Aim: To translate and culturally adapt the FRAIL scale into Spanish and perform a preliminary test of diagnostic accuracy in patients admitted to intensive care units.Design: Cross-sectional diagnostic study.Methods: Five intensive care units (ICU) in Spain were participated. Stage 1: Three native Spanish-speaking bilingual translators familiar with the field of critical care translated the scale from English into Spanish. Stage 2: Three native English-speaking bilingual translators familiar with critical care medicine. Stage 3: Authors of the original scale compared the English original and back-translated versions of the scale. Stage 4: Five nurses with more than 5 years of ICU experience and five critical care physicians assessed the comprehension and relevance of each of the items of the Spanish version in 30 patients of 3 different age ranges (<50, 50-65 and >65 years).Results: The FRAIL scale was translated and adapted cross-culturally for patients admitted to intensive care units in Spain. The process consisted of four stages: translation, back translation, comparison and pilot test. There was good correspondence between the original scale and the Spanish version in 100% of the items. The participating patients assessed the relevance (content validity) and comprehensibility (face validity) of each of the items of the first Spanish version. The relevance of some of the items scored low when the scale was used in patients younger than 65 years.ConclusionsWe have cross-culturally adapted the FRAIL scale, originally in English, to Spanish for its use in the critical care medical setting in Spanish-speaking countries.Implications for ProfessionalsP: hysicians and nurses can apply the new scale to all patients admitted to the intensive care units. Nursing care can be adapted according to frailty, trying to reduce the side effects of admission to these units for the most fragile patients.Reporting Method: The manuscript's authors have adhered to the EQUATOR guidelines, using the COSMIN reporting guideline for studies on the measurement properties of patient-reported outcome measures.Patient or Public Contribution: In a pilot clinical study, we applied the first version of the FRAIL-Spain scale to intensive care unit (ICU) patients. Five nurses with more than 5 years of ICU experience and five critical care physicians assessed the relevance (content validity) and comprehensibility (face validity) of the five items of the first Spanish version. Relevance was assessed using a 4-point Likert scale ranging from 1 (no relevance) to 4 (high relevance), and comprehensibility was assessed as poor, acceptable or good. Each health professional applied the scale to three patients (total number of patients = 30) of three different age ranges (<50, 50-65 and >65 years) and recorded the time of application of the scale to each patient. Although the frailty scales were initially created by geriatricians to be applied to the elders, there is little experience with their application in critically ill patients of any age. Therefore, more information is needed to determine the relevance of using this scale in critical care patients. In this pilot study, we considered that nurses and critical care physicians should evaluate frailty using this adapted scale in adult patients admitted to the Intensive Care Units.

Background: Nurses' perceptions of preceptorships for undergraduate nursing students are crucial for designing effective and tailor-made strategies to improve nurses' involvement, motivation, commitment, and satisfaction in preceptorships. Objectives: The aim of this study was to determine nurses' perceptions of preceptorships for nursing students in two hospitals located in northern Spain.Settings: This study was conducted in two highly specialized, medium-large, university tertiary care hospitals, including one public and one private hospital, located in northern Spain. Participants: The participants of this study were clinical nurses in private and public health centers who had been preceptors for at least one year. Methods: A descriptive cross-sectional study was carried out between October 2021 and April 2022, with a total sample of 307. The validated Involvement, Motivation, Satisfaction, Obstacles and Commitment (IMSOC) questionnaire was used. Descriptive statistics and bivariate analysis were carried out. The variables included sex, age, educational level, preceptorship training, professional experience, work sector, work setting, and type of contract.Results: The mean global questionnaire score was 115.25 +/- 33.86 (95 % CI: 111.62-123), with the highest score obtained for the Involvement dimension (29.96; SD: 9.23; 95 % CI: 29.01-34.87). Age showed statistically significant negative correlations with the overall and dimension scores (p < 0.05). Comparisons by work sector and type of contract reflected that nurses working in the private sector and those with permanent contracts had higher motivation and commitment scores.Conclusions: Preceptors had positive perceptions of their role in undergraduate nursing students' education. Age, work sector, type of contract and time allocation should be considered when designing strategies to enhance the involvement, motivation, commitment, and satisfaction of nurses in their experiences as preceptors for under-graduate nursing students. Improving the preceptorship experience will benefit both nurses and students by improving preparation, satisfaction, and retention.

