Objective: To explore the existing knowledge in the literature about nurses¿ clinical leadership in the intensive care unit. Methods: A scoping review was conducted according to Arksey & O¿Malley¿s methodology. The search process encompassed five main online databases, PubMed (including MEDLINE), CINAHL, PsycINFO, Scopus and Cochrane, for the period January 2007-September 2022. Data abstraction, quality appraisal and narrative synthesis were conducted in line with the Preferred Reporting Items for Systematic reviews and meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Results: Eleven studies were included. The evidence reveals that idealised influence, motivational inspiration, intellectual stimulation and intrinsic individual consideration are the key clinical nurse leader competencies needed in the intensive care unit. The compatible leadership styles in this setting are situational and transformational. Communication skills and professional experience seem to be determinants to consider in the strategies to promote clinical leadership in intensive care units. Conclusions: This scoping review provides broad and comprehensive knowledge, which helps to understand, in a single study, the key competencies, leadership styles, determinants and strategies needed to promote intensive care unit nurses¿ clinical leadership.

Aims: To analyze the personal experiences of Jane Stuart Woolsey in Hospital Days (1868), an inspiring nurse who brought order, training and quality to nursing activities in the context of the American Civil War (1861-1865). Background: In a restrictive context where the general access of women to public sphere activities was rather limited and where nursing was not a formally regulated professional activity, Jane Woolsey wrote Hospital Days to recount her wartime nursing experiences as the superintendent of Fairfax Seminary Hospital in Virginia. Design: Historical research. Methods: Historical research methods were used to analyze Hospital Days. Data gathered from primary and secondary sources were synthesized and discussed in terms of their historical context and significance. Results: Unlike other triumphal narratives at the time, Woolsey develops a compelling account describing the work expected of a nurse and denouncing the lack of training among most nurses working in the war context. Conclusion: Jane Woolsey was a pioneering nurse who improved the quality of nursing care amidst the American Civil War. Her personal experiences collected in Hospital Days reflect her desire for the proper training of nurses and her contributions to emerging professional nursing activities built on the integration of previous domestic values, good training and good administration.

Aim: The aims of this paper are (1) to present the results of the development, content validation and imple-mentation study of the Relationship Competencies Guiding Tool; (2) to provide examples of how each item in the tool is reflected in clinical narratives written by nurses and justify the corresponding scores after the evaluation; (3) to present how the language and content of the narratives are interpreted with the tool and to describe an exemplar; and (4) to present barriers to and facilitators of the application of the tool. Background: From a person-centered care approach, the fostering of authentic relationships with patients is key to achieving therapeutic benefits. Therefore, it is essential to help nurses establish meaningful relationships with patients and help them acquire these abilities. Clinical narratives can be used as a way to promote reflective practice and professional competency development among nurses. A tool to evaluate the knowledge, skills, at-titudes and values necessary for developing authentic encounters with patients through clinical narratives was developed, validated and implemented.Design: An instrument-development study comprised of three steps: (1) conceptualization; (2) item generation and content validity; and (3) implementation of the tool and linguistic evaluation.Methods: This study was conducted in three major steps. Step one entailed conceptualization. Step two included the generation of items and content validation. In step three, the tool was used to independently evaluate 25 narratives. One of these narratives was also linguistically analysed to provide a comprehensive view of the interpretative strategies deployed by evaluators.Results: The Relationship Competencies Guiding Tool was developed, validated and implemented. It could help nurses work on nursing relationship-based professional competencies, guided the evaluators in the process of assigning scores to the corresponding items and helped the researchers identify certain barriers and facilitators before and during the narrative evaluation process.Conclusions: The tool has been shown to be clear, relevant and conceptually and linguistically suitable for evaluating clinical narratives. The Relationship Competencies Guiding Tool could be applied to interpret how nurses reflect professional competencies in a clinical narrative as a preliminary step in the construction of a mea-surement tool.Tweetable abstract: From a person-centered relationship-based care approach, clinical narratives can be used to promote professional competencies between nurses. The Relationship Competencies Guiding Tool may help eval-uate the knowledge, skills, attitudes and values necessary for developing authentic encounters with persons/ families, as reflected by nurses' clinical narratives.

El autocuidado diádico en la insuficiencia cardiaca crónica (ICC) es clave para garantizar la continuidad del tratamiento, disminuir las complicaciones y los reingresos, y minimizar la sobrecarga del cuidador, pero demanda estrategias específicas. El objetivo fue identificar las intervenciones de autocuidado diádico en la ICC en el contexto hospitalario mediante una revisión sistemática de la literatura en PubMed, CINAHL y PsycInfo; la calidad metodológica se valoró según las herramientas de CASPe y del Joanna Briggs Institute. Se identificaron los principales componentes de las intervenciones: formato de administración; dimensiones y estrategias utilizadas (cognitivo-actitudinal, afectiva-emocional y conductual); proveedores y receptores; instrumentos de medida utilizados; y efectividad. La mayoría de estudios mejoraron los resultados, especialmente síntomas de depresión y/o ansiedad, adherencia al tratamiento, dieta y control del peso. Se recomiendan intervenciones innovadoras que incluyan componentes de las tres dimensiones identificadas y el uso de escalas válidas, fiables y específicas para medir los resultados.

Chronic heart failure (CHF) is a progressive and disabling condition that significantly impacts patients' daily lives. One of its effects is decreased opportunities to participate in social life, leading to reduced social interaction, loneliness, social isolation and lack of social support to continue with their daily life activities. This study aimed to explore the causes, experiences, and consequences of the impact of CHF on the social dimension of the person. According to the Arksey & O'Malley method, a scoping review of the literature was conducted to examine existing knowledge in the area, summarise existing evidence and identify gaps in the literature. The search was conducted in the PubMed, CINAHL, PsychINFO, Scopus, and Web of Science databases from January 2010 to November 2021. Twenty-six articles were identified. The reasons why CHF influences the social dimension of the person were multifactorial and related to physical aspects, sociodemographics, lifestyle changes and the feelings experienced by these patients. Social relationships play a key role, and the benefits of good social relationships and the impact of poor or inadequate social support were identified. Furthermore, the influence of alterations in the social dimension on the CHF patient's clinical outcomes was described. This approach will help to detect and better understand the bidirectional influence that exists in each person between social isolation, relationships, and support life experiences, self-care activities, and morbi-mortality rates. These findings have shown the importance of detecting higher-risk groups and systematically assessing factors related to the social dimension in all patients with CHF.

