Affective Impact on Informal Caregivers over 70 Years of Age: A Qualitative Study.

Given today's rapidly ageing society, family members providing informal care to dependent older adults face ever-increasing challenges. The aim of this study was to describe the affective impact on older adults over 70 years of age caring for a dependent older person at home. A qualitative study was designed from a phenomenological perspective. Thirteen in-depth interviews were conducted with caregivers aged 70 or older. A content analysis of the interviews was carried out in five stages. Three themes were identified: "Emotions", "Feelings", and "Looking to the future". Caregivers express negative emotions (sadness, anger, and fear) and feelings of social and emotional isolation, and they feel abandoned by health professionals, family, and friends. In conclusion, prolonged caregiving by older adults has a negative affective impact and creates uncertainty about the future. There is a need to devise social and healthcare policies and actions, creating social support networks to improve their health and emotional wellbeing.

[The perspective of caregivers from a gender analysis.] / La perspectiva de las personas cuidadoras desde un análisis de género.

OBJECTIVE: Gender influences the provision of family caregiving, identifying inequalities in the distribution of care-related tasks. The aim of this study was to analyze the gender influence in family caregiving, provided by elderly while, identifying the sociodemographic characteristics of caregivers. METHODS: Mixed, descriptive and phenomenological study was made. Eight women and five men aged seventy and over participated who cared for dependent people at home, selected by intentional sampling in Valencia. The analysis of the in-depth interviews was carried out in three stages: reading to the participants of the transcripts for their verification; discrimination of units of meaning; eidetic and phenomenological reduction to obtain the statements of meaning. Frequencies and percentages were calculated. RESULTS: The mean age, educational level and years dedicated to care were higher in caregivers. Caregivers had a greater burden related to caregiving. Three categories influenced by androcentric culture were idenfied: vital perspective; reasons that support care; coping strategies. 90% of female caregivers cared out of moral obligation, compassion, reciprocity, and love; and 80% of male caregivers by responsibility and reciprocity, obtaining a satisfactory achievement and learning. Both developed resilience skills, reaching higher levels of adaptation. Male caregivers used more protective coping mechanisms and 50% of female caregivers obtained the most comforting support from religion. CONCLUSIONS: Gender determines the meaning given to the experience of caring. The reasons and coping strategies in men and women are different.

OBJETIVO: El género influye en la prestación de cuidados familiares, identificándose desigualdades en la distribución de tareas relacionadas con el cuidado. El objetivo de este estudio fue analizar la influencia del género en los cuidados familiares, identificando las características sociodemográficas de los/as cuidadores/as. METODOS: Se realizó un estudio mixto, descriptivo y fenomenológico. Participaron ocho mujeres y cinco hombres de setenta y más años que cuidaban en el domicilio a personas dependientes, seleccionadas por muestreo intencional en Valencia. El análisis de las entrevistas en profundidad se realizó en tres etapas: lectura a los/las participantes de las transcripciones para su comprobación; discriminación de unidades de significado; reducción eidética y fenomenológica para obtener las declaraciones de significado. Se calcularon frecuencias y porcentajes. RESULTADOS: La edad media, el nivel de estudios y los años dedicados al cuidado fue mayor en los cuidadores. Las cuidadoras tenían una mayor carga relacionada con los cuidados. Se idenficaron tres categorías influenciadas por la cultura androcéntrica: perspectiva vital; motivos que sustentan el cuidado; estrategias de afrontamiento. Un 90 % de las cuidadoras lo hacían por obligación moral, compasión, reciprocidad y amor; y un 80 % de los cuidadores por responsabilidad y reciprocidad, obteniendo un logro y un aprendizaje satisfactorio. Ambos desarrollaron habilidades de resiliencia, alcanzando mayores niveles de adaptación. Los cuidadores utilizaron más mecanismos protectores de afrontamiento y un 50% de las cuidadoras obtuvieron en la religión el apoyo que más les reconfortaba. CONCLUSIONES: El género determina el significado que se otorga a la experiencia de cuidar. Los motivos y las estrategias de afrontamiento en hombres y mujeres son distintos.

La perspectiva de las personas cuidadoras desde un análisis de género / The perspective of caregivers from a gender analysis

Fundamentos: El género influye en la prestación de cuidados familiares, identificándose desigualdades en la distribución de tareas relacionadas con el cuidado. El objetivo de este estudio fue analizar la influencia del género en los cuidados familiares, identificando las características sociodemográficas de los/as cuidadores/as.Métodos: Se realizó un estudio mixto, descriptivo y fenomenológico. Participaron ocho mujeres y cinco hombres de setenta y más años que cuidaban en el domicilio a personas dependientes, seleccionadas por muestreo intencional en Valencia. El análisis de las entrevistas en profundidad se realizó en tres etapas: lectura a los/las participantes de las transcripciones para su comprobación; discriminación de unidades de significado; reducción eidética y fenomenológica para obtener las declaraciones de significado. Se calcularon frecuencias y porcentajes. Resultados: La edad media, el nivel de estudios y los años dedicados al cuidado fue mayor en los cuidadores. Las cuidadoras tenían una mayor carga relacionada con los cuidados. Se idenficaron tres categorías influenciadas por la cultura androcéntrica: perspectiva vital; motivos que sustentan el cuidado; estrategias de afrontamiento. Un 90 % de las cuidadoras lo hacían por obligación moral, compasión, reciprocidad y amor; y un 80 % de los cuidadores por responsabilidad y reciprocidad, obteniendo un logro y un aprendizaje satisfactorio. Ambos desarrollaron habilidades de resiliencia, alcanzando mayores niveles de adaptación. Los cuidadores utilizaron más mecanismos protectores de afrontamiento y un 50% de las cuidadoras obtuvieron en la religión el apoyo que más les reconfortaba. Conclusiones: El género determina el significado que se otorga a la experiencia de cuidar. Los motivos y las estrategias de afrontamiento en hombres y mujeres son distintos.(AU)

