Comparison of the effects of two educational strategies on the development of competence in basic professional communication amongst nursing students

Resumen La enfermería se considera parte integral del sistema de atención de salud y se concibe como una profesión que abarca cuidados de promoción de la salud, prevención y tratamiento de la enfermedad. Para el desarrollo de esta profesión, los enfermeros han de recibir una formación específica a nivel teórico y clínico que en nuestro país está enmarcada dentro del Espacio Europeo de Educación Superior. Así, en este marco educativo se apuesta por el aprendizaje basado en competencias y dentro de las competencias imprescindibles de enfermería, destaca la competencia comunicativa. La comunicación busca la creación de vínculos significativos con los pacientes, así como el trabajo multidisciplinar para aportar un cuidado seguro y de calidad. Para ello los enfermeros han de contar con conocimientos, habilidades y confianza suficientes. Sin embargo, los estudiantes de enfermería parecen tener problemas en el trabajo de la comunicación, llegando a presentarse dificultades cuando ejercen la profesión. Así, para favorecer el aprendizaje, en los últimos años se está apostando por metodologías que se centran en el estudiante, como el role-play y el uso de pacientes estandarizados. Por tanto, la idea principal de esta tesis doctoral fue comparar la eficacia de estas dos estrategias educativas en la consecución de la competencia comunicativa. Sin embargo, dada la inexistencia de herramientas validadas que permitieran medir esta competencia en todos sus dominios, la tesis tuvo que estructurarse en dos bloques: un bloque de elaboración y validación de herramientas de evaluación y un segundo bloque de aplicación de las intervenciones educativas. Para la primera parte se planteó un diseño observacional y transversal con una muestra de 365 estudiantes de enfermería de la UAL y 17 expertos universitarios en comunicación. Para la validación de la herramienta de conocimientos se realizó una validación de contenido por expertos y una medición de la validez de los ítems y la validez de constructo por alumnos. Para la herramienta de autoeficacia, se planteó una validación del contenido por expertos; una validación piloto para medir fiabilidad; y una validación final para valorar fiabilidad y validez de contenido, de criterio y de contructo por parte de los alumnos. La tercera herramienta fue validada por expertos a nivel de contenido y por estudiantes a nivel de fiabilidad, validez de contenido y de constructo. Los resultados obtenidos fueron positivos en relación a la fiabiliad y la validez de todas las herramientas, de forma que contaron con excelentes características psicométricas para la valoración de la competencia comunicativa. En cuanto a la segunda parte, se utilizó un diseño de ensayo clínico aleatorizado con 126 estudiantes divididos aleatoriamente en dos grupos de intervención: role-play y paciente estandarizado. Recibieron formación teórica sobre comunicación con el paciente y comunicación interprofesional, y visualizaron interacciones reales realizadas por actores. Tras esto, el grupo role-play tuvo que utilizar esta técnica en pequeños grupos para resolver casos prácticos. Mientras que en el grupo paciente estandarizado se desarrollaba una interacción con un actor que hacía de paciente o de médico, para practicar los contenidos trabajados. Para conocer la eficacia de las intervenciones se evaluaron los dominios de conocimiento, habilidad y actitud en tres momentos diferentes. Con estos datos se calculó el número de estudiantes que alcanzaron tasas de éxito y se llevaron a cabo comparaciones entre las mediciones realizadas, así como entre los resultados de los grupos en las tres mediciones. Los resultados mostraron que las tasas de éxito mejoraban de forma significativa tras ambas intervenciones. Sin embargo, no se encontraron diferencias significativas entre los dos grupos de trabajo. Por ello, no es posible determinar cuál de las estrategias utilizadas es la más adecuada para la enseñanza de la competencia comunicativa. Abstract Nursing is an important component of health care system and it encompasses health promotion care, disease prevention and disease treatment. In order to get a complete education, nurses have to receive specific theoretical and clinical training. In our country this education is framed within the European Higher Education Area which bet on a competency-based learning. Nursing is based on several essential competences among which communicative competence stands out. Communication seeks to create meaningful relationships with patients, as well as with healthcare professionals in order to provide a safe care. To that end, nurses must have sufficient knowledge, skills and confidence on communication. However, nursing students seem to experience difficulties communicating, and these problems arise when they become professional nurses. Thus, in order to promote a better learning on this competence, in recent years educational programs have applied methodologies that focus on the student, such as role-play and the use of standardized patients. Therefore, the main idea of this doctoral dissertation was to compare the effectiveness of these two educational strategies in achieving communicative competence. However, a literature review showed that there weren’t validated tools to measure this competence in all its domains. Because of that, the dissertation is structured in two sections: a section to present the development and validation of three assessment tools and a second section to present the application of educational interventions. For the first section, an observational and cross-sectional design was proposed with a sample of 365 nursing students from UAL and 17 university communication experts. For the validation of the knowledge tool, a content validation was carried out by experts and the validity of the items and the structure validity were assessed by students. For the self-efficacy tool, three steps were proposed: an expert content validation; a pilot validation to measure reliability; and a final validation by students to assess reliability and content, criteria and structure validity. The third tool was validated by experts who assessed the content validity and by students who evaluated the reliability, the content validity and the construct validity. The results obtained were positive in terms of reliability and validity for the three tools, so they had excellent psychometric characteristics for the assessment of communicative competence. For the second section, a randomized clinical trial design was used with 126 students randomly divided into two intervention groups: role-play and standardized patient. They received a theoretical training on communication with patients and other healthcare providers, and they visualized real interactions carried out by actors. After this, the role-play group had to use this technique in small groups to solve practical cases. While in the standardized patient group, an interaction was developed with an actor who played a role as a patient or a doctor, in order to practice the theoretical training. The domains of knowledge, ability and attitude were evaluated at three different moments to assess the efficacy of both interventions. Thereby, the number of students achieving success rates was calculated and comparisons were made between the measurements, as well as between the results of the groups. The results showed that the success rates improved significantly after both interventions. However, no significant differences were found between the two groups. Therefore, it is not possible to determine which of the strategies used is the most appropriate for teaching the communicative competence

