Evaluación de la simulación de alta fidelidad con actores en cuidados paliativos y estudiantes de Enfermería: un estudio de método mixto / Assessment of high fidelity simulation with actors in palliative care in nursing students: A mixed methods study

Objetivo: Los métodos formativos más efectivos son los experienciales, y entre ellos, los que están centrados en las vivencias y emociones. La simulación clínica, especialmente la de alta fidelidad, es una de las metodologías más efectivas para la adquisición de competencias en cuidados. La simulación con actores puede preparar a los futuros sanitarios en técnicas y competencias intelectuales e interpersonales. El objetivo fue valorar la simulación de alta fidelidad con actores como herramienta en la formación de cuidados paliativos en estudiantes de enfermería. Método: Durante tres años se realizó el estudio en la Facultad de Enfermería de la Universidad de Murcia con estudiantes de enfermería. Se realizó un estudio de método mixto con un diseño secuencial explicativo en tres momentos: 1)Estudio cuasi-experimental con grupo único (n=12) antes y después de cursar la asignatura de cuidados paliativos donde se realizó simulación clínica y se evaluaron competencias de comunicación mediante la escala CICAA. 2)Estudio cualitativo fenomenológico tras la simulación (174 narrativas reflexivas de estudiantes). 3)Estudio transversal observacional, un año después, para valorar la transferencia a la clínica de conocimientos y habilidades (contestaron 71 estudiantes). Resultados: La simulación de alta fidelidad con actores mejora las habilidades comunicativas y la capacidad para establecer una relación de ayuda eficaz tanto con pacientes en la fase final de la vida como con sus familiares. Es una metodología de aprendizaje innovadora, útil y que fomenta la reflexión y el traslado del aprendizaje a la clínica. Conclusiones: Se recomienda la estandarización de metodologías activas de aprendizaje para mejorar la adquisición de habilidades transversales como las de comunicación en cuidados paliativos.(AU)

Objective: The most effective training methods are experiential, including those focused on experiences and emotions. Clinical simulation, especially high-fidelity simulation, is one of the most effective methodologies for the acquisition of competencies in care like palliative care. The simulation with actors can train future healthcare science professionals in technical, intellectual, or interpersonal skills. The objective is to evaluate high-fidelity simulation with actors as a tool in palliative care training for nursing students. Method: Over three years, the study was conducted in the Faculty of Nursing of Murcia with nursing students. A mixed methods study with sequential explanatory design in three moments was conducted: 1)Quasi-experimental study in a single group (n=12) before and after attending the palliative care course with clinical simulation with actors to assess the communication skills (CICAA scale). 2)Qualitative study with phenomenological perspective after clinical simulation (174 reflective students’ narratives). 3)Cross-sectional observational study, one year later, to assess the transfer of knowledge and skills to the clinical practice (71 students). Results: Students who interacted with actors in clinical simulation improved their communication skills and the ability to establish an effective helping relationship with both end-of-life patients and their families. The students perceived the clinical simulation as an innovative learning methodology that is useful to encourage reflection and transfer of learning during their clinical internship. Conclusions: Standardization of the use of active learning methodologies is recommended for a better acquisition of transversal skills such as communication skills in palliative care.(AU)

Fighting for inclusion across borders: Latin American Trans women's health in Canada.

Background: Worldwide, Trans women from Latin America experience some of the highest rates of violence, which has led many to emigrate. There is limited research exploring the experiences of Trans migrants, and most LGBTQI2S + migrant research focuses on immigrant gay men. This study uses the frameworks of Intersectionality and the Social Determinants of Health (SDoH) to examine the impact of migration on the health and wellbeing of Latin American Trans women living in Toronto, Canada. Methodology: This qualitative arts-based study included nine participants and used hand mapping, a sociodemographic questionnaire, and focus groups to generate data. Data analysis encompassed inductive and deductive approaches and rigor was maintained through reflexivity and several verification strategies. Results: While migration was used as a safety strategy, participants' multiple identities as immigrants, Trans women, and Latinas, produced compounded experiences of oppression post-migration. Facing transphobia and xenophobia simultaneously, participants were forced to navigate precarious housing and employment, minimal social capital, and low social position. This limited their ability to exercise power and ultimately caused poor health and wellbeing post-migration; however, participants used sophisticated strategies to resist asymmetrical power relations, actively searching for safety and community participation, and caring for themselves and each other. Conclusion: The participants fought for inclusion across borders of economic exclusion and gender identity, borders of power and social position, as well as geopolitical borders. Their intersectional experiences across these "borders" should be understood in the context of migration without liberation, consumption without income, compounding oppressions, as well as positive intersectionality. While the women's resistance and strength are positive by-products of fighting oppression, they cannot be the solution. Access to health and wellbeing should not be a privilege for some; it must be a right for all.

Migration of Latin American nurses to Spain 2006-2016: a case study.

