Artículos (Enfermería)

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Respuesta a la carta «Inteligencia artificial y atención primaria: entre la adaptación y la pérdida de centralidad»
(2026) Coronado-Vázquez, Valle; Allande Cussó, Regina; Caparrós-González, Rafael A.; Gómez-Salgado, Juan; Enfermería; CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud
Effects of transcutaneous vagus nerve stimulation on gastrointestinal symptoms and cardiovascular autonomic outcomes: a systematic review and meta-analysis
(MDPI, 2026-07-03) María Pérez-Montalbán; Encarna García-Domínguez; Pabón Carrasco, Manuel; Oliva Pascual-Vaca, Ángel; Enfermería; Fisioterapia; Instituto de Biomedicina de Sevilla (IBIS); CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud; CTS1043: Salud, Fisioterapia y Actividad Física
Background: Autonomic dysfunction is increasingly recognized as a key mechanism in disorders involving the brain–gut axis and gastrointestinal symptom generation. Transcutaneous vagus nerve stimulation (tVNS) is a noninvasive neuromodulatory technique investigated for its potential effects on autonomic regulation. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines, with protocol registration in PROSPERO. Randomized controlled trials (RCTs) investigating auricular or cervical tVNS in patients with visceral disorders were included. Continuous outcomes were pooled using mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs). When multiple publications originated from the same trial population, only independent datasets were considered for quantitative synthesis to avoid double-counting participants. Risk of bias was assessed using the PEDro scale and certainty of evidence with the GRADE approach. Results: Seven RCTs met the inclusion criteria. tVNS demonstrated a small but statistically significant improvement in gastrointestinal symptoms based on change-from-baseline GSRS scores (MD −0.19; 95% CI −0.29 to −0.09; p < 0.001; I2 = 0%). Although statistically significant, the magnitude of this effect was modest, and its clinical relevance remains uncertain. No significant effects were observed on cardiac vagal tone (SMD 0.19; 95% CI −0.53 to 0.90; p = 0.61; I2 = 73%) or systolic blood pressure (MD −1.24 mmHg; 95% CI −6.69 to 4.21; p = 0.66; I2 = 0%). Evidence regarding cardiac autonomic neuropathy (CAN) was limited to a single independent randomized controlled trial, which found no significant differences between tVNS and sham stimulation. Conclusions: tVNS provides modest statistically significant improvements in gastrointestinal symptoms, supporting its role as a symptomatic neuromodulatory intervention. However, the available evidence for this outcome was based on only two studies, and the clinical relevance of the observed effect remains uncertain. No statistically significant pooled effects were observed for the cardiovascular autonomic markers assessed in this review. Evidence regarding CAN was limited to a single independent study. Therefore, the available evidence remains limited and heterogeneous, and further high-quality randomized controlled trials are warranted.
Dermatological safety of chlorhexidine‐impregnated dressings in paediatric intensive care: a randomised clinical trial nosi
(Wiley, 2026-06-26) Portero‐Prados, Francisco Javier; Pabón Carrasco, Manuel; Ponce Blandón, José Antonio; Enfermería; CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud; CTS284: Promoción de la Salud
Background: Central venous catheters are essential in paediatric intensive care but are associated with catheter-related bloodstream infections (CRBSIs) and skin complications. Chlorhexidine gluconate (CHG)-impregnated dressings may reduce infection risk; however, concerns remain regarding their dermatological safety in vulnerable paediatric populations. Aim: To evaluate the dermatological safety of CHG-impregnated dressings in critically ill paediatric patients requiring central venous catheters and to explore their impact on catheter-related outcomes. Study Design: A single-blind, prospective randomised clinical trial was conducted in a tertiary paediatric intensive care unit. Within routine clinical practice, patients were randomly assigned to receive either a conventional transparent dressing or a dressing incorporating a 2% CHG gel pad. The primary outcome was the occurrence of tegumentary alterations at the catheter insertion site. Secondary outcomes included CRBSI incidence and catheter maintenance variables. Results: Skin alterations were identified in 14.0% of patients, with no significant differences between groups (16.8% vs. 11.2%; p = 0.202). However, dermatological alterations occurred at a significantly younger age in the CHG group (6.5 ± 4.8 vs. 46.0 ± 43.2 months; p = 0.003), with a similar pattern for pruritus. Multivariable analysis showed a significant interaction between dressing type and age, indicating age-dependent dermatological responses. CHG dressings were associated with fewer dressing changes and longer intervals between replacements. CRBSI incidence was lower in the CHG group (2.4% vs. 18.4%; p < 0.001), although this was a secondary outcome. Conclusions: CHG-impregnated dressings showed an acceptable dermatological safety profile. Their use was associated with improved catheter-related outcomes, although skin reactions occurred at younger ages. Relevance to Clinical Practice: CHG dressings may support safer catheter management but require careful dermatological monitoring in infants. These findings may help inform dressing selection and catheter care strategies in paediatric intensive care settings where infection prevention and skin integrity must be balanced.
