Valoraciones de docentes y evaluadores sobre evaluación del aprendizaje en la carrera de enfermería / Evaluations by Professors and Evaluators about Learning Assessment in the Nursing Major

Introducción: La evaluación del docente y del evaluador está centrada en criterios de valoración que la posiciona en el paradigma interpretativo, pues busca llegar a comprender e interpretar experiencias académicas sobre la calidad y el compromiso docente. Objetivo: Describir la valoración de docentes y evaluadores sobre evaluación del aprendizaje en la carrera de enfermería. Métodos: Estudio cuantitativo, descriptivo transversal, en la carrera de enfermería de la Universidad Estatal Península de Santa Elena, Ecuador, durante primer trimestre del 2018. Universo de 41 docentes y 9 evaluadores que impartieron docencia durante el periodo estudiado, se aplicó un cuestionario y lista de chequeo, validados por criterios de expertos. Se calcularon frecuencias absolutas, porcentajes y varianzas, las comparaciones para los grupos de docentes y evaluadores se realizaron con prueba U de Mann-Whitney. El nivel de significación si p ≤ 0,05. Resultados: Existieron consistencias y similitud entre las valoraciones de la heteroevaluación durante el proceso, los valores encontrados en docentes y evaluadores están entre intervalos 0,80 y 0,89, en evaluadores superior a 0,85, equivalente a resultado fiable, con consistencia interna del instrumento, el indicador con mayor tendencia negativa evidenció 24,39 por ciento, lo que significa que en la evaluación no se alcanzan los logros deseados. Conclusiones: Los evaluadores áulicos consideran que en la evaluación no se alcanzan los logros deseados, que se evidencian aspectos que no corresponden con los preceptos de la evaluación del aprendizaje y que por lo general resulta ser lo típico del proceso evaluativo tradicional, a pesar de estar normado por Reglamento Nacional para Evaluación Estudiantil en Ecuador(AU)

Introduction: Evaluation by any professor or evaluator is centered on assessment criteria belonging to the interpretive paradigm, since it is aimed at understanding and interpreting academic experiences concerning quality and commitment of the professor. Objective: To describe evaluation by professors and evaluators on learning assessment in the Nursing major. Methods: Quantitative, descriptive and cross-sectional study carried out, during the first trimester of 2018, in the Nursing major of Universidad Estatal Península de Santa Elena, Ecuador. The universe was made up of 41 teachers and nine evaluators teaching during the study period. A questionnaire and a checklist, validated using expert judgment, were applied. Absolute frequencies, percentages and variances were calculated. The comparisons for the groups of professors and evaluators were made using Mann-Whitney U test. Differences were statistically significant if P ≤ 0.05. Results: There were consistencies and similarity among the evaluations of heteroassessment during the process; the values found in professors and evaluators are in the intervals between 0.80 and 0.89. In evaluators, it is greater than 0.85, equivalent to a reliable result, with internal consistency of the instrument. The indicator with the greatest negative trend showed 24.39 percent, which means that the desired achievements were not reached in assessment. Conclusions: Classroom evaluators consider that the desired achievements are not reached in assessment, that aspects that do not correspond to the precepts of learning assessment are evidenced, and that, in general, it turns out to a typical characteristic in traditional assessment, despite being regulated by the National Regulation for Student Assessment in Ecuador(AU)

Identifying Gaps in Population Health Nursing Educational Resources Through a Culture of Health Initiative Project.

BACKGROUND: To meet the health care challenges and increasing population health demands of today and the future, the Missouri Center for Nursing developed the Culture of Health Initiative Project (CHIP). METHOD: Phase one surveys examined 33 nurse leaders' responses to the population health knowledge and training needs of nurses in their organizations. In phase two, 71 nurse leaders' and practicing nurses' responses from the Population Health Nursing Skills Survey provided insight into the education needs of Missouri nurses. RESULTS: Findings identified a lack of available education and resources related to nursing, limited knowledge of concepts among nursing leaders, and a need for flexibility in the format and content to educate nurses in all types of nursing practice. CONCLUSION: Professional development practitioners must collaborate with nurses and nurse leaders, in all settings, to meet the learning needs necessary for Culture of Health competence. [J Contin Educ Nurs. 2020;51(12):568-573.].

Escape Room Relay Race: "Go for the Gold" in Formative Assessment.

