Reducing mental health stigma among nursing students through an educational intervention.

BACKGROUND: Patient-centred care must consider service consumers' needs and improve their health and well-being as well as their satisfaction and the quality of their healthcare assistance. However, individuals experiencing mental illness often struggle with barriers and misunderstandings by health care professionals. Nursing Faculties are uniquely positioned to reduce stigmatising attitudes via new educational interventions that could align nursing curricula and individuals with mental illness needs. However, there are few studies about the stigma toward mental illness among nursing students in Spain. OBJECTIVES: The present study aimed to analyse the effect of a 9-month educational intervention on the level of stigma in nursing students. DESIGN: a one-group pre-postintervention design with no control group was conducted. METHODS: A total of 194 nursing students completed the EVEPEM scale before and after the intervention. The intervention comprised 55 hours of campus sessions and 150 h practicum in mental health settings. RESULTS: A destigmatising tendency was captured by a large main effect and a statistically significant stigma reduction. CONCLUSIONS: The educational 9-month intervention was effective in reducing students' stigma by providing theoretical education, personal contact with mental health service consumers, and critical reflection activities.

Psychometric properties of the positive mental health questionnaire: short form (PMHQ-SF18) in young adults.

Introduction: Positive Mental Health (PMH) plays a pivotal role in the promoting of mental health. Assessing this phenomenon is essential for early recognition and intervention in mental health. To date, only one tool was validated with 39 items to assess PMH among Portuguese young adults. Method: This study sought to examine the psychometric properties of the short version of the Positive Mental Health Questionnaire (PMHQ) among Portuguese university students. The PMHQ Short Form was administered to a sample of 3,647 university students via an online platform. Exploratory and confirmatory factor analyses were performed. The principal factor solution was employed because some items showed higher levels of kurtosis. Multivariate analysis was tested using the Mardia's Test, Henze-Zirkler, and Royston. Findings of content, construct validity tests, and Cronbach's alfa demonstrated the satisfactory validity and suitable reliability of the PMHQ-Short Form (PMHQ-SF). Results and discussion: The exploratory factor analysis produced six dimensions of the PMHQ-SF with three items in each factor demonstrating adequate internal reliability. The global internal consistency was 0.92, with factors ranging between 0.60 to 0.82. The results suggest that the PMHQ-SF is reliable, easier, and more practical to complete by university students due to the shortening of the number of items. The PMHQ-SF is useful for assessing positive mental health in young adults. The final version of the instrument contains from 32 to 18 items.

Percepción del uso del humor por parte de enfermeras y pacientes en los servicios de salud mental / Perception of the use of humour by nurses and patients at Mental Health Units

Objetivo: conocer, en función de la literatura disponible, el significado del sentido del humor entre enfermeras y pacientes en el contexto de servicios de salud mental, así como determinar los factores que facilitan o dificultan el uso del sentido del humor en las unidades de salud mental. Métodos: se llevó a cabo una revisión narrativa en el periodo 2022-2023. Las búsquedas se realizaron en Pubmed, PsycINFO, LILACS y CINAHL, usando los descriptores: “Nurse-patient relations”, “mental health”, “wit and humor as topic”, "psychiatric nursing”. Se incluyeron todo tipo de documentos que abordaran el tema según los objetivos, publicados desde 2012 hasta noviembre de 2022 en inglés, español o portugués. Se añadió un artículo traducido del coreano por su relevancia. Resultados: se incluyeron 10 manuscritos en la revisión. Los hallazgos sugieren que el sentido del humor se percibe como una herramienta esencial para fortalecer la relación entre enfermeras y pacientes en entornos psiquiátricos. No obstante, se destaca la existencia de factores que podrían conducir a un uso inapropiado del humor, llevando a la deshumanización de la atención y la posible ruptura del vínculo terapéutico. Conclusiones: es importante considerar cuidadosamente el empleo del humor en el contexto de la salud mental, para garantizar su efectividad sin comprometer la calidad asistencial. (AU)

