Critical thinking level in nursing degree students according to sociodemographic and academic variables: A correlational study.

AIMS: To determine the level of critical thinking of undergraduate nursing students during their clinical practice, as well as to identify the relationship between sociodemographic and academic variables. BACKGROUND: Nursing degree programs should prioritize the development of critical thinking skills in their curriculum and regularly assess students to ensure the acquisition of core competencies. DESIGN: Multicenter, descriptive, cross-sectional, correlational, descriptive study. Participants included were students from the Degree in Nursing enrolled during the academic year 2020-2021. Students were selected by convenience from three universities located in Catalonia, Spain. Data were collected from 429 students, with 98 being excluded due to incomplete data. METHODS: Data were collected by administering the Nursing Critical Thinking in Students Questionnaire and an ad hoc form of sociodemographic and academic characteristics. The STROBE guidelines checklist were followed. The study involves a secondary analysis of data from a previous study that presented psychometric analysis. RESULTS: No significant differences were observed in total Critical Thinking scores across various parameters including academic year, current situation, work experience in healthcare, previous academic training, family situation, or recent stressful events. On average, students demonstrated moderate critical thinking scores. However, statistically significant relationships emerged between critical thinking scores and gender (p=0.046), institution attended for undergraduate studies (p=0.019) and having satisfactory social relationships despite experiencing stressful events (p=0.330). CONCLUSIONS: The study delves into the correlation between critical thinking skills and sociodemographic and academic factors, identifying students who may benefit from specific interventions and advocating for adaptable educational methods. It emphasizes the pivotal role of trust in fostering critical thinking in nursing education and suggests a connection between critical thinking and strong social relationships. In conclusion, evaluating critical thinking is crucial for addressing healthcare challenges, validating teaching strategies and promoting continuous improvement in nursing education.

Intention to use physical restraint in paediatric intensive care units and correlated variables: A multicentre and cross-sectional study.

OBJECTIVES: To determine the intention to use physical restraint (PR) and the relationship with sociodemographic and professional variables of the Paediatric Intensive Care Unit (PICU) nurses. RESEARCH METHODOLOGY/DESIGN AND SETTING: A multicentre and correlational study was carried out from October 2021 to December 2023 in five paediatric intensive care units from five maternal and child hospitals in Spain. The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire was provided. Moreover, sociodemographic and employment variables were registered. RESULTS: A total of 230 paediatric nurses participated in the study. A total of 87.7 % were females with an average age of 35.5 ± 9.7 years and working experience of 10.5 ± 8.4 years. The mean scores obtained were 21.1 ± 3.8 for attitude, 13.1 ± 5.0 for subjective norms, 14.4 ± 4.3 for perceived behavioural control and 28.0 ± 6.0 for intention. The nurses apply more physical restraint to anxious patients, with scarce analgesics and sedation, those affected with pharmacological withdrawal symptoms and those with a high risk of accidental removal of vital support devices or fall from bed. The sex (p = 0.007) and type of employment contract (p = 0.01) are the variables that are significantly correlated with the intention to use of PR. CONCLUSION: The paediatric nurses analysed had a moderate attitude, social pressure and perceived behavioural control towards the use of PR. IMPLICATIONS FOR CLINICAL PRACTICE: It is important to know the factors that influence the intention to use physical restraint in order to standardise safe practice for critically ill paediatric and to ensure that patients' rights are respected by obtaining informed consent and assessing the prescription, continuation and removal of physical restraint.

Adaptation and validation of the Physical Restraint-Theory of Planned Behaviour Questionnaire to the paediatric context.

OBJECTIVE: To create and test psychometrically a paediatric version of the Physical Restraint-Theory of Planned Behaviour Questionnaire to assess paediatric critical care nurses' intention to use physical restraint. DESIGN: A psychometric study. SETTING: Five medical-surgical Paeditric Intensive care Units from five hospitals in Spain. METHODS: The study took place in three phases. In phase 1, the questionnaire was adapted. In phase 2, the content validity of each item was determined, and a pilot test was conducted. In phase 3, we administered the questionnaire and determined its psychometric properties. RESULTS: The assessment of the intention to use physical restraint was extended to all critical paediatric patients, two items were eliminated from the initial questionnaire, four new items were included, and the clinical scenarios of the intention subscale were expanded from three to six. Overall content validity index for the full instrument of 0.96 out of 1. The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire is made up of four subscales (attitude, subjective norms (SN), perceived behavioural control (PBC), and intention) subdivided into 7 factors and 51 items. The internal consistency for the attitude subscale obtained a Cronbach's Alpha of 0.80 to 0.73, for the SN it was 0.72 to 0.89, for the PBC it was from 0.80 to 0.73 and for the intention subscale it was 0.75. CONCLUSIONS: The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire is an instrument composed of seven factors and 51 items that validly and reliably assesses the intention of paediatric nurses to apply PR in PICUs. RELEVANCE FOR CLINICAL PRACTICE: Having this instrument will help health centres move towards restraint-free care by allowing managers to assess professionals' attitudes, beliefs, and intentions around the use of PR in PICUs.

