Leal Costa, César

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Leal Costa, César

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Leal Costa, César

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Universidad de Murcia. Departamento de Enfermería

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Open Access
Assessing Evidence-Based Practice Competence in Nurse Leadership Roles in Spain
(Wiley, 2026) Pedro Simón Cayuela-Fuentes; César Leál-Costa; Serafín Fernández-Salazar; José Antonio Vera-Pérez; Antonio Jesús Ramos-Morcillo; María Ruzafa-Martínez; Segura López, Gabriel; Cayuela Fuentes, Pedro Simón; Leal Costa, César; Vera Pérez, José Antonio; Ramos Morcillo, Antonio Jesús; Ruzafa Martínez, María; Enfermería; Facultades de la UMU
ABSTRACT Objective: This study evaluated the competency of nursing leaders and managers in Spain regarding evidence-based practice (EBP) and identified factors that affect its implementation in clinical environments. Background: EBP is essential for enhancing healthcare quality; however, there are still gaps between theoretical knowledge and its practical application. Nursing leaders are crucial in promoting EBP, yet their competence levels and obstacles have not been thoroughly examined in Spain. Material and methods: A cross-sectional study surveyed 159 nurse managers across 16 autonomous communities in Spain, utilizing the validated EBP-COQ Prof tool. The questionnaire assessed four competency domains—attitude, knowledge, skills, and utilization—using a 1 to 5 Likert scale. Predictors of EBP competency, including training, mentorship, and organizational afiliation, were analyzed using multivariate linear regression. Results: Participants demonstrated a strong overall EBP competence, with an average total score of 143.77 out of 175. The highest scores were in the attitude domain (36.26/40) and knowledge (43.09/55), whereas utilization scores were relatively lower (37.57/ 50). This indicates that applying EBP in practice still lags behind positive attitudes and knowledge. Key factors predicting higher EBP competence included EBP training, consistent reading of scientific literature, mentoring nursing students, and working in a BPSO center. These results also imply that organizational constraints may continue to impede the integration of EBP competence into routine managerial practice. Conclusions: Spanish nurse managers possess strong EBP knowledge but continue to encounter difficulties in applying it clinically. The study highlights four adjustable factors of EBP competency that could guide focused interventions. Implications for Nursing Management: Healthcare institutions should implement (1) training programs for addressing knowledge-to-practice gaps, especially for nonspecialist managers; (2) mentorship systems pairing EBP-competent leaders with novices; (3) protected time for EBP activities; and (4) expanded BPSO accreditation to institutionalize evidence-based care. Future initiatives should include EBP metrics in performance evaluations, and research should explore factors such as leadership styles and the impact of resource allocation on patient outcomes through longitudinal designs.
Open Access
Prevalence of unwanted loneliness and associated factors in people over 65 years of age in a health area of the Region of Murcia, Spain: HELPeN Project
(MDPI, 2024-09-21) Hernández López, María Jesús; Hernández Méndez, Solanger; Leal Costa, César; Ramos Morcillo, Antonio Jesús; Díaz García, Isidora; López Pérez, María Verónica; García González, Jessica; Ruzafa Martínez, María; Enfermería; Facultades de la UMU::Facultad de Enfermería
Background/Objectives: Population aging poses many challenges to public health, highlighting loneliness and social isolation as severe problems that affect the physical and mental health of older adults. During the COVID-19 pandemic, these became aggravated. The objective of the present study was to assess the prevalence of loneliness and its relationship with social isolation, depression, cognitive deterioration, sleep quality, and the level of physical mobility and functioning of older adults in Health Area 3 of the Region of Murcia. Methods: A descriptive, observational, and cross-sectional study was performed. The inclusion criteria were age ≥ 65, living in Health Area 3 of the Region of Murcia, and not being institutionalized. The following variables were evaluated: sociodemographic variables, loneliness (UCLA scale), social isolation (DUFSS), depression (GDS), cognitive deterioration (Pfeiffer), sleep quality (PSQI), and mobility (Barthel index). A univariate and multivariate regression model was created to examine how the dependent variable was related to the independent variables. Results: A total of 102 older adults participated in the study. Of these, 31.4% perceived unwanted loneliness and 14.7% low social support. The multivariate regression analysis showed that social isolation, geriatric depression, and cognitive deterioration were significant predictors of loneliness. Conclusions: The findings highlight the importance of developing multifaceted interventions that address not only social isolation but also other interrelated factors such as depression, cognitive deterioration, and sleep quality. The strategies should be centered on community programs and support networks. It is fundamental to perform longitudinal studies to better understand the causal relationships between these variables.
