El rol de la enfermera en los ensayos clínicos: un nuevo reto para la Enfermería / Nurses’ role in clinical trials: a novel challenge in nursing

OBJETIVO: describir el rol de la enfermera en ensayos clínicos (EC), definirlas competencias, funciones y responsabilidades que debe tener y de qué manera mejora la calidad y la fiabilidad de cualquier EC. MÉTODO: se efectuó una revisión bibliográfica de los últimos 20 años en las bases de datos: CINHAL, Medline (Pubmed). Se utilizaron las palabras clave: enfermera coordinadora, enfermera de ensayos clínicos, ensayo clínico y rol de enfermera coordinadora. RESULTADOS: el análisis de los 30 artículos seleccionados permitió que se generaran dos categorías principales en las que se describe el rol quela enfermera desempeña en los EC: "Importancia de la enfermera coordinadora de EC" (además de recopilar datos, incluye el manejo de los mismos, y con frecuencia presta atención y tratamiento en un contexto complejo y aislado, lo que exige conocimiento y aplicación de responsabilidades éticas y profesionales), y "Funciones de la misma" (según Green (2011), son seis: 1. Persona de referencia para el paciente; 2.Persona de referencia y contacto entre los distintos miembros del equipo investigador; 3. Manejo de los datos; 4. Recogida de muestras biológicas;5. Administración de fármacos y medicamentos; y 6. Conocimiento de protocolos y monitorización).CONCLUSIONES: el rol de la enfermera coordinadora resulta esencial para asegurar la calidad y rigurosidad de cualquier EC, ya que hace de enlace entre paciente, promotor y resto del equipo investigador, minimizando errores y aumentando la adherencia al tratamiento

PURPOSE: to describe the role of nurses in clinical trials (CT), to define competences, tasks and responsibilities nurses should have and the way they can improve quality and reliability in any CT. METHODS: a literature search and review was carried out covering the last 20 years; the following databases were used: CINHAL, Medline (Pubmed). Searching keywords were: coordinating nurse, clinical trials nurse, clinical trial and coordinating nurse role. RESULTS: a review of 30 selected articles showed two main categories reporting nurses' role in CT: Importance of a CT coordinating nurse(besides data collection, nurse's role includes data management, and frequently care and treatment in a complex and isolated setting, which requires expertise, along with ethical and professional competences),and Tasks of a CT coordinating nurse (according to Green, the following six tasks: 1- Reference staff member for patients, 2- Reference member and person in charge of contact among research team members, 3- Data management, 4- Biological samples collection, 5-Drugs and medicines administration, and 6- Knowledge of protocols and monitoring).CONCLUSIONS: the role of a coordinating nurse is critical to ensure quality and rigor in any CT, acting as a liaison between patients, sponsor and other members of the research team, minimizing mistakes, and enhancing adherence to therapy

[Advanced nursing practice: development of an emerging model]. / Enfermería de práctica avanzada: desarrollo de un modelo emergente.

AIM: To describe the historical evolution of Advanced Practice Nursing (APN) in the international arena, and to describe the characteristics and competencies of this nursing role, with the ultimate aim of encouraging reflection on the implementation of this model of nursing in the Spanish context. METHODS: A literature review in the databases CINAHL, MEDLINE and CUIDEN was conducted. In addition, several websites were reviewed. RESULTS: At the international level, there is evidence on the impact of the APN in the healthcare system, reducing the number and length of hospital stays and showing greater user satisfaction. Regarding the national context, it is clear the interest on this issue, although the implementation of this advanced practice role is a pending matter. CONCLUSIONS: In Spain, the implementation of the APN is a challenge due to the legislative, educational, organizational and political factors that are involved in the official introduction of this new nursing model.

Primeros pasos en la investigación cualitativa: desarrollo de una propuesta de investigación / Getting started with qualitative research: developing a research proposal

El objetivo de este artículo es ilustrar en detalle las cuestiones importantes que tienen que tratar los investigadores noveles durante el diseño de una propuesta de investigación cualitativa en Enfermería y en ciencias de la salud. Los autores han desarrollado un proceso de 17 pasos para describir el desarrollo de un proyecto de investigación cualitativa. Este proceso puede ayudar de un modo sencillo para comenzar a investigar y asegurar una propuesta integral y rigurosa (AU)

The aim of this article is to illustrate in detail important issues that research beginners may have to deal with during the design of a qualitative research proposal in nursing and health care. The authors have developed a 17-step process to describe the development of a qualitative research project. This process can serve as an easy way to start research and to ensure a comprehensive and thorough proposal (AU)

