Experiences for Geriatric Care from Nursing Students' Knowledge: A Qualitative Approach.

(1) Background: Studies have shown that clinical experience has an impact on how students perceive geriatric care. The vulnerability of older people particularly allows students to reflect on and evaluate their learning. In this context, communication between tutors and students is important to guiding a contextualized view of the complexity of clinical situations. The principal objective was to explore the feelings, perceptions, and experiences of nursing students in geriatric care units during their practices. (2) Methods: This is a qualitative study using content analysis where the data collected were analyzed deductively. An intentional sample of 81 nursing degree students enrolled in the subject of clinical practices. During these sessions, a dynamic discussion forum was incorporated. (3) Results: There were 6 forums with a total of 591 participants, with an average of 98.5 per forum. Four categories emerged: humanization, geriatric nurse, aging, and learning. (4) Conclusions: A change of management oriented to the person-centered model would improve the quality in the residences and as well as in the expectations of the students towards geriatric nursing. Changing perspectives could be a way to confront and become aware of the fallacies of care that have been evidenced. This study was not registered.

Self-management of Risk for the Prevention of Traffic Accidents from a Health Perspective: A Qualitative Study.

Introduction: In the world, deaths and injuries caused by traffic collisions have been considered a public health problem. In Colombia, 7.238 fatalities were recorded in 2021, with motorcycle riders representing the largest group of victims at 59.7%. Methods: The aim of this qualitative phenomenological study is to describe the risky experiences and deliberate actions of diverse road users that influence the self-management of the risk of traffic collisions. Results: Data were obtained from 22 participants: motorists, pedestrians and drivers. The content analysis describes various human conditions that affect self-management of the risk of traffic accidents, such as unsafe behaviors, non-compliance with traffic regulations by the different road actors, competitive culture among drivers, eagerness, among others. Additionally, factors related to care were determined: healthy recreational activities, promoting the value of one's own life and that of others, adequate time management and preventive behaviors by some road users. Conclusion: This research provides information on social and cultural aspects, experiences and risky behaviors of different road actors that influence the incidence of traffic accidents in Colombia.

A Hybrid Methodology for the Evaluation of Clinical Practice in Final-Year Nursing Students.

(1) Background: Clinical practice constitutes a scenario where the student approaches reality. The pedagogical relationship that is built between the nurse, the tutors and the student becomes important. And this requires intentional and reflective accompaniment. The principal objective was to design a hybrid-learner-centered training model requiring reflection and acquisition of specific skills. (2) Methodology: This was a prospective observational study using an intentional sample of 87 students. A hybrid model based on a dynamic virtual forum and Individual Improvement Plan (IIP) was constructed, evaluated using a self-completed questionnaire with a Likert scale. (3) Results: A model of accompaniment to the practices was built that allows for unifying a work plan. A transversal activity IIP was designed. A discussion forum was incorporated for each subject tutor. The analysis of the questionnaire showed that learning assessment, tutorials, virtual forums, self-assessment and satisfaction statistically differed. (4) Conclusions: The model allows students to be accompanied to acquire skills, knowledge, and attitudes and to develop critical thinking, as well as to improve the teaching quality of the practices of the Curriculum of the Nursing degree and to achieve their own competences through student-centered methodologies. This study was not registered.

Stressor Factors for Spanish Nursing Students in a Pandemic Context: An Observational Pilot Survey.

BACKGROUND: The context of the pandemic in Spain meant a high demand for care. The purpose of this pilot work was to determine the stress factors, conducted on final-year nursing students at a Spanish university, who volunteered to carry out healthcare tasks, in pandemic and post-pandemic contexts. METHODS: An observational prospective cohort pilot survey was conducted with an intentional sampling of the forty-seven students. We collected sociodemographic and stressor data using the validated KEZKAK questionnaire. The STROBE checklist was used to evaluate the study. RESULTS: The median scores obtained from nursing students incorporated as auxiliary health workers are lower than those who were not incorporated, and statistically significant differences were found: lack of skills and abilities (p = 0.016); relationship with tutors and colleagues (p = 0.004); impotence and uncertainty (p = 0.011); inability to manage the relationship with the patient (p = 0.009); emotional involvement (p = 0.032); distress caused by the relationship with patients and item overload (p = 0.039); and overload items (p = 0.011). The post-pandemic only maintained "lack of skill and abilities" (p = 0.048), from nursing students incorporated as auxiliary health workers. CONCLUSION: This pilot study showed that nursing students who joined as auxiliary health personnel presented less perceived stress than non-incorporated nursing students. Still, more prospectively designed clinical research is needed.

