José Manuel Romero-Sánchez

Background: Measuring patient‐level complexity of nursing care in acute medical wards is essential for staffing and care planning, yet validated brief instruments in Spanish settings are scarce. The Sistema Informativo della Performance Infermieristica (SIPI) is a brief, intervention‐based index designed to quantify nursing‐care complexity on general wards. Aim: To translate SIPI into Spanish and evaluate its clinimetric properties in acute medical hospital wards. Methods: A cross‐sectional clinimetric instrument validation study. SIPI was translated into Spanish by two bilingual nurses, and a third bilingual nurse performed a back‐translation, which was reviewed by one of the original SIPI authors to ensure semantic equivalence. Construct validity was assessed in 212 hospitalised patients in four internal medicine wards. Convergent validity was examined using nurses’ perception of the complexity of care. Known‐groups validity was assessed by examining whether SIPI behaved as expected in relation to patient age and admission type. The optimal cut‐off was determined using a receiver operating characteristic analysis to evaluate discriminant validity. Results: The Spanish version was semantically equivalent to the original, with only minor wording adjustments. Convergent validity was supported: SIPI scores increased significantly across the four nurse‐rated complexity levels and were significantly higher in patients rated as high versus low complexity. In the ROC analysis, SIPI discriminated high‐ from low‐complexity patients with excellent accuracy (AUC = 0.94; 95% CI 0.91–0.97); the optimal cut‐off of 53.50 yielded 88.4% sensitivity, 86.0% specificity, 87.6% positive predictive value and 86.9% negative predictive value. Known‐groups validity was supported, as patients classified as high complexity by SIPI were significantly older than those classified as low complexity, and SIPI scores were significantly higher in urgent versus scheduled admissions. Implications for Nursing Management: The Spanish version of SIPI offers nurse managers a brief, patient‐level measure of nursing‐care complexity that could complement existing staffing and workload systems to support early identification of high‐complexity patients and more equitable, transparent resource allocation, pending confirmation in multicentre, outcome‐based studies. Conclusion: The Spanish version of SIPI showed adequate clinimetric properties, similar to the original Italian version, supporting its use as a brief instrument for measuring the patient‐level complexity of nursing care in acute medical hospital wards.

Background: In an increasingly complex healthcare system, the use of nursing diagnosis is considered a gold standard of care and has become more integrated into clinical practice. Many countries have introduced policies to support the use of nursing diagnosis and align them with international nursing standards. In Romania, accreditation requirements have recently incorporated nursing diagnosis into clinical practice. However, although a legal framework exists, it remains unclear whether individual and organizational factors promote their use in daily practice. Aim: This study aims to examine the associations between individual factors (nurses’ education, attitudes, and self‐directed learning) and organizational factors (department size and type) and the use of nursing diagnosis in clinical practice, while accounting for theoretically relevant confounders. Methods: A cross‐sectional survey was conducted among clinical and managerial nurses in Romanian hospitals. A total of 691 nurses participated, and the final sample included 589 participants. Data were collected using a multistage sampling strategy and analyzed using multilevel regression modeling. Results: Multilevel regression analysis showed that positive attitudes and formal education were significantly associated with nursing diagnosis use, while lack of formal education or reliance on self‐training was associated with lower use. Greater time dedicated to self‐directed learning was associated with increased use. Older age, male gender, and larger department size were negatively associated with nursing diagnosis use, while use was lower in emergency and intensive care units compared to medical departments. Conclusions: Both individual and organizational factors are associated with the use of nursing diagnosis. Education, self‐directed learning, and positive attitudes support their use, while department characteristics, older age, and male gender are associated with lower use. Targeted training and the promotion of self‐directed learning may enhance the use in clinical practice. Implications for Nursing Leadership: Nurse leaders should promote nursing diagnosis‐focused education and continuing professional development tailored to nurses’ prior training, support opportunities for self‐directed learning, and implement structural measures in larger departments and adapted protocols in high‐acuity settings where lower use was observed.

Purpose: This study describes the design, integration, and semantic interoperability process of a minimum data set using standardized nursing language in the caring module of the TEC-MED care platform. Methods: The caring module was developed in three phases (2020–2022): platform concept, functional design and construction, and testing and evaluation. Phases involved collaboration among academics, information technology developers, and social/healthcare professionals. Nursing taxonomies (NANDA-I, NOC, NIC) were integrated to support the nursing process. The platform was piloted in six Mediterranean countries. Findings: The final platform features an assessment module with eight dimensions for data collection on older adults and their caregivers. A clinical decision support system links assessment data with nursing diagnoses, outcomes, and interventions. The platform is available in six languages (English, Spanish, French, Italian, Greek, and Arabic). Usability testing identified the need for improved Arabic language support. Conclusions: The TEC-MED platform is a pioneering tool using standardized nursing language to improve care for older adults in the Mediterranean. The platform's multilingualism promotes accessibility. Limitations include offline use and mobile app functionality. Pilot testing is underway to evaluate effectiveness and facilitate cross-cultural validation of nursing taxonomies. Implications for nursing practice: The TEC-MED platform offers standardized nursing care for older adults across the Mediterranean, promoting consistent communication and evidence-based practice. This approach has the potential to improve care quality and accessibility for a vulnerable population.

