Investigación y Educación en Enfermería

Challenges in Feeding Children with Autism Spectrum Disorder: the Role of Nurses in Research and Interventions

Márcio Flávio Moura de Araújo — 2024-11-15

Practical Guide to Achieve Rigor and Data Integration in Mixed Methods Research

Elisiane Lorenzini — 2024-11-21

Mixed methods research represents a dynamic approach, that combines quantitative and qualitative perspectives in the same study to answer complex questions, beyond the reach of each method used separately. This type of research is increasingly used in health sciences and in social sciences, where it is possible to identify important contributions to knowledge and the practice, derived from the characteristic integration of this approach. Nevertheless, it important to reiterate the importance of recognizing their own perspectives, methods, rigor criteria, and challenges. This work presents general aspects of the epistemological perspective of mixed methods research, describes basic and advanced designs, forms and possible integration moments of each design, as well as the rigor criteria that guide these types of studies. Graphic elements are presented to facilitate recognizing the structure of each design. Furthermore, a visual tool is introduced denominated “anatomy of mixed methods research”, which seeks to guide researchers regarding each of the key elements in the design and development of this type of research.

Influencing Factors on the Success of Mobile Learning: A Systematic Review and Meta-Analysis

Abdollah Mehrfar — 2024-11-15

Objective. To study the geographical regions, success factors, and types of mobile device features that could result in educational success and early take-up.

Methods. This systematic review and meta-analysis searched PubMed, CINAHL, EMBASE, PsycINFO and ProQuest databases between 2010 and November 2022. The keywords were m-learning features, practical experiences, and influencing. Comprehensive Meta-Analysis software was used to analyze and combine data.

Results. 48 articles were reviewed in this study. Compatibility and user-friendliness of mobile phones were mentioned as key factors influencing the use of mobile devices in learning. Also, the key role of users’ perspectives, attitudes, and skills as determinant factors of applying mobile technology in the learning process was revealed, which confirms its significant role in the success of m-Learning. Other influencing factors were tools readiness, the availability of appropriate resources, motivation of learners and their active engagement, support, and learning styles which considerably could play a key role in improving the quality of m-learning. Applying different strategies including collaboration, effective interaction, reflection, or inquiry-based learning can be beneficial in improving the success rate of m-learning. The final factor was technical competence which showed a significantly negative correlation with m-learning success according to learners’ perspective. The meta-analysis indicated that most studies on mobile learning were conducted between 2015 and 2021, primarily utilizing quantitative methodologies. These studies focused on young adults and were carried out in various countries, including the United States, Spain, Taiwan, Saudi Arabia, the United Kingdom, Turkey, China, Australia, Italy, Sri Lanka, Malaysia, Oman, Austria, South Africa, Egypt, India, Portugal, Jordan, South Korea, Iran, Finland, Brazil, and Israel. A meta-analysis identified 23 countries, with the United States having the highest number of studies on mobile learning success factors. Key determinants reported were learning approach and learners’ perception, with estimates of 0.68 (95% CI 0.06-0.98) and 0.44 (95% CI 0.33-0.56), respectively. In contrast, Jordan and Iran had the lowest number of studies, with learning approach being the main contributing success factor from the learners’ perspective, estimated at 0.736 (95% CI 0.68-0.78)

Conclusion. Successful m-learning should include the investigation of trainees’ educational needs and motivation; provision of adequate infrastructure and learning materials; definition of learning objectives and course contents; and coordination of appropriate learning activities in order to ensure continuous progress in learners’ knowledge and awareness on different course topics.

Effect of patient sorting done by nurses on care request management in primary care emergency services

Genoveva Pérez Romero — 2024-11-15

Objective. To determine the influence of patient sorting done by nurses in primary care emergency services on care priorities and discharge referrals, both in general and in relation to the reasons for consultation.

Methods. Descriptive retrospective study. Variables were compared before and after the involvement of nurses in sorting patients in the primary care emergency services of the Granada Health District (Andalusia, Spain). 41,295 records were analyzed, 18,663 before and 22,632 two years after the inclusion of nurses. The reasons for consultation, priority levels, and types of discharge referral during the two study moments were compared.