BACKGROUND: Immersive learning activities, such as escape room educational gaming in nursing simulation laboratories, have proven to be effective teaching strategies that promote communication and teamwork. These activities also provide educators with opportunities to assess clinical skills competencies, as well as providing them with a means for evaluating the transfer of didactic knowledge to clinical practice. METHOD: An obstetrical skills relay race with an escape room element was created as a formative evaluation method to determine if nursing students were able to demonstrate competency related to the identified learning needs. RESULTS: The competitive aspects of this learning activity were perceived as exciting and motivating by the educators and students. CONCLUSION: An escape room-themed relay race incorporated into an obstetric skills laboratory is considered an innovative and formative evaluation method, as well as an engaging and motivating learning activity for nursing students. [J Nurs. Educ. 2020;59(11):646-650.].

Programa de escalonamiento clínico: una respuesta para la retención de las enfermeras / Scale ladder program: An answer for nursing retention

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A Tool to Guide Clinical Nurse Specialist Orientation, Professional Development, and Evaluation.

PURPOSE/OBJECTIVES: Currently, orientation for clinical nurse specialists (CNSs) in the Baltimore region is based on past practices: facility-specific or position-specific. A Chesapeake Bay affiliate work group identified a need to develop a theory-driven, competency-based program and tool to guide orientation and ongoing professional development reflecting the scope of CNS practice. DESCRIPTION OF THE PROJECT/PROGRAM: The tool incorporates Benner's concepts of novice-to-expert competence levels, guides progressive development of the CNS, and has relevant assessment metrics that highlight contributions to the patient, nurse, and system. OUTCOME: The group developed a comprehensive orientation tool grounded in the spheres of influence and advanced practice competencies and specific, measurable behavioral statements related to competencies from the 2018 National Association of Clinical Nurse Specialists' draft. This program is adaptable to guide the practice of a CNS in any facility, validate competence, and relate to those with varied experience in the role. CONCLUSION: In a method similar to the process for developing nationally recognized educational standards used to develop the competencies, the program was revised based on an iterative, stepwise process. It was distributed to the membership for evaluation and feedback, which was incorporated into the final version.

Translation, cultural adaptation, validation, and reliability study of the Quick-EBP-VIK instrument: Chinese version.

RATIONALE, AIMS, AND OBJECTIVES: Valid and reliable instruments for measuring are needed. To add knowledge to the subject of tools of evidence-based practice (EBP) evaluation in mainland China, the present study aims to translate the Quick-EBP-VIK into Chinese, which is an instrument for the assessment of nurses' value, knowledge, and implementation of EBP, and to evaluate the metric characteristics of the Chinese version. METHODS: In this methodological study, a total sample of 402 nurses from mainland China was applied. Construct validity was evaluated by using factor analysis and further supported through known-group validity. A panel of experts examined the content validity. Internal consistency was determined using composite reliability and Cronbach alpha. The intraclass correlation coefficient (ICC) was calculated to assess test-retest reliability. RESULTS: The exploratory factor analysis revealed a three-factor structure model same to the original instrument. The confirmatory factor analysis showed a good fit model with a comparative fit index of 0.957 and a root mean square error of approximation of 0.065. Significant differences were found in the item means of the tool between nurses who received EBP training and those who had not, which supported the known-group validity. The Cronbach alpha and composite reliability for the three subscales were all higher than 0.70. The ICC ranged from 0.569 to 0.928 for the three subscales and from 0.494 to 0.903 for the items included in the instrument. CONCLUSION: The Chinese version of the Quick-EBP-VIK has evidence of acceptable reliability and validity and can be used to measure value, knowledge, and implementation of EBP for Chinese nurses.

Evaluation of a nurse-led intervention program in heart failure: A randomized trial.

BACKGROUND AND OBJECTIVE: Several trials have evaluated the effect of disease management programs in heart failure (HF) with diverse results. The aim of this study was to develop a simple nurse-led clinic intervention program for patients with HF and assess whether this intervention positively affects the prognosis of patients, their care costs and perceived quality of life (QoL). METHODS: Between 2011 and 2013, 127 patients with reduced ejection fraction were prospectively randomly allocated (1:2) to standard care or intervention program. Primary composite endpoint was all-cause mortality and hospital readmissions. Secondary endpoints were all-cause mortality, all-cause hospital readmissions, readmissions for HF, time to first readmission and QoL improvements assessed by "Minnesota Living with Heart Failure Questionnaire" (MLHFQ). An intention-to-treat analysis was performed. RESULTS: After a median follow-up of 2-years, no differences were found in the primary composite endpoint. Likewise, there were no differences between groups in the predefined secondary endpoints of mortality and readmissions from any cause. However, in the intervention group, readmissions for HF were significantly reduced (35% vs. 18%; p=0.04) and QoL significantly improved (MLHFQ±SD: 2.29±14 vs. 10.9±14.75; p=0.04). CONCLUSIONS: In patients with HF, the use of a nurse-led intervention program significantly improves perceived QoL and reduce HF hospital readmissions.