Enfermería de práctica avanzada. desarrollo de un modelo emergente / Advanced nursing practice: development of an emerging model

Objetivo. Exponer la evolución histórica de la enfermería de práctica avanzada (EPA) en el ámbito internacional, así como describir las características y competencias de este perfil enfermero, con el propósito último de fomentar la reflexión sobre la implementación de este modelo de enfermería en el contexto español. Metodología. Se realizó una revisión bibliográfica en las bases de datos CINAHL, MEDLINE y CUIDEN. Además se consultaron varias páginas web. Resultados. A nivel internacional, se ha identificado el impacto que tiene la EPA en el sistema sanitario, reduciendo el número y la duración de las estancias hospitalarias así como consiguiendo una mayor satisfacción de los usuarios. Respecto al contexto nacional queda manifiesto el interés sobre esta temática, a pesar de que la implantación de este rol de práctica avanzada es una asignatura pendiente. Conclusiones. En España, la implementación de la EPA supone un desafío por los retos legislativos, educativos, organizacionales y políticos que conlleva la introducción oficial de esta nueva figura de enfermería(AU)

Aim: To describe the historical evolution of Advanced Practice Nursing (APN) in the international arena, and to describe the characteristics and competencies of this nursing role, with the ultimate aim of encouraging reflection on the implementation of this model of nursing in the Spanish context. Methods: A literature review in the databases CINAHL, MEDLINE and CUIDEN was conducted. In addition, several websites were reviewed. Results: At the international level, there is evidence on the impact of the APN in the healthcare system, reducing the number and length of hospital stays and showing greater user satisfaction. Regarding the national context, it is clear the interest on this issue, although the implementation of this advanced practice role is a pending matter. Conclusions: In Spain, the implementation of the APN is a challenge due to the legislative, educational, organizational and political factors that are involved in the official introduction of this new nursing model(AU)

[Direct clinical practice: conceptual analysis. Central competence for the development of advanced nursing practice]. / Práctica clínica directa: análisis conceptual. Competencia central para el desarrollo de la práctica avanzada en enfermería.

UNLABELLED: The recent implementation in Spain of post degree in nursing has made possible the emergence of new advanced profiles, which direct clinical practice is the core competence. OBJECTIVE: To analyse and clarify the term of direct clinical practice. METHODOLOGY: A conceptual analysis was carried out based on Rogers's evolutionary approach. A review of the literature was made in the following data bases: PubMed, CINAHL, ISI Web of Knowledge, Psych INFO (Ovid) and Cochrane Library. Furthermore, five books about advanced practice nursing were revised. RESULTS: 7 articles and 4 books based on the inclusion criteria were selected. After their analysis the concept of direct clinical practice is defined. CONCLUSIONS: This paper clarifies the concept of direct clinical practice and helps to have a stronger base of knowledge. This will serve as foundation to improve and perfect the conceptualization of this term.

Práctica clínica directa: análisis conceptual. Competencia central para el desarrollo de la práctica avanzada en enfermería / Direct clinical practice: conceptual analysis. Central competence for the development Of advanced nursing practice

La aprobación en España del posgrado en enfermería ha posibilitado el surgimiento de nuevos perfiles profesionales más avanzados, cuya competencia central es la práctica clínica directa. Objetivo: analizar y clarificar el término de práctica clínica directa. Metodología: se realizó un análisis conceptual basado en el método evolutivo de Rogers. Para ello, se llevó a cabo una revisión de la evidencia disponible en Pubmed, CINAHL, ISI Web of Knowledge, PsychINFO (Ovid) y la Cochrane Library. Asimismo, se revisaron cinco libros referentes en la práctica avanzada de enfermería. Resultados: se seleccionaron siete artículos y cuatro libros en base a los criterios de inclusión. Del análisis de los mismos se ofrece una definición del término práctica clínica directa. Conclusiones: este trabajo clarifica el concepto de práctica clínica directa y con ello contribuye a tener una base de conocimiento más sólida que sirva de fundamento para mejorar y perfeccionar la conceptualización del término PCD(AU)

