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1.
Cancer Nurs ; 2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38857172

RESUMO

BACKGROUND: With the increasing survival rates of childhood cancer, nurses' familiarity with published evidence has become crucial to care for this population and their families throughout the survival process. OBJECTIVE: To systematically identify and conduct a bibliometric analysis of nursing-related evidence concerning extended and long-term survival of childhood survivors. METHODS: A scoping review was conducted using bibliometric analysis with searches performed in the PubMed, CINAHL, SCOPUS, and Web of Science databases. A total of 300 studies on childhood cancer survival within the nursing field were included. RESULTS: The first study on this topic was published in 1975. American and Chinese researchers lead study publications, primarily publishing in nursing journals such as Cancer Nursing. Quantitative designs were prevalent, and the majority of the studies focused on physical late effects, overall quality of life, and survivor follow-up care. CONCLUSIONS: This study has allowed us to map and synthesize the bibliometric evidence pertaining to the extended and long-term survivorship of childhood cancer survivors in the nursing field. Consequently, it identifies gaps in knowledge, research trends, and areas necessitating further exploration. IMPLICATIONS FOR PRACTICE: The evidence presented in this review can facilitate academic and clinical discussions, offering a comprehensive synthesis of the published knowledge. More research needs to be developed on the topic, particularly in Central and Latin America, Africa, Southern and Eastern Europe, and in some regions of Asia. Furthermore, the scope of studies should extend beyond late effects and quality of life, encompassing the experience of surviving childhood cancer, including psychosocial and spiritual dimensions.

2.
Eur J Oncol Nurs ; 70: 102614, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38795448

RESUMO

PURPOSE: To identify, analyze and describe the available scientific evidence about the influence of social determinants of health on cancer survivors. METHODS: A scoping review was outlined according to the steps described by the Joanna Brigs Institute Reviewer's Manual: selection of studies, data mapping, and results grouping, synthesis and report, was conducted. PubMed, CINAHL, Scopus and LILACS databases were searched from 2011 to 2023. RESULTS: Out of a total of 1783 papers initially screened, only 19 studies met the inclusion criteria for the scoping review, focusing on the primary social determinants impacting the health of cancer survivors. These studies were categorized into six main themes: a) employment (challenges in work reintegration and work-place difficulties); b) variations among different ethnic groups; c) disparities based on sex; d) barriers and facilitators in accessing health and social security services; e) the role of support networks and social environments; and f) socioeconomic lever (influence of income and socioeconomic status). CONCLUSIONS: Understanding the impact of social determinants on the post-treatment quality of life for cancer survivors is crucial. Comprehensive survivorship care should address not just medical needs but also holistic aspects like social support, education, overall well-being, and improvements in physical and social environments. This multifaceted approach ensures the well-rounded support needed for optimal survivorship outcomes.


Assuntos
Sobreviventes de Câncer , Determinantes Sociais da Saúde , Humanos , Sobreviventes de Câncer/psicologia , Qualidade de Vida , Apoio Social , Neoplasias/terapia , Neoplasias/psicologia , Masculino , Fatores Socioeconômicos , Feminino , Emprego
3.
Curr Diab Rep ; 24(5): 96-107, 2024 05.
Artigo em Inglês | MEDLINE | ID: mdl-38457015

RESUMO

PURPOSE OF REVIEW: People with diabetes require continuous self-monitoring and face numerous decisions in their day-to-day lives. Therefore, on many occasions, they need more support than that provided by health professionals. In this context, peer support in online diabetes communities could be a useful tool. The purpose of the review is to describe, analyze and synthesize the available evidence on the use and health out-comes of online communities for people with type 2 diabetes mellitus. A scoping review was conducted in accordance with the Joanna Briggs Institute guidelines. Searches were performed PubMed, Web of Science, CINHAL, Scopus and Cochrane databases. RECENT FINDINGS: From 1821 identified documents, 6 articles were included. These studies explored the characteristics of diabetes online communities and the population features. Besides, the results were classified according to whether they were clinical, psychosocial, or addressed people's experiences with the online community. The analysis underscores their value in facilitating communication, improving diabetes management, and enhancing psychosocial well-being. Future investigations should prioritize longitudinal assessments to elucidate the sustained impact of community engagement and optimize user participation for enhanced patient outcomes. The growing relevance of new technologies has led to a significant number of individuals with chronic illnesses seeking peer support. Online health communities have emerged as virtual spaces where individuals with shared health interests interact and form relationships. Within these digital spaces, individuals can engage in peer interaction, observe behaviors, and mutually benefit, potentially leading to improved attitudes toward the disease.


