A successful nursing education promotes newly graduated nurses' job satisfaction one year after graduation: a cross-sectional multi-country study.

BACKGROUND: Job satisfaction is a key factor for the successful transition of newly graduated nurses (NGNs) and for retaining NGNs in their workplaces. However, there is limited evidence of the relationship between satisfaction regarding the nursing education program and NGNs' job satisfaction in the first year after graduation. Therefore, this study aims to examine the association of the nursing education related factors and NGNs' job satisfaction. METHODS: A cross-sectional study design with the utilization of data collected from the same respondents one year earlier as educational factors was applied. The data were collected from NGNs (n = 557) in 10 European countries using an electronic survey between February 2019 and September 2020, and analyzed in detail for four countries (n = 417). Job satisfaction was measured with three questions: satisfaction with current job, quality of care in the workplace, and nursing profession. Nursing education related factors were satisfaction with nursing education program, level of study achievements, nursing as the 1st study choice, intention to stay in nursing, and generic nursing competence. The data were analyzed statistically using logistic regression. RESULTS: Most of the NGNs in the 10 countries were satisfied with their current job (88.3%), the quality of care (86.4%) and nursing profession (83.8%). Finnish, German, Lithuanian and Spanish NGNs' satisfaction with the nursing education program at graduation was statistically significantly associated with their job satisfaction, i.e., satisfaction with their current job, the quality of care, and the nursing profession. Moreover, NGNs who had fairly often or very often intention to stay in nursing at graduation were more satisfied with their current job, with the quality of care, and with the nursing profession compared with NGNs who had never or fairly seldom intention to stay in nursing at graduation. CONCLUSIONS: Nursing education plays a significant role in NGNs' job satisfaction one year after graduation, indicating the importance to start career planning already during nursing education. Both nursing education providers and healthcare organizations could plan in close collaboration a transition program for NGNs to ease the transition phase and thus increase the NGNs' job satisfaction and ultimately the high-quality care of the patients.

Dor e articulação do punho na artrite reumatoide: O impacto na capacidade funcional / Pain and wrist joint in rheumatoid arthritis: The impact on functional capacity / Dolor y articulación de la muñeca en la artritis reumatoide: El impacto en la capacidad funcional

Resumo Enquadramento: Artrite reumatoide (AR), doença autoimune, inflamatória e crónica. Caracteriza-se por poliartrite, dor crónica e dificuldade em mobilizar as articulações, que levam à incapacidade funcional dos doentes. Objetivos: Avaliar a influência da mobilidade articular do punho e da dor, na capacidade funcional de doentes com AR. Metodologia: Estudo quantitativo, descritivo e correlacional, constituído por uma amostra de 105 doentes, com aplicação do Índice de Incapacidade - Questionário Avaliação de Saúde (HAQ-DI); Escala Visual Analógica da Dor (EVA) e medição da amplitude articular do punho, com goniómetro. Resultados: A mobilidade articular do punho é representativa na funcionalidade (p < 0,05), no entanto, a sua extensão e flexão, não influenciam diretamente a dor (p > 0,05). Observou-se que a dor é impactante na capacidade funcional dos doentes (p = 0,010). Conclusão: A mobilidade articular do punho e a dor afetam as atividades diárias dos doentes com AR, expressas através da capacidade funcional de avaliação de saúde.

Abstract Background: Rheumatoid arthritis (RA) is a chronic, autoimmune, and inflammatory disease. Symptoms include polyarthritis, chronic pain, and difficulty in joint mobilization, which lead to functional disability in patients. Objectives: To assess the influence of wrist joint mobility and pain on the functional capacity of patients with RA. Methodology: Quantitative, descriptive, and correlational study in a sample of 105 patients. Health Assessment Questionnaire - Disability Index (HAQ-DI) and Visual Analog Pain Scale (VAS) were applied, and the wrist joint range of motion was measured with a goniometer. Results: Joint wrist mobility is representative of functionality (p < 0.05). However, wrist joint extension and flexion do not directly influence pain (p > 0.05). Pain was observed to impact the functional capacity in patients (p = 0.010). Conclusion: Joint wrist mobility and pain affect the daily activities of patients with RA, expressed through the functional capacity for health assessment.

