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 analyzed 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.

During the COVID-19 pandemic, the world's healthcare systems were extremely strained. Intensive care units were stretched to capacity and healthcare facilities were forced to set up spaces to care for critically ill patients. Professionals were required to work in strenuous conditions, completely disrupting their work routines.In this scenario, hand hygiene and the use of gloves by healthcare professionals became a critical point of transmission risk.The results of the ENVIN study in 2020 and 2021, corresponding to the pandemic period, showed worrying data on the increase in infection rates, with rates rising by 250% at the worst moments of the pandemic. This suggested that excessive risk situations were occurring for the patient. Any preventive strategy must place correct hand hygiene and proper use of gloves among its priority objectives. For this reason, the Project Zero Advisory Board made a series of adaptations and recommendations based on available evidence and expert opinion related to hand hygiene and glove use during the pandemic situation to promote best practice in extreme situations. This article reviews the key aspects of hand hygiene as part of the WHO safety strategy, the main barriers to compliance and the main adaptations proposed by the Advisory Board of the Zero projects.

Purpose/Aims To explore nurses' perceptions of clinical nurse specialist practice as implemented in a highly specialized university hospital in Spain. Design A descriptive qualitative study was carried out in 3 inpatient wards, with a clinical nurse specialist within the team, at a highly specialized university hospital in Spain. Method Semistructured interviews were conducted by purposive sampling with 17 selected nurses with at least 2 years of professional experience who voluntarily agreed to participate and signed the informed consent form. Analysis of the qualitative data was conducted according to Burnard's method of content analysis. The Consolidated Criteria for Reporting Qualitative Research checklist was used. Results Four main categories emerged from the analysis of the data: "qualities of the role-holder," "role competencies in practice," "integration with the team," and "impact of the role" on nursing, the patient, and the organization. Conclusions The findings of this study have interesting implications for the development and implementation of clinical nurse specialist practice in healthcare organizations. They also provide evidence of the benefit of implementing clinical nurse specialist practice for improving the quality of care, patient outcomes, and healthcare efficiency.

Understanding the unique experience of nursing students providing frontline support in COVID-19 hospital wards is crucial for the design of strategies to improve crisis management and mitigate future pandemic outbreaks. Limited research concerning this phenomenon has been published. This qualitative study aimed to understand the experience of providing support from COVID-19 frontline nursing students' perspective. Online interviews were conducted with nine nursing students from April to May 2020; interview data were analyzed by content analysis using Burnard's method. Six main categories emerged from the data analysis: "experiencing a rapid transition from student to professional," "fear and uncertainty of the unknown," "resilience throughout the crisis," "sense of belonging to a team," "shared responsibility," and "importance of the profession." Based on these findings, multicomponent strategies that function in parallel with practical contexts should be developed to enable students to diligently adapt their abilities to their new role and cope with health crises.

goal Main objective: To evaluate the level of satisfaction of new nurses with the high-fidelity clinical simulation at training of CPR during Covid-19. Methodology: Cross-sectional descriptive observational study. The High Fidelity Clinical Simulation Satisfaction Scale was used, questionnaire validated with 33 items with response subject Likert. Descriptive statistics and nonparametric inferential statistics (Spearman correlation) were used to analyze the correlation between variables. Main results: N=35 (100%). Overall satisfaction average was 4.97±0.17. The items relating to the appropriateness of the cases to the knowledge of the participants, the ability to provide care to patients, the benefit of the simulation and the impact on the improvement of their technical skills were the highest rated (average of 4.97). A strong positive relationship was found between items: 4-9, and 27-9 (rho= 0.804; p=0.000). Main conclusion: The level of satisfaction of new nurses with the high-fidelity clinical simulation was high, confirming its usefulness in the CPR learning process during Covid-19 or pandemic outbreaks of the same nature.

The negative impact of the pandemic on the fees of controlled infections has highlighted the need to resume the application of the Project Zero (PZ) recommendations. In this article, firstly, an analysis of the status of intensive care units in Spain during the pandemic is made. This is followed by the adaptation of the recommendations of each of the four PZs and their Degree compliance and risk of invasive device-related infections and/or multidrug-resistant bacteremia. For this purpose, we have taken into account: 1) the document published in October 2020 by the committee advisor of the Critical Patient Safety Program, and 2) the exploratory study carried out, one year later, by the committee advisor of the PZs, together with the project leaders of the units participating in the ENVIN registry. Finally, based on the findings, five tentative and priority recommendations are formulated.

Background. Establishing the level of chronic cardiac inpatient empowerment is essential. By doing so, it is possible to identify groups with a lower level. It also provides a basis for designing effective strategies to improve their control over decision making and the actions that affect their health and wellness. The shortage of studies of this phenomenon for this particular population and context suggests that such patients are not receiving proper care. Methods. A prospective and descriptive study was carried out. A validated Spanish version of the Patient empowerment in long-term conditions scale was used. The survey has 47 items, grouped into three dimensions: Positive attitude and feeling of control, Knowledge in shared decision making, and Seeking information and sharing with other patients. It was distributed 24 hours before hospital discharge. Results. Twenty five questionnaires were collected (81%). The mean global empowerment score of the patients was 165.92 +/- 20.9. The dimension Positive attitude and sense of control showed the lowest score, with a mean of 3.4 +/- 0.5. An inverse weak relationship was found between the level of empowerment and age (rho =-0.240; p = 0.000) while a positive one was found with 10-year survival (rho = 0.316; p= 0.01). Conclusion. The level of empowerment of the patients in this study was medium-high. The strategies used to address the care of this population should focus on working on their attitude towards the disease and perceived control of the situation, and should be individualized according to age.

This chapter presents how the advanced role has been developed during the postgraduate training through the model PEPPA and what has been its implication on the area Cardiology hospitalisation.