Spanish version of the Self-Care of Chronic Illness Inventory: A validation study amongst community-dwelling older adults with chronic multimorbidity.

AIM: To psychometrically assess the Spanish version of the Self-Care of Chronic Illness Inventory (SC-CII-Sp) in community-dwelling older adults with chronic multimorbidity. DESIGN: A methodological study. METHOD: A total of 1260 older adults participated in the study between May 2020 and February 2022. The data were analysed using SPSS Statistics® 26 and AMOS® 24. The items' content validity index and the Fleiss' kappa were calculated to assess the SC-CII-Sp's content validity. Convergent validity was assessed by calculating the Pearson correlation coefficient between the participants' scores on the SC-CII-Sp and their scores on the Spanish Chronic Disease Self-Efficacy scale (SCD-SE). Construct validity was tested by performing a confirmatory factor analysis (CFA). The SC-CII-Sp's reliability was tested by computing the Cronbach's alpha. RESULTS: The SC-CII-Sp showed good content and convergent validity. The CFA showed that the SC-CII-Sp has three sub-scales. The 8-item Self-Care Maintenance sub-scale has good internal consistency and is comprised of two dimensions: illness-related and health-promoting behaviour. The Self-Care Monitoring sub-scale had excellent internal consistency and its five loaded items belonged to a single dimension. The 6-item Self-Care Management sub-scale has adequate internal consistency and two dimensions: autonomous and consulting behaviour. CONCLUSION: The Spanish version of SC-CII is a valid and reliable instrument to be used in the assessment of self-care behaviours amongst Spanish-speaking, community-dwelling older adults with chronic multimorbidity. IMPLICATIONS FOR THE PROFESSION: Nurses need valid and reliable tools to assess self-care behaviours in Spanish-speaking community-dwelling older adults with chronic multimorbidity. This study provides a 19-item tool that allows for the comprehensive evaluation of self-care behaviours in healthy and ill states. IMPACT: Using the SC-CII-Sp in clinical or research settings could help nurses to examine the effects of different interventions on self-care behaviours amongst Spanish-speaking, community-dwelling older adults with chronic multimorbidity. PATIENT OR PUBLIC CONTRIBUTION: None to be reported.

Spanish version of the Maastricht Personal Autonomy Questionnaire: A validation study among community-dwelling older adults with chronic multimorbidity.

BACKGROUND: Loss of personal autonomy in older adults with chronic multimorbidity is associated with worsened biopsychosocial health. In order to facilitate the standardised assessment of personal autonomy in older adults with chronic conditions, nurses could use the Maastricht Personal Autonomy Questionnaire (MPAQ). OBJECTIVE: To translate, culturally adapt and psychometrically assess the Spanish version of the MPAQ in community-dwelling older adults with chronic multimorbidity (MPAQ-Sp). METHODS: Observational cross-sectional study. A convenience sample of 884 community-dwelling older adults was recruited from 10 community centres in five health districts in southeastern Spain. Data were collected between January 2021 and September 2022. The study was completed in four phases. Phase 1: The MPAQ was translated into Spanish. Phase 2: A pilot test of reliability and content validity was conducted. Phase 3: To test the dimensionality of the tool, an exploratory factor analysis (EFA) was conducted. Phase 4: a final validation study was conducted which included a confirmatory factor analysis (CFA) and assessed the validity (content, criterion and construct), reliability and readability of the MPAQ-Sp. RESULTS: The average age of the sample was 75.89 years (SD = ±8.04). Their mean number of chronic conditions was 4.84 (SD = ±2.19) and 67% were women. The MPAQ-Sp is comprised of 16 items distributed in four subscales: [1] the 'Degree of autonomy' scale, [2] the 'Working on autonomy' scale, [3] the 'Dilemmas: health over preferences' scale and [4] the 'Dilemmas: preferences over health' scale. CONCLUSIONS: The Spanish version of the MPAQ-Sp is a valid and reliable instrument to assess personal autonomy in Spanish-speaking, community-dwelling older adults with chronic multimorbidity. IMPLICATIONS FOR PRACTICE: The use of the MPAQ-Sp would allow researchers and healthcare professionals to identify a loss of personal autonomy among Spanish-speaking community-dwelling older adults with chronic multimorbidity.

Compassion in health professionals: Development and validation of the Capacity for Compassion Scale.