Results. Regarding the reasons for consultation, it was observed that the percentages of malaise (p<0.001) and diseases of the genitourinary system (p<0.001) increased, while fever (p<0.001), among others, decreased. In the two-year measurement period after sorting done by nurses was implemented, type IV priorities increased in percentage (p<0.001) and type V priorities decreased (p<0.001). Discharges to home decreased (p<0.001), while family physician referrals increased (p<0.001).

Conclusion. The participation of nurses in the sorting of patients in primary care emergency services was related to significant changes in priority assignment, discharge referrals, and management of the reasons for consultation, showing an improvement in patient care autonomy and in the resolution of minor clinical problems in the emergency room.

“My Kidney Disease, My World as an Arena:” Unpacking the Situation of Adolescents from the Perspective of Postmodern Grounded Theory

Keidis Sulay Ruidiaz Gómez — 2024-11-15

Objective. To explore the meanings of quality of life for adolescents with chronic kidney disease (CKD).

Methods. This qualitative study was conducted using a grounded theory situational analysis approach, following the interpretive turn. Four in-depth interviews were conducted with adolescents with CKD, five with parents, and four with healthcare professionals (three nurses and one physician). The collected data were analyzed using situational maps, social world/arenas maps, and positional maps, as proposed by Adele Clarke.

Results. The characterization of these adolescents’ situations shows that they are the main actors and modify their social role when they suffer from CKD. It is the mothers that traditionally care for them, until they regain their health. The social world map shows the interactions among the worlds of individuals, their families, and the healthcare system, constituting a well-being arena which defines the quality of life for adolescents with CKD. Discursive positions constitute a key element in the discussion concerning the relational dimensions of well-being and the feelings emerging in relation to the disease.

Conclusion. For adolescents with CKD, quality of life is defined as the state of well-being emerging from the recognition of their own environment in micro-, meso‑, and macro-systems, which bring together structural (political, cultural, symbolic) elements, discursive constructions, and the integration of interactions in the social arenas, as well as the representation of the main discourses and their positions.

Prevalence and severity of nomophobia among nurses: A systematic review and meta-analysis

Shiv Kumar Mudgal — 2024-11-15

Objectives. To determine the prevalence and severity of nomophobia (dread of not having a smartphone) among nurses.

Methods. A systematic search was carried out across different electronic databases, including Medline (PubMed), SCOPUS Embase, CINAHL, EBSCO, and Google Scholar, until March 2024. The meta-analysis included studies that reported the prevalence of nomophobia in nurses and used the Nomophobia Questionnaire (NMP-Q). Two independent reviewers identified the studies, extracted the data, and assessed the risk of bias using Joanna Briggs Institute Critical Appraisal Tool. PROSPERO register number CRD42024512079.

Results. A total 10 studies (4 in Italy and 6 in Turkey) with 3086 individuals were found to meet the inclusion criteria for the systematic review. However, data could not be retrieved for one research, thus nine studies being included in the meta-analysis. The Overall Prevalence of nomophobia was 68.15% (95% CI: 57.49%-78.81%; I² = 99%). The prevalence of mild nomophobia was reported to be 43% (95% CI, 24%-65%; I² = 99%), moderate nomophobia was 31% (95% CI, 17%-50%; I² = 99%), and severe nomophobia was 7% (95% CI, 2%-25%; I²= 95%). Country-specific analysis revealed that Turkish nurses had a greater level of nomophobia than their Italian nurses.

Conclusion. Nurses have a high prevalence of mild to moderate nomophobia which emphasizes the need of preventative initiatives and tailored intervention for nurses in health care organizations.

Repercussions of neck pain on the quality of life of health professionals in Intensive Care Units

Alberto de Oliveira Redü — 2024-12-06

Objective. To analyze the repercussions of neck pain on the quality of life of health professionals in intensive care units.

Methods. Cross-sectional, descriptive and correlational study, carried out with 94 health professionals (21 nurses, 13 physical therapists and 60 nursing technicians) in Intensive Care Units of two medium-sized hospitals in a municipality in the far south of Brazil. An instrument containing variables of sociodemographic and work environment characterization was applied; the Neck Bournemouth Questionnaire (NBQ) and the WHOQOL-Bref were applied.