Objective: based on the literature available, to understand the meaning of sense of humour between nurses and patients in the setting of Mental Health Units, as well as to determine the factors that facilitate its use, o make it difficult. Methods: a narrative review was conducted during the 2022-2023 period. Searches were conducted in Pubmed, PsycINFO, LILACS and CINAHL, using the descriptors: “Nurse-patient relations”, “mental health”, “wit and humor as topic”, “psychiatric nursing”. All type of documents addressing this matter according to the objectives were included, published from 2012 until November 2022 in English, Spanish or Portuguese. An article translated from Korean was added due to its relevance. Results: ten (10) manuscripts were included in the review. Findings suggested that sense of humour was perceived as an essential tool in order to strengthen the relations between nurses and patients in psychiatric settings. However, it was highlighted that there are factors which could induce an inadequate use of humour, leading to dehumanization in care and a potential breach in the therapeutic link. Conclusions: it is important to carefully consider the use of humour in the mental health setting, in order to guarantee its effectiveness without compromising the quality of care. (AU)

The therapeutic relationship from the perspective of patients and nurses in the first days of admission: A cross-sectional study in acute mental health units.

The therapeutic relationship (TR) is essential in mental health nursing care and plays a fundamental role in the understanding and treatment of the patient's health status. Despite being a bidirectional construct, limited evidence is available to shed light on this issue in mental health units and even less so in the first days of admission. This study aimed to examine the association and differences between nurses' and patients' perspectives on the establishment of the therapeutic relationship in acute mental health units during the first days of hospitalization. A cross-sectional study was carried out in 12 Spanish mental health units. Data were collected from patients and nurses using the Working Alliance Inventory-Short (WAI-S) questionnaire. A total of 234 cases were analysed, including 234 patients and 58 nurses. The results showed a positive association between nurses' and patients' perspectives on the therapeutic relationship, but also revealed significant differences on each WAI-S dimension. Nurses assigned higher scores compared to patients on the perception of the quality of the therapeutic relationship. The dimensions with the greatest weight from the patients' perspective regarding the quality of the therapeutic relationship were the perception of greater agreement on goals and tasks among nurses. This study demonstrates the importance of establishing shared goals and tasks with nurses from the first days of hospitalization to improve the quality of the therapeutic relationship as perceived by patients. These findings underline the need to consider the different perspectives of both parties to promote a high-quality therapeutic relationship.

The experiences of family members of persons with intellectual disabilities who used residential care homes during the COVID-19 pandemic.

BACKGROUND: The global COVID-19 pandemic has shown the vulnerability of some population groups, including persons with intellectual and developmental disabilities (IDD). AIM: The present paper will provide more clarity and understanding of the experiences of family members of persons with IDD housed in residential facilities in Catalonia within the period of maximum restrictions during the COVID-19 pandemic. METHODS AND PROCEDURES: Semi-structured interviews were conducted using an interpretive phenomenological qualitative approach. Study participants consisted of 14 relatives of IDD individuals who were institutionalized in residence facilities or homes. The guiding questions emerged from group discussions with relatives of those with IDD who did not participate in the subsequent interviews. Drawing from this group, the factors that were identified to have had the greatest impact on their lives were later used to guide the interviews. Data collection was carried out in face-to-face individual interviews that were recorded together with the observations of two researchers between February and October 2022. RESULTS: Our analysis identified 4 main themes that developed into additional factors: the decision to stay at home or in the residence, fear, illness, and protocol. Individuals with IDD lost their daily routines, suffered from social isolation, and did not understand the situation. CONCLUSION: The results of this study allow for a better understanding of the experiences of families of persons with IDD in residential centres during the lockdown by identifying their needs and how to better support them in the future. OUTCOMES AND RESULTS: Knowledge and understanding of these events should allow for better management of similar situations in the future.

This study contributes to a growing body of research that examines the experiences of IDD individuals and their families during the early months of the COVID-19 pandemic. A qualitative phenomenological interpretative approach was used following the recommendations of qualitative research practices in health care. Our findings reveal that relatives of persons with IDD who lived in residential care homes felt that the residents were not adequately cared for by the staff, who applied measures for containment and contagion prevention that were disproportionate, resulting in their needs not being considered; these recommended measures had been developed for elderly care homes. Individuals with IDD lost their daily routines, suffered from social isolation, and did not understand the situation. The present findings show that residential care homes for persons with IDD require specific action protocols in crisis situations that are adapted to the needs and characteristics of each centre,thus adopting a model of care based on human rights.

Transcultural adaptation and psychometric properties of the spanish version of the therapeutic relationship Assessment Scale-Nurse.

