An Educational Intervention to Explore and Overcome Nursing Students' Breastfeeding Barriers: A Mixed-Methods Quasi-experimental Study.

BACKGROUND: Nursing and midwifery students do not feel adequately prepared during their clinical training to support women who breastfeed, demanding more effective communication skills and knowledge. AIM: The aim was to evaluate changes in students' breastfeeding knowledge. METHODS: This was a mixed-methods quasi-experimental design. Forty students voluntarily participated. Using a 1:1 ratio, 2 groups were randomly created and completed the validated questionnaire ECoLaE (pre-post). The educational program consisted of focus groups, a clinical simulation, and a visit to the local breastfeeding association. FINDINGS: The control group's posttest scores ranged from 6 to 20 (mean = 13.1, standard deviation [SD] = 3.0). The intervention group ranged from 12 to 20 (mean = 17.3, SD = 2.3). A Student's t test for independence samples was calculated ( P < .005, t = 4.5, median = 4.2). The intervention group had a mean difference of 10 points in improvement (mean =10.53, SD = 2.20, min = 7, max = 14), whereas the control group had a mean of 6 points (mean = 6.80, SD = 3.03, min = 3, max = 13). The multiple linear regression explained the intervention's effect. The regression model had statistical significance ( F = 4.87, P = 0.004), with an adjusted R2 = 0.31. The linear regression between the posttest scores and group variables after adjusting by age showed an increment of 4.1 points in the intervention posttest scores ( P < .005, 95% confidence interval [CI] = 2.1-6.1). CONCLUSIONS: The educational program "Engage in breaking the barriers to breastfeeding" improved nursing students' knowledge.

Uso del acido tranexámico en hemorragias en zona de combate / Use of tranexamic acid in hemorrhages in combat zone

El control de la hemorragia es uno de los aspectos más importantes en el tratamiento de los heridos en zona de operaciones. A lo largo de los últimos años, en conflictos como el de Irak y Afganistán se han desarrollado nuevos protocolos de tratamiento por la necesidad de mejorar el pronóstico de las bajas. La sanidad militar de varios países, entre ellos España, ha realizado diferentes estudios en relación con el tema. Este trabajo presenta una revisión bibliográfica del uso del ácido tranexámico como favorecedor en el control de las grandes hemorragias (AU)

Controlling bleeding is one of the most important aspects when treating casualties in the area of operations in a conflict zone. Conflicts in Irak and Afghanistan have spurred the development of new treatment guides to improve the prognosis of casualties over the past few years. The Military Health of several countries, amongst them Spain, have researched along these lines to improve health care for patients in areas of operations. The present work is a bibliographic revision of the use of tranexamic acid to favor control over massive bleeding (AU)

Diálisis peritoneal y hemodiálisis ¿Qué factores deberían influir en su elección? / Peritoneal dialysis and hemodialysis. What factors should influence treatment choice?

La enfermedad renal crónica afecta en sus diferentes estadios al 0.1 % de la población española, y aumentan de forma progresiva las personas subsidiarias de las distintas modalidades de tratamiento sustitutivo renal existentes. Dicho tratamiento perturba de forma muy significativa la calidad de vida y supervivencia de los pacientes, e implica además grandes costes sanitarios al Sistema Nacional de Salud. Por esta razón, resulta fundamental conocer cuál de las técnicas de tratamiento lleva consigo una mejor calidad de vida, un menor grado de morbimortalidad, así como un menor gasto sanitario. Analizados los resultados, se observó que el tratamiento sustitutivo renal (TSR) que mejores resultados aporta es la diálisis peritoneal (DP). Así, en cuanto a calidad de vida, los pacientes con DP obtienen puntuaciones más altas respecto a los pacientes en hemodiálisis (HD), y, del mismo modo, los pacientes con DP en los primeros años de tratamiento resentaran menor morbimortalidad respecto a la HD, siendo en años posteriores similar en ambas modalidades. Por último, la DP presenta un menor coste sanitario respecto a la HD, fundamentado sobre todo en el acceso peritoneal y lo que a costes indirectos se refiere. Pese a todo, serán las características propias de cada paciente las que van a determinar la utilización de una técnica u otra, por lo que deberá realizarse una valoración exhaustiva e integral del paciente en la consulta de enfermedad renal crónica, para que este pueda ser subsidiario de la técnica de TSR que más se adapte a sus características (AU)