Gut–brain axis in the executive function of austism spectrum disorder

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impaired communication and social interactions, and repetitive behavioural patterns. These patterns are believed to be dysfunctional symptoms in executive processing, which impact other cognitive functions such as attention or cognitive flexibility. In recent years, several studies have shown that certain intestinal bacteria may play a role in shaping cognitive networks encompassing emotional and social domains. A microbiota–gut–brain axis is known to exist, establishing several mechanisms by which microbiota may modulate brain development, function and behaviour, including immune, endocrine and neural pathways. As the aetiology of ASD is largely unknown, some studies have shown that intestinal bacteria may be involved in its pathogenesis. The aim of this review was to focus on the role of the gut–brain axis in ASD and, specifically, on its role in executive functions. First, we summarize the relationship between the gastrointestinal and cognitive symptoms of ASD patients. In addition, we highlight the evidence that supports and emphasizes the involvement of gut microbiota, and the putative underlying mechanisms in this population. Finally, we present evidence from preclinical and clinical studies on the modulation of microbiota and their effects on cognitive symptoms, specifically in relation to executive function. In conclusion, manipulation of microbiota could be a positive intervention to improve ASD symptoms. However, more research evaluating the role of microbiota in the cognitive symptoms ASD is needed

Effects of Biodanza on Stress, Depression, and Sleep Quality in University Students

Background: The existing literature shows dance to be an innovative and successful form of stress management. Previous research indicates that Biodanza is able to increase well-being and personal resources and prevent stress. However, Biodanza has not yet been empirically tested as a possible therapy for application outside the clinical context in young adults with perceived stress. Objectives: This study aimed to determine the effectiveness of Biodanza in reducing symptoms of perceived stress and depression and in promoting sleep quality in young adults, comparing the changes with those observed in a control group. Design: Randomized controlled trial. Settings/Location: This study was carried out at the Faculty of Health Sciences of the University of Almería. Subjects: One hundred and twenty-one university students with perceived stress were randomly placed into either a Biodanza group or a wait-list control group. Intervention: Study participants attended Biodanza sessions for 90 min a week, over a period of 4 weeks. Outcome measures: Depression, perceived stress, and sleep quality were assessed both before and after intervention. Results: Ninety-five participants completed the program and were included in the statistical analysis. Significant differences in perceived stress [t (93) = 2.136; p = 0.015] and depression [t (93) = 2.738; p = 0.000] were observed after the Biodanza period. Pre/post analysis found that Biodanza also had a significant effect on depression (Cohen d = 1.88; p < 0.05) and perceived stress (Cohen d = 0.79; p < 0.05). Conclusion: The Biodanza program is an effective stress management strategy for students. The results of this study showed Biodanza to have a positive effect on perceived stress and depression in young adults. This demonstrates how artistic, collaborative, and psychophysical interventions are an effective means of preventing and managing these problems in university students