Aim Survivorship care plans (SCPs) are recommended as a tool for the care of cancer survivors. SCPs have been implemented with a multidisciplinary approach; however, the specific role of nurses in the SCP is unknown. Our aim is to determine the role of nurses and their degree of participation in cancer SCPs. Design Integrative review of the literature with systematic methodology. Data sources PubMed, CINAHL, PsycINFO, Web of Science, Cochrane and Cancerlit databases were reviewed. Articles published up to March 2021 were included. Review method Of the 2,638 publications identified, 22 studies met our inclusion criteria. Quality of included studies was assessed using Joanna Briggs Institute quality assessment tools. Results The studies showed that nurses play a key role and participate in different phases of the SCP, including design, delivery, monitoring and coordination among different levels of care, with varying degrees of involvement and responsibility; design and delivery of the SCP are the phases with the highest nurse participation (18 out of 22 studies). The majority of SCPs are implemented in specialized, hospital-based care and focus on short-term cancer survivors, who are actively undergoing oncological treatments. Conclusion This review shows that nurses actively participate in the design, implementation and coordination of SCPs. However, SCPs focus on the acute survival and treatment phases, and there is a gap in their use in long-term cancer survivorship. This gap may be one reason the needs of long-term cancer survivors are not covered. Impact This review contributes to the current body of knowledge by addressing the role of nurses in cancer SCPs. We recommend the involvement of an advanced practice nurse as SCP coordinator to improve communication between cancer specialists and primary care providers and to promote continued care throughout the different phases of cancer survivorship, including long-term survival.

Aims To identify the most effective interventions to empower cardiorenal patients. Design A systematic review of the literature has been carried out. Data sources The PubMed, CINAHL, PsycINFO and Cochrane databases were reviewed, and journals in the field were manually searched between January and February 2020. Review methods Five randomized clinical trials and quasi-experimental studies that met the selection and CONSORT & TREND methodological quality criteria were selected. Results The evidence supports that there are no existing interventions aimed at empowering cardiorenal patients. However, the interventions to empower people with chronic kidney disease and heart failure suggest that their integration should address seven domains: patient education, sense of self-management, constructive coping, peer sharing, enablement, self-efficacy and quality of life. Conclusion A gap has been revealed in the literature regarding the empowerment of cardiorenal patients. This review provides relevant information to help design, implement and evaluate interventions to empower these patients by describing the strategies used to empower people experiencing both chronic conditions and the tools used for their assessment. Impact There is a need for further research to design, implement and evaluate a multidimensional intervention that favours the empowerment of cardiorenal patients by using valid and reliable instruments that measure the domains that constitute it in an integrated manner. Interventions aimed at empowering the cardiorenal patient should include seven domains: patient education, sense of self-management, constructive coping, peer sharing, enablement, self-efficacy and quality of life.

Background: Integrating the family of patients with kidney failure on comprehensive conservative care could benefit patients, families, and the health care system. However, there is a knowledge gap in this phenomenon since no systematic review has focused on the families' needs who care for individuals with kidney failure on comprehensive conservative care. Objectives: To understand the primary needs of families who care for people with kidney failure on comprehensive conservative care. Method: A systematic literature review of qualitative studies, followed by a content analysis was carried out. PubMed, CINAHL, and PsycINFO databases were used to search for articles published in English and Spanish between 2010 and 2021. The ENTREQ guideline was used for reporting. Results Five relevant studies were included in this study. The analysis has allowed identifying key aspects of knowledge, psychological, social and spiritual needs of family members of patients with kidney failure on comprehensive conservative care. Conclusions: This systematic review has revealed that families experience a lack of information and continuity of care by health care professionals. Added to this is the psychological burden they bear due to the feeling of indefinite care in time and uncertainty about the death of their loved one. All this, without the necessary support from their immediate family environment and social institutions. In light of these data, a paradigm shift in society and the health care received by these families is essential.

Background Cancer survivors (CSs) have needs that can negatively impact their quality of life (QoL). Oncology nurses play a key role in providing comprehensive care in cancer survivorship, although little is known about their impact on health outcomes. Objective The aim of this study was to determine the effectiveness of nursing interventions to improve QoL and satisfaction with care of CSs. Methods A systematic review was conducted. PubMed, CINAHL, PsycINFO, and Cochrane databases were searched for experimental studies. The Joanna Briggs Institute Checklist for Randomized Controlled Trials was used to verify the quality of the studies (Prospero reference: CRD42020148294). Results Of the 8 clinical trials eligible for inclusion, 5 demonstrated that interventions conducted by nurses improved the overall QoL or some of its domains in CSs. The included studies focused on short-term survival; no studies in long-term CSs were identified. Two studies assessed satisfaction with care of survivors, obtaining positive results. Conclusions Nursing interventions seem to improve the QoL of short-term CSs. However, because of the low number of studies identified, the findings of this systematic review should be interpreted with caution. Implications for practice Further studies are necessary to strengthen the implementation of effective nursing intervention in cancer practice. Research should particularly be conducted with long-term CSs as there is lack of data on this specific stage of cancer.

Aim This study aims to identify the most effective interventions to facilitate nurses' clinical leadership in the hospital setting. Background There is a gap in the literature on the identification and measurement of effective interventions for leadership skill development among clinical nurses in hospitals. To the best of our knowledge, no systematic review has been performed on this issue. Evaluation A systematic review was conducted. The PubMed, CINAHL, PsycINFO and Cochrane databases were reviewed. Data extraction, quality appraisal and narrative synthesis were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Key issues The evidence reveals that interventions designed to promote nurses' clinical leadership are complex, requiring that cognitive, interpersonal and intrinsic competencies as well as psychological empowerment, emotional intelligence and critical reflexivity skills be addressed. Conclusions The development of multicomponent, theory-based and mixed-format programmes may be more suitable to facilitate nurses' clinical leadership in the hospital setting. Implications for Nursing Management Strategies to facilitate nurses' clinical leadership in the hospital setting should address simultaneously the knowledge and ability of bedsides nurses to solve the practical problem collaboratively with a sense of control, competency and autonomy. Hence, it would promote high quality care, satisfaction and retention of bedside nurses.

