Description and Analysis of Research on Death and Dying during the COVID-19 Pandemic, Published in Nursing Journals Indexed in SCOPUS.

AIM: To offer an overall picture of the research published regarding the different aspects of death and dying during the COVID-19 pandemic in journals covering the field of nursing in the Scopus database. DESIGN: bibliometric analysis. METHODS: The metadata obtained were exported from Scopus for subsequent analysis through Bibliometrix. Using the VOSviewer co-word analysis function, the conceptual and thematic structure of the publications was identified. RESULTS: A total of 119 papers were retrieved, with the participation of 527 authors. The publications were found in 71 journals covering the nursing area. The main lines of research revolved around the keywords "palliative care" and "end-of-life care" in regard to the ethical, psychological, and organizational challenges faced by the health professionals who cared for these patients. CONCLUSION: The results obtained offer a range of data and images that characterize the scientific production published on this topic, coming to the conclusion that, due to the multifaceted and multidisciplinary approach to the experience of death, care, and accompaniment in the dying process, bibliometric maps improve the comprehensive understanding of the semantic and conceptual structure of this field of research. This study was retrospectively registered with the OSF Registries on the 14 March 2024.

Functional Status of Patients over 65 Years Old Intervened on for a Hip Fracture One Year after the Operation.

OBJECTIVES: Evaluation of the functional status one year after a hip fracture surgery and the influence of sarcopenia and other clinical factors at the time of admission. METHOD: Prospective observational study with 135 patients over 65 years of age. Functional status of basic (modified Katz) and instrumental activities (Lawton and Brody) and walking ability (Functional Ambulation Classification, FAC) was measured on admission, at discharge, and telephonically one year later. The risk or positive screening of sarcopenia (SARC-F) and cognitive status (Pfeiffer), as well as clinical variables, were evaluated. RESULTS: 72% of patients are women; 36% have a risk of sarcopenia (Sarc-F ≥ 4), and 43% have moderate-severe cognitive impairment (Pfeiffer ≥ 5). Walking capacity at one year was closer to the values at admission more often in women than in men (0.2 ± 1.3 points vs. 0.9 ± 1.6; p = 0.001), as well as in patients without risk of sarcopenia versus sarcopenic patients (0.3 ± 1.2 points vs. 0.7 ± 1.7; p = 0.001), although their evolution did not show significant differences (p = 0.183). Instrumental activities after one year have not been recovered (1.7 ± 2.5 points; p = 0.032), and patients at risk of sarcopenia showed worse values (1.7 ± 1.9 points vs. 3.7 ± 2.7; p < 0.001) and worse evolution (p = 0.012). The evolution of basic activities varied according to the risk of sarcopenia (0.6 ± 1.4 points vs. 1.4 ± 2.1; p = 0.008). CONCLUSIONS: Functional status at one year is related to the functional status at admission, the positive screening of sarcopenia, sex, and cognitive impairment of the patient. Knowing at the time of admission an estimate of the functional status at one year will help to reinforce the individual treatment of patients with a worse prognosis.

[Benefits of early social transition in transgender minors. Family perspectives: qualitative study.] / Beneficios de la transición social temprana en menores transgénero. Perspectivas de familias: estudio cualitativo.

OBJECTIVE: The term trans brings together all transgender identities. The early social transition towards the affirmed gender has benefits in the child's development. For families, transit is a period of great uncertainty, requiring support aimed at families of trans minors. The aim of this paper was to explore the needs and experiencies of parents and close-relatives who supported the social transition of their children. METHODS: We worked with focus groups of functional families of transgender minors who had begun the transition (n=14), with a medium-high educational level and who belonged to urban areas of Tenerife. Through a semi-structured interview, they commented on their experiences in the process of supporting the social transition of their children. The data was recorded in a video recording and processed through content analysis and categorization. RESULTS: Early social transition had positive and immediate benefits on child development as well as in the reduction of anxiety. There was a general improvement in mood, self-esteem, and social and family relationships. The accompaniment of specialists and associations helped in the different social situations and favoured resilience. CONCLUSIONS: Early social transition is positive in the personal and socio-family sphere of the minor. To improve their resilience, families demand accompaniment in this process, as well as meeting other trans people who serve as transpositive references. In addition, they point out the need for specific training in health professionals.

