Construcción y validación de una escala de evaluación del nivel de competencia en la interacción de cuidado para estudiantes de Grado en Enfermería

Las recomendaciones del Espacio Común Europeo de Educación Superior destacan la necesidad de adecuar los títulos de Grado a la adquisición de competencias, y el uso de métodos adecuados, como las rúbricas de evaluación, para la evaluación de dicha adquisición. Por otro lado, la competencia en la relación enfermera-paciente, integrada en el currículo del estudiante que obtiene el Grado en Enfermería, se convierte así en objeto de evaluación. El objetivo del presente estudio fue la construcción y validación de una escala de evaluación del nivel de competencia en la relación enfermera-paciente para estudiantes de Grado en Enfermería de la Universidad de Sevilla, a partir del cuestionario “Caring Nurse-Patient Interactions Scale (CNPI)” de 70 ítems. Además, se estudió la posible relación entre el nivel de competencia en la relación enfermera-paciente y el nivel en habilidades sociales. Para ello, se llevó a cabo un estudio observacional de validación clinimétrica, durante el año 2016, en tres fases. En la primera, se desarrolló un proceso de traducción y adaptación cultural del cuestionario CNPI, mediante el método de traducción-retro traducción, por un panel de expertos. En la segunda fase, se realizó un estudio piloto sobre una muestra estudiantes de 4º curso de Grado en Enfermería de la Universidad de Sevilla. En la tercera, se procedió al análisis de constructo, de criterio, –mediante el uso de un cuestionario elegido como “gold standard”- y consistencia interna mediante un estudio de campo. Para ello, se llevó a cabo un análisis factorial exploratorio (AFE), análisis factorial confirmatorio (AFC), y método de regresión de mínimos cuadrados parciales (PLS). Se correlacionaron también las puntuaciones del cuestionario creado con las obtenidas en otro cuestionario que mide competencia en habilidades sociales, obtenidas por los mismos sujetos de la muestra de estudio. Los resultados ofrecieron una versión traducida al español, que se sometió a estudio piloto sobre una muestra de estudiantes de 4º curso de Grado en Enfermería de la Universidad de Sevilla. El análisis factorial exploratorio obtuvo una versión reducida de 28 ítems, con una estructura dimensional de 8 factores y un 63% varianza explicada. La misma se utilizó sobre una muestra de 332 sujetos para el estudio de campo. El AFE aplicado sobre estos nuevos datos redujo el número de factores a 5, aunque el AFC no obtuvo resultados satisfactorios. Por ello, teniendo en cuenta criterios teóricos y fundamentales, se construyó un modelo de senderos que relacionan los 5 constructos. Sobre el mismo, se ejecutó el método de regresión de mínimos cuadrados parciales que ofreció valores de fiabilidad aceptables, óptima validez discriminante y tamaños de efecto excelentes. Se validó así una estructura de 5 constructos y 16 ítems, y se nombró el cuestionario como “Nursing Interactions in Caring _ Competence Assessment (NIC_CA)”. No se obtuvo correlación entre el cuestionario NIC_CA y el cuestionario elegido como “gold standard”, por lo que la validez de criterio no pudo ser estudiada; no obstante, se confeccionó un baremo de niveles de competencia a partir de los valores de la mediana y los percentiles. Tampoco se encontró convergencia entre las puntuaciones del cuestionario NIC_CA y las del cuestionario que valoraba competencia en habilidades sociales. En resumen, esta investigación aporta un cuestionario fiable y válido, para medir el nivel de competencia en la relación enfermera-paciente de los estudiantes de 4º curso de Grado en Enfermería. Futuros estudios deberían estudiar la validez de criterio, aportando datos de sensibilidad y especificidad, así como contemplar la perspectiva de género en la conceptualización y ejecución de las conductas y actitudes que caracterizan la relación enfermera-paciente.The competence acquirement is described in the European Higher Education area recommendations, and Universities should adapt their programs to get this standard using appropriate instruments, like the evaluation rubric. In addition, the nurse-patient relationship competence acquirement, as a specific competence in Nursing Degree programs, becomes an object to be evaluated. The objective of this study was the validation of a tool which measures the nurse-patient interaction competence in nursing students, based on Caring Nurse Patient Interaction Scale (CNPI)- 70 items and Jean Watson’s model. A clinimetric validation study was conducted in three phases. First, the translation and cultural adjustment of the CNPI questionnaire was developed, using the translation-back translation method, by a panel of experts. Secondly, a pilot study was carried out on a sample of last-year Nursing Degree students at the University of Seville. Thirdly one, we achieved the analysis construct, criteria and internal consistency analysis. Furthermore, exploratory factorial analysis (EFA), confirmatory factorial analysis (CFA), and partial least squares (PLS) method were performed. The scores of the created questionnaire were also correlated with those obtained in another questionnaire that measures social skill competence, obtained by the same subjects of the study sample. Data were collected in 2016 from a sample of students belonging to the six teaching centres of the University of Seville. Permissions were requested, and all participants signed an informed consent. A Spanish version of the CNPI Scale was obtained and tested in a pilot study on a sample of 74 students. Using EFA, a reduced version of 28 items was made, with a dimensional structure of 8 factors and 63% explained variance. The scale reliability was α of 0. 94, ranging between 0. 62 and 0. 87 in its dimensions. This reduced version was tested again on a sample of 332 subjects. 80% were women, with an average age of 24 years. The CFA applied on these new data reduced the number of factors to 5, although the CFA did not obtain satisfactory results. Therefore, taking into account theoretical and fundamental criteria, a model of paths was built, demonstrating a lineal relationship among the 5 constructs. So, the PLS method was used, which offered, among others, a value of SRMR <0. 08, acceptable reliability values (α Cronbach, composite reliability, and mean extracted variance), demonstrating discriminant validity (HTMT <0. 85) and effect sizes of the related constructs (named factors in EFA and CFA). A structure of 5 constructs and 16 items was validated, and the questionnaire was named “Nursing Interactions in Caring - Competence Assessment (NIC_CA)". No correlation was obtained between the NIC_CA questionnaire and the questionnaire chosen as “gold standard", so the criterion validity could not be studied; however, it was made a scale of competence levels using the median and percentiles values. There was also no convergence between the scores of the NIC_CA questionnaire and those of the questionnaire that assessed social skill competence. In summary, this research provides a reliable and valid questionnaire to measure the nurse-patient competence in Nursing Degree students. There is no correlation between nurse-patient competence and social skill competence, so this is not related with higher levels of nurse-patient relationship competence or vice versa. Future researches should study the criterion validity, providing data on sensitivity and specificity, as well as consider the gender perspective in the conceptualization and execution of the behaviours and attitudes that characterize the nurse-patient relationship

