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To adapt the Edinburgh Feeding Evaluation in Dementia Scale (EdFED) for use in a Spanish-speaking population and to assess its validity and reliability in patients with dementia. A cross-sectional study was carried out in two stages: 1. Cross-cultural adaptation (translation, back-translation, review by committee of experts, pilot test and weighting of results); 2. Clinimetric validation comprising interobserver reliability assessment, test-retest reliability and internal consistency. To determine construct validity, confirmatory factorial analysis and principal components analysis were performed by oblique rotations. Criteria validity was analysed using the Pearson correlation (p<0.05) with the BMI, MNA and analytical values of albumin, transferrin, cholesterol, absolute lymphocytes and total proteins. Data collection was carried out for six months in 2016 in nursing homes and Alzheimer's day centers in the province of Málaga (Spain), at nine centers, with 262 patients (aged over 60 years and presenting feeding difficulties), 20 nurses, 20 professional caregivers and 103 family caregivers. A version of EdFED culturally adapted to Spanish was obtained. The sample presented the following characteristics: 76.3% women, mean age 82.3 years (SD: 7.9); MNA 18.73 (SD: 4.44); BMI 23.99 (SD: 4.72); serum albumin 3.79 mg/dl (SD: 0.36). A Cronbach's alpha of 0.88 was obtained, with an inter-item global correlation of 0.43 and a homogeneity index ranging from 0.42 to 0.73. The exploratory factor analysis reproduced the three-factor model identified by the original authors, explaining 62.32% of the total variance. The criterion validity showed a good inverse correlation with MNA and a moderate one with albumin, total proteins, transferrin and BMI. The Spanish version of EdFED is reliable and valid for use in elderly people with dementia. The most appropriate for our environment is the three-factor model, which maintains the original factors, with a slight redistribution of the items.

IntroductionDementia conditions the patient’s nutrition from the beginning and vice versa. Generating difficulties for feeding (FEDIF) will influence its evolution. There are currently few nutritional longitudinal studies in people with dementia. Most focus on problems already established. The Edinburgh Feeding Evaluation in Dementia (EdFED) Scale identifies FEDIF of patients with dementia by studying their behaviours while eating or being fed. It also indicates areas of potential clinical interventions.Methods and analysisProspective multicentre observational study carried out in nursing homes, Alzheimer’s day care centres and primary healthcare centres. The study population will be dyads composed by the patient (diagnosed of dementia, over 65 years of age and who have feeding difficulties) and their family caregiver. Sociodemographic variables and nutritional status (body mass index, Mini Nutritional Assessment, blood test and calf and arm circumference) will be assessed. The Spanish version of the EdFED Scale will be completed and the presence of nursing diagnoses related to feeding behaviours will be collected. Follow-up will take place for 18 months.Ethics and disseminationAll data will be carried out respecting European legislation 2016/679 in data protection, and the Spanish ‘Organic Law 3/2018 of December 2005’. The clinical data will be kept segregated and encrypted. The informed consent has been obtained. The research has been authorised by the Costa del Sol Health Care District on 27 February 2020 and the Ethics Committee on 2 March 2021. It has obtained funding from the Junta de Andalucía on 15 February 2021. Findings of the study will be presented at provincial, national and international conferences and published in peer-reviewed journals.

Pressure ulcers represent a major current health problem and produce an important economic impact on the healthcare system. Most of studies to prevent pressure ulcers have been carried out in hospital contexts, with respect to the use of hyperoxygenated fatty acids and to date, no studies have specifically examined the use of olive oil-based substances. Main objective: To assess the effectiveness of the use of olive oil, comparing it with hyperoxygenated fatty acids, for immobilised home-care patients at risk of suffering pressure ulcers. Design: Non-inferiority, triple-blind, parallel, multicentre, randomised clinical trial. Scope: Population attending Primary Healthcare Centres in Andalusia (Spain). Sample: 831 immobilised patients at risk of suffering pressure ulcers. The follow-up period was 16 weeks. Groups were similar after randomization. In the per protocol analysis, none of the body areas evaluated presented risk differences for pressure ulcers incidence that exceeded the 10% delta value established. Sacrum: Olive Oil 8 (2.55%) vs HOFA 8 (3.08%), ARR 0.53 (-2.2 to 3.26) Right heel: Olive Oil 4 (1.27%) vs HOFA 5 (1.92)%, ARR0.65 (-1.43 to 2.73). Left heel: Olive Oil 3 (0.96%) vs HOFA 3 (1.15%), ARR0.2 (-1.49 to 1.88). Right trochanter: Olive Oil 0 (0%) vs HOFA 4 (1.54%), ARR1.54 (0.04 to 3.03). Left trochanter: Olive Oil 1 (0.32%) vs HOFA 1 (0.38%), ARR0.07 (-0.91 to 1.04). In the intention to treat analysis the lower limit of the established confidence interval was never exceeded. The results obtained confirmed that the use of topical extra-virgin olive oil to prevent PU in the home environment, for immobilised patients at high risk, is not inferior to the use of HOFA. Further studies are needed to investigate the mechanism by which olive oil achieves this outcome. Clinicaltrials.gov NCT01595347.