Validation of the Knowledge and Self-management Nursing Outcomes Classification for Adults With Diabetes.

People with diabetes have to self-manage their health conditions to promote, maintain, and restore their health. The Nursing Outcomes Classification provides two outcomes for people with diabetes to evaluate their knowledge and self-management behaviors. The purpose of this study was to validate these two Nursing Outcomes Classification outcomes for adults with diabetes. A descriptive exploratory design using the Delphi technique was used. Two groups of experts were invited for validation of the outcomes. Descriptive statistics were used to determine definition adequacy, clinical usefulness, and content similarity. The Outcome Content Validity method was used to evaluate each outcome and the indicators. A total of 16 nurse experts participated in this study. The definition adequacy of the two Nursing Outcomes Classification outcomes was rated higher than 4.0 out of 5. Clinical usefulness was rated higher than 4.0 out of 5. The range of content validity of the two Nursing Outcomes Classification outcomes was from 0.89 to 0.92 (perfect score is 1.0). The invited experts reported that the content of this outcome pair was very similar. By using validated Nursing Outcomes Classification outcomes, nurses who take care of patients with diabetes can evaluate patient outcomes effectively and determine the effect of nursing interventions accurately.

Quality Assurance in Nursing Education: A Qualitative Study Involving Students and Newly Graduated Nurses.

Background: Assuring quality training for future nursing professionals is essential to preserving population health and socio-economic development. Quality assurance in the European Higher Education Area places students in a leading role to transform and improve higher education programs. Therefore, an innovative way of reviewing strengths and weaknesses of the nursing education program of a Spanish university has been developed. Objectives: The aim of this paper was to explore the perceptions and opinions of nursing students and newly-qualified nurses regarding the contents of the nursing curriculum in order to improve its quality. Methods: Descriptive and exploratory qualitative research was carried out involving 12 newly-qualified nurses and 12 student nurses. Semi-structured interviews and focus groups were performed. Results: Based on the thematic analysis, two themes emerged: improving clinical practices and reviewing the theoretical curriculum. Conclusions: Among the improvements suggested by the participants, the most relevant ones were establishing a clear structure of learning contents in the practicum, and redistributing the European Credit Transfer and Accumulation System ECTS credits in various courses of the study program. However, additional evidence is needed prior to proceeding with any changes.

Psychometric Validation of the Family Nurse Caring Belief Scale in a Neonatal Nursing Population.

PURPOSE: To psychometrically validate and strengthen the construct validity of the Family Nurse Caring Belief Scale (FNCBS) with a sample of neonatal nurses. DESIGN AND METHODS: Confirmatory factor analysis of the 25-item FNCBS, using the factor structure based on the original exploratory principal components analysis, was performed to evaluate the psychometric properties of the FNCBS with the neonatal nurse population. RESULTS: Confirmatory factor analysis (CFA) examined the factor structure of the FNCBS using the sample of neonatal nurses. The chi-square test determined overall model fit. Comparative fit index (CFI) and Tucker-Lewis index (TLI) were both <0.90 therefore, neither of these indices indicated good fit. The root mean square of error approximation (RMSEA) of the sample data was >0.06 and the standardized root mean square residual (SRMR) of the sample data is >0.08 and, therefore, the data did not demonstrate good fit. In addition, the factor correlations between the four latent variables were small. This suggests there is no parsimony and the sample data with neonatal nurses did not fit the model. CONCLUSION: The findings suggest the FNCBS was not psychometrically validated with the population of neonatal nurses and this study was unable to strengthen the construct validity of the FNCBS beyond the pediatric nurse sample in the original study. IMPLICATIONS FOR PRACTICE: This study highlighted the opportunity for continued research in the area of measuring nurses' beliefs regarding the provision of family-sensitive care to families in crisis and will generate a revision of the FNCBS to incorporate concepts which are important to care for a family unit.

