Experiences of nursing students in A peer mentoring program during their clinical practices. A qualitative study.

BACKGROUND: Clinical placements allow nursing students to develop the skills and attitudes necessary to provide care. Peer mentoring programmes seem to facilitate these achievements, but there are very few studies on the effects of peer mentoring on clinical placements and what it can bring to both mentors and mentees. AIM: To describe the perspectives of nursing students on a peer mentoring programme during their clinical placements. DESIGN: A qualitative descriptive and exploratory study. SETTINGS AND PARTICIPANTS: First year and third year nursing students were included. METHODS: Focus groups were conducted with students after they participated in a peer mentoring programme during their clinical practice rotation. RESULTS: The support received from the student mentors was very important both academically and personally. Mentors also acknowledged having improved their teaching and leadership skills. CONCLUSIONS: Our results can be applied to future studies to inform peer mentoring programmes as a complementary teaching tool in clinical placements to improve leadership and empowerment in nursing students.

Medication Adherence and Contraceptive Counseling.

Combined oral contraceptives (COC) are a very popular form of birth control. Incorrect use and lack of adherence to treatment reduce the effectiveness of this method. Having a standard tool to identify poor-adherence profiles quickly and objectively can be helpful for midwives and potentially for COC users. The MMAS-4 adherence scale has been used in various medical fields, but there is little evidence of its potential in contraceptive consultation. This paper presents a piece of multicenter observational research based on a sample of 327 women who had attended contraceptive counselling in Spain and were COC users or had informed the midwife that they want to start to use this method. Two interviews were conducted: at the time of consultation and after one year. In our research, the MMAS-4 identified high-risk behaviors: during the 1-year follow-up period, COC users classified as poorly adherent had a significantly higher risk of missed contraceptive pills, more incidents and problems related to the method of contraception, as well as a lower degree of satisfaction with the contraceptive method. One case of unplanned pregnancy and two cases of emergency contraception were identified, all of them corresponding to poorly adherent women. The use of MMAS-4 in consultation can improve midwives' contraceptive counselling.

Reflective based learning for nursing ethical competency during clinical practices.

BACKGROUND: A combination of theoretical and practical approaches is required to learn and acquire ethical competencies in caring. Occasionally, reflection on practical action differs from theoretical learning. In the context of reflective learning, issues such as ethical values can be discussed since they evoke conflict among nursing students. AIM: To identify ethical conflicts encountered by nursing students during clinical placements and to determine their cooperation strategies. RESEARCH DESIGN: Qualitative study with a content analysis according to Elo and Kinglas framework. PARTICIPANTS AND RESEARCH CONTEXT: Students enrolled in a nursing program at a Spanish university aged between 22 and 35, mainly women. METHODOLOGY: The study includes 134 ethical reflections from nursing students in the last year of the nursing program, written during their clinical practices in a variety of learning environments. The research team analyzed the reflections using an inductive content analysis method. ETHICAL CONSIDERATIONS: Ethical permission was obtained by the management center according to Law 3/2028, and all the participants accepted to participate through the informed consent form. FINDINGS: Three main categories emerged from the analysis of the ethical reflections: (1) evaluation of professional performance and patient care; (2) the student as the protagonist of the dilemma; (3) student coping. Student dilemmas and concerns are related to ignorance, student-patient communication, mistakes made and self-confidence. Some situations conflict with the autonomy of patients and their rights, and can contribute to stressful situations for patients. Stress factors include hospital routines, which the patient cannot modify, and asymmetric relationships with staff, which encourage passivity. CONCLUSION: All ethical problems detected by the students begin with the professional-patient relationship, including issues related to bad news, errors or malpractice. Reflection on the ethical values of nursing, both in the classroom and in clinical practices, allows students to develop a greater ethical awareness of care, enhancing their decision-making skills in ethical dilemmas.

New Life Transition of Former Caregivers: Positive Mental Health Approach.

After the end of their time as a caregiver, former caregivers have needs and feelings that have been subject to little study to date. The aim of the study is to determine and analyse the feelings, perceptions and practices of former caregivers in the reconstruction of their daily lives. This is a qualitative study based on the Grounded Theory developed by Charmaz. The study involved 14 former caregivers who had cared for their relative for more than 2 years and who had stopped caring for them more than 2 years previously. Fourteen in-depth interviews were conducted and data were collected over 13 months between 2015 and 2017. Data were analysed using the Grounded Theory Method. In addition, this study was approved by the ethics committee of the Institut Universitari d'Investigació en Atenció Primària Jordi Gol. The former caregiver experiences a transition, which begins in the days before the death of their relative and may continue for more than 3 years. Three critical moments in the post-caring transition were found: (1) the post-caring emptiness; (2) the end of the period as a caregiver; and (3) the movement towards a new life. Family and professional support is needed during this transition. Former caregivers experience a transition in the rebuilding of their daily lives; furthermore, former caregivers may be a source of support for other caregivers, which is linked to positive mental health factors. Healthcare organisations need to acknowledge the emotional, psychosocial and psychological health of former caregivers.

