of stress than novice students. The results showed a significant correlation for perceived stress and state anxiety (r = 0.463, p < .000) and also for trait anxiety (r = 0.718, p < .000). There was also a significant relationship between the total amount of perceived stress and the following domains of the coping behavior inventory: problem solving (r = -.452, p < .01), self-criticism (r = .408 p < .01), wishful thinking (r = .459, p < .01), social support(r = -.220, p < .01), cognitive restructuring (r = -.375, p < .01), and social withdrawal (r = .388, p < .01). In the current study, the coping strategy most frequently used by students was problem-solving, followed by social support and cognitive restructuring. CONCLUSIONS: Nursing students in our study presented a moderate level of stress, in addition there was a significant correlation with anxiety. Nursing teachers and clinical preceptors/mentors should be encouraged to develop programs to help prepare nursing students to cope with the challenges they are about to face during their clinical placements.

Perception of Menstrual Normality and Abnormality in Spanish Female Nursing Students.

Menstrual problems are usually taboo; and often, some, such as dysmenorrhea, are presumed normal. This study seeks to compare the menstrual characteristics and symptoms of female university students reporting self-perceived normality concerning their cycles and menstruation with those who perceive their menstruation as being abnormal. A cross-sectional descriptive study was conducted among 270 nursing students using a self-report questionnaire that included sociodemographic and gynecological issues, together with Visual Analog Scale, the Andersch and Milsom Scale, and the Spanish version of the EuroQol-5 Dimension (EuroQol-5D) to measure self-perceived health status. A bivariate analysis was performed using the chi-square test, linear trend chi-square, and Student's t-test, and a multivariate analysis of stepwise binary logistic regression was performed to predict the perception of cycle abnormality. In total, 77.4% of participants displayed normality; however, in self-reporting of menstrual characteristics, 67.4% identified alterations. Young women suffering from menstrual dizziness were 1.997 (CI95% = 1.010-3.950; p = 0.047) more likely to manifest abnormal menstruation, 4.518 (CI95% = 1.239-16.477; p = 0.022) more likely if they suffered from Grade 3 menstrual pain, and 2.851 (CI95% = 1.399-5.809; p = 0.004) more likely if they perceived that menstruation interfered with their daily lives. Many menstrual changes and symptoms are still considered normal, making it difficult to identify and address these issues. Therefore, it is necessary to develop health policies and strategies to improve menstrual health literacy for increased knowledge and earlier diagnosis.

Living with Pain and Looking for a Safe Environment: A Qualitative Study among Nursing Students with Dysmenorrhea.

Dysmenorrhea refers to chronic pain associated with menstruation that is often accompanied by other symptoms. Primary dysmenorrhea (PD) occurs without any associated pelvic disease. Nonetheless, it may negatively affect women's quality of life. Among university students, dysmenorrhea decreases academic performance and is a cause of absenteeism. The purposes of our study were to describe how nursing students experienced PD and the changes affecting their body and mood. A qualitative case study was performed among 33 nursing students with PD. Data were collected through five focus groups (with two sessions each) and 10 researchers' field notes. We used a video meeting platform to conduct the focus groups. A thematic analysis was performed, and the Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative Research guidelines were followed. Three main themes emerged from the data: (a) living with dysmenorrhea, with two subthemes: menstruation and pain; (b) body changes and mood swings; and (c) seeking a safe environment, with three subthemes: safe environment, unsafe environment, and key safety aspects. Students considered menstruation to be negative and limiting, causing physical and mood changes, making them feel less attractive, and conditioning their way of dressing and relating.

Interference and Impact of Dysmenorrhea on the Life of Spanish Nursing Students.

Dysmenorrhea is a cause of absenteeism in universities which, in the context of nursing studies, may affect mandatory attendance. Moreover, presenteeism is associated with medication errors, patient falls, and a reduced quality of patient care. This study sought to identify the degree of interference of dysmenorrhea on daily life and its impact on academic performance among Spanish nursing students, and to explore the reasons for presenteeism. A cross-sectional descriptive study was conducted on 261 nursing students. Data were collected using a self-administered questionnaire. The chi square tests, chi-square linear trend, Student's t-test, one-way analysis of variance of polynomial contrasts, and post hoc tests for the bi-variate analysis were used to compare the participants' responses regarding their type of dysmenorrhea and pain intensity. In addition, a multivariate regression was performed to predict absenteeism. The answers to the open questions were analyzed using thematic content analysis techniques. We observed 62.8% of absenteeism and 92.7% of presenteeism due to dysmenorrhea. Absenteeism was observed to be 3.079 (confidence interval (CI): 95%1.724-5.499; p < 0.001) times more likely among women with severe menstrual pain, 2.513 (CI 95%1.314-4.807; p = 0.005) times more in those suffering from menstrual nausea and 1.936 (CI 95%1.098-3.411; p = 0.022) times more frequent in those suffering from diarrhea. The reasons for presenteeism were grouped into five categories: the pain was bearable, it is not a reason to be absent, others don't consider it a reason to be absent, responsibility and guilt, and academic consequences. Dysmenorrhea can have a significant impact on academic performance. The concern among students about the academic repercussions and even feelings of guilt and incomprehension from others leads to high rates of presenteeism with potentially negative consequences for patient care.