OBJETIVO: El término trans aglutina a todas las identidades transgénero. La transición social temprana hacia el género sentido tiene beneficios en el desarrollo del menor. Para las familias, el tránsito es un periodo de grandes incertidumbres, siendo necesario el acompañamiento dirigido a las familias de menores trans. El objetivo del artículo fue explorar, desde una perspectiva paterna y familiar, las necesidades y experiencias sobre el tránsito de menores trans que sirvieran de referente a otros padres/madres que apoyan el tránsito social de sus hijos e hijas. METODOS: Se trabajó con grupos focales de familias funcionales de menores transgénero que habían iniciado la transición (n=14), de nivel educativo medio-alto y que pertenecían a zonas urbanas de Tenerife. Mediante entrevista semiestructurada, comentaron sus experiencias en el proceso de dar soporte al tránsito social de sus hijos e hijas. Los datos fueron registrados en una videograbación y se procesaron mediante análisis de contenido y categorización. RESULTADOS: La transición social temprana tuvo beneficios positivos e inmediatos en el desarrollo del menor, además de en la disminución de la ansiedad. Hubo una mejora general en el humor, la autoestima y las relaciones tanto sociales como familiares. El acompañamiento de especialistas y asociaciones ayudó en las distintas situaciones sociales y favoreció la resiliencia. CONCLUSIONES: El tránsito social temprano es positivo en la esfera personal y sociofamiliar del menor. Para mejorar su resiliencia, las familias demandan acompañamiento en este proceso, así como conocer otras personas trans que les sirvan como referentes transpositivos. Además, señalan la necesidad de formación específica en los profesionales sanitarios.

Beneficios de la transición social temprana en menores transgénero. Perspectivas de familias: estudio cualitativo / Benefits of early social transition in transgender minors. Family perspectives: qualitative study

FUNDAMENTOS: El término trans aglutina a todas las identidades transgénero. La transición social temprana hacia el género sentido tiene beneficios en el desarrollo del menor. Para las familias, el tránsito es un periodo de grandes incertidumbres, siendo necesario el acompañamiento dirigido a las familias de menores trans. El objetivo del artículo fue explorar, desde una perspectiva paterna y familiar, las necesidades y experiencias sobre el tránsito de menores trans que sirvieran de referente a otros padres/madres que apoyan el tránsito social de sus hijos e hijas.MÉTODOS: Se trabajó con grupos focales de familias funcionales de menores transgénero que habían iniciado la transición (n=14), de nivel educativo medio-alto y que pertenecían a zonas urbanas de Tenerife. Mediante entrevista semiestructurada, comentaron sus experiencias en el proceso de dar soporte al tránsito social de sus hijos e hijas. Los datos fueron registrados en una videograbación y se procesaron mediante análisis de contenido y categorización. RESULTADOS: La transición social temprana tuvo beneficios positivos e inmediatos en el desarrollo del menor, además de en la disminución de la ansiedad. Hubo una mejora general en el humor, la autoestima y las relaciones tanto sociales como familiares. El acompañamiento de especialistas y asociaciones ayudó en las distintas situaciones sociales y favoreció la resiliencia. CONCLUSIONES: El tránsito social temprano es positivo en la esfera personal y sociofamiliar del menor. Para mejorar su resiliencia, las familias demandan acompañamiento en este proceso, así como conocer otras personas trans que les sirvan como referentes transpositivos. Además, señalan la necesidad de formación específica en los profesionales sanitarios.(AU)

BACKGROUND: The term trans brings together all transgender identities. The early social transition towards the affirmed gender has benefits in the child’s development. For families, transit is a period of great uncertainty, requiring support aimed at families of trans minors. The aim of this paper was to explore the needs and experiencies of parents and close-relatives who supported the social transition of their children. METHODS: We worked with focus groups of functional families of transgender minors who had begun the transition (n=14), with a medium-high educational level and who belonged to urban areas of Tenerife. Through a semi-structured interview, they commented on their experiences in the process of supporting the social transition of their children. The data was recorded in a video recording and processed through content analysis and categorization. RESULTS: Early social transition had positive and immediate benefits on child development as well as in the reduction of anxiety. There was a general improvement in mood, self-esteem, and social and family relationships. The accompaniment of specialists and associations helped in the different social situations and favoured resilience.CONCLUSIONS: Early social transition is positive in the personal and socio-family sphere of the minor. To improve their resilience, families demand accompaniment in this process, as well as meeting other trans people who serve as transpositive references. In addition, they point out the need for specific training in health professionals.(AU)

La expresión no verbal y el lenguaje de pacientes con cáncer / Nonverbal Expressions And Language Of Oncological Patients

