Nurses' perceptions of the performance of nurse managers and senior hospital management during the COVID-19 pandemic.

BACKGROUND: The first waves of the COVID-19 pandemic had a negative impact on health systems and health professionals, due to the high number of cases and a lack of preparation. The aim of this study was to understand how nurses working in hospital units and in intensive care perceived the performance of nurse managers and senior hospital management during the first two waves of the pandemic. METHODS: The phenomenological approach proposed by Giorgi was used to investigate perceptions of the performance of nurse managers and senior hospital management during the first two waves of the COVID-19 pandemic in Spain. Fourteen clinical nurses who worked on the front line in inpatient units or intensive care units of the Health Services of Extremadura and Madrid in the first (March-April 2020) and second (October-November 2020) waves of the COVID-19 pandemic participated in this study. The data was collected through semi-structured interviews, following a script of themes, in a theoretical sample of nurses who were worked during the pandemic. RESULTS: Two main themes emerged from the analysis of the data: (1) perceptions about the performance of nurse managers and senior hospital managers during the first and second waves of the pandemic (health system failure; belief that senior hospital management professionals could have managed the pandemic better; recognizing the efforts of middle management (nursing supervisors); insufficient institutional support) and (2) strategies employed by nurses to compensate for the weaknesses in pandemic management. CONCLUSIONS: The clinical nurses perceived that the nurse managers demonstrated better management of the pandemic than the hospital's senior management, which they attribute to their proximity, empathy, accessibility, and ability to mediate between them and the senior management. The nurses also believe that the senior management of the hospitals was to blame for organisational failures and the poor management of the pandemic.

Nurses' Perceptions Regarding Their Professional Commitment and Development during the COVID-19 Pandemic.

INTRODUCTION: During the pandemic, nurses have undergone a high level of professional burnout, suffering emotional exhaustion, depersonalization, and lack of personal realization. OBJECTIVE: The object of this study is to understand in depth, through a phenomenological study of Giorgi, the perceptions on commitment and professional development of frontline nurses during the first and second waves of the COVID-19 pandemic. METHOD: Qualitative study designed and analyzed using Giorgi's phenomenological focus. For data collection, semi-structured interviews were utilized in a theoretical sample of frontline nurses who worked in public hospitals of Extremadura and Madrid, Spain, until saturation of data. The interviews were conducted between the months of May and December 2020 following an outline of topics. The analysis was based on the phenomenological focus of Giorgi and was supported by the software Atlas-Ti 8.0. RESULTS: A total of 14 nurses participated in this study. Two main themes emerged to explain the perceptions of the nurses: (1) the professional commitment of the nurses during the pandemic and (2) the effects of the pandemic on professional development; seven subcategories were also identified. CONCLUSION: The social and professional development of nurses is important. If nurses feel that they are quality professionals, this will enable them to protect their psychosocial health and increase professional commitment toward their patients in difficult situations such as pandemics. The results of this study may serve as a guide for better understanding the problems and needs of nurses as healthcare providers. This may help administrators in the generation of solutions for the establishment of a safe and reliable work environment, which will in turn promote a healthcare system that can efficiently respond to future catastrophes.

Efficacy of cognitive-behavioral therapy in improving the quality of life of people with compulsive gambling, a systematic review.

FUNDAMENTALS: Cognitive-behavioral therapy can reduce gambling behavior and other symptoms of pathological gambling. AIM: To synthesize and analyze the evidence on the efficacy of cognitive-behavioral interventions to improve the quality of life of people with pathological gambling. METHODOLOGY: Systematic review with a narrative synthesis of clinical trials published in English and Spanish in Medline, Scopus, Web of Science, CINAHL, The Cochrane Library Plus, PsycoInfo, and ProQuest of articles until January 2020 that will analyze this phenomenon. The PRISMA Declaration was followed and the quality of the articles was analyzed with the Jadad scale. RESULTS: 1233 articles were found, including nine in the review. Two studies confirmed the efficacy of cognitive behavioral therapy-based interventions for improving the quality of life in people with pathological gambling. In addition, these interventions improved depression, anxiety, the amount of money played, and reduced alcohol consumption and the gambling diagnosis score, which had an impact on improving the quality of life. Cognitive behavioral interventions were more effective when it was supported by a manual or when were combined with Mindfulness or Player Anonymous sessions. Having better long-term results in these cases. CONCLUSIONS: Cognitive behavioral-based interventions can improve the quality of life of people with pathological gambling and other psychological variables without being its immediate effect. Future research should analyze whether they are more efficacy online or in person, individually, or in groups, and the number of sessions required for their effects to last over time.