BackgroundDifficulty in adherence to treatment and self-care behaviours is a leading cause of preventable readmission in people with chronic heart failure (CHF). Although there is evidence of benefits of health coaching for the management of this situation, few interventions have been tested in the hospital setting.AimTo evaluate a coaching programme (H-Coaching) designed to develop nursing capacity in health coaching for chronic heart failure inpatients.MethodsA quasi-experimental pre-post study including all nurses in a single centre cardiology ward (N = 19). The intervention consisted of two training packages: (1) five theoretical-practical sessions on health-coaching competencies, emotional intelligence, communication and support of chronic heart failure patients in their illness in the hospital setting; and (2) training sessions seven months after the first training package to reinforce the theoretical and practical knowledge. On four occasions, the Competence Instrument of Health Education for the Nursing professional was used to measure nurses' knowledge, skills and attitudes in health coaching for chronic heart failure patients.ResultsThe difference between the preintervention and postintervention scores were statistically significant for knowledge [mean difference = 1.00 (95% CI -1.45 to -0.51; p = 0.000)], skills in general [mean difference = 0.50 (95% CI -1.41 to -0.21; p = 0.015)] and personal/social skills [mean difference = 1.00 (95% CI -1.10 to -0.01; p = 0.048)]. While attitudinal and affective domains did not differ, there were differences in knowledge and skills.ConclusionThe H-Coaching programme proved to be effective for building nursing capacity in health coaching CHF inpatients. Similar programmes designed to improve knowledge in verbal and nonverbal communication techniques, and skills for coaching interventions adapted to meet the needs of individual patients, should be tested in future interventional experimental studies.Clinical Trial Registration NumberNCT05300880Impact statementTo our knowledge, this is the first nursing training intervention in health coaching for chronic heart failure the inpatient setting. This study has demonstrate improvements in both the knowledge and personal and social skills of cardiology nurses with regard to the development of health coaching in a hospital setting. Given the study design, further research is warranted.Plain Language SummaryMany patients with chronic heart failure have problems in adhering to the treatment and self-care behaviours and this is one of the main causes of preventable readmission. To promote self-care, patients need to be empowered to integrate these habits into their daily lives and we should implement innovative strategies to achieve this. Health coaching is an ideal alternative to this but very few nurses in the hospital cardiology setting are experienced in health coaching. Our study has shown preliminary results demonstrating that a structured theoretical and practical training programme for nurses can improve nurses' knowledge and skills in health coaching for inpatient patients with chronic heart failure. This study provides an opportunity for future research to demonstrate whether nurses with this training have a positive impact on the health outcomes of chronic heart failure patients and, more specifically, on their levels of self-care and empowerment.

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.

Background. Person-centred practices - following national and international developments in health-care policies - have become a key approach in healthcare. The Person-Centred Practice Inventory - Staff is an instrument based on the theo-retical framework Person-Centred Practice that focuses on the staff's perspective and how they experience person -cen-tred practices. Here, the aim of this study is to obtain the first Spanish version of the PCPI-S translated and adapted into the Spanish context. Methods. The translation and adaptation of the instrument followed the Translation and Cultural Adaptation of Patient Reported Outcomes Measures - Principles of Good Practice, which included a consulting session with experts. Content va-lidation measures on clarity and relevance were assessed for every item (I-CVI) and the survey as a whole (S-CVI/Ave). Results. No major difficulties were registered to reach an agree-ment on the 12 items that needed to be clarified. Regarding cla-rity and relevance. The validity index per item (I-CVI) obtained excellent scores for clarity in 53 items and for relevance in 59; the S-CVI/Ave showed excellent results (>= 90). Conclusions. This first version of the Person-Centred Practice Inventory - Staff instrument adapted to the Spanish context is conceptually and semantically equivalent to the original one. This valuable tool will be of great help to identify the perception of healthcare professionals on person-centred practices.

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.

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.