El cáncer es una enfermedad que demanda un gran número de recursos exigiendo no solo la eficacia sino también la eficiencia de las intervenciones que se realicen durante todo el proceso oncológico. Su diagnóstico puede ser considerado como un evento vital estresante que afectará tanto al individuo, como a su entorno familiar y social. Partiendo de este planteamiento, se deben considerar los aspectos físicos, psicológicos y sociales del fenómeno oncológico y, por consiguiente, un manejo integral y multidisciplinar. El objetivo general de este estudio se basa en observar las expresiones de los pacientes oncológicos con diagnósticos de tumores sólidos metastásicos (estado III – IV), que están en tratamiento con quimioterapia y/o inmunoterapia en la isla de Tenerife, en el Hospital Universitario de Canarias y el Hospital Universitario Nuestra Señora de Candelaria, durante las entrevistas para detectar alteraciones no manifestadas verbalmente. Para ello se ha realizado una investigación cualitativa y fenomenológica, de carácter multicéntrico desde noviembre de 2022 a mayo de 2023. La muestra fue constituida por 362 pacientes con previo consentimiento informado de los sujetos de estudios. Se usó la entrevista semiestructurada procesada mediante análisis de contenido. Se tuvieron en cuenta los criterios de rigor científico y los principios de bioética personalista. Con relación a los resultados, se obtuvieron tres categorías donde se analizó lapercepción de la Calidad de Vida; la satisfacción hacia los profesionales sanitarios y las preocupaciones sobre el pronóstico de la enfermedad. Como conclusión, .... (AU)

Cancer is a disease that demands a large number of resources, demanding not only the effectiveness but also the efficiency of the interventions carried out throughout the oncological process. Its diagnosis can be considered a stressful life event that will affect both the individual and their family and social environment. Starting from this approach, the physical, psychological and social aspects of the oncological phenomenon must be considered and, consequently, a comprehensive and multidisciplinary management. The general objective of this study is based on observing the expressions of oncological patients with diagnoses of metastatic solid tumors (stage III – IV), who are being treated with chemotherapy and/or immunotherapy on the island of Tenerife, at the University Hospital of Canarias and the Nuestra Señora de Candelaria University Hospital, during the interviews to detect alterations not expressed verbally. For this, a qualitative and phenomenological investigation has been carried out, of a multicenter nature from November 2022 to May 2023. The sample was made up of 362 patients with prior informed consent from the study subjects. The semi-structured interview processed through content analysis was used. The criteria of scientific rigor and the principles of personalist bioethics were taken into account. In relation to the results, three categories were obtained where the perception of Quality of Life was analyzed; satisfaction with health professionals and concerns about the prognosis of the disease. In conclusion, the patients who participated in the study perceived the quality of life as a changing state depending on the time of the disease and the treatment, they highlighted the communication skills of the nurses and demanded a multidisciplinary team... (AU)

Virtual Reality and Simulation Videos as Effective Training Tools for Creating Safe and Inclusive Environments for Transgender People.

BACKGROUND: University education is undergoing a paradigm shift towards active methodologies, such as virtual reality and training videos, which have proven to be valuable resources, especially in the health sciences. The scarcity of existing research on the topic prompted us to conduct this study, which seeks to measure the knowledge gained from the aforementioned tools by users, their level of satisfaction with them, and their perceived utility. METHODS: This is a quasi-experimental intervention study analysing the impact of virtual objects as learning resources for undergraduate nursing students. RESULTS: Fifty-four participants completed the training, yielding highly significant differences between their mean scores, with a high statistical power and a large effect size. A total of 85.46% of participants confirmed that the virtual resources helped them considerably to empathise with the experiences of trans people in healthcare settings. Students were comfortable using the virtual resources, very satisfied with the methodology employed, and would recommend the training received. CONCLUSIONS: University teaching must adapt to meet the current legislations and changing health needs of society, and teaching staff must be prepared to implement new active teaching methodologies that make learning a more dynamic process. Considering these results, our study serves as a guide for other nursing educators who seek to promote inclusive healthcare regarding gender diversity. This study is not registered.

Psychometric Properties of the WHO-5 Well-Being Index among Nurses during the COVID-19 Pandemic: A Cross-Sectional Study in Three Countries.