Management of Primary Dysmenorrhea among University Students in the South of Spain and Family Influence.

The present study analyses the management of primary dysmenorrhea by university students in the south of Spain. In this cross-sectional observational study, 224 women participated, using an ad hoc self-report questionnaire about menstrual pain and self-care and including sociodemographic and gynecological variables. Some 76.8% of participants consumed analgesics and the majority self-medicated with non-steroidal anti-inflammatory drugs (NSAIDs) without consulting a health professional, with a correlation between pain intensity and the number of pills ingested during menstruation (r = 0.151, p < 0.05). The higher proportion of women who found their analgesia effective were those who took medication after being prescribed by a health care provider (60.8%) compared to those who self-medicated (40%; p < 0.01). Only 43.8% employed non-pharmaceutical methods, most commonly antalgic positions, massages and local heat. These choices were not related to the intensity of menstrual pain nor with the severity of the dysmenorrhea, nor did these most common methods prove to be the most effective. However, a higher percentage of women using non-pharmacological methods was identified in women with family members suffering from dysmenorrhea (73.2%) compared to those without (60%; p = 0.040), which may indicate that the choice of remedies is more related to learning self-care in the family context. This study identifies the need for education on self-care and management of menstrual pain.

Type of Dysmenorrhea, Menstrual Characteristics and Symptoms in Nursing Students in Southern Spain.

Dysmenorrhea is a form of chronic pain associated with menstruation that affects a high percentage of young people. This study sought to determine the prevalence of primary and secondary dysmenorrhea among female nursing students in southern Spain and to compare their menstrual characteristics and symptoms. A cross-sectional observational study was conducted using a self-report questionnaire that included sociodemographic variables, menstrual characteristics and related symptoms. Descriptive bivariate analysis and binary logistic regression were performed in which the dependent variable was secondary dysmenorrhea. The prevalence of dysmenorrhea was 73.8% (of which 63.3% had primary dysmenorrhea and 10.5% had secondary dysmenorrhea), and was more likely in women with longer periods, heavier bleeding and those not using oral hormonal contraception (OCP). Secondary dysmenorrhea was 31.75, (confidence interval (CI)95% = 4.44-238.59; p < 0.01) times more likely among those with menstrual headache, 8.37 (CI95% = 2.35-19.80; p < 0.01), times greater among those suffering nausea during menstruation, 6.60 (CI95% = 1.42-30.67; p < 0.01), times greater among those suffering from menstrual vomiting, it was also 1.17 (CI95% = 1.08-1.26; p < 0.01) times more likely for each day that the period was prolonged and 6.63 (CI95% = 1.47-30.01; p = 0.014) times more likely in women with a heavy menstrual flow. These findings may help guide professionals towards the prescription of additional tests in certain cases in which secondary dysmenorrhea is suspected.

Relationship between Diet, Menstrual Pain and other Menstrual Characteristics among Spanish Students.

This study sought to describe and compare adherence to the Mediterranean diet and consumption of local foods from the Huelva region among Spanish university women in relation to menstrual pain and other menstrual characteristics. This cross-sectional study included 311 health science students. The study variables were sociodemographic and gynecologic characteristics, adherence to the Mediterranean diet using the KIDMED questionnaire, alcohol consumption (SDU) and consumption of local food. A descriptive bivariate analysis and multiple binary regression were performed for menstrual pain. Up to 55.3% of participants had moderate adherence to the Mediterranean diet and only 29.6% had high adherence. Women with low adherence had longer menstrual cycles (p < 0.01). Eating less than two pieces of fruit per day (OR = 3.574; 95%CI = 1.474-8.665; p < 0.05) and eating pulses more than one day a week (OR = 2.320; 95%CI = 1.006-5.348) raised the probability of suffering menstrual pain. A positive correlation between SDU and cycle length was identified (r = 0.119, p = 0.038), and menstrual bleeding was lower in women who consumed olive oil daily (p = 0.044). In conclusion, the Mediterranean diet, alcohol consumption and consuming typical foods from southern Spain appear to influence cycle length, menstrual flow and menstrual pain. Further research is necessary to confirm and expand these findings.