Resultados clínicos asociados al uso del parche de capsaicina al 8% en el dolor neuropático localizado: un estudio cuasiexperimental
(Elsevier, 2026) Cristina García-Librero; Pabón Carrasco, Manuel; Vilar Palomo, Samuel; Enfermería; CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud
Objetivo Evaluar los resultados clínicos asociados al uso del parche de capsaicina al 8% en la intensidad del dolor, la calidad de vida y la calidad del sueño en pacientes con dolor neuropático localizado, y analizar el rol de las enfermeras en su aplicación y seguimiento dentro de una Unidad hospitalaria del Dolor Crónico. Métodos Se realizó un estudio longitudinal cuasiexperimental pre-post en la Unidad del Dolor Crónico del Hospital Universitario Virgen del Rocío de Sevilla (España) entre 2019 y 2024. Se incluyó un total de 110 pacientes, que fueron seguidos durante seis meses. La intensidad del dolor, la calidad de vida y la calidad del sueño se evaluaron en diferentes momentos mediante instrumentos validados (escala numérica verbal, EuroQol-5D y MOS Sleep Scale). Además, se utilizó la impresión global de mejoría del paciente (PGI-I) para determinar la diferencia mínima clínicamente importante (DMCI) desde la perspectiva del paciente. Resultados De los 117 pacientes reclutados, 110 completaron el estudio (edad media 57,2 años; 58,2% mujeres). La mayoría presentó dolor en extremidades inferiores (63,6%) y neuropatía posquirúrgica (75,5%). Se observaron mejoras significativas en términos de dolor, calidad de vida y calidad del sueño en ambos puntos de seguimiento. Se alcanzaron reducciones clínicamente relevantes del dolor (≥ 1,5 puntos al mes y ≥ 3 puntos a los tres meses, p ≤ 0,05). Los episodios adversos fueron mínimos y bien tolerados. Conclusión El uso del parche con capsaicina al 8% se asoció a mejoría del dolor y los resultados relacionados, y mostró un perfil de seguridad favorable. Las enfermeras desempeñan un papel importante en la aplicación, la educación del paciente y el seguimiento de esta intervención. La formación específica en esta intervención podría mejorar la calidad de la atención y los resultados de los pacientes. Se deben realizar más estudios para evaluar su eficacia a largo plazo y su combinación con terapias sistémicas.
Beyond omission: missed nursing care as prioritization under complexity in intensive care units
(Elsevier, 2026) Barrientos Trigo, Sergio; Gil-Rees, Esther; Ochando-García, Antonio; Jiménez-Caro, Rosario; González-Caro, María-Dolores; Reguera Carrasco, Cristina; Enfermería; CTS1141: Investigación Clínica Aplicada a los Cuidados y Nuevos Paradigmas Asistenciales
Background Missed nursing care in intensive care units (ICUs) is commonly understood as needed care that is delayed, partially completed, or omitted. However, less is known about how critical care nurses describe and negotiate these omissions during real-time prioritization under complexity of care. Purpose To explore ICU nurses’ perceptions of missed nursing care and the contextual factors shaping its occurrence and prioritization. Methods A qualitative descriptive study was conducted using five focus groups with 39 nurses from 11 adult ICUs across five hospitals in Spain. Data were analyzed inductively using thematic analysis. Discussion This study shows that missed nursing care in ICUs extends beyond complete task omission and includes care that is delayed, partially completed, or provided less frequently. Nurses described missed care across both direct care, including fundamental physical and psycho-emotional care, and indirect care, including relational care, care recording, and clinical monitoring. Less visible forms of nursing work were particularly vulnerable to displacement when physiologically urgent and technically measurable interventions were prioritized. These omissions appeared to arise from multifactorial and interrelated conditions involving organizational management, healthcare provider-related factors, patient complexity, and environmental conditions. Conclusion Missed nursing care in ICUs should be understood not only as isolated task omission, but as a dynamic prioritization process shaped by complexity of care. Strategies to reduce missed care should address the system conditions that make less visible nursing work vulnerable to displacement.