Background: Gender influences the provision of family caregiving, identifying inequalities in the distribution of care-related tasks. The aim of this study was to analyze the gender influence in family caregiving, provided by elderly while, identifying the sociodemographic characteristics of caregivers.Methods: Mixed, descriptive and phenomenological study was made. Eight women and five men aged seventy and over participated who cared for dependent people at home, selected by intentional sampling in Valencia. The analysis of the in-depth interviews was carried out in three stages: reading to the participants of the transcripts for their verification; discrimination of units of meaning; eidetic and phenomenological reduction to obtain the statements of meaning. Frequencies and percentages were calculated.Results: The mean age, educational level and years dedicated to care were higher in caregivers. Caregivers had a greater burden related to caregiving. Three categories influenced by androcentric culture were idenfied: vital perspective; reasons that support care; coping strategies. 90% of female caregivers cared out of moral obligation, compassion, reciprocity, and love; and 80% of male caregivers by responsibility and reciprocity, obtaining a satisfactory achievement and learning. Both developed resilience skills, reaching higher levels of adaptation. Male caregivers used more protective coping mechanisms and 50% of female caregivers obtained the most comforting support from religion. Conclusions: Gender determines the meaning given to the experience of caring. The reasons and coping strategies in men and women are different.(AU)

Percepciones de las enfermeras sobre la seguridad de medicamentos en los sistemas de salud / Percepções de enfermeiros sobre segurança de medicamentos nos sistemas de saúde / Nurses' perceptions of drug safety in health systems

Objective: To know the nurses' perception of the factors that influence the safe administration ofmedications in the work context of the General University Hospital of Elda (Alicante), Spain. Method:This is a qualitative phenomenological study through interviewssemi-structured in which 15 nurses chosen by deliberate sampling participated. Results: The participantsexpressed concern about the performance of the medication administration procedures, which made itpossible to perceive safety as the greatest concern in the study unit. A main category called “knowing”was established, which encompasses all the reflections about the nurse's performance during themedication administration process. The following subcategories are developed from this main category:work overload, insufficient training, distractions, and communication and information failures.Conclusion: Knowing the nurses' perception of the factors that influence the safe administration ofmedications could facilitate the use of instruments to standardize and reduce variability in the safeadministration of medications. As well as improving conditions in work environments and not favoringsocial, personal and professional stigmatization due to care error. (AU)

Objetivo: Conocer la percepción de las enfermeras sobre los factores que influyen en laadministración segura de medicamentos en el contexto laboral del Hospital General Universitario de Elda(Alicante), España. Método: Se trata de un estudio cualitativo fenomenológico mediante entrevistas semiestructuradas en donde participaron 15 enfermeras elegidas por muestreo intencionado. Resultados: Lasparticipantes manifestaron preocupación ante la realización de los procedimientos de administración demedicamentos, lo que permitió percibir la seguridad como la mayor preocupación en la unidad deestudio. Se estableció una principal categoría denominada “conocer” que engloba todas las reflexionesacerca de la actuación de la enfermera durante el proceso administración de medicamentos. A partir deesta categoría principal se desarrollan las siguientes subcategorías: sobrecarga de trabajo, formacióninsuficiente, distracciones y fallos de comunicación e información. Conclusión: Conocer la percepción delas enfermeras sobre los factores que influyen en la administración segura de medicamentos nos podríafacilitar el uso de instrumentos para estandarizar y disminuir la variabilidad en la administración segurade medicamentos. Así como mejorar las condiciones en los entornos laborales y no favorecer laestigmatización social, personal y profesional por el error asistencial. (AU)

Objetivo: Conhecer a percepção dos enfermeiros sobre os fatores que influenciam aadministração segura de medicamentos no contexto de trabalho do Hospital Geral Universitário de Elda(Alicante), Espanha. Método: trata-se de um estudo qualitativo fenomenológico por meio de entrevistas.semiestruturado no qual participaram 15 enfermeiras escolhidas por amostragem deliberada. Resultados:Os participantes expressaram preocupação com a realização dos procedimentos de administração demedicamentos, o que possibilitou perceber a segurança como a maior preocupação na unidade de estudo.Foi estabelecida uma categoria principal denominada “saber”, que engloba todas as reflexões sobre aatuação do enfermeiro durante o processo de administração de medicamentos. As seguintes subcategoriassão desenvolvidas a partir desta categoria principal: sobrecarga de trabalho, treinamento insuficiente,distrações e falhas de comunicação e informação. Conclusão: Conhecer a percepção dos enfermeirossobre os fatores que influenciam na administração segura de medicamentos pode facilitar a utilização deinstrumentos para padronizar e reduzir a variabilidade na administração segura de medicamentos. Alémde melhorar as condições nos ambientes de trabalho e não favorecer a estigmatização social, pessoal eprofissional por erro assistencial. (AU)

European Educational Programmes in Health Emergency and Disaster Management: An Integrative Review.