Nurses' Perspective of Treating Patients With an Amputation Due to Diabetic Foot Syndrome.

BACKGROUND: Expert nurses must provide both physical and emotional care to patients with diabetic foot syndrome (DFS) who require an amputation. This includes helping patients and families to cope with this situation, while ensuring the maximum level of comfort. PURPOSE: The aim of this study was to explore the perspective of expert nurses on the needs and hospital care of people requiring an amputation due to DFS. METHOD: This was a qualitative multicenter study involving 8 hospitals in Spain and Portugal. In-depth interviews with expert nurses were transcribed verbatim to enable content analysis. RESULTS: Twenty-four expert nurses were interviewed about their knowledge and experience of treating patients with diabetic foot disease. Two themes emerged from the qualitative analysis: (1) poor self-care and the disease trajectory, and (2) effective hospital care. CONCLUSIONS: The results of this study highlight the key role that expert nurses play in the care of patients with DFS. Expert nurses considered that amputation leaves the individual physically and psychologically vulnerable, especially upon discharge from hospital. It is therefore essential to provide these patients with comprehensive and multidisciplinary care that includes emotional support.

Nurses' emotions on care relationship: A qualitative study.

AIMS: To describe nurses' experiences regarding the care relationship built with medical-surgical patients in acute hospitalization units and the association with their clinical practice. BACKGROUND: Nurses' commitment to care and their relationships as well are the core of quality of care. Nurses consider that the emotional commitment is essential to the profession, thus accepting to be exposed to emotional distress. METHODS: In-depth interviews were conducted to explore the experience of 23 nurses from seven Spanish hospitals. Taped interviews were transcribed verbatim and analysed according to inductive content analysis. RESULTS: Six subcategories emerged from the data analysis: Fulfilling experiences, Feeling the pain of others, Emotional distress, Stepping back, Seeking professional support, and Evolution of emotions, which were combined in two main categories: Nurses' emotions and Nurses' coping strategies. Patient's suffering, work environment and interprofessional relations influence the care relationship. CONCLUSIONS: Positive and negative emotions emerge spontaneously in professional relationships of experienced nurses. Lack of time and high workloads are factors that hinder the nurse-patient relationship. This care relationship is often the reason that fulfils them. Despite their level of expertise and having coping strategies, these are not always effective and, sometimes, nurses need professional help. IMPLICATIONS FOR NURSING MANAGEMENT: Nurses will continue performing their job with commitment; therefore, nursing managers should take care of their staff and pay attention to the emotional competence related to patients' relationships. Promoting self-care and a good working environment could improve their coping mechanisms.

La mirada de Watson, Parse y Benner para el análisis complejo y la buena práctica / The glance of Watson, Pair and Benner for the complex analysis and the good practice

La necesidad de encontrar el significado y orden del quehacer enfermero por encima de especialidades, culturas, tareas, funciones o competencias, hace necesario llevar a la práctica teorías y conceptos de análisis que se puedan insertar en cada situación, como fundamento que guía la buena práctica enfermera. Los modelos y filosofías enfermeras nos dan elementos de reflexión, nos siembran la duda respecto a la práctica, nos dan elementos de investigación y cuando los integramos o nos reconocemos en ellos, además de flexibilizar la interpretación y el cuidado persona-situación, colocan a la enfermería dentro de su marco más maduro consistente con el modelo de Nithingale actualizado. Este trabajo tiene como objetivo plantear lo que para nosotras son los elementos básicos de las filosofías y teorías de Watson, Parse y Benner, que nos permiten el análisis complejo de las situaciones de cuidados y la comprensión del juicio clínico, que emerge de la práctica como acontecimiento real. El paradigma de la complejidad nos lleva a prácticas responsables, a estar no en objetivos, sino en procesos, no en partes o en todos sino en individuos que son a la vez sujeto-objeto

The need to find the meaning of nursing activity independently of specialties, cultures, tasks, functions or competences, leads us to the usage of theories and concepts of analysis than can be applied in each situation, as a guide for the right nursing activity. Nursing philosophies and models provide us elements of reflection, creating doubts in relation to the practice, and once they are assumed, we recognize ourselves on them, helping us to the interpretation of the person-situation caring, carrying nursing to its matures side, validating Nigthingale's model. This work has the aim of implanting the basic elements of Watson, Parse and Benner's theories in order to analyze situations of caring and understand the clinical judgment emerging from the practice. The paradigm of complexity leads us to responsible practices, to think not in the objectives but in the process, not in parts or in wholes, but in subjects that are, at once, subject and object (AU)