Access to the Health Care System of Undocumented Moroccan Migrant Slum Dwellers in Southern Spain: A Qualitative Study.

Spain has grown economically due to the recent boosts in the industrial sector, the agricultural sector, construction and services. Those who carry out agricultural tasks are mainly undocumented immigrants living in marginal neighborhoods. OBJECTIVES: to know the perception of undocumented Moroccan migrants living in marginal neighborhoods regarding access to the Public Health System. METHODS: A qualitative method with a phenomenological approach was used to get closer to the experience of the participants in the study. In this work, 24 semi-structured interviews were conducted following a guide with a set of open questions to facilitate an in-depth discussion of the topics of interest. The participants were given an informed consent form, which guaranteed anonymity and confidentiality regarding the information obtained. For this, codes were used to identify them. The data were stored, managed, classified, and organized with the ATLAS-ti 9 software. RESULTS: access and use of health services by the immigrants in the study was difficult due to communication problems related to language and culture, the discriminatory attitude and lack of cultural competence of health personnel, and the location of the neighborhoods (which were marginal far from urban centers), as well as the lack of transportation to health centers. CONCLUSIONS: it is an ethical imperative of the Health System to offer greater attention to the population in situations of extreme vulnerability, implement intercultural mediators and train health professionals in cultural competence.

Cultural adaptation and validation of the Family Nursing Practice Scale (FNPS) for use with Spanish-speaking Nursing Degree students.

AIM: The task proposed was to conduct a cultural adaptation of the Family Nursing Practice Scale and to assess the psychometric properties of the resulting instrument. BACKGROUND: Nursing students must obtain sufficient personal competence and confidence to act with patients and their families. For this purpose, an assessment scale is needed to inform teachers of the student's progress and to determine whether further training or changes in teaching methods are required. DESIGN: A cross-sectional study design was used. METHODS: The researchers conducted this study with 202 students of nursing at two Spanish universities. In the cultural adaptation, the following steps were followed: definition of concepts, translation, back translation, expert group review and implementation by a pilot group with a subsequent cognitive interview. Internal consistency was determined by Cronbach's alpha. Reliability was verified by an initial application of the scale, followed by a repetition after seven days, analysing the results obtained in terms of the intraclass correlation coefficient, the construct validity (by Spearman's non-parametric correlation test) and confirmatory factor analysis (using JASP 0.16.4 statistical software). RESULTS: Cronbach's alpha resulted in 0.95. Spearman's correlation coefficient Family Nursing Practice Scale total with the course year was -0.26 < 0.001. The intraclass correlation coefficient for the total score of the scale was 0.91. The confirmatory factor analysis was performed on a model in which the total score for the scale was considered in relation to the two subscales, and each subscale in relation to its constituent items. The p-value associated with the chi-square was 0.550. The root mean square error of approximation and comparative fit indices presented values of <0.001 (90 % C.I. <0.001-0.048) and 1.000, respectively. CONCLUSIONS: These results indicate that the Spanish version presents good internal consistency, construct validity and reliability. Moreover, the confirmatory factor analysis confirms that it presents a good fit to the model initially proposed for this scale for Nursing Degree students.

Type of Sex Education in Childhood and Adolescence: Influence on Young People's Sexual Experimentation, Risk and Satisfaction: The Necessity of Establishing School Nursing as a Pillar.

The aim is to identify the source of sexuality education used during childhood and adolescence and to analyse whether this education influences their sexual attitudes, their ability to cope with unwanted situations they experience and their satisfaction with their sexual lives. This is a non-experimental, quantitative, ex post facto, cross-sectional study. The sample is formed of 675 young people, with 50% of the ages included being between 20 (Quartile 1) and 22 (Quartile 3) years. The data collection was done by means of an online questionnaire, including sociodemographic and Likert questions about their sex life. Fisher "Independence Contrasts"and correlations were used to see and quantify the relationship among the variables. The main source of education was pornography (29.3%) and the internet (12.4%). The source of education has a significant relationship with whether the use of contraceptives is accepted or not (p < 0.001), refusal to use contraceptives (p < 0.001), engaging in risky sexual practices (p < 0.001), facing unwanted sexual situations (p < 0.001) and dissatisfaction with their sex life (p < 0.001). It is necessary that children and adolescents have sex education in safe environments, such as in a home or school setting, and the school nurse plays a vital part in this education. This would reduce the need for adolescents and young people to use the internet and pornography as a source of education. School nurses should be the educational axis to offer children and adolescents a reliable point of information about sex education. A joint work with teachers, nurses, students and parents would contribute positively to reduce the number of risky situations young people are facing, and it would promote and improve healthy attitudes towards sex and interpersonal relationships.