There is a need for trained health professionals who can swiftly respond to disasters occurring worldwide. Little is known about whether the currently available programmes in disaster management are in line with the recommendations of expert researchers. Our objective was to qualitatively review the characteristics of European educational programmes in health emergency and disaster management and to provide guidance to help improve their curricula. We carried out an integrative review to extract the main characteristics of the 2020/21 programmes available. We identified 34 programmes, the majority located in Spain, the UK or France. The primary qualification types awarded were master's degrees, half of them lasting one year, and the most common teaching method was in person. Almost all of the programmes used a virtual university classroom, a third offered multidisciplinary disaster management content and teachers, and half of them employed situational simulations. The quality of European educational programmes in health emergency and disaster management has improved, especially in terms of using more practical and interactive teaching methodologies and in the inclusion of relevant topics such as communication, psychological approaches and evaluation of the interventions. However, generally, the educational programmes in disaster management have not yet incorporated the skills related to the intercultural and interprofessional awareness aspects.

[Degree of compliance with hand hygiene recommendations by health care personnel in an emergency department before and after the COVID-19 pandemic.] / Grado de cumplimiento de las recomendaciones de higiene de manos del personal sanitario de un servicio de urgencias antes y después de la pandemia de COVID-19.

OBJECTIVE: Hand Hygiene (HH) is the most important measure to prevent healthcare-associated infections. The aim of this study was to determine the impact of the COVID-19 pandemic on the degree of compliance (DC) of HH in an Emergency Department (ED). METHODS: Cross-sectional study. DC of HH in the ED was calculated from 2005 to 2021. We studied the association between DC of HH and different variables (age, sex, status, ED area, time of WHO, etc.) by calculating the Odds Ratio (OR) and its 95% confidence interval (95%CI). To study the impact of the pandemic, we compared the C of HH before and after the onset of the COVID-19 pandemic, calculated the OR and its 95%CI. RESULTS: DC of HH increased to 75.9% (95%CI: 68.6%-83.2%) in the period after pandemic onset from the previous baseline period of 48.9% (95%CI: 43.4%-54.5%) (p<0.001). Factors significantly and independently associated with DC of HH were time period (before or after pandemic), attending training sessions, having alcohol solution in pocket format and WHO moments 3,4 and 5. CONCLUSIONS: DC of HH in the ED has reached the highest value in 17 years of monitoring following the COVID-19 pandemic. This increase reflects a very positive change in the behavior of healthcare personnel with respect to HH.

OBJETIVO: La Higiene de Manos (HM) es la medida más importante para prevenir las infecciones asociadas a la asistencia sanitaria. El objetivo de este trabajo fue conocer el impacto de la pandemia de COVID-19 en el grado de cumplimiento (GC) de la HM en un Servicio de Urgencias (SU). METODOS: Estudio transversal. Se calculó el GC de la HM en el SU desde 2005 hasta 2021. Se estudió la asociación entre el GC de la HM y distintas variables (edad, sexo, estamento, área de urgencias, momento de la OMS, etc) calculando la Odds Ratio (OR) y su intervalo de confianza al 95% (IC95%). Para estudiar el impacto de la pandemia, se comparó el GC de la HM antes y después del inicio de la pandemia de COVID-19, se calculó la OR y su IC95%. RESULTADOS: El GC de la HM aumentó al 75,9% (IC95%: 68,6%-83,2%) en el periodo posterior al inicio de la pandemia con respecto al periodo de referencia anterior que fue del 48,9% (IC95%: 43,4%-54,5%) (p<0,001). Los factores asociados de forma significativa e independiente al GC de la HM fueron el periodo de tiempo (antes o después de la pandemia), asistir a sesiones formativas, disponer de solución alcohólica en formato bolsillo y los momentos 3,4 y 5 de la OMS. CONCLUSIONES: El GC de la HM en el SU ha alcanzado el máximo valor en 17 años de monitorización tras la pandemia de COVID-19. Este incremento refleja un cambio muy positivo en el comportamiento del personal sanitario con respecto a la HM.

Nurses' Perceptions on the Implementation of a Safe Drug Administration Protocol and Its Effect on Error Notification.