Anxiety and fear related to coronavirus disease 2019 assessment in the Spanish population: A cross-sectional study

Background: The coronavirus disease 2019 pandemic has affected millions of people worldwide, compromising the responsiveness of governments and states and thus generating anxiety and fear at the population level. Objective: To assess the level of anxiety and fear of coronavirus disease 2019 in a Spanish adult population group. Methods: A descriptive cross-sectional study, using the anxiety and fear of COVID-19 assessment scale (AMICO, for its acronym in Spanish). The sample was composed of 1038 subjects. Univariate and bivariate statistical analyses were performed, after analysis of normality in the data distribution. Categorical regression analyses were also executed. Findings: The total sample size was 1036 subjects, 56.3% was made up of females, with a mean age of 48.11 years (SD=15.13). The mean score obtained on the AMICO scale was 5.54 points (SD=1.83), with a score range between 1.22 and 10. Bivariate analysis only demonstrated statistically significant differences in the mean score of the scale and the variables: sex, marital status, work area and academic level. The executed categorical regression analysis revealed an R2 value of 0.75 and a significance of p=0.00. Conclusions: The results obtained show that the Spanish population presents moderate anxiety levels to coronavirus disease 2019. Women, married, with primary and/or secondary education level, and working in the public transport, services and/or hospitality sectors are more likely to have high levels of fear and anxiety. Application to Practice: These results could be used for therapeutic and preventive psychological interventions, and also to plan new research under sex perspective and observing the socio-economic environment