: Adults with type 1 diabetes (T1D) often experience psychological distress that interferes with their ability to maintain optimal self-care. The purpose of this study was to evaluate the effectiveness of the , a nurse-led structured diabetes self-management education (DSME) intervention designed to improve glycemic control, self-care practices and mental health among adults with T1D. : A total of 224 adults with type 1 diabetes were randomized and final analyses included 110 participants in the intervention group and 106 in the control group. The intervention group received the program, consisting of five daily 90 min sessions integrating education, skill training, self-management and coping strategies in addition to usual care. The control group received standard diabetes care. Outcomes were assessed at baseline, 1 month and 3 months. The primary measure was glycemic control and secondary outcomes including self-management, anxiety and depressive symptoms. : The intervention group achieved a significant increase in time in range at both 1 and 3 months. Self-management adherence improved significantly in the intervention group ( < 0.001). Anxiety and depression scores decreased significantly in the intervention group at 1 and 3 months, while they remained unchanged in controls. Regression analyses identified depressive symptoms as the strongest predictor of anxiety (OR = 4.34, 95% CI = 2.99-6.28, < 0.001), while female sex, older age, and low self-management were predictors of depression. Belonging to the intervention group was strongly protective against depression (OR = 0.11, 95% CI = 0.05-0.24, < 0.001). : The program significantly improved glycemic control, self-management, and psychological outcomes in adults with T1D. These findings highlight the dual clinical and mental health benefits of structured nurse-led DSME, supporting its integration into routine diabetes care. The trial is registered at ClinicalTrials.gov, ID: NCT05159843.

Aim To analyze the use of health services for children with severe chronic diseases, seeking to identify patterns of use according to sociodemographic and clinical conditions, and to identify unmet needs of care coordination that could benefit from nursing case management services. Design Cross‐sectional study. Methods Children treated in ambulatory and hospital care in Granada, Spain, with complex chronic diseases in 2016 were analyzed to determine their use of healthcare resources. Socioeconomic variables were evaluated, along with clinical status and duration of their conditions. Results In total, 265 children were analyzed (mean age 7.3 years, SD 4.63; 56.6% male). The average duration of the disease was 63.26 months (SD 54.09). The most common types of disease were neurological (35.80%), congenital (23.90%), and oncological (18.90%). Multivariate analysis showed that children in need of advanced care (β = 0.71), with a relatively recent diagnosis (β = ‐0.11), with criteria for palliative care 1 (β = ‐0.26), and whose mothers were older (β = 0.36) and had a higher educational level (β = 0.19) made greater use of healthcare resources during the preceding 12 months, whether urgent or scheduled (r2 = 78.0%, p < .001). Conclusions Children with higher needs for advanced care have a heterogeneous use of healthcare resources depending on certain clinical and sociodemographic determinants. This finding highlights the importance of the identification of profiles of children and families for care coordination. The presence of sociodemographic determinants may need individualized approaches to assure a timely health care utilization. Clinical Relevance A significant proportion of the children used multiple health services, being treated at several centers simultaneously, and producing up to 139 total yearly contacts with the health system. Policymakers, healthcare providers, and patients’ families should engage in a redesign of healthcare services for these children, providing comprehensive and coordinated systems of care for this population.

Purpose To develop an evaluation system of clinical competencies for the practicum of nursing students based on the Nursing Interventions Classification (NIC). Design and Methods Psychometric validation study: the first two phases addressed definition and content validation, and the third phase consisted of a cross‐sectional study for analyzing reliability. The study population was undergraduate nursing students and clinical tutors. Findings Through the Delphi technique, 26 competencies and 91 interventions were isolated. Cronbach's α was 0.96. Factor analysis yielded 18 factors that explained 68.82% of the variance. Overall inter‐item correlation was 0.26, and total–item correlation ranged between 0.66 and 0.19. Conclusions A competency system for the nursing practicum, structured on the NIC, is a reliable method for assessing and evaluating clinical competencies. Further evaluations in other contexts are needed. Clinical Relevance The availability of standardized language systems in the nursing discipline supposes an ideal framework to develop the nursing curricula.