Patient safety and quality of care are fundamental pillars in the health policies of various governments and international organizations. The purpose of this study is to evaluate nurses' perceptions on the degree of implementation of a protocol for the standardization of care and to measure its influence on notification of adverse events related to the administration of medications. This comparative study used data obtained from questionnaires completed by 180 nurses from medical and surgical units. Our analyses included analysis of variance and regression models. We observe that the responses changed unevenly over time in each group, finding significant differences in all comparisons. The mean response rating was increased at 6 months in the intervention group, and this level was maintained at 12 months. With the new protocol, a total of 246 adverse events and 481 incidents without harm was reported. Thus, actions such as the use of protocols and event notification systems should be implemented to improve quality of care and patient safety.

The impact of volunteering in mental health settings on nursing students' attitudes.

Nursing faculties are working to improve students' attitudes towards mental illness and people with severe mental illness, given the repercussions a lack of knowledge and negative attitudes may have on the quality of care. Complementing undergraduate programmes with volunteering activities affords students the opportunity to interact with people with a severe mental illness, and allow them to develop positive attitudes and overcome prejudice. Aim: to explore and deepen in nursing students attitudes prior to and following volunteering on an Acute Mental Health Inpatient Unit. By means of mixed methods approach, students were assessed at two time points by questionnaires including "Community Attitudes to Mental Illness" and "Semantic Differential", and by testimonies gathered from interviews. Positives changes in attitudes were identified and monitored over time capturing a destigmatizing tendency. The participation in educational strategies such as volunteering in Acute Mental Health Inpatient Unit, complementary to undergraduate programmes and clinical placements in mental health, allows nursing students to develop more diversified and positive attitudes towards mental illness and people with severe mental illness. The impact of an interventional education strategy is not as powerful in nursing students as it might be in students of other non-healthcare oriented university degrees due to their baseline attitudes.

Validation of a questionnaire designed to measure nursing student satisfaction with practical training.

OBJECTIVE: to validate an instrument designed to assess practical training and measure nursing student satisfaction with clinical practice modules. METHOD: cross-sectional study (academic year 2014-2015). Validation of the self-administered, anonymous, 17-item Nursing Student Satisfaction with Practical Training Questionnaire, developed by consensus by eight practical training experts in three nominal group sessions. Exploratory and confirmatory factor analyses were performed to assess internal consistency and validity. Student satisfaction was measured in relation to each module and all modules as a whole. RESULTS: 174 responses. High item-test correlation (≥0.90); Cronbach's alpha = 0.91; Káiser-Meyer-Olkin index =0.86; the results of the Bartlett sphericity test were statistically significant (p<0.001); S-stress=0.17; R2=0.81. Exploratory factor analyses identified 4 factors: simulation, teacher tutoring, care facility selected for the placement, and clinician tutoring. Total explained variance was 66.6%. Confirmatory factor analysis obtained a chi-squared value of 285.275 (p= 0.000). Student satisfaction increases proportionately with each academic year. CONCLUSION: the questionnaire was shown to have good validity and is therefore a reliable instrument for measuring level of nursing student satisfaction with practical training in both clinical and simulated environments.

Humanização dos cuidados de saúde no serviço de urgência: análise qualitativa baseada nas experiências dos enfermeiros / Humanization of healthcare at the emergency department: a qualitative analysis based on nurses' experiences / Humanización de la asistencia en urgencias: un análisis cualitativo basado en las experiencias de las enfermeras

Enquadramento: As condições de trabalho dos profissionais dos serviços de urgência e a tecnicização dos cuidados de saúde tiveram um impacto negativo na relação profissional de saúde-doente, desumanizando-a. Objetivo: Este estudo qualitativo explorou as perspetivas das enfermeiras em relação à humanização dos cuidados de saúde nos serviços de urgência em Espanha. Metodologia: Foi realizado um estudo qualitativo com recurso a entrevistas semiestruturadas a 11 enfermeiros a trabalhar em serviços de urgência. Os dados foram analisados com recurso à técnica de análise de conteúdo. Resultados: Foram identificados dois temas principais: as dimensões dos cuidados de saúde humanizados e implementação de cuidados de saúde humanizados nos serviços de urgência, bem como cinco subtemas. Conclusão: São apresentadas recomendações para reforçar as iniciativas para implementação de modelos integrados de assistência em saúde. A implementação do cuidado holístico, centrado no doente e na sua família é essencial para garantir a humanização dos cuidados de saúde nos serviços de urgência.

Background: The working conditions of emergency department professionals and the technification of healthcare have had a negative impact on the healthcare professional-patient relationship, dehumanizing it. Objective: This qualitative study explored nurses' perspectives about the humanization of healthcare in Spanish emergency departments. Methodology: A qualitative design, centred on the opinions of 11 nurses working in the emergency department was applied via semi-structured interviews. data were analysed using the content analysis technique. Results: Two main themes were identified: The dimensions of humanized healthcare and implementing humanized healthcare at emergency departments, as well as five subthemes. Conclusion: Recommendations are put forward to strengthen initiatives for implementing integrated models of healthcare assistance. The implementation of holistic, patient and family-oriented healthcare is essential to guaranteeing humanized healthcare at the emergency department.