AIM: To examine the migration of nurses from Latin America to Spain over the period from 2006 to 2016. BACKGROUND: This study examines the impact of the 2008 global economic crisis on migration flows of nurses to Spain from its major source countries of Latin America. METHODS: Using an exploratory case study, we present original data provided by the Ministry of Education, Culture and Sport of the Government of Spain upon request on applications and success rates for credential recognition of nurses intending to immigrate to Spain, with an extended analysis of Latin American applications which account for the 70% of skilled worker migration to Spain. RESULTS: Successful applications for credential recognition of overseas nursing qualifications plummeted from a peak of 1384 in 2007 to 55 in 2016. Migration intentionality also decreased but has undergone a slight increase in recent years. DISCUSSION/CONCLUSION: We found that the economic crisis effectively closed the door to internationally educated nurses to work as nurses in Spain. Moreover, the denial of official recognition of nursing credentials appears to be unaffected by the existence of bilateral trade and mobility agreements between Spain and source countries. We conclude that the level of nursing migration to Spain is a sensitive indicator of domestic labour market conditions. IMPLICATIONS FOR HEALTH POLICY: Despite the lack of any transparent policy on the credential approvals, in practice the government is limiting access to the nursing labour market by overseas education nurses. We urge that attention be paid by health human resource planners on the intersection between labour market and migration trends to support a transparent and data-informed discussion by all stakeholders on the current state of the nursing labour market in Spain and its future needs.

Propuesta de un método para la valoración médico legal del perjuicio estético por cicatrices / A proposal for a method of forensic medical evaluation of the aesthetic damage of scarring

Una de las principales actividades en el ámbito médico forense es la valoración del perjuicio estético. Son diferentes los métodos recogidos en la literatura para efectuar esta valoración, pero sólo tres son dirigidos exclusivamente al daño estético ocasionado por cicatrices. Proponemos en este trabajo un método para la valoración médico legal del perjuicio estético por cicatrices: inicialmente se valoran y puntúan tres parámetros: zona del cuerpo donde está la cicatriz, longitud en centímetros y distancia a la que se ve la cicatriz. Cada uno de estos parámetros se pondera de forma diferente en la valoración global del perjuicio estético. El resultado podrá incrementarse o reducirse en función del grado de deformidad y del color de la cicatriz, aplicando una tabla cruzada. La puntuación final (sobre 100) se puede dividir por dos para asimilarla al RD Legislativo 8/2004 que contiene el baremo, actualmente vigente para la valoración de secuelas de un accidente de tráfico (AU)

One of the main activities in the medical forensic area is the evaluation of aesthetic damage. There are different methods reported in the literature to perform this evaluation, but only three are intended solely for the aesthetic damage caused by scarring. We propose, in this paper, a method for evaluation the damage forensic aesthetic scars: initially three parameters are evaluated and given a numerical value: the area of the body, the length in cm and distance at which the scar is seen. Each of these parameters is pondered differently in the overall evaluation of aesthetic damage. The result may be increased or decreased depending on the degree of deformity and scar color, applying a crossed table. The final result (out of 100) can be divided by two to assimilate the RDL 8/2004 containing the scale, currently applicable to the assessment of the consequences of an accident (AU)

Valoración psiquiátrico forense en geriatría / Psychiatric forensic assessment in geriatrics

El geriatra en el ejercicio de su profesión puedeencontrarse cuestiones que exceden del ámbitopuramente asistencial, y que entran dentrodel marco de la medicina legal. El objetivo del artículoes, precisamente proporcionar al facultativoinformación que le ayude a comprender algunosconceptos ampliamente utilizados en elcampo legal y forense y que están íntimamenteligados con cuestiones psiquiátricas.El artículo se centra en el estudio de conceptoscomo: imputabilidad, capacidad e internamientoen el anciano, tanto desde un punto devista exclusivamente médico, como el marco legalque lo regula

The geriatrician may come across questionsthat exceed the area of care and would be includedin the area of legal medicine. The aim of thisarticle is to provide the practitioner with informationwhich will help him or her to understand someconcepts used widely in the field of forensicmedicine and that are closely linked with psychiatricquestions.The article concentrates on the study of conceptssuch as: imputability, capacity and internmentin the elderly, from a strictly medical pointof view as well as the legal framework by which itis regulated

El geriatra y el Código Penal / The geriatrician and the Penal Code

Se abordan en el presente trabajo los aspectosmédico-legales de mayor interés, que se lepueden plantear al geriatra, en el ejercicio de suprofesión, relacionados con la normativa penalvigente (Código Penal) como son: la emisión decertificados con falsedad, la incomparecenciaante un tribunal estando legalmente citado, lafalsedad en el peritaje, el intrusismo, la revelacióndel secreto profesional, la omisión del deberde socorro y la discriminación en la asistencia facultativaSe revisa y se discute, desde una perspectivamédico-legal, el articulado del Código Penal aeste respecto

In the present study the medico-legal questionsof greatest interest related to the criminallaw in force (Penal Code) that a geriatrician maybe faced with when carrying out his or her professionare examined. These questions may include:the emission of false certificates, failure toappear in court when summoned legally, dishonestyin expert work, infiltration, the revealing ofthe professional secret, the omission of duty toassist and discrimmination in facultative assistance.The articles of the Penal Code are revised anddiscussed from a medico-legal point of view inthis respect

Deontología en geriatría / Deontology in geriatrics

Se abordan en el presente trabajo los aspectosdeontológicos de mayor interés, recogidos enel Código de Ética y Deontología Médica, que sele pueden plantear al profesional sanitario, en elejercicio de la geriatría, como: deber de socorrorechazo de un tratamiento, información y consentimiento,secreto médico, eutanasia, malostratos y tortura, la medicina en equipo, charlatanismoy la actuación del médico como perito

In this article some deontological questions ofgreat interest from the Code of Medical Ethicsand Deontology that the health professional maycome across in the area of geriatrics are examined.These include: duty to assist, rejection of atreatment, information and consent, medical secret,euthanasia, ill treatment and torture, medicinein teams, charlatanism and the behaviour ofthe doctor as an expert