Pilot Testing and Psychometric Validation of the Nijmegen Professionalism Scale for Spanish Nursing.

BACKGROUND AND PURPOSE: Professional commitment is frequently used as a humanistic care indicator. Thus, it is important to design and validate a tool which is able to measure professional commitment of nurses in Spain. In this study we aimed to analyze the psychometric properties of the Nijmegen Professionalism Scale for Spanish (NPS-S) nursing in order to verify its validity and reliability. METHODS: We undertook the pilot testing and psychometric validation of the NPS-S. A total sample of 249 nursing professionals from a variety of areas of expertise took part in this study. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) Statement was used for reporting this research. RESULTS: The NPS-S achieved a high degree of content validity, construct validity, internal consistency, temporal stability, and usability; this version is, thus, equivalent to the Nijmegen Professionalis Scale in its original version. IMPLICATIONS FOR PRACTICE: Based on the results obtained from the validation of this tool, it is possible to affirm that the NPS-S is an effective instrument for measuring professional commitment in this population. The NPS-S will evaluate and thus contribute to the promotion of professional commitment in Spanish nursing. Additionally, it will serve to establish correlations between professional commitment and other variables including quality of care and patient satisfaction. Future studies should analyze the evaluation capacity of this tool.

Interventions to facilitate shared decision-making using decision aids with patients in Primary Health Care: A systematic review.

BACKGROUND: Shared decision making (SDM) is a process within the physician-patient relationship applicable to any clinical action, whether diagnostic, therapeutic, or preventive in nature. It has been defined as a process of mutual respect and participation between the doctor and the patient. The aim of this study is to determine the effectiveness of decision aids (DA) in primary care based on changes in adherence to treatments, knowledge, and awareness of the disease, conflict with decisions, and patients' and health professionals' satisfaction with the intervention. METHODS: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in Medline, CINAHL, Embase, the Cochrane Central Register of Controlled Trials, and the NHS Economic Evaluation Database. The inclusion criteria were randomized clinical trials as study design; use of SDM with DA as an intervention; primary care as clinical context; written in English, Spanish, and Portuguese; and published between January 2007 and January 2019. The risk of bias of the included studies in this review was assessed according to the Cochrane Collaboration's tool. RESULTS: Twenty four studies were selected out of the 201 references initially identified. With the use of DA, the use of antibiotics was reduced in cases of acute respiratory infection and decisional conflict was decreased when dealing with the treatment choice for atrial fibrillation and osteoporosis. The rate of determination of prostate-specific antigen (PSA) in the prostate cancer screening decreased and colorectal cancer screening increased. Both professionals and patients increased their knowledge about depression, type 2 diabetes, and the perception of risk of acute myocardial infarction at 10 years without statins and with statins. The satisfaction was greater with the use of DA in choosing the treatment for depression, in cardiovascular risk management, in the treatment of low back pain, and in the use of statin therapy in diabetes. Blinding of outcomes assessment was the most common bias. CONCLUSIONS: DA used in primary care are effective to reduce decisional conflict and improve knowledge on the disease and treatment options, awareness of risk, and satisfaction with the decisions made. More studies are needed to assess the impact of shared decision making in primary care.

Conflictos de interés en la profesión médica / Conflicts of interest in the medical profession

En las últimas décadas el mundo de la medicina se ha familiarizado con la valoración de los conflictos de interés (CDI). En las revistas científicas se ha generalizado el requisito de que los autores declaren sus CDI en relación con los artículos que proponen publicar; otros aspectos sensibles que merecen atención son los CDI en la toma de decisiones sobre prescripción y los CDI de quienes ocupan puestos de responsabilidad en instituciones científicas, asistenciales o de representación profesional. Estos debates son coherentes con la preocupación de las sociedades democráticas por la justicia y la ética social que exigen juego limpio en la toma de decisiones que afectan a terceros, particularmente a los pacientes. En el presente trabajo se analiza el concepto de los CDI, los tipos de conflictos que pueden abarcar y se reflexiona sobre propuestas para la gestión de los mismos en la profesión médica