BACKGROUND: The nurse-patient therapeutic relationship is considered a pillar of mental health nursing, contributing to improved person-centered care and shared decision making with the patient. Given the importance of the nurse-patient therapeutic relationship, appropriate evaluation instruments are required to assess its quality. The aim of this study was to adapt and validate the Spanish version of the Therapeutic Relationship Assessment Scale-Nurse. METHODS: A translation and back-translation of the scale was carried out. To analyze the psychometric properties, the scale was administered to 213 nurses working in the field of mental health care. Temporal stability or test-retest was examined by means of the intraclass correlation coefficient (ICC) in a sample of 100 nurses. RESULTS: Confirmatory Factor Analysis revealed a four-factor structure identical to the original version, with some poor model fit indices. The ordinal alpha values for the total scale and the four factors were 0.939, 0.654, 0.798, 0.801, and 0.866, respectively. The intraclass correlation coefficient was 0.928 (95% CI: 0.893-0.952). CONCLUSIONS: The results show that the Spanish version of the Therapeutic Relationship Assessment Scale-Nurse is reliable for determining the quality of the therapeutic relationship that mental health nurses can establish with their patients. However, more studies are needed to analyse the model fit of the instrument's factor structure in the Spanish population.

The Role of Food Addiction and Lifetime Substance Use on Eating Disorder Treatment Outcomes.

Food addiction (FA) and substance use (SU) in eating disorders (ED) have been associated with a more dysfunctional clinical and psychopathological profile. However, their impact on treatment outcomes has been poorly explored. Therefore, this transdiagnostic study is aimed at examining whether the presence of FA and/or SU is associated with treatment outcomes in patients with different ED types. The results were not able to reveal significant differences in treatment outcomes between patients with and without FA and/or SU; however, the effect sizes suggest higher dropout rates in the group with both FA and SU. The predictive models of treatment outcomes showed different features associated with each group. High persistence (i.e., tendency to perseverance and inflexibility) was the personality trait most associated with poor treatment outcomes in patients without addictions. High harm avoidance and younger age at ED onset were the variables most related to poor outcomes in patients with FA or SU. Finally, in the group with both addictive behaviors (FA and SU), the younger patients presented the poorest outcomes. In conclusion, our results suggest that, regardless of presenting addictive behaviors, patients with ED may similarly benefit from treatment. However, it may be important to consider the differential predictors of each group that might guide certain treatment targets.

Análisis de las complicaciones del acceso vascular en hemodiálisis. Una revisión sistemática / Analysis of complications of vascular access in hemodialysis: A systematic review

Introducción:El acceso vascular sigue siendo uno de los retos más importantes en todas las unidades de diálisis, por todas las complicaciones derivadas de su uso y el gran impacto en la mor-bimortalidad del enfermo renal. Los tres tipos de acceso vascu-lar más utilizados son la fístula arteriovenosa nativa, el injerto o fístula arteriovenosa protésica y el catéter venoso central. Objetivo: Analizar y evaluar la situación actual y la incidencia de las complicaciones relacionadas con los diferentes accesos vasculares en hemodiálisis. Metodología: Se realizó una revisión sistemática en las bases de datos PubMed, CINAHL, SCOPUS y SciELO. Se incluyeron todos los artículos originales de menos de 5 años de antigüe-dad en los que uno de sus objetivos fuera analizar la preva-lencia o incidencia de las complicaciones de cualquier acceso vascular en hemodiálisis en población adulta. Resultados: El número de artículos para el análisis fueron 15. De ellos, 14 fueron estudios observacionales y uno, un ensa-yo clínico multicéntrico. Se analizaron datos demográficos de los pacientes, la prevalencia de complicaciones entre todos los accesos vasculares y la incidencia de complicaciones se-gún fístula nativa/protésica/catéter venoso central.Conclusiones: La fístula arteriovenosa nativa es el acceso vas-cular de elección ya que tiene tasas de complicaciones muy bajas. De entre ellas, la trombosis, es la complicación con más incidencia. El uso de catéter venoso central todavía es muy habitual, pese a ser el acceso vascular que presenta mayores tasas de complicaciones como las infecciones y la bacteriemia, produciéndose en un 10%-17% de los pacientes portadores.(AU)