Background: In a period of hopelessness motivated by a restrictive Victorian society that confined women to the domestic realm, Florence Nightingale wrote the cathartic Cassandra (1852) in an attempt to transform her despair into rebellion. Aims: To discuss Nightingale's approach to women's role in Cassandra. Methods: Historical Research was used to analyse Cassandra. Data gathered from primary and secondary sources were synthesised and reported in terms of their historical context and significance. Findings: Adopting the genre of `sage writing¿, Nightingale positions herself as a female messiah in an autoreferential narrative that projects women's future possibilities for release. Discussion: Assuming the identity of a prophetic Greek heroine cursed to never be believed, Nightingale's Cassandra claims professional work as the liberating solution for Victorian women. Conclusion: For the first time, Nightingale predicts in Cassandra some incipient prerequisites for a future nursing path for women's change.

Objetivo principal: Evaluar el nivel de satisfacción de las enfermeras nóveles con la simulación clínica de alta fidelidad en la formación de RCP, durante la Covid-19. Metodología: Estudio observacional descriptivo transversal. Se utilizó la Escala de Satisfacción en Simulación Clínica de Alta Fidelidad, cuestionario validado de 33 ítems con respuesta tipo Likert. Se utilizó estadística descriptiva, e inferencial no paramétrica (correlación de Spearman) para analizar la correlación entre las variables. Resultados principales: N=35 (100%). La satisfacción global media fue de 4,97±0,17. Los ítems relativos a la adecuación de los casos a los conocimientos de los participantes, la capacidad para proporcionar cuidados a los pacientes, el beneficio de la simulación e impacto en la mejora de sus habilidades técnicas fueron los mejores puntuados (media de 4,97). Se encontró una relación positiva y fuerte entre los ítems: 4-9, y 27-9 (rho= 0,804; p=0,000). Conclusión principal: El nivel de satisfacción de las enfermeras de nueva incorporación con la simulación clínica de alta fidelidad fue elevado, lo que confirma su utilidad en el proceso de aprendizaje en RCP durante la Covid-19 o brotes pandémicos de la misma naturaleza. Palabras clave: Enfermería. Enseñanza mediante Simulación de Alta Fidelidad. Reanimación Cardio-Pulmonar. Satisfacción. Formación Continuada. Covid-19.

The SARS-Cov-2 pandemic has had a negative impact on the implementation of the Zero Pneumonia recommendations and has been accompanied by an increase in rates of ventilator- associated pneumonia (VAP) in intensive care units in Spain. With the aim of reducing the current rates to 7 episodes per 1000 days of MV, the recommendations of the initial project have been updated.Twenty-seven measures were identified and classified into 12 functional measures (semi- sitting position, strict hand hygiene, airway manipulation training, daily assessment of possible extubation, protocolisation of weaning, early tracheostomy, non-invasive ventilation, microbiological surveillance, tubing change, humidification, respiratory physiotherapy, post- pyloric enteral nutrition), 7 mechanical measures (pneumotap pressure control, subglottic suction tubes, subglottic suctioning of tubes, subglottic suctioning of tubes, post-pyloric enteral nutrition, subglottic suction tubes, small-bore/small-bowel tube nutrition, closed/open circuit secretion suctioning, respiratory filters, tooth brushing, negative pressure techniques for secretion suctioning) and 8 pharmacological (selective digestive decontamination, oropharyngeal decontamination, short course of antibiotics, chlorhexidine mouth hygiene, inhaled antibiotics, antibiotic rotation, probiotics, monoclonal antibodies).Each measure was analysed independently, by at least two members of the working group, through a systematic review of the literature and an iterative review of recommendations from scientific societies and/or expert groups.For the classification of the quality of the evidence and strength of the recommendations, the GRADE group proposal was followed. To determine the level of recommendation, each measure was scored by all members of the working group in relation to its effectiveness, tolerability and applicability in Spanish ICUs in the short term. The support of external experts was requested for some of the measures reviewed. Those measures that achieved the highest score were selected.

During the COVID-19 pandemic, the world's healthcare systems were extremely strained. Intensive care units were stretched to capacity and healthcare facilities were forced to set up spaces to care for critically ill patients. Professionals were required to work in strenuous conditions, completely disrupting their work routines.In this scenario, hand hygiene and the use of gloves by healthcare professionals became a critical point of transmission risk.The results of the ENVIN study in 2020 and 2021, corresponding to the pandemic period, showed worrying data on the increase in infection rates, with rates rising by 250% at the worst moments of the pandemic. This suggested that excessive risk situations were occurring for the patient. Any preventive strategy must place correct hand hygiene and proper use of gloves among its priority objectives. For this reason, the Project Zero Advisory Board made a series of adaptations and recommendations based on available evidence and expert opinion related to hand hygiene and glove use during the pandemic situation to promote best practice in extreme situations. This article reviews the key aspects of hand hygiene as part of the WHO safety strategy, the main barriers to compliance and the main adaptations proposed by the Advisory Board of the Zero projects.

Objetivo principal: Evaluar el nivel de satisfacción de las enfermeras nóveles con la simulación clínica de alta fidelidad en la formación de RCP, durante la Covid-19. Metodología: Estudio observacional descriptivo transversal. Se utilizó la Escala de Satisfacción en Simulación Clínica de Alta Fidelidad, cuestionario validado de 33 ítems con respuesta tipo Likert. Se utilizó estadística descriptiva, e inferencial no paramétrica (correlación de Spearman) para analizar la correlación entre las variables. Resultados principales: N=35 (100%). La satisfacción global media fue de 4,97±0,17. Los ítems relativos a la adecuación de los casos a los conocimientos de los participantes, la capacidad para proporcionar cuidados a los pacientes, el beneficio de la simulación e impacto en la mejora de sus habilidades técnicas fueron los mejores puntuados (media de 4,97). Se encontró una relación positiva y fuerte entre los ítems: 4-9, y 27-9 (rho= 0,804; p=0,000). Conclusión principal: El nivel de satisfacción de las enfermeras de nueva incorporación con la simulación clínica de alta fidelidad fue elevado, lo que confirma su utilidad en el proceso de aprendizaje en RCP durante la Covid-19 o brotes pandémicos de la misma naturaleza.

