Stress, mental health, and protective factors in nursing students: An observational study.

BACKGROUND: Nursing students suffer high levels of stress, especially in the first year. OBJECTIVES: to compare academic stress at the beginning and end of nursing studies; to analyse the relationships between academic stress, mental health, and protective factors; and to examine whether resilience mitigates the effect of academic stress on psychological well-being. DESIGN: A cross-sectional study. SETTING AND PARTICIPANTS: Sample was 370 first- and fourth-year nursing students from Spain (University of Castilla-La Mancha, University of Cantabria, and University of Sevilla). VARIABLES AND DATA COLLECTION: We assessed academic and clinical stress, coping skills, anxiety, depression, psychological well-being, and resilience were measured. DATA ANALYSIS: We performed a descriptive analysis of the study sample, as well as correlation and hierarchical regression models. Additionally, mediation models were estimated. RESULTS: First-year students presented higher academic stress than fourth-year students. Clinical stress, anxiety, depression, and emotional coping predicted academic stress, while academic stress, depression, and coping skills predicted psychological well-being. Mediation models showed a significant path between academic stress, resilience, depression, and psychological well-being. CONCLUSION: Academic stress has a detrimental effect on the mental health. Coping strategies and resilience may be protective factors that should be encouraged in interventions designed to improve psychological well-being.

Lifestyle in Emerging Adults with Type 1 Diabetes Mellitus: A Qualitative Systematic Review.

Emerging adulthood is a transitional stage with significant lifestyle changes, making it especially challenging for those living with type 1 diabetes mellitus. This systematic review synthesizes qualitative research to explore how emerging adulthood (18-29 years) influences lifestyle behaviors in individuals with type 1 diabetes mellitus. CINAHL, Cochrane Library, Global Health, Nursing & Allied Health Premium, PsycINFO, PubMed, Scopus, and WOS were searched for original qualitative studies addressing the lifestyle of 18-31-year-olds with type 1 diabetes mellitus, published between January 2010 and March 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Thirty-five studies met the inclusion criteria and their findings were categorized into eight topics (emotions and feelings, nutrition, perceptions, risky behaviors, self-care, sleep, social relationships, and stigma) using meta-aggregation, as outlined in the Joanna Briggs Institute Manual for Evidence Synthesis. The spontaneity characteristic of emerging adulthood can undermine self-care. This is because new environments, schedules, and relationships encountered during this life stage often lead to the neglect of diabetes management, owing to the various social, academic, and occupational demands. This review highlights the necessity of creating health promotion strategies tailored to the unique lifestyle aspects of emerging adults with type 1 diabetes mellitus.

Effect of a Podiatric Health Education Intervention on the Level of Self-care in Patients with Diabetes Mellitus.

OBJECTIVE: To test the effect of a podiatric health education activity on foot self-care and the degree of foot-related disability in a group of people with diabetes mellitus (DM) in the province of Seville. A pretest-posttest quasi-experimental design was used. METHODS: Twenty-nine people with DM participated. The intervention was a podiatric health education activity consisting of a 1-hour informative talk. Foot pain-related disability was measured using the Manchester Foot Pain and Disability Index. The degree of foot self-care was measured with the University of Malaga Foot Self-care questionnaire. RESULTS: One month after the intervention, both parameters had improved significantly. The mean score on the Manchester Foot Pain and Disability Index increased from 59.96 (SD, 8.69) at baseline to 67.39 (SD, 6.99) at 1 month, and the mean score on the University of Malaga Foot Self-care questionnaire improved from 11.65 (SD, 20.07) at baseline to 4.52 (SD, 5.47) after 1 month. CONCLUSIONS: Therapeutic education increases the level of self-care and decreases the degree of foot-related disability in people with DM.

Sociodemographic and Clinical Determinants on Health-Related Quality of Life in Emerging Andalusian Adults with Type 1 Diabetes: A Cross-Sectional Study.