Nurses' Perceptions of Ethical Conflicts When Caring for Patients with COVID-19.

The COVID-19 pandemic has caused ethical challenges and dilemmas in care decisions colliding with nurses' ethical values. This study sought to understand the perceptions and ethical conflicts faced by nurses working on the frontline during the first and second waves of the COVID-19 pandemic and the main coping strategies. A qualitative phenomenological study was carried out following Giorgi's descriptive phenomenological approach. Data were collected through semi-structured interviews until data saturation. The theoretical sample included 14 nurses from inpatient and intensive care units during the first and second waves of the pandemic. An interview script was used to guide the interviews. Data were analyzed following Giorgi's phenomenological method using Atlas-Ti software. Two themes were identified: (1) ethical conflicts on a personal and professional level; and (2) coping strategies (active and autonomous learning, peer support and teamwork, catharsis, focusing on care, accepting the pandemic as just another work situation, forgetting the bad situations, valuing the positive reinforcement, and humanizing the situation). The strong professional commitment, teamwork, humanization of care, and continuous education have helped nurses to deal with ethical conflicts. It is necessary to address ethical conflicts and provide psychological and emotional support for nurses who have experienced personal and professional ethical conflicts during COVID-19.

The psychological impact on frontline nurses in Spain of caring for people with COVID-19.

AIM: To understand the perceptions of National Health System nurses who have been working on the frontline of the psychological impact of caring for people with COVID-19 during the first and second waves. METHODS: A qualitative study, the design and analysis of which was based on phenomenology. For data collection, a semi-structured interview was administered to a sample of nurses who worked on the frontline in public hospitals in Extremadura and Madrid, Spain. The interviews, which followed a script including various topics, were conducted between May and November 2020 so as to include the experiences of the first and second waves of the pandemic. Sample collection continued until data saturation. The data were analysed following the phenomenological method of Giorgi with the help of the Atlas-Ti software. RESULTS: Two main themes emerged from the data analysis that explained the nurses' perceptions: (i) the main psychological repercussions of being frontline carers (anxiety, fear, stress, impotence, frustration, and an increase in obsessions and obsessive behaviours) and (ii) psychological coping strategies (collapse in the face of the situation, dissociative amnesia, leaning on colleagues and working as a team, resigning oneself, perceiving the situation as a war, and being aware of psychological repercussions). DISCUSSION: Caring as the first line causes great psychological repercussions for nurses. It is necessary to implement psychological and emotional support programmes to address the post-traumatic stress that nurses can suffer.

Eficacia del ejercicio acuático en personas mayores de 50 años prefrágiles. Una revisión sistemática / Efficacy of aquatic exercise in pre-fragile people over 50 years old. A systematic review

Esta revisión sistemática, tipo síntesis narrativa, analiza la eficacia del ejercicio acuático en personas mayores de 50 años prefrági es que viven en la comunidad. Siguiendo la declaración PRISMA se realizó una búsqueda sistemática de ensayos clínicos aleatorizados, estudios cuasiexperimentales y revisiones sistemáticas publicados en inglés o castellano en Scopus, Medline (PubMed), Cochrane Library, Web of Science, ÍnDICEs CSIC, CUIDEN, PsycINFO, Cinahl y ProQuest. Siete estudios cumplieron los criterios de inclusión. El ejercicio acuático reportó incrementos significativos (p < 0,05) en la fuerza, funcionamiento ejecutivo, eficiencia del sueño, calidad de vida, estabilidad postural, índice de masa corporal, glucemia en ayunas, colesterol, rigidez y presión arterial. En un estudio, la fuerza y el equilibrio volvieron a niveles basales tras 6 semanas de desentrenamiento. Aunque el ejercicio acuático puede mejorar la calidad de vida de personas mayores prefrágiles, futuros estudios deben indagar en sus beneficios cardiovasculares y en las consecuencias del desentrenamiento (AU)