Assuntos
Diabetes Mellitus Tipo 2 , Apoio Social , Humanos , Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/terapia , Internet , Grupo Associado , Autocuidado
4.
Healthcare (Basel) ; 11(8)2023 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-37108005

RESUMO

Nursing workforce shortage is one of the main challenges for healthcare organizations and it is important to determine if nurses are fulfilling their full scope of practice. There is a questionnaire that measures the activities carried out by nurses, but there is no version available for the Spanish context. The purpose of this study was to develop a cross-cultural adaptation of the "Actual Scope of Nursing Practice" questionnaire by D'Amour et al., and to assess the psychometric characteristics of the Spanish version. An exploratory sequential research design was used. The cross-cultural adaptation was performed using translation, back-translation, review, and pre-testing. Psychometric properties were assessed to determine its construct validity and internal consistency. Among the 501 eligible nurses from the three main hospitals in the region, the first 310 nurses to respond to an online questionnaire were included in our study. The response rate was 61.9%. They were invited via email and completed the survey using the SurveyMonkey platform. The Spanish version of the questionnaire was obtained. A final scale with twenty items and two factors was confirmed with an adequate fit, with the item scores demonstrating that all items were optimally related to their respective latent construct. The alpha coefficients for the Spanish ASCOP scale were robust and revealed good internal consistency. This study showed that the Spanish version of the scale, "Scope of Nursing Practice", has a good degree of validity and reliability. This questionnaire can support nurse managers in realising nursing activities within their organisations and in promoting desirable work outcomes among nurses.

5.
Telemed J E Health ; 29(7): 956-985, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36445755

RESUMO

Background: Long-term cancer survivors have specific needs that are frequently neglected. Telehealth, as a new form of health care, can benefit this growing population. Objective: To identify, analyze, and synthesize the existing evidence on the use of telehealth in the care of cancer survivors after the end of treatment. Methods: A scoping review was conducted in the databases PubMed, CINAHL, COCHRANE, SCIELO, DIALNET, and LILACS and reference institutions in cancer. Results: The initial search yielded 406 publications with 59 articles meeting the eligibility criteria. There are different types of telehealth (video calls, phone calls, websites, mobile applications, and short message services) used for the care of cancer survivors. Most telehealth interventions focus on improving the physical and mental spheres of quality of life in the extended survival phase (from 1 to 3 years postdiagnosis), with only two articles (3%) on long-term cancer survivors (>5 years postdiagnosis). Survivors are satisfied with telehealth interventions, noting the importance of improving comprehensibility, personalization of the platforms, and the lack of excessive information included. Conclusions: Telehealth is a feasible modality for cancer survival care. The scarcity of interventions aimed at long-term survivors stands out, as does the general neglect of the social and spiritual spheres of quality of life. Implications for Practice: Telehealth platforms must adapt their content, format, and items to the preferences reported by the survivors.


Assuntos
Sobreviventes de Câncer , Neoplasias , Telemedicina , Envio de Mensagens de Texto , Humanos , Qualidade de Vida , Sobreviventes , Neoplasias/terapia
6.
J Psychiatr Ment Health Nurs ; 30(3): 326-340, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36270926

