No abstract

Nursing staff need proper training on end-of-life care through the use of guidelines or protocols and the development of coping strategies, in addition to a change in the organisation of the ICU dedicated to the terminal care of critically ill patients and family support.

Background:Nurses who practice limitation of therapeutic effort become fully involved in emotionally charged situations, which can affect them significantly on an emotional and professional level.Objectives:To describe the experience of intensive care nurses practicing limitation of therapeutic effort.Method:A qualitative, phenomenological study was performed within the intensive care units of the Madrid Hospitals Health Service. Purposeful and snowball sampling methods were used, and data collection methods included semi-structured and unstructured interviews, researcher field notes, and participants’ personal letters. The Giorgi proposal for data analysis was used on the data.Ethical considerations:This study was approved by the Ethical Research Committee of the relevant hospital and by the Ethics Committee of the Rey Juan Carlos University and was guided by the ethical principles of voluntary enrollment, anonymity, privacy, and confidentiality.Results:In total, 22 nurses participated and 3 themes were identified regarding the nurses’ experiences when faced with limitation of therapeutic effort: (a) experiencing relief, (b) accepting the medical decision, and (c) implementing limitation of therapeutic effort.Conclusion:Nurses felt that, although they were burdened with the responsibility of implementing limitation of therapeutic effort, they were being left out of the final decision-making process regarding the same.

Background: The first wave of the COVID-19 pandemic caused a shortage of qualified nurses in Spain. As a result, the government authorized the hiring of senior students. Objectives: To explore the ethical dilemmas and ethical conflicts experienced by final-year nursing students who worked during the first outbreak of the COVID-19 pandemic in Spain. Research design: A qualitative exploratory study was conducted using purposive sampling. Semi-structured interviews were carried out using a question guide. Interviews took place via a private video chat room platform. A thematic, inductive analysis was performed of the information gathered. Participants and research context: Eighteen nursing students were recruited from two universities of Madrid, aged between 18 and 65 years old, enrolled in the fourth year of nursing studies and who were hired under a relief contract for health professionals during the pandemic. Ethical considerations: The present study was carried out in accordance with the Declaration of Helsinki, and the study was approved by the Local Ethics Committee of Universidad Rey Juan Carlos. Results: Three specific themes emerged: (a) coping with patient triage, (b) difficulties in providing end-of-life care, and (c) coping with patient death. Nursing students participated in the process of patient selection for resource allocation and ICU bed occupancy. They were shown how to care for patients who were not admitted to the ICU, in their last moments and were faced with the difficulties of applying end-of-life care. Finally, the nursing students were confronted with the death of their patients, in overwhelming numbers and under adverse conditions. Conclusions: These findings can help shed light on the ethical dilemmas and ethical conflicts faced by novice nursing students, incorporated into the workforce during the COVID-19 pandemic. Moreover, it was described that students may normalize the death due to the exhaustion and overwhelmed routine.

Background: The development of educational research, critical thinking skills, and evidence-based practice requires proposals for educational innovation. The purpose of this study was to explore the perspectives of undergraduate nursing students on the barriers and facilitators after the implementation of a novel activity within the course of research methodology, composed of three active learning strategies: (a) project-based learning; (b) small-group learning; and (c) self-directed learning. Methods: A qualitative exploratory study using reflective writing was conducted at the Nursing Department of the Red Cross School (Spain). Seventy-four nursing students participated in the study, enrolled in the research methodology course. Purposive sampling was used. Online reflective notes were collected from a script of open-ended questions. An inductive thematic analysis was performed. Results: The new proposals facilitated learning of the subject matter and its contents. They were useful and enabled the students to put the contents into practice. In addition, they improved the students’ organization, planning, and involvement. The barriers identified were a lack of time, ambiguity, inadequate tutoring or novelty of the work, and inequity in the distribution of tasks and workloads. Conclusions: Our findings shed light on the barriers and facilitators identified by nursing students when implementing an educational innovation proposal, using three active learning methodologies as learning tools for the subject of nursing research.