This systematic review, type narrative synthesis, analyses the evidence on the efficacy of aquatic exercise in pre-fragile people over 50 years living in the community. Following the PRISMA declaration we conduct a systematic search of randomized clinical trials, quasi-experimental studies, and systematic reviews published in English and Spanish in Scopus, Medline (PubMed), Cochrane Library, Web of Science, ÍnDICEs CSIC, CUIDEN, PsycINFO, Cinahl, and ProQuest. Seven studies fulfilled the inclusion criteria. Aquatic exercise reported significant increases (p < 0,05) in strength, executive functioning, sleep efficiency, quality of life, postural stability, body mass index, fasting blood glucose, cholesterol, arterial stiffness, and blood pressure. In one study, strength and balance returned to baseline levels after 6 weeks of detraining. Although aquatic exercise can improve the quality of life of pre-fragile older people, future studies should investigate their cardiovascular benefits and consequences of detraining (AU)

Individualised Care Scale-Nurse: Construct validity and internal consistency of the Spanish version.

BACKGROUND: Individualising the provided care is mandatory in nursing and is essential in clinical practice. Therefore, there is a need to develop accurate instruments to evaluate the quality of care. Moreover, there is no validated instrument to assess nurses' views of individualised care in Spanish-speaking countries. AIM: To assess the construct validity and internal consistency of the Spanish version of the Individualised Care Scale-Nurse. METHODS: A cross-sectional study including 108 nursing professionals (40.84 ± 9.51 years old, 86.1% female) was used to validate the Spanish Individualised Care Scale-Nurse version. A forward-back translation method with an expert panel and a cross-sectional study was used for transcultural adaptation and psychometric validation purposes. Psychometric properties of feasibility, reliability and validity were assessed. Construct validity was examined through a confirmatory factor analysis and fit indices of the overall model were computed. Internal consistency was explored through McDonald's omega and Cronbach's alpha coefficients among other correlation measures. RESULTS: The back-translation concluded both Spanish and English Individualised Care Scale-Nurse versions to be equivalent. The original structure of the Individualised Care Scale-Nurse was verified in the Spanish version through the confirmatory factor analysis (factor loadings >0.3; acceptable fit indices: SRMR ≈ 0.08, CFI ≈ 0.9, RMSEA ≈ 0.09 after posteriori modifications). McDonald's omega exceeded 0.7 for both subscales and complete scales revealing an adequate internal consistency. CONCLUSIONS: The Spanish version of the Individualised Care Scale-Nurse has exhibited good properties of homogeneity and construct validity for its use in practice and research in health care systems.

The Psychological Impact of COVID-19 on Front Line Nurses: A Synthesis of Qualitative Evidence.

Caring for people with COVID-19 on the front line has psychological impacts for healthcare professionals. Despite the important psychological impacts of the pandemic on nurses, the qualitative evidence on this topic has not been synthesized. Our objective: To analyze and synthesize qualitative studies that investigate the perceptions of nurses about the psychological impacts of treating hospitalized people with COVID-19 on the front line. A systematic review of qualitative studies published in English or Spanish up to March 2021 was carried out in the following databases: The Cochrane Library, Medline (Pubmed), PsycINFO, Web of Science (WOS), Scopus, and CINHAL. The PRISMA statement and the Cochrane recommendations for qualitative evidence synthesis were followed. Results: The main psychological impacts of caring for people with COVID-19 perceived by nurses working on the front line were fear, anxiety, stress, social isolation, depressive symptoms, uncertainty, and frustration. The fear of infecting family members or being infected was the main repercussion perceived by the nurses. Other negative impacts that this review added and that nurses suffer as the COVID-19 pandemic progress were anger, obsessive thoughts, compulsivity, introversion, apprehension, impotence, alteration of space-time perception, somatization, and feeling of betrayal. Resilience was a coping tool used by nurses. Conclusions: Front line care for people with COVID-19 causes fear, anxiety, stress, social isolation, depressive symptoms, uncertainty, frustration, anger, obsessive thoughts, compulsivity, introversion, apprehension, impotence, alteration of space-time perception, somatization, and feeling of betrayal in nurses. It is necessary to provide front line nurses with the necessary support to reduce the psychological impact derived from caring for people with COVID-19, improve training programs for future pandemics, and analyze the long-term impacts.