RESUMO

WHAT IS KNOWN ON THE SUBJECT?: Working on the frontline during the pandemic has had a negative impact on the mental health of health professionals. A significant proportion experienced anxiety, insomnia, posttraumatic stress or depression. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Analysis and synthesis of the evidence of the impact of the COVID-19 pandemic on the mental health of nurses based on their work context. There exists a gap in the literature as no studies were found that analysed the effects on nurses' mental health according to the level of care they worked in (hospital-primary care-nursing home). WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is an urgent need to assess and respond to the impact of COVID-19 on the physical and mental well-being of nurses, and to monitor international policies for the improvement of nurses' working conditions. ABSTRACT: Introduction Health professionals have suffered negative consequences during the COVID-19 pandemic. No review has specifically addressed the impact of the pandemic on the mental health of nurses exclusively according to the work context. Aim To analyse the impact of the COVID-19 pandemic on the mental health of nurses who have worked in hospitals, primary care centres and social health centres. Method PubMed, CINAHL, PsychINFO and Cochrane databases were searched (Prospero number: CRD42021249513). Out of 706 papers, 31 studies (2020-2021) were included in the systematic review. A qualitative synthesis method was used to analyse the data. Results Most studies were conducted in hospitals or frontline settings. The prevalence of moderate-to-severe symptoms was for anxiety 29.55%, depression 38.79%, posttraumatic stress disorder 29.8%, and insomnia 40.66%. Discussion This review highlights the mental health effects among nurses working in acute hospital settings. It also evidences a data gap on mental health effects among nurses working in primary health care and in nursing homes. Implications for practice In the post phase of the pandemic, there is an urgent need to assess and respond to the impact on the mental well-being of nurses, and to monitor international policies for the improvement of nurses' working conditions.


Assuntos
COVID-19 , Enfermeiras e Enfermeiros , Distúrbios do Início e da Manutenção do Sono , Humanos , Pandemias , Saúde Mental , Pessoal de Saúde/psicologia
7.
Artigo em Inglês | MEDLINE | ID: mdl-36231542

RESUMO

Long-term breast cancer survivors (>5 years free of disease) may suffer late sequelae of cancer that impact on their quality of life. The use of telehealth for cancer care is recommended but little is known about the effectiveness of digital interventions for long-term cancer survivors. This study aims to evaluate the effectiveness of a web-based personalized intervention based on artificial intelligence instead of usual primary health care to improve the quality of life of long-term survivors of breast cancer and self-efficacy for the management of late sequelae. A randomized controlled trial will be conducted. The sample will consist of long-term breast cancer survivors recruited from primary health centers. Women will be randomly assigned to the intervention group to receive a web-based personalized intervention or to the control group to receive standard primary health care by nurses. Data on quality of life of cancer survivors and self-efficacy for the management of late sequelae of cancer will be collected and assessed at preintervention, and at 3, 6, and 9 months. It is expected that, at the end of the programme, the experimental group will have improved quality of life and improved self-efficacy for the management of late sequelae of cancer.


Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Intervenção Baseada em Internet , Inteligência Artificial , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Exercício Físico , Feminino , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Autoeficácia
8.
Int Nurs Rev ; 69(4): 538-545, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35689833

RESUMO

AIM: To explore the impact of the COVID-19 pandemic on the mental health of nurses working in primary, secondary, and tertiary healthcare centers in Navarre (Spain). BACKGROUND: Healthcare workers, especially nurses, are at high risk for developing mental health problems during the COVID-19 pandemic. INTRODUCTION: Spain ranks among the European countries with the highest incidence of and mortality from COVID-19 and has a 31% deficit in the number of nurses compared with the average for the European Union. METHODS: This was a cross-sectional study involving 800 Registered Nurses in Navarre, Spain. Four standardized instruments, along with a self-administered online questionnaire, were used to measure the impact in terms of depression, anxiety, insomnia, and posttraumatic stress disorder. The STROBE checklist for cross-sectional studies was used to report this study. RESULTS: Of the 800 nurses, 68% had some level of depression, anxiety, insomnia, and distress, and of these, 38% had moderate or severe symptoms. Those who worked in hospital COVID units and in nursing homes showed a higher impact on their mental health. DISCUSSION: The sustained pressure that nurses have experienced in their work during the COVID-19 pandemic has negatively affected their mental health. CONCLUSION: This study found that nurses who worked in hospital COVID units and in nursing homes during the pandemic had worse mental health outcomes. IMPLICATIONS FOR NURSING/POLICY: Recommendations for nursing policy include the need to implement coaching and emotional programs to support nurses on the frontlines of the pandemic. There is also an urgent need for the implementation of national training programs to strengthen health emergency preparedness, improve response capacity, and increase the resilience of nurses to disasters.