(1) Background: Having type 1 diabetes during emerging adulthood can impact quality of life due to the challenge of balancing optimal glycemic blood levels with a period of transition and exploration. The purpose of this study was to characterize the quality of life of emerging adults aged 18 to 29 years with type 1 diabetes and to determine the associations between dimensions of Health-Related Quality of Life in type 1 diabetes and sociodemographic and diabetes-related variables. (2) Methods: This cross-sectional descriptive study was conducted in Andalusia, Spain, from October 2021 to July 2022. A total of 362 emerging adults with type 1 diabetes (67.4% women, mean age 22.8 ± 3.4 years) participated. Data were gathered via sociodemographic information form and the ViDa1 scale. Statistical evaluations, encompassing descriptive analyses, t-tests, ANOVA, Pearson correlations, and logistic regression, were conducted using SPSSv26, adhering to STROBE guidelines. (3) Results: Among the participants, 52.1% have a glycosylated hemoglobin level over 7%. Interference with Life is correlated with sex, age, and age at diagnosis, with age being the only predictor. Self-Care is correlated with and predicted by glycosylated hemoglobin levels. Well-being is correlated with and predicted by sex, Body Mass Index, and glycosylated hemoglobin levels. Concern about the Condition is correlated with and predicted by sex and glycosylated hemoglobin levels. (4) Conclusions: Despite concerns about their disease, participants generally maintain optimal levels of Health-Related Quality of Life in type 1 diabetes. Predictive factors for Health-Related Quality of Life in type 1 diabetes in this group include sex, age, Body Mass Index, and glycosylated hemoglobin.

COVID-19 Infection among Nursing Students in Spain: The Risk Perception, Perceived Risk Factors, Coping Style, Preventive Knowledge of the Disease and Sense of Coherence as Psychological Predictor Variables: A Cross Sectional Survey.

The exploration of patterns of health beliefs about COVID-19 among nursing students may be beneficial to identify behaviors, attitudes and knowledge about contagion risk. We sought to analyze the variables of risk perception, perceived risk factors, coping style, sense of coherence and knowledge of preventive measures as possible predictors of having suffered from COVID-19. Participants were nursing students from 13 universities in Spain. Sociodemographic and health variables were collected. To test the independent variables, the Perception Risk Coping Knowledge (PRCK-COVID-19) scale was created and validated because there was no specific survey for young people adapted to the pandemic situation of COVID-19. It was validated with adequate psychometric properties. A total of 1562 students (87.5% female, mean age 21.5 ± 5.7 years) responded. The high perception of the risk of contagion, the high level of knowledge and a coping style focused on the situation were notable. Significant differences by gender were found in the coping styles, problem-focused, avoidance and knowledge scales, with women scoring higher in all categories. The multiple regression analysis was significant (F = 3.68; p < 0.001). The predictor variables were the coping styles subscale search for support and the intrinsic and extrinsic perceived risk factors. Our model predicts that nursing students with a social support-based coping style are at a higher risk of becoming infected with COVID-19, based on their own health belief model.

Design and Validation of a Questionnaire on Risk Perception, Coping Behaviors and Preventive Knowledge against COVID-19 among Nursing Students.

As shown in the previous literature, in view of the future responsibilities of nursing professionals and the consequences for healthcare, it is of great interest to examine their risk perceptions, coping behaviors, and sense of coherency during the COVID-19 pandemic. The purpose of this study is to design and to validate a specific questionnaire that evaluates the factors relating to perceived risk, coping behaviors, and preventive knowledge against COVID-19 infection among nursing students from Spain. This is a psychometric study of a questionnaire's design and its validation in 1562 nursing students at 16 undergraduate nursing institutions in Spain. An ad-hoc survey was designed by a panel of six experts drawing from the literature. After a trial test, the questionnaire was formed with four scales (perception, risk, coping, and knowledge of preventive practices for COVID-19), with a total of 69 items. The final questionnaire was composed of 52 items grouped into four scales, with good psychometric properties to measure risk perception (Cronbach's alpha 0.735), factors related to perceived risk (Cronbach's alpha 0.653), coping behaviors (Cronbach's alpha 0.80), and knowledge of preventive practices against COVID-19 (Cronbach's alpha 0.77). This questionnaire, specifically designed and validated for nursing students, is the first to address four important areas in the development of preventive measures against COVID-19.

Do health literacy levels of nursing students change throughout the study programme? A cross-sectional study.