Coping Strategies during Childbirth Related to Cultural Identity: Companionship, Choice of Analgesia and Maternal Satisfaction.

Childbirth is a biological process and how it is experienced and managed is influenced by numerous factors, among them, socio-cultural or health care received. OBJECTIVE: The objective of this study is to ascertain whether cultural factors influence the way in which women deal with childbirth through the treatment of pain, companionship and maternal satisfaction. METHODS: This study is a non-experimental, quantitative, ex post facto, cross-sectional study of women who gave birth in a border town in southern Spain. The sample consisted of 249 women. RESULTS: No relationship was found between cultural factors and the choice of epidural analgesia, alternative methods to alleviate pain, being accompanied nor maternal satisfaction. There was a significant relationship between the type of companionship and with maternal satisfaction. CONCLUSIONS: Cultural factors did not influence how women dealt with dilation and childbirth. Results found that the person accompanying the mother was important for increasing maternal satisfaction. The intercultural training of healthcare professionals is necessary.

Analysis of University Student Motivation in Cross-Border Contexts.

The development of the personality of university students can determine their affinities for certain disciplines; therefore, it is important to know their specific socio-demographic and motivational profile, what motivates them to start a certain university degree and what encourages them to continue with it, which can help to adapt the teaching methodology. A total of 292 university students from the University of Granada (Ceuta and Melilla campuses) participated in this quantitative study with a descriptive, cross-sectional design, in which motivation and social skills were analysed. Among the results, it can be highlighted that the student population is mainly female, with a higher level of motivation. Sociability, communication, thinking (optimistic or pessimistic), empathy and self-confidence are skills that affect university students' motivation levels. This study highlights the importance and impact of students' motivation on their learning and the development of their social competence, so it is essential to carry out educational interventions that promote these types of skills, especially in cross-border contexts, which can be demotivating environments.

Caloric and Lipid Profiles during Pregnancy in a Socio-Culturally Diverse Society.

This research analyzes the determining factors in diet quality among the Spanish pregnant population with the aim of promoting healthier eating habits and preventing the development of non-communicable diseases. It is a diagnostic, non-experimental, cross-sectional, and observational study, with correlational descriptive methodology, and 306 participants. The information was collected using the 24 h dietary recall. Various sociodemographic factors that influence diet quality were analyzed. It was found that pregnant women consume too much protein and fat, score high in SFA consumption, and do not achieve the CH recommendations, consuming twice as much sugar. Carbohydrate intake is inversely related to income (ß = -0.144, p < 0.005). Likewise, protein intake is linked to marital status (ß = -0.114, p < 0.005) and religion (ß = 0.110, p < 0.005). Finally, lipid intake appears conditional upon age (ß = 0.109, p < 0.005). As regards the lipid profile, a positive association is only observed with age and MFA consumption (ß = 0.161, p < 0.01). On the other hand, simple sugars are positively related to education (ß = 0.106, p < 0.005). The results of this research show that the diet quality of pregnant women does not meet the nutritional recommendations established for the Spanish population.

Sexuality and Religious Ethics: Analysis in a Multicultural University Context.

Sexuality is still perceived by some cultures as a taboo subject. Although there is now a more open attitude towards sexuality, the maintenance of virginity is one of the most concerning issues in some religions. The aim of this research is to investigate the sexual behavior of university students and analyze how culture and religion influence the beliefs and maintenance of virginity in women and men. A mixed methodology was used, involving 355 students in the quantitative design and 18 informants for the qualitative study who took part in two focus groups. The results indicate that religion and the degree of religious practice are predictor variables for the decision to have penetrative sex, with Muslim women and men giving more importance to the maintenance of a woman's virginity. However, this hymen-centric view does not prevent other sexual practices, such as oral and/or anal sex, among young people who wish to maintain their virginity until marriage. Religious ethics continue to influence the sexual behavior of young people today. Therefore, nursing education must address these issues to improve the affective sexual health of the population.

