Resumen: En el presente artículo se describe la evolución del sistema sanitario catalán utilizando, para ello, el desarrollo de un concepto cultural –el hospitalo-centrismo– clave para entender la hegemonía de la institución hospitalaria en los dispositivos de salud actuales. A tales efectos y utilizando dos perspectivas complementarias como son la historia antropológica y la antropología médica, el artículo analiza un case study a partir de tres ejemplos: la demanda de urgencias hospitalarias asociadas a una concepción cultural de lo que es “grave” y al embodiment de su eficacia por los ciudadanos; la necesidad del rol de asilo en las enfermedades crónicas o terminales; y la conversión del cuidado doméstico como “hospitalización doméstica” en el caso de la salud mental. Palabras clave: hospital-centrismo, sistema sanitario, historia de hospitales, urgencias, cuidados crónicos, salud mental. This article describes the evolution of the Catalan Health System, using the development of a key cultural concept –hospital-centrism– to understand the hegemony of the hospital institution in the current health devices. To this purpose, and using two complementary perspectives such as anthropological history and medical anthropology, the article analyzes a case study from three examples: the demand for hospital emergencies related with a cultural conception of what is “severe”, and with its effectiveness embodied by the citizens; the need of the asylum role in chronic or terminal diseases; and the transformation of domestic care to “domestic hospitalization” in mental health cases. Keywords: hospital-centrism, health system, history of hospitals, emergencies, chronic care, mental health.

(1) Background: Studies have shown that clinical experience has an impact on how students perceive geriatric care. The vulnerability of older people particularly allows students to reflect on and evaluate their learning. In this context, communication between tutors and students is important to guiding a contextualized view of the complexity of clinical situations. The principal objective was to explore the feelings, perceptions, and experiences of nursing students in geriatric care units during their practices. (2) Methods: This is a qualitative study using content analysis where the data collected were analyzed deductively. An intentional sample of 81 nursing degree students enrolled in the subject of clinical practices. During these sessions, a dynamic discussion forum was incorporated. (3) Results: There were 6 forums with a total of 591 participants, with an average of 98.5 per forum. Four categories emerged: humanization, geriatric nurse, aging, and learning. (4) Conclusions: A change of management oriented to the person-centered model would improve the quality in the residences and as well as in the expectations of the students towards geriatric nursing. Changing perspectives could be a way to confront and become aware of the fallacies of care that have been evidenced. This study was not registered.

A finales de los años cincuenta del siglo pasado, en Asturias, se empezó a implantar una nueva manera de entender el hospital, cuya influencia terminaría siendo enorme y decisiva en la modernización de la organización hospitalaria española. Proyectado para ser utilizado por cualquier tipo de enfermo, tanto por su patología como por su situación económica, el Hospital General de Asturias (HGA) se convirtió en el pionero del Estado español en implementar una estructura jerárquica en todos sus servicios médicos, clínicos y comunes, tanto en hospitalización como en consultas externas y en urgencias. Otra de sus consecuencias más palpables fue la introducción de la formación sanitaria especializada en España mediante la creación del primer programa de médicos residentes. Hasta entonces, el hospital era todavía un recurso asistencial poco accesible a amplios sectores de la ciudadanía, lo que demuestra la existencia de un desajuste cronológico en relación con lo sucedido en otros países europeos de referencia. El modelo organizativo del HGA supuso el punto de inflexión para el desarrollo de un proceso más amplio de reforma hospitalaria que acabó rompiendo definitivamente con los conceptos ya obsoletos de hospital «autónomo» y «cerrado». El primero se integró dentro de una coordinación funcional y escalonada de hospitales en red, conocida como «regionalización», y el segundo quedó eclipsado por la hegemonía del hospital «abierto» a toda la comunidad. Esta nueva realidad exigió el desarrollo e implantación de unos rigurosos criterios de acreditación en los hospitales para homologarse con los establecidos por la doctrina hospitalaria internacional y para ofrecer un mínimo de garantías, a empresas aseguradoras y usuarios, de la calidad y racionalidad de su oferta de servicios. Las consecuencias de este proceso acabaron por implantar una nueva cultura sanitaria en la población fundamentada sobre una visión hospitalocéntrica del sistema sanitario.

Background: The context of the pandemic in Spain meant a high demand for care. The purpose of this pilot work was to determine the stress factors, conducted on final-year nursing students at a Spanish university, who volunteered to carry out healthcare tasks, in pandemic and post-pandemic contexts. Methods: An observational prospective cohort pilot survey was conducted with an intentional sampling of the forty-seven students. We collected sociodemographic and stressor data using the validated KEZKAK questionnaire. The STROBE checklist was used to evaluate the study. Results: The median scores obtained from nursing students incorporated as auxiliary health workers are lower than those who were not incorporated, and statistically significant differences were found: lack of skills and abilities (p = 0.016); relationship with tutors and colleagues (p = 0.004); impotence and uncertainty (p = 0.011); inability to manage the relationship with the patient (p = 0.009); emotional involvement (p = 0.032); distress caused by the relationship with patients and item overload (p = 0.039); and overload items (p = 0.011). The post-pandemic only maintained “lack of skill and abilities” (p = 0.048), from nursing students incorporated as auxiliary health workers. Conclusion: This pilot study showed that nursing students who joined as auxiliary health personnel presented less perceived stress than non-incorporated nursing students. Still, more prospectively designed clinical research is needed.

(1) Background: Clinical practice constitutes a scenario where the student approaches reality. The pedagogical relationship that is built between the nurse, the tutors and the student becomes important. And this requires intentional and reflective accompaniment. The principal objective was to design a hybrid-learner-centered training model requiring reflection and acquisition of specific skills. (2) Methodology: This was a prospective observational study using an intentional sample of 87 students. A hybrid model based on a dynamic virtual forum and Individual Improvement Plan (IIP) was constructed, evaluated using a self-completed questionnaire with a Likert scale. (3) Results: A model of accompaniment to the practices was built that allows for unifying a work plan. A transversal activity IIP was designed. A discussion forum was incorporated for each subject tutor. The analysis of the questionnaire showed that learning assessment, tutorials, virtual forums, self-assessment and satisfaction statistically differed. (4) Conclusions: The model allows students to be accompanied to acquire skills, knowledge, and attitudes and to develop critical thinking, as well as to improve the teaching quality of the practices of the Curriculum of the Nursing degree and to achieve their own competences through student-centered methodologies. This study was not registered.