BACKGROUND: Health professionals witness pain and suffering when they care for sick people and their families. Compassion is a necessary quality in their work as it combines the will to help, alleviate suffering and promote the well-being of both the people they are attending and the professionals themselves. The aim of the study was to design and evaluate the psychometric properties of the Capacity for Compassion Scale (CCS). DESIGN: A quantitative, descriptive and cross-sectional study was carried out to evaluate the psychometric properties of the scale (reliability, temporal stability, content validity, criterion validity and construct validity). METHODS: The study was carried out in two phases: pilot study and final validation. The data were collected between April and May 2022. The sample was selected by convenience sampling and was made up of a total of 264 participants, 59 in the pilot phase and 205 in the final validation. RESULTS: The Capacity for Compassion Scale has been shown to have good psychometric properties in relation to reliability, temporal stability, and content, criterion, and construct validity. Factor analysis showed that there were four subdimensions of the scale: motivation/commitment, presence, shared humanity and self-compassion. The results also indicate that compassionate ability is significantly correlated with age and work experience. CONCLUSIONS: The Capacity for Compassion Scale shows adequate psychometric properties. This instrument measures the compassion capacity of health professionals, which is a valuable discovery for new lines of research in this field. IMPACT: Through this scale, low levels of capacity for compassion can be detected that negatively influence the quality of care provided by health professionals. The Capacity for Compassion Scale can therefore contribute to the identification of needs and promote training around compassion for health professionals. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. WHAT PROBLEM DID THE STUDY ADDRESS?: Compassion in health professionals has positive effects on improving the quality of care, the satisfaction of professionals and the work environment. There are compassion cultivation programmes whose validity has been proven for the development of the dimensions of compassion. There is no specific instrument that measures capacity for compassion in healthcare professionals. WHAT WERE THE MAIN FINDINGS?: A scale is designed to measure capacity for compassion in health professionals. This is the only such scale available up until now. The scale measures four dimensions of compassion: motivation/commitment, presence, shared humanity and self-compassion. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: The development of specific programmes that can increase the compassion of health professionals with all the benefits that this can bring to health care is encouraged. It will be possible to analyse the effects of training programmes on the cultivation of compassion.

Spanish version of the self-care self-efficacy scale: A validation study in community-dwelling older adults with chronic multimorbidity.

OBJECTIVE: To test the psychometric properties of the Spanish version of the Self-Care Self-Efficacy Scale (SCSES-Sp) in community-dwelling older adults with chronic multimorbidity. METHODS: A sample of 1013 community-dwelling older adults with chronic multimorbidity participated in an observational cross-sectional study that was carried out in 3 phases. RESULTS: Confirmatory factor analysis showed that the SCSES-Sp has 4 dimensions: "self-efficacy in self-care behaviours based on clinical knowledge", "self-efficacy in self-care maintenance", "self-efficacy in self-care monitoring", and "self-efficacy in self-care management". A panel of independent experts considered the content of the SCSES-Sp valid. Convergent validity analysis showed moderate-strong correlations between all of the SCSES-Sp's dimensions and the reference criteria chosen. Reliability was good for the SCSES-Sp and all its dimensions. Test-retest reliability analysis showed that the SCSES-Sp was temporally stable. CONCLUSIONS: The SCSES-Sp is a valid and reliable tool to assess self-efficacy in self-care in Spanish-speaking, community-dwelling older adults with chronic multimorbidity.

Effects of home visiting programmes on community-dwelling older adults with chronic multimorbidity: a scoping review.

BACKGROUND: Chronic ultimorbidity is the most frequent and serious health problem in older adults. Home visiting programmes could be a strategy with potential benefits. However, there are no scoping reviews to date that examine the effects of home visiting programmes on community-dwelling older adults with chronic multimorbidity. OBJECTIVE: To examine the effects of home visiting programmes on community-dwelling older adults with chronic multimorbidity. METHODS: A scoping review was carried out following PRISMA-ScR reporting guidelines. The search was conducted in six databases (PubMed/Medline, Cochrane, CINAHL, Web of Science, Scopus and EMBASE) between October 2021 and April 2022. RESULTS: Four RCTs with 560 patients were included. The visits were carried out by nurses, nursing students, volunteers, and other healthcare professionals. The interventions varied in the number of visits, frequency, duration of follow-up, and whether or not they were combined with other strategies such as telephone calls. Discrepancies were found in the effects of the interventions on quality of life, self-efficacy, self-rated health, and use and cost of health and social services. CONCLUSION: This review shows that home visiting programmes could have potential benefits for older adults with chronic multimorbidity. However, its results have been inconclusive. There is a need for high quality studies involving a larger number of patients, in which home visits are the main intervention.