Background. Person-centered care has become a key global approach that seeks to provide answers to all factors of the complex health care-related processes. This has led to the development of theoreti-cal frameworks that represent the components of person-centered care. The internationally recognized Person-Centred Practice Framework (PCPF) (McCormack and McCance) allows multidisciplinary teams to understand and operationalize the dimensions for the development of person-centered care. The aim of this study was to obtain the first Spanish version of the PCPF translated and adapted to the Spanish con-text. Methods. We translated the PCPF following the Translation and cul-tural adaptation process for Patient-Reported Outcomes (PRO) Measures guidelines. A consulting session with experts was part of the process and content validation on clarity and relevance for each domain was performed. Results. We encountered no significant difficulties to reach agree-ments on most of the terms except for Having a sympathetic presence. Not only was a complex term to translate but also to trans-culturally adapt. Regarding relevance and clarity, the content index by construct (I-CVI) and the global framework (S-CVI/Ave) were consistent with their original counterparts (>= 0.90). Conclusions. The adapted Spanish version is clear, significant, and conceptually equivalent to the original PCPF. It will allow a better com-prehension of the person-centered practice framework in the Spanish context and facilitate the implementation of this approach in clinical practices.

Currently, the dying process in Spain is moving to the home environment where responsibility for care falls largely on the family, thereby challenging and testing the stability of the family. Previous research has focused on the impact of illness on the primary caregiver; therefore, a knowledge gap exists. This study aimed to understand families' unitary experiences of providing home care to terminally ill family member. Using the "Model of Interpersonal Relationship Between the Nurse and the Person/Family Cared For," narrative research included family and individual interviews with nine families (9 groups/23 individuals). Thematic narrative analysis was used to interpret the interviews. The results highlight the impact of illness on family well-being as a whole. Family members often felt abandoned while caring for an ill family member and wished to be cared for themselves. However, their immediate community and the nurses caring for their ill family member neglected them. A paradigm shift is required by society and in home care at the end of life to better support the family.

Diversos estudios confirman que no existe una sintonía entre lo que las enfermeras son y lo que la sociedad conoce de ellas. Esta disociación genera consecuencias negativas en las propias enfermeras, en los pacientes y en el conjunto de la sociedad. Este artículo describe y aporta evidencia sobre una de las posibles causas que puede explicar por qué se produce esa desinformación. La hipótesis de partida es que las enfermeras no han recibido la formación adecuada para desarrollar la competencia comunicativa con todos los grupos de interés con los que interactuarán en su trayectoria profesional. La carencia es notoria cuando tienen que interactuar con los medios de comunicación. La mayoría de las enfermeras no han sido formadas para poder responder de manera eficaz a las demandas informativas que los periodistas pueden solicitarles. La escasa presencia de enfermeras en las informaciones que se publican sobre salud podría justificarse por lo tanto no sólo por el desconocimiento que los periodistas tienen sobre esta profesión, sino también por la falta de formación que las enfermeras han recibido al respecto durante su etapa universitaria. El artículo concluye animando a una reflexión / diálogo sobre esta cuestión desde los cuatro ámbitos en los que las enfermeras ejercen su profesión: asistencial, gestor, académico e investigador. Se confía en que este debate sea el germen que contribuya a que las enfermeras se formen para crear su propia narrativa. Con ello se favorecerá que la

Purpose/Aims To explore nurses' perceptions of clinical nurse specialist practice as implemented in a highly specialized university hospital in Spain. Design A descriptive qualitative study was carried out in 3 inpatient wards, with a clinical nurse specialist within the team, at a high specialized university hospital in Spain. Method Semistructured interviews were conducted by purposive sampling with 17 selected nurses with at least 2 years of professional experience who voluntarily agreed to participate and signed the informed consent form. Analysis of the qualitative data was conducted according to Burnard's method of content analysis. The Consolidated Criteria for Reporting Qualitative Research checklist was used. Results Four main categories emerged from the analysis of the data: "qualities of the role-holder," "role competencies in practice," "integration with the team," and "impact of the role" on nursing, the patient, and the organization. Conclusions The findings of this study have interesting implications for the development and implementation of clinical nurse specialist practice in healthcare organizations. They also provide evidence of the benefit of implementing clinical nurse specialist practice for improving the quality of care, patient outcomes, and healthcare efficiency.

Introducción. Las decisiones políticas en el ámbito de la gestión sanitaria resultan fundamentales con impacto directo en la salud. Los profesionales en gestión sanitaria, entre ellos enfermeras, están llamados a participar en la toma de decisiones políticas. Objetivo. Conocer que¿ evidencia científica hay disponible sobre programas educativos formales e informales para formar en participación y en la toma de decisiones políticas de salud dirigidos a enfermería. Analizar cuáles son las características que definen los programas educativos en participación y toma de decisiones políticas para enfermeras. Método. Revisión bibliográfica sistemática en las principales bases de datos. Resultados. No se han hallado programas formativos en el contexto español. Se analizan los programas formativos existentes en base a similitudes y diferencias entre ellos identificadas en la revisión. Discusión. El desarrollo de las competencias de gestión en enfermería abarca más que gestión de la práctica clínica. La formación completa en gestión en enfermería incluye el liderazgo, la participación y toma de decisiones políticas mediante el desarrollo de múltiples habilidades de comunicación y la aplicación de la ética, entre otras. Conclusiones. La inexistencia de programas formativos en toma de decisiones políticas para enfermeras en España, justifica el desarrollo de nuevos estudios a nivel nacional e internacional que complementen y profundicen en el tema abordado en esta revisión. Implicaciones para la práctica. Desarrollar programas formativos en toma de decisiones políticas para enfermeras impulsará al desarrollo de perfiles gestores mejor formados y capacitados para ocupar puestos de responsabilidad en la toma de decisiones estratégicas en salud.

Aim To explore experiences of frontline nurse managers during COVID-19. Background The COVID-19 pandemic has complicated care provision and healthcare management around the world. Nurse managers have had to face the challenge of managing a crisis with precarious resources. Little research has been published about the experiences of nurse managers during the COVID-19 pandemic. Methods A qualitative descriptive study of 10 frontline nurse managers at a highly specialized university hospital in Spain was carried out. Semi-structured interviews were conducted between June and September 2020. The Consolidated Criteria for Reporting Qualitative Research checklist was used for reporting. Results Six themes emerged: constant adaptation to change, participation in decision-making, management of uncertainty, prioritization of the biopsychosocial well-being of the staff, preservation of humanized care and 'one for all'. Conclusions This study provides evidence for the experiences of nurse managers during the COVID-19 pandemic. In addition, analysing these experiences has helped identify some of the key competencies that these nurses must have to respond to a crisis and in their dual role as patient and nurse mediators. Implications for Nursing Management Knowing about the experiences of frontline nurse managers during the pandemic can facilitate planning and preparing nurse managers for future health disasters, including subsequent waves of COVID-19.