Marco contextual: Las condiciones laborales de los profesionales de los servicios de urgencias y la tecnificación de la atención sanitaria han tenido un impacto negativo en la relación médico-paciente, y la han deshumanizado. Objetivo: Este estudio cualitativo exploró el punto de vista de las enfermeras sobre la humanización de la atención sanitaria en los servicios de urgencias españoles. Metodología: Se aplicó un diseño cualitativo, centrado en las opiniones de 11 enfermeros que trabajan en el servicio de urgencias, mediante entrevistas semiestructuradas. Los datos se analizaron mediante la técnica del análisis de contenido. Resultados: Se identificaron dos temas principales: Las dimensiones de la atención humanizada y la implementación de la atención humanizada en el servicio de urgencias, así como cinco subtemas. Conclusión: Se presentan recomendaciones para fortalecer las iniciativas de implementación de modelos integrados de atención de la salud. La aplicación de una atención holística, centrada en el paciente y en su familia, es esencial para garantizar la humanización de la atención sanitaria en los servicios de urgencias.

Experiencing the care of a family member with Crohn's disease: a qualitative study.

OBJECTIVES: To explore the experiences of caregivers living with relatives affected by Crohn's disease (CD) in a context in which the family provides social support. DESIGN: A qualitative study based on a phenomenological approach was conducted through in-depth interviews. SETTING: Participants living in Alicante (Spain) were recruited PARTICIPANTS: Eleven family caregivers of people with CD were interviewed. METHODS: The in-depth interviews took place in the participants' homes and were audio recorded and then transcribed for a qualitative thematic analysis. RESULTS: Five themes and accompanying subthemes were identified: (1) adaptation to the caring experience, (2) dichotomy 'with or without me', (3) unending burden, (4) need for knowledge and control of the disease, and (5) getting used to CD and normalising life. CONCLUSION: The findings contribute to an increase in the knowledge and comprehension of the experience of being the caregiver of a relative with CD, which could be useful for professionals towards improving the quality of the CD caring process. Due to the temporal dimension of CD with frequent bouts of exacerbation and remission, family caregivers must adapt and acquire skills during chronic illness evolution. Moreover, the lack of family caregivers' inclusion and follow-up within the Spanish health system makes them feel invisible and useless, which may contribute to caregivers' burdens.

Handover of Patients From Prehospital Emergency Services to Emergency Departments: A Qualitative Analysis Based on Experiences of Nurses.

BACKGROUND: During the transfer of patients, both ambulance and hospital emergency service professionals need to exchange necessary, precise, and complete information for an effective handover. Some factors threaten a quality handover such as excessive caseload, patients with multiple comorbidities, limited past medical history, and frequent interruptions. PURPOSE: To explore the viewpoint of nurses on their experience of patient handovers, describing the essential aspects of the process and areas for improvement, and establishing standardized elements for an effective handover. METHODS: A qualitative research method was used. RESULTS: Nurses identified the need to standardize the patient transfer process by a written record to support the verbal handover and to transmit patient information adequately, in a timely manner, and in a space free of interruptions, in order to increase patient safety. CONCLUSIONS: An organized method does not exist. The quality of handovers could be enhanced by improvements in communication and standardizing the process.

Tutorización clínica en enfermería / Nursing clinical tutoring

En la docencia y el aprendizaje clínico, la tutorización universitaria se comparte con la que las enfermeras y los enfermeros de los distintos puestos de prácticas llevan a cabo en instituciones sociosanitarias (centros de atención familiar y comunitaria, hospitales, instituciones geriátricas, centros de atención a la diversidad funcional y a la salud mental, colegios, comunidades de vecinos, etc.). Sus funciones son coordinadas e interdependientes y ambas deben confluir en el aprendizaje en competencias del alumnado. Sin embargo, la tutoría clínica se diferencia de aquella que el alumnado realiza con el profesorado a nivel teórico en la universidad, ya sea de forma online o presencial, individual o grupal. Esta diferencia se basa fundamentalmente en que la tutorización clínica siempre se realiza de forma presencial en cada uno de los centros de prácticas y a través de la instrucción y el modelaje. El tutor clínico está satisfecho con la función docente que realiza y reclama mayor formación, acreditación y participación en la planificación de objetivos de aprendizaje conjuntamente con el profesorado de la universidad

When it comes to teaching and clinical learning, university tutoring is shared with nurses from different disciplines in public health institutions (Family and Community Care Centers, Hospitals, Geriatric Institutions, Mental Health Centers, schools, neighboring communities, etc...). Their activities are coordinated and interdependent; both must coalesce in students' competency-based learning process. However, clinical tutoring differs substantially from the university tutoring that students receive at a theoretical level, either online or face to face, individually or in groups. The difference is fundamentally based on the fact that clinical tutoring is always carried out in person at each of the practice centers and is based on instruction and modeling. The clinical tutor, satisfied with the teaching function he performs, logically demands greater training, accreditation and participation in the planning of learning objectives jointly with the university faculty

Efectividad de medidas no farmacológicas para la disminución del dolor y el miedo en niños durante la venopunción en urgencias: dispositivos de vibración más frío frente a distracción / Effectiveness of non-pharmacological measures for reducing pain and fear in children during venipuncture in the emergency department: a vibrating cold devices versus distraction