Spanish adaptation and validation of the Cultural Competence Assessment Tool (CCATool) for undergraduate nursing students.

AIM: To analyse and validate a contextually adapted version of the Papadopoulos' Cultural Competence Assessment Tool (CCATool) for Spanish undergraduate nursing students. BACKGROUND: Globalization has driven and intensified international migration. Thus, nurses must treat patients of many different cultural origins. Accordingly, both cultural competence and an appropriate tool with which to evaluate it are required. METHODS: The CCATool questionnaire was adapted for use in a Spanish context and was evaluated through a questionnaire completed by 262 undergraduate nursing students. Seven days later, the same students completed the questionnaire, without any intervention, and a subgroup of 144 students completed the questionnaire for a third time after taking a course in Transcultural Care. The reliability, sensitivity and stability of the questionnaire were assessed. RESULTS: The reliability of the questionnaire obtained an adequate Cronbach's alpha of 0.81. Stability was assessed at seven days, using the intraclass correlation coefficient, which showed good/excellent results. Moreover, the questionnaire was able to detect the changes related to the nursing educative programme, thus highlighting a good sensitivity of the tool. CONCLUSION: Cultural competence is an essential element of nurses' education, and instruction in this area should begin as soon as possible. In addition, an appropriate evaluation system is required. For this purpose, the present study describes and analyses a valid, reliable tool for use with undergraduate nursing students in Spain. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Health and education policies must be sensitive to the ethnic and cultural differences of the patients who are cared for, and address the situations that cause difficulties in care. Hospitals and health centres must offer good care to patients from diverse cultures, so one of the necessary situations is the training and evaluation of the cultural competence of health professionals.

Analysis of the Lifestyle of Spanish Undergraduate Nursing Students and Comparison with Students of Other Degrees.

BACKGROUND: Nursing students are exposed to concepts of healthy lifestyles while they are attending university. OBJECTIVE: The aim of this study was to analyze whether nursing students have a healthier lifestyle than non-nursing students and to determine whether their behaviour is consistent with their beliefs. METHODS: A cross-sectional study, with 293 university students was performed by using a validated questionnaire to measure beliefs and behaviour regarding health. RESULTS: The lifestyle pattern of the nursing students evaluated was characterised by a high percentage of nurses with low levels of physical activity, poor balanced diet and smoking habits. The comparative analysis showed no significant differences between nursing students and students from other degrees. CONCLUSIONS: Students have a positive attitude and knowledge about healthy lifestyle, but do not transfer it to their own lives. Nurses' lifestyle can unintentionally affect the behaviour of other people through their own behaviour and beliefs because they serve as a model for a healthy lifestyle. These findings support that nurse educators have an active role as promoter of health by using lessons to modify the behaviour of their students.

Attitudes and Perceptions of School Teachers in Melilla Regarding the Care Provided to Students with Type 1 Diabetes.

The main objective of the study was to assess the perception of non-university teachers in the city of Melilla to help students with type 1 diabetes mellitus (T1DM), as well as their attitudes towards helping these students in diabetic emergencies. This observational, descriptive, cross-sectional study analyzed the answers given by 441 teachers from 25 public institutions in the city of Melilla to a survey on the attitude and perception regarding the capacity of educational institutions (16 questions) to help and manage students with T1DM. Out of 47.6% of teachers who represent having had students with TIDM, only 4.8% acknowledged having been trained in diabetes. The percentage that has experienced a hypoglycaemia episode at the institution was 29.9%. More than half of participants acknowledged that their educational institution is not prepared to manage diabetic emergencies. Only 5.7% stated their institutions have glucagon in their first-aid kit and less than half of participants (44.7%) would be willing to administer it if necessary. Teachers of educational institutions believe they have not been particularly trained in the care of students living with T1DM and point out that their educational institutions are not prepared to help in diabetic emergencies.

Cultural adaptation and validation of the Transcultural Self-Efficacy Tool for use with undergraduate nursing students in Spain.

