Características de la profesión enfermera en el contexto español a partir de la experiencia de las enfermeras docentes

El objetivo general de esta investigación fué conocer, a partir del discurso de las enfermeras pioneras 'Ayudantes Técnicos Sanitarios' en impartir la asignatura de 'Enfermería Fundamental', cuáles son las características de la profesión enfermera en el contexto español actual. El diseño fué cualitativo y como estrategia metodológica se utilizó la Inducción analítica. El muestreo fué teórico y se utilizó como técnica de recogida de datos la entrevista en profundidad. Para el análisis de datos se utilizó la estrategia analítica propia de la teoría fundamentada. Se establecieron estrategias específicas para asegurar los criterios de rigor. El proyecto fue aprobado por una comisión de ética asistencial y se ha pasado consentimiento informado a las participantes estableciendo, además, un protocolo de seguridad, para asegurar la confidencialidad de los datos.El discurso de las cuatro docentes pioneras entrevistadas hace intuir que la profesión sigue teniendo un rol profesional basado en la técnica y no en el cuidado. La falta de confianza en el valor del cuidado, la falta de iniciativa que implica no querer asumir responsabilidades y la poca capacidad para la práctica reflexiva se establecen como principales carencias del colectivo. En cuanto al rol profesional ejercido en la práctica, según la opinión de las docentes de la asignatura fundamentos en enfermería, se destaca la clara preferencia del colectivo por el rol técnico vinculado al tratamiento en detrimento del rol vinculado al cuidado

Transfer of nurse education to universities under a model of person-centred care: A consequence of changes in Spanish society during the democratic transition.

Background. In Spain the transfer of nurse education to universities was accompanied by a shift towards a model of person-centred care. Aim. To explore whether the change in nurses' professional profile (from physician assistant to providers of person-centred care) was a response to changing needs in Spanish society. Design. Qualitative study. Methods. Theoretical sampling and in-depth interviews using an inductive analytical approach. Results. Four categories described the nursing profession in Spain prior to the introduction of university training: the era of medical assistants; technologisation of hospitals; personal care of the patient based on Christian values; professional socialisation differentiated by gender. Further analysis showed that these categories could be subsumed under a broader core category: the transfer of nurse education to universities as part of Spain's transition to democracy. Conclusion. The transfer of nurse education to universities was one of several changes occurring in Spanish society during the country's transition to democratic government. The redefined public health system required a highly skilled workforce, with improved employment rights being given to female health professionals, notably nurses

Professional responsibility and decision-making in the context of a disease-focused model of nursing care: The difficulties experienced by Spanish nurses

When, in 1977, nurse education in Spain was transferred to universities a more patient-centred, Anglo-American philosophy of care was introduced into a context in which nurses had traditionally prioritised their technical skills. This paper examines the characteristics of the nurse's professional role in Spain, where the model of nursing practice has historically placed them in a position akin to that of physician assistants. The study design was qualitative and used the method of analytic induction. Participants were selected by means of theoretical sampling and then underwent in-depth interviews. The resulting material was analysed using an approach based on the principles of grounded theory. Strategies were applied to ensure the credibility, transferability, dependability and confirmability of the findings. The main conclusion is that nurses in Spain continue to work within a disease-focused model of care, making it difficult for them to take responsibility for decision making

Development of a Guide to Multidimensional Needs Assessment in the Palliative Care Initial Encounter (MAP).

Context Ensuring patient-centered palliative care requires a comprehensive assessment of needs beginning in the initial encounter. However, there is no generally accepted guide for carrying out this multidimensional needs assessment as a first step in palliative intervention. Objectives To develop an expert panel-endorsed interview guide that would enable proactive and systematic Multidimensional needs Assessment in the Palliative care initial encounter (MAP). Methods A preliminary version of the MAP guide was drafted based on a published literature review, published semistructured interviews with 20 patients, 20 family carers, and 20 palliative care professionals, and a nominal group process with palliative care professionals and a representative of the national patient's association. Consensus regarding its content was obtained through a modified Delphi process involving a panel of palliative care physicians from across Spain. Results The published systematic literature review and qualitative study resulted in the identification of 55 needs, which were sorted and grouped by the nominal group. Following the Delphi process, the list of needs was reduced to 47, linked to six domains: Clinical history and medical conditions (n = 8), Physical symptoms (n = 17), Functional and cognitive status (n = 4), Psycho-emotional symptoms (n = 5), Social issues (n = 8), and Spiritual and existential concerns (n = 5). Conclusion MAP is an expert panel-endorsed semi-structured clinical interview guide for the comprehensive, systematic, and proactive initial assessment to efficiently assess multiple domains while adjusting to the needs of each patient. A future study will assess the feasibility of using the MAP guide within the timeframe of the palliative care initial encounter.post-print820 K