A new conceptualization of the nurse–patient relationship construct as caring interaction

The journey through the history of nursing, and its philosophical and political influences of the moment, contextualizes the interest that arose about the nurse–patient relationship after World War II. The concept has always been defined as a relationship but, from a phenomenological approach based on a historical, philosophical, psychological and sociological cosmology, it is possible to re‐conceptualize it as ‘caring interaction’. Under the vision of aesthetics and sociopoetics, the object of nursing care is the most delicate, vulnerable and unrepeatable raw material: the person, whose feelings and reciprocity, which must be considered. In addition, it involves the adoption of the socio‐critical paradigm, as it considers the importance of actively involving the person, not just patient anymore, or their family in the nursing cares, optimizing the reciprocity inherent to this interactivity. In short, our philosophical and epistemological approach to the concept of nurse–patient relationship proposes a new conceptualization of it as a caring interaction

Understanding the nurse-patient relationship: A predictive approach to caring interaction

Background: Caring nurse-patient interaction has been linked to improvements in patient health outcomes, empowerment, and security. Aim: To design a predictive model of caring interaction, based on the development of the Nursing Inter- actions in Caring _ Competence Assessment for Nursing Professionals (NIC_CA-Prof) tool. Methods: A cross-sectional psychometric study was carried out. Descriptive data analysis and exploratory factor analysis were performed. To design the predictive model, partial least squares regression analysis was used in consistent mode. Findings: The sample consisted of 544 nurses with a mean age of 45.9 years old (Standard Deviation = 10.7 years). Exploratory factor analysis yielded 19 items and four factors. A predictive model of four linearly related composites was validated: basic nursing care, therapeutic relationship, problem management, and adaptation. Conclusions: The predictive model provides a visual depiction of the linear and temporal development of the phases of caring interaction, showing the effect of one phase on the next.Funding for open access charge: Universidad de Huelva / CBU

Relação enfermeiro-paciente: Identidade histórica, metodológica e terapêutica no cuidado de enfermagem

Introducción: La relación enfermera-paciente permite desarrollar el cuidado enfermero, siendo el contexto en el que se da una interacción entre ambos con el objetivo de ejecutar un plan de cuidados y conseguir resultados en salud. Objetivo: Reflexionar acerca de a la identidad e importancia de la relación enfermera-paciente en los cuidados de enfermería. Método: Análisis teórico reflexivo acerca de la identidad de la relación enfermera-paciente desde una perspectiva fundamental, metodológica y clínica en los cuidados de enfermería.Resultado: La discusión argumenta el interés de la relación enfermera-paciente como objeto de estudio desde los inicios de la disciplina, así como su importancia en todos los procesos metodológicos que subyacen a los cuidados enfermeros, y las consecuencias terapéuticas de la misma sobre la situación de salud del paciente. Conclusión: La relación enfermera-paciente permite desarrollar el cuidado enfermero, y su importancia y presencia en los cuidados enfermeros la identifican como un pilar básico para el desarrollo del mismo en todas sus dimensiones.Introduction: The nurse-patient relationship allows the development of the nursing care, being the context in which there is an interaction between nurse and patient, executing a care plan by nurse to achieve health results. Objective: Reflect about the identity and importance of the nurse-patient relationship in nursing care. Method: Reflective and theoretical analysis about the fundamental, methodological and clinical identity of the nurse-patient relationship in nursing care. Result: The discussion argues the interest of the nurse-patient relationship as an object of study from the beginning of the discipline, as well as its importance in all the methodological processes that underlie nursing care, and its therapeutic consequences on the patient's health situation. Conclusion: The importance and presence of the nurse-patient relationship identify it as a basic pillar of the nursing cares comprehensive development.Introdução: A relação enfermeiro-paciente permite desenvolver o cuidado de enfermagem, sendo o contexto em que há interação entre ambos com o objetivo de executar um plano de cuidados e alcançar resultados de saúde. Objetivo: Refletir sobre a identidade e importância da relação enfermeiro-paciente na assistência de enfermagem. Método: Análise teórico-reflexivo sobre a identidade da relação enfermeiro-paciente a partir de uma perspectiva fundamental, metodológica e clínica no cuidado de enfermagem. Resultado: A discussão discute o interesse da relação enfermeiro-paciente como objeto de estudo desde o início da disciplina, bem como sua importância em todos os processos metodológicos que fundamentam a assistência de enfermagem, bem como as conseqüências terapêuticas da mesma na situação de saúde do paciente. Conclusão: A relação enfermeiro-paciente permite o desenvolvimento do cuidado de enfermagem, e sua importância e presença na assistência de enfermagem o identifica como pilar básico para desenvolvimento do cuidado em todas as suas dimensões

