Patient safety in surgical settings: A study on the challenges and improvement strategies in adverse event reporting from a nursing perspective.

AIMS: To explore adverse event reporting in the surgical department through the nurses' experiences and perspectives. DESIGN: An exploratory, descriptive qualitative study was conducted with a theoretical-methodological orientation of phenomenology. METHODS: In-depth interviews were conducted with 15 nurses, followed by an inductive thematic analysis. RESULTS: Themes include motives for reporting incidents, consequences, feelings and motivational factors. Key facilitators of adverse event reporting were effective communication, knowledge sharing, a non-punitive culture and superior feedback. CONCLUSION: The study underscores the importance of supportive organisational culture for reporting, communication and feedback mechanisms, and highlights education and training in enhancing patient safety. IMPLICATIONS: It suggests the need for strategies that foster incident reporting, enhance patient safety and cultivate a supportive organisational culture. IMPACT: This study provides critical insights into adverse event reporting in surgical departments from nurses' lived experience, leading to two primary impacts: It offers specific solutions to improve adverse event reporting, which is crucial for surgical departments to develop more effective and tailored reporting strategies. The research underscores the importance of an open, supportive culture in healthcare, which is vital for transparent communication and effective reporting, ultimately advancing patient safety. REPORTING METHOD: The study followed the Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative Research guidelines. PATIENTS OR PUBLIC CONTRIBUTION: No patients or public contribution.

Perspectiva parental del cuidado humanizado de la Unidad de Cuidados Intensivos Pediátricos / Parental perspective of humanized care at the Paediatric Intensive Care Unit

Objetivo: describir el cuidado humanizado en Enfermería desde la perspectiva parental en la Unidad de Cuidados Intensivos Pediátricos (UCIP).Método: orientación fenomenológica de Husserl. Los participantes han sido progenitores de población infantil de entre 3 a 6 años ingresados en la UCIP en la Comunidad de Madrid. Se ha realizado un muestreo por conveniencia y bola de nieve con nueve participantes. La recopilación de datos ha sido mediante entrevistas semiestructuradas a partir de preguntas abiertas sobre temas de interés con una duración entre 40 y 50 minutos. El análisis de contenido se realizó siguiendo el método de Strauss y Corbin en tres fases.Resultados: se identificaron tres categorías: Disrupción del ingreso en la UCIP, Tiempo y espacio en la UCI Pediátricos y Atención enfermera en la UCIP. Los progenitores manifestaron un gran desconocimiento acerca de los cuidados y las labores realizadas en las unidades de cuidados intensivos antes del ingreso de sus hijos e hijas. En todos los casos sintieron miedo e incertidumbre. Los progenitores valoraron la constancia, el seguimiento exhaustivo y el apoyo emocional como una parte fundamental de los cuidados del personal de Enfermería en estas unidades.Conclusiones: todavía existe un desafío en la inclusión efectiva de los padres y hay una percepción insuficiente del apoyo del equipo de Enfermería hacia ellos y ellas. Se debe considerar incluir a las familias en los cuidados de sus hijos e hijas en una UCIP para disminuir el estrés y mejorar la percepción de la atención enfermera. (AU)

Objective: to describe the humanized Nursing care from the parental perspective at the Paediatric Intensive Care Unit (PICU).Method: husserlian-oriented descriptive phenomenological methodology. The participants were parents of the paediatric population (3-to-6 years old) admitted at the PICU in the Community of Madrid. Convenience and snowball sampling were conducted with nine participants. There was data collection through semistructured interviews based on open questions about topics of interest, with a duration between 40 and 50 minutes. Content analysis was conducted following the method in three stages by Strauss and Corbin.Results: three categories were identified: Disruption of admission at the PICU, Time and space at the Pediatric ICU, and Nursing care at the PICU. Parents showed a major lack of knowledge about the care and tasks conducted at the Intensive Care Units before their children were admitted. In all cases, they felt fear and uncertainty. Parents valued consistency, thorough follow-up and emotional support as an essential part of Nursing care in these units.Conclusions: the effective inclusion of parents still represents a challenge, and there is an insufficient perception of the support by the Nursing team towards them. It must be considered to include families in the care of their children at the PICU, in order to reduce stress and improve the perception of Nursing care. (AU)

Validation of a short version of the high-fidelity simulation satisfaction scale in nursing students.

