Effectiveness of "Escape Room" Educational Technology in Nurses' Education: A Systematic Review.

Escape room games are educational gamification technologies that consist of introducing a team of players into a physical or digital space in search of clues to answer puzzles, riddles or enigmas and solve a mystery or problem. This study aims to determine the effectiveness of escape room games on the training of nursing students in an international context. A systematic review was carried out in MEDLINE, WOS, SCOPUS, CINAHL and LILACS databases using the MeSH terms "Education, Nursing" and "Educational Technology", and the free term "Escape room", combined with Boolean operators AND/OR. Intervention studies in Spanish, English and Portuguese were included, without limitation for the year of publication. Selection and critical appraisal were conducted by two independent reviewers. A total of n = 13 interventional studies were included (n = 2 Randomized Clinical Trials and n = 11 quasi-experimental design). Escape rooms are a recent and growing educational methodology, increasingly used in academia and in the training of nurses and nursing students. However, it is necessary to expand their use and the quality of the studies in a greater number of contexts. Furthermore, it is necessary to homogenize and standardize validated instruments to evaluate the effectiveness of escape rooms in the nursing education area.

Effectiveness of a Standardized Nursing Process Using NANDA International, Nursing Interventions Classification and Nursing Outcome Classification Terminologies: A Systematic Review.

The decision-making in clinical nursing, regarding diagnoses, interventions and outcomes, can be assessed using standardized language systems such as NANDA International, the Nursing Interventions Classification and the Nursing Outcome Classification; these taxonomies are the most commonly used by nurses in informatized clinical records. The purpose of this review is to synthesize the evidence on the effectiveness of the nursing process with standardized terminology using the NANDA International, the Nursing Interventions Classification and the Nursing Outcome Classification in care practice to assess the association between the presence of the related/risk factors and the clinical decision-making about nursing diagnosis, assessing the effectiveness of nursing interventions and health outcomes, and increasing people's satisfaction. A systematic review was carried out in Medline and PreMedline (OvidSP), Embase (Embase-Elsevier), The Cochrane Library (Wiley), CINAHL (EbscoHOST), SCI-EXPANDED, SSCI and Scielo (WOS), LILACS (Health Virtual Library) and SCOPUS (SCOPUS-Elsevier) and included randomized clinical trials as well as quasi-experimental, cohort and case-control studies. Selection and critical appraisal were conducted by two independent reviewers. The certainty of the evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation Methodology. A total of 17 studies were included with variability in the level and certainty of evidence. According to the outcomes, 6 studies assessed diagnostic decision-making and 11 assessed improvements in individual health outcomes. No studies assessed improvements in intervention effectiveness or population satisfaction. There is a need to increase studies with rigorous methodologies that address clinical decision-making about nursing diagnoses using NANDA International and individuals' health outcomes using the Nursing Interventions Classification and the Nursing Outcome Classification as well as implementing studies that assess the use of these terminologies for improvements in the effectiveness of nurses' interventions and population satisfaction with the nursing process.

Necesidades de atención domiciliaria en el paciente paliativo pediátrico percibidas por los profesionales: Una teoría fundamentada / Home care needs of paediatric palliative patients perceived by professionals: A grounded theory

Objetivo: Explorar los elementos que intervienen en el proceso de los cuidados paliativos pediátricos domiciliarios en el contexto de España según la opinión de los profesionales. Método: Estudio cualitativo sustentado en la Teoría Fundamentada, ajustado a normas COREQ, mediante muestreo teórico con entrevistas en profundidad (junio 2021 - febrero 2022) a pediatras, enfermeras pediátricas y trabajadores sociales de unidades de cuidados paliativos infantiles en España, excluyendo profesionales con experiencia inferior a 1 año. Las entrevistas han sido grabadas y transcritas literalmente para su codificación y categorización mediante un proceso comparativo constante a través de coocurrencias de códigos hasta la saturación de datos usando Atlas-Ti®. Se ha garantizado el anonimato de los informantes empleando pseudónimos tras la aprobación por el Comité de Ética de la Investigación del Hospital Universitario de Gran Canaria Doctor Negrín (Las Palmas, Islas Canarias) con número de registro 2021-403-1. Resultados: Se realizaron 18 entrevistas que expusieron 990 citas agrupadas en 22 categorías de análisis y estructuradas en cuatro grupos temáticos (cuidados, entorno, paciente y familia y profesionales). Los hallazgos mostraron una visión holística que enfatiza la necesidad de organizar e integrar los factores que intervienen en el abordaje domiciliario a los cuidados paliativos domiciliarios en pediatría. Conclusiones: En nuestro contexto, el entorno domiciliario reúne unas condiciones apropiadas para desarrollar los cuidados paliativos pediátricos. Las categorías de análisis identificadas establecen un punto de partida para seguir profundizando en el abordaje desde las esferas temáticas implicadas: los cuidados, el entorno, el paciente y la familia y los profesionales.(AU)