The influence of Anglo-American theoretical models on the evolution of the nursing discipline in Spain

In Spain, the introduction of the new Diploma in Nursing in 1977 saw the role of nurses shifting from that of medical assistants with technical skills to being independent members of the healthcare team with specific responsibility for providing professional nursing care. Here, we analyse the evolution of the nursing profession in Spain following the transfer of nurse education to universities, doing so through interviews with the first generation of academic tutors. This was a qualitative study using the method of analytic induction and based on the principles of grounded theory. Participants were selected by means of theoretical sampling and then underwent in-depth interviews. Steps were taken to ensure the credibility, transferability, dependability and confirmability of data. The main conclusion of the analysis is that there is a gap between a theoretical framework borrowed from the Anglo-American context and a nursing practice that, in Spain, has traditionally prioritised the application of technical procedures, a role akin to that of a medical assistant. It is argued that a key factor underlying the way in which nursing in Spain has evolved in recent decades is the lack of conceptual clarity regarding what the role of the professional nurse might actually entail in practice

Emergencia del modelo de enfermería transmitido en las universidades españolas: una aproximación analítica a través de la Teoría Fundamentada

El objetivo fue conocer el significado del término 'enfermería' para las enfermeras docentes de las universidades españolas. El diseño fue cualitativo. Como estrategia se utilizó la inducción analítica. El muestreo fue teórico y enfocado en la selección de casos extremos. La técnica de recogida de datos fue la entrevista en profundidad. El análisis se llevó a cabo mediante la técnica específica de la Teoría Fundamentada. Se establecieron estrategias para asegurar la credibilidad, transferibilidad, confirmabilidad y auditabilidad. A partir del análisis de los datos se identificaron tres categorías que dieron respuesta al objetivo planteado: es una 'actividad humana vinculada a la maternidad', una 'vocación de ayuda al otro que tienen algunas personas' y una 'actividad que atiende las necesidades de los demás respetando su identidad'. Se puede concluir que en las universidades españolas se está transmitiendo un modelo de enfermera donde el rol propio de cuidado es inherente al género femenino y a la vocación de servicio al otro que tienen algunas personas. Esto es causa de que la Real Academia de la Lengua Española sólo identifique el rol de asistencia técnica a la medicina como elemento profesional de la enfermería

Características de la Profesión Enfermera en el Contexto Español a Partir de la Experiencia de las Enfermeras Docentes

The overall objective of this research was to determine – from the discourse of the former Ayudantes Técnicos Sanitarios (Technical Nursing Assistants) who are pioneers in teaching the subject of "Nursing Fundamentals" – what the characteristics of the nursing profession are in the current Spanish context. The design was qualitative and analytical induction was used as methodological strategy. The sampling was theoretical and in-depth interview was used as a technique for data collection. For data analysis, the very analytic strategy of the grounded theory was used. Specific strategies were established to ensure the criteria of rigor. The project was approved by a committee of health care ethics and informed consent was given by all the participants, thus establishing a security protocol to ensure data confidentiality...Keywords: Experience; Nursing; Nursing Fundamentals; Professional Role; Teachers.El objetivo general de esta investigación fué conocer, a partir del discurso de las enfermeras pioneras “Ayudantes Técnicos Sanitarios” en impartir la asignatura de “Enfermería Fundamental”, cuáles son las características de la profesión enfermera en el contexto español actual. El diseño fué cualitativo y como estrategia metodológica se utilizó la Inducción analítica. El muestreo fué teórico y se utilizó como técnica de recogida de datos la entrevista en profundidad. Para el análisis de datos se utilizó la estrategia analítica propia de la teoría fundamentada. Se establecieron estrategias específicas para asegurar los criterios de rigor...Palabras-Clave: Experiencia; Docentes; Enfermería; Enfermería Fundamental; Rol Profesional.

