Aims and Objective To explore differences in nurses' attitudes regarding the importance of family in nursing care and factors associated with nurses' attitudes across 11 European countries. Background Family involvement in healthcare has received attention in many European healthcare systems. Nurses have a unique opportunity to promote family involvement in healthcare; however, their attitudes and beliefs may facilitate or impede this practice. Design A cross-sectional survey across European countries. Method A broad convenience sample of 8112 nurses across 11 European countries was recruited from October 2017 to December 2019. Data were collected using the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire. We used the STROBE checklist to report the results. Results There were significant differences in nurses' attitudes about families' importance in nursing care across Europe. Country was the factor with the strongest association with the total scores of the FINC-NA. Older age, higher level of education, increased years since graduation, having a strategy for the care of families in the workplace, and having experience of illness within one's own family were associated with a higher total FINC-NA score. Being male and working in a hospital or other clinical settings were associated with a lower total FINC-NA score. Conclusion Nurses' attitudes regarding the importance of family in nursing care vary across 11 European countries. This study highlights multiple factors associated with nurses' attitudes. Further research is necessary to gain a deeper understanding of the reasons for nurses' different attitudes and to develop a strong theoretical framework across Europe to support family involvement in patient care. The inclusion of family healthcare programs in the baccalaureate curriculum may improve nurses' attitudes. Relevance for clinical practice In clinical practice, the focus should be on identifying influencing factors on nurses' attitudes to enhance families' importance in nursing care across Europe.

Nurses' attitudes toward families play an important role in improving relationships with patients' families. It is essential to have valid and reliable instruments to assess nurses' attitudes toward involving families. The aim of this study was to analyze the psychometric properties of the refined Spanish version of the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) according to classical test theory and the Rasch model (N = 263). Cronbach's alpha values were .73 to .87 and intraclass correlation coefficients ranged from .72 to .86. Rasch analysis results suggested that it was a multidimensional scale with four dimensions and a simpler response scheme than the original scale. Except for one item, the scale was free from bias regarding age and experience time. The FINC-NA is a reliable and valid measure showing a good fit to the Rasch model and is ready to map nurses' attitudes and measure the effectiveness of family nursing educational interventions.

Background: Motivational interviewing led by nurses has been demonstrated to be effective in reducing alcohol consumption among university students. However, most of these professionals feel that they lack the competence necessary for motivational interviewing due to a lack of formal training in the nursing curriculum. Objectives: To design, implement and evaluate a motivational interviewing training course for alcohol misuse in an undergraduate nursing curriculum and to explore students' experiences with this course. Design: A mixed-methods study involving a descriptive comparative quantitative design and qualitative focus group interviews with nursing students. Settings: An elective nursing course in a Spanish university. Participants: A total of 21 fourth-year nursing students. Methods: The course was developed as a twelve-week, two-hour course. It comprised three modules covering the concepts, tools and skills associated with motivational interviewing for alcohol misuse. Quantitative and qualitative data were collected after the completion of the course to evaluate the training received by students; these data were categorized using Kirkpatrick's model. The quantitative results included students' satisfaction, knowledge, skills and attitudes, which were measured using an ad hoc questionnaire, a multiple-choice exam, and two rater-based assessments (the Peer Proficiency Assessment instrument and an evidence-based checklist). Qualitative focus groups were used to explore students' experiences of the entire programme. Results: Students' satisfaction with the course was rated 9 out of 10, highlighting the usefulness and adequacy of the course content. The quantitative and qualitative results both indicated that all students acquired the knowledge necessary to perform motivational interviewing and significantly improved their motivational interviewing microskills. Only half of the students reached the level of proficiency in two of the three ratios calculated. The three main themes identified pertained to the learning atmosphere, module methodologies, and students' self-perceptions of competence. Finally, the students reported having transferred their learning to clinical practice. Conclusion: A course on motivational interviewing for alcohol misuse positively influences nursing students both personally and in terms of their future professional work by improving their knowledge, skills, attitudes and self-perceived competence.