The effectiveness of short answers test papers in evaluating academic nursing programs: A review of the literature.

Short answer tests (SAT) are an assessment that examines nursing students' knowledge and can be used to evaluate expectations for student educational success. The purpose of this literature review is to combine the best available evidence as to whether short answer test papers meet nursing facility curricula learning outcomes. A literature review was performed consisting of data bases which included; ERIC, SCOPUS, CINAHL MEDLINE, COCHRANE LIBRARY and JOHANNA BIGGS INSTITUTE (JBI). The following keywords were used: Short answer test, written assessment, quiz, organisations, university, higher degree education, tertiary education, nursing, perceptions, attitude, opinions, thoughts, feeling and belief. The majority of studies demonstrated that short answer tests equip nursing students with the knowledge and critical thinking skills for the clinical setting. Three major themes were identified: the effects of increasing class sizes; authenticity and the validity of short answer tests. Short answer tests are commonly used in undergraduate nursing programs to evaluate students' level of knowledge which consists of their ability to critically analyse and problem solve. To maintain authenticity and validity of an assessment, there is a need for an evidence-based approach to their design to meet the core learning objectives within the curriculum.

Instrumento para evaluar conocimientos en enfermeros sobre lesiones no intencionales en la infancia temprana / An Instrument for Assessing Nurses' Knowledge about Unintentional Injuries in Early Childhood

RESUMEN Introducción: Las lesiones no intencionales en la infancia temprana representan un problema de salud por su frecuencia, magnitud, severidad y trascendencia. La prevención de dichas lesiones es compleja y, en la atención primaria, el profesional de enfermería puede y debe ejercer una importante función dirigida a tal fin. Objetivo: Describir el diseño y validación de un instrumento para la evaluación del nivel de conocimientos que tienen los enfermeros sobre lesiones no intencionales en la infancia temprana. Métodos: Estudio metodológico que basó el diseño del instrumento en la literatura científica y la validación en criterio de expertos, que incluyó enfermeras nacionales e internacionales, pedagogos, médicos pediatras y epidemiólogos. El nivel de competencia fue medido por el coeficiente K. La concordancia se midió mediante el Índice Kappa de Cohen. Para medir la comprensión se realizó prueba piloto, con16 enfermeras del Policlínico Área I del municipio Cienfuegos. La confiablidad de consistencia interna se calculó con coeficiente Alfa de Cronbach mediante el programa estadístico Epidat. Resultados: Se obtuvo un instrumento fiable y válido que permite evaluar el nivel de conocimientos sobre lesiones no intencionales en la infancia temprana. Conclusiones: La utilización del instrumento diseñado y validado fue punto de referencia para la identificación nivel de conocimiento y el diseño de intervenciones educativas en la comunidad(AU)

ABSTRACT Introduction: Unintentional injuries in early childhood represent a health problem due to their frequency, magnitude, severity and transcendence. The prevention of such injuries is complex and in the primary care, the nursing professional can and should exercise an important function directed to that end. Objective: Describe the design and validation of an instrument for evaluation of the level of knowledge nurses have about unintentional injuries in early childhood. Methods: Methodological study that based the design of the instrument on the scientific literature and the validation in criterion of experts, who It included national and international nurses, pedagogues, pediatric doctors and epidemiologists. The level of competence was measured by the coefficient K. The concordance was measured by Cohen's Kappa Index. To measure comprehension, a pilot test was carried out, with 16 nurses from the Policlínico Área I of the Cienfuegos municipality. The reliability of internal consistency was calculated with the Cronbach's Alpha coefficient using the statistical program Epidat. Results: A reliable and valid instrument was obtained that allows assessing the level of knowledge about unintentional injuries in early childhood. Conclusions: The use of the designed and validated instrument was a point of reference for the identification level of knowledge and the design of educational interventions in the community(AU)

The economic impact of a nurse practitioner-directed lung cancer screening, incidental pulmonary nodule, and tobacco-cessation clinic.