Nurses' well-being has been increasingly recognised due to the ongoing pandemic. However, no validation scales measuring nurses' well-being currently exist. Thus, we aimed to validate the WHO-5 Well-Being Index (WHO-5) in a sample of nurses. A cross-sectional multinational study was conducted, and a total of 678 nurses who worked during the COVID-19 pandemic in Spain (36.9%), Chile (40.0%) and Norway (23.1%) participated in this study. The nurses completed the WHO-5, the Patient Health Questionnaire-2 (PHQ-2), the Generalized Anxiety Disorder-2 (GAD-2) and three questions about the quality of life (QoL). The WHO-5 demonstrated good reliability and validity in the three countries. Cronbach's alphas ranged from 0.81 to 0.90. High correlations were found between the WHO-5 and the psychological well-being dimension of QoL, and negative correlations between the WHO-5 and PHQ-2. The unidimensional scale structure was confirmed in all the countries, explaining more than 68% of the variance. The item response theory likelihood ratio model did not show discernible differences in the WHO-5 across the countries. To conclude, the WHO-5 is a psychometrically sound scale for measuring nurses' well-being during a pandemic. The scale showed strong construct validity for cross-cultural comparisons; however, more research is required with larger sample sizes.

Arterial Hypertension in Morbid Obesity after Bariatric Surgery: Five Years of Follow-Up, a Before-And-After Study.

BACKGROUND: Arterial hypertension (HTN) is common among morbidly obese patients undergoing bariatric surgery. The aim of this study is to analyse the prevalence and evolution of HTN and weight loss in patients suffering from morbid obesity before and after bariatric surgery, during a follow-up period of five years. METHODS: A before-and-after study was carried out on severely obese patients undergoing Laparoscopic Roux-En-Y Gastric Bypass (LRYGB). Criteria for HTN diagnosis were current treatment with antihypertensive agents and/or systolic blood pressure (SBP) > 140 mmHg and/or diastolic (DBP) > 90 mmHg. HTN remission was defined as normalisation of blood pressure (BP) maintained after discontinuation of medical treatment, and HTN recurrence was considered when HTN diagnostic criteria reappeared after remission. Weight loss during the study period was evaluated for each patient, calculating excess weight loss percentage (% EWL) and BMI loss percentage (% BMIL) with reference to the baseline value. RESULTS: A total of 273 patients were included in the study. HTN was present in 48.2%; 29.4% of hypertensive patients showed HTN remission two years after the surgical procedure, 30.3% of them had relapsed at five years. CONCLUSION: LRYGB in obese patients is associated with a remission of HTN, and no weight loss differences were observed between the group of patients showing HTN remission at two years and the group who did not. However, differences were observed after the second follow-up year, with an increased weight loss in the remission group, which could indicate that sustained weight loss favours the control of HTN.

Trends in Research on Art Therapy Indexed in the Web of Science: A Bibliometric Analysis.

Aim: Despite the increase in international research in art therapy, few studies have been developed with a bibliometric approach which describe the situation regarding this area of knowledge. Thus, the aim of this study is to describe and contextualize international scientific production in the visual arts modality in the context of artistic therapies, to offer a broader and more in-depth vision of the structure of this area of knowledge through of a bibliometric analysis of the publications indexed in the core collection of the Web of Science. Methods: This is a retrospective, exploratory and descriptive, cross-sectional study to analyze the bibliographic data retrieved from the databases of the core collection. The analysis parameters included the data corresponding to the production according to type of document, country, journal, and institution. In addition, the main lines of research were located and classified and the subject matter of the most cited articles in each of them was summarized. Four periods were selected, between 1994 and 2020, to facilitate the thematic analysis and offer an evolutionary perspective of art therapy research. Results: A total of 563 works were published, in 250 journals, in the 63 years between 1958, when the first document was published, and April 2021. The annual growth rate was 7.3% with a mean average of 8.7 publications per year, and 83.13% of the published works were articles. A total of 1,269 authors from 56 countries were counted. The mean number of citations per document was 5.6 and the mean number of citations per document and year was 0.6. The main research domains were psychology and/or rehabilitation and the highest production on this topic was concentrated in only three journals. In general, a high degree of variability was observed in the study topics and numerous theoretical and methodological articles. The most used visual arts modalities were in the main drawing, painting and photography. Conclusion: This work did not find previous existence of any bibliometric analysis on the international scientific production in art therapy. In general terms, there has been a substantial growth in the number of publications on the subject over the last decade. However, this research area does not appear to have peaked, but, on the contrary, is still growing and progressing despite its long history in clinical practice.

The Mediating Role of Resilience in the Relationship between Perceived Stress and Mental Health.