Understanding the unique experience of nursing students providing frontline support in COVID-19 hospital wards is crucial for the design of strategies to improve crisis management and mitigate future pandemic outbreaks. Limited research concerning this phenomenon has been published. This qualitative study aimed to understand the experience of providing support from COVID-19 frontline nursing students' perspective. Online interviews were conducted with nine nursing students from April to May 2020; interview data were analyzed by content analysis using Burnard's method. Six main categories emerged from the data analysis: "experiencing a rapid transition from student to professional," "fear and uncertainty of the unknown," "resilience throughout the crisis," "sense of belonging to a team," "shared responsibility," and "importance of the profession." Based on these findings, multicomponent strategies that function in parallel with practical contexts should be developed to enable students to diligently adapt their abilities to their new role and cope with health crises.

El impacto negativo de la pandemia sobre las tasas de infecciones controladas ha evidenciado la necesidad de reanudar la aplicación de las recomendaciones de los Proyectos Zero (PZ). En este artículo, en primer lugar, se realiza un análisis de la situación de las unidades de cuidados intensivos de España durante la pandemia. A continuación se presenta la adaptación de las recomendaciones de cada uno de los cuatro PZ y su grado de cumplimiento y riesgo de que existan infecciones relacionadas con dispositivos invasivos y/o bacteriemias multirresistentes. Para ello, se han tenido en cuenta: 1) el documento publicado en octubre de 2020 por el Consejo Asesor del Programa de Seguridad de pacientes críticos, y 2) el estudio exploratorio realizado, un año después, por el Consejo Asesor de los PZ, junto con los líderes de los proyectos de las unidades participantes del registro ENVIN. Por último, y en base a los hallazgos encontrados, se formulan cinco recomendaciones tentativas y prioritarias.

Background Nurses' political engagement is needed for societal advancements. Purpose The purpose of this study was to explain why and how nurses became politically active, and what they achieved. Methods Qualitative, constant-comparative data analysis was used for this study. After 10 elected or politically-active Canadian nurses were interviewed, data saturation was confirmed. Findings All were motivated by early life events to realize the importance of social justice and good government. Their nursing education and work equipped them to be capable of engaging in political spheres. All had developed knowledge of relevance for political purposes; in addition to confidence, communication skills, and other abilities to be effective politically. All highlighted the importance of being encouraged and assisted to engage politically. Positive micro-, meso-, and macro-level benefits of this involvement were identified. Conclusions More nurses should be inspired and helped to become active politically. It is critically important for nurses to inform and advance public policy, through direct political activities.

Background: Chronic heart failure (CHF) is a syndrome that greatly impacts people's lives. Due to the poor prognosis of CHF, together with the frequent exacerbations of symptoms, death is a topic that is very present in the lives of patients with CHF. Objective: To explore thoughts about death experienced by patients with chronic heart failure in their daily lives. Methods: A hermeneutic phenomenological study was carried out. Conversational interviews were conducted with 20 outpatients with chronic heart failure. Analysis of the responses was based on the method proposed by van Manen. Results: From the analysis, four main themes emerged: (1) Feeling afraid of the possibility of dying; (2) Acceptance of the possibility of death; (3) Desiring death for relief from suffering; and (4) Striving to continue living to enjoy family. Conclusions: This study presents, as a novel finding, that people with CHF experience the possibility of near death on a daily basis. This experience, which they must encounter on their own, makes them afraid. In addition, some of them, in view of the discomfort they are living, wish to die, with some even considering committing suicide. (C) 2021 The Authors. Published by Elsevier Inc.

Aim This commentary aims to spark debate on the ethical, legal, professional and institutional challenges faced by nurses' use and interactions when using traditional, mass and social media. Background Freedom of expression is a core value of democratic systems. However, it appears to be a complex right when exercised by nurses in traditional media and/or during online interactions. Active use of these types of media can help promote healthcare incentives and reach larger audiences, or even influence public policy. Nevertheless, with the increase in social media use, some nurses have been found to have engaged in unprofessional practices, which, in some serious cases, have led to their dismissal. Evaluation We identified specific instances of conflicts-most commonly related to breach of privacy, inappropriate interactions on social media or a simple lack of knowledge or guidance regarding its use-and formal complaints concerning nurses' freedom of expression. Key Issues While nursing codes do exist, professional guidelines concerning the use of mass and social media are still much needed. With the advent of social media, there may be ambiguity regarding how nurses engage with and make use of these platforms. In order to ensure that nurses interact professionally with any form of media, clear ethical, legal and professional frameworks of use are needed. Specific codes exist, such as the new ICN code of ethics or the NMC code, among other initiatives, but more comprehensive guidance is needed in order to support nurses in using better judgement regarding their media interactions. While the existence of such frameworks may not fix the problem of incorrect use, it can help those nurses looking for clear guidance when interacting with mass media or using social media. Also, it is important that more professionals are aware that such guidance exists, since understanding the limits and dangers of certain interactions would ultimately protect nurses' and patients' rights. Conclusion The increasing use of media platforms by nurses calls for further professional guidance regarding its professional utilization. To date, limited guidance exists to support media interactions. In an interconnected world that favours media interaction in both professional and private spheres, the development and widespread dissemination of clear guidance for professionals must also detail two essential points: how professionals can better interact with media platforms and also how they can avoid having unethical media interactions in the first place. Implications for Nursing Management The existence of a solid, comprehensive framework for generalized media use should ensure that nurses can exercise their right to freedom of expression. Clearer limitations should support nurses' professional presence and interactions in the media.

Introduction Chronic heart failure (CHF) is a progressive and disabling illness that affects daily life. Decreased opportunities to participate in social life are among the most common aspects experienced by these patients, leading to reduced social interaction, loneliness, social isolation, and lack of social support to continue their activities of daily living. These experiences, in turn, have significant consequences for the health of patients with CHF, increasing the risk of comorbidities and complications. Purpose This study aimed to identify the consequences of the altered social dimension on the health of those with CHF. [...]

hronic heart failure (CHF) is characterized by a progressive deterioration in the patient's health state that significantly impacts their whole life. Most of the scales available for its assessment show that the physical dimension is still given great prominence, even when they aim to address quality of life. Purpose This study aimed to design a scale to know the experience of living with CHF. [...]