BACKGROUND: Clinical simulation provides a practical and effective learning method during the undergraduate education of health professions. Currently there is only one validated scale in Spanish to assess nursing students' satisfaction with the use of high-fidelity simulation, therefore, our objective is to validate a brief version of this scale in undergraduate nursing students with or without clinical experience. METHOD: A cross-sectional descriptive study was performed. Between 2018 and 2020, the students from all academic courses of the Fundación Jiménez Díaz nursing school completed the satisfaction scale at the end of their simulation experiences. To validate this scale, composed of 33 items and eight dimensions, exploratory factor analysis (EFA) of the principal components was performed, the internal consistency was studied using Cronbach's alpha, and the corrected item-test correlation of each of the items of the total scale was reviewed. RESULTS: 425 students completed the scale, after the exploratory factor analysis, a scale consisting of 25 items distributed into six subscales, each containing between two and six items, explained a variance of 66.5%. The KMO test (Kaiser-Meyer-Olkin) obtained a value of 0.938, Bartlett's sphericity test was < 0.01 and Goodness of Fit Index (GFI) was 0.991. CONCLUSION: The modified ESSAF scale, reduced from 33 to 25 items and divided into six subscales, is as valid and reliable as the original scale for use in nursing students of different levels, with, or without clinical experience.

Help! Caring for People With Mental Health Problems in the Emergency Department: A Qualitative Study.

INTRODUCTION: After coronavirus disease 2019, there has been an increase in patients in the emergency department with mental health conditions. They are usually received by professionals who are not specialized in mental health. This study aimed to describe nursing staff's experiences in the emergency department, in the care they provide to people with mental health problems who often feel stigmatized by society and also in health care settings. METHODS: This is a descriptive qualitative study with a phenomenological approach. The participants were nurses from the Spanish Health Service from the emergency department of the Community of Madrid hospitals. Recruitment was performed by convenience sampling snowball sampling until data satruation was met. Data were collected through semistructured interviews conducted during January and February 2022. RESULTS: The exhaustive and detailed analysis of the nurses' interviews made it possible to extract 3 main categories-health care, psychiatric patient, and work environment-with 10 subcategories. DISCUSSION: The main study findings were the need to train emergency nurses to be prepared to care for people who experience mental health concerns including bias education and the need for implementation of standardized protocols. Emergency nurses never doubted their ability to care for people experiencing mental health disorders. Still, they recognized that they needed specialized professionals' support at certain critical moments.

Phantoms for ultrasound-guided vascular access cannulation training: a narrative review.

The objective of this paper is to review and compare the different commercial and homemade models of ultrasound-guided vascular cannulation phantoms, as well as the methods used for the elaboration of the latter. There are a variety of simulators for ultrasound-guided puncture techniques, from simple homemade phantoms to the most sophisticated and expensive virtual reality simulators. Commercial-grade ultrasound phantoms are expensive and although they are reusable, their cost can be a barrier to simulation-based training. Homemade phantoms are a cost-effective, highly useful tool for teaching vascular access using ultrasound. For the elaboration of the homemade ones, different substances and elements are usually used to produce varied echogenicities and geometries. Specifically, animal-based ones provide more realistic tissue feedback and have a back-ground echogenicity that is closer to that of human tissue. A powerful alternative is the use of poly vinyl alcohol or modified mixtures of this material, which would be better suited to cannulation simulation with high functional fidelity.

Back to Clinical Training during the COVID-19 Pandemic: Perspective of Nursing Students.

INTRODUCTION: The COVID-19 pandemic has affected many areas of life, including the formation of nursing students. After the COVID-19 crisis, learning during clinical training created different challenges. Nursing schools are responsible for ensuring that structures are in place to facilitate coping in the changed clinical setting. This study aimed to analyze nursing students' perceptions during clinical training while caring for COVID-19 patients. MATERIAL AND METHODS: A qualitative phenomenological study that explored nursing students' perceptions of learning in clinical settings with COVID-19 patients was performed. A total of 15 semi-structured face-to-face interviews were conducted with nursing students who carried out their clinical practices in COVID-19 units during February and April 2022. RESULTS: Through content analysis, categorization, and the method of comparison constant, four categories emerged: feelings, challenges, coping methods, and clinical practices. The students had to learn to "work" with fear and uncertainty and self-manage the emotional burden using different coping techniques to deal with learning during their practices. Interacting with professors and clinical tutors during the clinical practice were positive experiences. CONCLUSIONS: This study constituted an opportunity to build new and adapted educational approaches for teachers to train nursing students to deal with their emotions and thoughts in future pandemic situations.

Association between urinary concentrations of bisphenol A substitutes and diabetes in adults.