The recent implementation in Spain of post degree in nursing has made possible the emergence of new advanced profiles, which direct clinical practice is the core competence. Objective: To analyse and clarify the term of direct clinical practice. Methodology: A conceptual analysis was carried out based on Rogers’s evolutionary approach. A review of the literature was made in the following data bases: PubMed, CINAHL, ISI Web of Knowledge, Psych INFO (Ovid) and Cochrane Library. Furthermore, five books about advanced practice nursing were revised. Results: 7 articles and 4 books based on the inclusion criteria were selected. After their analysis the concept of direct clinical practice is defined. Conclusions: This paper clarifies the concept of direct clinical practice and helps to have a stronger base of knowledge. This will serve as foundation to improve and perfect the conceptualization of this term(AU)

Valoración geriátrica global del anciano por los servicios de urgencias extrahospitalarias. Caso clínico / Comprehensive geriatric assessment of elderly for outpatient emergency services. Case report

El progresivo envejecimiento de la población española conlleva un aumento de la atención sanitaria, por los servicios de urgencias extrahospitalarias (SUE), a este grupo de edad. El objetivo de este trabajo es evidenciar la importancia de realizar una valoración global del anciano en el contexto domiciliario y comunitario, que contemple tanto los aspectos físicos como los psicosociales y ambientales de la persona en situación de urgencia. Para ello, se desarrolla un caso clínico, que se apoya en la evidencia científica, para determinar la actuación más adecuada que mejore las intervenciones de los servicios de urgencias extrahospitalarias. El análisis del caso se estructura entres apartados: la valoración de enfermería, el registro de los datos y la transmisión de la información a otros equipos de salud. Como conclusión, se identifica la necesidad de valorar y registrar datos sobre el estado físico y fisiológico del anciano al mismo tiempo que se recoge información sobre su contexto familiar, comunitario o ambiental, para proporcionar unos cuidados integrales y de calidad. Asimismo, se recomienda el desarrollo de herramientas de valoración geriátrica específicas para utilizar en situaciones de urgencias extrahospitalarias (AU)

The progressive aging of the Spanish population leads to increased health care for Outpatient Emergency Services (EUS), in this age group. The aim of this paper is to highlight the importance of an overall assessment of the elderly in the household and community context, which involves both the physical and psychosocial in the emergency environmental. To do this, we develop a clinical case, which is based on scientific evidence, to determine the most appropriate action to improve interventions in emergency services. The case analysis is divided into three sections: nursing assessment, data recording and transmission of information to other health teams. In conclusion, it identifies the need to assess and record data on physical and physiological status of the elderly, at the same time it collects information about family background, community or environmental, to provide a comprehensive and quality care. It also recommends the development of specific geriatric assessment tools for use in emergency situations (AU)

[Patients' view of nursing care: a literature review]. / Visión de los pacientes sobre el cuidado de enfermería. Una revisión de la literatura.

AIM: To know patients'vision about nursing care, to explore what the patient perceives and expresses on the care of nursing and to identify which are the potential areas for improvement. METHODOLOGY: A narrative review was conducted in which a synthesis of the information, a codification and a thematic analysis of primary studies were carried out in order to categorize the emerging themes of the reviewed literature. For this purpose, a search was conducted in the databases CINAHL, CUIDEN, MEDLINE and Cochrane Library, from 1990 to 2011. RESULTS: Seven principal categories were identified: personal qualities of the nurse, individualized care, affective Implication, communication skills, "I am in good hands", knowledge and technical skills and the role of the nurse. DISCUSSION: From the patients' statements, positive aspects could be extracted about nursing care but also different ideas were identified that should be modified. It is important to include regularly in practice patients' views of the care that they receive, since they can better evaluate the reality of the nurse role. CONCLUSIONS: To provide a holistic and individualized care to the person, it is necessary to include her vision about the received care. This is the way to evaluate the quality of the care and to verify whether health care assistance corresponds with users' demands.

Impacto psicosocial del cáncer de mama en la etapa de larga supervivencia: propuesta de un plan de cuidados integral para supervivientes / Psychosocial impact of breast cancer in long-term survival: proposal of an integral follow-up care for survivors

La finalidad de este artículo es evidenciar el impacto psicosocial del cáncer de mama en la etapa de larga supervivencia y fomentar la reflexión sobre la implantación de un plan de cuidados para supervivientes. Para ello se ha realizado una revisión narrativa de los artículos publicados sobre la experiencia de supervivencia de las mujeres con cáncer de mama. Los datos se agruparon teniendo en cuenta los dominios de medición (físico, psicológico y social) del instrumento «Calidad de vida a largo plazo en cáncer de mama» (LTQOL-BC Scale). Las supervivientes de cáncer de mama pueden sentirse emocionalmente afectadas por las secuelas físicas (mastectomía, linfedema, menopausia temprana e infertilidad), psicológicas (miedo a la recidiva y estrés emocional) y/o sociales (cambios familiares y laborales) que experimentan. Estos datos se utilizan como base para una propuesta de plan de cuidados para supervivientes de cáncer de mama(AU)