Resumen Marco contextual: Artritis reumatoide (AR), una enfermedad autoinmune, inflamatoria y crónica. Se caracteriza por la poliartritis, el dolor crónico y la dificultad para movilizar las articulaciones, lo que provoca la incapacidad funcional de los pacientes. Objetivos: Evaluar la influencia de la movilidad articular de la muñeca y el dolor en la capacidad funcional de los pacientes con AR. Metodología: Estudio cuantitativo, descriptivo y correlacional, compuesto por una muestra de 105 pacientes, en el que se aplicó el Índice de Discapacidad - Cuestionario de Evaluación de la Salud (HAQ-DI); la Escala Visual Analógica del Dolor (EVA) y la medición de la amplitud articular de la muñeca, con un goniómetro. Resultados: La movilidad articular de la muñeca es representativa en la funcionalidad (p < 0,05), sin embargo, la extensión y la flexión no influyen directamente en el dolor (p > 0,05). Se observó que el dolor tiene un impacto en la capacidad funcional de los pacientes (p = 0,010). Conclusión: La movilidad articular de la muñeca y el dolor afectan las actividades diarias de los pacientes con AR, expresadas a través de la capacidad funcional de evaluación de la salud.

Graduating Nursing Students' Empowerment and Related Factors: Comparative Study in Six European Countries.

New nurses are needed in healthcare. To meet the role expectations of a registered nurse, nursing students must feel empowered at graduation. However, there are only a few studies focusing on nursing students' empowerment. This study aims to describe and analyze graduating nursing students' level of empowerment in six European countries and potential related factors. A comparative and cross-sectional study was performed in the Czech Republic, Finland, Italy, Portugal, Slovakia, and Spain with graduating nursing students (n = 1746) using the Essential Elements of Nurse Empowerment scale. Potentially related factors included age, gender, a previous degree in health care, work experience in health care, graduation to first-choice profession, intention to leave the nursing profession, level of study achievements, satisfaction with the current nursing programme, clinical practicums, theoretical education, and generic competence measured with the Nurse Competence Scale. The data were analysed statistically. Graduating nursing students' self-assessed level of empowerment was moderate, with statistical differences between countries. Those with high empowerment had no intention to leave the nursing profession, had a higher level of study achievements, and a higher self-assessed generic competence level. The results suggest that empowerment needs to be enhanced during nursing education. Further research is needed to understand the development of empowerment during the early years of a nursing career.

Nursing students' self-directed learning abilities and related factors at graduation: A multi-country cross-sectional study.

AIM: To describe nursing students' level of self-directed learning abilities and identify possible factors related to it at graduation in six European countries. DESIGN: A cross-sectional comparative design across the countries. METHODS: The study was conducted from February 2018 to September 2019. Nursing students (N = 4,135) from the Czech Republic, Finland, Italy, Portugal, Slovakia and Spain were invited to respond to the research instruments (the Self-Rating Scale of Self-Directed Learning and the Nurse Competence Scale) at graduation. The data were analysed using the chi-square test, Pearson correlation coefficient and the linear model. RESULTS: The nursing students' (N = 1,746) overall self-directed learning abilities were at high level in all countries. Statistically significant differences occurred between countries. Spanish nursing students reported the highest level of self-directed learning abilities while students from the Czech Republic reported the lowest. Higher level of self-directed learning abilities was related to several factors, particularly with the self-assessed level of competence and country.

The level of competence of graduating nursing students in 10 European countries-Comparison between countries.

AIM: To analyse graduating nursing students' self-assessed competence level in Europe at graduation, at the beginning of nursing career. DESIGN: An international cross-sectional evaluative design. METHODS: Data were collected in February 2018-July 2019 from graduating nursing students in 10 European countries. Competence was assessed with a validated instrument, the Nurse Competence Scale (NCS). The sample comprised 3,490 students (response rate 45%), and data were analysed statistically. RESULTS: In all countries, graduating nursing students assessed their competence as good (range 50.0-69.1; VAS 0-100), albeit with statistically significant differences between countries. The assessments were highest in Iceland and lowest in Lithuania. Older students, those with working experience in health care, satisfied with their current degree programme, with excellent or good study achievements, graduating to 1st study choice and having a nursing career plan for future assessed their competence higher.