AIM: To explore nurses' knowledge, skills and personal attributes for competent health education practice and their association with potential influencing factors. BACKGROUND: Clinical nurses are expected to perform effective health education interventions, but they do not feel competent. The self-assessment of the health education competence and its conditional factors is paramount for professional development. DESIGN: A cross-sectional study. METHODS: A total of 458 clinical nurses from two health specialized centers in Spain participated in this study. Data were collected using the Nurse Health Education Competence Instrument and a second self-report questionnaire from January to February 2019. Descriptive statistics, t-test, analysis of variance, Pearson's and Spearman's correlation and multiple linear regression were used to analyse the data. The STROBE guideline was used RESULTS: The mean scores of the knowledge (70.10±15.11), skills (92.14±15.18) and personal attributes scales (32.32±5.89) were found to be low to moderate. The main influencing factors for the health education implementation were lack of education and training (71.4%), lack of time (67.5%) and high workload (67.3%). Nurses with higher educational level and perceived self-efficacy for competently providing health education, more extensive professional experience and previous training in health education rated higher in knowledge, skills and personal attributes. Age and years of experience were negatively correlated with knowledge scores, but positively with the rest of domains of the competence and self-efficacy. The regression models for the overall health education competence's domains were significant (p<0.001) with R2 values ranging from 28.0% to 49.3%. Self-efficacy, previous health education training and working in intensive care units were found to be significant in all cognitive, psychomotor and attitudinal scales. CONCLUSION: Clinical nurses reported on some skills and personal attributes for health education practice, but they seem to lack health education knowledge necessary for a competent practice. This study suggested that effective education and training and supportive organizational cultures are key to enhance nurses' health education competence. Identifying nurses' educational needs on the main domains of the competence and its intrinsic/extrinsic influential factors may assist in both planning and organizing tailored training strategies and in promoting appropriate environments to support a high-quality health education practice TWEETABLE ABSTRACT: Nurses' knowledge, skills and attitudes about health education competence are low to moderate. Training and organizational support are key.

The aim of this study was to explore nurses' attitudes and beliefs about the importance of families in nursing care, as well as the barriers and facilitators within the clinical context that influence the implementation offamily nursing in an in-patient oncology service. A cross-sectional study design, incorporating quantitative and qualitative measurements, was used with a sample of nurses in Spain from an oncology service (N = 39). In general, oncology nurses reported positive attitudes and beliefs about the importance of family in nursing care. However, they did not effectively involve the family in their daily clinical practice. This was due to the nurses' lack of clinical skills and competence to work with families as well as contextual factors such as the lack of time and workload that acted as barriers to the implementation of family-oriented care. This study identified areas of improvement that are needed to promote the effective and sustainable implementation of family nursing knowledge in clinical practice settings.

Using constructivist grounded theory, this study explored how family groups respond to Alzheimer's disease in its early stages. Seven family units (N = 22) participated in a series of 26 longitudinal interviews and 14 other family caregivers took part in three focus groups at a later stage for refinement and verification of the findings. Data analysis revealed four types of family dynamics: close dynamics at the start that were maintained throughout the experience, close dynamics at the start which became conflicting, conflicting dynamics at the start which remained problematic, and conflicting dynamic at the start which became closer over time. Factors such as prior relationships and family history, motivation to care, family organization, communication, and the family vision for future shaped the development of these dynamics. This theory of family dynamics in Alzheimer's disease has the potential to inform the development of more adequate early interventions for families living with the illness.

Aim To develop and psychometrically test the Nurse Health Education Competence Instrument for assessing nurses' knowledge, skills and personal attributes concerning competent health education practice. Design A psychometric instrument development and validation study. Methods A four-step approach was used: Step 1) operational definition based on an up-to-date concept analysis and experts' judgement; step 2) item generation and content validation by expert panel and target population; step 3) item analysis based on acceptability, internal consistency and face validity; and step 4) psychometric evaluation based on construct validity, criterion validity, internal consistency and stability, conducted from January -February 2019 with 458 hospital-care nurses. Results The operational framework and expert groups showed good content validity, resulting in the first version. From the initial 88-item pool, 58 items were retained after item analysis. Exploratory factor analysis revealed three scales concerning the cognitive (three-factor solution with 23 items), psychomotor (two-factor solution with 26 items) and affective-attitudinal (one-factor solution with nine items) competency domains, which respectively accounted for 58%, 53% and 54% of the variance. Known-group study demonstrated significant differences by years working in the service and training received in health education, providing evidence for the measure's sensitivity. The three scales correlated positively ...