Development of a Guide to Multidimensional Needs Assessment in the Palliative Care Initial Encounter (MAP)

Técnica Delphi; Entrevista clínica; Cuidados paliativosDelphi technique; Clinical interview; Palliative careTècnica Delphi; Entrevista clínica; Cures pal·liativesContext: Ensuring patient-centered palliative care requires a comprehensive assessment of needs beginning in the initial encounter. However, there is no generally accepted guide for carrying out this multidimensional needs assessment as a first step in palliative intervention. Objectives: To develop an expert panel-endorsed interview guide that would enable proactive and systematic Multidimensional needs Assessment in the Palliative care initial encounter (MAP). Methods: A preliminary version of the MAP guide was drafted based on a published literature review, published semistructured interviews with 20 patients, 20 family carers, and 20 palliative care professionals, and a nominal group process with palliative care professionals and a representative of the national patient's association. Consensus regarding its content was obtained through a modified Delphi process involving a panel of palliative care physicians from across Spain. Results: The published systematic literature review and qualitative study resulted in the identification of 55 needs, which were sorted and grouped by the nominal group. Following the Delphi process, the list of needs was reduced to 47, linked to six domains: Clinical history and medical conditions (n = 8), Physical symptoms (n = 17), Functional and cognitive status (n = 4), Psycho-emotional symptoms (n = 5), Social issues (n = 8), and Spiritual and existential concerns (n = 5). Conclusion: MAP is an expert panel-endorsed semi-structured clinical interview guide for the comprehensive, systematic, and proactive initial assessment to efficiently assess multiple domains while adjusting to the needs of each patient. A future study will assess the feasibility of using the MAP guide within the timeframe of the palliative care initial encounter

Proactive and systematic multidimensional needs assessment in patients with advanced cancer approaching palliative care: a study protocol

Introduction: The benefits of palliative care rely on how healthcare professionals assess patients' needs in the initial encounter/s; crucial to the design of a personalised therapeutic plan. However, there is currently no evidence-based guideline to perform this needs assessment. We aim to design and evaluate a proactive and systematic method for the needs assessment using quality guidelines for developing complex interventions. This will involve patients, their relatives and healthcare professionals in all phases of the study and its communication to offer clinical practice a reliable approach to address the palliative needs of patients. Methods and analysis: To design and assess the feasibility of an evidence-based, proactive and systematic Multidimensional needs Assessment in Palliative care (MAP) as a semistructured clinical interview guide for initial palliative care encounter/s in patients with advanced cancer. This is a two-phase multisite project conducted over 36 months between May 2019 and May 2022. Phase I includes a systematic review, discussions with stakeholders and Delphi consensus. The evidence gathered from phase I will be the basis for the initial versions of the MAP, then submitted to Delphi consensus to develop a preliminary guide of the MAP for the training of clinicians in the feasibility phase. Phase II is a mixed-methods multicenter feasibility study that will assess the MAP's acceptability, participation, practicality, adaptation and implementation. A nested qualitative study will purposively sample a subset of participants to add preliminary clues about the benefits and barriers of the MAP. The evidence gathered from phase II will build a MAP user guide and educational programme for use in clinical practice. Ethics and dissemination: Ethical approval for this study has been granted by the university research ethics committee where the study will be carried out (approval reference MED-2018-10). Dissemination will be informed by the results obtained and communication will occur throughout

An International Consensus Definition of the Wish to Hasten Death and Its Related Factors

Background: The desire for hastened death or wish to hasten death (WTHD) that is experienced by some patients with advanced illness is a complex phenomenon for which no widely accepted definition exists. This lack of a common conceptualization hinders understanding and cooperation between clinicians and researchers. The aim of this study was to develop an internationally agreed definition of the WTHD. Methods: Following an exhaustive literature review, a modified nominal group process and an international, modified Delphi process were carried out. The nominal group served to produce a preliminary definition that was then subjected to a Delphi process in which 24 experts from 19 institutions from Europe, Canada and the USA participated. Delphi responses and comments were analysed using a pre-established strategy. Findings: All 24 experts completed the three rounds of the Delphi process, and all the proposed statements achieved at least 79% agreement. Key concepts in the final definition include the WTHD as a reaction to suffering, the fact that such a wish is not always expressed spontaneously, and the need to distinguish the WTHD from the acceptance of impending death or from a wish to die naturally, although preferably soon. The proposed definition also makes reference to possible factors related to the WTHD. Conclusions: This international consensus definition of the WTHD should make it easier for clinicians and researchers to share their knowledge. This would foster an improved understanding of the phenomenon and help in developing strategies for early therapeutic intervention