The aim of the article is to show the psychosocial impact of breast cancer in the long-term survival and to promote the idea of implementing a follow-up plan for survivors. A narrative review of published articles on the experience of survival in breast cancer survivors was conducted. Data were organised according to the domains of measurement (physical, psychological and social) of the Quality of Life of Long-term Breast Cancer Survivors Scale (LTQOL-BC). Breast cancer survivors may feel emotionally affected by the physical sequels (mastectomy, lymphedema, early menopause, and infertility), psychological (fear of recurrence and emotional stress) and/or social (family relationships and employment changes). The data are the foundation of a proposal of specific follow-up care for breast cancer survivors(AU)

Visión de los pacientes sobre el cuidado de enfermería: una revisión de la literatura / Patients’ view of nursing care: a literature review

Objetivo. Conocer la visión de los pacientes acerca del cuidado enfermero, explorar lo que el paciente percibe y expresa sobre el cuidado que recibe e identificar cuáles son las áreas susceptibles de mejora en la atención. Metodología. Se realizó una revisión narrativa en la que a través de una síntesis de los datos, la codificación y el análisis temático de los estudios primarios, se categorizaron los temas emergentes de la literatura revisada. Para ello, se desarrolló una búsqueda bibliográfica en las bases de datos CINAHL, CUIDEN, MEDLINE y The Cochrane Library entre los años 1990 y 2011. Resultados. Se identificaron siete categorías principales: Cualidades personales de la enfermera, Atención individualizada, Implicación afectiva, Habilidades de comunicación, «Me siento en buenas manos», Conocimientos y habilidades técnicas y El rol de la enfermera. Discusión. De los relatos de los pacientes se pueden extraer aspectos positivos sobre el cuidado recibido, pero también se señalan ideas que se tendrían que corregir. Se deberían tomar medidas que incluyesen regularmente en la práctica las opiniones de los pacientes sobre el cuidado que reciben, ya que son ellos los que mejor pueden evaluar la realidad de la labor enfermera. Conclusiones. Para proporcionar un cuidado holístico e individualizado a la persona, es necesario incluir su visión sobre la atención que recibe. Así se podrá evaluar la calidad de los cuidados prestados y comprobar si la asistencia proporcionada se corresponde con las demandas de los usuarios (AU)

Aim. To know patients’ vision about nursing care, to explore what the patient perceives and expresses on the care of nursing and to identify which are the potential areas for improvement. Methodology. A narrative review was conducted in which a synthesis of the information, a codification and a thematic analysis of primary studies were carried out in order to categorize the emerging themes of the reviewed literature. For this purpose, a search was conducted in the databases CINAHL, CUIDEN, MEDLINE and Cochrane Library, from 1990 to 2011. Results. Seven principal categories were identified: personal qualities of the nurse, individualized care, affective Implication, communication skills, «I am in good hands», knowledge and technical skills and the role of the nurse. Discussion. From the patients’ statements, positive aspects could be extracted about nursing care but also different ideas were identified that should be modified. It is important to include regularly in practice patients’ views of the care that they receive, since they can better evaluate the reality of the nurse role. Conclusions. To provide a holistic and individualized care to the person, it is necessary to include her vision about the received care. This is the way to evaluate the quality of the care and to verify whether health care assistance corresponds with users’ demands (AU)

[Psychosocial impact of breast cancer in long-term survival: proposal of an integral follow-up care for survivors]. / Impacto psicosocial del cáncer de mama en la etapa de larga supervivencia: propuesta de un plan de cuidados integral para supervivientes.

The aim of the article is to show the psychosocial impact of breast cancer in the long-term survival and to promote the idea of implementing a follow-up plan for survivors. A narrative review of published articles on the experience of survival in breast cancer survivors was conducted. Data were organised according to the domains of measurement (physical, psychological and social) of the Quality of Life of Long-term Breast Cancer Survivors Scale (LTQOL-BC). Breast cancer survivors may feel emotionally affected by the physical sequels (mastectomy, lymphedema, early menopause, and infertility), psychological (fear of recurrence and emotional stress) and/or social (family relationships and employment changes). The data are the foundation of a proposal of specific follow-up care for breast cancer survivors.