Nurses' views on the presence of family members during invasive procedures in hospitalised children: A questionnaire survey.

AIMS AND OBJECTIVES: (I) To identify the opinion and practices of nursing professionals regarding the presence of family members during invasive procedures in hospitalised children; (II) to determine the knowledge of nursing professionals about the patient-and family-centred care model. BACKGROUND: Family presence in invasive procedures benefits the patient and their relatives, but varied attitudes exist among healthcare personnel, with some being favourable and others unfavourable toward family presence. DESIGN: Observational, descriptive, cross-sectional study. METHODS: Study population: Nurses from paediatric critical care services, emergency services, hospital wards, day hospitals and outpatient clinics at a Catalan tertiary hospital who participated voluntarily between September 2021 and July 2022. Data collection instrument: A questionnaire prepared by the researchers, based on the literature and reviewed by experts. REDCap link with access to the questionnaire was sent out to potential respondents through the institutional email. Bivariate analysis was performed with the R 4.2 program. The study was approved by the hospital's Clinical Research Committee and participants gave informed consent before responding to the questionnaire. RESULTS: A total of 172 nurses participated, and 155 valid responses were obtained. All respondents consider the family as a key element in paediatric care and report inviting family members to participate in the care given to their child. However, 12.0% of nurses do not invite the family to be present in invasive procedures. Almost all respondents note the need for training to acquire communication skills and improve the management of emotions. CONCLUSIONS: The results show a favourable opinion towards the presence of family members and highlight the need to train nurses to develop communication skills. RELEVANCE TO CLINICAL PRACTICE: The data provided can favour the design of measures to improve and promote the presence of parents during invasive procedures, reinforcing the patient-and family-centred care model and improving the quality of care provided. One example is the creation of family care protocols where the inclusion of parents and the roles of each individual involved in the care process appears.

Critical thinking among institutional academic advisors and sociodemographic, professional and academic variables: A multicenter correlation study.

BACKGROUND: In nursing education, essential skills include Critical Thinking (CT). There is scant evidence on how nurse educators could promote CT in students in a clinical context. OBJECTIVE: To analyse the level of CT and correlated variables in healthcare nurses overseeing the clinicals of nursing undergraduates. METHODS: The study population were all nurse educators for clinicals at hospitals with nursing undergraduates. To evaluate the CT skills of nurses the Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 practice) was administered. Frequencies, percentages and measures of central tendency and scatter were obtained. A bivariate analysis was performed to analyze the correlation between the nurse educators' CT level and the sociodemographic, professional and academic levels. The nonparametric Mann-Whitney and Kruskal-Wallis tests were used to compare two independent groups. Statistical significance was defined as P < .05. RESULTS: The total number of participants was 639. The highest mean CT level was seen in clinical nurses involved in undergraduate nursing instruction and with experience of up to 10 years (mean CT score = 372 (33.3), p = .007). Global CT levels were similar in women and men (mean CT score: 364 (31.9) in women and 358 (40.5) in men, p = .187), with statistically significant differences only observed in the intellectual and cognitive indicator (P = .022). CONCLUSIONS: CT levels are high in teaching healthcare professionals in the clinical environment.

Expectations of patients awaiting lung transplantation: A qualitative study.