BACKGROUND: Due to new restrictions on the use of bisphenol A (BPA), industries are beginning to replace it with derived molecules such as bisphenol S and F (BPS and BPF). There is extensive evidence in the academic literature on the potential health effects of BPA, which is known to be a diabetogenic molecule. However, there are few publications related to new compounds derived from BPA. AIM: To perform an epidemiological study of urinary BPS and BPF in the American National Health and Nutrition Examination Survey (NHANES) cohort, and analyze their possible relationship with diabetes mellitus. METHODS: NHANES datasets from 2013 to 2016 were used due to the urinary BPF and BPS availability. Data from 3658 adults were analyzed to perform regression analysis exploring the possible relationship between BPA-derived compounds and diabetes. RESULTS: Descriptive statistics, linear regression modeling, and logistic regression analysis revealed a significant relationship between urinary BPS, but not BPF, and diabetes risk. Additionally, a relationship was observed between both compounds and hypertension and a slight relationship between BPF and dyslipidemia. CONCLUSION: In the present study, a strong relationship between urinary BPS, not BPF, and diabetes risk has been determined. BPA substitute molecules do not exempt the population from potential health risks.

Challenge, fear and pride: nursing students working as nurses in COVID-19 care units.

CONTEXT AND PURPOSE: During the crisis caused by the COVID-19 pandemic in Spain, students in the year of undergraduate degree were hired to provide care assistance support in hospitals. The purpose of the study is to explore their experiences of their premature professional incorporation into patient care in a pandemic situation. METHODS: A descriptive phenomenology research study was conducted. Data were collected in two phases: 1) Two focus groups and 2) Ten in-depth individual semi-structured interviews between July and August 2021. RESULTS: Twenty-two Nursing students from a Madrid University School of Nursing participated. All worked in COVID hospitalization units, 6 in intensive care units. Four main categories were identified. Student-professional nurse transition, Learning, Hospital integration and Emotions. CONCLUSION: Despite all the fears and negative emotions, the nursing students do not regret the decision to accept a contract to work as a healthcare professional in the COVID-19 pandemic. They feel that the pandemic has allowed them to see life from another perspective and with other priorities, strengthening their vocation to nursing.

Afrontamiento de la mastectomía preventiva en mujeres con riesgo de cáncer de mama hereditario / Coping with prophylactic mastectomy in women at risk of hereditary breast cancer

Objetivo: explorar las vivencias y el afrontamiento de las mujeres intervenidas de mastectomía preventiva ante el riesgo de cáncer de mama hereditario. Método: estudio cualitativo descriptivo con abordaje fenomenológico realizado con un muestreo de conveniencia y complementado por bola de nieve. Se llevaron a cabo entrevistas semiestructuradas en profundidad a mujeres con riesgo de cáncer de mama hereditario sometidas a mastectomía preventiva. El análisis de datos se efectuó según la propuesta de Miles y Huberman. Resultados: participaron nueve mujeres. Un 55,6% tenía entre 40 y 50 años y un 66,7% había sido diagnosticada antes de los 40 y tenía mutación BRCA2. Las mujeres demandaron un mayor conocimiento acerca del cáncer de mama hereditario y de la cirugía en sí, especialmente de la previsión del dolor y la interferencia en las actividades de la vida diaria. Expresaron también haber recibido la noticia con preocupación y contrariedad, ya que se debían someter a cirugía estando sanas. Las estrategias de afrontamiento más habituales fueron el acompañamiento de familiares y amistades, el deporte y la realización del tatuaje del pezón. Destacaron la importancia de la humanización de los cuidados y la comunicación activa de sus especialistas, y la importancia de recursos como asociaciones, banco de imágenes o terapia psicológica para facilitar el afrontamiento. Conclusiones: la mastectomía preventiva genera un gran impacto en las mujeres. Para mejorar su afrontamiento es necesario proporcionar un trato humanizado, transmitir información veraz y de calidad, ofrecer cuidados en función de sus necesidades promoviendo su autonomía y proporcionar apoyo emocional.(AU)