Eficacia de los agentes hemostáticos para el control de hemorragias externas en sanidad militar / Effectiveness of hemostatic agents to control external bleeding in military health

Introducción: Es creciente el uso de nuevos agentes hemostáticos para controlar la hemorragia en entornos militares. Objetivos: Sintetizar y analizar la evidencia disponible sobre la eficacia de diferentes agentes hemostáticos utilizados en ambientes tácticos, transportados por los combatientes del ejército. Desarrollo: Se realizó una revisión narrativa de artículos publicados en inglés y español, en las bases de datos Medline (PubMed), Cochrane, Web of Science y en revistas, protocolos, libros y manuales del ámbito de urgencias y emergencias en el campo de batalla, que analizaron el fenómeno de estudio y cumplieron los criterios de inclusión y exclusión. Tras la búsqueda y selección de los estudios, 7 artículos fueron incluidos en la síntesis narrativa. En los estudios se utilizaron los siguientes agentes hemostáticos QuikClot®, HemCon®, Celox® y el ChitoGauze HemCon®; en la mayoría de los estudios, los agentes hemostáticos tuvieron una eficacia superior al 88 por ciento para detener, disminuir y controlar la hemorragia externa en víctimas de combate, sobre todo en zonas de unión (articulaciones) y para reducir la morbilidad y mortalidad. Solo QuikClot® tuvo efectos secundarios negativos, al provocar quemaduras. El correcto manejo de los agentes hemostáticos requiere de formación previa, lo que evita errores de administración. Conclusiones: Los agentes hemostáticos son eficaces para el abordaje de la hemorragia externa y aumentan la supervivencia en víctimas de combate. Es necesario formar a los profesionales para evitar errores en su manejo. Futuros estudios deben indagar cuál de estos agentes es más eficaz(AU)

Introduction: The use of new hemostatic agents to control hemorrhage in military environments is growing. Objectives: To synthesize and analyze the available evidence about the effectiveness of the different hemostatic agents utilized in tactical environments that are transported by army fighters. Development: A narrative review of articles published in English and Spanish, in Medline (PubMed), Cochrane and Web of Science, and magazines, protocols, books, and manuals in the field of emergency and battlefield emergencies, who analyzed the study phenomenon and met the inclusion and exclusion criteria. After searching and selecting the studies, 7 articles were included in the narrative synthesis. In the studies, the following hemostatic agents were used QuikClot®, HemCon®, Celox®, and ChitoGauze HemCon®, in most studies, hemostatic agents were more than 88 percent effective in stopping, reducing, and controlling external hemorrhage in combat victims, especially in union areas, also decreasing morbidity and mortality. Only QuikClot® had negative side effects causing burns. The correct handling of hemostatic agents requires prior training, which avoids administration mistakes. Conclusions: Hemostatic agents are effective for treating external hemorrhage in combat victims and increasing their survival. It is necessary to train professionals to avoid mistakes in their handling. Future studies should investigate which of these agents is more effective(AU)

[The end-tidal carbon dioxide as an early sign and predictor of the return of spontaneous circulation during out-of-hospital cardiac arrest. A systematic review.] / El dióxido de carbono al final de la espiración como signo precoz y valor pronóstico de la recuperación de la circulación espontánea en la parada cardiaca extrahospitalaria. Una revisión sistemática.

BACKGROUND: There is no clear evidence on the maximum level of end-tidal carbon dioxide (ETCO2) predictor of the return of spontaneous circulation (RSC) after an out-of-hospital cardiorespiratory arrest. The aims of this work was to synthesise and analyse the available evidence on the usefulness of monitoring values ETCO2 in an out-of-hospital cardiorespiratory arrest as an early sign and prognostic indicator of the RSC. METHODS: Systematic review, with narrative synthesis of the results, of primary studies published in English or Spanish was conducted in Medline, CINAHL, Web of Science, EMBASE, Proquest, Scopus, Cochrane, ÍnDICEs CSIC and CUIDEN of studies that analyse the usefulness of monitoring of the level of ETCO2 as a sign of the RSC after an out-of-hospital cardiorespiratory arrest. PRISMA declaration was followed. The risk of bias was assessed with the Newcastle-Ottawa Scale. RESULTS: 1,011 studies were found, eight of which fulfilled the inclusion criteria. The studies reported an association between the abrupt increase in ETCO2 and RSC to disagree on the predictive cut-off points (an increase than 10 mmHg and initial values or three minutes greater than 10 mmHg or 19 mmHg). The studies were of moderate to high methodological quality. CONCLUSIONS: ETCO2 values correlate with the RSC in adults with cardiorespiratory arrest and could predict non-survival, so they should be incorporated into advanced life support algorithms and Utstein-style reports.