Predictive validity of the INTEGRARE scale in identifying the risk of hospital-acquired pressure ulcers in acute care hospital settings

Background: Hospital-acquired pressure ulcers (HAPUs) are prevalent around the world and are an indicator of care quality. Numerous instruments are available to predict their appearance, but few evaluate predictive val idity. No instruments based on Nursing Outcomes Classification indicators have been found, despite these in dicators reflecting the patient’s condition. The aim of the study was to analyse the predictive validity of the INTEGRARE scale in preventing the risk of HAPUs. Methods: A multicentre prospective observational cohort study design was used. 1,004 patients from 11 public hospitals in Andalusia (Spain) were recruited between February 2015 and October 2017. Participants were aged over 18 and had been admitted to medical and surgical units, with a predicted stay exceeding 48 h. Predictive validity was checked using a multivariate logistic regression model and a receiver operating characteristic curve, with development of pressure ulcers during the hospital stay as the dependent variable. Results: The INTEGRARE scale obtained an area under the curve of 0.886 (95% CI = 0.85–0.923). Within the 30- point range, the optimal cut-off value is 23 points with a sensitivity of 80.8% and a specificity of 80%. The odds ratio was 16.86 (95% CI = 8.54–33.28). Among the patient variables, age was significant, while among the hospital variables, the type of unit and the Nurse Staffing Level (NSL) were significant. Conclusions: The INTEGRARE scale has robust predictive validity when patients are admitted to medical and surgical inpatient units. Patients with a higher risk of developing HAPUs are in surgical units, are elderly, and have an NSL exceeding 10.4

Impact on the Mental and Physical Health of the Portuguese Population during the COVID-19 Confinement

versión editorConfinement of the population has been one of the measures implemented by different governments to address the COVID-19 health crisis, and it has led to social isolation together with a disruption of daily activities. The aim of the study is to analyze psychological distress during the COVID-19 pandemic in Portugal. During the quarantine, a cross-sectional study was carried out on a sample of 2120 subjects over 18 years of age, resident and born in Portugal. Data were collected using a self-developed questionnaire that considered socio-demographic variables, physical symptoms, health conditions, and history of contact with COVID-19, as well as psychological alterations. The General Health Questionnaire (GHQ-12) was also included. Univariate and bivariate statistical analyses were performed. Predictive capacity was studied using logistic regression models. The results showed a higher percentage of individuals presenting psychological distress (57.2.0%), with a higher percentage identified among women (79.0%), and in people with a higher educational level (bachelor’s + master’s and doctorate) (75.8%). The predictor variables with the greatest weight were sex, educational level (graduation, master’s, and doctorate), living with children or under 16 years of age, presence of symptoms, and quarantine in the last 14 days for having symptoms. Good self-assessment of health and working at home appear to be protective against psychological distress. These results highlight the impact of the COVID-19 pandemic on psychological distress and provide an opportunity to consider the need to implement specific multidisciplinary public health and mental health interventions in this pandemic situationThis work was funded by Portuguese national funds provided by Fundação para a Ciência e Tecnologia (FCT) (UIDB/05704/2020 and UIDP/05704/2020)