Clinical learning environment and graduating nursing students' competence: A multi-country cross-sectional study.

The purpose of this study was to explore nursing students' perceptions of their final clinical learning environment and its association with their self-assessed competence, satisfaction with nursing education, and turnover intentions at graduation in six European countries. A multi-country comparative cross-sectional study was conducted with nursing students (n = 1746) from the Czech Republic, Finland, Italy, Portugal, Slovakia, and Spain using the Nurse Competence Scale and the Clinical Learning Environment and Supervision scale. Nursing students' overall perceptions of their final clinical learning environment and supervision were positive in all the countries studied. The correlation between the students' perceptions of their final clinical learning environment and competence was statistically significant and positive. Satisfaction with the nursing program and clinical practicum and no consideration of career change were related to positive perceptions of the final clinical learning environment. Highlighting the importance of the supervisory relationship and pedagogical atmosphere, nursing students' positive perceptions of the final clinical learning environment and supervision contribute to a better level of self-assessed competence and satisfaction with the nursing program and clinical practicum, leading to lower turnover intentions.

Improving access to community-based pulmonary rehabilitation: 3R protocol for real-world settings with cost-benefit analysis.

BACKGROUND: Pulmonary rehabilitation (PR) has demonstrated patients' physiological and psychosocial improvements, symptoms reduction and health-economic benefits whilst enhances the ability of the whole family to adjust to illness. However, PR remains highly inaccessible due to lack of awareness of its benefits, poor referral and availability mostly in hospitals. Novel models of PR delivery are needed to enhance its implementation while maintaining cost-efficiency. We aim to implement an innovative community-based PR programme and assess its cost-benefit. METHODS: A 12-week community-based PR will be implemented in primary healthcare centres where programmes are not available. Healthcare professionals will be trained. 73 patients with CRD and their caregivers (dyads patient-caregivers) will compose the experimental group. The control group will include dyads age- and disease-matched willing to collaborate in data collection but not in PR. Patients/family-centred outcomes will be dyspnoea (modified Medical Research Council Questionnaire), fatigue (Checklist of individual strength and Functional assessment of chronic illness therapy - fatigue), cough and sputum (Leicester cough questionnaire and Cough and sputum assessment questionnaire), impact of the disease (COPD Assessment Test), emotional state (The Hospital Anxiety and Depression Scale), number of exacerbations, healthcare utilisation, health-related quality of life and family adaptability/cohesion (Family Adaptation and Cohesion Scale). Other clinical outcomes will be peripheral (biceps and quadriceps-hand held dynamometer, 1 or 10 repetition-maximum) and respiratory (maximal inspiratory and expiratory pressures) muscle strength, muscle thickness and cross sectional area (biceps brachialis, rectus femoris and diaphragm-ultrasound imaging), exercise capacity (six-minute walk test and one-minute sit to stand test), balance (brief-balance evaluation systems test) and physical activity (accelerometer). Data will be collected at baseline, at 12 weeks, at 3- and 6-months post-PR. Changes in the outcome measures will be compared between groups, after multivariate adjustment for possible confounders, and effect sizes will be calculated. A cost-benefit analysis will be conducted. DISCUSSION: This study will enhance patients access to PR, by training healthcare professionals in the local primary healthcare centres to conduct such programmes and actively involving caregivers. The cost-benefit analysis of this intervention will provide an evidence-based insight into the economic benefit of community-based PR in chronic respiratory diseases. TRIAL REGISTRATION: The trial was registered in the ClinicalTrials.gov U.S. National Library of Medicine, on 10th January, 2019 (registration number: NCT03799666 ).