[Experience on the implementation of the advanced clinical nursing practice in an oncology unit]. / Práctica avanzada en enfermería. Experiencia sobre la implementación en una unidad de oncología.

INTRODUCTION: Social and political changes have created an increased in the demand of health care enabling the emergence of diverse professional profiles under the term Advanced Practice Nurse (APN). The APN is a nurse who has acquired a basis of expert knowledge, skills for decision making, and clinical competencies for an extended practice. In Spain, due to the Bologna process and the changes within university, such as postgraduate training, these profiles have begun to emerge. OBJECTIVE: To describe the experience on the implementation of the advanced clinical nursing role in an inpatient oncology unit. DEVELOPMENT: Through the nine stages of the model known as Participatory, Evidence-Based Patient-Focused Process for Advanced Practice Nursing (PEPPA) the process of implementation of the Advanced Practice Nursing (APN) in an Oncology unit is described. For this purpose, the change project "Design of a care program for patients carrying a permanent draining catheter for malign ascitis and pleural effusion" was implemented. The project was grounded on the evidence-based theory and practice, and focused on the patient and the family. Its implementation has enabled the development of competences by the APN and the identification of barriers and facilitators. CONCLUSIONS: The changes that have taken place in society favor the development of new nursing profiles, which have a positive impact on the institutions, nursing practitioners, patients and families.

Propuesta de Investigación Cualitativa: un modelo para ayudar a investigadores noveles / Qualitative Research proposal: a model to help novice researchers

Los profesionales de enfermería contribuyen de modo importante, por medio de la investigación, a extender y actualizar su propio cuerpo de conocimientos con la intención de mejorar la calidad de los cuidados de enfermería. A los estudiantes y a los investigadores noveles, sin embargo, les puede resultar difícil comenzar la investigación y puede que necesiten supervisión a lo largo del proceso investigador. Este artículo se centra en la praxis para diseñar una propuesta de investigación cualitativa al presentar un ejemplo/modelo, con el propósito de que pueda ser beneficioso para aquellos principiantes a la hora de utilizar la metodología cualitativa (AU)

Nurses make an important contribution to extending and updating knowledge through research with the purpose of improving the quality of nursing care. Students and novice researchers, however, may find it difficult to initiate investigation and may require supervision during the research process. This paper focuses on the practicality of designing a qualitative research proposal by presenting an example/model, in the hope that it may be of benefit to beginners using a qualitative methodology (AU)

La Teoría Fundamentada como Metodología de Investigación Cualitativa en Enfermería / Grounded theory as a qualitative research methodology in nursing

La teoría fundamentada (TF) es un diseño de investigación cualitativa, reconocido a nivel internacional, que ha sido utilizado para desarrollar teorías sobre fenómenos de salud relevantes. Sin embargo, en el ámbito de la enfermería española, la TF ha tenido escasa consideración. Por ello, este artículo se centra en esta metodología cualitativa e ilustra su contribución en la investigación enfermera en España y su utilidad para la Enfermería. También, se presentan brevemente las características metodológicas distintivas de la teoría fundamentada (AU)

Grounded theory is a qualitative research design used at an international level. It has been applied as a methodology to develop theories about relevant health phenomena. However, in the Spanish nursing context, grounded theory has received very little attention. This article focuses on this qualitative methodology and illustrates its contribution to nursing research in Spain and its relevance for nursing. Moreover, the main methodological characteristics of grounded theory are briefly presented (AU)

'Again': the impact of recurrence on survivors of cancer and family members.

AIM: To examine the psychosocial impact of recurrence on survivors of cancer and their family members. BACKGROUND: Cancer recurrence is described as one of the most stressful phases of cancer. Recurrence brings back many negative emotions, which are different and may be more intense than those after first diagnosis of cancer. Survivors and their family members have to deal with new psychological distress. DESIGN: A qualitative descriptive study was conducted in four cancer units of two hospitals in North of Spain. METHODS: Fifteen survivors of cancer with a recent diagnosis of recurrence, 13 family members and 14 nurses were interviewed. Data collection and analysis were based on the constant comparative method of grounded theory. RESULTS: Four major categories were found: (1) 'Again': when cancer comes back, (2) the shock of recurrence, (3) the impact of the diagnosis on family life, and (4) factors that influence the impact of recurrence. Learning that cancer had come back was, for most of the families, more devastating than hearing that they had cancer for the first time. Signs of shock and suffering were experienced by families as an initial response to recurrence. The new diagnosis often entailed a change in the family life. Survivorship period and age seemed also significant in the psychosocial experience of recurrence. CONCLUSIONS: The term 'again', used by all the participants to describe a recurrence of the disease, symbolised a beginning and a continuation with cancer; it implied a re-encounter with health services, and it represented new suffering for the families. RELEVANCE TO CLINICAL PRACTICE: Therapeutic nursing interventions should be planned and provided to both patients with recurrent cancer and their family members. Family nursing can play an important role in helping families master the impact of the recurrent illness.