Open Access
Reducing loneliness and social isolation through the HELPeN telephone-call program: results from a randomized controlled trial in older adults living in the community
(MDPI, 2026) Hernández López, María Jesús; García González, Jessica; Leal Costa, César; Ramos Morcillo, Antonio Jesús; Díaz García, Isidora; López Pérez, María Verónica; Hernández Méndez, Solanger; Ruzafa Martínez, María; Enfermería; Facultades de la UMU::Facultad de Enfermería
Background/Objectives: Loneliness is a significant public health issue among older adults, especially in rural and socioeconomically vulnerable groups. Telephone-based interventions have become a scalable, cost-effective way to reduce social isolation, although evidence of their long-term effects on various health outcomes remains limited. This study aimed to assess how effective HELPeN, a structured telephone program delivered by trained nursing students, is in decreasing loneliness and enhancing psychosocial and cognitive health in community-living older adults. Methods: A randomized controlled trial was conducted with 119 older adults (≥65 years) residing in the community. Participants were allocated to either an intervention group (n = 65), which received weekly structured telephone calls over 9 months, or a control group (n = 54), which received standard care. Outcomes were evaluated at baseline (M0), mid-intervention (M1–M3), and 3 months after the intervention (M4). The primary outcomes measured included loneliness and perceived social support. Secondary outcomes comprised functional status, comorbidities, depressive symptoms, quality of life, sleep quality, and cognitive function. The data were analyzed using repeated-measures ANOVA with Greenhouse–Geisser correction. Results: Significant group interactions over time were identified for loneliness (F = 5.92, p = 0.001, η2 = 0.067), social support (F = 3.39, p = 0.023, η2 = 0.043), depressive symptoms (F = 3.87, p = 0.019, η2 = 0.046), and cognitive status (F = 5.35, p = 0.002, η2 = 0.063). No significant differences were found for functional status, comorbidity, sleep quality, or quality of life. Conclusions: The HELPeN program demonstrated significant effectiveness in reducing loneliness and social isolation, and in improving emotional, cognitive, and sleep-related outcomes in older adults. As a low-cost and scalable model, this intervention strengthens the role of nursing students in addressing social determinants of health and may be integrated into community and public health strategies targeting vulnerable aging populations.
Open Access
DATA SET HELPeN Project Reducing Loneliness
(2026-03-10) Hernández López, María Jesús; García González, Jessica; Leal Costa, César; Ramos Morcillo, Antonio Jesús; Díaz García, Isidora; López Pérez, María Verónica; Hernández Méndez, Solanger; Ruzafa Martínez, María; Enfermería; Facultad de Enfermería
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The communication skills and quality perceived in an emergency department: the patient's perspective
(Wiley, 2020-03-11) Orcajada Muñoz, Irene; Amo Setien, Francisco José; Díaz Agea, José Luis; Hernández Ruipérez, Tomás; Adánez Martínez, María de Gracia; Leal Costa, César; Medicina
Aim: To examine the influence of health care provider's communication skills on the quality of care perceived by Emergency Department patients. Background: Communication between patients and health care providers in the context of Emergency Department is challenging and can potentially have a negative impact on the quality of care perceived by patients. Design: Cross-sectional descriptive study conducted in the Emergency Department at the University Clinical Hospital Virgen de la Arrixaca of Murcia, Spain. Method: Data were collected from 6 to 9 June 2016. Different instruments were used to evaluate the perception of patients on the communication skills and quality of care at the Emergency Department. Results. The sample was composed of 200 patients, with an average age of 44.1 (SD = 18.3), of which 106 (53%) were men. The multiple linear regression analysis showed the association between communication skills (respect, problem solving, and nonverbal communication) and age with the quality of care perceived by the patients. Conclusions: We found that the communication skills of the health care providers were explanatory variables of the quality of care perceived in an Emergency Department.
