Learning outcomes and cost-utility analysis of hybrid patient and mannequin-based simulation

Introduction: There is no clear evidence on the relationship between nursing student learning outcomes and the type of simulator used or its cost-effectiveness. Objectives: Compare nursing student learning outcomes using either the hybrid patient or mannequin and the cost-utility of both simulators. Method: A randomised experimental study with an experimental group (hybrid patient = 99) and a control group (mannequin = 97). A training intervention was carried out for polytrauma patients. Results: Statistically significant differences were found between the simulator used and the performance results for tourniquet (hybrid 5.37 ± 1.33, mannequin 4.95 ± 1.09; p = .008) and spinal board (hybrid 6.18 ± 2.02, mannequin 6.97 ± 20.2; p = .001) application. The cost-utility ratio was estimated to be 3.29 for the hybrid patient and 1.92 for the mannequin. Conclusion: The use of a hybrid patient or mannequin has not been shown to be a determinant of performance outcomes or student perceptions in training interventions in polytrauma patient care. However, as the cost per participant with a mannequin is almost twice as high, the hybrid patient has a better cost-utility ratio.This work was supported by the University of Alicante, within the Programa de Investigación en Docencia Universitaria (Research in University Teaching Programme) 2022 (approval number: 5766)

Rúbrica de desempeño en la aplicación del collarín cervical

Manual de uso y rúbrica de evaluaciónRúbrica validada para valorar el desempeño en la aplicación del collarín cervical en la atención al paciente politraumatizado adulto, en entornos simulados de emergencias extrahospitalarias.Universidad de Alicante. Instituto de Ciencias de la Investigación. Programa de investigación en docencia universitaria (Xarxes-2022

Factors associated with the inappropriate use of the pediatric emergency department. A systematic review

Background: Pediatric emergency department (PED) admissions have risen in recent years, a trend not justified by the severity of the pathologies presented. The aim of this study is to analyse factors related to the inappropriate use of pediatric emergency departments. Methods: This is a systematic review reported in accordance with the PRISMA statement. We searched the PubMed, Web of Science and Science Direct databases, using keywords extracted from MeSH, and conducted a reverse search using Google Scholar and Open Grey, for the period January 2017 to August 2022. The quality of the papers was assessed using STROBE, CASPe, AMSTAR-2, GRADE, Levels Of Evidence and Grades Of Recommendation. Results: A total of 20 studies were selected. Factors related to inappropriate use included the younger age of children, black caregivers, lower socioeconomic status, lower parental educational attainment, perceived urgent demand for care, parental emotions in response to their children's health problems, psychological distress, the ineffective exercise of the parental role, the advantages of the PED and the nature of health insurance. Conclusions and implications: The results illustrate the heterogeneous nature of the phenomenon under investigation. Gaining an understanding of the factors related to the inappropriate demand of PEDs, from the perspective of health professionals, can help in developing interventions to reduce unnecessary consultations and relieve pressure on these healthcare services

Demand and stigma in paediatric emergency care: Interventions and potential solutions

Over the past decade, we have seen a steady increase in the demand for care in paediatric emergency departments (PED). Internationally, the annual increase is estimated at around 3–6% [1], which equates to approximately 23 million users seeking care across different emergency departments [2]. As a result of this growing demand, emergency healthcare systems around the world are facing significant challenges. In the context of this contemporary issue, our main objectives are: 1) to provide a comprehensive analysis of the underlying causes of this increase in demand for care and the stigmatisation of PED users, and 2) to identify interventions and potential solutions to tackle this complex issue

Factors associated with non-urgent presentations in the paediatric emergency department using Andersen's behavioural model: A cross-sectional descriptive study