The COVID-19 pandemic has created great uncertainty around the world, and due to the pandemic, nurses have been exposed to an increase in highly stressful clinical situations. This study examines the relationships between perceived stress and emotional disorders among nurses who have provided direct patient care during the COVID-19 pandemic and explores the mediating role of resilience in these relationships. In an online cross-sectional design, we asked Spanish nurses (N = 214) to complete self-reported scales, and we performed correlation and mediation analyses between perceived stress (Perceived Stress Scale, PSS-4), resilience (Wagnild Resilience Scale, RS-14), wellbeing (World Health Organization Wellbeing Index, five items, WHO-5), anxiety (PHQ-2) and depression (GAD-2). The nurses self-reported moderate levels of perceived stress, considerable psychological distress and high resilience. We found resilience to be significantly negatively correlated with the reported levels of perceived stress, anxiety and depression (p < 0.001). The mediating analysis revealed that resilience played a protective role in the direct relationships of stress with depression, anxiety, and psychological distress. To conclude, our findings supported the hypothesis that resilience mediated the relationship between stress and mental health.

Epidemiología y factores de riesgo para cuidados intensivos y mortalidad en pacientes hospitalizados por COVID-19 / Epidemiology and risk factors for intensive care and mortality in COVID-19 hospitalized patients

INTRODUCCIÓN: El Complejo Hospitalario Universitario Nuestra Señora de Candelaria (CHUNSC) ha sido el hospital con más ingresos COVID-19 de Canarias. OBJETIVO: determinar factores de riesgo de ingreso en Unidad de Cuidados Intensivos (UCI) y mortalidad. MATERIAL Y MÉTODOS: Estudio observacional analítico retrospectivo de pacientes con COVID-19 confirmado, ingresados entre 25 febrero y 31 mayo 2020 en el CHUNSC. RESULTADOS: Ingresaron 264 pacientes, 56,8% hombres, edad media 65,3 años. Tasa de letalidad 15,2%. Factores de riesgo asociados con ingreso en UCI: neumonía (OR 2,22, IC 95% 1,08-4,55, p = 0,029) y síndrome de distrés respiratorio agudo (SDRA) (OR 4,94, IC 95% 1,46-16,68; p = 0,010). Factores asociados con mortalidad: edad ≥ 60 años (OR 3,94, IC 95% 1,21-12,82, p = 0,023), neumonía (OR 3,38, IC 95% 1,35-8,47, p = 0,009), SDRA (OR 5,84, IC 95% 1,60-21,24, p = 0,007) y enfermedad renal crónica (ERC) (OR 3,74, IC 95% 1,40-9,98, p = 0,009). CONCLUSIONES: Neumonía y SDRA se asociaron con ingreso en UCI. Neumonía, SDRA, edad ≥ 60 años y ERC se asociaron con mayor riesgo de mortalidad

INTRODUCTION: Complejo Hospitalario Universitario Nuestra Señora de Candelaria (CHUNSC) had the highest number of COVID-19 admissions in the Canary Islands. Aim of the study was to determine the risk factors for admission to the Intensive Care Unit (ICU) and mortality. METHODS: Retrospective analytical longitudinal study of patients with confirmed COVID-19, hospitalized between February 25 and May 31, 2020, at CHUNSC. RESULTS: In the study period, 264 patients were admitted, 56.8% men, mean age 65.3 years. Most frequent symptoms: cough (67%) and fever (59.8%), most frequent comorbidities: cardiovascular disease (60.6%) and diabetes (26.5%). Global Case Fatality Rate (CFR) 15.2%. Risk factors associated with ICU admission: Pneumonia (OR 2.22, 95%CI 1.08-4.55, p = 0.029) and Acute Respiratory Distress Syndrome (ARDS) (OR 4.94, 95%CI 1.46-16.68; p = 0.010). Risk factors associated with mortality: age ≥ 60 years (OR 3.94, 95%CI 1.21-12.82, p = 0.023), pneumonia (OR 3.38, 95%CI 1.35-8.47, p = 0.009), ARDS (OR 5.84, 95%CI 1.60-21.24, p = 0.007) and chronic kidney disease (CKD) (OR 3.74, 95%CI 1.40-9.98, p = 0.009). CONCLUSION: Pneumonia and ARDS were associated with ICU admission. Pneumonia, ARDS, age ≥ 60 years and CKD were associated with mortality