Introduction: Vascular access remains one of the most important challenges in all dialysis units due to the complications associated with its use and its significant impact on the morbidity and mortality of renal patients. The three most used types of vascular access are native arteriovenous fistula, graft or prosthetic arteriovenous fistula, and central venous catheter. Objective: To analyze and evaluate the current situation and incidence of complications related to different vascular accesses in hemodialysis. Methodology : A systematic review was conducted using the PubMed, CINAHL, SCOPUS, and SciELO databases. All original articles published within the last 5 years that aimed to analyze the prevalence or incidence of complications related to any vascular access in hemodialysis in the adult population were included. Results: A total of 15 articles were included for analysis. Among them, 14 were observational studies, and one was a multicenter clinical trial. Demographic data of the patients, the prevalence of complications across all vascular accesses, and the incidence of complications for native fistula/prosthetic fistula/central venous catheter were analyzed. Conclusions: Native arteriovenous fistula is the preferred vascular access due to its very low complication rates. Among the complications, thrombosis has the highest incidence. The use of central venous catheters is still common, despite having higher rates of complications such as infections and bacteremia, occurring in 10%-17% of the patients.(AU)

mHealth to Improve Experience, Adherence to Pharmacological Treatment, and Positive Mental Health in Patients Diagnosed With Femur Fractures: Protocol for a Quasi-Experimental Study.

BACKGROUND: Considering the prognosis of femur fractures worldwide, the ageing of our society, and the problems in adherence to treatment found in these patients, it is believed that mobile health can have a positive impact on the process and quality of care. OBJECTIVE: We aim to evaluate the effectiveness of a pharmacological educational nurse intervention with Myplan app with regard to knowledge, adherence to pharmacological treatment, and positive mental health of patients with femur fractures. METHODS: A nonrandomized, quasi-experimental study will be carried out with a pretest-posttest control group. It will include 278 older patients diagnosed with femur fractures, with a Glasgow Coma Scale of 15 and access to mobile devices. Patients with psychological pathologies and cognitive impairment or patients treated in isolation will be excluded. Study variables are as follows: sociodemographic variables (AdHoc Form), patient experience (Patient Experience Questionnaire-15), adherence to pharmacological treatment (Morisky-Green questionnaire), and positive mental health (Positive Mental Health questionnaire). The measurements will be taken 24 hours after admission, upon discharge, and 25 days after discharge. RESULTS: Enrollment commenced in October 2022. Data collection will be completed in April 2023. CONCLUSIONS: The results of this study will offer evidence of the effectiveness of a pharmacological educational nurse intervention by means of a free smartphone app. If its efficacy is demonstrated and the results are acceptable, it could mean an improvement in the care of patients with femur fractures, and this technology could be used to guide other training interventions in patients with other pathologies. TRIAL REGISTRATION: ClinicalTrials.gov NCTT05669040; https://clinicaltrials.gov/ct2/show/NCTT05669040. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/45856.

Knowledge, attitudes, behavioral and organizational factors of health professions students for a competent smoking cessation practice: An instrument adaptation and psychometric validation study in Spanish and English samples.

BACKGROUND: To improve smoking cessation, training of health professions students is essential. However, no specific instrument is available to assess factors that may affect students' learning about smoking cessation practice. AIM: To adapt and validate the Knowledge, Attitudes, Behaviors and Organization questionnaire in the population of undergraduate health professions students. DESIGN: Methodological research. METHODS: The researchers conducted this study with 511 Spanish and 186 English health professions students from four different universities. We used a four-step approach: 1) adaptation of the items to the target population and validation of the content by a panel of experts; 2) a pilot study to test face validity; 3) linguistic adaptation of the Spanish version to English; and 4) the psychometric assessment based on construct validity, criterion validity and internal consistency. RESULTS: Exploratory factor analysis revealed four subscales for the Spanish version, namely 'Individual knowledge and skills', 'Individual attitudes and beliefs', 'Organizational support' and 'Organizational resources', which accounted for 85.1% of the variance. Confirmatory factor analysis in the holdout Spanish and English samples revealed adequate goodness-of-fit values, supporting the factor structure. Hypotheses testing demonstrated significant differences by capacitation in smoking cessation interventions and degree courses, providing further evidence regarding construct validity. All the subscales correlated positively with the criterion variables (5 A's smoking cessation model), except for the 'Organizational resources' subscale, which was not significantly correlated with the 5 A's. The overall Cronbach's alpha was.83 for the Spanish version and.88 for the English one. CONCLUSIONS: Our results provide empirical support for the use of the Knowledge, Attitudes, Behaviors and Organization questionnaire for Students as a reliable and valid instrument to assess knowledge, attitudes, behaviors and organization perceptions in health professions students, which is essential for competent smoking cessation practice. Interestingly, 'Organizational resources' subscale presented the lowest correlations among factors and did not correlate with any component of the 5 A's, suggesting the need of enhancing students' responsibility and involvement during their internships, as well as the interest of some organizations.