Aim: To investigate the effect of using recordings derived from interventions in simulated mental health scenarios on the self‐critical capacity of nursing undergraduate students. Background: Video‐assisted debriefing (VAD) allows students to visualize their intervention, clarifying certain aspects that might be clouded in their memory. It facilitates the application of theoretical knowledge to real practice and the self‐critical capacity to detect strengths and weaknesses in the interventions developed. Despite the benefits of this educational resource, no previous studies have been found that analyze the impact of using recordings on the development of self‐critical capacity in the field of mental health by nursing students. Methods: An exploratory quasi‐experimental study was conducted based on quantitative and qualitative data collected from students after double debriefing sessions (verbal and video‐assisted). Quantitative data identified self‐critical capacity trends, while qualitative analysis explored in‐depth reflections on strengths, weaknesses, and emotional responses. Both datasets were integrated for comprehensive insights. Results: Quantitative data revealed no significant differences between the two self‐evaluation moments. However, the qualitative analysis brought a wide range of in‐depth reflections and identified strengths, especially during the VAD. In addition, students felt more reflective and critical about their performance when watching the video, highlighting feelings of self‐awareness and opportunities to identify more specific areas for improvement. Conclusions: This study underscores the importance of VAD in enhancing nursing students’ self‐perception of competencies and emotional responses during mental health simulation scenarios. Certain aspects of mental health care remain paramount for students regardless of video review, emphasizing the need for targeted training in these areas. Employing multiple approaches in data collection is essential to obtain a thorough understanding of students’ experiences. Implications for Nursing Management: Nursing managers should integrate clinical simulations and VADs into training programs to enhance competency development, reduce stress, and foster a supportive learning environment.

Background/Objectives: Patients with dementia present with feeding difficulties (FDs) since diagnosis, conditioning their progression. Early identification is vital for preventing deterioration due to nutritional problems. The Edinburgh Feeding Evaluation in Dementia Scale (EdFED) identifies the FDs of patients with dementia by studying their behaviours while eating or being fed. The aim of this study was to assess the responsiveness of the EdFED over time in older people with cognitive impairment and to compare its effectiveness in identifying malnutrition and risk with that of the gold standard Mini Nutritional Assessment (MNA) method. Methods: This was a multicentre, prospective, observational, longitudinal, analytic study with a follow-up period of 18 months (with patients participating in nursing homes and in the community). Sociodemographic and nutritional data (body mass index (BMI), MNA, forearm circumference (FC), calf circumference (CC), and a nutritional blood test) were collected; EdFED score was reported by nurses, nursing assistants, and family caregivers. Results: The total sample consisted of 359 individuals—60.7% residential participants and 39.3% community participants. In the last follow-up there were 149 remaining (41.5%). Malnutrition was more than 30%, and the risk was 40% at the three follow-ups. The results suggest that the EdFED scale is a useful tool for assessing feeding difficulties (FDs) in older persons with dementia. It demonstrated good sensitivity and specificity in detecting malnutrition, similar to the MNA, and, more importantly, detecting risk and also identifying changes in nutritional status over time. Conclusions: The EdFED scale provides a means of evaluating nutritional problems, making it possible to work on prevention.

Pressure ulcers represent a major current health problem and produce an important economic impact on the healthcare system. Most of studies to prevent pressure ulcers have been carried out in hospital contexts, with respect to the use of hyperoxygenated fatty acids and to date, no studies have specifically examined the use of olive oil-based substances. Methods and Design Main objective: To assess the effectiveness of the use of olive oil, comparing it with hyperoxygenated fatty acids, for immobilised home-care patients at risk of suffering pressure ulcers. Design: Non-inferiority, triple-blind, parallel, multicentre, randomised clinical trial. Scope: Population attending Primary Healthcare Centres in Andalusia (Spain). Sample: 831 immobilised patients at risk of suffering pressure ulcers. Results The follow-up period was 16 weeks. Groups were similar after randomization. In the per protocol analysis, none of the body areas evaluated presented risk differences for pressure ulcers incidence that exceeded the 10% delta value established. Sacrum: Olive Oil 8 (2.55%) vs HOFA 8 (3.08%), ARR 0.53 (-2.2 to 3.26) Right heel: Olive Oil 4 (1.27%) vs HOFA 5 (1.92)%, ARR0.65 (-1.43 to 2.73). Left heel: Olive Oil 3 (0.96%) vs HOFA 3 (1.15%), ARR0.2 (-1.49 to 1.88). Right trochanter: Olive Oil 0 (0%) vs HOFA 4 (1.54%), ARR1.54 (0.04 to 3.03). Left trochanter: Olive Oil 1 (0.32%) vs HOFA 1 (0.38%), ARR0.07 (-0.91 to 1.04). In the intention to treat analysis the lower limit of the established confidence interval was never exceeded. Discussion The results obtained confirmed that the use of topical extra-virgin olive oil to prevent PU in the home environment, for immobilised patients at high risk, is not inferior to the use of HOFA. Further studies are needed to investigate the mechanism by which olive oil achieves this outcome. Trial Registration Clinicaltrials.gov NCT01595347