Assuntos
COVID-19 , Distúrbios do Início e da Manutenção do Sono , Humanos , COVID-19/epidemiologia , Pandemias , Estudos Transversais , Saúde Mental , SARS-CoV-2 , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Ansiedade/epidemiologia , Depressão/epidemiologia
13.
Aquichan ; 22(1): e2211, ene. 26, 2022.
Artigo em Inglês, Espanhol | LILACS, BDENF - Enfermagem, COLNAL | ID: biblio-1353798

RESUMO

The transformation of health systems to meet the needs of chronic and multi-pathological patients has turned continuity of care into one of the mainstays of care programs and the design of new resources to care for these patients and their families. In this context, nurses' professional practice poses challenges for the three dimensions of continuity of care: relational, informational, and managerial. Faced with these challenges, nursing research is essential for the profession and necessary to promote innovative quality care.


La transformación de los sistemas sanitarios para dar respuesta a las necesidades del paciente crónico y pluripatológico ha situado la continuidad de cuidados como uno de los pilares en los que se basan los programas de atención y el diseño de nuevos recursos para atender a estos pacientes y a sus familias. En este contexto, la práctica profesional de las enfermeras presenta retos y desafíos en las tres dimensiones de la continuidad de cuidados: relacional, informativa y de gestión. Ante estos desafíos, la investigación en enfermería es fundamental para la profesión y necesaria para promover unos cuidados innovadores y de calidad.


A transformação dos sistemas sanitários para atender às necessidades do paciente crônico e pluripatológico situa a continuidade de cuidados como um dos pilares nos quais os programas de atenção e a criação de recursos para assistir esses pacientes e suas famílias estão baseados. Nesse contexto, a prática profissional dos enfermeiros apresenta desafios e obstáculos nas três dimensões da continuidade de cuidados: relacional, informativa e de gestão. Diante desses desafios, a pesquisa em enfermagem é fundamental para a profissão e necessária para promover cuidados inovadores e de qualidade.


Assuntos
Criatividade , Papel do Profissional de Enfermagem , Governança Compartilhada de Enfermagem , Liderança , Cuidados de Enfermagem
14.
J Nurs Manag ; 30(8): 3922-3932, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34529301

RESUMO

AIM: To analyse the trends of density rates of nurses and midwives per population in sub-Saharan Africa over the period from 2004 to 2016. BACKGROUND: Nursing, the largest health care workforce, is actively contributing to the achievement of the Sustainable Development Goals. The African continent is one of the most affected areas by the differences in the density of nurses and midwives indicator. METHODS: Joinpoint regression analysis was applied to identify significant changes in trends of the density of nurses and midwives from the 50 countries of sub-Saharan Africa. RESULTS: From 2004 to 2013, the density of nurses and midwives in sub-Saharan Africa increased significantly from 5.6 to 12.44 per 10,000 population, although it exhibited a increasing trend of a magnitude of 8.3% until 2013 that does not continue from that year. CONCLUSIONS: Only seven countries show an increasing trend, although in the case of the rest, they do not present any trend that suggests a change in this indicator in the short term. IMPLICATIONS FOR NURSING MANAGEMENT: From a macrolevel nursing management point of view, our study shows the importance of implementing actions that contribute to the increase of the nursing workforce in Africa, essential to achieve the Sustainable Development Goals.


Assuntos
Tocologia , Recursos Humanos de Enfermagem , Gravidez , Humanos , Feminino , Pessoal de Saúde , África Subsaariana/epidemiologia
15.
J Assoc Nurses AIDS Care ; 32(6): 662, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33989245

RESUMO

ABSTRACT: The aim of this study was to use data from the United Nations Global Indicators Database to analyze the trends in the HIV incidence rate among women in sub-Saharan African countries between 2000 and 2017. The HIV incidence rate is defined as the number of new HIV infections per 1,000 uninfected population, aged 15 to 49 years old. Joinpoint regression analysis was applied to identify periods when there were significant changes in the HIV incidence rate. The results show that there was a global decrease trend in the HIV incidence rates among women in sub-Saharan Africa, decreasing in all sub-Saharan African countries, except in Angola, Equatorial Guinea, and Sudan, which have remained the same, and Madagascar, where the overall trend is increasing. The joinpoint regression statistical method offers an in-depth analysis of the incidence of HIV among women in sub-Saharan Africa.


Assuntos
Infecções por HIV , Adolescente , Adulto , África Subsaariana/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Humanos , Incidência , Pessoa de Meia-Idade , Adulto Jovem
16.
Artigo em Inglês | MEDLINE | ID: mdl-35010711

RESUMO

Having valid and reliable tools that help health professionals to assess fear in children undergoing medical procedures is essential to offer humanised and quality of care in the paediatric population. The aim of this study was to develop the cross-cultural adaptation and the evaluation of the psychometric properties of the Spanish version of the "Child Medical Fear Scale" in its shortened version (CMFS-R). The design consisted of two phases: first, of cross-cultural adaptation and second, of the psychometric validation of the CMFS-R with a sample of 262 children from Spain, applying a cross-sectional design. Confirmatory factor analysis was conducted to assess construct validity and the Cronbach's alpha and the adjusted item-total score correlation coefficients were performed to study reliability. The results confirmed internal consistency and construct validity of the Spanish version of the CMFS-R, indicating that the scale has an acceptable level of validity and reliability. Therefore, this study brings a new version of the scale to assess fear related to medical procedures for use in the Spanish paediatric population.


Assuntos
Comparação Transcultural , Medo , Criança , Estudos Transversais , Humanos , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
17.
Nurse Educ Pract ; 49: 102905, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33137561

RESUMO

One of the most demanding challenges for teachers in undergraduate nursing programmes is teaching the intangible aspects of the discipline, such as its conceptual and theoretical bases. This study aimed to evaluate nursing students' satisfaction and knowledge acquisition after taking part in a specific themed game to learn about nursing theories and models. A descriptive, cross-sectional, quantitative, interventional study was undertaken involving 105 nursing degree students. After taking part in a themed game called "The Nurse Theorist game", the knowledge acquired by the students was assessed plus their satisfaction with the game. The data was analysed using descriptive statistics. The results indicated that the average score for knowledge was 8.28 points (on a scale of 0-10); the overall average score for satisfaction was 7.60 points out of 10. The scores obtained for satisfaction with each aspect of the game ranged from 2.90 to 3.90 out of 5. All the students recommended using this game for this subject in the years to come. To conclude, the proposal for a themed game specifically for learning nursing theories and models has been revealed to be effective in terms of knowledge acquisition and student satisfaction.


Assuntos
Bacharelado em Enfermagem , Teoria de Enfermagem , Satisfação Pessoal , Estudantes de Enfermagem , Estudos Transversais , Bacharelado em Enfermagem/métodos , Humanos , Aprendizagem , Estudantes de Enfermagem/psicologia
18.
Int J Med Inform ; 128: 87-92, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31126843