Potential benefits of complementary therapies for women with breast cancer undergoing oncological treatment: a systematic review
(MDPI, 2026-06-04) Guerra Martín, María Dolores; Delgado-Saldaña, Irene; Magni, Eleonora; Calderón-Fernández, María; Borrallo Riego, Álvaro; Enfermería; CTS1158: Desarrollo y Evaluación de Intervenciones en Salud y en Educación
Background/Objectives: Breast cancer is the most prevalent malignancy among women worldwide and remains a major cause of morbidity and mortality. Conventional treatments, while effective, often produce physical and psychological adverse effects that impair quality of life. Complementary therapies (CTs) have gained prominence as supportive strategies to mitigate these effects. This systematic review aimed to evaluate the potential benefits of CTs in women with breast cancer undergoing or having completed chemotherapy and radiotherapy. Methods: Following PRISMA 2020 guidelines and Cochrane standards, a systematic search was conducted in PubMed, CINAHL, Web of Science, and Scopus for studies published up to March 2026. Randomized controlled trials assessing CTs in breast cancer patients were included. Methodological quality was appraised using the PEDro scale, and risk of bias was evaluated using the Cochrane RoB 2 tool. Results: Thirty-two RCTs met the inclusion criteria. The interventions included acupuncture and related techniques, mindfulness-based therapies, massage, dance–movement therapy, music therapy, slow breathing, prayer, and natural products. Overall, CTs produced improvements in pain, fatigue, anxiety, depression, sleep quality, and social well-being, though the effects were sometimes therapy-specific and varied. Conclusions: Complementary therapies represent non-pharmacological strategies that may offer potential benefits across physical, emotional, and social outcomes in women with breast cancer. However, mixed results in certain therapies indicate that conclusions must be drawn cautiously. Future research should pursue methodological consistency and longer follow-ups.
Nursing students’ opinions and perceptions regarding the clinical simulation service: a qualitative study
(Emerald, 2026) Jiménez-Álvarez, Juan Antonio; Borrallo Riego, Álvaro; Guerra Martín, María Dolores; Enfermería; CTS1158: Desarrollo y Evaluación de Intervenciones en Salud y en Educación
Purpose This study aimed to explore Nursing students' opinions and perceptions of their experiences with Clinical Simulation services at three centres affiliated with a public university in southern Spain. Design/methodology/approach A qualitative, descriptive-interpretive design was applied with third-year Nursing students who had completed a ten-session Clinical Simulation-based “Life Support” course. Open-ended responses regarding their perceptions of the service were analysed through categorical content analysis using Atlas.ti. Two independent evaluators conducted the analysis to ensure and enhance the trustworthiness of findings. Findings Approximately one-third of students provided a total of 96 verbatim statements, classified into three categories: (1) Time, (2) Resources and infrastructures, and (3) Utility of Clinical Simulation and adequacy. Students valued clinical simulation as an effective learning strategy bridging theory and practice, yet identified shortcomings in session duration, material accessibility, and realism of scenarios. Conclusions: The study highlighted the need to expand clinical simulation session time, improve material quality and accessibility, and diversify clinical scenarios to enhance realism and student engagement. These findings provided actionable insights for educators and institutions to optimise clinical simulation implementation, ensuring that simulation-based education fulfilled its potential as a core pedagogical tool in Nursing curricula. Originality/value Students perceived clinical simulation as an effective learning method. More time and frequency for simulation sessions were widely requested access to simulation materials outside class time was considered insufficient. Students reported poor quality and limited variety in simulation scenarios. Smaller group sizes were recommended to improve simulation experience.
Validation of “Victorian institute of sports assessment for patellar tendons” in patellofemoral pain: Reliability, interpretability and feasibility study
(Baishideng Publishing Group Inc., 2027-06-18) Chamorro Moriana, Gema; Espuny Ruiz, Fernando; Ridao Fernández, María Del Carmen; Magni, Eleonora; Fisioterapia; Enfermería; CTS305: Área de Fisioterapia
BACKGROUND The Victorian institute of sports assessment for patellar tendons questionnaire (VISA-P), a valid tool for patellar tendinopathy, has been used for patellofemoral pain (PFP). AIM To validate VISA-P in PFP. METHODS Study of validity, responsiveness and feasibility following COSMIN. Inclusion criteria: Subjects with PFP, aged 18 to 55. Agreement among 10 experts on the relevance and clarity of each item using Aiken's V coefficient determined content validity. An exploratory factorial analysis established structural validity. The correlation of VISA-P with knee injury and osteoarthritis outcome score for PFP and Osteoarthritis (KOOS-PF) and Kujala patellofemoral score (KPS; specific for PFP) analyzed the construct validity. Internal consistency was calculated with Cronbach's α and test-retest reliability with the intraclass correlation coefficient (ICC). Feasibility considered the subjects' self-completion time. RESULTS The sample consisted of 103 knees from 73 subjects (47 female/26 male; aged 34.9 ± 13 SD). The items were relevant and clear, with the exception of item-8, which didn't reach an acceptable level of agreement on clarity. Exploratory factorial analysis found a 2-factor solution, which explained 63.48% of the variance. VISA-P achieved a strong and significant correlation with KOOS-PF (Spearman rho = 0.826; P < 0.001) and KPS (Spearman rho = 0.771; P < 0.001). The questionnaire showed adequate reliability (Cronbach's α: 0.752; ICC: 0.934; P < 0.0001; 95%CI: 0.902-0.955). The mean self-completion time was 232 ± 0.52 SD seconds. CONCLUSION VISA-P proved to be valid and reliable to functionally assess PFP and/or chondromalacia patella. VISA-P is a feasible tool in the clinical and research environment, quick and easy to complete.