AIM: The main aim of the present study is to examine the expectations and feelings of people awaiting lung transplantation. BACKGROUND: The assessment of the benefits of lung transplant should consider, among other things, the subjective perceptions of patients about the procedure, especially in relation to the context and to their values, goals and expectations. This is an issue that has not been studied in depth, especially in Spain. DESIGN: Exploratory qualitative study. METHODS: Data were collected through semi-structured interviews during the period of being on the waiting list for transplantation. Thematic analysis of the data was supported by the Atlas.ti software. RESULTS: The study population comprised 16 patients awaiting lung transplant, a number sufficient to reach data saturation. Four categories were identified to describe patients' feelings and expectations: (1) reasons for undergoing the transplant, (2) expectations about life post-transplant, (3) emotional state, and (4) relationship with the healthcare team. CONCLUSIONS: Patients have high expectations of lung transplantation. They see it as offering them a second chance at life, although the future creates uncertainty. The healthcare professionals are identified as key actors, providing essential support and information throughout the various stages of the process. Future research should explore recipients' experiences of lung transplant at later stages. RELEVANCE TO CLINICAL PRACTICE: It is important to adapt care through all the lung transplant process, which is accompanied by intense and complex emotions since the beginning. Thus, providing social and psychological support from the beginning may contribute to their health status, helping them deal with all the emotions and feelings experienced, and find balance between expectations and reality. PATIENT OR PUBLIC CONTRIBUTION: Sixteen patients awaiting lung transplant were interviewed. Interview transcripts were returned to participants to check for accuracy with their experiences.

Efficacy of Presurgical Interventions to Promote Smoking Cessation: A Systematic Review.

The aim of this study was to evaluate the efficacy of presurgical interventions for promoting smoking cessation in terms of achieving smoking abstinence and reducing surgical complication rates. A systematic review of randomized clinical trials (RCTs) published from March 2009 to April 2021 was performed following the PRISMA guidelines. References were found in MEDLINE (via PubMed), Web of Science (WOS), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). RCTs comparing the efficacy of a smoking cessation program directed at an intervention group (IG) versus the usual intervention or another directed at a control group (CG) were included. No language restrictions were applied in the search. All approaches to smoking cessation were admitted (face-to-face, telephone, group, individual, multicomponent, etc.), as were all methods for assessing abstinence, follow-up times, surgical specialties, definitions of smokers, and all types of surgical complications. Four hundred forty-four references were pulled out, and 79 duplicates were discarded. We excluded 346 records that were after application of the inclusion/exclusion criteria. In addition to the remaining 19 articles, 1 article obtained from citation searches was also assessed. We finally included 11 original articles in this systematic review, corresponding to 9 studies, because 2 of the RCTs had 2 different articles referring to different aspects of the same study. The results showed long-term postoperative (6 to 12 months) abstinence rates between 25.0% and 36.4% in RCTs with intensive multicomponent interventions, versus rates about 13.0% in brief interventions. Two multicomponent interventions obtained significant improvements regarding the reduction of short-term postoperative surgical complications. In conclusion, presurgical multicomponent smoking cessation interventions are more effective than brief interventions in terms of achieving abstinence and reducing surgical complications. The follow-up time and the intensity of the interventions were predictors of dropout.

'My biggest fear is that people will forget about him': Mothers' emotional transitions after terminating their pregnancy for medical reasons.

AIMS AND OBJECTIVES: To explore women's emotional responses throughout the process of terminating a pregnancy for medical reasons. BACKGROUND: Making the choice to terminate a desired pregnancy for medical reasons has a negative impact on women's health, as it is a distressing process that involves making hard decisions and readjusting one's expectations of an idealised pregnancy. METHODS: A qualitative phenomenological study was conducted following the COREQ checklist. Fifteen semi-structured interviews and two focus groups were conducted with women who had terminated their pregnancies for medical reasons, previous to and during the COVID-19 lockdown. Subsequently, we analysed the content. RESULTS: One main category, emotional journey during the process of terminating the pregnancy, and six subcategories were identified: (I) representation and desire to become a mother, (II) main concerns, (III) impact of the news, (IV) decision-making, (V) emotional responses before termination for medical reasons and (VI) emotional responses after termination for medical reasons. All contributed to understanding the specificities of the different phases that make up the emotional journey of terminating a pregnancy for medical reasons. CONCLUSIONS: The findings of this study suggest that there are a number of predominant emotions that professionals need to be aware of in order to help women work through them and lessen the impact of pregnancy termination on their mental health. COVID-19 had different connotations depending on the women's experiences. RELEVANCE TO CLINICAL PRACTICE: Our results highlight how important the role of healthcare staff is in caring for these women and their partners, which involves recognising their emotions throughout the process. Our results also underline how useful it is to conduct qualitative studies in this context, since they constitute a set of activities and interventions that result in the administration of nursing care in itself. PATIENT OR PUBLIC CONTRIBUTION: The ultimate goal of the action research study is to design a positive mental health intervention. Participants will contribute to the design and final approval of the intervention.

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.