Results. There was a predominance of female professionals (88.3%), white (78.8%), aged 30 to 39 years (34.1%), with family income between one and two minimum wages (31.9%) and weekly workload between 31 and 40 hours (67%), night shift (54.3%), time of professional experience of one to five years (38.3%) and one job (73.4%). Neck pain and disability showed significant negative correlations with quality of life. The relationship was weak with the physical (r: -0.218; p=0.035) and psychological (r: -0.280; p=0.006) domains, and moderate with social relationships (r: -0.419; p<0.001), environment (r: -0.280; p<0.001) and general quality of life (r: -0.280; p<0.001). Overall quality of life showed a moderate correlation with the feeling of anxiety (r: -0.431; p<0.001) and depression (r: -0.515; p<0.001) of professionals in the last week.

Conclusion. Neck pain caused repercussions in the physical, psychological, social, environmental and general quality of life of health professionals in intensive care units.

Validity and Reliability of the Adolescent Lifestyle Profile-Revised 2 (ALP-R2) Scale in Colombian Adolescents

Eugenia del Pilar Herrera Guerra — 2024-11-15

Objective. The study sought to determine the validity and reliability of the Adolescent Lifestyle Profile-Revised 2 (ALP-R2) scale, translated into Spanish, in Colombian adolescents.

Methods. Psychometric study, which included the translation process (English to Spanish). The final version of the scale in Spanish was approved by Nola Pender; apparent and content validation was carried out through expert judgment (n = 6). With a sample of 1476 Colombian adolescents. Construct validity was determined through exploratory and confirmatory factor analysis. The internal consistency was calculated with Cronbach’s coefficient.

Results. Favorable evidence was obtained of apparent validity, content validity, and construct validity with a model comprised of 44 items and 7 subscales (total accumulated variance 44.9%) with good absolute fit (χ2: 18434.3; df = 946; p < 0.0001; CMIN/DF = 4.326; SRMR = 0.0562; RMSEA = 0.047), incremental (CFI = 0.834; NFI = 0.795; NNFI = 0.822) and parsimony (PCFI = 0.777; PNFI = 0.741; AIC = 4116.848). Good internal consistency in the total scale (α = 0.91) and in the subscales (α between 0.609 and 0.809).

Conclusion. The Spanish version of the ALP-R2 scale has adequate psychometric properties of validity and reliability, to measure the lifestyle profile of Colombian adolescents, coherent with the theoretical model of Health Promotion. Its use is recommended in populations similar to that of the study.

Cross mapping of self-care interventions for expert patients

Manacés dos Santos Bezerril — 2024-11-15

Objective. To compare the primary nursing interventions described in the literature to promote self-care among expert patients with the Nursing Interventions Classification.

Methods. This descriptive and exploratory study used a quantitative approach and cross-mapping focusing on 23 self-care actions obtained from a scoping review conducted in January 2022 in Brazilian and international databases. Data were descriptively analyzed, processed, and presented in tables.

Results. Twenty-three self-care actions were found in the scoping review. A total of 56 interventions were selected, 30 of which were associated with self-care actions; some were associated with more than one intervention (e.g., physical activity, avoiding alcohol consumption, blood glucose monitoring, blood sugar management, stress/anxiety).

Conclusion. The self-care interventions promoted among expert patients were compared to the Nursing Interventions Classification, enabling nurses to lead by encouraging, assisting, teaching, discussing, and guiding patients. Hence, nursing workers can improve their work process by encouraging patient self-care and autonomy in the health-illness continuum.

Establishing a Partnership to Support an HIV Prevention Intervention for Latina Women in South Florida (United States of America)

Evelyn Iriarte — 2024-12-09

Objective. To describe practices used in the formation of a community-based participatory research (CBPR) partnership between M.U.J.E.R., a community-based organization located in South Florida, and the School of Nursing and Health Studies at the University of Miami (United States of America). The purpose of this partnership was to adapt SEPA -Salud, Educación, Prevención, Autocuidado; Health, Education, Prevention, Self-care, in English- into SEPA+PrEP -Salud, Educación, Prevención, Autocuidado + Profilaxis Pre-exposición; Health, Education, Prevention, Self-care + Pre-exposure prophylaxis, in English) to facilitate CBPR focused on HIV prevention among Latina women.