Objective: To explore the elements involved in the process of paediatric palliative home care in the Spanish context according to the opinion of professionals. Method: Qualitative study based on Grounded Theory, adjusted to COREQ standards, using theoretical sampling with in-depth interviews (June 2021 - February 2022) with paediatricians, paediatric nurses and social workers from paediatric palliative care units in Spain, excluding professionals with less than 1 year's experience. Interviews were recorded and transcribed literally for coding and categorisation through a constant comparative process of code co-occurrence until data saturation using Atlas-Ti®. The anonymity of the informants has been guaranteed by using pseudonyms after approval by the Research Ethics Committee of the Hospital Universitario de Gran Canaria Doctor Negrín (Las Palmas, Canary Islands) with registration number 2021-403-1. Results: 18 interviews were conducted and 990 quotes were grouped into 22 categories of analysis and structured into four thematic groups (care, environment, patient and family, and professionals). The findings showed a holistic view emphasising the need to organise and integrate the factors involved in the home-based approach to paediatric palliative home care. Conclusions: In our context, the home environment meets appropriate conditions for the development of paediatric palliative care. The categories of analysis identified establish a starting point for further deepening the approach from the thematic areas involved: care, the environment, the patient and family, and professionals.(AU)

Home care needs of paediatric palliative patients perceived by professionals: A grounded theory.

OBJECTIVE: To explore the elements involved in the process of paediatric palliative home care in the Spanish context according to the opinion of professionals. METHOD: Qualitative study based on Grounded Theory, adjusted to COREQ standards, using theoretical sampling with in-depth interviews (June 2021-February 2022) with paediatricians, paediatric nurses and social workers from paediatric palliative care units in Spain, excluding professionals with less than 1 years' experience. Interviews were recorded and transcribed literally for coding and categorisation through a constant comparative process of code co-occurrence until data saturation using Atlas-Ti®. The anonymity of the informants has been guaranteed by using pseudonyms after approval by the Research Ethics Committee of the Hospital Universitario de Gran Canaria Doctor Negrín (Las Palmas, Canary Islands) with registration number 2021-403-1. RESULTS: 18 interviews were conducted and 990 quotes were grouped into 22 categories of analysis and structured into four thematic groups (care, environment, patient and family, and professionals). The findings showed a holistic view emphasising the need to organise and integrate the factors involved in the home-based approach to paediatric palliative home care. CONCLUSIONS: In our context, the home environment meets appropriate conditions for the development of paediatric palliative care. The categories of analysis identified establish a starting point for further deepening the approach from the thematic areas involved: care, the environment, the patient and family, and professionals.

Evaluation of the NANDA International, Inc. diagnostic classification in Spain: Development and validation of the EVALUAN-I tool.

