Pub Date : 2025-02-27DOI: 10.1016/j.enfi.2025.500528
Beatriz Lobo-Valbuena MD, PhD, MBE , María Dolores Sánchez-Roca RN , María Pilar Regalón-Martín RN , Julia Torres-Morales RN , Victoria Enciso-Calderón MD
The follow-up of the critically ill patient at discharge is an essential process to ensure continuity of care and prevent complications after the stay in an intensive care unit (ICU). The nurse's role as coordinator of this follow-up is crucial because of her experience in managing complex care and her ability to act as a liaison between the patient, her family and the interprofessional health care team. The article highlights that the transition of the critically ill patient from the ICU to other inpatient units or home represents a vulnerable period, where the risk of readmission and complications is high. The nurse plays a central role in planning and executing a comprehensive discharge plan, which includes educating the patient and family about continuing care, communicating with other healthcare professionals, and recognising warning signs that require immediate medical attention. In addition, she addresses the emotional and psychological needs of the patient and family, providing support and resources to adjust to life post-ICU. The nurse acts as an advocate for the patient, ensuring that person-centred care is maintained, respecting the patient's preferences and values.
{"title":"Intervención interprofesional en la prevención de PICS y PICS-F","authors":"Beatriz Lobo-Valbuena MD, PhD, MBE , María Dolores Sánchez-Roca RN , María Pilar Regalón-Martín RN , Julia Torres-Morales RN , Victoria Enciso-Calderón MD","doi":"10.1016/j.enfi.2025.500528","DOIUrl":"10.1016/j.enfi.2025.500528","url":null,"abstract":"<div><div>The follow-up of the critically ill patient at discharge is an essential process to ensure continuity of care and prevent complications after the stay in an intensive care unit (ICU). The nurse's role as coordinator of this follow-up is crucial because of her experience in managing complex care and her ability to act as a liaison between the patient, her family and the interprofessional health care team. The article highlights that the transition of the critically ill patient from the ICU to other inpatient units or home represents a vulnerable period, where the risk of readmission and complications is high. The nurse plays a central role in planning and executing a comprehensive discharge plan, which includes educating the patient and family about continuing care, communicating with other healthcare professionals, and recognising warning signs that require immediate medical attention. In addition, she addresses the emotional and psychological needs of the patient and family, providing support and resources to adjust to life post-ICU. The nurse acts as an advocate for the patient, ensuring that person-centred care is maintained, respecting the patient's preferences and values.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 2","pages":"Article 500528"},"PeriodicalIF":1.1,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-27DOI: 10.1016/j.enfi.2025.500529
Cristina Pérez-Talavera RN, MSc
Introduction
Nursing in Intensive Care Units (ICU) presents an additional difficulty due to the highly complex nature of the patients. This implies a demand for training, skills, and management from the nurses attending to this type of patient, which is not currently guaranteed due to the lack of mandatory prior training. Despite the importance of such education and training, there is currently no existing regulation or national or international consensus regarding its mandatory requirement for performing professional activities in ICUs.
Objectives
The main research question posed is to identify the existing recommendations on specialized nursing care in adult intensive care.
Methodology
A scoping review was conducted using the databases PubMed, CINAHL, MEDLINE, COCHRANE, CUIDEN, and SciELO. The review included studies in both Spanish and English with varied designs on the topic of study. The quality of the articles was analyzed, achieving moderate to high levels of compliance with quality guidelines.
Results
A sample of N = 25 was selected, divided according to the primary theme of the articles: 40% (n = 10) on the implementation of training programs in ICUs, 24% (n = 6) on nursing competencies, 16% (n = 4) on the needs identified by ICU staff themselves, and 20% (n = 5) on the clinical specialty of ICU nursing.
Conclusions
The findings indicate an improvement in both patient outcomes and the functioning of ICUs following appropriate training of nursing staff. A model for an Intensive Care Nursing Specialty in Spain is proposed as a viable option to develop the necessary specific training.