Condiciones laborales y salud psicosocial del personal sanitario en Atención Primaria
(Ministerio de Sanidad, 2026-05-28) Narbona-Gálvez, Ángela; Gómez-Salgado, Juan; Allande Cussó, Regina; Torrejón-Martínez, Julio; El Khoury Moreno, Luis; Fagundo-Rivera, Javier; Enfermería; Estomatología; CTS353: Estomatología Infantil y Ortodoncia; CTS353: Estomatología Infantil y Ortodoncia
Los riesgos psicosociales tienen un impacto importante en la salud física y mental de los profesionales sanitarios. Estos trabajadores se enfrentan a diario a una elevada carga de trabajo, la inestabilidad laboral y un notable desgaste emocional. Todo ello no solo repercute en su bienestar, sino también en la calidad de la atención que ofrecen a los pacientes. La incorporación al ejercicio profesional suele ser especialmente complicada, ya que muchos nuevos profesionales sienten que no cuentan con la preparación práctica suficiente, lo que dificulta su adaptación. A esto se suma la temporalidad de los contratos, que incrementa la sensación de incertidumbre y afecta a la continuidad de los cuidados. Por otro lado, las jornadas laborales prolongadas favorecen la fatiga, lo que puede comprometer tanto la salud de los trabajadores como la seguridad del paciente. Ante esta situación, resulta fundamental apostar por modelos laborales más flexibles, ofrecer apoyo psicológico adecuado y promover la formación continua. Estas medidas pueden contribuir a mejorar la estabilidad laboral, reducir el desgaste profesional y reforzar el liderazgo dentro de los equipos de Atención Primaria.
Consequences of nurse-to-nurse horizontal violence in hospital settings: A systematic review
(Elsevier, 2026) Reguera Carrasco, Cristina; Santana Berlanga, Nicia del Rocío; Gaia D'Antonio; Barrientos Trigo, Sergio; Enfermería; Instituto de Biomedicina de Sevilla (IBIS); CTS1141: Investigación Clínica Aplicada a los Cuidados y Nuevos Paradigmas Asistenciales
Background Nurse-to-nurse horizontal violence (NNHV) is a systemic issue characterized by hostile behaviors between nurses at equivalent hierarchical levels within healthcare settings. NNHV affects not only nurses, but also patient care and the healthcare system overall. Despite growing recognition of its prevalence, a comprehensive synthesis examining the full spectrum of consequences across personal and organizational domains is lacking from the literature. Purpose To synthesize the current evidence on horizontal violence and to define the consequences of NNHV on nurses, patients, and healthcare systems. Methods A systematic review of literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were retrieved from PubMed, CINAHL, Scopus, and Web of Science. Studies that evaluated the consequences of NNHV were included. The quality of included studies was assessed using Joanna Briggs Institute critical appraisal tools. Data were synthesized thematically into personal and work-related consequences. Results Of 2769 identified articles, 131 were assessed for eligibility, and 33 studies were ultimately included. Of these 33 studies, 28 used cross-sectional designs, four were qualitative studies, and one was a cohort study. Personal consequences included significant psychological distress (anxiety, depression, posttraumatic stress disorder, suicidal ideation), physical health deterioration (stress-related symptoms, chronic fatigue, insomnia), and impaired workplace relationships (emotional exhaustion, reduced trust, isolation). Work-related consequences encompassed decreased productivity, diminished job satisfaction, heightened turnover intention, increased medical errors, compromised patient safety, and adverse patient outcomes. Conclusion This review provides comprehensive evidence that NNHV constitutes a significant organizational risk requiring systematic intervention. Findings support the implementation of multilevel strategies that integrate zero-tolerance policies, transformational leadership approaches, and psychosocial support mechanisms.