In the last decades the world of medicine has become familiar with the disclosure of conflicts of interest (CDI). The requirement for authors to declare their CDIs concerning their publications is a common issue. Another topic for CDI is related to the medical decision making on prescription. Finally, professionals being in positions of responsibility in professional societies or associations and healthcare institutions are asked to show their disclosure of CDI. These debates show up the interest of democratic societies for justice and social ethics that demand fair play in making decisions that may affect third parties, particularly patients. In the present work, the concept and types of CDIs are analyzed, and authors make proposals for the management of CDI in the medical profession

Autonomía y heteronomía, una alianza necesaria para el abordaje del tabaquismo. Visión de profesionales y pacientes / Autonomy and heteronomy, a necessary alliance to address smoking cessation. Views of professionals and patients

Objetivo: Explorar la percepción de profesionales y pacientes sobre las cuestiones éticas que entraña la atención al tabaquismo en las consultas de atención primaria. Método: Se diseñó un estudio cualitativo. Se realizaron entrevistas semiestructuradas a 12 profesionales y 7 pacientes, y dos grupos focales con 6 profesionales y 7 pacientes de atención primaria (32 participantes en total). Se realizó un muestreo intencional buscando perfiles de profesionales y pacientes de ambos sexos, distintas edades y experiencia en relación con el tabaquismo. El análisis de contenido siguió una estrategia analítica inductiva desde los datos hasta la creación de categorías teóricas. Resultados: Se identificaron cuatro categorías principales: 1) cuestiones éticas relativas a la responsabilidad del/de la profesional con el/la paciente fumador/a; 2) cuestiones relacionadas con la actitud que debe mostrar el/la profesional ante el/la paciente; 3) aspectos relacionados con la justicia en la distribución de recursos y con el papel de la Administración pública en el control del tabaquismo; y 4) cuestiones relativas a la autonomía de la persona fumadora con respecto al consumo y al cese del tabaquismo. Conclusiones: Es necesaria una alianza entre la ética que favorece la auténtica autonomía de la persona fumadora y la regulación heterónoma del consumo de tabaco. Sería conveniente incluir estas cuestiones en los programas de formación para el manejo del tabaquismo por parte de los/las profesionales

Objective: To explore the perception of professionals and patients with regard to ethical issues involved in addressing the habit of smoking in primary care consultations. Method: A qualitative study was designed, consisting of 12 semi-structured interviews with professionals, 7 interviews with patients and 2 focus groups with 6 professionals and 7 primary care patients (a total of 32 participants). An intentional sampling was conducted, including profiles of professionals and patients of both sexes, different ages and experience in relation to smoking. A content analysis was performed with an inductive analytical approach from data to the creation of theoretical categories. Results: Four main categories were identified: 1) ethical issues related to the responsibility of the professional when treating patients who smoke; 2) issues related to attitude to patients who smoke; 3) issues related to fair and equitable distribution of resources and to the role of the different levels of government in relation to the control of smoking; and 4) issues related to smokers' autonomy regarding their habit and smoking cessation. Conclusions: An alliance is needed between the ethics that support the autonomy of patients who smoke and the regulation of tobacco consumption. This approach should be included in clinical training programmes dealing with tobacco use, dependence and cessation

Vocación y profesionalismo: reflexiones de los estudiantes catalizadas por el cine de Spielberg / Vocation and professionalism: Medical students' reflections facilitated by Spielberg's movies

La profesión médica tiene un marcado sentido vocacional que está estrechamente vinculado a su dimensión ética; sin embargo, existen dudas sobre el papel que los estudios de grado están ejerciendo en su desarrollo. Con la finalidad de favorecer la reflexión al respecto, se celebró un seminario con estudiantes y profesores desarrollado en 3fases: a) libre exposición de los alumnos sobre lo que consideraban que es la vocación médica; b) presentación por parte de los profesores del marco teórico de la educación médica, seguido del visionado de varias escenas de películas dirigidas por Steven Spielberg que facilitan la reflexión sobre el significado de los componentes éticos y humanos de la medicina, y c) discusión abierta entre alumnos y profesores. Se analizan las principales conclusiones: conviene crear espacios para la reflexión sobre la dimensión vocacional de la medicina a lo largo de los estudios del grado, lo cual, de algún modo, ya se debería considerar en los procedimientos de selección y acceso; en la tarea docente es fundamental el ejemplo de los formadores, así como una tutorización individualizada que «cuide» el desarrollo vocacional; es necesario promover una formación que vaya más allá de la adquisición de conocimientos y habilidades, prestando atención a la gestión de las emociones, el acompañamiento ante los problemas éticos y la educación de las actitudes; el contacto precoz con la actividad clínica, ya desde el comienzo de los estudios se valora como un factor decisivo para motivar a los alumnos ante la inmensa carga teórica que deben afrontar

