Impacto de la gamificación en el aprendizaje sobre administración de fármacos en pediatría en estudiantes del grado en enfermería / Impact of gamification on learning of the administration of pediatric medication by nursing degree students

Introducción: La motivación con la que afronta el aprendizaje el alumnado es un aspecto clave que todo docente universitario debe tener en consideración.Objetivos: Analizar la eficacia de un seminario estructurado mediante metodología de gamificación en estudiantes del grado de enfermería durante su formación clínica en unidades hospitalarias pediátricas y determinar el grado de satisfacción con la actividad llevado a cabo.Métodos: Participaron un total de 244 estudiantes de 4º curso del Grado en Enfermería y 50 enfermeras tutoras clínicas de un centro hospitalario. Se llevó a cabo un test pre y post seminario. El caso constó de tres fases: una relacionada con las actividades al ingreso en una Unidad de Cuidados Intensivos, la segunda con el cálculo de medicación pediátrica y la tercera con los cuidados de enfermería a aplicar. Para valorar la eficacia en relación a la práctica clínica se elaboraron dos encuestas ad hoc, una dirigida a los estudiantes y otra a enfermeras asociadas docentes y/o tutoras clínicas. También se administró una encuesta de satisfacción.Resultados: La puntuación media obtenida en el pre test teórico fue de 9,1 puntos sobre 10 y, en el post test, de 9,73. Las tres preguntas relacionadas con el nivel de conocimientos, autoconfianza y seguridad del alumnado obtuvieron las siguientes puntuaciones: 4,09, 4,83 y 3,99 puntos sobre 10 pre seminario versus los 7,71, 7,75 y 7,21 puntos post seminario, observándose significación estadística (p<0.001). Se obtuvo significación estadística en las preguntas que relacionaban la “consecución de objetivos docentes en áreas asistenciales” (enfermero/a) y la de “adquisición de competencias clínicas específicas” (alumnado), p=0.04. El grado de satisfacción global fue de 8,66±1,43 puntos.Conclusiones: La gamificación es una metodología docente eficaz muy bien valorada por parte de las estudiantes, considerándola de gran utilidad. (AU)

Background: The motivation of students in their approach to learning should be a matter of concern to all university instructors.Aims: To analyze the effectiveness of a structured seminar using gamification methodology with nursing degree students during their clinical training in pediatric hospital units, and to determine their level of satisfaction with the activity as carried out.Methods: A total of 244 fourth-year nursing degree students participated, along with 50 nurse clinical tutors from a hospital. A pretest and a post-test were administered. The case had three stages: one related to activities at the time of patient admission to the pediatric intensive care unit, a second involving the calculation of pediatric medication dosages, and a third involving the nursing care to be given. Two ad hoc surveys were used to assess the effectiveness of the seminar, one directed at the students and the other at the nursing instructors and/or clinical tutors. A satisfaction survey was also given.Results: The average score for the theoretical pretest was 9.1 over 10; on the post-test it was 9.73. The three questions addressing the level of knowledge, self-confidence, and self-assuredness of the students yielded the following scores: 4.09, 4.83, and 3.99 over 10 pre- seminar vs 7.71, 7.75, and 7.21 post-seminar; this difference was statistically significant (p<0.001). There was statistical significance in the responses to the questions related to “achieving pedagogical aims in areas of care” (nurses) and “acquisition of specific clinical skills” (students), p=0.04. The overall level of satisfaction was 8.66±1.43 points.Conclusions: Gamification is an effective teaching methodology that is well-received by the students and seen by them as useful. (AU)

Perinatal hypoxic-ischaemic encephalopathy: a national survey of end-of-life decisions and palliative care.

OBJECTIVE: To explore end-of-life (EoL) decision-making and palliative care in hypoxic-ischaemic encephalopathy (HIE) nationwide. METHODS: A cross-sectional national study on moderate-to-severe HIE in newborns ≥35 weeks' gestational age in 2015, including all 57 level III units that offered hypothermia. Forty-one questions were included to explore how the prognosis is established, as well as timing of the decision-making process, and also how ongoing palliative care is offered. RESULTS: The main difficulties in EoL decisions lie in the scarce time to make an early, accurate prognosis. Only 20% shared the neurological prognosis with the parents within 72 hours of life, and in only a third of the centres is the nurse present when the prognostic information is given to the family. Almost 50% do not use protocols to order the EoL process. Practically, all centres (91%) reported taking into account the wishes of the parents. However, in 30% the team does not always reach consensus on how the withdrawal process. Specialised psychological support is available in 54% of the hospitals; in more than 50%, interviews are not arranged to examine the grieving process with parents. CONCLUSIONS: There are four areas for improvement in the comprehensive, multidisciplinary approach to the EoL decision in the patient with HIE: (1) the need for EoL and interdisciplinary palliative care protocols, (2) participation of nurses in the process and improvement in the nurse-physician communication, (3) psychological support for parents involved in the EoL decisions and (4) implementation of strategies to give support during the grieving process.

