Lived Experiences of African Migrants Crossing the Strait of Gibraltar to Europe: A Cross-Cultural Approach to Healthcare from a Qualitative Methodology.

BACKGROUND: The migratory flow from the African continent to Europe is intense and the European countries should apply a humanitarian, health and social response to this emerging problem. Migrants coming from Africa to Europe are a very vulnerable population. Healthcare professionals should be prepared for answering their needs from a transcultural approach, which requires a better understanding of this phenomenon. Thus, the aim of this study was to improve nursing and healthcare professionals' awareness and better understanding of migrant life experiences during the migration journey. An exploratory descriptive qualitative research was conducted. In-depth interviews were conducted involving four key informants and content analysis were performed with the transcriptions. RESULTS: Three themes merged: life situations in their countries of origin; motivations that led them to undertake the migratory journey; and experiences they lived during the migratory journey. The results described the dramatic experience and motivations for crossing the strait of Gibraltar from Africa to Europe, including feelings, fears, hopes and lived experiences. The determination of immigrants to fight for a better life opportunity and the physical damage and psychological consequences they suffer were revealed. CONCLUSIONS: This study would help healthcare professionals to better understand this complex reality and deliver culturally adapted care. Knowledge of the starting reality of these populations can help health professionals to incorporate a cross-cultural approach that improves the relational, ethical and affective competences to provide quality care to the migrant population, as well as the development of health measures to fight against inequalities suffered by these population groups.

Systematic Review of the Relationship between Couple Dyadic Adjustment and Family Health.

The importance of family functioning in the development of child and adult psychopathology has been widely studied. However, the relationship between partners' adjustment and family health is less studied. This paper aims to describe and summarize research that analyzes the relationship between partners' adjustment and family health. A systematic review was conducted in the PubMed, PsycINFO, Scopus, Lilacs, Psicodoc, Cinahl, and Jstor databases. Inclusion criteria were as follows: articles published from 2012 to 2019 in English, Spanish, or Portuguese. Data were extracted and organized according to the family health model: family climate, integrity, functioning, and coping. Initially, 835 references were identified, and 24 articles were assessed for quality appraisal. Finally, 20 publications were selected. Results showed that couple adjustment was an important factor that triggered the emotional climate of the family, was positively intercorrelated to parenting alliance or coparenting, and contributed to family efficacy and help when facing stressful life events. Findings revealed a consensus about the relationship between couple dyadic adjustment and family health. The results could orientate interventions to promote well-being and to increase quality of life and family strength. Health professionals should thoroughly study couple relationships to identify risk factors, assess family skills, and promote family health.

The Relationship between Mindfulness and Emotional Intelligence as a Protective Factor for Healthcare Professionals: Systematic Review.

Emotional intelligence is an essential trait and skill for healthcare professionals. Mindfulness meditation has proved to be effective in increasing the wellbeing of those who practice it, leading to better mental health, self-care and job satisfaction. This paper aims to identify the recent evidence on the relationship between mindfulness and emotional intelligence among healthcare professionals and students. A systematic review was conducted including the databases PubMed, Cinhal, PsycINFO and Web of Science. The main variables were emotional intelligence skills and mindfulness practice. Data were extracted according to the following outcomes: authors, year of publication, country, study design, participants, mindfulness training intervention, tools used in data collection and main results. The following inclusion criteria were applied: peer-reviewed articles; published in English or Spanish; published between 2010 and 2020; quantitative methodology; a study population of healthcare professionals or students; the relationship with the aim of the study. The Joanna Briggs Institute criteria were followed for assessing the methodological quality of the selected studies. Three researchers were involved in the review. After the selection process, 10 studies were selected out of the 197 references initially identified. These studies revealed a positive relationship between mindfulness and emotional intelligence, particularly the capacity to regulate emotions. Furthermore, mindfulness is negatively related to emotional exhaustion. Training interventions based on mindfulness have proved to be useful in promoting emotional balance, emotional awareness, emotional acceptance, emotion recognition, expressive suppression and a reduction in emotional exhaustion. This study could serve as a basis for further research on the benefits of emotional intelligence and practicing mindfulness for the bio-psycho-social welfare of healthcare professionals.