From Abandonment to Hospitalisation: Evolution of Hospital Care in Rural Spain (1939-1975).

The aim of this article is to explain the situation of the Spanish hospital system during the twentieth century and to analyse the reasons why the difficulties that a significant part of the Spanish population, resident in rural areas, had to access hospital services during the Franco dictatorship were perpetuated. The first section uses a conceptual perspective to discuss the repercussions that the new medical significance of the hospital had for the notion of 'rural hospital'. The second section examines the projects for hospital modernisation that appeared before the Spanish Civil War (1936-39) and highlights what impeded the consolidation of these pioneering experiences in the country. The following section analyses the hospital situation in Spain's rural world as well as the profound changes that occurred during the last decades of the dictatorship, just on the threshold of the health reform that was finally implemented in the democratic period.

Genealogía de la reforma hospitalaria en España: la gestación de una nueva cultura hospitalocéntrica de la sanidad / Genealogy of hospital reform in Spain: the gestation of a new hospital-centric culture of health

A finales de los años cincuenta del siglo pasado, en Asturias, se empezó a implantar una nueva manera de entender el hospital, cuya influencia terminaría siendo enorme y decisiva en la modernización de la organización hospitalaria española. Proyectado para ser utilizado por cualquier tipo de enfermo, tanto por su patología como por su situación económica, el Hospital General de Asturias (HGA) se convirtió en el pionero del Estado español en imple-mentar una estructura jerárquica en todos sus servicios médicos, clínicos y comunes, tanto en hospitalización como en consultas externas y en urgencias. Otra de sus consecuencias más palpables fue la introducción de la formación sanitaria especializada en España mediante la creación del primer programa de médicos residentes. Hasta entonces, el hospital era todavía un recurso asistencial poco accesible a amplios sectores de la ciudadanía, lo que demuestra la existencia de un desajuste cronológico en relación con lo sucedido en otros países europeos de referencia. El modelo organizativo del HGA supuso el punto de inflexión para el desarrollo de un proceso más amplio de reforma hospitalaria que acabó rompiendo definitivamente con los conceptos ya obsoletos de hospital «autónomo» y «cerrado». El primero se integró dentro de una coordinación funcional y escalonada de hospitales en red, conocida como «regionalización», y el segundo quedó eclipsado por la hegemonía del hospital «abierto» a toda la comunidad. Esta nueva realidad exigió el desarrollo e implantación de unos rigurosos criterios de acreditación en los hospitales para homologarse con los establecidos por la doctrina hospitalaria internacional y para ofrecer un mínimo de garantías, a empresas aseguradoras y usuarios, de la calidad y racionalidad de su oferta de servicios (AU)

La economía política de los hospitales locales en la Cataluña moderna / The political economy of local hospitals in Catalonia during the modern age

Los hospitales, en Cataluña, se inscribieron desde la Baja Edad Media hasta nuestros días dentro un modelo de gobierno específico que dio lugar a la creación y mantenimiento de una densa red de instituciones asistenciales en prácticamente todos los municipios, incluso en los más pequeños, cuyo marco legal fue el derecho privado o civil. Dicho modelo tiene sus fundamentos, en primer lugar, en la constatación de cómo los individuos legaban al hospital no sólo por la filantropía o caridad, sino también por la necesidad de aportar algo a la comunidad después de su muerte, en una suerte de consigna con el fin de devolver parte de los activos que los testadores habían acumulado durante su vida como instrumento para asegurar la reproducción social de la comunidad. En segundo lugar, se observa que las pequeñas instituciones privadas locales se fusionaron con los hospitales municipales, no así sus activos que continuaron gestionandose por separado de los de la ciudad. En tercer lugar, además de la función de cuidado, el hospital era también un agente económico que operaba de manera similar a los «Monte dei Paschi» italianos. Por consiguiente, el significado de la institución resultó ser más complejo que la simple prestación de servicios asistenciales. Adquirió un valor específico en la identidad de la comunidad, se convirtió en uno de los centros de debate en la vida pública y adquirió un significado económico y financiero que contribuyó a fortalecer la construcción de la identidad colectiva de los ciudadanos (AU)