Objective: to explore the experiences and coping strategies of women undergoing prophylactic mastectomy when faced with the risk of hereditary breast cancer. Method: a descriptive qualitative study with phenomenological approach conducted with convenience sampling and complemented by snowball sampling. In-depth semistructured interviews were conducted with women at risk of hereditary breast cancer who had undergone prophylactic mastectomy. There was data analysis according to the Miles and Huberman’s model. Results: the study included nine women; 55.6% were between 40 and 50 years old and had been diagnosed before they were 40 and presented BRCA2 mutation. Women demanded higher knowledge about hereditary breast cancer and the surgery, particularly regarding estimated pain and interference in daily life activities. They also expressed concern and distress when receiving the news, because they had to undergo surgery while healthy. The most usual coping strategies were support by relatives and friends, sports, and nipple tattooing. They highlighted the importance of humanized care and active communication by specialists, as well as the importance of resources such as associations, image banks, or psychological therapy to enable coping. Conclusions: prophylactic mastectomy generates a high impact on women. For an improvement in coping, it is necessary to provide humanized care, to convey truthful and quality information, to offer care based on their needs encouraging autonomy, and to provide emotional support.(AU)

New Evidence of Renal and Cardiovascular Alterations Promoted by Bisphenol A.

Bisphenol A (BPA) is a phenolic compound that is widely used to synthesize plastics as a monomer or additive [...].

Bisphenol a Exposure and Kidney Diseases: Systematic Review, Meta-Analysis, and NHANES 03-16 Study.

Bisphenol A (BPA) is a compound that is especially widespread in most commonly used objects due to its multiple uses in the plastic industry. However, several data support the need to restrict its use. In recent years, new implications of BPA on the renal system have been discovered, which denotes the need to expand studies in patients. To this end, a systematic review and a meta-analysis was performed to explore existing literature that examines the BPA-kidney disease paradigm and to determine what and how future studies will need to be carried out. Our systematic review revealed that only few relevant publications have focused on the problem. However, the subsequent meta-analysis revealed that high blood concentrations of BPA could be a factor in developing kidney disease, at least in people with previous pathologies such as diabetes or hypertension. Furthermore, BPA could also represent a risk factor in healthy people whose urinary excretion is higher. Finally, the data analyzed from the NHANES 03-16 cohort provided new evidence on the possible involvement of BPA in kidney disease. Therefore, our results underline the need to carry out a thorough and methodologically homogeneous study, delving into the relationship between urinary and blood BPA, glomerular filtration rate, and urine albumin-to-creatinine ratio, preferably in population groups at risk, and subsequently in the general population, to solve this relevant conundrum with critical potential implications in Public Health.

Urinary excretion of parathyroid hormone-related protein correlates with renal function in control rats and rats with cisplatin nephrotoxicity.

Parathyroid hormone-related protein (PTHrP) and its receptor are abundantly expressed throughout the renal parenchyma, where PTHrP exerts a modulatory action on renal function. PTHrP upregulation is a common event associated with the mechanism of renal injury and repair. However, no study has yet explored the putative excretion of PTHrP in urine, including its potential relationship with renal function. In the present study, we tested this hypothesis by studying the well-known rat model of acute renal injury induced by the chemotherapeutic agent cisplatin. Using Western blot analysis, we could detect a single protein band, corresponding to intact PTHrP, in the urine of both control and cisplatin-injected rats, whose levels were significantly higher in the latter group. PTHrP was detected in rat urine by dot blot, and its quantification with two specific ELISA kits showed that, compared with control rats, those treated with cisplatin displayed a significant increase in urinary PTHrP (expressed as the PTHrP-to-creatinine ratio or 24-h excretion). In addition, a positive correlation between urinary PTHrP excretion and serum creatinine was found in these animals. In conclusion, our data demonstrate that PTHrP is excreted in rat urine and that this excretion is higher with the decrease of renal function. This suggests that urinary PTHrP levels might be a renal function marker.

Illness perception, coping and adherence to treatment among patients with chronic kidney disease.

AIM: To analyse the predictive value of illness representations on treatment adherence and coping strategies in a group of patients on haemodialysis. BACKGROUND: Understanding the cognitive and emotional factors that influence adherence behaviour and coping strategies and determining their relationship to sociodemographic factors remain a challenge; meeting this challenge would encourage comprehensive patient care, thereby improving their quality of life DESIGN: Cross-sectional study with predictive means in a sample of 135 patients on haemodialysis. METHODS: Data collection occurred from September 2010-January 2012 and tools included the following: sociodemographic data, Illness Perception Questionnaire-Revised, the Cuestionario de Afrontamiento del Estrés and the Morisky-Green test to study adherence to treatment. RESULTS: Being a woman, having a greater knowledge of the disease and having a poorer sense of personal control affected adherence to treatment on controlling for each factor. 'Identity', 'personal control' and 'adherence' were associated with a proactive coping strategy, whereas 'evolution' and 'gender' were related independently to avoidance coping strategies; those who believed that their illness had a chronic course were more likely to cope by avoiding the problem and this tendency was stronger among women. CONCLUSIONS: This study provides evidence supporting the role of gender, knowledge about the disease and sense of personal control in adherence to therapeutic regimens of patients in chronic haemodialysis. The identification and characterization of patients' perception of chronic illness may represent a useful framework to influence disease outcomes such as adherence.