OBJECTIVE: Lung cancer screening programs have become increasingly prevalent within the United States after the National Lung Screening Trial results. We aimed to review the financial impact after programmatic implementation of Advanced Registered Nurse Practitioner-led programs of Lung Cancer Screening and Tobacco Related Diseases, Incidental Pulmonary Nodule Clinic, and Tobacco Cessation Services. METHODS: We reviewed revenue from 2013 to 2016 by our nurse practitioner-led program. Encounters were queried for charges related to outpatient evaluation and management, professional procedures, and facility charges related to both outpatient and inpatient procedures. Revenue was normalized using 2016 data tables and the national Medicare conversion factor (35.8043). RESULTS: Our program evaluated 694 individuals, of whom 75% (518/694) are enrolled within the lung cancer-screening program. Overall revenue associated with the programs was $733,336. Outpatient evaluation and management generated revenue of $168,372. In addition, professional procedure revenue accounted for an additional $60,015 with facility revenue adding an additional $504,949. CONCLUSIONS: A nurse practitioner-led program of lung cancer screening, incidental pulmonary nodules, and tobacco-cessation services can provide additional revenue opportunities for a Thoracic Surgery and Interventional Pulmonology Division, as well as a health care system. The current national, median annual wage of a nurse practitioner is $98,190, and the cost associated directly to their salary (and benefits) may remain neutral or negative within certain programs. However, the larger economic benefit may be realized within the division and institution. This potential additional revenue appears related to evaluation of newly identified diseases and subsequent evaluations, procedures, and operations.

Utilidad del Análisis de Redes Sociales para la Enfermería / No disponible

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Nursing Documentation: An Evaluation of an Action Research Project.

This abstract describes an evaluation of an action research project conducted to improve nursing documentation practice in four municipalities in Norway. In an explorative design, four focus group interviews and two individual interviews were conducted. The interview data were analyzed using content analysis. Three themes emerged: healthcare professionals perceived the documentation process as complicated; they experienced competing interests; and they highlighted a clear and visible leader as important for success. This study provides knowledge about the importance of collaboration and involvement of stakeholders when developing electronic health record systems.

The NMC has to look beyond England, says Janet Finch.

The Nursing and Midwifery Council is a 4-country regulator. Our remit covers Wales, Scotland, Northern Ireland and England, which is reflected in the membership of our council and many of our activities.

Identifying Patterns in Implementation of Hospital Pressure Ulcer Prevention Programs: A Multisite Qualitative Study.

PURPOSE: To describe the presence or absence of key components of hospital pressure ulcer (PU) prevention programs in 6 acute care hospitals. DESIGN: Multisite comparative case study. SUBJECTS AND SETTING: Using purposeful selection based on PU rates (high vs low) and hospital size, 6 hospitals within the Veterans Health Administration health care system were invited to participate. Key informant interviews (n = 48) were conducted in each of the 6 participating hospitals among individuals playing key roles in PU prevention: senior nursing leadership (n = 9), nurse manager (n = 7), wound care specialist (n = 6), frontline RNs (n = 26). METHODS: Qualitative data were collected during face-to-face, semistructured interviews. Interview protocols were tailored to each interviewee's role with a core set of common questions covering 3 major content areas: (1) practice environment (eg, policies and wound care specialists), (2) current prevention practices (eg, conduct of PU risk assessment and skin inspection), and (3) barriers to PU prevention. We conducted structured coding of 5 key components of PU prevention programs and cross-case analysis to identify patterns in operationalization and implementation of program components across hospitals based on facility size and PU rates (low vs high). RESULTS: All hospitals had implemented all PU prevention program components. Component operationalization varied considerably across hospitals. Wound care specialists were integral to the operationalization of the 4 other program components examined; however, staffing levels and work assignments of wound care specialists varied widely. Patterns emerged among hospitals with low and high PU rates with respect to wound care specialist staffing, data monitoring, and staff education. CONCLUSION: We found hospital-level variations in PU prevention programs. Wound care specialist staffing may represent a potential point of leverage in achieving other PU program components, particularly performance monitoring and staff education.