Role-play versus standardised patient simulation for teaching interprofessional communication in care of the elderly for nursing students

This study aims to describe and compare the effects of standardised patient simulation and role-play in the acquisition and retention of interprofessional communication in elderly care competence amongst nursing students. In this controlled clustered randomised trial, 121 nursing students attended a workshop on interprofessional communication in elderly care using role-play or standardised patient simulation. The study was conducted between September 2017 and February 2018. Participants’ knowledge, self-efficacy and communication skills were assessed using a simulated scenario at pre-test, post-test and 6-week follow-up points. Between-subject and within-subject differences were measured using counts and proportions of participants who achieved competence. Regardless of the strategy applied, a significant improvement in knowledge, skills, self-efficacy and overall interprofessional communication competence was found between pre-test and post-test. Moreover, there were significant differences between pre-test and follow-up for all the studied variables, but no differences were found between post-test and follow-up. Lastly, when comparing the success rates of both strategies, no significant differences were observed (p > 0.05). In conclusion, standardised patient simulation and role-play have been shown to promote an improvement on knowledge, self-efficacy and interprofessional communication skills in nursing students, although it is not possible to state which strategy is the most adequate for teaching this competency

Psychometric evaluation and cultural adaptation of the Spanish version of the “Scale for End-of Life Caregiving Appraisal”

Objective: To translate, culturally adapt and psychometrically evaluate the Spanish version of the ‘Scale for End-of Life Caregiving Appraisal’ (SEOLCAS). Methods: Observational cross-sectional study. Convenience sample of 201 informal end-of-life caregivers recruited in a southern Spanish hospital. The reliability of the questionnaire was assessed through its internal consistency (Cronbach’s α) and temporal stability (Pearson’s correlation coefficient (r) between test-retest). The content validity index of the items (I-CVI) and the scale (S-CVI/Ave) was calculated. Its criterion validity was explored through performing a linear regression analysis to evaluate the SEOLCAS’ predictive validity. Exploratory factor analysis was used to examine its construct validity. Results: The SEOLCAS’s reliability was very high (Cronbach’s α=0.92). Its content validity was excellent (all items’ content validity index=0.8–1; scale’s validity index=0.88). Evidence of the SEOLCAS’ criterion validity showed that the participants’ scores on the SEOLCAS explained approximately 79.3% of the between-subject variation of their results on the Zarit Burden Interview. Exploratory factor analysis provided evidence of the SEOLCAS’ construct validity. This analysis revealed that two factors (‘internal contingencies’ and ‘external contingencies’) explained 53.77% of the total variance found and reflected the stoic Hispanic attitude towards adversity. Significance of the results: The Spanish version of the ‘Scale for End-of Life Caregiving Appraisal’ has shown to be an easily-applicable, valid, reliable and culturally-appropriate tool to measure the impact of end-of-life care provision on Hispanic informal caregivers. This tool offers healthcare professionals the opportunity to easily explore Hispanic informal end-of-life caregivers’ experiences and discover the type of support they may need (instrumental or emotional) even when there are communicational and organisational constraints

Design and psychometric evaluation of the 'Clinical Communication Self-Efficacy Toolkit'