Open Access
Technology-Facilitated Online Sexual Violence, Consent Negotiation, and Coping Among AdultWomen: A Qualitative Study
(MDPI, 2026-03-27) Martínez Díaz, Azucena; López Barranco, Pedro José; Guillén Martínez, Ascensión; Pérez Franco, Isabel María; Leal Costa, César; Jiménez Ruiz, Ismael; Cayuela Fuentes, Pedro Simón; Segura López, Gabriel; Enfermería
Background/Objectives: Online sexual violence is an increasingly prevalent form of genderbased harm facilitated by digital technologies, with significant consequences for the health, well-being, and rights of adult women. Despite growing attention to this phenomenon, women’s lived experiences remain underexplored, particularly regarding sexual consent and institutional responses. This study aimed to examine how adult women experience online sexual violence, how consent is negotiated or constrained in digital contexts, and how coping and institutional mechanisms are perceived. Methods: A qualitative study with a hermeneutic phenomenological approach was conducted. Data were collected through three focus groups with 23 women aged 21 to 42 years who were active users of social media. Results: Participants reported diverse forms of online sexual violence, including unsolicited sexual messages and images, persistent harassment, coercion, blackmail, and threats. Sexual consent was often undermined by emotional manipulation, social pressure, and fear, placing women in vulnerable positions. These experiences negatively affected well-being, contributing to anxiety, reduced self-esteem, fear, and difficulties in sexual and emotional relationships. Coping strategies were mainly individual, such as blocking perpetrators or reporting content, while social support was frequently perceived as insufficient. A generalized distrust of institutional responses emerged, with formal mechanisms viewed as ineffective or inaccessible. Conclusions: For the study participants, online sexual violence is increasingly normalized and concealed within digital environments, reinforced by anonymity and impunity. The findings highlight the need for continued research and the development of interventions that include early sexual and emotional education, awareness-raising initiatives, digital regulation, specialized professional training, and the strengthening of victim-centered support networks.
Open Access
Evidence-based practice competence among nurses in acute and critical care settings: a national cross-sectional study in Spain – The #Evidencer Project
(Elsevier, 0012-05-26) Segura López, Gabriel; Cayuela Fuentes, Pedro Simón; Leal Costa, César; Vera Pérez, José Antonio; Ruzafa Martínez, María; Ramos Morcillo, Antonio Jesús; Enfermería; Facultades de la UMU
Objectives: This study assessed EBP competence among critical care nurses in Spain and identified significant factors affecting the integration of EBP into clinical practice. Methods: A multicenter cross-sectional study involved nurses in emergency departments, pre-hospital emergency services, and intensive care units throughout Spain. Competence was assessed through self-report using the validated EBP-COQ Prof© questionnaire, comprising 35 items divided into four dimensions: attitude, knowledge, skills, and utilization. Descriptive, bivariate, and multivariate regression analyses were conducted to identify the predictors of EBP competence. Results: The sample comprised 847 nurses (78.5% female; mean age 39.89 years, SD = 9.13). The average total EBP competence score was 130.6 (SD = 17.29). Scores across dimensions were highest for attitude (37.1/40) and knowledge (38.0/55), while skills (23.0/30) and utilization (32.6/50) were lower. Key predictors of higher competence included EBP training (p < 0.001), regular reading of scientific articles (p < 0.001), postgraduate education (p < 0.001), mentorship roles (p = 0.018), and employment at Best Practice Spotlight Organization® (BPSO) centers (p = 0.001). Competence declined slightly with increasing professional experience (p = 0.037). Conclusions: Spanish critical care nurses exhibit moderate to high competence in evidence-based practice (EBP), showcasing solid attitudes and knowledge but lacking practical application. Healthcare institutions should emphasize organized EBP training to close this gap, encourage research involvement, and cultivate supportive environments by implementing initiatives such as BPSO programs. Tackling these elements can bolster EBP implementation and enhance patient outcomes in critical care environments. Implications for clinical practice: These findings emphasize the need for strategies to improve evidence-based practice (EBP) in critical care. Healthcare organizations should focus on structured EBP education, regular access to scientific literature, and mentorship, including BPSO® programs. Enhancing EBP skills among experienced nurses can boost decision-making, patient safety, and care quality in high-acuity settings environments.