Absenteeism during Menstruation among Nursing Students in Spain.

Absenteeism can clearly have a negative impact on academic performance among university students. Certain experiences or symptoms such as menstrual pain are very common in women and can lead to absenteeism. The current study was aimed at examining the presence of menstrual experiences or symptoms and their impact upon absenteeism among healthy (illness-free) female university nursing students in Spain. A total of 299 students participated in this research, which was a descriptive cross-sectional, observational study. An ad hoc online questionnaire was used based on sociodemographic and gynecological data, together with the noted menstrual experiences; the most prevalent of which were bloating, which affected 87.3% of students; dysmenorrhea and irritability, which affected 76.3%; and fatigue, which affected 70.6%. Students with dysmenorrhea had a 6.95 higher (odds ratio (OR) 6.95; 95% confidence interval (CI) 3.39-14.25) odds of absenteeism; in those who reported dizziness, the odds of absenteeism was 4.82 times higher (OR 4.82; 1.76-13.23); in those who manifested nausea and vomiting, the percentage of absenteeism was 3.51 higher (OR 3.51; 95% CI 1.51-8.15); in those who presented sleep alterations, the odds were 2.95 higher (OR 2.95; 95% CI 1.39-6.25); and for those who felt depressed the odds were 2.18 times higher (OR 2.18; 95% CI 1.21-3.94) Absenteeism was found to be more likely in women with dysmenorrhea. However, in addition, higher odds of absenteeism were also found in women with nausea and vomiting, dizziness, sleep disorders, and those who feel depressed. These menstrual experiences can be considered a relevant problem among young women, leading to absenteeism, and a negative influence on academic performance. It is essential to raise awareness of the socioeconomic impact of absenteeism and establish new strategies for improving menstrual experiences.

El lugar social del conocimiento enfermero: los editoriales científicos como artefactos lingüísticos desde la perspectiva de Certeau / O lugar social do conhecimento em enfermagem: editores científicos como artefatos lingüísticos na perspectiva de Certeau / The social place of Nursing knowledge: scientific editorials as linguistic artifacts read from a Certeau´s perspective

Resumen: El objetivo de este trabajo es analizar el proceso de producción del conocimiento enfermero. Este propósito se ha acometido desde una perspectiva filosófica, basada en el concepto de lugar social desarrollado por Michel de Certeau. El lugar social incluye la dimensión institucional, los procedimientos utilizados para generar conocimiento y los valores que lo sostienen. Para aplicar este marco epistemológico a la enfermería, los autores se han centrado en el estudio del Journal of Nursing Scholarship (JNS), a través de un análisis textual en el que se han estudiado los editoriales escritos por Susan Gennaro en JNS desde 2007 hasta mayo de 2018, aplicandoles las categorías epistemológicas certeaunianas. Después de una lectura atenta es posible afirmar que JNS puede ser visto como una institución del conocimiento, que mantiene una estrecha relación con el poder, establece acuerdos con autores y revisores, y que escribe su propio discurso sobre la realidad. También han sido identificados los procedimientos clave que marcan cómo ha de ser escrito un artículo para JNS. Finalmente, la práctica, la significación social, la eficiencia, la universalidad, la buena ciencia y el liderazgo han aparecido como los principales valores de JNS. Las aportaciones de este trabajo pueden ayudar a los enfermeros a comprender que ningún conocimiento (ni los artefactos lingüísticos asociados al mismo) está completamente libre de influencias sociales.

Resumo: O objetivo deste trabalho é analisar o processo de produção de conhecimento de enfermagem. Esse objetivo foi realizado a partir de uma perspectiva filosófica, baseada no conceito de lugar social desenvolvido por Michel de Certeau. O lugar social inclui a dimensão institucional, os procedimentos utilizados para gerar conhecimento e os valores que o sustentam. Para aplicar esse quadro epistemológico à enfermagem, os autores se concentraram no estudo da Journal of Nursing Scholarship (JNS), através de uma análise textual na qual os editoriais escritos por Susan Gennaro no JNS foram estudados de 2007 a maio de 2018, aplicando as categorias epistemológicas certeaunianas. Após uma leitura cuidadosa, é possível afirmar que a SNJ pode ser vista como uma instituição do conhecimento, que mantém uma estreita relação com o poder, estabelece acordos com autores e revisores e escreve seu próprio discurso sobre a realidade. Os principais procedimentos que marcam como um artigo para o JNS deve ser escrito também foram identificados. Finalmente, a prática, o significado social, a eficiência, a universalidade, a boa ciência e a liderança apareceram como os principais valores da SAN. As contribuições deste trabalho podem ajudar os enfermeiros a entender que nenhum conhecimento (ou os artefatos lingüísticos a ele associados) está completamente livre de influências sociais.