The medical profession has a marked vocational sense that is closely linked to its ethical dimension. However, there are doubts about the role that undergraduate studies are playing in their development. In order to encourage reflection on this issue, a seminar was held with students and teachers, developed in 3phases: a) free presentation by students about what they considered to be the medical vocation; b) presentation by professors of the theoretical framework of medical education, followed by the viewing of several scenes of films directed by Steven Spielberg that facilitate reflection on the meaning of the ethical and human components of medicine, and c) open discussion between students and teachers. The main conclusions were analysed: it is worth creating spaces for reflection on the vocational dimension of medicine throughout undergraduate studies. This, in some way, should already be considered in the selection and access procedures to medical school. In the teaching task it is essential that the lecturers are seen as role models, as well as providing individualised tutoring that includes vocational development. Thus, it is necessary to promote training that goes beyond the acquisition of knowledge and skills, paying attention to the management of emotions, the approach to the ethical problems, and the education of attitudes. Early contact with clinical activity, from the beginning of studies is considered a decisive factor to motivate students before the immense theoretical burden they have to face

[Conflicts of interest in the medical profession]. / Conflictos de interés en la profesión médica.

In the last decades the world of medicine has become familiar with the disclosure of conflicts of interest (CDI). The requirement for authors to declare their CDIs concerning their publications is a common issue. Another topic for CDI is related to the medical decision making on prescription. Finally, professionals being in positions of responsibility in professional societies or associations and healthcare institutions are asked to show their disclosure of CDI. These debates show up the interest of democratic societies for justice and social ethics that demand fair play in making decisions that may affect third parties, particularly patients. In the present work, the concept and types of CDIs are analyzed, and authors make proposals for the management of CDI in the medical profession.

English-to-Spanish Translation of the Nijmegen Professionalism Scale.

BACKGROUND AND PURPOSE: The aim of this investigation was to perform the cross-cultural and linguistic translation and adaptation of the Nijmegen Professionalism Scale for Spanish nursing. Originally designed by Tromp et al. (2010) for its use by general practitioners, the new Spanish version of this tool assesses professional commitment, allowing for the comparison, prevention, association, and longitudinal monitoring of commitment among nursing professionals. METHODS: The linguistic translation from English to Spanish was performed using the translation-back-translation method; the process of cross-cultural adaptation to the Spanish nursing context was carried out following the recommendations given by a panel of experts comprised of 24 practicing nurses with different professional backgrounds. The data for the feasibility study were collected between December 2015 and January 2016. RESULTS: The original English version of the instrument contains 106 items and was originally developed for assessing professional behavior of general practitioner trainees; the new version, with a significant reduction in the initial number of items, comprises 49 items and is now ready for pilot testing and validation in our context. IMPLICATIONS FOR PRACTICE: The Nijmegen Professionalism Scale in its Spanish version will act not only as a tool for measuring professional commitment among Spanish nurses but also as a motivational resource and means for reflection which will, in turn, increase the quality of the care provided by these professionals.

[Autonomy and heteronomy, a necessary alliance to address smoking cessation. Views of professionals and patients]. / Autonomía y heteronomía, una alianza necesaria para el abordaje del tabaquismo. Visión de profesionales y pacientes.