Chronic kidney disease affects at its different stages 0.1 % of the Spanish population, progressively increasing the amount of people subject to different types of renal replacement therapy (RRT). Such treatments disrupt very significantly the quality of life and survival of patients, Diálisis peritoneal y hemodiálisis carrying as well large health costs to the National Health System. It’s therefore essential to determine which treatment techniques involve quality of life improvement, a lesser degree of morbidity and mortality, as well as lower health care costs. After analyzing results, it was observed that peritoneal dialysis (PD) is the RRT showing better results. In terms of quality of life, patients with PD score higher compared to patients on hemodialysis (HD). Patients on PD during the early years of treatment present less morbidity and mortality compared to HD, showing however similar results in later years. Finally, PD implies lower health care costs over HD, mainly due to the peritoneal access and related indirect costs. Nevertheless, it’ll be the specific characteristics of each patient the ones that will determine the use of a technique over the other. A thorough and comprehensive patient assessment should be done in the chronic kidney disease consultation to determine the most suitable RRT (AU)

Dificultades para ofrecer cuidados al final de la vida en las unidades de cuidados intensivos. La perspectiva de enfermería / End of life care difficulties in intensive care units. The nurses’ perspective

Objetivo: Describir las dificultades percibidas por el personal de enfermería para prestar cuidados al final de la vida al paciente grave dentro de la unidad de cuidados intensivos (UCI). Método: Estudio cualitativo fenomenológico descriptivo. Se aplicó un muestreo por propósito y de bola de nieve. Las enfermeras debían tener una experiencia mínima de 1 año en UCI. Se incluyeron 22 participantes. Los datos se recopilaron mediante entrevistas en profundidad (no estructuradas y semiestructuradas) y notas de campo del investigador. El análisis se realizó mediante la propuesta de Giorgi. Resultados: Se identificaron tres temas: dificultades académico-culturales, relacionadas con la orientación curativa de la UCI y la falta de formación en cuidados al final de la vida; dificultades estructurales-arquitectónicas, relacionadas con la falta de espacio e intimidad para el paciente y la familia en los últimos momentos; y dificultades psicoemocionales, relacionadas con el distanciamiento emocional como estrategia aplicada por el personal de enfermería. Conclusiones: El personal de enfermería necesita formación sobre los cuidados al final de la vida mediante el uso de guías o protocolos y el desarrollo de estrategias de afrontamiento, junto a un cambio en la organización de la UCI orientado al cuidado terminal de los pacientes graves y a la atención de la familia (AU)

Objective: To describe the difficulties perceived by nursing staff in the delivery of end-of-life care to critically ill patients within intensive care units (ICU). Method: A descriptive phenomenological qualitative study was performed. A purposeful and snowball sampling of nursing staff with at least 1 year's previous experience working in an ICU was conducted. Twenty-two participants were enrolled. Data collection strategies included in-depth unstructured and semi-structured interviews and researcher's field notes. Data were analysed using the Giorgi proposal. Results: Three themes were identified: academic-cultural barriers, related to the care orientation of the ICU and lack of training in end of life care; architectural-structural barriers, related to the lack of space and privacy for the patient and family in the last moments of life; and psycho-emotional barriers, related to the use of emotional detachment as a strategy applied by nursing staff. Conclusions: Nursing staff need proper training on end-of-life care through the use of guidelines or protocols and the development of coping strategies, in addition to a change in the organisation of the ICU dedicated to the terminal care of critically ill patients and family support (AU)

[End of life care difficulties in intensive care units. The nurses' perspective]. / Dificultades para ofrecer cuidados al final de la vida en las unidades de cuidados intensivos. La perspectiva de enfermería.