Pensamiento crítico en tutoras de práctica clínica / Critical thought in female clinical practice mentors

Objetivo: conceptualizar el estado actual del pensamiento crítico en tutoras académicas y tutoras institucionales en el contexto de la práctica clínica e identificar los instrumentos más utilizados para medir el pensamiento crítico de estas.Método: revisión integrativa para la que se consultaron las bases de datos PubMed y Scopus en el periodo comprendido entre enero de 1998 y marzo de 2022. La búsqueda se efectuó utilizando los términos de lenguaje controlado (critical thinking; mentor; nurse educator; clinical practice; preceptor; Education; Nursing), y artículos publicados en español, inglés y portugués. El proceso de selección de artículos fue asistido con el software Rayyan y descrito con el diagrama de flujo de PRISMA. Se realizó un análisis de contenido de los artículos seleccionados para identificar los temas emergentes.Resultados: se incluyeron 72 artículos originales. 25 eran estudios cualitativos, tres de método mixto, un estudio Delphi, 18 descriptivos, seis cuasi-experimentales, cuatro ensayos clínicos aleatorizados, un estudio analítico, ocho revisiones de la literatura, cuatro estudios correlacionales y una revisión sistemática. Tres fueron las temáticas emergentes: los factores de contexto del pensamiento crítico, las estrategias de promoción y los instrumentos de evaluación del pensamiento crítico.Conclusiones: la profesión enfermera no ha adoptado todavía un estándar para evaluar el pensamiento crítico, esto dificulta el comparar resultados sobre el efecto de determinadas intervenciones relacionadas con el desarrollo del pensamiento crítico.(AU)

Objective: to conceptualise the current situation regarding critical thought in female academic mentors and institutional mentors in the clinical practice setting, and to identify the most widely used instruments to measure their critical thought.Method: an integrative review where the PubMed and Scopus databases were consulted in the period between January 1998 and March 2022. The search was conducted using these controlled language terms: critical thinking; mentor; nurse educator; clinical practice; preceptor; Education; Nursing; and in articles published in Spanish, English and Portuguese. The article selection process was assisted by the Rayyan software and described with the PRISMA flow diagram. There was content analysis of the articles selected, in order to identify the emerging subjects.Results: the study included 72 original articles: 25 qualitative studies, three with mixed method, one Delphi study, 18 descriptive studies, six quasi-experimental studies, four randomized clinical trials, one analytical study, eight literature reviews, four correlational studies, and one systematic review. There were three emerging subjects: context factors of critical thought, promotion strategies, and instruments for critical thought evaluation.Conclusions: the Nursing profession has not yet adopted a standard evaluation for critical thought: this makes it difficult to compare results regarding the effect of certain interventions associated with critical thought development.(AU)

Autonomy and isolation experienced by patients and primary caregivers during COVID-19 hospitalization in Barcelona (Spain).

This study aims to describe patients' and family caregivers' hospitalization experiences during the COVID-19 pandemic. Using qualitative exploratory descriptive methods, 13 patients admitted to the largest hospital in Barcelona (Spain) due to COVID-19 were interviewed by telephone once discharged, as were eight primary caregivers. Data were analyzed using the content analysis method proposed by Krippendorff. Two main themes were identified: (i) Acceptance of mandatory isolation for patients and family caregivers, which refers to the verbalization of a feeling that justifies the imposed isolation and the need for the use of personal protective equipment by the health team for everyone's safety; and (ii) Limited autonomy during hospitalization for patients and family caregivers, which describes participants' perceptions of autonomy during hospitalization. Patients and caregivers experienced feelings of loneliness, which negatively affected their emotional health. In addition, they experienced reduced autonomy due to new habits and routines intended to control the pandemic for the benefit of public and global health.

Adaptación transcultural al español de un cuestionario específico de calidad de vida en pacientes con traqueostomía / Transcultural adaptation to spanish of a specific questionnaire of quality of life in patients with tracheostomy