Summary: The purpose of this article is to analyze the process by which nursing knowledge is produced. It takes a philosophical perspective based on the concept of social place developed by Michel de Certeau. Social place comprises an institutional dimension, the procedures used to create knowledge and the values underlying it. In applying this epistemic framework to nursing, the authors focused on the Journal of Nursing Scholarship (JNS). The study took the form of a textual analysis, using Certeau's epistemic categories, of all JNS editorials by Susan Gennaro from 2007 to 2018. The results of this analysis support the Certeaunian view that the JNS can be regarded as a knowledge institution, which maintains a tight relationship with power, makes contracts with authors and reviewers, and generates its own discourse about reality. The key procedures and conventions for contributing papers to the JNS were also identified. Finally, practice, social significance, efficiency, universality, good science and leadership emerged as the core values of the JNS. The findings of this study can help researchers to appreciate that knowledge (and linguistic artifacts associated with it) is never absolutely free from social constraints.

Assessing the Prevalence of Orthorexia Nervosa in a Sample of University Students Using Two Different Self-Report Measures.

In recent decades, orthorexia nervosa (ON) has increased presence in society. It is related with beliefs and attitudes towards eating and is characterized by an obsessive behavior toward heathy eating. The prevalence of ON has been reported by numerous researchers, with rates varying considerably according to the tool used to evaluate the same parameter. The aim of this study was to compare the prevalence of ON in a single population using two different questionnaires. The test for the diagnosis of orthorexia (ORTO-11-ES) assessment tool for orthorexia nervosa and the Düsseldorfer Ortorexie Skala (DOS-ES), constitute brief self-report assessment tools which measure the risk of suffering ON. A sample of 492 students from the University of Castilla la Mancha (Spain) participated in this study, of whom 43.1% were male and 56.9% were female. The findings show that, according to the DOS-ES, only 10.5% of students displayed ON whereas, with the ORTO-11-ES, the prevalence of ON increased to 25.2%. The tendency towards orthorexic behavior is more closely associated with the female gender. The Body Mass Index (BMI) had no influence on the tendency for ON. This study provides valuable information on the usefulness of both questionnaires and the possible limitations associated with the use of these tools in the general population.

Coping strategies and quality of life in caregivers of dependent elderly relatives.

BACKGROUND: Despite the importance of coping in caregiving, there are few studies on the relationship between coping and quality of life in caregivers of the frail dependent elderly. Thus, this study aims to analyze the relationship between coping strategies and quality of life dimensions in primary caregivers of dependent elderly relatives. METHODS: A cross-sectional study was conducted from 86 caregivers. Predictive variables were coping strategies (problem-focused, emotion-focused, socially-supported, and dysfunctional); dependent variables were quality of life dimensions (psychological, physical, relational, and environmental); and potential confounding variables were age, gender, perceived health and burden of caregiver, and functional capacity of care receiver. Correlation coefficients were calculated and multiple linear regression analysis was performed. RESULTS: After controlling for potential confounders, dysfunctional coping was related to worse quality of life in the psychological dimension, while emotion-focused and socially-supported coping were related to superior psychological and environmental dimensions of quality of life. The physical and relational dimensions of quality of life were not related to coping strategies. CONCLUSIONS: 1) it is important to consider coping strategies in the assessment of primary caregivers of dependent elderly relatives; 2) the quality of life of caregivers is related to their coping strategies, 3) their quality of life can be worsened by avoidance-type coping, and 4) their quality of life can be improved by active emotion-focused coping and socially-supported coping.