O processo de ensinar competências para promoção da saúde / El proceso de enseñanza de competencias para promoción de la salud / The process of teaching competencies for health promotion

OBJETIVO: analisar as posturas pedagógicas e estratégias de ensino utilizadas para abordagem das competências para promoção da saúde na formação de enfermeiros. MÉTODO: Estudo de caso, ancorado na dialética. RESULTADOS: O currículo apresenta estratégias pedagógicas diferenciadas que podem funcionar como dispositivo para o desenvolvimento de competências para a promoção da saúde mediante uma educação multidimensional transformadora. Foram citadas: aulas teórico-práticas, construção de perguntas ou questões sobre textos, estudos dirigidos, narrativa, plenária orientada, jogos e aplicativos para celular e computador, dramatização, oficinas, estudos de caso, seminário integrado, projetos de extensão e pesquisa, ligas acadêmicas. A imersão na prática favorece o aprender a fazer, fazendo, o contato com o contexto de saúde da população e com a realidade da vida profissional. A Prática de Integração Ensino-serviço-comunidade e o estágio supervisionado aproximam o estudante do professor, integram o conhecimento e facilitam a aprendizagem prática e reflexiva. CONCLUSÃO: Os dispositivos da articulação teoria-prática podem perder a sua função precípua se não houver um direcionamento adequado durante as atividades práticas. Não basta alterar o formato do plano pedagógico e dos mecanismos de ensino, é imperativo mudar a essência do processo de ensino-aprendizagem, aproximando-o da real integração com a prática profissional crítica, dinâmica e socialmente contextualizada.

OBJECTIVE: to analyze the pedagogical attitudes and teaching strategies used to approach competencies for health promotion in the training of nurses. METHOD: Case study, grounded in the dialectic. RESULTS: The curriculum presents pedagogical strategies that can be a device for the development of competences for health promotion through a transformative multidimensional education. They were: theoretical-practical classes, construction of questions or questions about texts, directed studies, narrative, oriented plenary, games and applications for mobile and computer, dramatization, workshops, case studies, integrated seminar, extension and research projects, academic leagues. The immersion in practice favors the learning to "do-it-yourself", the contact with the population's health context and the reality of professional life. The Teaching-service-community Integration Practice and the supervised internship bring the student closer to the teacher, integrate knowledge and facilitate practical and reflective learning. CONCLUSION: The theory-practice joint devices may lose their prime function if there is no proper targeting during practical activities. It is not enough to change the format of the pedagogical plan and the teaching mechanisms, it is imperative to change the essence of the teaching-learning process, bringing it closer to the real integration with the critical, dynamic and socially contextualized professional practice.

OBJETIVOS: analizar las posturas pedagógicas y estrategias de enseñanza utilizadas para abordaje de las competencias para promoción de la salud en la formación de enfermeros. MÉTODO: Estudio de caso, anclado en la dialéctica. RESULTADOS: El currículo presenta estratégias pedagógicas diferenciadas que pueden actuar como dispositivo para desarrollo de competencias para promoción de la salud mediante una educación multidimensional transformadora. Se han citado: clases teórico-prácticas, construcción de preguntas o cuestiones sobre textos, estudios dirigidos, narrativa, plenaria orientada, juegos y aplicaciones para celulares y computadoras, dramatización, oficinas, estudios de caso, seminario integrado, proyectos de extensión e investigación, aleaciones de estudiantes. La inmersión en la práctica favorece el aprendizaje de un "hacer haciendo", el contacto con el contexto de la salud de la población y con la realidad de la vida profesional. La Práctica de Integración Enseñanza-Servicio-Comunidad y la práctica supervisada acercan al estudiante del profesor, integran el conocimiento y facilitan la práctica reflexiva. CONCLUSIÓN: Los dispositivos de articulación teoria-práctica pueden perder su función principal si no hay dirección adecuada durante las actividades prácticas. No basta cambiar el formato del plano pedagógico y sistemas de enseñanza, es imperativo cambiar la esencia del proceso de enseñanza-aprendizaje, acercándolo a real integración con la práctica profesional crítica, dinámica y socialmente contextualizada.

Knowledge about epilepsy in university health students: A multicenter study.