Objetivos: Evaluar la efectividad de medios no farmacológicos en el manejo del dolor y el miedo en los niños, y la ansiedad del acompañante, durante la realización de venopunción en urgencias. Método: Estudio cuasiexperimental con tres grupos: en uno se combinó distracción dirigida y dispositivo de vibración más frío, en otro solo se usó distracción dirigida y en otro no se usó distracción ni dispositivo alguno. Resultados: El dolor y la ansiedad del acompañante fueron similares entre los grupos en que se usó alguna medida de control del dolor, y mayor en el que no se usó ninguna. No se encontraron cambios en el miedo. Conclusiones: La distracción dirigida puede ser útil para el manejo del dolor en el paciente pediátrico, y disminuye la ansiedad de los acompañantes. Los dispositivos de vibración más frío no aportan beneficio adicional. El miedo no mejora con el uso de ninguna de estas medidas

Objective: To assess the effectiveness of a physical method of managing pain and fear in children and anxiety in the accompanying adult during venous puncture in the emergency department. Methods: Quasi-experimental study of 3 groups: one group used a combination of directed distraction by means of a vibration device with ice pack, a second group received only distraction, and no strategy was used in the third. Results: Pain and adult anxiety were similar in the 2 groups in which a pain management strategy was applied. Pain and adult anxiety were greater when no strategy was adopted. We detected no differences in the level of the children’s fear. Conclusions: Directed distraction can be useful for managing pain in children and it reduces the anxiety experienced by accompanying adults. The use of a vibration device with ice does not add benefits. Fear is not reduced by any of these measures

Effectiveness of non-pharmacological measures for reducing pain and fear in children during venipuncture in the emergency department: a vibrating cold devices versus distraction. / Efectividad de medidas no farmacológicas para la disminución del dolor y el miedo en niños durante la venopunción en urgencias: dispositivos de vibración más frío frente a distracción.

OBJECTIVES: To assess the effectiveness of a physical method of managing pain and fear in children and anxiety in the accompanying adult during venous puncture in the emergency department. MATERIAL AND METHODS: Quasi-experimental study of 3 groups: one group used a combination of directed distraction by means of a vibration device with ice pack, a second group received only distraction, and no strategy was used in the third. RESULTS: Pain and adult anxiety were similar in the 2 groups in which a pain management strategy was applied. Pain and adult anxiety were greater when no strategy was adopted. We detected no differences in the level of the children's fear. CONCLUSION: Directed distraction can be useful for managing pain in children and it reduces the anxiety experienced by accompanying adults. The use of a vibration device with ice does not add benefits. Fear is not reduced by any of these measures.

OBJETIVO: Evaluar la efectividad de medios no farmacológicos en el manejo del dolor y el miedo en los niños, y la ansiedad del acompañante, durante la realización de venopunción en urgencias. METODO: Estudio cuasiexperimental con tres grupos: en uno se combinó distracción dirigida y dispositivo de vibración más frío, en otro solo se usó distracción dirigida y en otro no se usó distracción ni dispositivo alguno. RESULTADOS: El dolor y la ansiedad del acompañante fueron similares entre los grupos en que se usó alguna medida de control del dolor, y mayor en el que no se usó ninguna. No se encontraron cambios en el miedo. CONCLUSIONES: La distracción dirigida puede ser útil para el manejo del dolor en el paciente pediátrico, y disminuye la ansiedad de los acompañantes. Los dispositivos de vibración más frío no aportan beneficio adicional. El miedo no mejora con el uso de ninguna de estas medidas.

Healthcare professionals' views of the experiences of individuals living with Crohn's Disease in Spain. A qualitative study.

Crohn's Disease (CD) in Spain lacks of a unified National Clinical Pathway and not even any early detection program and professional follow-up outpatient attention once it has been diagnosed. Little is known about the Spanish health professionals' views of the experiences of individuals living with Crohn's Disease nationwide and also about how the Spanish Health System faces this situation. A qualitative research method was conducted to explore this topic through in-depth interviews with eleven healthcare professionals, who represented different clinics treating people with CD from the province of Alicante (Spain). Three topics and seven sub-topics were derived from the analysis of the content emerging from the interviews. The three main topics were: the healthcare system as a hindrance for ongoing treatment of CD, the impact of the disease, support networks. The knowledge of CD gained by healthcare professionals, in the contexts studied here within, with regards to the psychosocial aspects and the experience of those living with the disease and their immediate circles, is poor, if not null on an academic level, becoming experiential on their incorporation into the professional field. Additionally, a priori, they lack the tools to address the doubts and concerns of patients from the moment of diagnosis through the ongoing care of the patient. Organizational hindrances, such as the lack of time and consensual guidelines for adequately monitoring CD patients in Alicante (Spain), further restrict the patient-professional relationship. Due to the consensus established by the National Agency regulating the contents of the Health Professions' Education and Training across the country, we are assuming that the phenomenon highlighted may be similar in other parts of Spain. Therefore, it can be said that healthcare professionals have a limited understanding of the impact of CD on the day-to-day life of those affected, not being considered a part of the CD patients' formal support network. Nonetheless, they are conscious of this limitation and advocate for multidisciplinary teams as the best means of attending to people living with CD. Our study outcomes may represent the first step onto identifying strategies and best practices for establishing an effective therapeutic relationship, as well as any hindering factors.