Sanidad y la II República Española (1931-1936): la creación de la figura de la primera Directora de Enfermeras / Saúde e da Segunda República Espanhola (1931-1936): a criação da figura do primeiro Director of Nurses / Health and the Second Spanish Republic (1931-1936): the creation of the figure of the first Head of Nurses

Introducción: La sanidad en España, como en otros tantos países, fue una preocupación máxima para sus gobernante. Pero es durante la Segunda República Española (1931-1936) cuando esta inquietud se hace más viva. Para su mejora se destinó un presupuesto que, ejercicio tras ejercicio, fue aumentando para solventar los graves problemas que sufría, buscando tan solo la modernización de las infraestructuras existentes y la creación de otras tantas nuevas, además de lograr una máxima cualificación de sus profesionales. Esta última fue de considerable calado equiparándola con los flamantes ejemplos de otros muchos países europeos que apostaban por dejar atrás modelos anclados en el medievo y dar paso a un sistema que funcionara como una "máquina de sanación". Objetivo: Establecer cuando surge por primera vez en España la figura de la Directora de Enfermeras. Método: Se realizó un "examen exhaustivo" de la documentación custodiados en el Archivo del Excelentísimo Cabildo Insular de Santa Cruz de Tenerife y bibliográficamente. Resultados: En Canarias, como en otros tantos lugares de la "piel de toro", las reformas se procuraron profundas. Un claro ejemplo de ello fue el reglamento, de corto tiempo en vigor, formulado por el consejero del Cabildo Insular de Tenerife Miguel Bethencourt del Rio, que daba un giro a la organización existente hasta ese momento. Conclusiones: Entre los cambios destacó la creación de la figura de Directora de Enfermeras, inédita hasta la fecha, y que hubo que esperar al ocaso de la Dictadura Franquista para verla nuevamente en la Sanidad Española (AU)

Introduction: Healthcare in Spain, as in many other countries, was a top concern for their ruler. But it is during the Second Spanish Republic (1931-1936) when this restlessness becomes more alive. To improve it was allocated a budget that, after exercise, was increased to solve the serious problems that suffered, seeking only the modernization of existing infrastructures and the creation of so many new ones, in addition to achieving a maximum qualification of its professionals. This last one was of considerable draft, matching it with the flamboyant examples of many other European countries that bet on leaving behind models anchored in the Middle Ages and giving way to a system that functions as a "healing machine". Objective: Establish when the figure of the Director of Nurses emerges for the first time in Spain. Method: A "thorough examination" of the documentation was carried out in the Archive of the Very Insular Cabildo of Santa Cruz de Tenerife and bibliographically. Results: In the Canary Islands, as in many other places in the "bullskin", the reforms were pursued deep. A clear example of this was the regulation, of short time in force, formulated by the councilor of the Insular Cabildo of Tenerife Miguel Bethencourt of the River, that gave a turn to the existing organization until that momento. Conclusions: Among the changes highlighted the creation of the figure of Director of Nurses, unpublished until now, and that we had to wait for the sunset of the Franco dictatorship to see it again in the Spanish Health (AU)

Introdução: Saúde em Espanha, como em muitos outros países, era uma das principais preocupações para a sua régua. Mas é durante a Segunda República espanhola (1931-1936), quando esta preocupação torna-se mais viva. Relativamente ao orçamento de melhoria que ano após ano, foi aumentando para resolver os graves problemas sofridos, procurando apenas a modernização da infraestrutura existente e criar outro era para muitos nova adição para atingir profissionais máximos qualificados. O último foi de considerável profundidade equiparando-a com os novos exemplos de muitos outros países europeus a deixar para trás padrões de apostas ancoradas na Idade Média e dar lugar a um sistema que funcionaria como uma "máquina de cura". Objectivo: Definir quando a figura do director de Enfermeiros surge pela primeira vez em Espanha. Método: uma "revisão completa" dos documentos mantidos no Arquivo de Sua Excelência Conselho de Ilha de Santa Cruz de Tenerife e bibliograficamente foi realizada. Resultados: Nas Ilhas Canárias, como em outros lugares da "pele de touro" reformas profundas procurado. Um exemplo claro disso foi a regulamentação em vigor curto espaço de tempo, feita pelo diretor do Cabildo Insular de Tenerife Bethencourt Miguel del Rio, que deu um toque para a organização existente até agora. Conclusões: Entre as mudanças, ele destacou a criação do cargo de Diretor de Enfermeiros, inéditos até à data, e não foi até o crepúsculo do franquista para vê-lo novamente no Saúde espanhol (AU)