Francisco Javier Pérez Rivera

Background: Burnout and job satisfaction among midwives have been studied extensively but not in the context of global pandemics. Given the effects of pandemics and similar crises on the experiences and working conditions of midwives, as well as the increasing incidence of such events, it is necessary to evaluate their impact. The dual aims of this study were to analyze whether there were differences in the levels of burnout and job satisfaction experienced during the pandemic between midwives in Spain and the United Kingdom, and to identify risk factors for high levels of burnout during this period. Methods: We conducted a cross‐sectional study using a questionnaire based on validated burnout and job satisfaction scales between October 2020 and March 2021. We recruited a total sample of 599 midwives, 170 in the UK and 429 in Spain. Data were analyzed using logistic regression models in SPSS 20.0. Results: Moderate and high levels of burnout were found in both countries, although UK midwives reported significantly higher levels of burnout than Spanish midwives ( p > 0.000). Spanish midwives had higher job satisfaction scores in all variables except benefits received (salary, promotion, and training) ( p > 0.000). Age, hospital care units, and rotating work shifts were the main factors related to high levels of burnout ( p > 0.000). Conclusions: During the pandemic, midwives in Spain and the United Kingdom experienced high levels of burnout and job dissatisfaction. Strategies need to be developed to reduce the impact of pandemic‐related stressors in order to minimize attrition in the profession without compromising quality of care.

Background: The loss of autonomy in midwives is associated with lower job satisfaction and consequently greater likelihood of leaving the profession. Given the international shortage of professionals, it is essential to explore how to increase their job satisfaction and reduce attrition. Objective: To explore Spanish midwives’ perceptions of the causes of their burnout and reasons for leaving the profession. Methods: Descriptive qualitative study. Four discussion groups were held with a total of 21 participating midwives between October 10 and 29, 2024. A thematic analysis of the data was performed. The Ethics Committees of the University of León (ETICA‐ULE‐033‐2020) and the University Healthcare Complex of León (Registration Number 20162) approved the study. Results: A total of 66.7% of the participants were women, 61.9% worked in hospital care, 47.6% were between 30 and 40 years old, and 57.1% had between 10 and 20 years of professional experience. The thematic analysis revealed several main themes: Causes (“Loss of autonomy,” “Excessive medicalization of childbirth,” “Conflict with gynecologists,” “Traumatic perinatal events,” “Lack of representation in management,” and “Working conditions”) Solutions (“Increased professional autonomy,” “Recognition of competences,” “Independent midwifery degree,” and “Professional Recognition”), and Consequences (“Demotivation, Anxiety, and Frustration” and “Leaving the profession”). Conclusions: In addition to improving overall well‐being within the profession, improving midwives’ mental health can have a positive impact on professional retention, which would help in the significant crisis caused by the international shortage of professionals. Implications for Nursing Management: Nursing and midwifery managers play a pivotal role in preventing burnout by creating organizational environments that support midwives’ professional autonomy, meaningful participation in leadership and policy decisions, and respectful interprofessional relationships. Management should ensure access to structured debriefing and psychological support following traumatic perinatal events, promote safe staffing and sustainable workloads, and invest in professional development and supportive workplace cultures. These strategies may improve midwives’ wellbeing, strengthen workforce retention, and ultimately enhance the quality and safety of maternity care.

Background: Anxiety and stress are common during pregnancy and can impact the health of the pregnant woman and the newborn. There is a lack of research focused on identifying weaknesses that promote equity in the care of pregnant women. The objective of this study was to describe the levels of anxiety and stress during the three trimesters of pregnancy and to compare whether there are differences according to obstetric and gynecological variables. Methods: A descriptive prospective longitudinal and correlational observational study was carried out. Non-probability sampling was carried out with 176 women. The Pregnancy-Related Anxiety Questionnaire and the Perceived Stress Scale were used. Results: The prevalence of anxiety was 23.9%, 17%, and 17.6%, and mean stress scores reached 32.24, 33.02, and 49.74 in the first, second, and third trimesters, respectively. In comparison, without miscarriages, anxiety was higher during the first trimester. In multiparous women who had suffered a miscarriage, anxiety was higher in the first trimester. Conclusions: Anxiety is higher during the first trimester. Mean stress levels are higher during the third trimester compared to the other two trimesters. Care for these vulnerable pregnant women can impact society’s health system and align with the Sustainable Development Goals of Health and Well-being and Gender Equality in others.

Objective: The purpose of this scoping review is to describe the characteristics of the decision‐making competency of nurse managers. In addition, this review analyzes how technological, organizational, and contextual factors influence the development and practical application of this competency and identifies the key barriers and facilitators that specifically impact its growth and use in managerial practice. Background: Nurse managers’ decision‐making abilities are essential for organizational performance in rapidly evolving healthcare systems. Despite its relevance, the specific characteristics that define this competency have not been thoroughly examined. Following our research methodology, we searched the Web of Science, Scopus, CINAHL, and PubMed electronic databases, focusing on the decision‐making characteristics of nurse managers between January 2009 and February 2025. Results: Twenty‐five studies were included, identifying 15 core characteristics that define nurse managers’ decision‐making competency. The most frequently reported characteristics were professional values and ethics, information processing, systems and data management, and risk management. Technology was consistently identified as a critical facilitator of decision‐making, enabling efficient information access and analysis. Conversely, high levels of stress and the complexity of healthcare environments were identified as the primary barriers to effective decision‐making. Conclusions: Strengthening decision‐making competency in nurse managers requires the development of ethical reasoning, data literacy, systems thinking, and risk evaluation. Technological proficiency is essential to enhance decision quality, while organizational stressors must be managed to reduce cognitive load and improve performance. Implications for Nursing Management: These findings support the design of targeted training programs, particularly those using simulation and virtual reality, focused on strengthening decision‐making competency, a critical skill for effective nursing management. Developing this competency enhances nurse managers’ ability to navigate complex clinical and organizational challenges, make ethically sound decisions, and lead their teams with greater confidence and strategic insight.