Nursing students' experiences of a home visiting programme for older adults with multimorbidity (VISITAME project): A phenomenological study.

INTRODUCTION: Nursing students should acquire competence in promoting self-care in older adults with chronic multimorbidity, but opportunities for clinical practice are limited. The implementation of a home visiting programme to community-dwelling older adults with chronic multimorbidity could contribute to nursing students' acquisition of this competence. OBJECTIVE: The aim of our study was to understand the experience of nursing students participating in a home visiting programme to community-dwelling older adults with chronic multimorbidity. DESIGN: Qualitative study based on Gadamer's hermeneutic phenomenology. METHOD: Twenty-two in-depth interviews were conducted with nursing students participating in a home visiting programme. Data were recorded, transcribed and analysed following the procedure developed by Fleming. RESULTS: Three main themes were extracted in the data analysis process: (1) 'living the theory. Experience as a catalyst for learning', (2) 'the home visiting programme as a tool for promoting competence in caring for older adults', and (3) 'when learning sparks interest in working with older adults'. CONCLUSION: The home visiting programme to community-dwelling older adults has an important impact on the personal and professional development of nursing students. The experience of the home visiting programme leads to deep learning that sparks interest in caring for older adults. The implementation of a home visiting programme could be a beneficial strategy for the acquisition of competence to promote health and self-care.

Experiences of poverty amongst low-income older adults living in a high-income country: A qualitative study.

AIM: To understand the experience of low-income older adults living in poverty in a high-income country. DESIGN: A qualitative study based on Gadamer's hermeneutic phenomenology. METHODS: A convenience sample of twenty-seven low-income older adults were interviewed in-depth between September 2021 and January 2022. Fleming's method for conducting phenomenological qualitative studies was followed and ATLAS.ti software was used for data analysis. RESULTS: Three main themes were extracted from the analysis: (i) 'living in the shadow of poverty', (ii) 'unprotected by the 'social shield' of the welfare state' (iii) 'the struggle to attain good health'. CONCLUSION: Living in poverty affects all spheres of life. Older adults living in poverty feel excluded from social support policies and laws. This has a negative impact on the older adults' mental health and can lead to social isolation. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nursing interventions to promote health amongst older adults living in poverty should include an assessment of the patient's social determinants and a focus on increasing social participation. Older people living in poverty experience difficulties accessing formal social support so nurses should implement patient navigation interventions that aim to help them overcome the complexities of the system. Nursing interventions to improve mental health amongst older adults living in poverty are much needed. IMPACT: Living in poverty increases older adults' vulnerability. Older adults living in poverty suffer from mental health issues as they live under constant pressure to meet their basic needs and lack formal social support. These findings are important for nurses, who play a pivotal role in the design, implementation and evaluation of policies and interventions that promote health equity. REPORTING METHOD: The study has been conducted following the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION: There has been no public or patient involvement in the design or development of the study.

Understanding the consequences of Female Genital Mutilation: a phenomenological study in sub-Saharan women living in Spain.

BACKGROUND: Female Genital Mutilation (FGM), which is culturally accepted in some African communities, has serious consequences on the physical, psychological, urogynecological, obstetrical and sexual health of girls and women. It is therefore important to understand women's experiences of the consequences of FGM. OBJECTIVE: to understand the experiences of the consequences of female genital mutilation in sub-Saharan female survivors living in Spain. DESIGN: a qualitative study based on Merleau-Ponty's hermeneutic phenomenology. PARTICIPANTS AND SETTING: 13 sub-Saharan female survivors of female genital mutilation participated. The study was carried out in two south-eastern Spanish provinces where many jobs in the agricultural and service industry are done by African immigrants originating from ethnic groups in which FGM is still prevalent. FINDINGS: In-depth interviews were carried out for data collection. ATLAS.ti was used for inductive analysis, from which two main themes were developed that represent the experiences of the consequences of FGM: (a) The impact of FGM: Hijacked sexual health and (b) The difficult process of genital reconstruction: overcoming the aftereffects and regaining integrity. CONCLUSION AND IMPLICATIONS FOR PRACTICE: The mutilated women experienced serious consequences in their sexual, psychological and obstetrical health. Genital reconstruction was a difficult decision but contributed to regaining their sexual health and identity. The professionals involved play an important role in the care provided for the associated consequences of FGM, in identifying risk groups and in providing advice that allows the women to regain their sexual and reproductive health.