'Es más difícil': experiencias de las enfermeras sobre el cuidado del paciente con recidiva de cáncer / 'It's harder': nurses’ experiences of caring for patients with cancer recurrence

Objetivo. Explorar las experiencias y las respuestas de enfermeras sobre el cuidado del paciente con recidiva de cáncer. Material y métodos. Estudio cualitativo transversal basado en la teoría fundamentada. La recogida de datos, basada en la entrevista semiestructurada, se llevó a cabo en cuatro unidades oncológicas de dos hospitales de la Comunidad Foral de Navarra tras obtener la aprobación ética. La muestra se compuso de 14 enfermeras. Se utilizó un muestreo de máxima variación para la selección de casos de amplia diversidad con el fin de fomentar la transferencia de los datos. Se llevó a cabo una única entrevista con cada participante, con una duración aproximada de 40 min. Resultados. El cuidado en la recidiva es descrito como una situación difícil, incluso más que el primer diagnóstico de cáncer, porque las enfermeras deben enfrentarse a pacientes con sentimientos de desconfianza en los tratamientos así como de desesperanza y miedo a una posible muerte. Ante esta realidad, los profesionales de enfermería tratan de abordar las necesidades emocionales de los pacientes lo mejor que pueden, desafiando con frecuencia obstáculos como la falta de tiempo, la sobrecarga de trabajo y la escasa formación en psicooncología. Conclusiones. Los datos evidencian la dificultad de las enfermeras para el abordaje de aspectos emocionales en el cuidado del paciente con recidiva. Si el compromiso de los servicios sanitarios es proporcionar un cuidado integral a los pacientes oncológicos y sus familias, debería existir un compromiso correspondiente para ofrecer una formación más amplia en aspectos psicosociales para los profesionales de enfermería(AU)

Objective. To examine the experiences and responses of nurses caring for patients with recurrence of cancer. Material and methods. A qualitative cross-sectional study based on grounded theory. Data was collected, based on semi-structured interviews carried out in four cancer units of two hospitals in Navarra, after obtaining ethical approval. The sample consisted of 14 nurses. Results. Providing care during cancer recurrence is described as a difficult situation, even more than in the first diagnosis of cancer. This is because nurses have to deal with the loss of patient hope in treatment and the fear of the possibility of the patient's death. To deal with this reality, nurses try to do their best to meet the emotional needs of the patient, at the same time as managing barriers including lack of time, workload, and inadequate training in psycho-oncology. Conclusions. The data show the difficulty nurses have in dealing with the emotional care of patients with recurrence. If the Health Service commitment is to offer holistic care to cancer patients and their families, there should be a corresponding commitment towards improving nursing training in psychosocial issues(AU)

["It's harder": nurses' experiences of caring for patients with cancer recurrence]. / "Es más difícil": experiencias de las enfermeras sobre el cuidado del paciente con recidiva de cáncer.

OBJECTIVE: To examine the experiences and responses of nurses caring for patients with recurrence of cancer. MATERIAL AND METHODS: A qualitative cross-sectional study based on grounded theory. Data was collected, based on semi-structured interviews carried out in four cancer units of two hospitals in Navarra, after obtaining ethical approval. The sample consisted of 14 nurses. RESULTS: Providing care during cancer recurrence is described as a difficult situation, even more than in the first diagnosis of cancer. This is because nurses have to deal with the loss of patient hope in treatment and the fear of the possibility of the patient's death. To deal with this reality, nurses try to do their best to meet the emotional needs of the patient, at the same time as managing barriers including lack of time, workload, and inadequate training in psycho-oncology. CONCLUSIONS: The data show the difficulty nurses have in dealing with the emotional care of patients with recurrence. If the Health Service commitment is to offer holistic care to cancer patients and their families, there should be a corresponding commitment towards improving nursing training in psychosocial issues.