Impact of the 'reserved therapeutic space' nursing intervention on patient health outcomes: An intervention study in acute mental health units.

AIMS: To evaluate the effectiveness of the 'reserved therapeutic space' intervention for improving the nurse-patient therapeutic relationship in acute mental health units in Spain. DESIGN: Multicentre intervention study with control group. METHODS: The study will be carried out in 12 mental health units. The 'reserved therapeutic space' intervention to be tested has been co-designed and validated by both nurses and patients. The quality of the therapeutic relationship, the care received and perceived coercion among patients will be assessed. An estimated 131 patients per group are expected to participate. Funding was granted by the Instituto de Salud Carlos III. Co-financed by the European Union (European Regional Development Fund (ERDF) (PI21/00605)) and College of Nurses of Barcelona (PR-487/2021). The proposal was approved by all the Research Ethics Committees of participating centres. RESULTS: This project will lead to changes in clinical practice, transforming the current models of organization and care management in mental health hospitalization units. No patient or public contribution.

Transcultural adaptation and assessment of psychometric properties of the Spanish version of the Scale for the Evaluation of Staff-Patient Interactions in Progress Notes.

PURPOSE: To adapt the Scale for the Evaluation of Staff Patient Interactions in Progress Notes to Spanish and to test the psychometric properties. DESIGN AND METHODS: The study was conducted in two phases: (1) Adaptation of the instrument to Spanish following the Standards for Educational and Psychological Testing. (2) Psychometric study in a sample of mental health nurses. FINDINGS: The Cronbach's alpha values were 0.97 for the total scale and 0.83 to 0.81 for each dimension. The inter-rater reliability values were between 0.94 and 0.97. PRACTICE IMPLICATIONS: The scale is a reliable tool for assessing nurses' clinical notes in relation to the quality of nurse-patient interactions.

Quality in Psychiatric Care in the Community Mental Health Setting from the Perspective of Patients and Staff.

The current paradigm of mental health care focuses on care provided in the community, increasingly moving away from hospital care models that involve considerable economic burden. Patient and staff perspectives on the quality of psychiatric care can highlight strengths and areas for improvement to ensure better care provision. The aim of this study was to describe and compare perceptions of quality of care among patients and staff in community mental health services and to determine possible relationships between these perceptions and other study variables. A comparative cross-sectional descriptive study was conducted in a sample of 200 patients and 260 staff from community psychiatric care services in the area of Barcelona (Spain). The results showed high overall levels of quality of care from patient (m = 104.35 ± 13.57) and staff (m =102.06 ± 8.80) perspectives. Patients and staff both gave high scores to Encounter and Support factors, while factors concerning patient Participation and Environment received the lowest scores. Continuous assessment of the quality of psychiatric care in the community setting is essential to ensure the highest quality of care, taking the perspectives of those involved into account.

A systematic review on the use of action research methods in mental health nursing care.

AIMS: To identify and synthesize evidence on the use of action research methods in mental health nursing care. DESIGN: Systematic review. DATA SOURCES: CINAHL, Web of Science, PubMed and Scopus databases were searched in January 2021. REVIEW METHODS: Data were selected using the updated Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework. Two reviewers independently conducted the study selection, and quality appraisal using Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research, data extraction and data analysis procedures. RESULTS: Sixteen studies, half of which used participatory action research, were included in this review. Nurses, along with other stakeholders, were an active part of the action research process. The main topics of interest addressed were categorized as improving the adoption of a person-centred approach to care and improving decision-making procedures. The use of action research helped the participants to identify the meaning they attached to the topic of interest to be improved. Moreover, this method helped to identify needs and strategies for improving care. The studies concurred that the use of action research enabled participants to gain awareness, improve attitudes and acquire knowledge. In addition, it enabled participants to gain confidence and security in the group context, as key aspects of their empowerment. CONCLUSION: This review shows the usefulness of action research in any mental health nursing context, contributing to the improvement of care at both the individual and collective levels. IMPACT: This paper demonstrates the use of the action research method in the field of mental health nursing. Its use has improved the clinical practice of nurses as well as that of teams in both community and hospital settings, addressing issues of the person-centred approach to care and decision-making procedures.