The aim of this paper is to highlight how hospitals, in Catalonia since the late Middle Ages to the currently, adopted a governance model which resulted in the creation and preservation of hospitals or care institutions in virtually all municipalities, even in small, whose frame legal was the private or civil law. Firstly, we observed how individuals were motivated not only by philanthropy or charity, but also by a need to contribute something to the community after their death, to give back part of the assets the testators had accumulated during their lifetimes, as citizens who had benefited from their positions. Secondly, we observed that the small local private institutions merged with municipal hospitals, but that their assets were managed separately from those of the town. Third, as well as its care function, the hospital was also an economic agent that operated along similar lines to the Italian «Monte dei Paschi». It provided loans to working class citizens at a modest rate of interest. The meaning of the institution was found to be more complex than the simple provision of care services. It acquired a specific value in the identity of the community, it became one of the centers of debate in public life and it took on an economic and financial meaning that strengthened the construction of the citizens’ collective identity (AU)

El proceso de fusión hospitalaria en la ciudad de Tarragona (1464) / The Merging Process of the Hospitals in Tarragona (1464)

Los hospitales, en cataluña, se inscribieron desde la Baja edad Media hasta nuestros días dentro un modelo de gobierno específico que dio lugar a la creación y mantenimiento de una densa red de nstituciones asistenciales en prácticamente todos los municipios, incluso en los más pequeños, cuyo marco legal fue el derecho privado o civil. dicho modelo tiene sus fundamentos, en primer lugar, en la constatación de cómo los individuos legaban al hospital no sólo por la filantropía o caridad, sino también por la necesidad de aportar algo a la comunidad después de su muerte, en una suerte de consigna con el fin de devolver parte de los activos que los testadores habían acumulado durante su vida como instrumento para asegurar la reproducción social de la comunidad. En segundo lugar, se observa que a partir de los procesos de fusión del siglo XV las pequeñas instituciones asistenciales locales privadas –laicas o religiosas– se fu sionaron con los hospitales de titularidad municipal, y los activos patrimoniales resultantes de dicha fusión se gestionaron por separado de los de la municipalidad a través de una estructura administrativa propia y, a priori, autónoma respecto de los poderes políticos. en tercer lugar, además de la función de cuidado, el hospital era también un agente económico que operaba de manera similar a los Monte dei paschi italianos. por consiguiente, el significado de la institución resultó ser más complejo que la simple prestación de servicios asistenciales. Adquirió un valor específico en la identidad de la comunidad, se convirtió en uno de los centros de debate en la vida pública y adquirió un significado económico y financiero que contribuyó a fortalecer la construcción de la identidad colectiva de los ciudadanos, tal y como refleja el presente artículo a partir del ejemplo de la ciudad de tarragona (AU)

The aim of this paper is to highlight how hospitals in catalonia, from the late Middle Ages to the present, adopted a governance model which resulted in the creation and preservation of hospitals or care institutions in virtually all municipalities, even the smallest, whose legal framework was private or civil law. Firstly, we observed how individuals were motivated not only by philanthropy or charity, but also by a need to contribute something to the community after their death, to give back part of the assets they had accumulated during their lifetimes, as citizens who had benefitted from their positions. Secondly, we observed that, from the XVth century, small local private care institutions –secular or religious– merged with Municipal hospitals, but managed the resulting assets separately from those of the municipality. thirdly, as well as its care function, the hospital was also an economic agent that operated along similar lines to the Italian Monte dei paschi. It provided loans to working class citizens at a modest interest rate. the significance of the institution was more complex than the simple provision of care services. It acquired a specific value in the identity of the community, it became one of the centres of debate in public life and it took on an economic and financial meaning that strengthened the building of the citizens’ collective identity as shown in this article which uses the city of tarragona as its example (AU)

Recursos y modelos de atención al pie diabético en Cataluña (España): estudio descriptivo sobre espacios de mejora / Resources and models for diabetic foot care in Catalonia (Spain): A descriptive study on areas of improvement

Objetivos: Identificar espacios de mejora en la atención al pie diabético relacionados con la disponibilidad de materiales y especialidades en atención primaria y secundaria. Determinar el modelo asistencial de los centros quirúrgicos/hospitalarios que atienden problemas del pie diabético y su relación con las amputaciones realizadas. Diseño: Estudio transversal. Emplazamiento y participantes: Muestra aleatoria de 36 áreas básicas de salud (ABS) y el total de centros quirúrgicos/hospitalarios de Cataluña (España). Mediciones principales: Información recogida mediante entrevista estructurada a los responsables de cada centro sobre: disponibilidad de especialistas, material para descargas y exploración. Los modelos se establecieron según la clasificación de Van Acker y las amputaciones según el registro de altas hospitalarias. Resultados: Un 36,1% [intervalo de confianza (IC) del 95%:19,0-53,2] de las ABS disponían de endocrinólogo y un 11,1% [IC del 95%:3,1-26,1] de podólogo. El 100% [IC del 95%:90,3-100,0] tenían doppler, el 91,7% [IC del 95%:77,5-98,2] monofilamento, el 5,6% [IC del 95%:0,7-18,7] diapasón con escala graduada, el 11,1% [IC del 95%:3,1-26,1] material de descarga y el 8,3% [IC del 95%:1,8-22,5] un centro de referencia especializado. Un total de 85 centros quirúrgicos/hospitalarios atendían estos problemas: 11 (13,0%) modelo excelente, 29 (34,1%) intermedio y 45 (52,9%) básico/insuficiente. Un 12,5% de las amputaciones se realizaron en centros con modelo básico/insuficiente, un 56,4% en intermedio y un 31,1% en excelente. Conclusiones: La proporción de ABS con materiales, especialistas y/o centros de referencia especializados, fue baja. Entre los centros quirúrgicos/hospitalarios, el modelo básico/insuficiente era el más frecuente. La mayoría de las amputaciones se realizaban en centros con modelo excelente e intermedio; no obstante, un porcentaje considerable se practicaban en centros con modelos básico/insuficiente(AU)