BACKGROUND: The provision of culturally competent care helps reduce healthcare inequalities. There is a positive association between the cultural competence of nursing professionals and patient satisfaction, and also between nurses' self-efficacy and patients' adherence to treatment. While training in this respect is important, the self-assessment of skills should also be addressed. AIMS: To produce a culturally-validated Spanish-language version of the Transcultural Self-Efficacy Tool (TSET) for use in undergraduate nursing studies, and to evaluate its implementation within the Spanish educational system. METHODS: This cultural adaptation and psychometric validation study was carried out with student nurses from two universities. International standards were followed for the translation and cultural adaptation of the questionnaire. All students completed the questionnaire twice, the second time 14 days after the first. Those who took the Transcultural Care course at the University of Málaga also completed the questionnaire a third time, after concluding this study subject. The reliability, discriminatory capacity, stability and sensitivity to change of the questionnaire were tested and confirmed, and a confirmatory factor analysis was performed. RESULTS: A total of 286 students took part in this study. Overall, the TSET obtained a reliability score of 0.978, according to Cronbach's alpha test. In relation to nationality of origin, the discriminatory capacity of the questionnaire was -1.067 (-1815 a -0,320) = 0.005. Stability, assessed at 14 days using the intraclass correlation coefficient, was 0.901 (0.873 a 0.923) <0.001. The before-after sensitivity to change for those who took the Transcultural Care course was 1.820 (1558 a 2083) <0.001. CONCLUSIONS: This Spanish-language version of the TSET is culturally suitable for the educational context of undergraduate nursing students in Spain, and its psychometric validation was performed with satisfactory results.

Estudio preliminar del proceso fin de vida mediante triangulación de datos en un hospital comarcal / Preliminary study of the end-of-life process through data triangulation in a regional Hospital

OBJETIVO: Conocer las características del proceso de final de vida en un Hospital Comarcal, según los actores implicados, estableciendo los elementos de convergencia/divergencia en el proceso asistencial, toma de decisiones, información y conocimientos. MÉTODO: Estudio observacional, transversal, descriptivo, convergente y analítico de métodos mixtos y triangulación de datos. Se realizó sobre una muestra de 63 sujetos, de los que 25 fueron profesionales, 19 familiares cuidadores y 19 historias clínicas de pacientes fallecidos a lo largo de un año. RESULTADOS: La triangulación de datos muestra discrepancias entre familiares y profesionales de salud en cuanto a la calidad de la asistencia y la información facilitada. Destaca la falta de registro en las historias clínicas revisadas sobre aspectos del proceso asistencial relacionados con la toma de decisiones o la sedación terminal. CONCLUSIÓN: Este estudio proporciona una visión integrada sobre la atención sanitaria en el proceso de final de vida prestada en un Hospital Comarcal. Muestra áreas prioritarias de intervención, para mejorar la calidad de vida en este proceso, como son la implicación del paciente en la toma de decisiones, la cumplimentación adecuada en las historias clínicas y la formación de los profesionales

OBJECTIVE: To know the characteristics of the end-of-life process in a Regional Hospital, according to the actors involved, establishing convergence/divergence elements in care process, decision-making, information and knowledge. METHOD: Observational, cross-sectional, descriptive, convergent of mixed methods and data triangulation study. Carried out on a sample of 63 subjects, of which 25 were health professionals, 19 family caregivers and 19 medical records of patients who died in the course of a year. RESULTS: Data triangulation shows discrepancies between family members and health professionals regarding care quality and the information provided. The lack of documentation in medical records of care aspects related to decision-making or terminal sedation stands out. CONCLUSION: This study provides an integrated view of end-of-life care provided in a Regional Hospital, identifying priority areas of intervention in order to improve quality of life in this process, such as patient involvement in decision-making, appropriate completion of medical records and health professional training

The Influence of Training in Cross-Culturalism on Future Nurses: Can Education Change Prejudiced Attitudes Toward Migrants?