OBJECTIVE: To describe the difficulties perceived by nursing staff in the delivery of end-of-life care to critically ill patients within intensive care units (ICU). METHOD: A descriptive phenomenological qualitative study was performed. A purposeful and snowball sampling of nursing staff with at least 1 year's previous experience working in an ICU was conducted. Twenty-two participants were enrolled. Data collection strategies included in-depth unstructured and semi-structured interviews and researcher's field notes. Data were analysed using the Giorgi proposal. RESULTS: Three themes were identified: academic-cultural barriers, related to the care orientation of the ICU and lack of training in end of life care; architectural-structural barriers, related to the lack of space and privacy for the patient and family in the last moments of life; and psycho-emotional barriers, related to the use of emotional detachment as a strategy applied by nursing staff. CONCLUSIONS: Nursing staff need proper training on end-of-life care through the use of guidelines or protocols and the development of coping strategies, in addition to a change in the organisation of the ICU dedicated to the terminal care of critically ill patients and family support.

[THERAPEUTIC LIMITATION OF INTENSIVE CARE UNIT]. / La limitación terapéutica en la Unidad de Cuidados Intensivos.

The therapeutic limitation is a relatively common in Intensive Care Units practice. There are different types of therapeutic limitation, and the patient can be classified according to measures likely to withdraw or not start. Among such measures include removal of stand mechanical ventilation with the analgesia and sedation applied to the end of life of the patient.

La limitación terapéutica en la Unidad de Cuidados Intensivos / Therapeutic limitation of intenseve care unit

La limitación terapéutica es una práctica relativamente frecuente dentro de las Unidades de Cuidados Intensivos. Existen distintos tipos de limitación terapéutica, y se puede clasificar al paciente en función de las medidas susceptibles de retirarse o no iniciarse. Entre dichas medidas, cabe destacar la retirada de la ventilación mecánica junto con la analgesia y la sedación aplicadas al final de la vida del paciente (AU)

The therapeutic limitation is a relatively common in Intensive Care Units practice. There are different types of therapeutic limitation, and the patient can be classified according to measures likely to withdraw or not start. Among such measures include removal of stand mechanical ventilation with the analgesia and sedation applied to the end of life of the patient (AU)

El estudiante como protagonista de su aprendizaje: La necesidad del uso del portafolio en enfermería dentro del contexto de Educación Superior / The student as protagonists of their learning: the need to use the portfolio in nursing within the context of higher education

Las reformas promovidas por el proceso Bolonia han implicado cambios en las formas de enseñar y aprender dentro del marco del Espacio Europeo de Educación Superior. Esta amplia remodelación trae consigo por un lado un cambio estructural y, por otro, una reconceptualización del proceso de aprendizaje apoyada en las teorías constructivistas, a través de estrategias metodológicas de construcción del conocimiento desarrolladas por los estudiantes. El objetivo del presente artículo es presentar una reflexión teórica acerca del uso del portafolio como recurso didáctico para la enseñanza y aprendizaje dentro de este contexto. Se ha observado que la implicación de los estudiantes en la identificación de los problemas a través del portafolio, facilita a los docentes una mayor comprensión de los procesos de aprendizaje de los estudiantes, así como una oportunidad para éstos de efectuar un aprendizaje más reflexivo, autónomo y participativo, tan importante en disciplinas eminentemente prácticas como la Enfermería

The reforms promoted by the Bologna process have led to changes in the forms of teaching and learning within the framework of European Higher Education. This brings extensive remodeling on the one hand a structural change and on the other, a re-conceptualization of the learning process supported by constructivist theories, through methodological strategies developed knowledge construction by students. The aim of this paper is to present a theoretical reflection on using the portfolio as a teaching resource for teaching and learning in this context. It has been observed that the involvement of students in identifying problems through the portfolio, provides teachers with a greater understanding of the learning processes of students as well as an opportunity for them to make a more reflective learning, independent and participatory practices eminently important in disciplines such as Nursing