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.

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.

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.

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.

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.

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.

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.

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.

En este capítulo se presenta cómo se ha desarrollado el rol avanzado durante la formación de postgrado mediante el modelo PEPPA y cuál ha sido su implicación en el área de hospitalización de Cardiología.