Irregular migrants' experiences of health disparities while living in informal settlements during the COVID-19 pandemic.

AIMS: The objective of this study was to describe and understand irregular migrants' (IMs') experiences of health disparities while living in informal settlements (ISs) during the COVID-19 pandemic. DESIGN: Qualitative descriptive study. METHODS: Thirty-four IMs originating from different African countries living in ISs took part in this study. Data were collected between January and March 2022 through three focus groups and 17 in-depth interviews. Thematic analysis was used to analyse qualitative data with ATLAS.ti computer software. RESULTS: Three main themes emerged: (1) Extreme vulnerability: ISs and abuse; (2) Inequality in health treatment has increased during COVID-19; and (3) The impact of COVID-19 on the health of IMs: help from non-governmental organizations and nurses. CONCLUSION: Irregular migrants are at a higher risk of exposure to COVID-19 due to their precarious living conditions, administrative situation and access to the health system. It is recommended that specific programmes be strengthened to improve health care for this population. IMPACT: What problem did the study address? This study examines IMs' experiences of health disparities during the COVID-19 pandemic. What were the main findings? IMs are at higher risk of exposure to COVID-19 due to social, health, housing and work inequalities. Community health nurses alongside non-governmental organizations have facilitated the implementation of measures to protect this population against COVID-19. Where and on whom will the research have an impact? With the aim of improving care for IMs, strategies have been suggested for health institutions to address problems relating to accessing the health system, and to promote networking between non-governmental organizations and community health nurses.

Lived experiences and opinions of women of sub-Saharan origin on female genital mutilation: A phenomenological study.

AIMS AND OBJECTIVES: This study aimed to describe and understand the lived experiences and opinions of sub-Saharan women living in Spain in relation to female genital mutilation. BACKGROUND: Female genital mutilation is a bloody procedure with serious consequences for the health of women and girls. Understanding mutilated women's lived experiences plays a crucial role in the management of health consequences and could help healthcare professionals to provide assistance to these women. DESIGN: A descriptive phenomenological study was carried out. The COREQ checklist was followed as guidance to write the manuscript. METHODS: A total of 12 in-depth interviews were conducted. Interviews were recorded, transcribed and analysed using ATLAS.ti 9.0. RESULTS: Two themes with four subthemes were identified from the data analysis: 1) 'The traumatic experience of female circumcision' with the subthemes 'Female mutilation is a physical and psychological torture procedure' and 'recognising and coping with negative emotions'; 2) 'The fight for the eradication of female genital mutilation' which contains the subthemes 'the need for a real sociocultural change at the origin' and '"I want to be the last": Personal development leads to sociocultural change'. CONCLUSIONS: Female genital mutilation was experienced by women as a very aggressive and traumatic event. It causes considerable negative emotions that last over time. Although there is a tendency to reject the practice, in women's countries of origin, there is social pressure for girls to be mutilated. RELEVANCE TO CLINICAL PRACTICE: Caring for women who have suffered from female genital mutilation requires awareness of the traumatic experience they underwent when they were girls. Healthcare professionals play a crucial role in eradicating female genital mutilation. Apart from education, preventive measures may include specific recommendations when girls are travelling to the country of origin and participatory action research.

Patients' experiences and perceptions of dignity in end-of-life care in emergency departments: A qualitative study.