Understanding life experiences of people affected by Crohn's disease in Spain. A phenomenological approach.

BACKGROUND AND OBJECTIVES: People affected by Crohn's disease must adapt their lives to their new chronic condition, and therefore, understanding such experience can be helpful in planning effective interventions for the affected ones. The aim of this study was to gain an insight into such experience and how they adapted in different areas of their lives, particularly in a family-centred culture such as the Spanish one. METHOD: A descriptive phenomenological study was conducted through in-depth interviews to 19 people diagnosed of Crohn's disease in the province of Alicante (Spain). Once the interviews were transcribed, data were analysed using Colaizzi's seven-step method. RESULTS: Five emergent themes were identified: self-protection against the unknown cause; self-training; learning to live with Crohn's disease; perceived losses associated to Crohn's disease; and relationship with others. The results portrayed a chronically ill patient who is unconscious about the chronicity and consequently must develop strategies to keep living a similar life like the one lived before. CONCLUSIONS: This study revealed that people affected by Crohn's disease struggle with the fact of being a chronic patient with uncertainty about the illness and need to learn living with a chronic condition that limits their daily lives. Furthermore, the lack of Crohn's disease a professional in charge of these people's Cares such as the specific nursing role existing in other countries support in the Spanish Health System determines the loneliness those diagnosed experience to cope with the new situation.

[Efficacy and safety of endotracheal intubation performed in moving vs motionless environments]. / Estudio comparativo de la eficacia y seguridad de la intubación endotraqueal en movimiento y en estático.

OBJECTIVES: To compare the efficacy and safety of endotracheal intubation (ETI) in a simulated clinical environment in motion vs a motionless one. MATERIAL AND METHODS: Clinical simulation trial of ETI with 3 endotracheal tubes (Airtraq, Fast-trach, Macintosh laryngoscope) in mannequins with realistic physiological responses (MetiMan) in 2 scenarios: an environment in motion vs a motionless one. Thirty-six physicians expert in prehospital ETI participated. Outcome variables were successful intubation, effective intubation, number of attempts, maximum apnea time, and total maneuver time. The safety variables were the presence of bradycardia, tachycardia, or high or low systolic blood pressures (ie, 20% variation from baseline); hypoxemia (decrease in oxygen saturation to <90% or 10% below baseline), tube placement in the esophagus or main bronchus, and dental trauma. RESULTS: No statistically significant differences between the 2 scenarios were found in the numbers of successful ETI (motionless, 71 [65.7%]; in motion, 67 [62.0%]; P=.277) or effective ETI (motionless, 104 [96.3%]; in motion, 105 [97.2%]; P=.108). Likewise, the number of attempts were similar (motionless, 91 [84.2%]; in motion, 90 [83.3%]; P=.305). Nor did we see differences in the mean (SD) maximum apnea times (motionless, 14.0 [5.6] seconds; in motion, 14.9 [8.1] seconds; P=.570) or mean total maneuver times (motionless, 236.7 [73.4] seconds; in motion, 210.3 [77.9] seconds; P=.164). The prevalences of bradycardia, tachycardia, high or low systolic blood pressure, hypoxemia, placements in the esophagus or bronchus, and dental trauma also did not differ significantly between the 2 scenarios. CONCLUSION: Neither efficacy nor safety variables differed significantly when ETI was performed in mannequins in a motionless environment vs one simulating ambulances in motion.

OBJETIVO: Evaluar la eficacia y seguridad de la intubación endotraqueal (IET) en movimiento en comparación con la realización en estático. METODO: Ensayo de simulación clínica con maniquíes con respuesta fisiológica MetiMan® que comparó la IET en dos escenarios, intubar en estático (IE) y en movimiento (IM), utilizando 3 dispositivos de IET (Airtraq®, Fast-trach® y Laringoscopio Macintosh®). Treinta y seis médicos expertos en intubación prehospitalaria fueron los intervinientes. Las variables de resultado fueron la intubación efectiva y exitosa, el número de intentos, el tiempo máximo de apnea (TMA) y el tiempo total de la técnica (TTT). Las variables de seguridad fueron la presencia de bradi- y taquicardia, hiper- e hipotensión, hipoxemia, tubo endotraqueal (TET) alojado en esófago o en bronquio y el traumatismo dental. RESULTADOS: No hubo diferencias estadísticamente significativas en el porcentaje de IET exitosa [IE: 71 (65,7%) vs IM: 67 (62,0%); p = 0,277] ni de efectividad (IE: 104 (96,3%) vs IM: 105 (97,2%); p = 0,108), en el número de intentos [IE: 91 (84,2%) vs IM: 90 (83,3%); p = 0,305], en la media de TMA [IE: 14,0 (DE 5,6) segundos vs IM: 14,9 (DE 8,1) segundos; p = 0,570], TTT [IE: 236,7 (DE 73,4) segundos vs IM: 210,9 (DE 77,9) segundos; p = 0,164]. Tampoco se demostró aumento o descenso de un 20% de las cifras iniciales de la frecuencia cardiaca o de la presión arterial sistó- lica, la saturación de oxígeno inferior a 90% o descenso de un 10% de la basal, intubación esofágica o bronquial ni trauma dental, entre ambos escenarios. CONCLUSIONES: No se encontraron diferencias significativas en términos de eficacia ni seguridad entre la IET en movimiento y en dinámico en un escenario simulado.