Health-related factors of psychological distress during the COVID-19 pandemic among non-health workers in Spain

Background: Non-health workers engaged in essential activities during the pandemic are less researched on the effects of COVID-19 than health workers. Objective: to study the differences between those who work away from home and those who do so from home, when the effects of fear of contagion cross with those of confinement, about the psychological distress during the COVID-19 in Spain. Design: Observational descriptive cross-sectional study. Data sources: The study was carried out receiving 1089 questionnaires from non-health workers that were working away from home and doing so from their homes. The questionnaire included sociodemographic and occupational data, physical symptoms, self-perceived health, use of preventive measures and possible contacts, and the Goldberg GHQ-12. Results: 71.6% of non-health female workers and 52.4% of non-health male workers had psychological distress, with differences among those working away from home and those working from home. The level of psychological distress among non-health workers is predicted by 66.5% through the variables: being a woman, 43 years old or younger, having a home with no outdoor spaces, poor perception of health, number of symptoms, and having been in contact with contaminated people or material. Among workers who work away from home, being self- employed is another predictive variable of distress. Conclusion: More than the half of the sample showed inadequate management of the psychological distress. There are modifiable factors which provide necessary elements to support a positive attitude of the workers, such as: knowledge of hygiene, transmission of the virus, protective measures, and social distancing measures

Emotional health assessment related to COVID-19 in older people: A cross-sectional study

Background: The aim of this study was to assess the presence of anxiety, fear and psychological distress in the population of people over 65 years of age and to study possible differences with a sample of subjects aged between 60 and 65 years. Methods: A descriptive and psychometric cross-sectional study. The total sample used consisted of 1112 subjects from university training programmes for the old people from all over Spain. Anxiety and fear of COVID-19 were measured using the AMICO scale and psychological distress using the GHQ-12 instrument. Results: Significant differences were found in the AMICO (p = 0.006) and GHQ-12 (p = 0.03) measures between age subgroups, with lower values in older age groups. Contrast statistics showed significant differences on both measures (AMICO and GHQ) in women, single or widowed subjects, and those who had not been infected by the SARS-CoV-2 virus. Limitations: It would be desirable to increase the sample size, especially in the lower age group (<65). The establishment of the age limit between the two groups could be located at 60 years of age. The use of new technologies to get information should be considered. Conclusions: Overall, moderate levels of fear and anxiety of COVID-19 were present. Women tended to have higher levels of both general psychological distress and fear and anxiety of COVID-19. Especially in those over 65, higher levels of distress and fear/anxiety of COVID-19 were associated with being widowed or single, and not having been infected before with SARS-CoV-2.FUNDING FOR OPEN ACCESS CHARGE: Universidad de Huelva / CBUA

History of contact with the SARS-COV-2 virus and the sense of coherence in the development of psychological distress in the occupational health professionals in Spain

The COVID-19 pandemic has affected the psychological well-being of healthcare professionals, among them, on medical and nursing occupational specialists. This study describes the psychologi cal distress that this group has suffered, analyzing the effect that the sense of coherence related with the history of contact with infected people has generated in their mental health. Cross-sec tional descriptive study using online questionnaires. Data were collected on a sample of 499 sub jects, representing 42.0% and 38.8% of the associations of specialists in Occupational Medicine and Nursing, respectively. A univariate data analysis, independence test, and the CHAID multivari ate method were carried out. The percentage of workers with high psychological distress was higher among women than among men; this was also higher in public sector workers than in the private sector. No differences have been observed regarding psychological distress and educa tional level, coexistence, having children, working away from home, having a pet, or between being a physician or nurse. The most efficient measure to prevent psychological distress was act ing regarding the comprehensibility dimension of the sense of coherence. Sex, contact with any infected person, age, living as a couple, working in public or private centers, the availability of diagnostic tests, and the correlation with the manageability dimension were modulating factors. Sense of coherence is an effective measure to prevent psychological distress due to contact with people affected by COVID-19 in Occupational Health professionals