OBJECTIVES: The aim of this research was to analyse if the level of health literacy (HL) of nursing students changes throughout the study programme. DESIGN: A cross-sectional study with anonymous self-reporting was conducted. PARTICIPANTS/SETTING: 329 public university nursing students in Seville, Spain; 243 of the first year and 86 of the fourth. INTERVENTIONS: The short Spanish version of the Health Literacy Survey Questionnaire-European Union was used to evaluate HL. PRIMARY AND SECONDARY OUTCOME MEASURES: The proportions of the limited level of HL were compared between academic years and the crude and corrected OR were calculated with the Mantel-Haenszel test to evaluate the effect of confusion of the sex variable on the HL level and academic year relationship. A logistic regression model with step-by-step analysis was run, including the independent variables sex, age, marital status, academic year and HL level (limited/sufficient) as the dependent variable. RESULTS: 62.1% of the participants of the first year versus 47.7% of the fourth year had a limited literacy level for a crude OR of 1.5 (95% CI 1.10 to 2.21; p=0.014) and a corrected by sex OR of 1.8 (95% CI 1.10 to 2.96; p=0.026). Only the strata in women had a statistically significant relationship. The logistic regression model ratified that the HL was a function exclusive to the academic year. CONCLUSION: The HL level of nursing students increases from the first to the fourth academic year, even when controlling for sex. Although the HL level in the fourth academic year was greater than that of the first, both groups had inadequate HL levels. It is hence recommended to implement intervention strategies, which reinforce in the curriculum the knowledge and experiences related with health communication and education to ensure that future professionals improve their HL. Achieving adequate HL is crucial to be able to provide care to patients, their families and the community.

Burnout, Compassion Fatigue and Psychological Flexibility among Geriatric Nurses: A Multicenter Study in Spain.

Nurses working at nursing homes are one of the most vulnerable populations for suffering burnout and compassion fatigue. In Spain, the concept of compassion fatigue and psychological flexibility related to stress in geriatric nurses has not been fully explored until now. It is important to analyze their situation in order to design robust coping and management strategies. The aim was to analyze the relationship between burnout, compassion fatigue and psychological flexibility in geriatric nurses in Spain. Participants included 291 nurses from 97 centers in 51 cities across Spain. Psychological flexibility (AAQ-II), burnout (MBI) and compassion fatigue (ProQOL) were evaluated. Responses were recievced from 281 nurses (91% women), with an average of 7.6 years of work experience. The MBI results were average (26.71), and the ProQOL scores were average for compassion fatigue (40.2%) and high for compassion satisfaction (70.3%), whereas for AAQ-II, the mean score was 37.34 (SD 4.21). The correlation was significant and negative for flexibility, burnout and compassion fatigue, and positive for compassion satisfaction. The ANOVA indicated a significant association between all variables (p < 0.05). We can conclude that geriatric nurses suffer from medium levels of burnout and compassion fatigue, together with high levels of psychological flexibility, which appears to act as a stress reliever, supporting compassion satisfaction.

Design of the EBE-ST Questionnaire among Nursing Students: Multicenter Study from Eight Universities in Spain.

BACKGROUND: Twenty years after the degree in nursing was introduced in Spain, the subject of evidence-based nursing is still unstructured and unestablished in most faculties. Moreover, there are hardly any rigorous studies at a national level that evaluate the current state of this competence in our faculties. Understanding the starting point is essential for the curricular design to ensure that evidence-based practice is implemented among future professionals. AIM: To design and validate an evidence-based nursing competency questionnaire for fourth-year nursing students. METHODS: A specific questionnaire was developed and validated (EBE-ST). A cross-sectional survey design with psychometric validation of an instrument. Participants were 304 senior year nursing students from eight universities in Spain (2020). RESULTS: The EBE-ST questionnaire is composed of 33 items that determine eight factors. It presents adequate reliability and validity (alpha = 0.882), measuring knowledge, attitudes and the practical application of evidence-based practice. CONCLUSIONS: We have created an instrument with good psychometric properties to measure evidence-based practice competence among senior nursing students. The heterogeneity of knowledge regarding evidence-based nursing in our country suggests that further reflection is warranted on the incorporation of this topic during undergraduate training. We have designed and validated an evidence-based nursing competency questionnaire specific to nursing students.