Objectives: To explore the rate of NUPs and associated factors in the PED of the ‘Hospital Universitario y Politécnico La Fe’ in Valencia (Spain) using Andersen's Behavioural Model. Methods: We conducted a descriptive cross-sectional study using Andersen's Behavioural Model in parents visiting the PED with their children at the ‘Hospital Universitario y Politécnico La Fe’ in Valencia (Spain). Results: The study involved a total of 530 participants, of whom 419 (79%) had made an NUP. The predisposing factors identified were: (I) paediatric patients brought in by their fathers (OR = 0.460; p= 0.005), (II) lower educational attainment (OR = 3.841; p= 0.000), (III) first-time parenthood (OR = 2.335; p= 0.000) and (IV) higher parental stress (OR = 1.974; p= 0.023). The enabling factors included: (I) responsibility for a significant part of the childcare shared with others (OR = 0.348; p= 0.041) and (II) the perception that PEDs provide better care than primary care (PC) services (OR = 1.628; p= 0.005). The need factors were: (I) existing chronic illness in the child seeking care (OR = 0.343; p= 0.000) and (II) the perceived severity of the urgency (OR = 0.440; p= 0.031). Conclusions: The NUP rates found in this study are similar to those found interna tionally. In accordance with Andersen's Behavioural Model, we identify predisposing, enabling and need factors to explain the multifactorial nature of NUPs in PEDs. Implications for Practice: Identifying the factors associated with NUPs enables interven tions to be targeted at those groups most likely to engage in NUPs, thereby optimising the functioning of the PED and improving the well-being of children and families. These interventions should focus on improving parental health literacy, providing education on making appropriate decisions about accessing health services and recognising severe symptoms in children, as well as improving access to high-quality PC services. Providing support to parents during the transition to parenthood would also be beneficial. Reporting Method: This paper adheres to the STROBE initiative guidelines. Contribution from patients or members of the public: Participants, who voluntarily agreed to take part, contributed to the study by completing a paper-based questionnaire containing all the study variables as prepared by the research team

Factors associated with frequent users in hospital paediatric emergency departments: A single centre study in Spain

Background: Over the last decade, the demand for hospital paediatric emergency departments (PEDs) has been on the rise. Studies have been carried out in adults, but in paediatrics, and in Spain, they are few and far between. In order to develop interventions to alleviate this problem, it is necessary to understand the factors that predispose people to use these services. Objective: The main objective of this study was to identify the factors associated with frequent users of PEDs in Spain. Methods: A descriptive, cross-sectional study conducted between September 2021 and December 2022 in the PED of a referral hospital in Spain. Results: There were 530 participants, 12.07% of whom were frequent users. There was an indirect association between frequent use and having a secondary level of education (OR = 0.282, p = 0.002). The factors which were directly associated included: perceived urgency (OR = 10.209, p = 0.002) and the perception that PEDs provide better care than primary care (PC) (OR = 2.664, p = 0.044). Conclusions: The percentage of frequent users is comparable with international levels. As a strategy to reduce the frequency of visits, health interventions are needed to ensure that parents know how to correctly interpret their children’s symptoms and are well informed about the recommended flow of care

Psychometric properties of parental stress scales used in paediatric health care settings: A systematic review

Aim: To identify scales that assess parental stress in the paediatric clinical population and to analyse their psychometric properties. Methods: Four electronic databases (PubMed, Web of Science, PsycINFO, and Scopus) and metasearch engines (Google Scholar and Open Grey) were searched with no time period limitations. Methodological quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach modified by COSMIN. Finally, recommendations were made for the instruments with the highest quality of evidence. Results: A total of 38 studies reporting on 11 different instruments for assessing parental stress in the paediatric clinical setting were included. Six instruments were ‘A’ rated (recommended) in the final phase in line with COSMIN guidelines. The Paediatric Inventory for Parents was the instrument that evaluated the highest number of psychometric properties and obtained the highest methodological quality, global assessment, and quality of evidence for the different psychometric properties. Conclusions: This systematic review provides an overview of the measurement properties of the parental stress instruments used in the paediatric clinical setting. The Paediatric Inventory for Parents stands out as being one of the most robust instruments for measuring stress in parents with a hospitalised or sick child. Evidence needs to be generated for all the parental stress scales used in the clinical setting. Impact: Given that the psychometric properties of the existing parental stress scales used in paediatric health care settings have not been systematically assessed, the present review utilised comprehensive methods according to COSMIN. No Patient or Public Contribution. Reporting method: PRISMA statement and COSMIN reporting guidelines for studies on measurement properties of patient-reported outcome measures

A descriptive cross-sectional study on eating disorders, suicidal thoughts, and behaviors among adolescents in the Valencian community (Spain). The pivotal role of school nurses

Purpose: The aims of this study were: 1) to describe the rates of risk of having an Eating Disorder (ED) and the rates of suicidal thoughts and behaviors, and 2) to examine the relationship between the risk of having an ED with suicidal thoughts and behaviors in adolescents enrolled in educational centers in the Community of Valencia (Spain). Design and methods: A cross-sectional study was conducted with 718 adolescents between September 2019 and July 2020 in five schools in the Community of Valencia (Spain). Results: The adolescents studied, mostly females, are at risk of having an ED (18.6% to 30.8%) and experiencing suicidal thoughts (23% to 30.7%) and behaviors (2.2% to 6.2%). A strong association was found between EDs and suicidal thoughts and behaviors in both sexes. This association was higher in females with positive EAT-26 scores (OR: 2.09; 95% CI: 1.35–3.24) and in males with positive SCOFF scores (OR: 4.66; 95% CI: 2.40–9.02). Suicidal behaviors were positively associated with both EAT-26 (OR: 2.58; 95% CI: 1.17–5.67) and SCOFF (OR: 1.89; 95% CI: 1.21–2.26) scores in females. Conclusions: A considerable number of adolescents, females in particular, are at risk of having an ED and of experiencing suicidal thoughts and behaviors, establishing a strong link between EDs and suicidal tendencies. Practical implications: The study highlights the importance of establishing national and regional regulations to ensure the availability of school nurses in the Community of Valencia (Spain). Collaboration between school nurses, educators, and policy makers is critical to the early detection of problems and the provision of support to both adolescents and families

