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. To determine attitudes towards smoking, perception of self-efficacy, and the intention of smoking cessation in college student smokers, and their variation according to the stage of the tobacco cessation process. Methods. Cross-sectional study with 255 college students (18-24 years old) smokers of >= 1 cigarette per week. Instruments used: a personal interview, Fagestrom test, transtheoretical change model, scale of Attitudes, self-efficacy and intention to quit smoking in college smokers and CO in exhaled air. Results. Sample with a majority of women (62%), average age 20.3 years, users of 9.2 cigarettes/day for 5.7 years, with mild dependence on nicotine; 69% were in the stages of pre-contemplation and contemplation. Although smoking was considered to be negative for health and the environment for more than 70%, and 96.7% had negative attitudes towards tobacco, only 45.1% were aware of the associated morbidity and mortality. More than 60% considered tobacco to be a social facilitator, thus anxiety (72.6%) and having friends who smoke (69.4%) are factors considered negative for tobacco cessation. Ninety-one percent believed that they would smoke next year, but 86% stated that they would not be a smoker within five years. One hundred percent of the subjects in pre-contemplation considered that they will smoke during the next year as opposed to 83.5% of those in the stage of preparation. Conclusion. College student smokers show positive attitudes, erroneous beliefs and a low perception of self-efficacy about smoking cessation. All students in the pre-contemplation phase do not even consider smoking cessation in the medium and long term.

Objectives: The concept of health education has traditionally focused on enabling people to change unhealthy behaviours and lifestyles. Although, at the theoretical level, there exist definitions of the concept, it remains complex and ambiguous. Furthermore, nurses often confuse the concept with other related terms, such as health information or health promotion. The aim here is to report a concept analysis of health education and elucidate a current definition. Design: Rodgers' evolutionary concept analysis. Data sources: A systematic search was conducted using PubMed and CINAHL for articles written in English or Spanish, published between 1986 and 2017. A manual search was performed, and grey literature was also reviewed. A pre-determined template of study inclusion-related questions assisted the process. Review methods: Rodgers' evolutionary method guided the narrative analysis. The attributes of health education, as well as its antecedents, consequences, related terms and contextual bases were extracted and synthesized. Results: Based on the review of 31 studies on health education, the attributes are a learning process, health-oriented, multidimensional, person-centred and partnership. The antecedents are professional awareness of health education, training of health professionals, available resources, individual's willingness to act, and health as an individual's priority in life. The consequences are the increase in knowledge, skills and/or attitudes; ...

An effective strategy to quit smoking should consider demographic aspects, smoking-related characteristics and psychological factors. This study examined potential predictors of smoking cessation in Spanish college students. A total of 255 college student smokers (18¿24 years old), recruited to a cessation trial (Spain, 2013¿2014), comprised an observational cohort. The main outcome was biochemically verified (urine cotinine) abstinence at the 6-month follow-up. Baseline potential predictors included socio-demographic, smoking-related and psychological variables (Fagerström Test for Nicotine Dependence (FTND), expired monoxide level (CO), intention to quit, previous quit attempts, participation in previous multicomponent programmes and confidence in quitting). Logistic regression models were used to identify potential predictors, the area under the ROC curve (AUC) was used to discriminate the capacity of the predictors and the Hosmer¿Lemeshow goodness-of-fit test was used to assess model calibration. After 6 months of follow-up, variables related to high nicotine dependence, FTND and expired CO levels were associated with lower odds of quitting smoking (OR¿=¿0.69 [95% CI 0.54¿0.89] and 0.84 [0.77¿0.92], respectively). Furthermore, being prepared to change (OR¿=¿3.98 [1.49¿10.64], p¿=¿0.006) and being confident to quit (OR¿=¿4.73 [2.12¿10.55], p¿<¿0.001) were also potential predictors of smoking cessation. The model that combined all these variables had the best predictive validity (AUC¿=¿0.84 [0.78¿0.91], p¿=¿0.693) and showed good predictive capacity (¿2¿=¿10.36, p¿=¿0.241). Findings highlight that, in this population of college student smokers, having a lower level of nicotine dependence, being prepared to quit and having the confidence in the ability to quit were associated with smoking cessation, and these factors had good predictive capacity.

Background: Although beliefs, self-efficacy and intention to quit have been identified as proximal predictors of initiation or quitting in young adults, few studies have studied how these variables change after a smoking cessation intervention. Purpose: To evaluate the changes in the beliefs, self-efficacy and intention to avoid smoking, and determine if these are potential mediators in quitting, following a smoking cessation intervention, aimed at tobacco-dependent college students. Design: Single-blind, pragmatic randomized controlled trial with a 6-month follow-up. Method: A total of 255 smoker students were recruited from September 2013 to February 2014. Participants were randomly assigned to intervention group (n=133) or to control group (n=122). The students in the intervention group received a multi-component intervention based on the Theory of Triadic Influence. The strategies of this program consisted of a 50-minute motivational interview conducted by a nurse and online self-help material. The follow-up included a reinforcing e-mail and group therapy. The smoking-related Self-efficacy, Belief and Intention scale was used to assess outcomes. Results: Intention to quit smoking is partial moderator explaining 36.2% of the total effects in smoking cessation incidence. At 6-month follow-up, the differences in the mean scores of self-efficacy and intention related to stopping smoking were significantly higher in the intervention than in the control group. Conclusions: A multicomponent intervention based on the Theory of Triadic Influence, tailored to college students positively increased the self-efficacy to avoid smoking, and the intention to quit, suggesting intention as potential mediator of quitting.

El consumo de tabaco representa la primera causa prevenible de enfermedad, discapacidad y muerte en el mundo, considerándose una pandemia evitable. Los profesionales sanitarios tienen un papel esencial en ayudar a los fumadores a dejar este hábito. Es por ello que estos, durante su formación universitaria, deberían recibir los conocimientos, habilidades y aptitudes necesarias para llevar a cabo intervenciones de cesación tabáquica. Con este objetivo investigadores y profesores del Institut Català d'Oncologia (ICO), la Universidad de Navarra, el King's College de Londres, la Escola Superior de Enfermagem de Coimbra, la Université Libre de Bruxelles, la Universitat de Barcelona, el Erasmushogeschool Brussel y la Universitat de Lleida han desarrollado el curso INSTrUCT. Este recurso educativo innovador de aprendizaje online está disponible en abierto en cuatro idiomas: español, inglés, francés y portugués. La finalidad de este manual es guiar a los profesores universitarios en la implementación y evaluación de este curso, así como profundizar en el rol del profesor y del estudiante en el mismo. Por último, es importante señalar que el desarrollo de este curso ha sido posible gracias a la financiación del programa ERASMUS+.

Tobacco consumption represents the first cause of preventable illness, disability, and death in the world, being considered an avoidable "pandemic". According to the World Health Organization (2020; [WHO]), tobacco consumption, at a global level, is responsible for over eight million deaths per year. All in all, the INSTrUCT course has the general goal to enable healthcare profession students in the assessment of the tobacco consumption status and in the main interventions to quit smoking. This manual intends to guide the professor through the implementation and assessment of the INSTrUCT course and to discuss which is the role of the professor and the student during its development.