Purpose: To validate the content of the “Health Literacy Behaviour” nursing outcome (NO). Methods: A content validation study was conducted during 2022. Each indicator was included in the NO, and its response levels were operationally defined. The initial version of each indicator and its response levels were refined and validated through the Delphi method. A panel of health literacy (HL) and nursing taxonomies experts evaluated the content through two content validity indicators. The content validity of the NO and each index was determined by calculating the content validity index (CVI). A qualitative analysis of the recommendations provided by the experts was carried out to improve the understanding of the indicators and their levels. Findings: A total of 108 experts participated in this study. Mostly females with more than 10 years of professional experience. The results demonstrated a high CVI of the indicators and the NO “Health Literacy Behaviour.” All indicators achieved excellent (CVI ≥ 0.80) relevance and clarity. The CVI universal average method (CVI-p) of the NO achieved an excellent result of 0.90. Conclusions: The indicators included in the NO “Health Literacy Behaviour” have content validity. Implications for nursing practice: These findings provide evidence-based indicators to measure the patient's actions to obtain, process, and understand information about health and disease, interact with the health system, and make informed health decisions. The validation of this NO would identify populations with low HL, allowing the health of this community to be promoted. Health literacy should be a priority objective of health management and policies.

Purpose: To identify clusters of beliefs about nursing diagnosis (ND) among Romanian hospital nurses and to ascertain variations in attitudes, intention to use, behavior associated with the use of ND, and sociodemographic characteristics. Methods: A cross-sectional online survey study was conducted on a convenience sample of 498 hospital nurses in Romania. The questionnaire comprises six scales measuring normative, behavioral, and control beliefs, intention to use, attitudes, and behavior toward ND. Results were reported through cluster analysis. Findings: Three clusters were identified: highly positive, average, and highly negative beliefs about ND. Romanian nurses have more homogeneous beliefs regarding ND than nurses from other countries. Comparisons among clusters showed significant differences in intention [ H (2) = 111.59, p < 0.001], attitudes [ H (2) = 145.27, p < 0.001], and reported behavior [ H (2) = 43.84, p < 0.001]. The stronger the attitude toward ND, the intention to use it, and the behavior of using ND, the more favorable the beliefs and vice versa. Significant disparities among clusters were discovered regarding education in ND, whereas differences were not observed regarding years of experience, age, and gender. Conclusion: Nurses exhibited different belief patterns about ND. Those with more positive beliefs demonstrated a more favorable attitude, a higher intention, and a more frequent behavior in using ND. Training in ND facilitates positive beliefs about it. Implications for nursing practice: When designing interventions to promote ND in clinical practice, policymakers, administrators, and educators should consider addressing and potentially changing these beliefs. Modifying nurses’ attitudes could positively impact patient care quality during their hospital stay and post-discharge.

Purpose: The aim was to translate and adapt The Anterior Cruciate Ligament Return to Sport after Injury Scale (ACL‐RSI) to Spanish and provide evidence of its psychometric properties and responsiveness in a both sexes multisport sample.Methods: ACL‐RSI Spanish version (SP ACL‐RSI) was obtained by forward‐back‐translation method. Internal consistency, test‐retest reliability, construct validity and responsiveness were assessed. Standardized response mean (SRM), smallest detectable change (SDC) and minimally important change (MIC) were obtained by anchor‐based method. The sample consisted of n = 132 multisport patients who underwent ACL‐RSI. Sixty‐seven patients (Group A) completed test‐retest of the SP ACL‐RSI within 15 days and 65 patients (Group B) fulfilled SP ACL‐RSI, the Tampa Scale of Kinesiophobia (TSK‐11), the International Knee Documentation Committee‐Subjective Knee Form (IKDC‐SF 2000), the Knee Osteoarthritis Outcome Score (KOOS) preoperative, 6 and 12 months.Results: The SP ACL‐RSI shows satisfactory internal consistency (Cronbach's α = 0.95) and test–retest reliability (ICC = 0.92), with acceptable floor (9%) and ceiling (6%) effects. Convergent validity was supported with moderate positive correlations with KOOS and IKDC‐SF 2000 dimensions, and a negative correlation with the TSK (p < 0.001). For SDC responsiveness, a high effect was observed with SRM = 0.97 at 12 months, and the MIC for SP ACL‐RSI was 15.Conclusions: The SP ACL‐RSI is as valid and reliable as the original for measuring emotions, confidence in performance, and re‐injury risk on return to sport after ACL‐R in Spanish‐speaking multisport practitioners of both sexes. Moreover, it shows acceptable responsiveness, performing better at the group level than the individual level.Level of evidence: A cohort study (diagnosis); Level II of evidence.

Purpose: The aim of this study is to design and validate the content of an instrument based on the Nursing Outcomes Classification (NOC) “Knowledge: disease process” and “Risk control: hypertension” to measure pregnant women's knowledge and self-care behaviors about hypertensive disorders. Methods: The study was carried out in three phases: (a) content validity of the indicators, (b) construction, and (c) content validity of the instrument. Findings: The instrument contains 72 items with an average content validity ratio and representativeness of 0.92. The items that did not reach the established values were eliminated or reformulated according to the observations made by the experts. Conclusions: This study provides the first instrument for perinatal maternal care designed from the NOC that has demonstrated adequate content validity and representativeness of the NOCs on which it is based. The next phase in the development of the instrument is to test its validity and reliability. Implications for nursing practice: CoNOCiTHE is a tool that can be useful in assessing pregnant women's knowledge and self-care behaviors about hypertensive disorders, contributing to the documentation and quality of maternal perinatal nursing care.

Aim: To determine the prevalence and clustering of NANDA‐International nursing diagnoses in patients assisted by pre‐hospital emergency teams. Design: Retrospective descriptive study of electronic record review. Methods: Episodes recorded during 2019, including at least a nursing diagnosis, were recovered from the electronic health records of a Spanish public emergency agency ( N = 28,847). Descriptive statistics were used to characterize the sample and determine prevalence. A two‐step cluster analysis was used to group nursing diagnoses. A comparison between clusters in sociodemographic and medical problems was performed. Data were accessed in November 2020. Results: Risk for falls (00155) (27.3%), Anxiety (00146) (23.2%), Acute pain (00132), Fear (00148) and Ineffective breathing pattern (00032) represented 96.1% of all recorded diagnoses. A six‐cluster solution ( n = 26.788) was found. Five clusters had a single high‐prevalence diagnosis predominance: Risk for falls (00155) in cluster 1, Anxiety (00146) in cluster 2, Fear (00148) in cluster 3, Acute pain (00132) in cluster 4 and Ineffective breathing pattern (00032) in cluster 6. Cluster 5 had several high prevalence diagnoses which co‐occurred: Risk for unstable blood glucose level (00179), Ineffective coping (00069), Ineffective health management (00078), Impaired comfort (00214) and Impaired verbal communication (00051). Conclusion: Five nursing diagnoses accounted for almost the entire prevalence. The identified clusters showed that pre‐hospital patients present six patterns of nursing diagnoses. Five clusters were predominated by a predominant nursing diagnosis related to patient safety, coping, comfort, and activity/rest, respectively. The sixth cluster grouped several nursing diagnoses applicable to exacerbations of chronic diseases. Implications for the profession and/or patient care: Knowing the prevalence and clustering of nursing diagnoses allows a better understanding of the human responses of patients attended by pre‐hospital emergency teams and increases the evidence of individualized/standardized care plans in the pre‐hospital clinical setting. Impact: What problem did the study address? There are different models of pre‐hospital emergency care services. The use of standardized nursing languages in the pre‐hospital setting is not homogeneous. Studies on NANDA‐I nursing diagnoses in the pre‐hospital context are scarce, and those available are conducted on small samples. What were the main findings? This paper reports the study with the largest sample among the few published on NANDA‐I nursing diagnoses in the pre‐hospital care setting. Five nursing diagnoses represented 96.1% of all recorded. These diagnoses were related to patients' safety/protection and coping/stress tolerance. Patients attended by pre‐hospital care teams are grouped into six clusters based on the nursing diagnoses, and this classification is independent of the medical conditions the patient suffers. Where and on whom will the research have an impact? Knowing the prevalence of nursing diagnoses allows a better understanding of the human responses of patients treated in the pre‐hospital setting, increasing the evidence of individualized and standardized care plans for pre‐hospital care. Reporting method: STROBE checklist has been used as a reporting method. No Patient or Public Contribution: Only patients' records were reviewed without further involvement.