OBJECTIVE: To explore the perception of professionals and patients with regard to ethical issues involved in addressing the habit of smoking in primary care consultations. METHOD: A qualitative study was designed, consisting of 12 semi-structured interviews with professionals, 7 interviews with patients and 2 focus groups with 6 professionals and 7 primary care patients (a total of 32 participants). An intentional sampling was conducted, including profiles of professionals and patients of both sexes, different ages and experience in relation to smoking. A content analysis was performed with an inductive analytical approach from data to the creation of theoretical categories. RESULTS: Four main categories were identified: 1) ethical issues related to the responsibility of the professional when treating patients who smoke; 2) issues related to attitude to patients who smoke; 3) issues related to fair and equitable distribution of resources and to the role of the different levels of government in relation to the control of smoking; and 4) issues related to smokers' autonomy regarding their habit and smoking cessation. CONCLUSIONS: An alliance is needed between the ethics that support the autonomy of patients who smoke and the regulation of tobacco consumption. This approach should be included in clinical training programmes dealing with tobacco use, dependence and cessation.

Resident Physicians as Patients: Perceptions of Residents and Their Teaching Physicians.

OBJECTIVE: This study aims to broaden understanding into the process by which resident physicians deal with illness and to identify areas for improvement regarding healthcare of residents and teaching physicians training to support them adequately. METHODS: A qualitative study of ten semi-structured interviews with residents who had suffered a serious illness and a focus group of teaching physicians were conducted. Analysis of the interview transcripts was performed using the grounded theory approach, with information divided into five categories: Differences between residents as patients and general patients; confidentiality; feelings and attitudes; learning from illness; and impact on work and training. RESULTS: There are differences between residents and the general population: In the initial stage, diagnosis is made promptly with preferential treatment shown by colleagues. Subsequently, the lack of clear guidelines can lead to poor follow-up. They accept a loss of confidentiality in the process. One of the most serious concerns felt by residents is the impact of their illness on their training as specialists, meaning that teaching physicians are charged with the important role of guaranteeing the resident's proper recovery, return to work, and readaptation to the training program. Teaching physicians demand their own training be reinforced in these aspects. CONCLUSION: There is a need to assess the great diversity observed in training-related decisions made by teaching physicians when residents fall ill. Given the differences observed, more research is required to improve the care provided to sick residents and particularly the teaching physicians training to handle them.

A concept analysis of professional commitment in nursing.

BACKGROUND: The concept of professional commitment is being widely studied at present. However, although it is considered an indicator for the most human part of nursing care, there is no clear definition for it, and different descriptors are being used indiscriminately to reference it. OBJECTIVE: The aim of this study is to clarify the concept of professional commitment in nursing through the Rodgers' evolutionary concept analysis process. DESIGN: Systematic search using English and Spanish descriptors and concept analysis. Studies published between 2009 and June 2015, front-to-back analysis of the Nursing Ethics journal and manual check of articles cited in studies related to the Nijmegen Professionalism Scale. RESEARCH DESIGN: The procedure of concept analysis developed by Rodgers was used. ETHICAL CONSIDERATIONS: Although the topic was not labeled as sensitive and subject to ethical approval, its realization was approved by the Ethical Committee of Clinical Research of Aragon (CEICA) approved the study on 18 March 2015 and also careful procedures have been followed according to ethics expressed in the Declaration of Helsinki. FINDINGS AND DISCUSSION: A total of 17 published studies. A clear definition of the concept was made, and surrogate terms, concept dimension, differential factors related to the concept, sociocultural variations and consequences for nursing practice were identified. CONCLUSION: There is a need for continuous advancement in the development of the concept, specific actions to encourage this and the improvement of evaluation methods for its study.

Teaching Confidentiality through Comics at One Spanish Medical School.

At the University of Zaragoza in Spain we developed an innovative way to teach the concept of confidentiality to medical students, which we tested by comparing the use of customized comics with more traditional methods. We proved that using comics is more attractive to students than lectures and class discussions, that it increases class participation and students' self-awareness of learning, and that it maintains the same academic results. We share our experience visually in a two-page comic.