Interés, motivación y barreras para investigar de las residentes de matrona de Cataluña al inicio y al final de la residencia / Interest, motivation and barriers to research of midwifery residents in Catalonia at the beginning and end of the residency

Objetivo: Analizar la actitud, motivación y barreras percibidas a la investigación en las enfermeras residentes de matrona de Cataluña, al inicio y al final de su periodo formativo. Personas/Material y método: Estudio cuasi experimental pre-post intervención, dirigido a las enfermeras residentes de matrona en Cataluña en el periodo 2019-2021. Se estudiaron las características sociodemográficas y laborales a través de un cuestionario propio. Para estudiar la actitud y motivación a la investigación se utilizó el cuestionario de Cepeda, y para estudiar las barreras a la utilización de la investigación en enfermería se utilizó la escala The Barriers to research Utilization Scale adaptada al castellano por Moreno-Casbas. Resultados: Durante la residencia aumentaron la lectura de literatura científica y la actividad investigadora. Las matronas incrementaron sus conocimientos para realizar un trabajo de investigación. No se observaron diferencias estadísticamente significativas entre la puntuación de las barreras identificadas al inicio y al final de la residencia; no obstante, las barreras relacionadas con las características del profesional tienden a disminuir, y aumentan las relacionadas con la organización, la calidad de la investigación, la presentación y la accesibilidad de los resultados. Conclusiones: Las residentes de matrona consideran la investigación una actividad propia que contribuye al desarrollo de la profesión enfermera. Los elementos facilitadores y las barreras percibidas por las residentes de matrona coinciden con las identificadas por enfermeras de otros contextos, y parecen mantenerse estables a lo largo del tiempo. (AU)

Objective: To analyze the attitude, motivation and perceived barriers to research in midwifery resident nurses in Catalonia, at the beginning and end of their training period. Persons/Material and Method: Quasi-experimental pre-post intervention study, aimed at midwifery resident nurses in Catalonia from 2019-2021. Sociodemographic and labor characteristics were studied through an own questionnaire. To study the attitude and motivation towards research, the Cepeda questionnaire was used. To study the barriers to the use of research in nursing, The Barriers to research Utilization Scale adapted to Spanish by Moreno-Casbas was used. Results: During the residency, the reading of scientific literature and research activity increased. The midwives increased their knowledge to carry out research work. No statistically significant differences were observed between the score of the barriers identified at the beginning and end of the residency; however, the barriers related to the characteristics of the professional tend to decrease, and those related to the organization, the quality of the research, the presentation and accessibility of the results, increase. Conclusions: Midwifery residents consider research as their own activity that contributes to the development of the nursing profession. The facilitating elements and the barriers perceived by the midwifery residents match with those identified by nurses from other contexts and seem to remain stable over time. (AU)

Knowledge and perceptions of food sustainability in a Spanish university population.

In 2015, the United Nations adopted the 2030 Agenda for Sustainable Development, with 17 Sustainable Development Goals (SDGs) at its core. Besides tackling climate change and the fight to reduce inequality, the SDG number 12 is specifically focused to develop strategies toward food sustainability. The aim of this study, aligned with SDG number 12, was to analyze the level of knowledge and perceptions of food sustainability in a university community from Spain. A descriptive cross-sectional study, based on an online questionnaire, was carried out between July and November 2021 with convenience sampling. The survey included 28 items and was distributed among students, teachers, researchers and administrative staff from a Spanish university. A total of 1,220 participants completed the survey. 70.4% of the respondents heard about the environmental impact of food and more than 50% were aware of the existence of the SDGs. The different aspects related to diet that concerned them the most were food waste, plastic usage, and environmental impact. They reported that a sustainable diet should be mainly based on local and seasonal products and with a low environmental impact as well as no or the minimum food waste. When asked if they were following a sustainable diet, 77% answered affirmatively. Moreover, the food groups more involved in a sustainable diet should be vegetables and fruits, olive oil, legumes, and whole grains. Regarding food waste, 60% of the surveyed population claimed to generate it at home, with the use of leftovers and planning shopping and meals being some of the most important domestic actions to avoid it. Further initiatives must be implemented to increase the level of knowledge as well as to raise the awareness on the importance to translate it into individual and collective actions that allow a shift toward more sustainable practices.