Nurses' continuing professional development (CPD) improves the quality of nursing care, patients' safety, nurses' satisfaction and healthcare costs. However, evidence has shown that nurses do not always participate in their CPD and that CPD does not always address nurses' real needs. To examine this issue, a systematic review of the literature on nurses' experiences regarding their CPD in the clinical context was carried out. The studies selected for this review (n = 9) were analyzed thematically, through which three themes were identified: The relevance of CPD to nurses; the intrinsic and extrinsic motivations of nurses to participate in CPD; and the specific needs of nurses to participate in CPD. The findings of this review highlight that nurses' experiences regarding their CPD is a key issue that has not been deeply studied. For nurses, their CPD continues throughout their professional career, and keeping their knowledge and skills up to date is important. The goals, motivations and needs that nurses may have to lead and participate in their CPD may vary according to their age and position. Organizations should consider nurses' specific professional situation as well as their actual needs to boost their CPD through different approaches and enhance nurses¿ retention at hospitals.

When someone is terminally ill, it is often a very stressful time for the dying person and their family. It would not be unusual for intra-family conflict, involving one or more family members and even the dying person, to occur. However, this type of conflict has not been identified as an end-of-life issue needing to be noticed and addressed or prevented when possible. This lack of attention could be because it is not known how common or how impactful this type of conflict is. A scoping research literature review was conducted for available 2004-2019 evidence on the incidence or prevalence of intra-family conflict, factors contributing to it or causing it, and the outcomes or impact of it. A search for published peer-review articles identified 18 research reports for a scoping review. The 18 studies, all conducted in developed countries, revealed intra-family conflict is often present; and with a range of harmful effects for the dying person, the family as a whole or individual family members, and other persons and organizations. The identified factors contributing to or predisposing intra-family conflict were grouped into three categories: (a) family disagreements over curative treatment and/or end-of-life care and decisions, (b) previous family conflict and other family dynamic matters, and (c) the dying process itself. The evidence identified through this scoping review, although relatively minimal, should be useful for planning future research and for [...]

The complicated situation experienced by chronic heart failure (CHF) patients affects their entire well-being but clinical practice continues to fail to adequately respond to their demands. The aim of this study was to understand the meaning of living with CHF from the patient¿s perspective. A hermeneutic phenomenological study was conducted according to Van Manen's phenomenology of practice method. Individual conversational interviews were held with 20 outpatients with CHF. Six main themes emerged from the analysis: (1) Living with CHF involves a profound change in the person; (2) The person living with CHF has to accept their situation; (3) The person with CHF needs to feel that their life is normal and demonstrate it to others; (4) The person with CHF needs to have hope; (5) Having CHF makes the person continuously aware of the possibility of dying; (6) The person with CHF feels that it negatively influences their close environment.

Background. Establishing the level of chronic cardiac inpatient empowerment is essential. By doing so, it is possible to identify groups with a lower level. It also provides a basis for designing effective strategies to improve their control over decision making and the actions that affect their health and wellness. The shortage of studies of this phenomenon for this particular population and context suggests that such patients are not receiving proper care. Methods. A prospective and descriptive study was carried out. A validated Spanish version of the Patient empowerment in long-term conditions scale was used. The survey has 47 items, grouped into three dimensions: Positive attitude and feeling of control, Knowledge in shared decision making, and Seeking information and sharing with other patients. It was distributed 24 hours before hospital discharge. Results. Twenty five questionnaires were collected (81%). The mean global empowerment score of the patients was 165.92 +/- 20.9. The dimension Positive attitude and sense of control showed the lowest score, with a mean of 3.4 +/- 0.5. An inverse weak relationship was found between the level of empowerment and age (rho =-0.240; p = 0.000) while a positive one was found with 10-year survival (rho = 0,316; p= 0.01). Conclusion. The level of empowerment of the patients in this study was medium-high. The strategies used to address the care of this population should focus on working on their attitude towards the disease and perceived control of the situation, and should be individualized according to age.

Aims To analyse the evolving social role of female nurses in the American Civil War context in terms of gender, class and race and to examine whether their caring efforts correspond to the beginnings of a new nursing professional identity. Design Historical research. Methods Thirteen American Civil War nurses' triumphal narratives written between 1865-1902 were analysed. The search and work were carried out between 2012-2020. Women's history and thematic analysis provided, respectively, the theoretical and analytical frameworks. Results The arrival of the war was the catalyst for change. The nurses' autobiographies were written in a hostile environment where class and racial tensions had to be released. This analysis points to nursing care being transformed from its traditional domestic traits to a progressive and intentional professional dimension. Conclusion American Civil War nurses' autobiographies offer an innovative vision of their lives and their nursing work. Specifically, the autobiographical accounts provide new perspectives on the evolution of the authors' social dimension in terms of class, race and gender as well as the development of a new nursing professional identity in that context. Impact Illuminating overlooked meanings hidden in nurses' autobiographies improves women's visibility and their contribution to the history of nursing

A study of the bereavement programs provided by hospices in Ireland and the Canadian province of Alberta was done to determine if and how these are evaluated for efficacy. All but one hospice offered multiple different bereavement programs, with routine in-house evaluations of all programs performed. In all cases, staff and client unsolicited and solicited comments made during and at the end of each program provided data for continuing program refinement. Most hospices also routinely employed a self-devised questionnaire to gain specific sought information to retain or change programs. Other information, including news about program developments elsewhere, was also actively sought for program adoption or for the improvement of existing programs. With most bereavement programs having been in place for many years, participants were confident their programs are needed, safe, and effective. Their continuing quest for high-quality programming, however, meant they were active in monitoring these programs and in seeking developments in this field.

This study is an analysis on the Spanish media coverage of the Covid-19 crisis and the role of information on health and healthcare professionals within it. We studied the treatment given to healthcare sources and topics in news broadcasts released by Radiotelevisión Española (RTVE) between December 31, 2019, and June 8, 2020. To this end, we conducted a quantitative content analysis on 452 news items from 21 news broadcasts. The results showed that debates on political issues were the main topics and politicians were the main sources, in the broadcasts analyzed, ahead of health issues and healthcare professionals. Our study thus confirms the lack of visibility of healthcare professionals in the television news coverage of the Covid-19 crisis in Spain.