ntroducción: La traqueostomía es uno de los procedimientos quirúrgicos realizados con mayor frecuencia en el mundo. En Europa, a entre el 1.3 % y el 10 % de los pacientes hospitalizados en Unidades de Críticos se les realiza una traqueostomía. La traqueostomía provoca cambios físicos, funcionales, psicológicos, sociales, económicos y laborales en la vida del individuo que afectan a su calidad de vida. Siendo el cuestionario Tracheostomy Specific Quality Of Life (TQOL) una herramienta válida y fiable para su medición.Objetivo: Adaptar a la cultura y al idioma español un cuestionario específico para evaluar la calidad de vida de los pacientes con traqueostomía y medir su validez de contenido.Método: Se realizó una adaptación transcultural del inglés al español mediante el proceso de traducción-retrotraducción del cuestionario, seguido por una comprobación de la validez de contenido mediante un panel de expertos.Resultados: Los ítems del TQOL no presentaron problemas de traducción, se introdujeron cambios semánticos siendo la retrotraducción equivalente al original. Todos los ítems obtuvieron un índice de validez de contenido superior a 0,80, siendo el índice global de validez de contenido de la escala (S-CVI) de 0,98. El estudio piloto mostró adecuada comprensibilidad del instrumento.Conclusiones: Se ha obtenido una versión adaptada al español del TQOL lingüísticamente equivalente al cuestionario original para evaluar la calidad de vida en pacientes con traqueostomía. (AU)

Introduction: Tracheostomy is one of the most frequently performed surgical procedures in the world. In Europe, between 1.3% and 10% of patients hospitalized in Critical Units undergo a tracheostomy. The tracheostomy causes physical, functional, psychological, social, economic and work changes in the life of the individual that affect her quality of life. The Tracheostomy Specific Quality Of Life (TQOL) questionnaire is a valid and reliable tool for its measurement. Objective: To adapt to the Spanish culture and language a specific questionnaire to evaluate the quality of life of patients with tracheostomy and to measure its content validity. Method: A cross-cultural adaptation from English to Spanish was carried out by means of the translation-back-translation process of the questionnaire followed by a content validity check by a panel of experts.Results: The TQOL items did not present translation problems, semantic changes were introduced, the back translation being equivalent to the original. All items obtained a content validity index greater than 0.80, with the scale’s global content validity index (S-CVI) of 0.98. The pilot study showed adequate comprehensibility of the instrument.Conclusions: A version adapted to Spanish of the TQOL has been obtained, linguistically equivalent to the original questionnaire to evaluate the quality of life in patients with tracheostomy. (AU)

Prevalencia de la lactancia materna exclusiva en un hospital Best Practice Spotlight Organization / Prevalence of exclusive breastfeeding in a hospital Best Practice Spotlight Organization

Objetivo: Conocer la prevalencia de la lactancia materna exclusiva al alta de los recién nacidos sanos, y determinar el nivel de satisfacción de las mujeres puérperas con las intervenciones realizadas para la promoción de la lactan- cia materna según recomendaciones de la guía Lactancia materna de la Re- gistered Nurses’ Association of Ontario (RNAO) aplicadas desde 2017. Método: Estudio descriptivo transversal, llevado a cabo entre junio de 2018 y junio de 2019. La muestra fue de mujeres puérperas ingresadas en la Unidad de Obstetricia del Hospital de la Mujer del Hospital Universitari Vall d’Hebron de Barcelona. Se analizaron variables sociodemográficas y relacionadas con el grado de satisfacción de las intervenciones de promoción de la lactancia ma- terna que habían recibido todas las madres, tanto si ofrecían el pecho como lactancia artificial, recogidas a través de un cuestionario diseñado ad hoc. Resultados: Se analizaron 337 encuestas realizadas por mujeres que recibie- ron intervenciones de promoción de la lactancia materna. Un total de 306 mu- jeres (90,8 %) alimentaron a su recién nacido con lactancia materna exclusiva en el momento del alta. La proporción de madres que dieron lactancia ma- terna exclusiva al alta fue significativamente superior en el grupo que ya lo había hecho anteriormente. El grado de satisfacción sobre las intervencio- nes de promoción recibidas obtuvo una puntuación media de 5,41 ± 0,88 en la escala de Likert, siendo 1 totalmente insatisfecha y 6 totalmente satisfe- cha. El grado de satisfacción fue alto tanto en el grupo que alimentó con lactancia materna exclusiva como en el que no lo hizo. Conclusiones: Casi la totalidad de las mujeres es dada de alta ofreciendo lactancia materna exclusiva a sus recién nacidos, siendo la lactancia mater- na previa un factor de predisposición hacia la misma. El grado de satisfac- ción con las intervenciones de promoción de la lactancia materna fue alto. (AU)