Nursing students experience difficulties when communicating in clinical practice. Their self-efficacy in clinical communication should be explored as part of their competence assessment before they are exposed to real human interactions in the clinical setting. The aim of this study was to design and psychometrically evaluate a toolkit to comprehensively assess nursing students’ self-efficacy in clinical communication. The study followed an observational cross-sectional design. A sample of 365 nursing students participated in the study. The ‘Clinical Communication Self-Efficacy Toolkit’ (CC-SET) was comprised of three tools: the ‘Patient-Centered Communication Self-efficacy Scale’ (PCC-SES), the ‘Patient clinical Information Exchange and interprofessional communication Self-Efficacy Scale’ (PIE-SES), and the ‘Intrapersonal communication and Self-Reflection Self-Efficacy Scale’ (ISR-SES). The tools’ reliability, validity (content, criterion, and construct) and usability were rigorously tested. The Cronbach’s alpha coefficient of the three tools comprising the CC-SET was very high and demonstrated their excellent reliability (PCC-SES = 0.93; PIE-SES = 0.87; ISR-SES = 0.86). The three tools evidenced to have excellent content validity (scales’ content validity index > 0.95) and very good criterion validity. Construct validity analysis demonstrated that the PCC-SES, PIE-SES, and ISR-SES have a clear and theoretically-congruent structure. The CC-SET is a comprehensive toolkit that allows the assessment of nursing students’ self-efficacy in interpersonal, interprofessional, and intrapersonal communication

Adherence to the Mediterranean Diet and Self-efficacy as Mediators in the Mediation of Sleep Quality and Grades in Nursing Students

University is a period in which students can experience a considerable amount of challenges that may influence their health lifestyles. The aim of this article is to discover the role of therapeutic adherence to the Mediterranean diet and self-efficacy as mediators in the relationship between sleep quality and the average grades of nursing students. The sample was made up of 334 nursing students, with a mean age of 21.84 years (SD = 6.24). Pittsburgh Sleep Quality questionnaires, adherence to the Mediterranean diet and the Baessler and Shwarzer General Self-efficacy Scale were administered. The results of the multiple mediational model determined that quality of sleep has a direct influence on academic performance. Adherence to the Mediterranean diet and quality of sleep have an effect on the degree of self-efficacy of nursing students. This study demonstrates that good sleep quality and adherence to the Mediterranean diet improve academic performance in nursing students. Future research should include multicenter longitudinal studies

Innovación, desarrollo tecnológico y gestión : una construcción desde la investigación