Fundamento. Conocer el nivel de empoderamiento de las personas con insuficiencia cardiaca crónica hospitalizadas es crucial para identificar a las personas con un nivel de empoderamiento más bajo y fundamentar el diseño de estrategias efectivas para mejorar su control sobre las decisiones y acciones que afectan a su salud y bienestar. La falta de estudio de este fenómeno en esta población y contexto, sugiere que estos pacientes no están siendo atendidos adecuadamente. Material y métodos. Estudio descriptivo, prospectivo. Se utilizó el Cuestionario de empoderamiento del paciente con enfermedad crónica, traducido y validado al español, que consta de 47 ítems, agrupados en tres dimensiones: Actitud positiva y sentido del control, Toma de decisiones compartida e informada, y Búsqueda de información y compartir entre iguales. Fue distribuido para su cumplimentación en las 24 horas previas al alta hospitalaria. Resultados. Se recogieron 25 cuestionarios (81%). La puntuación global media de empoderamiento fue de 165,92 ± 20,9. La dimensión Actitud positiva y sentido de control fue la peor puntuada, con una media de 3,4 ± 0,5. Se encontró una relación inversa y débil entre el nivel de empoderamiento y la edad (rho¿=¿-0,240; p¿=¿0,000) y una relación débil y positiva con la supervivencia a los 10 años (rho¿=¿0,316; p¿=¿0,01). Conclusión. El nivel de empoderamiento de los pacientes de este estudio fue medio-alto. Las estrategias para abordar la atención de esta población deberían centrarse en trabajar su actitud respecto a la enfermedad y percepción de control de la situación e individualizarse conforme a la edad.

Background: Nominal group technique (NGT) is a well-established research method for establishing consensus. Owing to the COVID-19 pandemic, research methods need to be adapted to engage with participants online. Objective: To determine the feasibility and acceptability of adapting NGT to an online format. Setting: Palliative care clinicians (n = 31) in Greece, Romania, and Spain. Methods: NGT discussions were used to elicit palliative care clinicians' opinions, and to rank priorities regarding their understanding and needs about clinical research. Preliminary online training of country-based facilitators was followed by content analysis of debriefing reports to capture learning related to the online NGT format. Results/Implementation: Three NGT sessions used online platforms (Zoom/MS Office/Mentimeter) for the meetings. Analysis of the facilitator reports generated three themes: preparation/facilitation/timing; optimizing technology; and interactions. Conclusions: Conducting NGT meetings online is viable and may be advantageous when compared with traditional face-to-face meetings, but requires careful preparation for participants to contribute effectively.

La educación interprofesional (EIP) es clave para garantizar el aprendizaje integrado de los alumnos de diferentes titulaciones, que ejercerán una labor profesional basada en el cuidado centrado en la persona, de manera conjunta. El proyecto de EIP de la Universidad de Navarra pretende dar a los alumnos de medicina, enfermería y farmacia los conocimientos, habilidades y actitudes necesarias para trabajar de manera interprofesional, centrándonos en trabajo en equipo, conocimiento y respeto de roles, resolución de conflictos y comunicación interprofesional. Para ello, el equipo de docentes implicados en este proyecto ha tenido que trabajar colaborativamente, experimentando las claves de este trabajo interprofesional, centrado en el alumno, constituyendo una experiencia enriquecedora, constructiva, y que ha aportado las claves del trabajo en equipo necesario para llevar a cabo un proyecto docente de EIP.

Presentación del caso: Paciente de 76 años residente en un centro geriátrico, con Alzheimer en fase moderada, que manifiesta agitación y estrés ante una situación incómoda. Ante la aparición de estos cambios conductuales, tanto la enfermera a su cuidado como la familia desconocen cómo actuar. Objetivos: Identificar, con base en la literatura científica, las intervenciones de enfermería más efectivas para manejar y prevenir cambios conductuales en una persona con Alzheimer en fase moderada y valorar la integración familiar en dichas estrategias de cuidado. Revisión bibliográfica: Se realizó una búsqueda bibliográfica en las bases de datos CINAHL y PubMed, seleccionándose 7 artículos. Resultados: Se han identificado cuatro tipos de intervenciones de enfermería para el manejo y prevención de cambios conductuales: sensitivas, ambientales, físicas y psicoemocionales. Existen escasas intervenciones desarrolladas en centros geriátricos que integren a la familia en el cuidado de los pacientes. Conclusión: La ejecución de las intervenciones de enfermería seleccionadas podrá favorecer una mejoría tanto en el manejo como en la prevención de los cambios conductuales. La realización de dichas actividades por parte de la unidad familiar incrementa los efectos positivos en la familia, la residente y en el equipo de enfermería. Sin embargo, se precisa un número mayor de estudios que integren a la familia para poder generalizar los resultados.

El empoderamiento del paciente con insuficiencia cardiaca crónica es clave para mejorar su calidad de vida, autonomía, autoestima, nivel de satisfacción y los costes sanitarios. Sin embargo, las estrategias diseñadas para educar y cambiar su comportamiento no siempre tienen en cuenta a los pacientes como parte activa de su proceso. El objetivo de esta revisión sistemática fue identificar cuáles son las intervenciones de enfermería más efectivas para favorecer el empoderamiento del paciente con insuficiencia cardiaca crónica en el medio hospitalario. Para ello, se realizó una búsqueda en las principales bases de datos: CINAHL, Scopus, PhyINFO, PubMed y en revistas especializadas, seleccionándose ocho artículos para revisión, de los que cuatro fueron experimentales, dos cuasi-experimentales y dos revisiones sistemáticas. Del análisis de estos estudios se identificaron 3 tipos de intervenciones para empoderar a este tipo de paciente en este contexto: educativas, cognitivo-comportamentales y combinadas, siendo estas últimas las más efectivas. Los resultados de esta revisión también revelaron la caracterización de estas intervenciones, enfatizando su carácter holístico e individualizado. Por último, se aboga por el uso del Empowerment Questionnaire como un instrumento válido y fiable para medir el empoderamiento del paciente crónico hospitalizado. Esta revisión pone de manifiesto la escasez de estudios sobre esta temática, por lo que se recomiendan futuras investigaciones

Aim: To describe and explain nurses' protocol-based care decision-making. Background: Protocol-based care is a strategy to reduce variability in clinical practice. There are no studies looking at protocol-based care decision-making. Understand this process is key to successful implementation. Method: A multiple embedded case study was carried out. Nurses' protocol-based care decision-making was studied in three inpatient wards (medical, surgical and medical-surgical) of a university hospital in northern Spain. Data collection was performed between 2015 and 2016 including documentary analysis, non-participant observations, participant observations and interviews. Analysis of quantitative data involved descriptive statistics and qualitative data was submitted to Burnard's method of content analysis (1996). The data integration comprised the integration of the data set of each case separately and the integration of the findings resulting from the comparison of the cases. The following the thread method of data integration was used for this purpose. The SRQR guideline was used for reporting. Results: The multiple embedded case study revealed protocol-based care decision-making as a linear and variable process that depends on the context and consists of multiple interrelated elements, among which the risk perception is foremost. Conclusion: This study has allowed progress in protocol-based care decision-making characterisation. This knowledge is crucial to support the design of educational and management strategies aimed at implementing protocol-based care. Relevance to clinical practice: Strategies to promote protocol-based care should address the contexts of practice and the ability of professionals' to accurately assess the degree of risk of clinical activity. Hence, it will promote quality of care, patient safety and efficiency in healthcare cost.