Even with economic development and improvements in health care around the world, it is estimated that nowadays, 50 million people have epilepsy. It is one of the most prevalent neurological diseases, yet it is still surrounded by prejudice, stigma, lack of awareness, and wrong attitudes of the population towards the disease. The aim of this study was to evaluate and compare the knowledge about epilepsy in health students from different countries: Brazil, Argentina, Portugal, United States, and South Africa. Students were asked to complete a survey regarding knowledge about epilepsy (the Epilepsy Knowledge Questionnaire). One hundred and two students participated, 62.2% of them were female. Portuguese students had significantly higher values than the American ones (p=0.025). Regarding the medical aspects, on average, students hit 63.8% of the questions, and the students from Portugal had significantly higher average than the ones from the United States (p=0.0007). Statements with lower percent of correct answers were about pathophysiology, medication, and treatment of the disease. There were no differences between the scores obtained by the students of each country in the social aspects of the disease. Statements with higher percent of mistakes were about sports practice, labor, proceedings in case of convulsion, and ability to drive vehicles. General knowledge of senior health students about epilepsy was considered low, however, regarding the medical aspects of the disease, students from Brazil and Portugal exhibited a slightly superior knowledge. Changing the way of seeing and treating people with epilepsy brings, as a consequence, increased opportunities for these people in different sectors of society.

Reflective practice and vocational training: theoretical approaches in the field of Health and Nursing / Práctica reflexiva y formación profesional: aproximaciones teóricas en el campo de la Salud y de la Enfermería / Prática reflexiva e formação profissional: aproximações teóricas no campo da Saúde e da Enfermagem

Abstract Objective: Theoretical reflection that uses Reflexivity as a theoretical reference and its objective is to approach Donald Schön's reflective thinking, interrelating it with the innovative curriculum. Method: The writings of Schön and other authors who addressed the themes in their works were used. Results: The innovative curriculum as an expression of dissatisfaction with the fragmentation paradigm may favor reflective practice, since it is necessary to mobilize reflexivity for actions and contexts that are unpredictable in the field of health promotion. Conclusions: The innovative curriculum favors and is favored by a reflective practice and the development of competencies for the promotion of health. Implications for practice: The findings apply to the practice of nurses to deal with the conditioning and determinants of the health-disease process.

Resumen Objetivo: Reflexión teórica que utiliza la Reflexividad como referencial teórico y que tuvo como objetivo aproximar el pensamiento reflexivo de Donald Schön, interrelacionándolo con o currículo innovador. Método: Fueron utilizados escritos de Schön y de otros autores que abordaron los temas en sus obras. Resultados: El currículo innovador como expresión de la insatisfacción que se tiene sobre el paradigma de la fragmentación puede favorecer la práctica reflexiva, puesto que en el campo de la promoción de la salud, es necesario movilizar la reflexividad sobre acciones y contextos imprevisibles. Conclusiones: El currículo innovador favorece y es favorecido por una práctica reflexiva y el desarrollo de competencias para promover la salud. Implicaciones para la práctica: Los hallazgos se aplican a la práctica del enfermero para lidiar con los condicionantes y determinantes del proceso salud-enfermedad.

Resumo Objetivo: Reflexão teórica que utiliza a Reflexividade como referencial teórico e teve por objetivo aproximar o pensamento reflexivo de Donald Schön, interrelacionando-o com o currículo inovador. Método: Foram utilizados escritos de Schön e de outros autores que abordaram os temas em suas obras. Resultados: O currículo inovador como expressão da insatisfação ao paradigma da fragmentação pode favorecer a prática reflexiva, visto que, no campo da promoção da saúde, é necessário mobilizar a reflexividade para ações e contextos imprevisíveis. Conclusões: O currículo inovador favorece e é favorecido por uma prática reflexiva e o desenvolvimento de competências para a promoção da saúde. Implicações para a prática: Os achados se aplicam à prática do enfermeiro para lidar com os condicionantes e determinantes do processo saúde-doença.