Aim: The aim of this study was to review the existing evidence on burnout levels in midwives and the main related factors. Design: Mixed studies systematic review. Data Sources: PubMed, Scopus and Web of Science were sourced from 2018 and 2023. Review Methods: Inclusion criteria: quantitative cross‐sectional or qualitative articles published in English within the last 5 years. Exclusion criteria: studies with undergraduate or trainee midwives, studies examining the factors in a pandemic setting and those not answering the research question. Potential risk of bias was assessed using the Mixed Methods Assessment Tool (MMAT). A convergent synthesis design was followed through a thematic synthesis using Thomas and Harden's three‐step method: inductive coding of the text, development of descriptive themes and generation of analytical themes. Qualitative approaches adopted exploratory descriptive studies and participatory action research. Results: Thirty‐six studies were included, with a total of 17,364 participants. There were higher levels of burnout in midwives who were single, under 35–40 years of age, with less than 10 years of experience and those with young children. Stress, anxiety and depression, as well as the emotional impact of traumatic events, have been described as related psychological factors. Conclusion: Although extrinsic work factors such as shifts, workload, pay and interpersonal relationships increase burnout, intrinsic factors such as lack of autonomy and recognition are the main factors related to it. Impact: What problem did the study address? Burnout among healthcare workers has been recognized as a global crisis requiring urgent attention, specifically in midwives. What were the main findings? There is a persistent shortage of midwives that is attributed in part to chronic retention difficulties related to job burnout expressed by these professionals. Where and on whom will the research have an impact? We seek to address the paucity of research on burnout in midwives in the current crisis in the profession. Work factors such as lack of autonomy or recognition in the profession carry an associated risk of burnout and job attrition. Understanding the factors that contribute to burnout will enable healthcare organizations to reduce the current problem. Reporting Method: Preferred: Reporting items for systematic review and meta‐analyses (PRISMA). Patient of Public contribution: No patient or public contribution.

Introducción: Las intervenciones educativas en el entorno escolar, parecen la forma más efectiva de actuar contra la obesidad infantil. Los objetivos de esta revisión sistemática fueron, describir las intervenciones educativas sobre alimentación y/o actividad física llevadas a cabo en alumnos de Educación Primaria con el fin de disminuir o prevenir la obesidad infantil y analizar la eficacia de dichas intervenciones.Metodología: Se realizó una búsqueda bibliográfica en las bases de datos WOS y SCOPUS. Los criterios de elegibilidad fueron establecidos en base al acrónimo PICOS: (P) niños de educación primaria (6-12 años), (I) estudios que llevaran a cabo intervenciones de nutrición y/o actividad física en el ámbito escolar, (C) no recibir ninguna intervención, (O) evaluar el efecto de los programas educacionales sobre la obesidad infantil, (S) estudios experimentales, publicados entre 2013 y 2017.Resultados y discusión: Se identificaron 571 artículos, y finalmente se incluyeron 22 estudios. Se encontró que las intervenciones más prometedoras fueron las combinadas. La duración, la participación de los padres, el sexo y nivel socioeconómico pueden influir en la efectividad de las intervenciones. Se observó una escasez de intervenciones teóricamente fundamentadas.Conclusiones: Las intervenciones con mejores resultados son las combinadas, con actividades incluidas en el currículo y la participación de los padres. Las intervenciones a largo plazo parecen tener mejores resultados. Estos programas ayudan a la adquisición de hábitos saludables y existe cierta evidencia de que son útiles en la disminución del Índice de Masa Corporal (IMC) o en la prevención de la obesidad infantil. Introduction: Educational interventions in the school environment seem the most effective way to act against childhood obesity. The objectives of this systematic review were to describe the educational interventions on nutrition and / or physical activity carried out in primary school students in order to reduce or prevent childhood obesity and analyze the effectiveness of these interventions.Methodology: A bibliographic search was carried out in the WOS and SCOPUS databases. Eligibility criteria were established based on the acronym PICOS: (P) primary school children (6-12 years), (I) studies that will carry out nutrition and / or physical activity interventions in the school setting, (C) not receive any intervention, (O) evaluate the effect of educational programs on childhood obesity, (S) experimental studies, published between 2013 and 2017.Results and discussion: 571 articles were identified, and finally 22 studies were included. It was found that the most promising interventions were the combined ones. Duration, parental involvement, gender and socioeconomic status can influence the effectiveness of interventions. A shortage of theoretically based interventions was observed.Conclusions: The interventions with the best results are the combined ones, with activities included in the curriculum and the participation of the parents. Long-term interventions seem to have better results. These programs help the acquisition of healthy habits and there is some evidence that they are useful in decreasing the Body Mass Index (BMI) or in the prevention of childhood obesity.