Open Access
Learners’ perspectives on interprofessional simulation and co-debriefng: an exploratory mixed-methods study
(Wiley, 2026-02-26) Díaz Agea, José Luis; Ros-Romero, Álvaro; Leal Costa, César; Vera Pérez, José Antonio; Cánovas-Pallarés, Juan Manuel; Piñero Zapata, Manuel; Cinesi-Gómez, César; Adánez Martínez, María de Gracia; Pujalte-Jesús, María José; Cayuela Fuentes, Pedro Simón; Segura López, Gabriel; José Luis Díaz-Agea; Enfermería
Introduction: Interprofessional simulation enhances both technical and nontechnical skills among healthcare professionals, improving their clinical practice. Co-debriefng, where two facilitators lead debriefng sessions, is a common approach in these trainings. This study aims to assess educational aspects of interprofessional simulation and co-debriefng in postgraduate medical and emergency nursing students. Methods: A descriptive cross-sectional study with a mixed-methods approach was conducted among postgraduate students (n = 46). A mixed-methods design was used, combining quantitative questionnaire data with qualitative content analysis of openended responses, allowing integration of numerical trends with in-depth learner perspectives. A valid and reliable ad hoc questionnaire was designed, and qualitative content analysis was used to examine participants’ free-text responses. Results: Students’ perceptions were evaluated across six dimensions: applicability, satisfaction, motivation, safe environment, organization, and co-debriefng. Signifcant diferences were found between medical and nursing students in all dimensions except applicability and organization. Overall, students rated interdisciplinary sessions and co-debriefng positively, though nurses highlighted areas for improvement, such as icebreaker activities, more dynamic simulations, and equal representation of both professions. Conclusions: While interprofessional simulation and co-debriefng were well received, participants—especially nurses—identifed areas for enhancement to ensure a more balanced and engaging learning experience. By integrating quantitative outcomes with qualitative insights, the study highlights when co-debriefng adds value in interprofessional simulation and when singlefacilitator approaches may be sufcient.
Open Access
Effectiveness of debriefing after a short training on brief tobacco intervention for nursing students: a randomized clinical trial
(Elsevier , 2025-05-13) Ramos Morcillo, Antonio Jesús; Leal Costa, César; Suárez Cortés, María; Molina Rodríguez, Alonso; Ruzafa Martínez, María; Enfermería; Facultad de Enfermería
Aim: To determine the effectiveness of debriefing after the objective assessment of brief tobacco interventions (BTI) training and its changes after 3 and 9 months. Design: Controlled clinical trial with random assignment by blocks. Methods: 145 sec-year students enrolled in a 4-year nursing degree program participated in the study, with 80 in the intervention group and 65 in the control group. Training according to the 5As (Ask, Advise, Assess, Assist and Arrange) and 5Rs (Relevance, Risks, Rewards, Roadblocks and Repetition) model was provided to both the control and experimental groups as a brief tobacco intervention strategy in primary care. Presentation of three clinical scenarios through videotaped objective structured clinical examination (VOSCE) and assessment with the BTI-St© tool. Posterior debriefing with the experimental group. Descriptive statistical analyses, 2-factor repeated measures ANOVA. Each subject was measured 5 times. (ID protocol: NCT06564766). Results: The time*group interaction results demonstrated significant differences with large effect sizes across all three scenarios. In the experimental groups, the most notable differences were observed immediately after the debriefing compared with baseline. Although these differences decreased over time, they remained present at 3 and 9 months in all scenarios relative to the baseline. Conclusions: The inclusion of debriefing in a brief intervention for learning about BTI within the context of primary care of nursing students resulted in a significant increase in their learning and greater durability, at least after nine months.
Open Access
Effects of a clinical simulation-based training program for nursing students to address social isolation and loneliness in the elderly: a quasi-experimental study
(MDPI, 2023-09-19) Hernández López, María Jesús; Ruzafa Martínez, María; Leal Costa, César; Ramos Morcillo, Antonio Jesús; Díaz García, Isidora; López Pérez, María Verónica; Hernández Méndez, Solanger; García González, Jessica; Enfermería
Introduction: The population of older adults is rapidly increasing worldwide, presentingboth prospects and complexities for society and healthcare professionals to maximize the functionalcapacity of this age group. Social isolation and loneliness significantly affect this population. Theobjective was to determine the effectiveness, satisfaction, and perceptions of the simulation-basededucation practices of a training program for nursing students, which was created to palliate thesocial isolation and loneliness of older adults. Method: A quasi-experimental study was conductedwith nursing students who participated in an online training program using teleservice based on high-fidelity clinical simulation. The program included asynchronous theoretical training and synchronouspractical training using an online platform. Five scenarios were designed using simulated phonecalls to address the social isolation and loneliness of older adults. Results: Twenty-five nursingstudents participated in the program, and they had a mean age of 27.44, with 76% of them beingwomen. After the training program, the participants showed statistically significant improvements(p< 0.05) with respect to their knowledge and attitudes towards older adults, and the programwas adapted to the best educational practices in simulations. Conclusions: Simulation-based onlinetraining efficiently improved the knowledge and attitudes of nursing students towards older adults,improving their ability to address social isolation and loneliness. The high satisfaction and adhesion tothe best educational practices underline the usefulness of high-fidelity online simulations, especiallyin situations in which face-to-face training is not feasible, and accessibility and equilibrium could beguaranteed between work and personal life.