Libro que compila investigaciones de carácter aplicadas y descriptivas en materia de innovación y desarrollo tecnológico, gestión organizacional y empresarial orientada a productividad, rentabilidad, competitividad y sostenibilidadBook that compiles researches of applied and descriptive character in the matter of innovation and technological development, organizational and business management oriented to productivity, profitability, competitiveness and sustainabilityCapítulo 1. Material compuesto para la construcción a partir de la celulosa del papel y cartón reciclado / Carlos Arturo Tamayo S; Nicolás Montero Camacho; Fredy Antonio Herrera -- Capítulo 2. Tecnologías de conservación para base de sopa de frijol rojo (phaseolus vulgaris) y vegetales / Yaceris Castro Escorcia; Teresa Altamar Pérez; Enedys Florez Cortés; Ángela Ortiz Ruiz. Capítulo 3. Utilización de harina compuesta de frijol caupi (vigna unguiculata) en masas para alimentos congelados / Marcela Villalba Cadavid; Matilde Rodríguez Muñoz; Beatriz Fernández; Juan Mendoza Combatt -- Capítulo 4. Elaboración de biorrecubrimiento comestible para carne de hamburguesa como alternativa de conservación y condimento natural / Camila Andrea Ubaque Beltrán. CAPÍTULO 5. Identificación de alternativas de industrialización de productos y subproductos agroindustriales en nuevos materiales bio poliméricos / Luz Henao Díaz; Deya Pérez Zúñiga; Herold Arango Gómez. Capítulo 6. SCADA inalámbrico para monitoreo de sistemas de energía solar / Nelson Giovanni Agudelo Cristancho; Juan Carlos Amezquita Tovar; Ángela María Montoya Castro. -- Capítulo 7. Evaluación de la calidad del agua para consumo humano del corregimiento de Jaraquiel, Montería, Córdoba / Carlos Burgos Galeano; Álvaro Aleán Vásquez; Paula Estrada Palencia -- Capítulo 8. Optimización del sistema de abastecimiento de agua en la comunidad de Jaraquel, Montería Colombia / Carlos Burgos Galeano; Pedro Ramos Tejada; Paula Estrada Palencia; Jhon Sánchez Correa. -- Capítulo 9. Ejecución y sostenibilidad de proyectos productivos en la microrregión cafetera del municipio de Ciénaga, Magdalena / Sugey Issa Fontalvo; Eduardo Robles Panetta; Freddy González Castillo. -- Capítulo 10. Aplicación del método cualitativo por puntos para determinar aspirante favorito a cargos directivos en IES / Zamir Martelo Ballesteros; Raúl Martelo Gómez; Luis Tovar Garrido; Natividad Villabona Gómez; David Franco Borré. -- Capítulo 11 Responsabilidad social en comunidades indígenas orientada al diseño de automatización de válvulas del gasoducto Riohacha-Maicao / Gelvis Melo Freile; César Rivera Romero; Jesús García Guiliany. -- Capítulo 12 Fortalecimiento de la gestión económica de las Mipymes a través de la consultoría / Gloria Amparo Acosta Romero; Mónica Andrade Ríos; Karen Roxana Sánchez. -- Capítulo 13. El compromiso como valor en la responsabilidad social universitaria / Maura Quintero Gutiérrez, Dubys Villarreal Torres; Jesús García Guiliany; Annherys Paz Marcano; Marieth Orcasitas Peñaloza. -- Capítulo 14. Educación financiera como alternativa de desarrollo económico y social para el distrito de Riohacha / Henitzo Martínez Pinedo; Darcy Luz Mendoza; Martha Jaramillo Acosta; Edwin Salas Solano. -- Capítulo 15. Tecnologías de información y comunicación en proceso contable y financiero en pymes del sector turístico / Martha Josefina Castrillón Rois; Edilberto Rafael Santos Moreno; Lorena Esther Gómez Bermúdez; Génesis Barros González. -- Capítulo 16. Aplicación de brainstorming y problem trees para determinar factores que inciden en enseñanza del inglés / Jesús Llerena; Raúl J. Martelo; Jhon Cuesta; Javier Pinedo; David Franco.-- Capítulo 17. Incidencia del marketing en las microempresas del sector comercio en Rionegro Antioquia: conceptualización / Santiago Álzate Carmona; María Yamile Mazo Gil; Leidy García Jaramillo. -- Capítulo 18. Turismo en el Cabo de la Vela: un acercamiento entre los imaginarios turísticos de los visitantes y la creencia de Jepirra, territorio sagrado / María Laura Aponte Aarón; Esmerlis Camargo Torres. -- Capítulo 19. Caracterización de la actividad turística en buenaventura y su integración con las comunidades locales / Víctor Cándelo Aragón; Henry Orobio García; Luis Montaño Aguilar. -- Capítulo 20. Plataforma de comercialización electrónica de un centro de abastos / Karen Ávila Suarez; Mauro Reyes Ortiz. -- Capítulo 21. El teletrabajo en la gestión administrativa / Estefanía Sandoval Cruz; René Alexander Guerrero Vergel. -- Capítulo 22. Gestión del conocimiento y alianzas estratégicas en los procesos de innovación tecnológica / Elder Rivero Gutiérrez; Fátima Bolaño Mendoza. -- Capítulo 23. Competitividad e innovación en el aprendiz SENA: perspectivas de formación / Elizabeth Tuberquia Vanegas; René Alexander Guerrero Vergel. -- Capítulo 24. Bomba de riego por goteo solar, una alternativa para aumentar la eficiencia energética en las unidades acuícolas / Sergio Gabriel Brito Brito; Daldo Ricardo Araujo Vidal; Nicolás Annicharico Jiménez. -- Capítulo 25. Herramienta digital de consultas contables y tributarias para unidades productivas creadas en el fondo emprender / Elkin Fuentes Jiménez; Alda Pérez Campuzano; Marieth Orcasitas Peñaloza; Olga Elena Guerra ArmentaPrimera ediciónna347 página

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p &lt; 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics