Juan Carlos Paramio-Cuevas

Background/Objectives: Mental health nurses are among the health professionals who show the highest levels of empathy and the most positive attitudes towards patients with mental disorders. Nevertheless, burnout is a prevalent issue among these professionals, as well as throughout their training as residents. The objective of this study is to examine the relationship between empathy, burnout and attitudes towards patients with mental disorders among mental health nurse residents in Spain. Methods: A cross-sectional descriptive design was employed with a sample of 214 resident nurses engaged in specialty training in mental health teaching units in Spain. The sample was selected purposely. The Jefferson Empathy Scale, the Maslach Burnout Inventory and the Community Attitudes Towards Mental Illness Inventory were employed to quantify the study variables. Results: The study sample included 214 residents, composed of 46 males (21.5%) and 168 females (78.5%), with an overall median age of 27.00 years (IQR: 25.00–29.00). The internal reliability of the instruments was high (JSE α = 0.834, MBI α = 0.821, CAMI-CMH α = 0.851). Our findings indicate that empathy during residency is associated with an enhancement in positive attitudes towards patients with mental disorders, and a reduction in the associated stigma (JSE vs. CAMI-SR: ρ = −0.210, p < 0.01). However, empathy did not act as a protective factor against burnout in the study sample, showing a moderate positive correlation with emotional exhaustion (JSE vs. MBI-EE: ρ = 0.481, p < 0.01). Conclusions: Our findings suggest that although empathy does not necessarily act as a protective factor against burnout, it may favour more positive and less stigmatising attitudes towards people with mental disorders. Future research is needed to further investigate the complex interplay between emotional competencies and work-related stress in this context.

Stress and stressors related to clinical practice are some of the main reasons for the discomfort reported by nursing students. It is important to identify the causes of stress and seek strategies to reduce the stress levels in nursing students. Clinical training seminars have proven to be a useful tool to reduce stress levels. This study aims to evaluate the effects of a series of clinical training seminars on the levels of stress and perception of stress factors before the start of clinical practice among undergraduate Spanish nursing students. A two-phase, sequential mixed-methods design was used. For the quantitative phase, data were collected using Cohen’s Perceived Stress Scale and the KEZKAK questionnaire before and after the clinical training seminars. Qualitative data were collected through a focus group session held after the clinical training period. The results show a significant reduction (p = 0.002) in perceived stress levels after the clinical training seminars, and also a change in students’ perception of stressors in the clinical placement. This study provides valuable information for the development of content for clinical training seminars. Universities should develop strategies to reduce stress in their students caused by the clinical placement.

Objective: The aim of the present study was to design a content-valid nursing objective structured clinical examination attending a first-year clinical nursing practice program. Method: The examination was designed following a procedure based on the consensus of experts which was comprised of three phases: selection of the activities in which students should be competent according to the learning outcomes of the course, clinical case design, and integration of the clinical cases designed into the stations of the test. Results: Of the 44 surveys submitted for the design of the stations, 37 were answered, of which 31 respondents met the inclusion criteria of the panel of experts. The activities on which the experts reached the highest degrees of consensus were: basic physical assessment and monitoring of vital signs, assessment of hygiene and skin status, ability to develop care plans, management of safety principles in administration of medication and administration of oral medication. Based on the selected activities, the experts developed 20 clinical cases, from which a four-station nursing objective structured clinical examination was designed. Conclusion: The structured methodology based on the design of experts enabled the design of a content-valid objective structured clinical examination appropriate for the evaluation of the learning outcomes achieved by the students attending a clinical practice program.

Aim To identify clusters of nurses in relation to the utilisation and attitude towards nursing diagnosis and to compare their profiles considering demographics, professional characteristics and nursing practice environments. Background Nursing diagnosis has benefits for both patients and nurses, and the attitude of nurses towards nursing diagnosis has been proposed as a determinant of its use. Therefore, an adequate understanding of nurses’ attitude and utilisation profiles regarding nursing diagnosis is essential for the nursing managers who want to adopt nursing diagnosis as a practice framework. Methods A cross‐sectional survey design was used. A sample of 239 nurses working in the Catalan primary health care system were categorised into clusters with similar attitude and utilisation profiles, which were compared with each other a posteriori. Results Nursing managers were grouped into more positive attitude clusters than clinical nurses. Nurses working in supportive nursing practice environments were classified into more positive attitude and higher utilisation clusters. Conclusion The field of work and nursing practice environments were found as differential factors in profiles of nurses with different attitudes towards and/or utilisation of nursing diagnosis. Implications for Nursing Management The promotion of supportive nursing practice environments could enhance the implementation and maintenance of nursing diagnosis as a practice framework in primary health care.