Aim To explore the perception of normality in life experienced by patients with chronic heart failure. Design A hermeneutic phenomenological study was conducted. Methods Individual conversational interviews were held with 20 outpatients with chronic heart failure between March 2014-July 2015. Van Manen's phenomenology of practice method was used for data analysis. Results From the analysis, four main themes emerged: (a) Accepting my new situation; (b) Experiencing satisfaction with life; (c) Continuing with my family, social and work roles; and (d) Hiding my illness from others. Conclusions The present study makes a novel contribution to understanding the importance of the perception of normality in the lives of patients with chronic heart failure. It was found that patients need to incorporate this health experience into their lives and reach a 'new normal', thus achieving well-being. Several factors were identified that can help promote this perception in their lives; therefore, nursing interventions should be designed to help develop scenarios encouraging this normalization process. Impact Although the implications of having a sense of normality or experiencing 'normalization' of the illness process in life have been studied in other chronic patient populations, no studies to date have examined how patients with chronic heart failure experience this phenomenon in their lives. For the first time, the results of this research prove that the perception of normality is a key aspect in the experience of living with chronic heart failure.

Objetivo: Describir el uso que hacen los profesionales de enfermería de las TIC. Metodología: Estudio descriptivo transversal, mediante encuesta auto-administrada, diseñada en base a la literatura, que mide el uso que los profesionales realizan de las TIC. Este instrumento consta de 14 preguntas cerradas y dos abiertas. Resultados: La tasa de respuesta fue del 25,7% (264/1.026). El 86% utilizaba el teléfono móvil para conectarse a internet. Las herramientas digitales menos utilizadas fueron las bases de datos electrónicas (41%) y la biblioteca virtual (27%). La edad fue un factor condicionante del nivel de conocimientos y uso de las TIC (rho=-0,413; p=0,000). Conclusiones: Este estudio ha proporcionado evidencia sobre el uso poco extendido de las TIC entre los profesionales de enfermería y su disminución conforme aumenta la edad, motivada por la falta de conocimientos y capacitación. Este conocimiento permitirá diseñar estrategias educacionales y de gestión de implantación de las TIC adecuadas.

Objetivo principal: Conocer la evidencia existente acerca del fenómeno del conocimiento del paciente desde la perspectiva de las enfermeras. Metodología: Se ha realizado una revisión sistemática de la bibliografía, en la que se encontraron nueve estudios. Resultados principales: Tras realizar un análisis temático de los artículos seleccionados, se identificaron cuatro temas, que pueden ayudar a explicar cómo es la experiencia de las enfermeras acerca del conocimiento del paciente. Conclusión principal: Además de confirmar la relevancia y el impacto del concepto en el proceso del cuidado y en los resultados de salud del paciente, la revisión de la literatura ha permitido profundizar sobre qué conocen y cómo conocen las enfermeras, así como identificar los factores facilitadores e inhibidores de ese conocimiento los cuales están relacionados en su mayoría con el profesional de enfermería y el entorno de la práctica. Palabras clave: Conocimiento del paciente. Relación enfermera-paciente. Experiencia. Enfermería. Revisión bibliográfica.

Background: Clinical narratives may be used as a means to improve the acquisition of clinical competences. Even though there are studies that recognize the potential value of clinical narratives to promote nursing professional development, there is no evidence that shows their value as a tool to improve nurses' competences to provide person-centred nursing care. Purpose: To evaluate the preliminary efficacy of narratives for the development of three nursing professional competences -respect, intentional presence and knowing the person- for providing person-centred care. Method: Using a pre-post quasi-experimental design, a pilot study with a total of 34 nurses enrolled in a training course of nursing specialization was conducted between September 2016 and June 2017. All the nurses received a multi-component intervention based on the Critical Reflective Inquiry model. The strategies of this programme consisted of writing three narratives, attending two masterclasses, participating in a discussion group, and participating in a face-to-face interview. The NarratUN Evaluation tool was used to assess the outcomes. Changes among nurses were analysed using the Wilcoxon signed Rank test. Results: The difference in the means between the pre- and post-intervention scores were statistically significant for respect [0.59 (95% CI 0.23-0.95; p = 0.001)], intentional presence [0.75 (95% CI 0.32-1.17; p < 0.0001)] and knowing the person [0.62 (95% CI 0.25-0.99; p = 0.001)]. The difference in the mean score for use of the narrative and reflection also increased significantly [0.65 (95% CI 0.32-0.98, p < 0.001)]. Conclusions: The use of narratives combined with other reflective strategies (masterclass sessions and discussion groups) proved to be effective for the development of professional competences of nurses.

Population ageing is escalating rapidly now worldwide. This is an important time to determine if ageism or discrimination against older people is of concern, such as it being prevalent and/or increasing in prevalence. Over the years, many ageism measurement tools have been developed, with research findings from their use of prime consideration then for determining the prevalence of ageism and any prevalence trends. All print and open access English-language research articles published in 1953+ that used one or more ageism measurement tools in a study were sought using the Directory of Open Access Journals and EBSCO Discovery Service. A total of 25 ageism measurement tools were identified. However, only six had been used one or more times to measure the prevalence of ageism. The identified prevalence levels varied considerably, but most investigations using small convenience samples, with limited generalizability of findings. This paper highlights the need to continue developing ageism measurement tools to estimate ageism or use other measures, such as census and population representative polling, to assess the extent and impact of ageism. This foundational measurement is needed, as ageism could be prevalent and growing in effect.