Factores relacionados con el ajuste diádico conyugal en parejas con hijos en edad pediátrica / Factors related to dyadic adjustment in couples with children of pediatric age

Objetivo: Determinar si el apoyo social, el ciclo vital familiar, la transición familiar y los acontecimientos estresantes se relacionan con el ajuste diádico de parejas con hijos en edad pediátrica. Método: Estudio descriptivo, observacional y de corte transversal. Noventa y cinco parejas de la provincia de Sevilla fueron escogidas mediante muestreo consecutivo estratificado por cuotas, y cumplimentaron un cuestionario con las variables de estudio y las escalas Ajuste Diádico Conyugal y Apoyo Social Percibido. La recogida de datos se realizó en el último trimestre del 2015 con el visto bueno del Comité Ético de Investigación de la Universidad de Sevilla. Se aplicaron los test no paramétricos U de Mann-Whitney y Kruskal-Wallis. Para la relación entre variables se utilizó el test de correlación de Spearman y para demostrar correlaciones significativas se comprobó que p<0,05. Resultados: Las parejas mayoritariamente eran matrimonios con buen ajuste diádico y apoyo social. El 26,3% tenían hijos lactantes y el 73,7% en edad escolar. No existe influencia del ciclo vital y la transición familiar sobre el ajuste diádico. El comienzo-fin de la escolaridad influye en la cohesión conyugal y existen correlaciones positivas entre ajuste diádico y apoyo social, y negativas entre el número de hijos y el apoyo social, el consenso y la satisfacción de la pareja. Conclusiones: El apoyo social y el número de hijos se identifican como los principales factores condicionantes del ajuste diádico. En este sentido, es fundamental conocer los recursos de los que dispone cada pareja para hacer frente a las dificultades donde el apoyo social y la unión entre los cónyuges pueden ayudarles a enfrentar los desafíos.(AU)

Aim: To identify a relationship between social support, family life cycle, family transition and stressful events; and the dyadic adjustment among couples from Seville with children of pediatric age. Method: Descriptive, observational and cross-sectional study. Ninety-five Sevillian couples were recruited following a consecutive stratified sampling by quotas. They filled in a questionnaire with the study variables and the Dyadic Adjustment and Social Support scales. Data collection was carried out in 2015. The project was approved by the Research Ethics Committee of the University of Seville. Mann-Whitney U and Kruskall-Wallis non-parametric tests were used for statistical analysis, and Spearman test for correlation between variables. Significance was stated for P<.05. Results: The couples were mostly marriages with good dyadic adjustment and social support. A percentage of 26.3 had infant and 73.7% children of school age. No relationship between the life cycle nor the family transition and the dyadic adjustment were identified. The beginning-end of schooling was related to spousal cohesion and there were positive correlations between dyadic adjustment and social support; and negative correlations between the number of children and social support, consensus and satisfaction of the couple. Conclusions: Social support and the number of children are identified as the main conditioning factors of dyadic adjustment. In this sense, it is essential to know the resources available to each couple to face the difficulties where social support and the union between the spouses can help them face the challenges.(AU)

Factors related to dyadic adjustment in couples with children of pediatric age. / Factores relacionados con el ajuste diádico conyugal en parejas con hijos en edad pediátrica.

AIM: To identify a relationship between social support, family life cycle, family transition and stressful events; and the dyadic adjustment among couples from Seville with children of pediatric age. METHOD: Descriptive, observational and cross-sectional study. Ninety-five Sevillian couples were recruited following a consecutive stratified sampling by quotas. They filled in a questionnaire with the study variables and the Dyadic Adjustment and Social Support scales. Data collection was carried out in 2015. The project was approved by the Research Ethics Committee of the University of Seville. Mann-Whitney U and Kruskall-Wallis non-parametric tests were used for statistical analysis, and Spearman test for correlation between variables. Significance was stated for P<.05. RESULTS: The couples were mostly marriages with good dyadic adjustment and social support. A percentage of 26.3 had infant and 73.7% children of school age. No relationship between the life cycle nor the family transition and the dyadic adjustment were identified. The beginning-end of schooling was related to spousal cohesion and there were positive correlations between dyadic adjustment and social support; and negative correlations between the number of children and social support, consensus and satisfaction of the couple. CONCLUSIONS: Social support and the number of children are identified as the main conditioning factors of dyadic adjustment. In this sense, it is essential to know the resources available to each couple to face the difficulties where social support and the union between the spouses can help them face the challenges.