Decarbonizing the Spanish health system: a qualitative study on the implementation of environmental regulations and management strategies in health institutions
(MDPI, 2026-03-17) Montes-Pina, Laura; Badanta Romero, Bárbara; Diego Cordero, Rocío de; Enfermería; VII Plan Propio de Investigacin-V.1C Program; CTS1149: Salud Integral y Sostenible: Enfoque Bio-Psico-Social, Cultural y Espiritual para el Desarrollo Humano
Background/Objectives: The healthcare sector, despite its mission to protect health, is a major consumer of resources and emitter of greenhouse gases, giving rise to an ethical and governance paradox: how to reconcile the duty of care with the environmental impact of its activities. In the Spanish healthcare system, which is highly decentralized and regulated at multiple levels, this tension shapes the implementation of environmental policies. This study analyzes the governance and implementation of environmental regulations in Spanish healthcare institutions and the associated experiences. Methods: A qualitative, exploratory, descriptive study was conducted using effective meetings and semi-structured interviews with 20 participants, working in healthcare provision and environmental management within health institutions, across different regions of Spain, between September 2024 and November 2025. In addition, a documentary analysis of relevant regulations was undertaken. Results: The results indicate that Spanish healthcare institutions improve their environmental performance through the implementation of standards such as ISO or EMAS, although their adoption varies according to each institution’s level of development in environmental management. In addition, differences were observed in the environmental dynamics of healthcare institutions, linked to the decentralization of the Spanish healthcare system, as well as administrative barriers to accessing funding and gender disparities in environmental leadership. Conclusions: The standardization of environmental regulations and measures across the country, along with strengthening organizational capacity, could strengthen progress toward more sustainable healthcare.
Measuring hospitalised patients' experiences of sleep and rest: development and validation of a nursing-informed patient-reported instrument
(Elsevier, 2026-05-19) Porcel Gálvez, Ana María; Allande Cussó, Regina; Swanson, Elisabeth; Mejías-Martín, Yolanda; García-Juárez, María del Rosario; Moorhead, Sue; Enfermería; CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud
Background: Sleep and rest are fundamental to recovery during hospitalisation and are highly sensitive to nursing care. However, they are rarely assessed systematically in a way that captures patients' experiences and caresensitive dimensions within routine nursing practice. Aim: To develop and psychometrically evaluate a patient-reported, nursing-informed instrument of hospitalised patients' experiences of sleep and rest, derived from selected Nursing Outcomes Classification (NOC) indicators. Methods: A multicentre, cross-sectional psychometric study was conducted in two phases. First, a panel of experts reached consensus on relevant NOC outcomes and indicators related to sleep and rest. Second, the resulting instrument was administered to 1060 adult patients hospitalised in Internal Medicine units across eight hospitals. Psychometric evaluation included factor analyses, internal consistency assessment, hierarchical latent structure analysis and convergent validity testing. Results: Analyses supported a three-dimensional structure encompassing physiological, contextual and emotional domains, explaining 70.6% of the total variance. The confirmatory model showed good overall fit, and reliability estimates indicated high internal consistency for both the total instrument and individual dimensions. Hierarchical modelling revealed a strong general latent factor underlying the three domains, supporting the primary interpretation of an overall score, with dimension-specific information considered supplementary. Conclusions: The findings support the validity and reliability of a multidimensional, nursing-informed instrument to assess patients' experiences of sleep and rest during hospitalisation. The instrument provides a clinically meaningful framework informed by nursing theory and operationalised using selected NOC indicators, facilitating systematic nursing assessment of sleep and rest during hospitalisation.
Quality of work life, resilience, gratitude and social support in workers of a city council: a descriptive cross-sectional study
(SEAPA (Sociedad de Enfermería Familiar y Comunitaria de Asturias), 2026) Fernández Garrido, Carmen; de-Pedro-Jiménez, Domingo; Vega Escaño, Juan; Curcio, Felice; Pérez Jiménez, José Miguel; Diego Cordero, Rocío de; Enfermería; CTS1149: Salud Integral y Sostenible: Enfoque Bio-Psico-Social, Cultural y Espiritual para el Desarrollo Humano
Objectives: The quality of work life influences the well-being, productivity, and satisfaction of workers. The aim of this study was to analyse the associations between resilience, gratitude, social support, sociodemographic, occupational, and health factors with quality of work life among mu-nicipal employees. Methods: A cross-sectional descriptive analy-sis was conducted on 374 municipal employees between June and November 2023. Sociodemo-graphic, health, and lifestyle variables, occupation-al factors, the gratitude questionnaire, and scales of resilience, social support, and quality of work life were collected. A sequential multiple linear regression was performed to assess the associa-tions of the collected variables with the quality of work life. The study was approved by the Bioethics Committee of Granada (record number 5/23). Results: Significant relationships were found between quality of work life and perceived health, experience, resilience, gratitude, social support, and levels of stress and job satisfaction. Conclusions: Resilience, gratitude, social sup-port, lower stress, and higher job satisfaction are positively associated with better quality of work life. Occupational health nursing plays a key role in improving well-being in the work environment, using tools such as social support, gratitude, and recognition.