Evaluación de la calidad de vida en el periodo postoperatorio inmediato en cirugía general / Quality of life measurement in the postoperative period in general and gastrointestinal surgery

Introducción: La calidad de vida relacionada con la salud es un resultado aceptado en cirugía para medir efectividad y para ajuste de riesgos, si bien su medición en el postoperatorio precoz ha presentado limitaciones. El propósito de este estudio es probar que es posible medir la calidad de vida relacionada con la salud en dicho periodo mediante un instrumento específico. Material y método: Se obtuvo un cuestionario específico estructurado en dominios con el uso consecutivo de 3 fuentes: la revisión bibliográfica, la entrevista con pacientes (n=30) y métodos de consenso Delphi con profesionales. Finalmente el instrumento es validado sometiéndolo a preprueba (n=36) y mediante un estudio clínico observacional prospectivo (n=250) analizando su capacidad de discriminar cohortes de pacientes por tipo de intervención, complicaciones, estado clínico, su evolución temporal y sus propiedades como medida, comparándolo con el short form-36. Resultados: El instrumento mostró buena sensibilidad al cambio y capacidad de discriminación para las diferentes cohortes de pacientes, además de facilidad de uso, alta coherencia interna (alfa de Cronbach 0,88), ausencia de redundancia entre dominios (rho de Spearman entre 0,29–0,84) y adecuada convergencia con la opinión de los pacientes. En cambio el short form-36 no mostró adecuada capacidad de discriminación, ni idoneidad para su uso en dicho periodo. Conclusiones: Estos resultados sugieren que el cuestionario elaborado es válido para evaluar la calidad de vida relacionada con la salud en el periodo postoperatorio inmediato, siendo más sensible y específico que el short form-36 (AU)

Introduction: Health related quality of life measurement (HRQL) is widely accepted as an appropriate outcome of surgical care for assessing effectiveness and for risk adjusted outcomes. Nevertheless its use in the immediate postoperative period has show limitations. The aim of this study is to prove that is possible, with a specific new tool, to assess the HRQL during this period. Patients and Methods: The study is designed to create a specific close questionnaire related to the patient's condition after surgery, structured in domains, with the subsequent use of: literature searches, patient interviews (n=30), and a Delphi survey with health care providers. Finally the tool was validated using a pre-test (n=36) and a prospective observational cohort trial (n=250), to assess the discriminant validity for different cohorts of patients, reliability, responsiveness, and convergent validity, and to compare with the widely used generic tool, Short Form 36 (SF-36). Results: The questionnaire was shown to have good sensitivity to change (single index and domains score), as well as good sensitivity to distinguish cohorts of patients, a high internal consistency (Cronbach's alpha 0.88), absence of redundancy between domains (Spearman's rho range, 0.29–0.84), and good convergent validity with patient opinion. The SF-36 questionnaire showed poor discriminant validity, and lack of convergent validity with patient opinion. Conclusions: These results support that the created questionnaire is appropriate to assess HRQL in the immediate postoperative period; and was more specific than SF-36 (AU)

[Quality of life measurement in the postoperative period in general and gastrointestinal surgery]. / Evaluación de la calidad de vida en el periodo postoperatorio inmediato en cirugía general.

INTRODUCTION: Health related quality of life measurement (HRQL) is widely accepted as an appropriate outcome of surgical care for assessing effectiveness and for risk adjusted outcomes. Nevertheless its use in the immediate postoperative period has show limitations. The aim of this study is to prove that is possible, with a specific new tool, to assess the HRQL during this period. PATIENTS AND METHODS: The study is designed to create a specific close questionnaire related to the patient's condition after surgery, structured in domains, with the subsequent use of: literature searches, patient interviews (n=30), and a Delphi survey with health care providers. Finally the tool was validated using a pre-test (n=36) and a prospective observational cohort trial (n=250), to assess the discriminant validity for different cohorts of patients, reliability, responsiveness, and convergent validity, and to compare with the widely used generic tool, Short Form 36 (SF-36). RESULTS: The questionnaire was shown to have good sensitivity to change (single index and domains score), as well as good sensitivity to distinguish cohorts of patients, a high internal consistency (Cronbach's alpha 0.88), absence of redundancy between domains (Spearman's rho range, 0.29-0.84), and good convergent validity with patient opinion. The SF-36 questionnaire showed poor discriminant validity, and lack of convergent validity with patient opinion. CONCLUSIONS: These results support that the created questionnaire is appropriate to assess HRQL in the immediate postoperative period; and was more specific than SF-36.