PURPOSE: To develop and validate a tool to evaluate the NANDA International, Inc. diagnostic classification. METHODS: The tool, EVALUAN-I, was validated in a non-probabilistic sample (N = 460) on Spanish Registered Nurses (September-December 2019) in two phases. First, design and construct the instrument in three steps: (1) literature review to define the construct focusing on the orientation toward nursing concepts and theoretical foundations, the level of scientific evidence, the structural configuration, the applicability, the nurses' clinical reasoning skills, and the attitudes toward nursing diagnosis, (2) substantiation of the questionnaire items and design according to the criteria for a diagnostic classification, (3) expert test to establish the face validity and content validity. The second phase revolved around (4) conducting a pilot test and measuring the temporal stability (test-retest) and Cohen's kappa coefficient; assessing psychometric properties by measuring (5) reliability (internal consistency using Cronbach alpha and interfactor correlation) and (6) construct validity (exploratory and confirmatory factor analysis). The manuscript follows the STROBE checklist. The study was approved by the Research Ethics Committee with registration number 2019-190-1. FINDINGS: EVALUAN-I displayed moderate test-retest stability, adequate construct validity, and excellent reliability. The confirmatory factor analysis provided evidence about the configuration of EVALUAN-I in relation to nine analytical dimensions: clinical competence, nurses' reasoning skills, attitudes towards nursing diagnosis, discipline's central concepts, classification's contents, physiopathological attributes, level of scientific evidence, diagnostic precision, and conceptual correspondence between terminologies. CONCLUSIONS: EVALUAN-I is a valid and reliable instrument, which can be used to improve the epistemological, normative, and intuitive configuration of NANDA International, Inc. in a structured, systematic manner. IMPLICATIONS FOR NURSING PRACTICE: Comprehensive evaluation of NANDA International, Inc. in different clinical settings around the world using a validated instrument, like EVALUAN-I, would allow strengths and weaknesses to be identified and contribute to the classification's development and practical application.

OBJETIVO: Diseñar y validar un instrumento de medida para evaluar la taxonomía diagnóstica NANDA International, Inc. MÉTODOS: La herramienta, EVALUAN-I, ha sido validada con una muestra no probabilística (N = 460) de enfermeras españolas (septiembre-diciembre 2019) en dos fases. Primera, diseño y construcción del instrumento en tres etapas: (1) definición del constructo a través de una revisión bibliográfica centrada en la orientación hacia los conceptos y fundamentos teóricos de la enfermería, el nivel de evidencia científica, la configuración estructural, la aplicabilidad, las habilidades de razonamiento clínico de las enfermeras y las actitudes hacia los diagnósticos enfermeros, (2) fundamentación normativa de los criterios que debe reunir una clasificación diagnóstica y (3) prueba de expertos para establecer la validez aparente y validez de contenido. La segunda fase se centra en (4) el desarrollo de un pilotaje y medición de la estabilidad temporal a través del test-retest y cálculo del coeficiente Kappa de Cohen; evaluación de las propiedades psicométricas a través de la (5) fiabilidad (consistencia interna mediante Alfa de Cronbach y correlación interfactorial) y (6) validez de constructo (análisis factorial exploratorio y confirmatorio). El manuscrito se ajusta a los criterios STROBE. El estudio fue aprobado por el Comité de Ética de la Investigación con el número de registro 2019-190-1. [Correction added on 20 April 2022, after first online publication: In point (4) of the 'Methods' section, "Kappa de ohen" has been corrected to "Kappa de Cohen" in this version.] RESULTADOS: EVALUAN-I mostró moderada estabilidad test-retest, adecuada validez de constructo y excelente fiabilidad. El análisis factorial confirmatorio mostró evidencias acerca de la configuración de EVALUAN-I en 9 dimensiones de análisis: competencia clínica, aptitudes para el razonamiento diagnóstico, actitudes ante el diagnóstico enfermero, conceptos centrales de la disciplina, contenidos de la clasificación, atributos fisiopatológicos, nivel de evidencia científica, precisión diagnóstica y comparativa conceptual entre terminologías. CONCLUSIONES: EVALUAN-I constituye un instrumento válido y fiable para mejorar la configuración epistemológica, normativa e intuitiva de NANDA International, Inc. de una manera estructurada y sistematizada. IMPLICACIONES PARA LA PRÁCTICA CLÍNICA: La valoración global de la taxonomía NANDA International, Inc. en los distintos contextos clínicos a nivel internacional a través de una herramienta validada como EVALUAN-I permitiría identificar las fortalezas y debilidades necesarias para contribuir a su desarrollo y aplicación práctica.

Uso de terminología enfermera normalizada en los informes de cuidados al alta en un hospital de Canarias: Un estudio descriptivo / Use of standardised nursing terminology at discharge care reports in a canary islands hospital: a descriptive study