The nursing critical thinking in clinical practice questionnaire for nursing students: A psychometric evaluation study.

AIM: To adapt and validate the N-CT-4 Practice for use with Spanish nursing students. BACKGROUND: Promoting critical thinking is one of the primary objectives of nursing education programs all over the world. Using reliable and valid instruments to measure critical thinking is essential. The Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 Practice) is used internationally to assess critical thinking in nursing practice. However, little is known about the possible applications of this instrument in the context of nursing education. METHODS: Two-phase study: Phase I, adaptation of the N-CT-4 Practice for use with nursing students and verification of its content validity; phase 2, cross-sectional study to validate its psychometric properties in a sample of 331 nursing students from three university nursing schools. A subsample of 34 students completed the questionnaire on two occasions, with a time interval of two weeks. The construct validity and reliability of the instrument were tested using confirmatory factor analysis, convergent validity, internal consistency reliability and test-retest reliability. The STROBE guidelines and the COSMIN checklist were followed. RESULTS: All items obtained optimal content validity values. The model fit indices obtained from the confirmatory factor analysis supported the hypothesis of the four-dimensional structure on which the original questionnaire was based. Cronbach's alpha of 0.96 indicated high reliability. The correlations between the total score and the scores for the dimensions were statistically significant, positive and high, with values above r = 0.78 (p < 0.05). Lin's concordance correlation coefficient was 0.6 (p < 0.001). CONCLUSIONS: The adapted version of the N-CT-4 Practice is suitable for measuring critical thinking skills in the educational context of the degree course in nursing in Spain. Its psychometric validation yielded satisfactory results.

Spanish adaptation of the quality in psychiatric care-outpatient (QPC-OP) instrument community mental health patients' version: psychometric properties and factor structure.

BACKGROUND: Health systems in the field of mental health are strongly committed to community models that allow patients to be attended in their own environment. This helps them to maintain their family and social ties while trying to avoid costly hospital admissions. The patients' perspective is a key component in the assessment of the quality of psychiatric care and can even determine their adherence to the devices where they are treated. However, there are few instruments with adequate psychometric properties for the evaluation of the quality of psychiatric care in community mental health. The Quality in Psychiatric Care - Outpatient (QPC-OP) instrument has adequate psychometric properties to assess the quality of psychiatric care from the patients' perspective. The aim of this study was to adapt and validate the Spanish version of the QPC-OP instrument. METHODS: A translation and back-translation of the instrument was carried out. To examine its psychometric properties, the instrument was administered to 200 patients attending various community mental health services. To assess test-retest reliability, the instrument was readministered after 7-14 days (n = 98). RESULTS: The Confirmatory Factor Analysis revealed a structure of 8 factors identical to the original version, with an adequate model fit. The internal consistency coefficient (Cronbach's alpha) was 0.951. The intraclass correlation coefficient was 0.764 (95% IC: 0.649 - 0.842), and higher than 0.70 in 5 of the 8 factors. Additionally, an EFA was performed and revealed that the instrument could behave in a unifactorial or four factor manner in the sample analyzed. CONCLUSIONS: Results show that the Spanish version of the QPC-OP instrument is valid and reliable for the assessment of quality of psychiatric care in the community setting.