Objective: To identify the prevalence of exclusive breastfeeding at discharge of healthy newborns and to determine the level of satisfaction of postpartum women with the interventions carried out to promote breastfeeding accord- ing to the recommendations by the Registered Nurses’ Association of Ontario (RNAO) applied since 2017. Methodology: Cross-sectional descriptive study, carried out between June 2018 and June 2019. The sample was postpartum women admitted to the Obstetrics Unit of the Maternity Hospital of Vall d'Hebron University Hospital in Barcelona. Sociodemographic variables and those related to breastfeeding promotion interventions were collected through an ad hoc designed ques- tionnaire and analysed, which included those mothers who were breastfeed- ing and those choosing to bottle feed their newborn neonates. Results: 337 surveys completed by women who received breastfeeding pro- motion interventions were analysed. 306 women (90.8 %) exclusively breast- fed their newborn at discharge. The proportion of mothers who exclusively breastfed at discharge was significantly higher in multiparous women who breastfed previous siblings. The degree of satisfaction with the interventions received had a mean score of 5.41 ± 0.88 on the Likert scale, with 1 being totally unsatisfied and 6 totally satisfied. The degree of satisfaction was high regardless of having breastfed or not. Conclusions: Almost all women are discharged with exclusive breastfeeding, with previous breastfeeding being a predisposing factor towards it. The de- gree of satisfaction with breastfeeding promotion interventions was high. (AU)

Postsurgical pain assessment in children and adolescents with cerebral palsy: A scoping review.

AIM: To investigate factors that influence the assessment of postoperative pain in children and adolescents with cerebral palsy (CP) and the tools available to determine pain intensity. METHOD: The search was performed in January 2022 using six databases. Articles focused on paediatric patients with CP; we included instruments for postsurgical pain assessment in this population published in the last 11 years. RESULTS: Eight of 441 studies were included. Males and females behave differently; their families can be called on to describe their pain responses. Seven instruments for pain assessment were identified: the Non-Communicating Children's Pain Checklist and its Postoperative Version; the Paediatric Pain Profile; the revised Face, Legs, Activity, Cry and Consolability (FLACC) pain scale; the Douleur Enfant San Salvador scale; the Pain Indicator for Communicatively Impaired Children; the University of Wisconsin Children's Hospital Pain Scale; and the Individualized Numeric Rating Scale. INTERPRETATION: The revised FLACC pain scale is suited to postsurgical units because of its ease of use and the fact that parental collaboration is not required. More studies are needed to demonstrate the clinical utility of these scales in postsurgical units and the factors that influence pain assessment. WHAT THIS PAPER ADDS: Families should be asked to collaborate when assessing pain in children and adolescents whenever possible. Larger studies that focus on the factors influencing pain assessment in this population are required.

Experiences and needs of patients undergoing clinical isolation. Phenomenological-hermeneutic study.

OBJECTIVE: To know the experience lived by people subjected to hospital isolation, as well as to recognize the most significant needs expressed during this process. METHOD: Qualitative study from a phenomenological-hermeneutical approach. The study participants were patients subjected to hospital isolation during their admission to the trauma ward of the Vall d'Hebron University Hospital. Six in-depth interviews were conducted and recorded by audio. The data was analyzed using a thematic content analysis. RESULTS: The feedback from the participants in this study was essential to understand the experience lived by people subjected to hospital isolation. These perceptions were listed in the format of 5 categories related to the following experiences: loneliness, perception of "feeling like the last one", lack of communication, resilience and lack of attention and 3 categories related to their needs. CONCLUSIONS: The findings suggest that isolation requires compliance with a series of rules and restrictions in the hospital setting that, despite its therapeutic purposes, can promote negative feelings. Based on the results of our research, we conclude that an effort should be made to improve actions aimed at minimizing these feelings in situations of isolation.

Vivencias y necesidades de los pacientes sometidos a aislamiento clínico. Estudio fenomenológico-hermenéutico / Experiences and needs of patients undergoing clinical isolation. Phenomenological-hermeneutic study

Objetivo:Conocer la experiencia vivida de las personas sometidas a un aislamiento hospitalario, así como explorar las necesidades más significativas durante ese proceso.Método:Estudio cualitativo con enfoque fenomenológico-hermenéutico. Los participantes fueron pacientes sometidos a aislamiento hospitalario durante su ingreso en el Hospital de Traumatología de la Vall d’Hebron. Se realizaron 6 entrevistas en profundidad grabadas en audio. Los datos fueron analizados a través de un análisis de contenido temático.Resultados:Las interpretaciones de los participantes de este estudio fueron fundamentales para comprender la experiencia vivida de las personas sometidas a aislamiento hospitalario. Estas percepciones fueron capturadas en formato de 5 categorías para las experiencias: soledad, percepción de «sentirse el último», falta de comunicación, resiliencia y desatención y 3 categorías para las necesidades.Conclusiones:Los hallazgos sugieren que el aislamiento comporta una serie de normas y restricciones en el entorno hospitalario que a pesar de sus propósitos terapéuticos pueden favorecer sentimientos negativos. Debe fomentarse la búsqueda de acciones de mejora dirigidas a minimizar estos sentimientos frente al aislamiento.