Objetivos: Analizar el uso de len guajes normalizados en los informes de enfermería identificando tipologías, eti quetas y contenidos diagnósticos. Méto do: Estudio descriptivo transversal sobre una muestra aleatoria simple (n = 370) de informes al alta hospitalaria en el Complejo Hospitalario Universitario Insu lar Materno-Infantil (Islas Canarias, Es paña). Se han calculado media y desvia ción estándar para las variables cuantita tivas y frecuencias para las cualitativas usando SPSS® (versión 25). Resulta dos: Menos de la mitad de los informes (49,23%) incorporaron terminología nor malizada, incluyendo n = 1922 diagnósti cos activos, n = 93 diagnósticos resuel tos, n = 72 intervenciones y n = 103 re sultados enfermeros. Conclusiones: Los informes que usan lenguajes normaliza dos son insuficientes, mostrando elevado número de etiquetas diagnósticas que revelan escasa resolución de diagnósti cos focalizados en el problema, con me nor registro de intervenciones y resulta dos enfermeros (AU)

Objectives: To analyse the use of standardised language in nursing care reports identifying typologies, labels and diagnostic content. Methods: Cross-sec tional descriptive study of a simple ran dom sample (n = 370) in the Complejo Hospitalario Universitario Insular Ma terno-Infantil (Canary Islands, Spain). The mean and standard deviation for quantitative variables, and frequency for qualitative variables were calculated using SPSS® (version 25). Results: Less than half of the reports (49.23%) incorpo rated standardized terminology, including n = 1922 active diagnoses, n = 93 resol ved diagnoses, n = 72 interventions, and n = 103 nurses outcomes. Conclusions: Reports using standardized languages are insufficient, showing a high number of diagnostic labels that reveal poor reso lution of problem-focused nursing diag noses, with less recording of interven tions and nurses outcomes (AU)

Actitudes ante el Diagnóstico Enfermero: aplicación de la escala Position on Nursing Diagnosis en Canarias / Attitudes towards Nursing Diagnosis: application of the Position on Nursing Diagnosis scale in Canary Islands

Introducción: Las enfermeras tienen opiniones y actitudes diferentes sobre la funcionalidad clínica de los Diagnósticos Enfermeros. Objetivo: Describir las actitudes de los profesionales de Enfermería ante el Diagnóstico Enfermero. Método: Estudio observacional, descriptivo, transversal en un hospital de las Islas Canarias (España). Position on Nursing Diagnosis constituye un instrumento validado con excelente fiabilidad. Conformado por una escala codificada de 20 parejas de adjetivos opuestos; puntuaciones extremas 1 (más negativa) y 7 (más positiva); valor central 4. Puntuación máxima 140 y mínima 20. Se realizó análisis de fiabilidad mediante Alfa de Cronbach y correlación interelementos. Distribución de frecuencias para variables cualitativas y de proporción para cuantitativas. Análisis de asociación. Resultados: Población muestral n=170. La escala ha expuesto alta fiabilidad (α=0,955) y adecuado poder de explicación de la varianza (66,13%). La puntuación media global fue 74,41 (sd=23,53); la peor actitud correspondió a Rutinario (µ=2,91; sd=1,55) mientras que la mejor fue Positivo (µ=4,20; sd=1,56). Conclusiones: Las actitudes de las enfermeras son similares a las observadas en otras realidades, con puntuaciones globales inferiores a la media. El incremento de la formación académica y del uso del Diagnóstico Enfermero en el entorno laboral parecen mejorar las actitudes de estos profesionales, principalmente en lo que respecta a su aceptación, comodidad, facilidad, relevancia, validez, creatividad y gratificación.

Introduction: Nurses have different opinions and attitudes about the clinical functionality of Nursing Diagnosis. Objective: To describe the attitudes of Nursing professionals towards the Nursing Diagnosis. Method: observational, descriptive, cross-sectional study in a hospital in the Canary Islands (Spain). Position on Nursing Diagnosis is a validated instrument to measure the attitudes of nurses towards the Nursing Diagnosis with excellent reliability. It is made up by a coded scale of 20 pairs of opposite adjectives in which the interviewed must position himself; extreme scores 1 (most negative attitude) and 7 (most positive attitude); 4 middle value; 140 maximum score and 20 minimum one. Reliability analysis was performed using Cronbach's alpha and inter-element correlation. Frequency distribution for qualitative variables and proportion for quantitative variables. Association analysis. Results: The study population was N=170. The scale has shown high reliability (α=0.955) as well as adequate power to explain the total variance (66.13%). The global mean score was 74.41 (sd=23.53); the worst attitude was Routine (µ=2.91; sd=1.55) while the best attitude was Positive (µ=4.20; sd=1.56). Conclusions: The attitudes of the nurses in our environment are similar to other contexts, with global scores lower than the average. The increase in academic training and the use of the Nursing Diagnosis in the work environment seem to improve the attitudes of this professionals, mainly with regard to acceptance, comfort, ease, relevance, validity, creativity and gratification. (AU)

Use of the Nursing Interventions Classification and Nurses' Workloads: A Scoping Review.