Neonatal nursing in the COVID-19 pandemic: can we improve the future?

The current 2019 coronavirus disease (COVID-19) is the world's largest and most pervasive public health emergency in more than one hundred years. Although neonatal units have not been at the epicentre of the current health crisis, they have also been forced to adopt contingency plans with the aim of protecting hospitalised neonates, their families, and professionals. Neonatal units have been forced to alter the neonatal care framework based on promoting neurodevelopment and family-centred care. The peak of the pandemic is falling in most countries, but COVID-19 infection is not eradicated and there is uncertainty about new outbreaks. It is time to reflect about better strategies to preserve the rights and excellence of care for newborns and their families. This column will highlight the changes that have occurred in neonatal units, and their impact on neonatal care and families. It is a time for critical reflection on nursing practice.

Atención integral del neonato con encefalopatía hipóxico-isquémica en España / Holistic approach of the care of the infant with hypoxic-ischaemic encephalopathy in Spain

INTRODUCCIÓN: Apenas conocemos cómo es la asistencia de los recién nacidos (RN) con encefalopatía hipóxico-isquémica (EHI) en hipotermia terapéutica (HT), especialmente si existen protocolos asistenciales, la neuromonitorización que se realiza o cómo es la aproximación al pronóstico neurológico. Este conocimiento permite detectar e implementar áreas de mejora asistencial. MÉTODO: Estudio transversal de los 57 hospitales españoles que realizaban HT en 2015, mediante cuestionario sobre: 1) la disponibilidad de protocolos y de recursos tecnológicos; 2) el uso de herramientas de neuromonitorización; 3) los conocimientos de los profesionales; 4) la información pronóstica que se da los padres, y 5) el informe al alta y del plan de seguimiento. RESULTADOS: El 95% utiliza enfriamiento corporal-total servocontrolado y dispone de protocolos específicos de actuación. El 70% utiliza sedación y el 68% deja al paciente a dieta absoluta. La monitorización con electroencefalografía integrada por amplitud se utiliza en más del 80% de los centros, aunque solo en el 50% la enfermera es capaz de interpretarlo. La saturación de oxígeno cerebral es escasamente monitorizada (16%). Entre los estudios diagnóstico-pronósticos, la neuroimagen es universal, pero los neurobiomarcadores apenas se utilizan (29%). Solo el 21% ofrece información pronóstica antes de las 72 h de vida; sin presencia de la enfermera en el 70%. El seguimiento lo realiza el neuropediatra (84%), con una duración desigual entre centros. CONCLUSIONES: La asistencia del RN con EHI en España es adecuada, con áreas de mejora en: neuromonitorización, sedación, marco temporal de la información pronóstica, trabajo en equipo y estandarización de la duración del seguimiento

INTRODUCTION: There is not much information about the care of infants with hypoxic-ischaemic encephalopathy (HIE) treated with therapeutic hypothermia (TH) in Spain. This includes whether protocols are routinely used, the type of neuro-monitoring performed, and how information on the neurological prognosis is presented to families. The answers to these would allow to detect and implement areas of improvement. METHOD: A cross-sectional analysis was performed on the responses to structured questionnaires sent to all the Spanish neonatal units that were performing TH in June 2015. Questions were divided into 5 sections: 1) the availability of protocols and technological resources, 2) the use of neuro-monitoring tools, 3) the knowledge and training of the professionals; 4) the prognostic information given to the parents; and 5) the discharge report and the follow-up plan. RESULTS: Most centres (95%) use servo controlled whole-body cooling methods and have specific management protocols. Sedation is used in 70% of centres, and in 68% of them the onset of enteral feeding is delayed until the end of the cooling period. Amplitude-integrated electroencephalography monitoring is used in more than 80% of the centres, although only in 50% are nurses able to interpret it. Cerebral oxygen saturation is not often monitored (16%). As regards diagnostic-prognostic studies, neuroimaging is universal, but brain damage biomarkers are hardly used (29%). Prognostic information is offered within the first 72 posnatal hours in 21% of the centres, and is given without the presence of the nurse in 70% of the centres. Follow-up is performed by a neuro-paediatrician (84%), with an uneven duration between centres. CONCLUSIONS: The care of infants with HIE treated with TH in Spain is generally adequate, although there are areas for improvement in neuromonitoring, sedation, prognostic information, teamwork, and duration of follow-up

[Holistic approach of the care of the infant with hypoxic-ischaemic encephalopathy in Spain]. / Atención integral del neonato con encefalopatía hipóxico-isquémica en España.