Revisión sistemática sobre el uso de la prescripción de enfermería en Europa / Nurse prescribing in Europe: a systematic review

OBJETIVO: Conocer las ventajas y desventajas de la prescripción enfermera en los países europeos, su costo/eficacia con relación a la prescripción médica, y la satisfacción de los usuarios y profesionales. MÉTODOS: Se utilizó una estrategia de revisión sistemática de la literatura, a través de una evaluación crítica de los artículos que abordan con métodos analíticos o experimentales la eficacia de la prescripción de enfermería en los distintos países europeos en los que existen experiencias de este tipo. RESULTADOS: Un total de nueve artículos fueron incluidos, de los cuales cinco se desarrollaron en el Reino Unido, tres en España y uno en Holanda. Cinco artículos usaron metodologías experimentales, un artículo aplicó diseño cuasiexperimental y tres trabajos presentaban diseños analíticos observacionales. Cinco artículos abordaban las ventajas y desventajas, cuatro los criterios usados para la prescripción, seis la satisfacción y cuatro el coste/efectividad. CONCLUSIONES: La prescripción de enfermería en países de Europa es útil para el usuario, así como para las enfermeras y para la gestión del sistema de salud, pues ofrece innumerables ventajas. Se puede afirmar que ayuda a aumentar el nivel de satisfacción de los usuarios y de los profesionales de enfermería. La prescripción de enfermería tiene menor costo/eficiencia que la prescripción médica, aunque son necesarios nuevos estudios de carácter experimental, particularmente en España

OBJECTIVE: To know the advantages and disadvantages of nurse prescribing in European countries, its cost/effectiveness in relation to medical prescription, and satisfaction of patients and professionals. METHODS: A systematic review of the literature was carried out, through a critical evaluation of articles researching with analytical or experimental methods the efficacy of nurse prescribing in the different European countries where this experience has been developed. RESULTS: A total of nine articles were included, five of them developed in United Kingdom, three in Spain and one in the Netherlands. Five articles carried out experimental methodologies, one article applied quasi-experimental design and three papers presented observational analytical designs. Five articles addressed the advantages and disadvantages, four, criteria used for the prescription; six, the satisfaction and four, the cost/effectiveness. CONCLUSIONS: Nurse prescribing in European countries is useful for patients, as well as for nurses and for the health system management, since it offers innumerable advantages. It can be affirmed that it helps to increase the level of satisfaction of patients and nursing professionals. Nurse prescribing has lower cost/effictiveness than medical prescribing, although new experimental studies are necessary, particularly in Spain

Razones para decidir morir en el hospital o en el domicilio. Visión de los/las profesionales / Reasons for deciding to die in hospital or at home. The vision of professionals

Objetivo: Conocer las razones que llevan a decidir que los pacientes terminales mueran en el hospital o en su domicilio, desde la perspectiva de los/las profesionales. Método: Estudio cualitativo fenomenológico. Muestreo intencionado. Se realizaron cuatro grupos focales multidisciplinarios: dos en hospitales y dos en centros de Atención Primaria de Salud (APS) de Sevilla. Participaron 29 profesionales con al menos 2 años de experiencia con pacientes terminales, siguiendo el criterio de saturación teórica. Resultados: Las respuestas obtenidas del guion inicial se agruparon en tres categorías centrales: paciente y familia, profesionales y proceso asistencial. No suele consultarse al paciente sobre sus preferencias respecto al lugar donde quiere morir, y si además la familia las desconoce, no se puede realizar una planificación anticipada de cuidados. La familia elige el hospital por inseguridad respecto a la posibilidad de seguimiento y recursos en APS. Los/las profesionales poseen formación para abordar la muerte, pero no se sienten preparados, focalizando la atención en aspectos clínicos o administrativos. El proceso asistencial favorece a los pacientes oncológicos, pues es más sencillo identificar su terminalidad. No hay equidad en los recursos y es mejorable la comunicación interniveles. No se facilita la integración de la familia en el proceso que interfiere en su toma de decisiones. Conclusiones: Se debe fomentar la planificación anticipada de cuidados y usar el documento de voluntades anticipadas, la comunicación y la coordinación interniveles, dotar de recursos, especialmente a APS, y formar y preparar a los/las profesionales para abordar la muerte. Hay que implicar a la familia en el proceso, aportándole el apoyo necesario

Objective: To discover the reasons for deciding to die in hospital or at home, from the perspective of professionals involved. Method: Qualitative phenomenological study. Intentional sample. Four multidisciplinary focus groups were held, two in hospitals and two in primary care centres in Seville (Spain). Twenty-nine professionals with at least two years experience in the care of people with a terminal disease participated, following the theoretical saturation of information criterion. Results: Responses from the first script were gathered in three core categories: patient and the family, professionals and care process. Patients are generally not asked about their preferences as to where they wish to die, and if their family is not aware of their preference, it is not possible to carry out advanced planning of care. Families tend to choose the hospital because of the possibility of monitoring and resources in primary care. Professionals are trained in how to approach death, but they do not feel sufficiently prepared and focus on the clinical and administrative issues. The care process favours oncology patients because it is easier to identify their illness as terminal. Resources are not equal and interlevel communication needs to be improved. The family's involvement in the process is not facilitated, which impedes their decision-making. Conclusions: Advance care planning and use of the advance directive should be promoted, as well as, interlevel communication and coordination, supply resources, especially in primary care, and professionals should receive training on how to approach death.. The patient's family should be involved in the care process and provided the necessary support

[Reasons for deciding to die in hospital or at home. The vision of professionals]. / Razones para decidir morir en el hospital o en el domicilio. Visión de los/las profesionales.