Methods. Our community-based participatory research (CBPR) partnership blends multiple perspectives from community partners (community advisory board, community centers), clinical experts, cisgender heterosexual Latina members of the community, and academic/research members.

Results. Partnering practices included (i) developing a collaborative and trusting partnership, (ii) relationship building and attending to power dynamics, (iii) building capacity through mutual learning, (iv) conducting research to address barriers to HIV prevention among Latina women, and (v) implementation of knowledge gained in future CBPR.

Conclusion. The long-term success of our CBPR partnership should be measured by the capacity developed within the community and the successful implementation of community programming. Key Intentional implementation of CBPR partnership practices, tailored to academic and community institutions’ unique needs, can result in high-trust, long-term relationships.

Effectiveness of a Nursing Intervention to Improve Knowledge, Attitudes, and Practices in Malaria Prevention in an Emberá Katío Community in the Department of Córdoba

Jorge Luis Herrera Herrera — 2024-12-09

Objective. To evaluate the effectiveness of a nursing intervention, against routine care, to improve knowledge, attitudes, and practices (KAP) in malaria prevention in an Emberá Katío community from the department of Córdoba, Colombia.

Methods. This was an intervention study with quasi-experimental design with control group, conducted in three phases: (I) design of the educational intervention, (II) content validation of the educational intervention through expert judgment, and (III) execution of a quasi-experimental study with two groups: experimental (n = 60) and control (n = 58). The intervention consisted in four modules taught in person, using educational strategies, like classes, guided discussions, workshops, and a booklet designed for the study. The control group received the routine care provided by the Secretariat of Health. The study used the instrument by the Pan-American Health Organization “Survey on knowledge, attitudes, and practices in addressing malaria in indigenous communities” to measure pre- and post-intervention scores.

Results. The four modules of the educational intervention obtained Content Validity Indices between 0.83 and 0.90 that are considered adequate. The General Linear Models of repeated measures showed positive effect of the educational intervention on the KAP scores (p < 0.001), with an effect size of 91% in knowledge, 49% in attitudes, 85% in practices, and 93% in the total score.

Conclusion. The educational intervention proved effective to improve KAPs in malaria prevention in the Emberá Katío community from the department of Córdoba.

Construction and Validation of a Compassionate Nursing Care Scale from the Perspective of the Patient-Family Caregiver Dyad

Edwin Darío Archila Hernández — 2024-12-09

Objective. This work sought to determine the composition, comprehensibility, face validity, and content validity of the Compassionate Care Scale “HUS-CC”, to assess the perception of the patient-family caregiver dyad on the compassionate nursing care they receive in hospital services.

Methods. Methodological research conducted in a hospital network with services at different levels of complexity in Colombia. To evaluate the comprehensibility of the HUS-CC, 204 individuals participated. The face and content validity were valued by 17 experts and ratified with 213 dyads. An exploratory factor analysis with varimax rotation was conducted and reliability was calculated with Cronbach’s alpha.

Results. The scale was clear and understandable. Its face and content validity index were 0.77; the Fleiss Kappa index was 0.59 and Aiken’s V was 0.9; with Cronbach’s alpha of 0.84. The HUS-CC has 16 items grouped into three dimensions: warm treatment, inclusive attitude, and supportive behavior.

Conclusion. The HUS-CC scale proved valid to evaluate the perception of patient-family caregiver dyads about compassionate nursing care in hospital services.

Intention, Motivations, and Barriers to Emigration of Nursing Students in Colombia

Bairon Steve Peña Alfaro — 2024-12-09

Objective. To explore the intention, motivations, and barriers to emigrate of final semester nursing students from Colombia.

Methods. Quantitative, descriptive, and cross-sectional study with participation by 556 last-semester students matriculated in 26 undergraduate nursing programs in Colombia. Data were collected through an online questionnaire.

Results. The study found that 84% of the participants consider among their plans as future nursing professionals to emigrate to practice their profession in another country. Destinations of preference for those who have thought of emigrating include countries, like Canada (63.5%), Spain (57.7%), Germany (44.9%), and the United States (44.4%). The main reasons that motivate nursing students to emigrate when they complete their professional studies are: better remuneration (81.6%), better quality of life (67.9%), greater professional growth (64.1%), greater job stability (54.7%), and more employment options (49.8%). In turn, the reasons that discourage nursing students from emigrating when they complete their professional studies are: language (71.9%), going away from the family (60.6%), and the complexity of the emigration process (55.4%).