Estudio comparativo de la eficacia y seguridad de la intubación endotraqueal en movimiento y en estático / Efficacy and safety of endotracheal intubation performed in moving vs motionless environments

Objetivo: Evaluar la eficacia y seguridad de la intubación endotraqueal (IET) en movimiento en comparación con la realización en estático. Método: Ensayo de simulación clínica con maniquíes con respuesta fisiológica MetiMan® que comparó la IET en dos escenarios, intubar en estático (IE) y en movimiento (IM), utilizando 3 dispositivos de IET (Airtraq®, Fast-trach® y Laringoscopio Macintosh®). Treinta y seis médicos expertos en intubación prehospitalaria fueron los intervinientes. Las variables de resultado fueron la intubación efectiva y exitosa, el número de intentos, el tiempo máximo de apnea (TMA) y el tiempo total de la técnica (TTT). Las variables de seguridad fueron la presencia de bradi- y taquicardia, hiper- e hipotensión, hipoxemia, tubo endotraqueal (TET) alojado en esófago o en bronquio y el traumatismo dental. Resultados: No hubo diferencias estadísticamente significativas en el porcentaje de IET exitosa [IE: 71 (65,7%) vs IM: 67 (62,0%); p = 0,277] ni de efectividad (IE: 104 (96,3%) vs IM: 105 (97,2%); p = 0,108), en el número de intentos [IE: 91 (84,2%) vs IM: 90 (83,3%); p = 0,305], en la media de TMA [IE: 14,0 (DE 5,6) segundos vs IM: 14,9 (DE 8,1) segundos; p = 0,570], TTT [IE: 236,7 (DE 73,4) segundos vs IM: 210,9 (DE 77,9) segundos; p = 0,164]. Tampoco se demostró aumento o descenso de un 20% de las cifras iniciales de la frecuencia cardiaca o de la presión arterial sistólica, la saturación de oxígeno inferior a 90% o descenso de un 10% de la basal, intubación esofágica o bronquial ni trauma dental, entre ambos escenarios. Conclusiones: No se encontraron diferencias significativas en términos de eficacia ni seguridad entre la IET en movimiento y en dinámico en un escenario simulado (AU)

Objective: To compare the efficacy and safety of endotracheal intubation (ETI) in a simulated clinical environment in motion vs a motionless one. Method: Clinical simulation trial of ETI with 3 endotracheal tubes (Airtraq, Fast-trach, Macintosh laryngoscope) in mannequins with realistic physiological responses (MetiMan) in 2 scenarios: an environment in motion vs a motionless one. Thirty-six physicians expert in prehospital ETI participated. Outcome variables were successful intubation, effective intubation, number of attempts, maximum apnea time, and total maneuver time. The safety variables were the presence of bradycardia, tachycardia, or high or low systolic blood pressures (ie, 20% variation from baseline); hypoxemia (decrease in oxygen saturation to < 90% or 10% below baseline), tube placement in the esophagus or main bronchus, and dental trauma. Results: No statistically significant differences between the 2 scenarios were found in the numbers of successful ETI (motionless, 71 [65.7%]; in motion, 67 [62.0%]; P=.277) or effective ETI (motionless, 104 [96.3%]; in motion, 105 [97.2%]; P=.108). Likewise, the number of attempts were similar (motionless, 91 [84.2%]; in motion, 90 [83.3%]; P=.305). Nor did we see differences in the mean (SD) maximum apnea times (motionless, 14.0 [5.6] seconds; in motion, 14.9 [8.1] seconds; P=.570) or mean total maneuver times (motionless, 236.7 [73.4] seconds; in motion, 210.3 [77.9] seconds; P=.164). The prevalences of bradycardia, tachycardia, high or low systolic blood pressure, hypoxemia, placements in the esophagus or bronchus, and dental trauma also did not differ significantly between the 2 scenarios. Conclusion: Neither efficacy nor safety variables differed significantly when ETI was performed in mannequins in a motionless environment vs one simulating ambulances in motion (AU)

[Crohn's disease: The experience of living with a chronic illness]. / Enfermedad de Crohn: experiencias de vivir con una cronicidad.

OBJECTIVE: To explore the experiences of people with Crohn disease (CD), their life-changing events, the impact on their lives and the strategies used to cope with it. MATERIALS AND METHODS: Qualitative study. In-depth interviews were carried out on 10 people affected by the disease in the province of Alicante (Spain). The collection, processing and analysis of data was performed using some phenomenological elements. RESULTS: The experiences of those affected can be classified into four main areas: recognition of the illness; perceived consequences of the disease itself by CD affected patients; disease management, and the search for support. CONCLUSIONS: Knowledge of the life experience of people affected by CD appears to be essential for the effective management of chronic illnesses when planning specific health treatment programs.