Intervenciones enfermeras para disminuir la sobrecarga de cuidadores informales. Revisión sistemática de ensayos clínicos / Nursing interventions to reduce the overload on informal caregivers. Systematic review of clinical trials

Introducción: Los cuidadores informales suelen ser miembros de la familia de un paciente, que conducen a la dependencia del paciente del cuidador. Esto puede resultar en perturbaciones en la calidad de vida de los cuidadores. Para abordar los efectos negativos de la atención informal, existen varios tipos de intervenciones eficaces para reducir las visitas médicas tanto de los cuidadores informales como de los pacientes a su cargo. Objetivo: Examinar la eficacia de las intervenciones de enfermería existentes diseñadas para reducir la sobrecarga del cuidador informal de personas con enfermedad crónica. Metodología: Diseño: Revisión sistemática. Fuentes de datos: Bases de datos como Pubmed (MEDLINE), Embase, The Cochrane Library y CINAHL fueron buscadas usando palabras clave sobre intervenciones de enfermería en cuidadores familiares. Los artículos publicados entre 2014-2019 fueron recuperados y sometidos a análisis de datos y síntesis de conocimientos Método de revisión: Dos revisores seleccionados de forma independiente. La evaluación de la calidad se basó en la lista de verificación de evaluación de declaraciones prisma. La síntesis es narrativa. Resultados: Noventa y cinco estudios fueron examinados en su totalidad, y setenta y siete fueron descartados por no proporcionar resultados adecuados. El recuento final de artículos incluidos en esta revisión fue de dieciocho que fueron todos ensayos clínicos aleatorizados. Conclusiones: El análisis de los diferentes estudios muestra eficacia en la reducción de síntomas como estrés, ansiedad, depresión o incluso necesidades insatisfechas. Las intervenciones más eficaces para reducir la carga del cuidador fueron las visitas domiciliarias y las intervenciones psicoeducacionales, tanto individuales como grupales. (AU)

Background: Informal caregivers are usually family members, which lead to dependence of the patient on the caregiver. This may result in disturbances to the caregivers' quality of life. Address the negative effects of informal caregiving, several types of interventions have been reported to be effective in reducing medical visits by both informal caregivers and the patients in their care Aim: Examine the effectiveness of existing nursing interventions designed to reduce the overload of the informal caregiver of people with chronic illness. Methodology: Design: Systematic review Data Sources: Databases including Pubmed (MEDLINE), Embase, The Cochrane Library and CINAHL were searched using keywords about nursing interventions in family caregivers. Articles published between 2014-2019 were retrieved and underwent data analysis and knowledge synthesis. Review method: Two reviewers independently selected studies. Quality appraisal was based on PRISMA statements appraisal checklist. Synthesis was narrative. Results: Ninety-five studies were examined in their entirety, with seventy-seven being discarded as not providing results or not related to reducing overload. The final count of articles included in this review was eighteen which were all randomised clinical trials. Seven were categorized as technology-based interventions; two as self-help manuals; one as a physical activity-based intervention; and eight as group or individual psychoeducational therapy. Conclusions: Analysis of the different studies shows effectiveness in reducing symptoms such as stress, anxiety, depression or even unmet needs. The interventions that were found to be most effective in reducing caregiver overload were home care visits and psychoeducational interventions, both individual and group. (AU)

Validity of the Functioning Assessment Short Tests (FAST), in patients with schizophrenia.

INTRODUCTION: Functional impairment in schizophrenia is one of the main features of the disorder and implies a great impact on the patient's quality of life. The Brief Functioning Assessment Scale (FAST), originally validated in bipolar disorder, has also been validated for its application in other mental disorders. However, we only found one study on the reliability and validity of the Brazilian version in schizophrenia. The purpose of this study was to analyze the psychometric properties of the Spanish version of the FAST in patients diagnosed with schizophrenia. MATERIAL AND METHODS: A total of 226 patients with a diagnosis of schizophrenia were evaluated by mean the FAST, the GAF and the self-care requirements scale (ERA). Scale properties were analyzed in terms of internal consistency, inter-observer agreement and test-retest reliability. Convergent validity with the GAF and ERA scales was also analyzed, as well as construct validity by means of a Confirmatory Factor Analysis (CFA). RESULTS: For the total scale, the results showed high internal consistency (Cronbach's Alpha of, 87), as well as good inter-observer (ICC=,86) and test-retest (ICC=,77) agreement. Concurrent validity with the GAF scale was discrete (r=-,32; P<,001) and with the ERA scale was moderate (r=,50; P<,001). CFA showed an internal structure that matched the six factors proposed by the original scale, with a good level of item saturation for each factor. CONCLUSIONS: The FAST scale showed good psychometric properties in terms of reliability and validity in its Spanish version for its application in patients with schizophrenia. It can be considered as a good tool to assess different areas of functional impairment in clinical practice and research.