Conclusion. The findings of this research show that a notable proportion of last-semester nursing students consider among their plans to emigrate to practice in another country when they receive their degree. Knowing the intentions, motivations, and barriers to emigrate of future nurses will permit having elements to design strategies that improve the retention of professionals in Colombia.

Attitudes of nursing students towards ageism and associated factors

Jaedson Capitó de Santana — 2024-12-09

Objective. To evaluate the associated factors on ageism in nursing students from a public university in Recife-PE.

Methods. This is a cross-sectional, quantitative, analytical study, whose participants (n=215) were students of the bachelor's degree in Nursing at a public university in Recife, Pernambuco, Brazil. Data regarding responses to a sociodemographic questionnaire and Fraboni Ageism Scale were analyzed.

Results. The characteristics that predominated among the participants were: female (83.3%), age between 17-20 years (41.9%), single (92.1%), did not have a scholarship (83.5%), lived with parents and/or siblings (60.9%), had no child (98.1%), did not live with the older adult (74.4%), and was attending the first year of under graduation (28.4%). On the Fraboni Scale, the score was 36.74 out of 84 possible points for ageism, being by domain: 11.55 points for Avoidance, 11.54 points for Antilocution, and 10.05 points for Discrimination.

Conclusion. Among the nursing students surveyed, ageism was associated with the male gender, younger age, not being a scholarship holder and living alone. Education and training aimed at caring for the older adults are effective tools to challenge prejudice related to aging.

Effect of a Specialized Nursing Subject Assignment on Perceived Knowledge and Skills to Care for Drug Users

Miguel A. Villegas-Pantoja — 2024-12-09

Objective. To identify the effect of a specialized subject on addictions on the knowledge and skills perceived by undergraduate nursing students to care for drug users.

Methods. This was a pre-experimental study of a single group with post- and pre-test measurements. The study included a sample of 59 students registered in the seventh semester in a public university in northeastern Mexico, who received 64 theoretical hours of the subject assignment “Nursing and addictions”, which was taught in face-to-face classes by professor nurses with training in the care of addictions. The emphasis was theoretical, where strategies, like clinical cases, screening instruments, and audiovisual material were used. Information was collected about sociodemographic data and the scale by Happel et al., of knowledge and perceived skills on the care of alcohol and other drug users was applied.

Results. The post-test registered higher scores in the subscales of overall knowledge on substance use (W = –4.532, p < 0.001), perceived knowledge on management of drug users (W = –5.909, p < 0.001), and perceived competences to care for alcohol and drug users (t = –8.000, p < 0.001).

Conclusion. The subject assignment analyzed contributed to increasing knowledge by nursing students regarding the phenomenon of addictions. As for perceived competences, although these increased significantly, they would have to be demonstrated in light of practical scenarios that confirm their persistence and impact on the quality of care.

Social determinants of health and exclusive breastfeeding: a longitudinal study

Ananda Larisse Bezerra da Silva — 2024-12-09

Objective. To analyze the social determinants of health of exclusive breastfeeding on the 7^thand 27^th day after delivery.

Methods. A longitudinal, multicenter study with a quantitative approach was conducted with postpartum women and newborns in three maternity hospitals in the state of Espírito Santo (Brazil). The sample consisted of 2,325 and 1,819 mother/baby pairs on the 7^th and 27^th day, respectively. The variables that most influence women in exclusive breastfeeding were assessed by logistic regression.

Results. The rate of exclusive breastfeeding seven days after delivery was 80.7% and 79.2% on the 27^th day. The social determinants of health up to the 27^th day after delivery that were related to exclusive breastfeeding aimed at the mother were: mother's age up to 19 years (OR 1.9); and in newborns, the following stood out: full-term baby (OR 2.2) and no difficulty in EBF (OR=8.8).

Conclusion. The relationship between social determinants of health such as maternal age, gestational age of the baby at birth and difficulties in breastfeeding influence the practice of EBF.