The Suffering of Advanced Chronic Renal Patients and Their Relationship with Symptoms in Loja, Ecuador.

Advanced Chronic Kidney Disease (ACKD) supposes a public health problem in Ecuador that requires a comprehensive approach. In view of the scarcity of studies on the subject in this country, the objective of this research was to determine the signs and symptoms associated with the patients' physical, social and psychological spheres that allow properly developing palliative care. A longitudinal, prospective and observational study was conducted with ACKD patients. In order to assess the symptomatic burden and suffering of these patients, the Edmonton Symptom Assessment System Revised: renal (ESAS-r) for renal patients and the Distress Thermometer (DT) were used. The sample consisted of a total of 246 patients. The most common symptoms that affect them, causing them suffering in their daily lives, are those related to well-being, difficulty falling asleep and itching. It is necessary that health professionals adapt care measures and help patients undergoing renal treatment, especially those who have suffered the disease for a longer period of time, in order to alleviate the patients' suffering and therefore improve their daily lives. To such an end, a care plan could be designed that includes early palliative care.

Study of the Distortion of the Indirect Angular Measurements of the Calcaneus Due to Perspective: In Vitro Testing.

The study of the foot is relevant in kinematic analyses of gait. Images captured through a lens can be subjected to various aberrations or distortions that affect the measurements. An in vitro study was performed with a rearfoot simulator to compare the apparent degrees (photographed) with the real ones (placed in the simulator) in the plane of the rearfoot's orientation, according to variations in the capture angle in other planes of space (the sagittal plane and transverse plane-the latter determined by the foot progression angle). The following regression formula was calculated to correct the distortion of the image: real frontal plane = 0.045 + (1.014 × apparent frontal plane) - (0.018 × sagittal plane × foot progression angle). Considering the results of this study, and already knowing its angle in the transverse and sagittal planes, it is possible to determine the angle of a simulated calcaneus with respect to the ground in the frontal plane, in spite of distortions caused by perspective and the lack of perpendicularity, by applying the above regression formula. The results show that the angular measurements of a body segment made on frames can produce erroneous data due to the variation in the perspective from which the image is taken. This distortion must be considered when determining the real values of the measurements.

Social Support and Peer Group Integration of Adolescents with Diabetes.

The aim of this study was to examine, through the roles of peers with regards to diabetes, the relationship between the support perceived by adolescents with diabetes and their peer-group affiliation. This is a descriptive, phenomenological and retrospective study based on a qualitative methodology. In-depth interviews with 15 people aged 18-35 with type 1 diabetes mellitus diagnosed in their childhood or adolescence were carried out. Data was analyzed through the interpretation of general discourses. Peers have considerable influence on adolescents and provide them social support from different roles. The protective role basically offers emotional support and sends reminders of different aspects of the treatment, while the indifferent role does not meddle in any aspect related to the diabetes. Both roles can foster social integration of adolescents with diabetes into the peer group. The offender role creates social conflicts through discrimination and stigma of adolescents with diabetes. These roles appear during the process of socialization of adolescents with diabetes, where commensality and situations of self-monitoring or administering insulin, key aspect of diabetes treatment, are crucial. Peer groups, depending on the role adopted, may offer support or bring a specific conflict regarding diabetes to their adolescent peer. The combination of roles that friends and peer group play with regards to diabetes will determine the degree of socialization and integration of adolescents with diabetes.

Importance of Mediation against Addictive, Affective-Emotional, and Sexual Behavior in Adolescents. Educational System versus Associations.

This article analyzes health mediation among equals as an educational strategy against risk behaviors in young people from both the educational and associative systems in Seville (Spain), based on qualitative research, with the aim of assessing and comparing its impact in those areas. To this end, interviews with 49 professionals and 427 adolescents were conducted in discussion groups. Results acknowledge mediation as individual or group intervention accepted by young people as advice and information on health issues and conflict resolution, but also as a method for data collection in order to obtain a community health diagnosis. The educational system implements this strategy, but in associations it seems to work better, particularly in the psycho-emotional and sexual spheres. Unfortunately, intervention programs are usually discontinuous due to lack of resources and territorial variability. And this is why mediators' support is highly valued by the target users, with preference for a male figure in the case of boys, and larger predisposition towards a female mediator in girls, except in cases where this agent has a special social relevance.