INTRODUCTION: Increased migration may lead to an increase in prejudiced attitudes in the host population, which may affect the nursing care provided to this group. OBJECTIVES: To identify the attitudes of nursing students toward Moroccan patients and to analyze whether changes in attitude toward this population have taken place after completing a course on cross-culturalism. METHOD: A quasi-experimental design with a single group and pretest/posttest measurements. The sample consisted of 116 nursing students. RESULTS: There were significant differences after receiving the course on cross-culturalism, with a more positive influence on students who exhibited the most negative attitudes in the pretest phase. DISCUSSION: Nursing students have negative attitudes toward the Moroccan population as do the rest of the host population, but these attitudes improve after their training in the course on cross-culturalism.

Nursing Students' Attitudes towards Immigrants' Social Rights.

The migrant population has increased in recent years and, as a result, so has cultural diversity. Universities are incorporating specific modules addressing cultural diversity. However, the native population has negative attitudes towards immigrants, as they believe that immigrants receive more social benefits and abuse healthcare services. Nurses may have these attitudes too, which may affect the way they treat patients. The objective of this study was to determine nursing students' attitudes towards the rights of the migrant population. This is a descriptive ex post facto study using a cross-sectional design, with 821 nursing students in Melilla, Ceuta, and Almeria, Spain. An anonymous questionnaire was used for data collection. Students recognize the same rights for both the immigrant and native populations. More than 80% of the sample upholds the right of undocumented immigrants and their families to access publicly funded healthcare. Attitudes were more positive among students with a Berber background and first-year students. Students approved of the right of immigrants and their families to healthcare and education. The students' negative attitudes towards the social rights of immigrants need to be addressed with intercultural training to reduce their prejudices as future professionals in a multicultural society.

Attitudes towards Immigration among Students in the First Year of a Nursing Degree at Universities in Coimbra, Toledo and Melilla.

Increased migration has led to increased prejudice towards immigrant populations. This study aims to analyse attitudes towards immigration among student nurses in three universities, two in Spain and one in Portugal. Methodology: A descriptive, transversal, prospective study was carried out among student nurses (n = 624), using the Attitude towards Immigration in Nursing scale. Results: Nursing students showed some positive attitudes towards immigration, such as that immigrants should have the right to maintain their customs or that immigrants should have free access to healthcare and education, in contrast to some negative attitudes, such as that crime rates have increased due to immigration or that immigrants receive more social welfare assistance than natives. Significant differences in attitudes were revealed between students from the three universities. Discussion: Training in transcultural nursing is necessary for all nursing students in order to reduce negative attitudes towards the immigrant population and increase the awareness and sensitivity of future healthcare staff in caring for patients of all backgrounds.

Content Validation of an Instrument for the Assessment of School Teachers' Levels of Knowledge of Diabetes through Expert Judgment.

The objective of this study was to describe the content validation, through expert judgment, of a questionnaire for determining the level of knowledge that school teachers have of diabetes in order to design relevant educational interventions to improve the health of school-aged children. This psychometric study involved 15 experts who assessed each of the items in the instrument. The results revealed that the strength of agreement shown by the questionnaire ranged from substantial to almost perfect in its four dimensions, with the characteristics of "sufficiency" and "relevance" having the highest scores (0.982 and 0.903, respectively) based on the judgments made by the participating experts. Regarding statistical significance, the characteristics "sufficiency", with p < 0.001, and "relevance", with p = 0.001, were particularly relevant. The overall degree of understandability for the new version of the instrument was high (91.54%). The psychometric results obtained from validation of the "grado de conocimientos sobre diabetes en docentes del ámbito escolar" (Spanish for "level of knowledge of diabetes in school teachers")-GCDDaE questionnaire through expert judgment and the pre-test indicate that it is recommended for use as it is both relevant and quick and easy to administer.

Development and Validation of a Rating Scale of Pain Expression during Childbirth (ESVADOPA).