AIMS: To explore and understand the experiences of patients with advanced illness in relation to dignity during end-of-life care in emergency departments. DESIGN: Qualitative study based on Gadamer's hermeneutics. METHODS: Between September 2019 and February 2020, 16 in-depth interviews were carried out with advanced illness patients who attended emergency departments. The participants were informed priorly and signed informed consent. The data were analysed using an inductive strategy for finding emerging themes. The Consolidated Criteria for Reporting Qualitative Research was used for writing the study's report. RESULTS: In the data analysis process, two main themes emerged that glean the experiences of patients in relation to dignity during end-of-life care in emergency departments. 'Dignity as an individual's attribute' and 'Acting with dignity: Dignity as a behavioural attribute'. CONCLUSION: Patient dignity in end-of-life care is centred around the principle of control (of oneself, one's death and one's emotions). The strategies required for patients to preserve their dignity can be somewhat incompatible with the dynamics and objectives of healthcare professionals who work in emergency departments. IMPACT STATEMENT: The dignity of patients with advanced illness who attend emergency departments is a relevant issue that merits being addressed from the patients' perspective. Participants have identified that dignity is a way of being and behaving in the face of illness. Emergency departments need to respect end-of-life patients' desires by supporting and accompanying them, avoiding therapeutic obstinacy. We recommend care to be centred on patients' well-being, to respect their autonomy and decision-making processes, and to allow prompt referrals to palliative care services. PATIENT OR PUBLIC CONTRIBUTION: Managers from the Emergency Departments participated in the study design and patients' recruitment. Patients' relatives were informed about the study's aim, and they contributed to the development of the interview protocol.

Attention Given to Victims of Gender Violence from the Perspective of Nurses: A Qualitative Study.

Women victims of gender violence consider the health system an appropriate place to seek help. Aims and Objectives: to describe and understand how nurses perceive gender-based violence in health care for women victims of gender-based violence. Qualitative descriptive study. The recommendations of the COREQ guide for qualitative research reporting were followed. Sixteen nurses who were working in different health services, both primary and specialized care, were selected to take part in the study. Three focus groups and a semi-structured interview were conducted. The ATLAS.ti 9 computer programme was used. The nurses highlighted that when caring for women who are victims of gender violence, they encounter two types of violence: invisible or latent, and visible or patent. Part of the nurses' role is based on the skill of knowing how to act and being trained to do so. In addition, there are certain controversies around the concept and origin of violence. On the one hand, they refer to gender violence as a universal phenomenon with strong cultural and educational roots, and, on the other hand, it is difficult to characterize. The findings report how nurses play a fundamental role in caring for victims of gender-based violence, but they encounter certain difficulties regarding this concept. It is therefore essential to continuously train and educate nurses on gender-based violence. Gender violence should be a competency in nursing curricula. Health systems must offer training and awareness programmes that teach nurses to detect and make decisions regarding female victims of gender violence. It is also necessary to set up spaces in the different services so that the nurses can attend to the victims.

Development and Psychometric Assessment of a Questionnaire for the Detection of Invisible Violence against Women.

BACKGROUND: Invisible violence against women (IVAW) can be understood as the set of attitudes, behaviors, and subtle beliefs that men use to subordinate women and that are culturally accepted. These behaviors can be a risk factor for intimate partner violence (IPV), so it is important to design tools that allow us to detect it early. The aim of this study was to design and psychometrically assess a questionnaire for the detection of invisible violence against women (Q-IVAW). METHODOLOGY: A descriptive cross-sectional methodological study carried out in three phases: (1) development of the initial version; (2) pilot study (N = 51); and (3) final validation study (N = 990). The tool's reliability, validity, and legibility were assessed. To assess reliability, the internal consistency (Cronbach's α) was analyzed. The validity assessment included an analysis of content, criterion, and construct validity. RESULTS: The EFA revealed that the Q-IVAW was comprised of five factors that explained 55.85% of the total variance found. The Q-IVAW showed very high reliability (α = 0.937), excellent content validity, and good construct validity. The criterion validity analysis showed a moderate correlation between A-IPVAW and Q-IVAW (r = 0.30; p < 0.001). CONCLUSION: The psychometric assessment of the Q-IVAW yielded good results, which could support the tool's ability to assess how often women are subjected to inviable violent behaviors by their partners.

The effect of home visit simulation on emotional intelligence, self-efficacy, empowerment, and stress in nursing students. A single group pre-post intervention study.

BACKGROUND: Clinical simulation, the teaching methodology used in the Nursing Degree, helps students to acquire certain skills. Home visiting is a complex scenario in community care that requires certain critical skills in order to function successfully. OBJECTIVES: The aim of this study was to analyze the improvement of self-efficacy, empowerment, management of emotions and perceived stress of nursing students through clinical simulation during home visits. DESIGN: A quasi-experimental study was carried out. PARTICIPANTS: A sample of Students of the 2nd year of the Nursing Degree. METHODS: A high-fidelity simulation programme was implemented in two sessions. The variables that were measured were: self-efficacy (General Self-efficacy Scale), empowerment (Spreitzer Psychological Empowerment Scale), emotional intelligence (Trait Meta-Mood Scale-24), and perceived stress (Perceived Stress Scale). RESULTS: 170 students with a mean age of 22.2 years took part. An increase in general self-efficacy, self-determination, impact, empowerment (total score), and emotional clarity was observed after the intervention. CONCLUSIONS: Clinical simulation as a teaching methodology allows the development of skills and competencies that are necessary for nursing students to be able to function in community settings such as home care. Therefore, this teaching methodology should be integrated into University Community Nursing training programmes.