Creencias sobre la insuficiencia renal crónica entre expertos y profanos / Beliefs about chronic renal failure of experts and laypeople

Objetivo: Identificar las creencias y representaciones sobre la insuficiencia renal crónica (IRC) en pacientes, población general y expertos. Metodología: Estudio descriptivo transversal que analiza una muestra de 120 participantes seleccionados por muestreo no probabilístico por cuotas. Se crearon cinco grupos de estudio en función de su nivel de interacción con la enfermedad. La herramienta utilizada fue el Cuestionario de Creencias Sobre la Enfermedad. Resultados: Identidad, Controlabilidad, Mutabilidad, Responsabilidad Personal y Azar no presentan diferencias significativas entre los grupos estudiados. El factor Causas muestra diferencias estadísticamente significativas entre el grupo de pacientes con universitarios de ciencias de la salud y expertos (p<0,001) y entre otros universitarios con universitarios ciencias de la salud y expertos (p<0.001). El factor Incapacidad muestra diferencias significativas entre pacientes, universitarios y población general (p<0,001) y entre expertos con otros universitarios y población general (p<0,001). Los pacientes ofrecen un menor número de síntomas asociados tanto a la IRC como a la hemodiálisis (HD). Y en cuanto a las causas, las de origen biológico y conductuales son las más consideradas por todos los grupos. Solo el grupo de pacientes en HD considera el azar factor causal de la enfermedad. Conclusiones: En oposición al modelo científico, pacientes y población general comparten la idea de que la IRC es curable, depende en gran medida del azar y de hábitos de conducta y es menos grave de lo que opinan expertos. La experiencia con la enfermedad aporta más información (no necesariamente conocimiento) que es recordada en función de la utilidad para lograr un mayor bienestar o una mejora de los cuidados (AU)

Objective: to identify beliefs and representations that patients, general public and experts keep about CKD. Methods: Cross-sectional study with a sample of 120 participants selected by non-probabilistic sampling. Five study groups were created according to their level of interaction with the disease. The tool used to identify and analyze the beliefs of the participants was the “Cuestionario de Creencias Sobre la Enfermedad” (Beliefs Questionnaire about Disease). Results: Identity, Controllability, mutability, Personal Responsibility and Chance present no significant differences among groups. Causes factor shows statistically significant difference between the group of patients with health science students and experts (p <0.001), and between health science students with students different from health sciences and experts (p <0.001). Inability factor shows significant differences between patients, students different from health sciences and general population (p <0.001) and between experts, general population and students different from health sciences (p <0.001). Patients provide a smaller number of symptoms associated with both CKD and HD. As for the causes, biological and behavioral origin is the most considered by all groups. Only HD patients considered chance a possible causal factor of the disease. Conclusions: As opposed to what scientific models defend, patients and general population share the idea that chronic renal disease is a curable condition, that the onset depends mainly on chance and behavioral patterns, and that it is a less serious condition than what experts in renal care state. Suffering the disease offers more information about it (not necessarily knowledge) and this information is recalled according to its usefulness to achieve greater wellbeing or improvement in health care (AU)

Investigación en Enfermería, fundamento de la disciplina / No disponible

El artículo expone la importanciade la investigación como fundamentode la disciplina y la profesiónenfermera. Recoge, entre otros, loshallazgos sobre las barreras para lainvestigación, formas de aproximarsea ella, la necesidad del compromisode la Enfermería con la prác ticabasada en la evidencia y los distintosniveles de compromiso posiblesa los que la enfermera debe y puedeacceder(AU)

Donación de órganos, una perspectiva antropológica / Organ donation - an anthropological perspective