Competency building for health promotion and change in the care model / Desarrollo de competencias para la promoción de la salud y cambio de modelo de atención / Desenvolvimento de competências para promoção da saúde e mudança no modelo assistencial

ABSTRACT Case study based on the theoretical and methodological framework of dialectics, aimed at analyzing competency building for health promotion, from the perspective of graduates from a nursing course and its relation to change in the care model. Interviews focused on competencies were held with ten graduates. Data were analyzed using critical discourse perspective. The results show that the competencies for health promotion, defined by two internacional consensus, were discussed in the course of the nursing education process. The discourses demonstrate that competency building for health promotion in nursing education can foster change in the care model, despite the challenges in this process. Curricular strategies like contact with reality through the immersion of students in the practical scenario since the beginning of the course and community service and research activities can contribute to competency building for health promotion in nursing education and foster the change in the care model.

RESUMEN Estudio de caso anclado en la dialéctica, con el fin de analizar el desarrollo de competencias para la promoción de la salud, desde la perspectiva de egresos de un programa de enfermería y su relación con el cambio del modelo de atención. Las entrevistas con enfoque en competencias con diez graduados de una licenciatura en enfermería. Los datos fueron analizados por análisis crítico del discurso. Los resultados muestran que competencias para promoción de la salud, definidas en dos consensos internacionales, se trabajaron durante todo el proceso de formación. Los discursos producidos muestran que este desarrollo de competencias puede fomentar el cambio del modelo de atención, a pesar de los desafíos en este proceso. Se necesita mayor cambio de paradigma, ya que el suelo parece fecundo para este proceso. Las estrategias curriculares de contacto con la realidad, a través de la inmersión del estudiante en el escenario de práctica desde el inicio del curso, y las actividades de extensión e investigación pueden contribuir al desarrollo de competencias para la promoción de la salud en la formación de enfermería y fomentar el cambio del modelo de atención.

RESUMO Estudo de caso ancorado no referencial teórico-metodológico da dialética, com o objetivo de analisar o desenvolvimento de competências para promoção da saúde, na perspectiva dos egressos de um curso de enfermagem, e sua relação com a mudança do modelo de atenção. Foram realizadas entrevistas com foco em competências com dez egressos. Os dados foram analisados pela perspectiva crítica do discurso. Os resultados demonstram que as competências para promoção da saúde, definidas em dois consensos internacionais, foram trabalhadas ao longo do processo de formação. Os discursos produzidos demonstram que o desenvolvimento de competências para promoção da saúde pode favorecer a mudança do modelo assistencial, apesar dos desafios neste processo. As estratégias curriculares de contato com a realidade, por meio da imersão do estudante no cenário de prática, desde o início do curso, e ações de extensão e pesquisa podem contribuir para o desenvolvimento de competências para a promoção da saúde e favorecer a mudança do modelo assistencial.

Clinical education reflective ecological model for health science majors

Os estágios clínicos (ECs) são parte integrante dos planos de estudo dos vários cursos da Escola Superior de Saúde da Universidade de Aveiro (i.e. Enfermagem , Fisioterapia, Radiologia, Radioterapia e Terapia da Fala) e têm como objetivo desenvolver competências clínicas para formar um profissional de saúde por excelência. A sua organização tem como base o Modelo Ecológico de Formação Clínico-Reflexiva. A abordagem de formação caracteriza-se pela inovação, centra-se na ação-reflexão do aluno em contexto profssional, e na multidisciplinaridade dos intervenientes(docentes, supervisores e alunos). Com este artigo, divulgam-se os dois primeiros estágios dos cursos de Enfermagem, Fisioterapia e Radiologia. O Estágio Clínico I contou com 123 estudantes e o objetivo foi porporcionar uma visão global da atividade de cada profissional de saúde. O Estágio Clínico II contou com 119 estudantes e visou o desenvolvimento de competências inerentes a cada profissional de saúde. A avaliação dos ECs foi realizada através de questionários dirigidos aos supervisores e aos estudantes visando a sua percepção sobre a preparação, organização e duração dos mesmos. Os questionários incluíram escalas categoriais de 1-5 e perguntas abertas. Os resultados revelaram médias superiores a 3, em todos os itens avaliados, quer pelos supervisores quer pelos estudantes. Em conclusão, verificou-se uma grande aceitação do Modelo Ecológico de Formação Clínico-Reflexiva pelos supervisores e estudantes, bem como a sua aplicabilidade na área da saúde