Aim To translate and psychometrically validate the Demand-Control-Support Questionnaire for nurses in Spain. Background Nurses are one of the groups most affected by work-related stress. The combination of high job demands and low control is identified as the main source of stress among nurses. The Demand-Control-Support Questionnaire is a valid and reliable tool for assessing psychosocial stress in the workplace. Methods A two-phase cross-sectional descriptive study. The instrument was translated according to Sousa and Rojjanasrirat guidelines, including forward and backward translations, consensus meetings, pilot testing and expert committee. Structural validity, convergent and discriminative validity, internal consistency and test-retest reliability were assessed in a sample of 247 nurses. Results Exploratory factor analysis verified a three-factor solution with good internal consistency (Cronbach's alpha values ranged from 0.62 to 0.87) and test-retest reliability (intraclass correlation coefficients ranged from 0.65 to 0.85). Conclusions The Spanish version of the Demand-Control-Support Questionnaire seems to be a brief, valid and reliable instrument to measure psychosocial stress in the workplace in nurses. Implications for nursing management The use of the Demand-Control-Support Questionnaire can be of value to inform the design and implementation of appropriate management strategies to foster a more favourable work environment that promotes the well-being of professionals.

The beliefs of nursing professionals who care for families experiencing illness are fundamental to the quality of the nurse-family relationship and the level of the nurse's involvement in the therapeutic process of Family Systems Nursing. It is essential to have valid and reliable instruments for assessing nurses' illness beliefs, especially in the Spanish context where no instruments have been identified to date. The Iceland Health Care Practitioner Illness Beliefs Questionnaire (ICE-HCP-IBQ) is a reliable and valid measure of professionals' beliefs about their understanding of the meaning of the illness experience of families. The purpose of this study was to adapt and psychometrically test the Spanish version of the ICE-HCP-IBQ (N= 249 nurses). The exploratory factor analysis showed one-factor solution with good internal consistency (Cronbach's alpha = .91) and test-retest reliability (r= .72,p< .01). This questionnaire is a promising tool for mapping nurse's illness beliefs and monitoring the effectiveness of family nursing educational interventions in the Spanish context.

Background. Nursing professionals are one of the groups most affected by work-related stress, which may affect the professional's quality of life and the quality of nursing care. At the international level, the Demand-Control-Support Questionnaire (DCSQ) has proved to be a brief, valid and reliable tool for assessing psychosocial stress at work. The objective of this study was to obtain a Spanish version of the DCSQ for nursing professionals. Methods. The linguistic validation proceeded in two phases: 1) forward-translation, back-translation and linguistic adaptation of the instrument and 2) content validation of the instrument using a panel of seven experts, and evaluation of the applicability and comprehension of the adapted version in a sample of twenty-one nursing professionals. Results. Phase 1) In the translation process, one item required semantic changes, while five items required syntactic changes. The back-translation versions were similar, and the most relevant doubts were found in item 5, identified as a problematic item throughout the entire process. Phase 2) The content validity analysis showed excellent values (content validity index >= 0.90 and Kappa index values >= 0.65); moreover, the pilot study confirmed the adequate comprehensibility and applicability of the questionnaire. Conclusions. The use of a systematic and rigorous methodology made it possible to obtain a Spanish version of the DCSQ that is conceptually and linguistically equivalent to the original instrument and suitable for assessing psychosocial stress of nursing professionals in the workplace in a multidimensional manner.

Introduction. The new university demands require redefining the management model of nursing research in order to consolidate its quality and socio-health impact. Aim. To present the strategies used in the implementation of a management model for the development of nursing research at the University of Navarra (UN). Methodology. The four phases of Marchette (the simulation, the individualistic, the unified and the balanced phases) are the framework to present the management model implemented by the UN to foster research in Nursing. Results. The following strategies are described: organizing conferences and meetings on research; research investment in teacher training; approval of the research areas as organizational structures for the development of nursing knowledge; creation of the Chair Maria Egea for research; implementation of the Research Strategic Plan 2013-2018; approval of the Doctoral Program in Nursing Science. Conclusions. There is a need to adopt and adapt new management structures that encourage disciplinary knowledge, the development of competitive research teams, interdisciplinary research, teamwork, and training of new researchers. Also, these structures must respond to new health and social demands, and promote clinical nursing practice of excellence.