Educar las emocoones para promover la formación ética / Educating motionns to promote ethics education / Educar as emçõess para promover a formação ética

Es común observar entre los médicos una razonable formación técnica que convive con una postura humanística deficiente, que decanta en insuficiencia ética y en falta de profesionalismo. Esta desproporción sugiere que es necesario ampliar el ámbito del humanismo médico y encontrar un nuevo punto de equilibrio, moderno, propio de los días actuales. Enseñar Bioética supone establecer fronteras y normas, pero requiere sobre todo creatividad, ir más allá de lo que está estipulado para hacer por el enfermo todo lo que es posible. ¿Cómo aliar la creatividad a la necesaria prudencia y sabiduría que requiere la formación ética? Los cuestionamientos éticos vienen con frecuencia envueltos en emociones que no pueden ser ignoradas; hay que contemplarlas y utilizarlas porque son un elemento esencial del proceso formativo. Compartir emociones, ampararlas en discusiones abiertas, abre caminos para una verdadera construcción afectiva y fomenta la empatía que aproxima al paciente. Entre los recursos pedagógicos modernos para desarrollar la educación de la afectividad se destacan la narrativa -oír, contar y compartir historias de vida-, el cine y la música -representantes de la actual cultura del espectáculo-, que los autores comentan de acuerdo con su experiencia docente. Las emociones, por sí solas, no son suficientes para educar. Es necesaria la habilidad del docente para conseguir que la emoción se transforme en vivencia, estimule la reflexión y se interiorice. Este proceso es el catalizador que, aprovechando el terreno fértil de la emoción, imprime una huella educativa: se genera la vivencia que es puerta abierta para incorporar actitudes estables y duraderas.

Among physicians, it is common to see reasonable technical training existing alongside a deficient humanistic stance, which results in ethical shortcomings and a lack of professionalism. This disparity suggests the need to broaden the scope of medical humanism and to find a new, modern balance particular to today's world. Teaching bioethics involves setting boundaries and rules but, above all, it requires creativity and going beyond what is stipulated in order to do all that is possible for the patient. The question is: How to combine creativity with the necessary prudence and wisdom required of ethics education? Ethical issues often are surrounded by emotions that cannot be ignored. Rather, they must be contemplated and used, because they are an essential element in the learning process. This involves sharing emotions, sheltering them in frank discussions, opening up paths to genuinely constructing emotions and encouraging empathy towards the patient. Among the modern educational resources that exist to develop emotional education the narrative is a particularly important one; that is, listening, telling and sharing stories of life - film and music - representatives of the current culture of entertainment, which the authors mention on in light of their teaching experience. Emotions, in and of themselves, are not enough to educate. Skill is required of the teacher to create a situation where emotion is transformed into experience, encourages reflection and is internalized. This process is the catalyst. Taking advantage of the fertile ground of emotion, it leaves an educational footprint by producing the experience that is the gateway to adopting stable and lasting attitudes.

É comum observar entre os médicos uma razoável formação técnica que convive com uma postura humanística deficiente, que decanta em insuficiência ética e em falta de profissionalismo. Essa desproporção sugere que é necessário ampliar o âmbito do humanismo médico e encontrar um novo ponto de equilíbrio, moderno, próprio dos dias atuais. Ensinar Bioética supõe estabelecer fronteiras e normas, mas requer, sobretudo, criatividade, ir mais além do que está estipulado para fazer pelo doente tudo o que for possível. Como aliar a criatividade à necessária prudência e sabedoria que a formação ética requer? Os questionamentos éticos vêm com frequência envolvidos em emoções que não podem ser ignoradas; há que contemplá-las e utilizá-las porque são um elemento essencial do processo formativo. Compartilhar emoções, ampará-las em discussões abertas, abre caminhos para uma verdadeira construção afetiva e fomenta a empatia que aproxima o paciente. Entre os recursos pedagógicos modernos para desenvolver a educação da afetividade se destacam a narrativa -ouvir, contar e compartilhar histórias de vida-, o cinema e a música -representantes da atual cultura do espetáculo- que os autores comentam de acordo com sua experiência docente. As emoções, por si só, não são suficientes para educar. E necessária a habilidade do docente para conseguir que a emoção se transforme em vivência, estimule a reflexão e se interiorize. Esse processo é o catalizador que, ao aproveitar o terreno fértil da emoção, imprime um rasto educativo: gera-se a vivência que é porta aberta para incorporar atitudes estáveis e duradouras.