{"title":"Especialización de enfermería en cuidados intensivos: una revisión de alcance","authors":"Cristina Pérez-Talavera RN, MSc","doi":"10.1016/j.enfi.2025.500529","DOIUrl":"10.1016/j.enfi.2025.500529","url":null,"abstract":"<div><h3>Introduction</h3><div>Nursing in Intensive Care Units (ICU) presents an additional difficulty due to the highly complex nature of the patients. This implies a demand for training, skills, and management from the nurses attending to this type of patient, which is not currently guaranteed due to the lack of mandatory prior training. Despite the importance of such education and training, there is currently no existing regulation or national or international consensus regarding its mandatory requirement for performing professional activities in ICUs.</div></div><div><h3>Objectives</h3><div>The main research question posed is to identify the existing recommendations on specialized nursing care in adult intensive care.</div></div><div><h3>Methodology</h3><div>A scoping review was conducted using the databases PubMed, CINAHL, MEDLINE, COCHRANE, CUIDEN, and SciELO. The review included studies in both Spanish and English with varied designs on the topic of study. The quality of the articles was analyzed, achieving moderate to high levels of compliance with quality guidelines.</div></div><div><h3>Results</h3><div>A sample of N<!--> <!-->=<!--> <!-->25 was selected, divided according to the primary theme of the articles: 40% (n<!--> <!-->=<!--> <!-->10) on the implementation of training programs in ICUs, 24% (n<!--> <!-->=<!--> <!-->6) on nursing competencies, 16% (n<!--> <!-->=<!--> <!-->4) on the needs identified by ICU staff themselves, and 20% (n<!--> <!-->=<!--> <!-->5) on the clinical specialty of ICU nursing.</div></div><div><h3>Conclusions</h3><div>The findings indicate an improvement in both patient outcomes and the functioning of ICUs following appropriate training of nursing staff. A model for an Intensive Care Nursing Specialty in Spain is proposed as a viable option to develop the necessary specific training.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 2","pages":"Article 500529"},"PeriodicalIF":1.1,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-25DOI: 10.1016/j.enfi.2025.500531
María Esther Salgado-Reguero PhD candidate, MsC, RN , Sara Furtado-Eraso PhD, RN , Arantxa Bujanda-Sainz de Murieta PhD candidate, MsC, RN , Cristina García-Vivar PhD, RN , Nelia Soto-Ruiz PhD, RN , Paula Escalada-Hernández PhD, RN
Background
The international HU-CI project advocates 8 strategic strands for the humanization of intensive care units. Despite of adult ICUs have received attention to promote humanization of care, in the pediatric context, the humanization of care continues to receive limited attention, with limited data on pediatric structures and humanization patterns lacking integration into practice.
Objectives
Identify available evidence related to humanization concepts according to the theoretical framework of the HU-CI Project and understand the implementations in the field of pediatric intensive care units.
Method
A scoping review was conducted through a literature search in PubMed and CINAHL. Studies addressing concepts or elements related to the strategic lines of the HU-CI framework within the context of pediatric intensive care units were included. The perspective of patients, families, and frontline healthcare professionals was considered, using quantitative, qualitative, and mixed methods approaches. Data analysis followed a narrative approach, categorically synthesized according to the strategic lines of the HU-CI framework in pediatric intensive care units.
Results
A total of 41 articles were included. Within the 8 action lines of action of the HU-CI framework, end-of-life care and communication predominated over flexible schedules, family presence and participation in care, patient well-being, professional care, post-ICU syndrome and humanized infrastructure.
Conclusions
The analyzed action lines suggest the need for development and improvement through further research to facilitate their full integration into the practice of pediatric intensive care units.