Objetive:To know the experience lived by people subjected to hospital isolation, as well as to recognize the most significant needs expressed during this process.Method:Qualitative study from a phenomenological-hermeneutical approach. The study participants were patients subjected to hospital isolation during their admission to the trauma ward of the Vall d’Hebron University Hospital. Six in-depth interviews were conducted and recorded by audio. The data was analyzed using a thematic content analysis.Results:The feedback from the participants in this study was essential to understand the experience lived by people subjected to hospital isolation. These perceptions were listed in the format of 5 categories related to the following experiences: loneliness, perception of “feeling like the last one”, lack of communication, resilience and lack of attention and 3 categories related to their needs.Conclusions:The findings suggest that isolation requires compliance with a series of rules and restrictions in the hospital setting that, despite its therapeutic purposes, can promote negative feelings. Based on the results of our research, we conclude that an effort should be made to improve actions aimed at minimizing these feelings in situations of isolation.

Critical thinking among clinical nurses and related factors: A survey study in public hospitals.

AIMS AND OBJECTIVES: The study investigated clinical nurses' critical thinking levels in public hospitals and related factors. BACKGROUND: Since health care environments have become more complex, the critical thinking skills of clinical nurses are more important in daily problem-solving and decision-making processes. However, little research was conducted on this topic among clinical nurses. METHODS: It was a cross-sectional study at five public hospitals between December 2018 and January 2019. The study followed the STROBE guideline. Data were collected from 559 nurses by a survey consisted of a data form and the Turkish version of the Nursing Critical Thinking in Clinical Practice Questionnaire. RESULTS: Nurses' mean critical thinking scores were moderate level. Total critical thinking scores of the clinical nurses significantly differed according to education, hospital type, shift work, professional category and role. There was a significant effect on the total critical thinking scores of the clinical nurses according to variables. CONCLUSION: This study found that critical thinking levels of nurses' working in clinical settings in public hospitals were moderate level. Hospital type, shift work, professional and educational level and role were significantly associated with clinical nurses' critical thinking levels. RELEVANCE TO CLINICAL PRACTICE: This study provides evidence related to the levels of critical thinking of clinical nurses working in public hospitals. Since the critical thinking scores of the manager nurses, daytime working nurses' and nurses with bachelor's and master's degree education are higher, hospital managers may benefit from the study to implement effective strategies to improve the competence of critical thinking levels of nurses.

Efectividad de una intervención para reducir las interrupciones durante la preparación y administración de medicación / Efficacy of an intervention to reduce interruptions during the preparation and administration of medication

Objetivo: analizar la efectividad de la implementación del programa multi-intervención Programa Interrupciones Zero (PIZ) para disminuir las interrupciones durante el proceso de preparación y administración de medicamentos (PPAM) en el ámbito hospitalario y aumentar la satisfacción de los profesionales de Enfermería.Método: analítico cuasi-experimental pre-post intervención de grupo único en una unidad de cirugía traumatológica hospitalaria. Se recogieron datos sociodemográficos y profesionales de los participantes, número de interrupciones autorreferido según la persona origen de la interrupción, otros motivos y turno laboral en la que se produjeron, y variables de percepción del tiempo dedicado al PPAM y satistacción respecto al proceso. Se llevó a cabo un análisis descriptivo y una comparación de proporciones pre-post a los dos meses con la prueba t para muestras apareadas considerando una p< 0,05 como estadísticamente significativa.Resultados: participaron 23 enfermeras y siete enfermeros. Se registraron 839 interrupciones antes del PIZ y 484 tras él. Las personas que más interrupciones generaron fueron los técnicos en curas auxiliares de Enfermería (24,3% pre y 22,7% post) y los principales motivos no originados por personas fueron los relacionados con el tratamiento (24,3% y 22,2% respectivamente) (p> 0,05). La reducción de interrupciones fue significativa en el turno de día disminuyendo un 51,3% (p< 0,01) y en el turno de noche disminuyendo un 22,8% (p= 0,03). La satisfacción de los profesionales aumentó significativamente tras el PIZ (p= 0,01).Conclusiones: el PIZ demuestra ser eficaz para la disminución del número de interrupciones totales durante el PPAM y para aumentar el grado de satisfacción del equipo de Enfermería respecto a este proceso.(AU)