La aproximación antropológica de la donación de órganos tiene como finalidad captar cómo se estructura la situación sociocultural de la donación y extraer los lazos de significación. El presente artículo pretende analizar la donación de órganos desde el enfoque amplio que la antropología permite, un enfoque que tiene presente a los actores implicados desde una perspectiva individual y desde la perspectiva social y cultural. Aunque la donación es un hecho físicamente individual, es básicamente un acto social, colectivo. Se hace por y para la colectividad. Utilizando una metodología cualitativa narrativa se recogieron las impresiones sobre el fenómeno de la donación entre familiares de pacientes y estudiantes de enfermería y psicología. Se analiza el concepto de donación, la donación como acto individual y hecho social, los distintos motivos que condicionan las diferentes representaciones de la donación, entre otros. Mayor información y un trato más sensible hacia el donante apuntan como factores facilitadores y de compensación social en la donación de órganos (AU)

The anthropological approach to organ donation has as a main goal to capture how the sociocultural aspect of donation is structured and to bring about the meaning of it. The present paper tries to analyze organ donation from the anthropologic perspective and the broad focus for it allowed, an approach that keeps in mind the actors involved not just from the individual perspective but from the social and cultural one. Even though organ donation is a physically individual act, it is basically a social and collective event. It is done by and for the collectivity. Using a qualitative narrative methodology, the impressions about donation were gathered among family patients and nursing and psychology students. Concept of donation, donation as an individual act and a social event, different motives conditioning the distinct cognitive representation of donation, among others, are analyzed. More information and a more sensitive treatment toward donors point out as social compensation and facilitator factors in organ donation (AU)

Las órdenes de no reanimar: perspectiva bioética y social / Ethics and society: do not resuscitate orders: bioethic and social perspective

La Reanimación Cardio-Pulmonar (RCP) puede lograr restablecer la función cardiaca y respiratoriaen algunos pacientes, mientras que en otros no resulta eficaz para evitar la muerte o,en el peor de los casos, provoca una lesión cerebral anóxico-isquémica. Esto lleva a la necesidadde tener que tomar la decisión de no reanimar a aquellos pacientes que presentan patologíasgraves o nulas expectativas terapéuticas, formando esta decisión parte de la actividadsanitaria habitual. Sin embargo, tal decisión debe de ser tomada con sumo cuidado y en basea criterios debidamente razonados, tanto desde el punto de vista de la corrección científicotécnicacomo desde el punto de vista de aquellos principios éticos que pudieran verse implicadosen la toma y puesta en práctica de estas decisiones. En el presente artículo se analizaránlas órdenes de no reanimar desde una perspectiva ético-social

CPR (Cardio pulmonary resuscitation) can restore cardiac and respiratory function in somepatients, whereas in other patients it is not effective to avoid death or, at worse, it causes ananoxic-ischemic brain lesion. This leads to the need to have to make a decision not to reanimatethose patients that present severe pathologies or nil therapeutic perspectives. This decisionforms part of normal healthcare daily routines. However, this decision must be takencarefully and based on properly reasoned criteria, both from the point of view of scientific andtechnical correction as well as from the ethical perspective involved in the taking and executionof this sort of decisions. This article aims to analyse the “do not resuscitate orders” froma socioethical perspective

Análisis ético-legal y social sobre las órdenes de no reanimar / Ethicolegal and social analysis on “do not resuscitate” orders

El periodo final de la vida, así como el de la muerte, constituyen uno de los hechos más significativosde la vida biológica y biográfica del ser humano. Por ello, los cuidados y la atenciónsanitaria en general, ante estas situaciones, han de formar parte de modo importantísimo delejercicio de la Enfermería y de la Medicina. Los profesionales deben comprometerse a suministraruna atención humana y competente a los pacientes que están muriendo y a sus familias.El nacimiento de los cuidados intensivos ha traído un cambio conceptual aparejado a grandesconsecuencias. El viejo concepto de “muerte natural” ha ido siendo poco a poco sustituidopor el de “muerte intervenida”. Es aquí donde comenzaron los problemas éticos. ¿Quién tieneque decidir si se interviene o no? ¿A quién corresponden dichas decisiones de las que dependela vida y la muerte de las personas? Ésta fue una de las grandes cuestiones que dioorigen al nacimiento de la Bioética

The last stretch of life, as well as death, represent one of the most significant facts of biologicaland biographic life of human beings. Because of this, the care and healthcare in generalin these situations must be part of the practice of Nursing and Medicine in a more than importantway. Healthcare professionals must commit themselves to supply humane and competentcare to those who are dying and their families.The birth of intensive care has brought with it a conceptual change, paired with severe consequences.The old concept of “natural death” has been substituted little by little by the conceptof “intervened death”. It is here where the ethical problems started. Whose responsibilityis it to decide whether to intervene? Who needs to take charge of life or death decisionsinvolving people? This was one of the great matters that gave birth to Bioethics