Fiabilidad de un cuestionario empleado para la aplicación en el seguimiento longitudinal de la opinión y percepciones de la medicina de familia de los estudiantes de medicina de la Universidad de Zaragoza / Reliability of a questionnaire used in the long-term follow up of the opinion and perceptions of family medicine by medical students of the University of Zaragoza (Spain)

Objetivo: La medicina de familia aborda determinados aspectos y perspectivas que suelen quedar relegados en la formación de otros niveles de atención por lo que cada vez cobra mayor importancia la necesidad de que los estudiantes tomen contacto con la atención primaria. El objetivo de este estudio es el de evaluar la fiabilidad del cuestionario del grupo Unimedifam (FIS PI070975) para conocer la evolución longitudinal de las expectativas y conocimientos sobre medicina de familia de los estudiantes de medicina. Diseño: Estudio de fiabilidad de un cuestionario. Emplazamiento: Alumnos de medicina de la Universidad de Zaragoza. Participantes: Contamos con un total de 371 alumnos de los cursos 1.°, 3.°, 5.° y 6.°. Método: La consistencia interna del cuestionario se determinó con el coeficiente alfa de Cronbach y su estabilidad en una prueba test-retest. Resultados: En la escala A del cuestionario encontramos que 3 ítems de 19 son poco estables; en la escala B 8 de 26 y en la escala C, 3 ítems de 38. El valor de alfa de Cronbach de la escala A es de 0,722, de la escala B de 0,861 y el de la escala C, 0,663.ConclusionesLas 3 escalas están entre los valores adecuados, excepto la escala C que aun así se encuentra muy próxima. Las conclusiones de este proceso de validación pueden servir de referencia y extrapolarse al cuestionario UNIMEDFAM a nivel estatal (AU)

Aim: Family medicine deals with certain aspects and perspectives that are often left behind in the training of other levels of care, thus the need for medical students to make contact with Primary Care is of increasing importance. The aim of this study is to evaluate the reliability of the questionnaire of the UNIMEDIFAM group (FIS PI070975) for the long-term outcome of expectations and knowledge about family medicine. Design: Reliability of a questionnaire. Setting: University of Zaragoza.Participants371 students from the 1st, 3rd, 5th, and 6th years. Method: The internal consistency of the questionnaire was determined using Cronbach's alpha coefficient, and the stability using the test-retest. Results: On scale A of the questionnaire we found that three of 19 items were unstable, in 8 of 26 on scale B, and 3 of 38 items on scale C. The Cronbach's alpha value of scale A was 0.722, 0.861 on scale B, and 0,663 on scale C. Conclusions: The 3 scales are within the appropriate values, except scale C, which is very close. The findings of this validation process can serve as a reference that may be extrapolated to the UNIMEDIFAM national questionnaire(AU)

[Reliability of a questionnaire used in the long-term follow up of the opinion and perceptions of family medicine by medical students of the University of Zaragoza (Spain)]. / Fiabilidad de un cuestionario empleado para la aplicación en el seguimiento longitudinal de la opinión y percepciones de la medicina de familia de los estudiantes de medicina de la Universidad de Zaragoza.

AIM: Family medicine deals with certain aspects and perspectives that are often left behind in the training of other levels of care, thus the need for medical students to make contact with Primary Care is of increasing importance. The aim of this study is to evaluate the reliability of the questionnaire of the UNIMEDIFAM group (FIS PI070975) for the long-term outcome of expectations and knowledge about family medicine. DESIGN: Reliability of a questionnaire. SETTING: University of Zaragoza. PARTICIPANTS: 371 students from the 1st, 3rd, 5th, and 6th years. METHOD: The internal consistency of the questionnaire was determined using Cronbach's alpha coefficient, and the stability using the test-retest. RESULTS: On scale A of the questionnaire we found that three of 19 items were unstable, in 8 of 26 on scale B, and 3 of 38 items on scale C. The Cronbach's alpha value of scale A was 0.722, 0.861 on scale B, and 0,663 on scale C. CONCLUSIONS: The 3 scales are within the appropriate values, except scale C, which is very close. The findings of this validation process can serve as a reference that may be extrapolated to the UNIMEDIFAM national questionnaire.