Effectiveness of chlorhexidine gluconate–impregnated dressings in preventing central line–associated bloodstream infection in a paediatric intensive care unit: A randomised controlled trial
(Elsevier, 2026-05-07) Francisco Javier Portero-Prados; Pabón Carrasco, Manuel; Ponce Blandón, José Antonio; Enfermería; CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud; CTS284: Promoción de la Salud
Objectives To compare the effectiveness and dermatological safety of chlorhexidine gluconate (CHG)-impregnated dressings versus conventional transparent dressings in preventing central line–associated bloodstream infection (CLABSI) in paediatric patients admitted to a PICU. Methods A single-blind, randomised controlled trial with a 1:1 allocation ratio was conducted in a tertiary PICU. A total of 250 paediatric patients with a central venous catheter were included (125 per group). Patient characteristics, catheter-related variables, catheter dwell time and skin alterations were recorded. The primary outcome was CLABSI, defined according to CDC/NHSN criteria. Bivariate analyses and multivariable logistic regression were performed, including clinically relevant covariates related to catheter exposure, dressing type, and vaccination status. The trial was registered at ClinicalTrials.gov (NCT07175116). Results CLABSI incidence was significantly lower in the CHG group compared with the conventional dressing group (2.4% vs. 18.4%; p < 0.001). In multivariable analysis, CHG-impregnated dressings were independently associated with reduced CLABSI risk (OR = 0.15; 95% CI: 0.04–0.58). Longer catheter dwell time (OR = 1.13 per day; 95% CI: 1.04–1.22) and absence of complete vaccination (OR = 8.68; 95% CI: 2.48–30.47) were also associated with increased infection risk. Incomplete vaccination showed a similar trend without reaching statistical significance (OR = 6.48; 95% CI: 0.95–44.20). Skin alterations were more frequent in the CHG group (16.8% vs. 11.2%), predominantly in younger infants. Conclusions CHG-impregnated dressings were associated with a significant reduction in CLABSI incidence in critically ill paediatric patients, although their use was linked to a modest increase in mild skin reactions. Implications for clinical practice CHG-impregnated dressings may be considered as part of a multifaceted infection prevention strategy, alongside appropriate catheter management, minimisation of catheter manipulation and proactive skin monitoring, with cautious and individualised use in infants.
Instruments for assessing spirituality in patients with chronic or advanced illnesses: a systematic review of the last 15 years
(MDPI, 2026-04-12) Portillo-Gil, María Ángeles; Lucchetti, Giancarlo; Diego Cordero, Rocío de; Enfermería; CTS1149: Salud Integral y Sostenible: Enfoque Bio-Psico-Social, Cultural y Espiritual para el Desarrollo Humano
Background/Objectives: Spirituality is a key component of coping and well-being in chronic and advanced illness, yet its assessment remains inconsistent across clinical settings. To identify, classify, and critically analyze the most commonly used and validated instruments for measuring spirituality in clinical contexts, focusing on their ability to assess the current spiritual state from a multidimensional perspective (cognitive, behavioral, and affective expressions). Methods: A systematic literature review was conducted using PubMed, Scopus, and Web of Science (2011–2024). Inclusion criteria targeted validation studies of instruments assessing spirituality in adults with chronic or advanced illnesses or in palliative care. A dual conceptual–functional classification was applied, and a custom scoring system was developed to evaluate psychometric quality. Contamination and tautological aspects were also examined. Results: Forty-three instruments were identified across 42 studies. Of these, 93.02% included cognitive, affective, and behavioral dimensions. Most were validated in oncology or chronic disease populations. Content validity and internal consistency were the most reported psychometric properties; responsiveness was rarely evaluated. Conclusions: The available instruments reflect several conceptual and functional approaches. The classification proposed in this review provides practical guidance for selecting scales according to specific clinical goals and settings, supporting the evaluation of the current spiritual state and the integration of spirituality into healthcare practice. Further research is recommended to develop culturally sensitive and responsive instruments suitable for diverse clinical contexts.