BACKGROUND: The Nursing Interventions Classification allows the systematic organisation of care treatments performed by nurses, and an estimation of the time taken to carry out the intervention is included in its characteristics. The aim of this study is to explore the evidence related to the use of the Nursing Interventions Classification in identifying and measure nurses' workloads. METHODS: A scoping review was conducted through a search of the databases Ovid Medline, PubMed, Web of Science, CINAHL, Scopus, LILACS and Cuiden. The DeCS/MeSH descriptors were: "Standardized Nursing terminology" and "Workload". The search was limited to articles in Spanish, English and Portuguese. No limits were established regarding year of publication or type of study. RESULTS: Few reports were identified (n = 8) and these had methodological designs that contributed low levels of evidence. Research was focused on identifying specific interventions, types of activities, the prevalence of interventions and the time required to perform them. CONCLUSIONS: The evidence found on determination of nurses' workloads using the Nursing Interventions Classification was inconclusive. It is essential to increase the number of reports, as well as the settings and clinical context in which the Nursing Interventions Classification is used, with greater quality and methodological rigour.

Continuidad de cuidados y alta hospitalaria / Continuity of care and hospital discharge

No disponible

Mapeo cruzado de los factores relacionados y de riesgo de NANDA-I con la Clasificación Internacional de Enfermedades / Cross-mapping of Related and Risk Factors of NANDA-I with those of the International Classification of Diseases

Introducción: Enfermería desarrolla su actividad en un contexto multidisciplinar donde se mezclan la esfera autónoma y la de otros profesionales, y es de primordial la competencia diagnóstica. NANDA-International es la clasificación enfermera más utilizada; mientras que la Clasificación Internacional de Enfermedades es la de referencia para los problemas médicos. En ocasiones, los factores relacionados/riesgo de NANDA-International coinciden con diagnósticos médicos. Objetivo: Realizar mapeo cruzado entre NANDA-International y la Clasificación Internacional de Enfermedades. Métodos: Estudio observacional con distribución de frecuencias mediante mapeo cruzado identificando sinónimos o cuasi-sinónimos en ambas clasificaciones. Resultados: Se determinaron n = 1715 factores relacionados/riesgo, n = 1193 clasificados en una ocasión y n = 522 duplicados. Los factores genuinos y específicos fueron n = 1593 (52,16 por ciento); n = 1460 (47,84 por ciento) estaban también en la clasificación médica. Conclusiones: Algunos Dominios y clases NANDA-International muestran factores genuinos y específicos de la disciplina enfermera; otros están, además, en la clasificación médica, cuya resolución no es competencia autónoma enfermera. De esta manera, NANDA-International puede llegar a convertirse en un instrumento extenso y poco útil, con etiologías poco específicas. Se deben mejorar y potenciar contenidos relativos a metaparadigmas enfermeros para hacerse visible con entidad propia en los sistemas de salud(AU)

Introduction: Nursing develops its activity in a multidisciplinary setting where the autonomous sphere and that of other professionals are mixed, while diagnostic competence is paramount. NANDA-International is the most widely used nurse classification, while the International Classification of Diseases is the reference for medical problems. Occasionally, the related factors/risk of NANDA-International coincide with medical diagnoses. Objective: To carry out cross-mapping between NANDA-International and the International Classification of Diseases. Methods: Observational study with frequency distribution by cross-mapping and identifying synonyms or quasi-synonyms in both classifications. Results: We determined 1715 related factors/risk; 1193 were classified on one occasion and 522 were duplicated. The genuine and specific factors were 1593 (52.16 percent); 1460 (47.84 percent) were also in the medical classification. Conclusions: Some NANDA-International domains and classes show genuine and specific factors in the nursing discipline, while others are also in the medical classification, whose resolution is not autonomously a nursing competence. In this way, NANDA-International can become an extensive and unhelpful tool, with little specific etiologies. Content related to nursing metaparadigms must be improved and enhanced to become visible with their own entity in the health systems(AU)