Propiedades psicométricas del Eating Attitudes Test-26 en escolares españoles

Introduction: Disordered Eating Attitudes and Behaviours (DEABs) can impact both the mental and physical health of children. Early detection is crucial to prevent complications and improve outcomes. The Eating Attitudes Test-26 (EAT-26) is a widely used, cost-effective tool for assessing DEABs. Objective: To evaluate the psychometric properties of the EAT-26 by analysing its factor structure, internal consistency, convergent validity, and measurement invariance across sexes in Spanish schoolchildren. Method: Validation study in a sample of 718 schoolchildren. The sample was randomly divided into 2 groups, each with 359 participants, and we carried out an exploratory factor analisis (EFA) and a confirmatory factor analysis (CFA) of the instrument. Subsequently, we assessed the internal consistency by means of the ordinal alpha, the convergent validity with the SCOFF questionnaire and the measurement invariance across the sexes. Results: The results of the EFA and CFA supported a multidimensional structure of the EAT comprising 6 factors and 21 items. These factors underlie a second-order model of DEABs. The internal consistency was adequate for most factors. The SCOFF questionnaire showed a moderate convergent validity for most of the EAT-21 factors. We found measurement invariance across the sexes. Conclusions: The abbreviated EAT-21 scale exhibited modest and promising psychometric properties, making it a suitable instrument for assessing DEABs in both sexes in educational settings.Introducción: Las Actitudes y Comportamientos Alimentarios Desordenados (DEAB, por sus siglas en inglés) pueden afectar tanto a la salud mental como física en los niños/as. Su detección temprana es crucial para prevenir complicaciones y mejorar las posibilidades de recuperación. El Eating Attitudes Test-26 (EAT-26) es una herramienta ampliamente utilizada para evaluar los DEAB debido a su costo-efectividad. Objetivo: Evaluar las propiedades psicométricas del EAT-26, analizando la estructura factorial, consistencia interna, validez convergente e invarianza de medida entre ambos sexos en escolares españoles. Método: Estudio instrumental con una muestra de 718 escolares. La muestra se dividió aleatoriamente en dos grupos, cada uno con 359 participantes, realizando un Análisis Factorial Exploratorio (AFE) y un Análisis Factorial Confirmatorio (AFC). Posteriormente, se estimó la consistencia interna con el alfa ordinal, la validez convergente con el cuestionario SCOFF y la invarianza de medida entre ambos sexos. Resultados: Los hallazgos del AFE y AFC respaldaron una estructura multidimensional del EAT, compuesta por seis factores y 21 ítems. Estos factores subyacen en un modelo de segundo orden de las DEAB. La consistencia interna fue suficiente para la mayoría de los factores. Se mostró una validez convergente moderada con el cuestionario SCOFF para la mayoría de los factores del EAT-21. Se alcanzó una invarianza de medida entre ambos sexos. Conclusiones: La escala abreviada EAT-21, mostró unas propiedades psicométricas modestas y prometedoras, constituyendo un instrumento adecuado para la evaluación de las DEAB, en niños y niñas, en contextos docentes

The Parental Stress Scale: Psychometric Properties in Pediatric Hospital Emergency Setting

Parental psychological distress has been identified as a predisposing factor in attendance at and the inappropriate use of hospital pediatric emergency departments (PEDs). The aim of the study was to validate the Parental Stress Scale (PSS), a 12-item Spanish scale, in parents seeking care at PEDs. The study involved 270 participants with a mean age of 37.9 (SD = 6.76) years, of which 77.4% were women. The properties of the PSS were analyzed. The scale showed adequate internal consistency for the different factors (0.80 for the “Stressors” factor and 0.78 for the “Baby’s Rewards” factor) and optimal model fit (chi-square = 107.686; df = 53; CFI = 0.99; TLI = 0.98; RMSEA = 0.028; 90% CI = 0.00–0.05). The 12-item Spanish version of the PSS is a valid and reliable instrument for assessing the stress levels of parents seeking care in PEDs