OBJECTIVE: To discover the reasons for deciding to die in hospital or at home, from the perspective of professionals involved. METHOD: Qualitative phenomenological study. Intentional sample. Four multidisciplinary focus groups were held, two in hospitals and two in primary care centres in Seville (Spain). Twenty-nine professionals with at least two years experience in the care of people with a terminal disease participated, following the theoretical saturation of information criterion. RESULTS: Responses from the first script were gathered in three core categories: patient and the family, professionals and care process. Patients are generally not asked about their preferences as to where they wish to die, and if their family is not aware of their preference, it is not possible to carry out advanced planning of care. Families tend to choose the hospital because of the possibility of monitoring and resources in primary care. Professionals are trained in how to approach death, but they do not feel sufficiently prepared and focus on the clinical and administrative issues. The care process favours oncology patients because it is easier to identify their illness as terminal. Resources are not equal and interlevel communication needs to be improved. The family's involvement in the process is not facilitated, which impedes their decision-making. CONCLUSIONS: Advance care planning and use of the advance directive should be promoted, as well as, interlevel communication and coordination, supply resources, especially in primary care, and professionals should receive training on how to approach death.. The patient's family should be involved in the care process and provided the necessary support.

Optimización de la atención sanitaria en una unidad de gestión clínica de atención primaria mediante una experiencia innovadora. Proyecto ganador del VI Premio Esteve. Área de Enfermería / Optimizing clinical management in a health care unit: an innovative experience

El aumento significativo de las indicaciones de la anticoagulación hace que el número de pacientes que precisan de seguimiento y control en AP crezca cada día, situación que requiere por parte de los gestores adecuar las agendas de los profesionales -médicos y enfermeras- a esta necesidad creciente. La prescripción colaborativa enfermera se está desarrollando en Andalucía. Esta actividad permitiría en nuestra Unidad de Gestión Clínica optimizar los tiempos dedicados al seguimiento de pacientes anticoagulados. La determinación y dosificación de los pacientes por parte de la enfermera supone menores tiempo de dedicación a esta actividad por parte del médico de familia y que oriente su actividad a otras tareas, como aumentar el número de citas disponibles o el tiempo que dedica actualmente a las mismas, atender las urgencias del centro, entre otras. Se realiza un estudio piloto diseñando un ensayo clínico (EC) para determinar la viabilidad del proyecto e implementar esta práctica. Se realiza el seguimiento de 146 pacientes asignados de manera aleatoria al grupo experimental y control y durante 4 meses y medio. Se midió el gasto en el consumo de tiras, coste en tiempo del servicio, valores de INR, tiempo en rango terapéutico y de dedicación a la consulta. Los resultados, con significación estadística contrastada, indican que, cuando la enfermera dosifica y sigue al paciente, los pacientes están más tiempo en rango terapéutico, el número de visitas es menor y el gasto en tiras se reduce (AU)

The increase of anticoagulation drug therapy indications translates into a rise of patients, which need primary healthcare monitoring and control. Managers have to adjust health professionals' timetables -of doctors and nurses to adapt them to the increasing demand. Collaborative nurse prescription is being tested in Andalusia. Implementing this development would allow our clinical management unit to optimize the amount of time dedicated to monitor patients taking anticoagulation drug therapy. When nurses monitor patients and determine anticoagulant drug therapy dosage, the amount of time that general practitioners dedicate to this group of patients is reduced, increasing their time for other duties such as: augmenting the amount of available medical appointments, providing better attention during the appointments, and increasing their availability to respond to emergencies within the unit, among others. We ran a pilot study designing a clinical trial to establish the viability of the project. We monitored 146 patients randomly assigned patients, both to the control and experimental group during four and a half months. We evaluated the expenditure of test strips, the cost of service time, INR values, the time of therapeutic range and consultations. Results showed a statistical significant difference: when nurses dose and monitor patients, patients have more time of therapeutic range, the number of visits declines, and the expenditure of test strips is reduced (AU)