Objective: to analyze the efficacy of implementing the multi-intervention “Zero Interruptions Program” (ZIP) to reduce the number of interruptions during the process of preparation and administration of medications (PPAM) in the hospital setting, and to increase the satisfaction of Nursing professionals.Method: an analytical, quasi-experimental, pre-post intervention with a single arm in an Orthopedic Surgery Unit in the hospital setting. Sociodemographic and professional data were collected from the participants, as well as self-reported number of interruptions according to the person causing the interruption, other reasons, and work shift when these occurred, and variables of perception of time spent for PPAM and satisfaction regarding the process. A descriptive analysis was conducted, as well as a pre-post comparison of proportions at two months, with the t test for paired samples, considering p< 0.05 as statistically significant.Results: the study included 23 female nurses and seven male nurses. In total, 839 interruptions were recorded before the ZIP and 484 after it. The persons who generated more interruptions were Nursing Assistants (24.3% before and 22.7% after), and the main reasons not originated by persons were those associated with the treatment (24.3% and 22.2% respectively) (p> 0.05). There was a significant reduction in interruptions during the day shift, by 51.3% p< 0,01) and in the night shift, with a 22.8% reduction (p= 0,03). There was a significant increase in the satisfaction of professionales after the ZIP (p= 0.01).Conclusions: the ZIP has shown efficacy in the reduction of the total number of interruptions during the PPAM, and in the increase of the level of satisfaction of the Nursing team regarding this process.(AU)

Very early mobilization in the stroke unit: Functionality, quality of life and disability at 90 days and 1 year post-stroke.

BACKGROUND: The evidence of early mobilization after stroke is conflicting, and the recovery period is an important concern. OBJECTIVE: To analyse the functionality, quality of life and disability at 90 days and 1 year post-stroke of patients who received a Very Early Mobilization Protocol. METHODS: Prospective cohort study in a tertiary stroke unit. Consecutive patients aged≥18 years and without prior significant disability, who presented motor deficit after acute stroke, were included. A symmetry test was performed to compare the changes in the main variables: Barthel Index (BI), Functional Ambulation Category (FAC), modified Rankin Scale (mRS) and EuroQol five-dimensions three-level (EQ-5D-3L) between 90 days and 1 year post-stroke. RESULTS: A total of 123 patients were recruited. The BI reflected an improvement at 1 year in transfer to chair/bed in 25.8%(p < 0.01) of patients and in toilet use in 25.8%(p = 0.02). The FAC showed an improvement at 1 year in 44.4%(p < 0.01) of patients and the mRS in 19.1%(p = 0.01). The usual activities dimension of the EQ-5D-3L showed a clinically relevant improvement after 1 year in 15.9%(p = 0.23) of patients. CONCLUSIONS: A significant percentage of patients show improvements in some functional areas and in disability between 90 days and 1 year post-stroke.

The emotional responses of women when terminating a pregnancy for medical reasons: A scoping review.

BACKGROUND: In most countries of the world the only basis for considering a termination of pregnancy is for medical reasons. Depending on the circumstances and determinants of each case, the emotional responses to this event vary greatly. The aim of this study is to map the emotional responses of women when their pregnancy is terminated for medical reasons. METHODS: A scoping review was carried out. This covered all types of qualitative and quantitative studies published in English or Spanish since 2014 which included first-person accounts of women's emotional responses when they had a termination. A bibliographic search was made of four databases (CINAHL, Cochrane Library, PsycINFO and Pubmed) along with an additional manual search and backward and forward citation chaining of the studies included. The data were reported in narrative form and the results grouped according to the descriptive characteristics of the study and the emotions involved. FINDINGS: The review process resulted in the inclusion of thirty-four studies. nineteen of these followed a qualitative approach and fifteen used quantitative methodology, with six of them being intervention studies. The emotions found ranged from anxiety and depression to guilt and thankfulness, so various authors stressed the need to improve training for health professionals to provide information, advice and support to the women during the entire process of the termination of pregnancy for medical reasons. CONCLUSIONS: The available studies cannot be compared given the variety of designs. The predominant emotions underlying the termination for medical reasons were stress, anxiety and depression. Future research should be carried out using samples of participants covering all causes of termination for medical reasons in a particular context so that an intervention can be designed to help lessen the impact of the process on women's mental health.