Ancianos válidos institucionalizados / Institutionalized, non-invalid old people

El ingreso en residencias ha sido denominado con el concepto de institucionalización, para diferenciarlo de la atención comunitaria y denotar su carácter de especialización. Los ancianos válidos al ingreso en un centro dejan de realizar tareas por un mecanismo de ajuste de su conducta a la vez que pueden adoptar una actitud pasiva; efecto generador de dependencia. Todos los ancianos al ingresar por primera vez en un centro geriátrico se someterán a un período de adaptación y observación establecido en 20 días tras el cual serán valorados por una Comisión Técnica. Objetivo general: Evaluar la influencia que ejerce la institucionalización en la autonomía de un anciano en el momento de su ingreso en una residencia geriátrica de válidos y compararlo con el obtenido tras el período de adaptacion. Materiales y método: Diseño preexperimental con estudio pretest-postest de un solo grupo en dos momentos diferentes, es decir, medición previa y posterior a una intervención, que en este caso sería el tiempo. Variables dependientes: Grado de autonomía: medir la capacidad del anciano/a referente a actividades cotidianas. Mediante el índice de Banhel: (ABVD). Actividades Básicas de la Vida Diaria y el índice de Lawton: (AIVD). Actividades Instrumentales de la Vida Diaria. Variable independiente: Ingreso del anciano/a en la Institución. Es la variable que puede modificar o no su grado de autonomía. Variables sociodemográficas: edad, sexo, procedencia, estado civil, capacidad adquisitiva, motivo de ingreso. Sujetos de estudio: Todos los ancianos ingresados la Residencia Mixta de Pensionistas de Huelva durante enero y la ultima semana de abril de 2002, muestra aproximada de 30 ancianos. Análisis de datos: El análisis estadístico se realizó mediante el programa Epi-info 6.0 y SPSS V 10. El test aplicado ha sido el test no paramétrico o de libre distribución de medias de muestras apareadas test de Wilcoxon, al no cumplirse las condiciones de distribución normal y ser la muestra obtenida menor de 30. Para comparar proporciones se usó el test de McNemman. En todos casos se consideraron significativos los niveles de probabilidad inferiores a 0,05. Resultados: El 40 por ciento de los residentes ingresados tiene entre 75 y 79 años, ninguno es menor de 70 años. Ingresan más hombres que mujeres. El índice de Barthel en el momento del ingreso refleja una media de 97 puntos con una DE: 3. Y tras el período de adaptación disminuyó con un valor de 92 y con DE: 6. En el Índice de Lawton en la primera medición presentaba independencia total un 45 por ciento de los casos. Tras los 20 días el 100 por ciento de los residentes era dependiente o necesitaba ayuda, no permaneciendo ninguno totalmente independiente. Discusión: Existe una relación significativa entre la autonomía e independencia de un anciano y su deterioro debido a la institucionalización. Las actividades que han sufrido mayor deterioro funcional han sido la deambulación y el subir y bajar escaleras, el lavado de la ropa, al igual que en el cuidado de la casa, preparación de comidas o la realización de compras. Conclusiones: Dentro de una institución el programa de adaptación del anciano debería tener como prioridad la adaptación organizativa del centro a las verdaderas necesidades de los usuarios y no al revés, implicando en este proceso siempre a la familia... todo en pro de fomentar en todo momento la autonomía tanto física como psicológica del anciano (AU)

Enfermería y el presente de las terapias complementarias / Nursing and the present for supplementary therapies

La situación actual de la enfermería es de claro avance, resultado de la búsqueda de lo que cada vez más enfermeros se plantean: el verdadero fin de la enfermería, "los cuidados" para mantener la salud o recuperarla. Para ello debemos utilizar todos los medios útiles a nuestro alcance. Sabemos que con una caricia de nuestras manos liberamos endorfinas que ayudan a disminuir el dolor, que la música nos relaja, que el color ilumina nuestra vida, que la reflexología nos libera de tensiones y que, en definitiva, tenemos a nuestro alcance un gran número de recursos que ofrecen alivio y bienestar a nuestros pacientes sin efectos secundarios y a bajo coste. Estos cuidados complementarios "no especializados de salud" se enseñan de forma no sistematizada y de forma optativa en las escuelas de enfermería españolas. Los profesionales de enfermería manifiestan un gran interés por las terapias alternativas y muchos de ellos son hoy especialistas en alguna de ellas. Sin embargo, a pesar de que las terapias alternativas están incluidas en los actuales planes de estudio, la producción científica de los enfermeros españoles en esta materia es escasa. Las líneas de investigación trazadas como prioritarias por el Instituto Carlos III y por el Comité Europeo de Salud, no reflejan de forma específica el estudio de estas formas de cuidados; pero sí está en nuestras manos demostrar, con líneas de investigación propias, hasta dónde llegan los beneficios de estas terapias (AU)