INTRODUCTION: There is not much information about the care of infants with hypoxic-ischaemic encephalopathy (HIE) treated with therapeutic hypothermia (TH) in Spain. This includes whether protocols are routinely used, the type of neuro-monitoring performed, and how information on the neurological prognosis is presented to families. The answers to these would allow to detect and implement areas of improvement. METHOD: A cross-sectional analysis was performed on the responses to structured questionnaires sent to all the Spanish neonatal units that were performing TH in June 2015. Questions were divided into 5sections: 1) the availability of protocols and technological resources, 2) the use of neuro-monitoring tools, 3) the knowledge and training of the professionals; 4) the prognostic information given to the parents; and 5) the discharge report and the follow-up plan. RESULTS: Most centres (95%) use servo controlled whole-body cooling methods and have specific management protocols. Sedation is used in 70% of centres, and in 68% of them the onset of enteral feeding is delayed until the end of the cooling period. Amplitude-integrated electroencephalography monitoring is used in more than 80% of the centres, although only in 50% are nurses able to interpret it. Cerebral oxygen saturation is not often monitored (16%). As regards diagnostic-prognostic studies, neuroimaging is universal, but brain damage biomarkers are hardly used (29%). Prognostic information is offered within the first 72 posnatal hours in 21% of the centres, and is given without the presence of the nurse in 70% of the centres. Follow-up is performed by a neuro-paediatrician (84%), with an uneven duration between centres. CONCLUSIONS: The care of infants with HIE treated with TH in Spain is generally adequate, although there are areas for improvement in neuromonitoring, sedation, prognostic information, teamwork, and duration of follow-up.

La confección del vestido por los padres para su hijo prematuro. Una herramienta para desarrollar cuidados centrados en la familia / Premature infant parents clothing. A tool for developed familys centered care

Los cuidados del desarrollo son un modelo de enfermería de cuidado neonatal que integra el estado del desarrollo, las necesidades individuales y del ambiente circundante. Un objetivo de los cuidados del desarrollo es reducir el estrés y las experiencias dolorosas para ofrecer apoyo al desarrollo del niño. Las modificaciones ambientales, así como favorecer un posicionamiento adecuado y vestir al recién nacido son muy importantes para reducir este estrés. Otro aspecto fundamental de esta filosofía de cuidado es la importancia del papel desempañado por la familia. El estrés de los padres por el nacimiento y la experiencia del cuidado intensivo neonatal de un bebé prematuro ocasionan problemas en la relación padres-hijos. Implicar a los padres en el cuidado de sus hijos mediante la confección de su ropa, puede ser una herramienta clínica para ayudarles a aumentar sus sentimientos de control y fomentar el vínculo parental. Las enfermeras neonatales están en una posición única para valorar este proceso e intervenir terapéuticamente (AU)

Developmental care is a model for nursing in neonatal care that integrates developmental age, individual requirements and surroundings environment. One aim of developmental care is reduce stressful and painful experiences to support the development of the child. Environmental modifications such as the promotion of supported positioning and clothing infant are very important in stress reduction. Another key issue of this philosophy of care is the importance of the role played by the family. The parental stress caused by a premature baby birth and the neonatal intensive care experience may create problems in the parent – child relationship. Involving parents in the childs caregiving, making clothes to dress the baby, could be a clinic tool to help increase parental feelings of control and improve bonding. Neonatal nurses are in a unique position to assess this process and intervene to promote these behaviours (AU)

[The role of neonatal nursing in palliative care of the newborn]. / El papel de la enfermera en los cuidados paliativos del recién nacido.

Nursing dying newborns is an inherent part of working in a neonatal intensive care (NICU). Holistic care involves recognizing the physical, emotional and spiritual needs of the dying infant and the family. The present article aims to explore how nurses can provide the best practices in neonatal palliative care. Palliative care is composed of three components: assistance with end-of-life decision making; pain and comfort management, and bereavement support with cultural competence. These issues have implications for improving nursing practice.

El papel de la enfermera en los cuidados paliativos del recién nacido / The role of neonatal nursing in palliative care of the newborn

El cuidado de los recién nacidos que van a fallecer es una tarea propia del trabajo en una unidad de cuidado intensivo neonatal (UCIN). Los cuidados holísticos implican reconocer las necesidades físicas, emocionales y espirituales del niño que va a morir y de su familia. El propósito de este artículo fue reflexionar acerca de cómo proporcionar la mejor asistencia en el cuidado paliativo (CP) del neonato en 3 áreas: ayuda en la toma de decisiones del CP; atención del dolor y el confort, y apoyo en el proceso del duelo con competencia cultural. Estos resultados tienen repercusiones para mejorar la práctica asistencial enfermera

Nursing dying newborns is an inherent part of working in a neonatal intensive care (NICU). Holistic care involves recognizing the physical, emotional and spiritual needs of the dying infant and the family. The present article aims to explore how nurses can provide the best practices in neonatal palliative care. Palliative care is composed of three components: assistance with end-of-life decision making; pain and comfort management, and bereavement support with cultural competence. These issues have implications for improving nursing practice

La ruptura de Rosa. La aceptacton de la enfermedad congenita / Rosa´s rupture (the acceptance of congenital disease)

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El hospital de San Martín. Oración y custodia en las Palmas de Gran Canaria / San Martín Hospital, praying and custody in Las Palmas

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