Objectives: To identify areas of improvement in diabetic foot care as regards the availability of materials and specialties in primary and secondary care. To determine the model of care for surgical centres and hospitals caring for diabetic foot problems and their relation to amputations. Design: Cross-sectional study Setting and participants: Random sample of 36 basic health areas (BHA) and all hospital surgery centres in Catalonia (Spain). Measurements: Information was collected by structured interview of managers of each centre on: availability of specialists, material off-loading and examination. The models were established according to the classification of Van Acker, and amputations from hospital discharge records. Results: An endocrinologist was available in 36.1% [confidence interval (CI) 95%:19.0-53.2] of the BHA and 11.1% [95% CI: 3.1-26.1] had a podiatrist,100% [95% CI: 90.3-100.0] had Doppler, 91.7% [95% CI:77.5-98.2] a monofilament, 5.6% [95% CI: 0.7-18.7] a quantitative tuning fork, 11.1% [95% CI:3,1-26, 1] material off-loading, and 8.3% [95% CI: 1.8 - 22.5] a specialist reference centre. A total of 85 surgical centres and hospitals dealt with these problems: 11(13.0%) excellent model, 29 (34.1%) intermediate and 45 (52.9%) basic/insufficient. Centres with a basic model/insufficient performed 12.5% of the amputation, intermediate models, 56.4%, and 31.1% in excellent models. Conclusions: The proportion of ABS with materials, specialists and/or specialist reference centres was low. The basic/insufficient model was the most common among surgical/hospital centres. Most amputations were performed in centres with excellent and intermediate model; nevertheless, a considerable percentage was performed in centres with basic/insufficient models(AU)

[Resources and models for diabetic foot care in Catalonia (Spain): a descriptive study on areas of improvement]. / Recursos y modelos de atención al pie diabético en Cataluña (España): estudio descriptivo sobre espacios de mejora.

OBJECTIVES: To identify areas of improvement in diabetic foot care as regards the availability of materials and specialties in primary and secondary care. To determine the model of care for surgical centres and hospitals caring for diabetic foot problems and their relation to amputations. DESIGN: Cross-sectional study SETTING AND PARTICIPANTS: Random sample of 36 basic health areas (BHA) and all hospital surgery centres in Catalonia (Spain). MEASUREMENTS: Information was collected by structured interview of managers of each centre on: availability of specialists, material off-loading and examination. The models were established according to the classification of Van Acker, and amputations from hospital discharge records. RESULTS: An endocrinologist was available in 36.1% [confidence interval (CI) 95%:19.0-53.2] of the BHA and 11.1% [95% CI: 3.1-26.1] had a podiatrist,100% [95% CI: 90.3-100.0] had Doppler, 91.7% [95% CI:77.5-98.2] a monofilament, 5.6% [95% CI: 0.7-18.7] a quantitative tuning fork, 11.1% [95% CI:3,1-26, 1] material off-loading, and 8.3% [95% CI: 1.8 - 22.5] a specialist reference centre. A total of 85 surgical centres and hospitals dealt with these problems: 11(13.0%) excellent model, 29 (34.1%) intermediate and 45 (52.9%) basic/insufficient. Centres with a basic model/insufficient performed 12.5% of the amputation, intermediate models, 56.4%, and 31.1% in excellent models. CONCLUSIONS: The proportion of ABS with materials, specialists and/or specialist reference centres was low. The basic/insufficient model was the most common among surgical/hospital centres. Most amputations were performed in centres with excellent and intermediate model; nevertheless, a considerable percentage was performed in centres with basic/insufficient models.