Gender Bias in Clinical Trials of Sodium–Glucose Cotransporter 2 Inhibitors for the Treatment of Type 2 Diabetes Mellitus: A Systematic Review
(Wiley, 2025-04-22) Lora Escobar, Santiago José; Rodríguez de Francisco, Lupe; López Feijoo, Manuel; Santos Ramos, Bernardo; Bellido, Virginia; Casado Mejía, Rosa María; Acosta García, Héctor; Enfermería; SEJ066: Mujeres, Bienestar y Ciudadanía
Aims: The study is aimed at assessing gender bias in Phase III clinical trials (CTs) of sodium–glucose cotransporter type 2 (iSGLT2) inhibitors in adults with Type 2 diabetes mellitus (T2DM). Methods: We searched PubMed and EMBASE databases until June 2023. To estimate sex bias in recruitment, the difference between F-Particip (fraction of women recruited) and F-Prev (prevalence fraction of women with T2DM) was calculated. A significant sex bias in recruitment was considered to exist when the difference between F-Particip and F-Prev was greater than 0.05, 0.1, and 0.2. The analysis was considered to have a sex bias when the efficacy variables were not analyzed by sex. Gender of the first, last, and corresponding author was also assessed. Results: In total, 70 articles met all inclusion criteria. Sex bias in recruitment showed variable results depending on the reference value. No significant sex bias in recruitment was found in the total number of included patients. Examining each CT individually, using values of significant sex bias in recruitment of ±0.05, ±0.1, or ±0.2, we found that 41.4%, 20%, and 5.7% of the trials, respectively, showed this bias. In 34.3% of the articles, women were the first, last, or corresponding authors. Sex-based analysis of the results was performed in five studies. Conclusions: Although the proportion of women included in iSGLT2 CTs seems acceptable, gender bias persists in the analysis of variables and in the study authors. However, the lack of gender focus may be explained by the characteristics of the patients included in the CTs.
Care as a Central Concept: Dimensions, Inequalities and Challenges in Chronic Care in Contemporary Societies: A Narrative Review
(MDPI, 2026-01-30) Torres Enamorado, Dolores; Casado Mejía, Rosa María; Enfermería; SEJ066: Mujeres, Bienestar y Ciudadanía
Background/Objective: Feminist theories and feminist economics have contributed to making visible the structural relevance of care work in sustaining capitalist societies and social reproduction, arguing that care must be addressed as a political phenomenon rather than a merely domestic issue. This perspective is particularly pertinent in contemporary healthcare, where chronic care represents one of the major public health challenges in a context of population ageing and increasing prevalence of chronic diseases. The aim is to contribute to a critical understanding that can support the development of public policies recognizing care as a fundamental pillar of socio-healthcare provision and as a matter of collective responsibility. Methods: A narrative literature review with a critical feminist approach was conducted using PubMed/MEDLINE, Scopus, and Web of Science. Results: A total of 299 records were identified, of which 30 studies were included following screening and eligibility assessment. Care is an essential element for sustaining life, although it has historically been rendered invisible, feminized, and relegated to the private sphere. Chronicity requires simultaneous consideration of the material dimension of care (as work), the subjective dimension (including emotional bonds and moral responsibility), and the political dimension (shaped by power relations). Global care chains reveal persistent inequalities related to gender, class, and race. Conclusions: Care is a structural, political, and transnational category that sustains life and healthcare systems. In the field of chronic care, the recognition, redistribution, and socialization of care are essential for achieving social justice and for safeguarding the dignity of both caregivers—predominantly women—and care recipients.
Chemsex y riesgo sexual en hombres que tienen sexo con hombres: una revisión de alcance
(Elsevier, 2026-01-16) Ayuga Luque, Miguel Ángel; Torres Enamorado, Dolores; Casado Mejía, Rosa María; Enfermería; SEJ066: Mujeres, Bienestar y Ciudadanía
Objetivo: Analizar si el chemsex constituye, por sí solo, un factor de riesgo sexual en hombres que tienen sexo con hombres (HSH), especialmente respecto al sexo sin preservativo y la adquisición de infecciones de transmisión sexual (ITS). Diseño: Revisión de alcance realizada siguiendo la guía PRISMA-ScR. Fuentes de datos: Se consultaron PubMed®, WOS®, Scopus®, CINAHL®, CUIDEN® y BV-SSPA entre diciembre de 2023 y enero de 2024. Se usaron descriptores como «Sexual and Gender Minorities», «Chemsex», «Sexual Behavior» y «Sexually Transmitted Diseases». Selección de estudios: Se identificaron 1.168 referencias. Tras eliminar duplicados y aplicar criterios de inclusión, se seleccionaron 19 estudios. Se exigió definición explícita de chemsex y análisis directo de su relación con sexo sin preservativo y/o ITS. Extracción de datos: Tres revisores extrajeron los datos. Se recogieron variables sobre tipo de estudio, rol del chemsex, uso de preservativo, cribado de VIH/ITS, uso de PrEP y prevalencia de ITS bacterianas. Resultados: El chemsex se asoció con mayor prevalencia de sexo sin preservativo (hasta el 79%) y más ITS (gonorrea: 57,4% en chemsexers vs. 39,1%). También se observó mayor uso de PrEP, sin clara disminución de ITS. No se reportaron intervalos de confianza ni análisis de sensibilidad de forma uniforme. Conclusiones: El chemsex representa una práctica sexual de riesgo en HSH. Se requieren intervenciones desde atención primaria centradas en prevención, diagnóstico precoz y educación sexual.