Validation of the persian version of the COVID-19 prevention, recognition and home-management self-efficacy scale.

INTRODUCTION: Adopting preventive behaviors and following the guidelines for controlling the COVID-19 epidemic depend on people's self-efficacy in carrying out these behaviors and instructions. The aim of this study was to investigate the psychometric properties of the Persian version of the COVID-19 Self-Efficacy Scale (COVID-19 SES, Hernández-Padilla et al., 2020). MATERIAL AND METHODS: This cross-sectional study was performed in a group of 400 people who were residents of the city of Asadabad in western Iran from December 2020 to January 2021. The participants were selected using a convenience sampling method. Face and content validity was assessed qualitatively based on feedback from the participants and experts, and the necessary changes were applied to the final version of the questionnaire. For construct validity, exploratory factor analysis (n=200) and confirmatory factor analysis (n=200) were performed. Internal consistency was expressed as Cronbach's alpha coefficient. Relative stability was assessed using the intraclass correlation coefficient (ICC), and absolute stability was calculated through examination of standard error of measurement (SEM). RESULTS: In exploratory factor analysis, three factors of prevention, symptom recognition, and homemanagement of COVID-19 were extracted that together explained 71.35% of the total variance. The internal consistency of the whole instrument was 0.955 and its three dimensions were 0.894, 0.916 and 0.955, respectively. In addition, an ICC of 0.986 (95% CI: 0.975-0.993, p=0.001) was found. In the confirmatory factor analysis, comparative and parsimonious fit indices were excellent, and absolute fit indices were moderate. CONCLUSIONS: The Persian version of the COVID-19 SES has good validity and reliability and can be used to measure self-efficacy in prevention, symptoms recognition, and home-management of COVID-19.

Influential Factors of Breastfeeding after Assisted Reproduction: A Spanish Cohort.

The impact of assisted reproduction techniques (ART) when starting to breastfeed is an important issue that has been sparsely addressed in scientific literature and yet has contradictory results. This study aims to determine the relation between the mode of fertilization and breastfeeding by means of a retrospective longitudinal cohort study that included newborns and mothers who gave birth between 2012 and 2019 in a third-level regional hospital. Data were collected from a total of 11,285 women and newborns, of which 302 (2.6%) used ART. Logistic regression was used to establish models that determine the administration of exclusive breastfeeding (BF). Among the 1208 analyzed participants, 30% conceived using fertility treatment. In this group of participants, BF was less prevalent, both in the delivery room (25.8% versus 45.5%; p < 0.001) and when discharged from hospital (42.1% versus 57.9%; p < 0.001). Healthy newborns and BF in the delivery room were predictors of BF when discharged. On the other hand, the use of ART, an Apgar score lower than 7 at birth, the use of an epidural and a premature or underweight baby are considered negative predictors of exclusive BF when discharged. It is necessary to offer greater support for all mothers regarding BF, especially those who have conceived through ART, even more so in those cases that involve an epidural and/or caesarean section, starting throughout the dilation process.

Milk Donation Following a Perinatal Loss: A Phenomenological Study.

INTRODUCTION: Perinatal loss is a traumatic event for women with negative consequences for their well-being and mental health. After perinatal loss, some women choose to not suppress lactation and to donate their breast milk. Donating milk can be a grief ritual to cope with the loss. The aim of this study was to explore women's experiences of donating their breast milk following a perinatal loss. METHODS: A hermeneutic phenomenology was carried out. Thirteen semistructured interviews were conducted. Data was recorded, transcribed, and categorized into themes and subthemes. RESULTS: Two main themes emerged from the data: (1) lactation after loss: a forgotten aspect of the care, with the subthemes "the silence surrounding grieving lactation" and "experiencing lactation amidst a sea of tears"; and (2) milk donation: a resource to alleviate pain and offer hope, with the subthemes "expressing and donating breast milk: a healing ritual" and "breaking the taboo of the grieving lactation." DISCUSSION: Information about lactation options is not typically included in participants' care plan. Women's experiences highlight the need for the support of health care professionals. Donating milk helps some women to cope with the loss and accept and integrate it into their daily lives. Milk donation is also an opportunity to educate society about options following a perinatal loss.