Purpose: To develop and psychometrically evaluate a questionnaire based on the outcome “Knowledge: Breast-feeding” of the Nursing Outcomes Classification (NOC) to determine the knowledge of parents on breast-feeding. Background: The NOC outcome “Knowledge: Breast-feeding” allows for nurses/midwives to assess the efficacy of interventions aimed to improve the knowledge on breast-feeding in parents thought the clinical interview/observation. However, the use of self-administered questionnaires by patients could facilitate its evaluation. Methods: Two-phased study: (1) Development of the questionnaire based on experts' opinions; (2) Methodological design to assess its psychometric properties. Implications for Nursing Practice: The availability of tools that enable the determination of the knowledge of patients would facilitate nurses/midwives to set objectives, individualize interventions, and measure their effectiveness.

Purpose: To validate the content of the NANDA-I nursing diagnosis of grieving in situations of perinatal loss. Methods: Using the Fehring's model, 208 Spanish experts were asked to assess the adequacy of the defining characteristics and other manifestations identified in the literature for cases of perinatal loss. Findings: The content validity index was 0.867. Twelve of the 18 defining characteristics were validated, seven as major and five as minor. From the manifestations proposed, “empty inside” was considered as major. Conclusion: The nursing diagnosis of grieving fits in content to the cases of perinatal loss according to experts. Implications for Nursing Practice: The results have provided evidence to support the use of the diagnosis in care plans for said clinical situation.

El Position on Nursing Diagnosis (PND) es una escala que utiliza la técnica del diferencial semántico para medir las actitudes hacia el concepto diagnóstico enfermero. El estudio objetivó desarrollar una forma abreviada de la versión española de esta escala, evaluar sus propiedades psicométricas y eficiencia. Se utilizó un doble enfoque empírico-teórico para obtener una forma reducida del PND, el PND-7-SV, que fuera equivalente a la original. Mediante un diseño transversal a través de encuesta, se evaluó la fiabilidad (consistencia interna y fiabilidad test-retest), validez de constructo (análisis factorial exploratorio, técnica de grupos conocidos y validez discriminante) y de criterio (validez concurrente), sensibilidad al cambio y eficiencia del PND-7-SV en una muestra de 476 estudiantes de enfermería españoles. Los resultados avalaron la utilidad del PND-7-SV para medir las actitudes hacia el diagnóstico enfermero de manera equivalente a la forma completa de la escala y en un tiempo más reducido.

In recent decades the fight against breast cancer has focused primarily on the treatment and secondary prevention (early detection mainly). In the case of breast self-examination, althought it has not been prove to reduce mortality, it is important in cases detected by women themselves (it is estimated 90% of total), mainly in the interval cancers. To identify within women with breast cancer, how many do self-examination and identify associated factors. Describe the clinical and pathological features of cancers in women who do perform self-examination. In women diagnosed with breast cancer during 2007 in a hospital in the province of Cadiz, Spain, is reconstructed in retrospect the story related the cancer process: symptoms, psychosocial factors that determine the contact with the health system, preventive practices (self-examination, mammography screening). A description of the pathological tumor: presenting symptom, tumor size, node negative, grade of differentiation. We studied 149 women with breast cancer, from whom 52% did self-exploration. Women who performed self-examination were younger (54.78 years) against the women who did not (65.63 years), married (66.2%), active workers and have a higher educational level. The assessment of the first symptoms in these women as "important" is positively correlated with those women who practice self-examination. For other preventive practices, women who does self-examination are also the most actives in early detection programs (74.4% against 29.5% which didn't do self-examination). For the pathologic characteristics of tumor in women who did self-examination: the tumor size was 2.5 cm, 50.7/are well differentiated, and 59.1% of cases the nodes are negative. Women who does self-examination are younger, have higher educational level, are married, are active workers and are often involved in other preventive practices. On them, the tumors diagnosed have a smaller size, are diagnosed at earlier stages and usually present better degree of differentiation.

Aim: To report the adaptation into Spanish and psychometric testing of the Position on Nursing Diagnosis scale.Background: The Position on Nursing Diagnosis is a scale that uses the semantic differential technique to measure nurses' attitudes towards the nursing diagnosis concept.Design: Methodological design.Method: The scale was cross‐culturally adapted through a process including translation, comparison with versions in other languages, back‐translation, review, and pre‐testing. An opportunistic sample of 621 Spanish registered nurses was recruited from August–December 2011. Reliability was evaluated through internal consistency and test–retest reliability. Construct validity, using both exploratory factor analysis and the known‐group technique, and concurrent validity were assessed.Findings: The Position on Nursing Diagnosis‐Spanish Version was obtained from the cross‐cultural adaptation process. High internal consistency and satisfactory test‐retest reliability over a two week period (n = 240) were found. In the principal component analysis, all items loaded strongly on a single‐factor which accounted for adequate variance, supporting the unidimensionality of the scale. A statistically significant difference was found comparing the scores of nurses who were members of the Spanish Association of Nomenclature, Taxonomy and Nursing Diagnosis and those who were not. Concurrent validity was supported by the significant correlation found between the scores and the degree of nursing diagnosis utilization and attendance to training sessions.Conclusion: The findings support the validity and reliability of the Position on Nursing Diagnosis‐Spanish Version for its use among Spanish registered nurses as a measurement of their attitude towards the nursing diagnosis concept.