Trabajo final de grado y plan de acción tutorial en el curriculum del grado en enfermería. Diseño, desarrollo y evaluación / Final project degree and tutorial action plan in the curriculum of the degree in nursing. Design, development and evaluation

La acción tutorial (PAT), en los estudios universitarios de Enfermería, se halla en el centro de la acción docente del profesorado. El tutor/a orienta en el proceso de aprendizaje y en la preparación del Trabajo Final de Grado (TFG). En este artículo presentamos los resultados de la investigación realizada con tutores y estudiantes, que tiene por objetivo evaluar el diseño y desarrollo del TFG, los resultados académicos y su vivencia y experiencia. Diseño mixto cuantitativo descriptivo y cualitativo de investigación acción participación. Muestra total de 124 estudiantes de 4º curso de Grado Enfermería y 37 tutores del TFG. Técnicas de recogida de datos: resultados académicos y evaluativos; 3 grupos focales con estudiantes y profesores; 3 entrevistas semiestructuradas abiertas a estudiantes. Los resultados constatan que las tipologías más elegidas fueron revisiones bibliográficas (38,75%) y Planes de cuidados (24,2%). El 63,9 % de la temática escogida es Enfermería Maternal, Pediátrica y Clínica. Estudiantes y tutores viven con dificultad la elaboración del TFG y se requiere una mayor cultura tutorial. Es un proceso complejo de organización y coordinación que, sin embargo, permite un trabajo colaborativo de todo el equipo docente (AU)

The Tutorial Action Plan (PAT) in the University School of Nursing, is central to the teaching action of professors. The tutor orients in the learning process and the preparation of the Final Degree Project (TFG). In this paper we present the results of research conducted with tutors and students, which aims to evaluate the design and development of the TGF, academic results and their experience and expertise. A descriptive qualitative and quantitative joint design of research and participation. A total sample of 124 students of 4th year in the nursing degree and 37 TGF tutor. Data collection techniques: Academic and evaluation results; 3 focus groups with students and professors; three semi-structured interviews open to students. Results indicate that the most commonly chosen typologies were literary reviews (38.75%) and care plans (24.2%). 63.9% of the chosen topics include Maternal, Pediatric and Clinical Nursing. Students and tutors struggle to develop the TGF and greater tutorial culture is required. It is a complex process of organization and coordination which, however, allows collaborative work of the entire faculty (AU)

Implicaciones del hostigamiento psicológico (mobbing) sobre los testigos: Un estudio observacional en enfermería / Implications of psychological harassment on witnesses: an observational study in nursing staff

El hostigamiento psicológico en el trabajo (mobbing) es un problema de considerable magnitud para el personal de enfermería a nivel mundial. Aunque el maltrato psicológico laboral esté basado en comportamientos subjetivos, el elevado número de personas que lo testifica plantea, como mínimo, una mayor reflexión sobre este tema. El objetivo de este estudio es analizar la problemática del mobbing desde el punto de vista exclusivo de los testigos y conocer las repercusiones psicológicas del fenómeno sobre los mismos. Se realizó un estudio descriptivo transversal, usando cuestionarios autoadministrados. La muestra está compuesta de 204 profesionales de enfermería, de los cuales el 28.4% reportaron haber testificado conductas hostiles hacia sus compañeros de trabajo. Las conductas más observadas fueron el desprestigio profesional, la humillación, el rechazo profesional, el ninguneo y el aislamiento profesional. Los resultados demostraron que los testigos de hostigamiento psicológico, aunque no se percibían víctimas de ello, presentaban significativamente más síntomas de estrés que los no testigos, así como un mayor deseo de abandonar la profesión y una mayor percepción de que la enfermería es una profesión poco valorada. Los resultados indican que el mobbing en enfermería es un comportamiento objetivable y que su impacto repercute negativamente en los observadores del mismo, convirtiéndolos en víctimas secundarias del fenómeno (AU)

Psychological harassment at work (mobbing) is considered a worldwide problem of great magnitude for nursing staff. Although hostility is described as a subjective behavior, the large number of witnesses suggests a reflection on the phenomenon. The aim of this study is to analyze the problem of psychological harassment from the point of view of the witnesses, and to find out the psychological impact of this phenomenon on them. We performed a cross-sectional study using self-administered questionnaires. The sample consisted of 204 nurses who were non-victims of mobbing. 28.4% (n = 58) of them reported to have observed hostile behavior toward coworkers. The most observed behaviors were professional discrediting, professional humiliation, rejection, scorn, and professional isolation. It was found that the witnesses of mobbing had significantly more symptoms of stress than non-witnesses, a greater desire to leave the profession, and a greater perception that nursing is an undervalued profession. The results indicate that mobbing in nursing is an objective behavior and its impact reaches observers thereof, who may be secondary victims of the phenomenon. The results indicate that mobbing in nursing is an objective behavior and its impact reaches observers thereof, which could be considered secondary victims of the phenomenon (AU)