RESUMO

BACKGROUND: According to current legislation, medical devices have to incorporate all the necessary information to eliminate or greatly minimise any problem associated with their use. However, the physical capacity of the actual device's packaging may frequently not be enough to contain all this information. To address this limitation, this study aimed to design and evaluate a prototype app for mobile devices applying augmented reality technology. The main feature of this kind of technology is combining virtual images with images from the real world. METHODS: This work, carried out in Spain, was developed in three different phases. 1) Assessment of users' needs: Through a focus group and an online questionnaire, information was obtained about the following aspects: type of medical devices likely to be included in the app, relevant information that should be included and format in which this information should be presented. 2) Development of the prototype: Considering all the functional features identified in the previous phase, the software was developed by a team of professionals specialised in AR technology and applying a user-centred model. 3) Evaluation of the software: functionality and usability were assessed by means of the think-aloud method. RESULTS: 1) Assessment of users' needs: a total of 11 nurses participated in the focus group and 280 healthcare professionals answered the questionnaire. Their findings showed that users consider that information about the following aspects of medical devices should be included in the app: instructions for use, indications for use, brief description of the device, special precautions and biocompatibility, image of the content with its components and meaning of icons. 2) Description of the prototype: Once the app has been launched, when the user scans the medical device with the mobile device camera, access to the home screen is activated, where three sections can be found: name of the medical device, image of the device and four icons which provide access to: a brief description of the device, a detailed description of it, the packaging iconography and a video about use of the device. 3) Evaluation of the software: the app was defined by users as "very intuitive". They highlighted, as one of its main positive aspects, the chance to obtain information about the medical device just by scanning the object. Additionally, the evaluation performed through the think-aloud method identified potential improvements in the app. These improvements were subsequently implemented to make the prototype more functional. CONCLUSION: Working with potential prototype users made it possible to identify information considered relevant for these users and to delve into the format which they consider more appropriate to show this information in the prototype. Our results show that AR technology can be used as support for clinical practice.


Assuntos
Desenho de Equipamento , Equipamentos e Provisões/normas , Pessoal de Saúde/estatística & dados numéricos , Aplicativos Móveis/estatística & dados numéricos , Software , Adulto , Humanos , Espanha
19.
Enferm. clín. (Ed. impr.) ; 29(2): 125-130, mar.-abr. 2019.
Artigo em Espanhol | IBECS | ID: ibc-182602

RESUMO

En este artículo se realiza un análisis general sobre la formación de las enfermeras de práctica avanzada a nivel internacional. En primer lugar, se presentan algunas características esenciales y globales de la formación en práctica avanzada, las competencias centrales y las dificultades encontradas en la implantación de programas formativos para estas figuras. Posteriormente, se expone la realidad de la formación de práctica avanzada en nuestro país, haciendo especial hincapié en algunos programas universitarios a nivel de máster y la expansión de las especialidades oficiales de enfermería. A continuación, se aborda la realidad europea, con una gran variabilidad entre países con relación a la implantación de estos roles, así como una gran heterogeneidad en la formación vinculada a su desempeño. Por último, la perspectiva internacional nos lleva al análisis de la formación de enfermeras de práctica avanzada en EE. UU., Latinoamérica, África, Asia y Oceanía


This article presents a general analysis about academic training of Advanced Practice Nurses at international level. Firstly, some essential and global characteristics of advanced practice training, the core competencies and the difficulties found in the implementation of the academic training programs for these figures are presented. Secondly, the reality of advanced practice training in our country is explained, with emphasis on some university programmes at Masters, level and the expansion of the official nursing specialties. Then the European situation is addressed, showing a great variability among countries in the implementation of these roles, as well as an important heterogeneity in the academic training associated with their performance. Lastly, continuing with the international perspective, the academic training for advanced practice nurses in the USA, Latin America, Africa, Asia and Oceania is described


Assuntos
Humanos , Prática Avançada de Enfermagem/educação , Europa (Continente) , América Latina , África , Oceania , Ásia
20.
Enferm Clin (Engl Ed) ; 29(2): 125-130, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30228037

RESUMO

This article presents a general analysis about academic training of Advanced Practice Nurses at international level. Firstly, some essential and global characteristics of advanced practice training, the core competencies and the difficulties found in the implementation of the academic training programs for these figures are presented. Secondly, the reality of advanced practice training in our country is explained, with emphasis on some university programmes at Masters, level and the expansion of the official nursing specialties. Then the European situation is addressed, showing a great variability among countries in the implementation of these roles, as well as an important heterogeneity in the academic training associated with their performance. Lastly, continuing with the international perspective, the academic training for advanced practice nurses in the USA, Latin America, Africa, Asia and Oceania is described.


Assuntos
Prática Avançada de Enfermagem/educação , Educação em Enfermagem/métodos , Europa (Continente) , Internacionalidade , Espanha
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