OBJETIVO: No existe evidencia robusta sobre el nivel máximo de dióxido de carbono al final de la espiración (ETCO2) predictor de la recuperación de la circulación espontánea (RCE) tras una parada cardiorrespiratoria extrahospitalaria. El objetivo de este trabajo fue sintetizar y analizar la evidencia disponible sobre la utilidad de la monitorización de los valores del ETCO2 en la parada cardiorrespiratoria extrahospitalaria como signo precoz e indicador pronóstico de la RCE. METODOS: Revisión sistemática, con síntesis narrativa de los resultados, de artículos primarios publicados en inglés o castellano en Medline, CINAHL, Web of Science, EMBASE, Proquest, Scopus, Cochrane, ÍnDICEs CSIC y CUIDEN que analizaran la utilidad de la monitorización de los niveles de ETCO2 como signo de la RCE tras una parada cardiorrespiratoria extrahospitalaria. Se siguió la declaración PRISMA. El riesgo de sesgo fue evaluado con la Escala Newcastle-Ottawa. RESULTADOS: 1.011 fueron encontrados, cumpliendo ocho los criterios de inclusión. Los estudios reportaron una asociación entre el aumento abrupto de ETCO2 y la RCE discrepando en los puntos de corte predictores (un aumento mayor a 10 mmHg y valores iniciales o a los tres minutos mayores de 10 mmHg o 19 mmHg). La calidad metodológica de los estudios fue de moderada a alta. CONCLUSIONES: Los valores de ETCO2 se asocian con la RCE en adultos con parada cardiorrespiratoria pudiendo predecir la no supervivencia, por lo que deberían incorporarse a los algoritmos de soporte vital avanzado y a los informes estilo Utstein.

Potencialidades de la resiliencia para los profesionales de Enfermería / Potentialities of resilience for nursing professionals

Justificación: la resiliencia aporta una visión esperanzadora del padecimiento siendo una herramienta clave para la promoción de la salud. Objetivo: conocer las potencialidades de la resiliencia para los profesionales de Enfermería tras el análisis de la evidencia científica. Metodología: revisión narrativa en las bases de datos MEDLINE (PubMed), Scopus, Scielo, Dialnet y Cuiden de artículos que indagaran en las potencialidades de la resiliencia para los profesionales de Enfermería. Fueron analizados 17 artículos. Resultados: la resiliencia mejora las fortalezas personales de los profesionales, su capacidad de afrontamiento y los cuidados prestados, disminuyendo la vulnerabilidad y la prevalencia de estrés postraumático, ansiedad, depresión y Síndrome de Burnout. Conclusión: la resiliencia es un factor protector de la salud y una herramienta útil para la promoción de la salud, la mejora de las fortalezas personales y de los cuidados prestados. Es necesario incorporar la resiliencia a los programas de formación y reciclaje profesional

Justification: resilience offered a hopefulvision for affliction and is a key tool for health promotion. Aim: to know the potentialities of resilience for nursing professionals after analysis of scientific evidence. Methodology: narrative review in databases MEDLINE (PubMed), SCOPUS, Scielo, Dialnet and CUIDEN of articles exploring the potentialities of resilience for nursing professionals. 17 articles were analysed. Results: resilience improves professionals’ personal strengths, their coping capacities, and the caregiving, reducing the vulnerability,and prevalence of post-traumatic stress, anxiety, depression, and Burnout Syndrome. Conclusion: resilience is a protective factor of health and an effective tool for health promotion, improving personal strengths and the caregiving. Resilience needs to be integrated into training and re-training programs