Nursing Students' Satisfaction: A Comparison between Medium- and High-Fidelity Simulation Training.

Training based on clinical simulation is an effective method of teaching in nursing. Nevertheless, there is no clear evidence about if it is better to use high- or medium-fidelity simulation. The aim is to analyse if students are more satisfied when their clinical simulation practices are based on high-fidelity simulation (HFS) or medium-fidelity simulation (MFS). Students´ satisfaction was assessed using the Satisfaction Scale Questionnaire with High-Fidelity Clinical Simulation. The sample is composed of 393 students from two Spanish Universities. Satisfaction with simulation in nursing students is significantly greater in MFS than HFS. Simulation is beneficial for learning in all its forms, but for the acquisition of basic skills, and at a lower cost, MFS proves to be effective. However, high-fidelity is not always better than medium-fidelity as this depends on the student's level of knowledge and clinical experience.

Countries' cultures and professional nursing values: Cross-cultural evidence from Spanish and Colombian nursing students.

This study aimed to identify countries' cultural values associated with the importance given to certain professional nursing values by nursing students from Spain and Colombia. Weis and Schank's Nurses Professional Values Scale-Revised (NPVS-R) in its Spanish version and the Hofstede cultural classification were used for this purpose. The sample was composed of 880 nursing students. Nursing students from both countries showed a greater importance for professional nursing values compared to evidence from other countries. Significant differences were also found in the total score, dimensions, and items, always being higher for Colombian students. Based on regression results, the impact that the academic year had on the importance given to NPVS-R is non-linear (U-inverted). Both groups of students gave the highest importance to the same group of items. Those showing the largest difference in the rankings were associated with country culture differences based on the scores identified by Hofstede. Colombian and Spanish societies present similarities in Power Distance and Uncertainty Avoidance, as well as differences in the other cultural dimensions.

Changes in anti-fat attitudes among undergraduate nursing students.

BACKGROUND: The number of people with obesity has been increasing significantly in recent decades. Nursing students play a role in the care of obese patients, but the presence of a stigma regarding this patient group reduces the quality of care due to a climate of mistrust and lack of expectations. OBJECTIVES: To analyse if the anti-fat attitudes of nursing students at the Faculty of Nursing, Physiotherapy and Podiatry at Universidad de Sevilla (Spain) change during their degree training. DESIGN: A cross-sectional study was carried out. SETTINGS: Undergraduate nursing institution in Spain. PARTICIPANTS: 578 nursing students enrolled at the Faculty in all academic years, from the first through the fourth. METHODS: Following ethical approval, each participant took part in an individual self-report via the Anti-Fat Attitudes (AFA) Questionnaire, in its validated Spanish version. RESULTS: The mean standardised AFA total was 2.29.; by domains: 1.29 in Dislike, 2.87 in Fear of fat, and 3.73 in Willpower. Analysis of variance tests showed significant differences in the AFA total score and domains by sex and academic year. Multiple linear regression analysis demonstrated that the highest prejudices were shown by enrolled participants in their first year, particularly when the AFA total score was considered. CONCLUSIONS: Nursing students at the Faculty do not have many prejudices towards obese people. Anti-obesity attitudes among nursing students decrease as the students progress in their degree, implying that the specific training received (degree curriculum) also enables students to develop their non-technical skills.

The invasive land flatworm Obama nungara (Platyhelminthes: Geoplanidae) reaches a natural environment in the oceanic island of São Miguel (Açores).