Effects of a Cluster Randomized Educational Intervention on Knowledge and Attitudes Toward Women’s Trafficking Among Undergraduate Nursing Students
(MDPI, 2025-12-15) Ramirez Zambrana, Cristina; León Larios, Fátima; Ruiz Ferrón, Cecilia; Casado Mejía, Rosa María; Enfermería; HUM873: Centro de Investigación y Acción Comunitaria de la Universidad de Sevilla; SEJ066: Mujeres, Bienestar y Ciudadanía
Background/Objectives: Sex trafficking is a form of modern-day slavery still present in our societies. Health professionals are in a key position to identify and support victims, but adequate training is required. The aim of this study was to analyze the impact of a structured educational intervention on knowledge, perceived professional role, and attitudes toward sex trafficking of women among undergraduate nursing students at the University of Seville, Spain. Methods: A cluster randomized pilot educational trial with a pre-test–post-test control group design and one-year follow-up was conducted. A two-hour educational session addressed key concepts related to sex trafficking, health professionals’ responsibilities, and survivor support. Knowledge and attitudes were assessed at baseline, immediately after the intervention, and at one-year follow-up. Results: 199 students participated. Significant post-intervention improvements were observed in knowledge and attitudes, with sustained impact after one year despite some knowledge decay. Conclusions: This pilot educational intervention appears to improve knowledge and attitudes toward sex trafficking among undergraduate nursing students and may represent a useful strategy for sensitizing and training future health professionals in this area.
Applications of artificial intelligence in the detection and prevention of assaults against healthcare Staff: A systematic review
(Elsevier, 2026-04-22) Moreno-Moreno, Antonio J.; García-Iglesias, Juan Jesús; Castaño Seiquer, Antonio Luis; Ribas Pérez, David; Fagundo-Rivera, Javier; Ruger-Navarrete, Azahara; Allande Cussó, Regina; Gómez-Salgado, Juan; Estomatología; Enfermería; CTS353: Estomatología Infantil y Ortodoncia; CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud
Background: The rising incidence of physical, verbal, and psychological assaults on healthcare workers has become a critical occupational and public health concern. Such incidents negatively impact staff well-being, contribute to burnout, and compromise the overall quality of patient care. Objectives: To explore how artificial intelligence (AI) techniques, including machine learning, deep learning, and natural language processing, can be applied in healthcare settings to detect, prevent, or mitigate workplace assaults against healthcare staff. Additionally, it sought to identify the most effective technical and ethical strategies for implementing AI-based interventions. Methods: A systematic review was performed following the PRISMA 2020 guidelines. Searches were conducted between July and August 2025 in electronic databases (PubMed, Scopus, Web of Science, CINAHL, IEEE Xplorer, and Google Scholar) and AI-assisted bibliographic tools (Perplexity, SciSpace, and Elicit). Studies were screened and assessed for methodological quality using the Joanna Briggs Institute critical appraisal tools. Results: Seventeen studies met the inclusion criteria. Evidence indicates that AI can play a substantial role in enhancing staff safety. Approaches include smart sensors for real-time detection of aggressive behaviors, deep learning models analyzing clinical notes to predict violent incidents, advanced natural language processing systems (BERT, GPT, RAG-ECE) for identifying threatening language, and interpretable machine learning algorithms (LightGBM-SHAP-ALE) for pinpointing key risk factors. Conclusions: Predicting and preventing violence in healthcare is a complex challenge requiring multidisciplinary solutions. AI offers promising tools for early detection, accurate prediction, and effective intervention. However, implementation must consider technical limitations, algorithmic bias, privacy concerns, and the necessity of human oversight.

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