One of the most representative symptoms during childbirth is pain, which is one of the most prominent concerns of pregnant women. There are different instruments to assess pain, all of which require interrupting the woman, thus interfering with the intimacy of childbirth. This study seeks to develop and validate a rating scale of the expression of childbirth pain that does not require the mother's attention and respects her privacy during labor. The study was conducted at a regional hospital in a border town in southern Spain between November 2018 and September 2019. Scale items were developed following a review of the scientific literature, and experts judged the content validity. After a pilot test, the scale was psychometrically evaluated. The psychometric tests consisted of internal consistency analysis, exploratory factor analysis, and determination of the content, construct, and convergent validity. The scale was evaluated by 36 experts in the field and was then applied to 55 women during the active phase of childbirth. The final version of the Rating Scale of Pain Expression during Childbirth (in Spanish, Escala de Valoración de la Expresión del Dolor durante el Trabajo de Parto-ESVADOPA) consists of six items in two dimensions. The scale had a Cronbach's alpha coefficient of 0.78, and the content validity measured by Aiken's V co-efficient was also 0.78. The exploratory factor analysis yielded two dimensions that explained 68.08% of the total variance. For convergent validity, a comparison was made with the visual analogue scale, yielding a medium-high value of 0.641. As indicated by the internal consistency and by the content and construct validity outcomes, the ESVADOPA successfully measures pain expression during childbirth and represents a suitable tool for pain expression during birth without the need for intervention or the need for the mother to speak the same language as the midwife.

Content Validation through Expert Judgement of an Instrument on the Nutritional Knowledge, Beliefs, and Habits of Pregnant Women.

The aim of this study was to conduct content validation through expert judgement of an instrument which explores the nutritional knowledge, beliefs, and habits during pregnancy. This is a psychometric study in which 14 experts participated in the evaluation of each of the questionnaire items, which were divided into two blocks according to the characteristics of sufficiency, clarity, coherence, and relevance. Fleiss' κ statistic was used to measure strength of agreement. A pre-test with 102 participants was conducted to measure the degree of understandability of the instrument. The strength of agreement obtained for each of the dimensions was almost perfect. For each pair of experts, strength of agreement ranged between substantial and almost perfect. Sufficiency was the characteristic of the questionnaire that obtained the highest values in the two blocks, and was also the most statistically significant (p < 0.001). Coherence was the most statistically significant characteristic in the first block (p = 0.030). Clarity was the most statistically significant characteristic in the second block (p = 0.037). The wording of five of the twenty original items was corrected. The new version of the instrument attained a high degree of understandability. The results suggest that the instrument is valid and may therefore be applied.

[Analysis of nursing student prejudices towards the migrant population]. / Análisis de los prejuicios del alumnado de enfermería hacia la población migrante.

OBJECTIVE: To determine whether nursing students have subtle or blatant prejudices towards migrants. METHOD: A descriptive ex post facto study was conducted. The sample consisted of 282 students and the study variables were sex, cultural origin, age, year, and contact with migrants. The Subtle and Blatant Prejudice Scale was used. Descriptive and inferential analyses were performed. RESULTS: There were significant differences in the culture variable, with students of Berber origin and of Muslim faith showing less prejudice than those of European origin and of Christian faith. Fourth-year students had the most blatant prejudices. According to the variable contact with migrants, it is the students who have not had contact with this group who have the greatest blatant prejudices. CONCLUSION: Nursing students have more subtle prejudices rather than blatant prejudices towards the migrant population.

Enfermería Transcultural. Formación de los futuros profesionales de Enfermería en España / Transcultural Nursing. Training of future Nursing professionals in Spain

Objetivo principal: conocer las Facultades de Enfermería que en España se imparte la asignatura de Enfermería Transcultural o similar, así como saber si son asignaturas obligatorias u optativas. Metodología: Revisión de los planes de estudios de las Universidades españolas donde se imparte la titulación de Enfermería. Resultados principales: De las Universidades examinadas, el 63% de las titulaciones de Enfermería ofrece formación específica en Enfermería Transcultural. Conclusión principal: No existe un compromiso firme desde el ámbito académico en Enfermería en la formación transcultural de los futuros profesionales de enfermería

Objective: Know what Faculties of Nursing in Spain are teaching Transcultural Nursing or similar subjetcs, as well as knowing if they are compulsory or optional subjects. Methods: Review of the curricula of the Spanish Universities where the Nursing degree is taught. Results: Results obtained show that only a 63% of Nursing degrees offers specific training in Transcultural Nursing. Conclusions: There is no firm commitment in Nursing degrees about cross-cultural training of future nursing professionals