A serious game for online-based objective structured clinical examination in nursing: A qualitative study.

BACKGROUND: The current pandemic has led to unprecedented scenarios worldwide. In this context, educational institutions had to move abruptly from in-person to online classes, having to be flexible and innovative, one of the main concerns being the semester-end examinations in practical modules. OBJECTIVE: This study aimed to explore nursing students' perceptions of the use of a serious game-like model in their final online objective structured clinical examination (OSCE). DESIGN: An exploratory phenomenological study was conducted during the COVID-19 pandemic, in particular during June 2020. SETTINGS: This study took place at the University of Almeria with nursing students enrolled in a clinical placement module. PARTICIPANTS: Eighty-nine fourth-year nursing students took part in this study. METHODS: Following the educational principles of the OSCE, a virtual OSCE was designed, using the Genially platform, an online platform for creating interactive content, to set up an assessment as a story-telling game-like model. A total of 5 focus groups (FGs) were conducted afterwards via the GoogleMeet platform. In addition, 30 semi-structured interviews were performed via the same platform. The data was analysed using a content analysis approach and supported by the ATLAS.ti 8.4 software. RESULTS: Our finding revealed 2 main themes and 4 sub-themes. The two main themes were (i) generating emotions and feelings in times of virtuality; including emotions and feelings experienced by students during their online assessment process, and (ii) online assessment: a potential alternative to educational barriers; describing the variability of traditional modality, its implications for learning and the acquisition of competences. CONCLUSIONS: Serious game-like models, such as the story-telling game proposed, as part of their online OSCE assessment appear to be an appropriate alternative assessment method for face-to-face approaches. This paper adds new evidence on the use of innovative and state-of-art resources as part of nursing OSCE assessments in a new reality for most students and teachers. Serious game-like models in online OSCE may empower students and help them to remove perceived barriers in face-to-face assessments.

Experiences of Home Care Nurses During the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has provoked several changes in home care. Understanding home care nurses' experiences during the COVID-19 pandemic plays an essential role in home care management. OBJECTIVE: This study aimed to explore and articulate the experience of home care nurses during the COVID-19 pandemic in Spain. DESIGN: A qualitative study using hermeneutic phenomenology was carried out. Twenty home care nurses were interviewed by teleconference between January and March 2021. Interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative data analysis software. RESULTS: Three main themes with five subthemes emerged from the data analysis: (a) "The effect of COVID-19 pandemic on home care," with the subtheme "the reorganization of home care nurses' competencies"; (b) "The role of telehealth in home care," which included the subthemes "home care nurses' satisfaction with telehealth" and "barriers to implement telehealth in home care"; and (c) "Effects of the pandemic on home care nurses' lives," including the subthemes "working in a pandemic is emotionally draining" and "the continuing fear of infecting others." DISCUSSION: The findings from this study demonstrate the profound effect that home care has experienced during the COVID-19 pandemic. Home care nurses' competencies were modified to care for and diagnose COVID-19 patients. Face-to-face home care was replaced by telehealth. All home care nurses experienced physical and psychological symptoms and the fear of infecting others.

Socio-family support for parents of technology-dependent extremely preterm infants after hospital discharge.

Parents of extremely preterm infants (<28 weeks of gestation) report high levels of stress and anxiety related to daily needs after hospital discharge. Social support has a significant role in reducing the negative psychological impact of preterm birth and parents' adaptation to caregiving. We conducted a hermeneutic phenomenological study using Gadamer's approach to explore and describe the experiences of parents of technology-dependent extremely preterm infants of socio-family support after hospital discharge. The study was conducted in four several Spanish organizations for families with preterm infants. It includes 17 semi-structured interviews (12 mothers and 5 fathers). Three main themes emerged from the analysis: post-discharge formal support for extremely preterm infants and families, home neonatal care: family support, and a thread of hope: parent-to-parent support. The parents' main support resources to deal with everyday difficulties are healthcare professionals, their partners, grandmothers, and peer parents of extremely preterm infants. The findings may be used to guide healthcare professionals in the creation of a support program according to preferences and needs of parents.