During an entomological sampling trip in the island of São Miguel (Açores, Portugal) on 02-11-2019 by José Rafael González-López, one specimen of the invasive flatworm Obama nungara Carbayo et al. 2016 was found under a rock (Fig. 1A). The specimen was photographed in situ and identified by its external morphology based on its large and broad leaf-like body with nearly parallel body margins, narrow and rounded anterior end, rounded posterior end, and dorsal pigmentation consisting of a light brown ground color covered with dark longitudinal and irregular stripes, and ventral surface grayish-white. Recent studies (Justine et al. 2020; Negrete et al. 2020) showed the reliability of photograph-based identification of O. nungara specimens. It is the sixth island where this species has been found (after Guernsey, Great Britain, Ireland, Corsica, and Madeira).

Risk factors concerning complications following permanent pacemaker implantation for patients on antithrombotic therapy: a cohort study.

The objective of this study was to identify the complications and associated factors presented by patients after pacemaker implantation, according to a regimen of antithrombotic therapy or without it. This is an analytical observational study on a prospective cohort of 310 consecutive patients with a permanent pacemaker implanted, included from January 1 to December 31, 2014 from 1 single center. The follow-up was conducted on 310 patients for 6 months. 239 patients (77%) received antithrombotic therapy at the time of the pacemaker implantation. 20.8% of complications are presented in patients without anticoagulant therapy, 80.8% of them being minor ones. In the case of patients with anticoagulant therapy, 30.3% of the complications are major ones. Factors associated with major complications were contusion (OR 2; 95% CI 1 to 3.8; p=0.049), and minor complications, arm immobilization >24 hours (p=<0.001) and contusion (p=0.002). This study found an increase in the overall risk and complications that can occur when implanting a permanent pacemaker in patients with antithrombotic therapy based on the time of immobilization and contusions after the implantation.

The Spanish version of the stressors in nursing students scale.

WHAT IS KNOWN ON THE SUBJECT?: The mental health of health professionals is affected by their own work. Nurses and nursing students face high levels of stress, which results in anxiety, burnout, and depression. There are scales that allow the measurement of specific stress levels of nursing students, especially when they first attend their clinical practices in real settings such as hospitals. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Our study consists of validating an existing scale (the Stressors in Nursing Students Scale, SINS) that measures these stress levels in Spanish. Stress is an issue for nursing students and is related to the specific stressors they encounter in the process of their professional work and study. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The validation and adaptation of this scale to Spain will allow us to adequately assess the stress levels of our students to give them adequate tools for the emotional control of their anxiety and stress. Once we have a reliable and appropriate tool for measuring the factors of greater impact in the generation of stress, we can implement preventive measures which may be very useful for the control of anxiety. ABSTRACT: Introduction Nursing professionals and students suffer a greater number of stressors with negative health consequences. Aim To translate and test a Spanish version of the Stressors in Nursing Students Scale (SINS-S), with a cohort of nursing students in Spain. Also, we sought to examine the factor structure of this test and explore the psychometric structure of stress among this population. Method The SINS scale was translated into Spanish and administered to a cohort (n = 398) of male and female Spanish nursing students in the final three years of their nursing program. Data were analyzed using exploratory factor analysis. Results Exploratory factor analysis revealed four factors: "Clinical," "Financial," "Confidence," and "Education." Discussion There were similarities between the perception of stressors by nursing students in Spain compared with the original version of the SINS from the United Kingdom. Stress is an issue for nursing students and is related to the specific stressors they encounter in the process of their professional work and study.

Determinants of Physical Activity Performed by Young Adults.

Despite the World Health Organization considering it important to promote physical activity as part of a healthy lifestyle, the official data show an increase in the percentage of physical inactivity, which has brought about the development of strategies at different levels (national and international) to reverse this trend. For the development of these strategies, it is relevant to know what the determinants of physical activity (at leisure and at work) are. Therefore, this is going to be analysed in the autochthonous young adults from Seville. A cross-sectional survey of their health behaviours was carried out. The sample was selected through a proportionally stratified random sampling procedure. From the results, we highlight that the general perceived health status is good and that most physical activity is performed during leisure time. However, a majority of the population analysed reported overweight or obesity. Participants with a low perceived health status, those who have low social support from their family and friends, and those who do not smoke are the ones who have more probability of engaging in physical activity during their leisure time. However, gender, education level, and alcohol consumption are revealed as determinants of the intensity of physical activity at work. In this regard, men and/or participants with a low level of studies are those who carry out more physically demanding activities at work.