{"title":"Estrategias de humanización en cuidados intensivos pediátricos: una revisión de alcance","authors":"María Esther Salgado-Reguero PhD candidate, MsC, RN , Sara Furtado-Eraso PhD, RN , Arantxa Bujanda-Sainz de Murieta PhD candidate, MsC, RN , Cristina García-Vivar PhD, RN , Nelia Soto-Ruiz PhD, RN , Paula Escalada-Hernández PhD, RN","doi":"10.1016/j.enfi.2025.500531","DOIUrl":"10.1016/j.enfi.2025.500531","url":null,"abstract":"<div><h3>Background</h3><div>The international HU-CI project advocates 8<!--> <!-->strategic strands for the humanization of intensive care units. Despite of adult ICUs have received attention to promote humanization of care, in the pediatric context, the humanization of care continues to receive limited attention, with limited data on pediatric structures and humanization patterns lacking integration into practice.</div></div><div><h3>Objectives</h3><div>Identify available evidence related to humanization concepts according to the theoretical framework of the HU-CI Project and understand the implementations in the field of pediatric intensive care units.</div></div><div><h3>Method</h3><div>A scoping review was conducted through a literature search in PubMed and CINAHL. Studies addressing concepts or elements related to the strategic lines of the HU-CI framework within the context of pediatric intensive care units were included. The perspective of patients, families, and frontline healthcare professionals was considered, using quantitative, qualitative, and mixed methods approaches. Data analysis followed a narrative approach, categorically synthesized according to the strategic lines of the HU-CI framework in pediatric intensive care units.</div></div><div><h3>Results</h3><div>A total of 41 articles were included. Within the 8<!--> <!-->action lines of action of the HU-CI framework, end-of-life care and communication predominated over flexible schedules, family presence and participation in care, patient well-being, professional care, post-ICU syndrome and humanized infrastructure.</div></div><div><h3>Conclusions</h3><div>The analyzed action lines suggest the need for development and improvement through further research to facilitate their full integration into the practice of pediatric intensive care units.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 2","pages":"Article 500531"},"PeriodicalIF":1.1,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143480380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of this study was to develop and validate the adaptation of the behavioral indicators of pain scale (ESCID) for patients with acquired brain injury (ESCID-DC), unable to self-report and with artificial airway.
Methods
Multicenter study conducted in two phases: scale development and evaluation of psychometric properties. Two blinded observers simultaneously assessed pain behaviors with two scales: ESCID-DC and Nociception Coma Scale-Revised version-adapted for Intubated patients (NCS-R-I). Assessments were performed at 3 time points: 5 minutes before, during and 15 minutes after the application of the painfull procedures (tracheal suction and application of pressure to the right and left nail bed) and a non-painful procedure (rubbing with gauze). On the day of measurement, the Glasgow Coma Score (GCS) and the Richmond Agitation Sedation Scale (RASS) were evaluated. A descriptive and psychometric analysis was performed.
Results
A total of 4,152 pain evaluations were performed in 346 patients, 70% men with a mean age of 56 years (SD = 16.4). The most frequent etiologies of brain damage were vascular 155 (44.8%) and traumatic 144 (41.6%). The median GCS and RASS on the day of evaluation were 8.50 (IQR = 7 to 9) and −2 (RIQ = −3 to −2) respectively. In ESCID-DC the median score was 6 (IQR = 4 to 7) during suction, 3 (RIQ = 1 to 4) for right pressure and 3 (RIQ = 1 to 5) for left pressure. During the non-painful procedure it was 0. The ESCID-DC showed a high discrimination capacity between painful and non-painful procedures (AUC > 0.83) and is sensitive to change depending on the time of application of the scale. High interobserver agreement (Kappa > 0.87), good internal consistency during procedures (α-Cronbach ≥ 0.80) and a high correlation between the ESCID-DC and the NCS-R-I (r ≥ 0.75) were obtained.
Conclusions
The results of this study demonstrate that the ESCID-DC is a valid and reliable tool for assessing pain in patients with acquired brain injury, unable to self-report and with artificial airway.
{"title":"Desarrollo y validación psicométrica de la Escala de Conductas Indicadoras de Dolor-Daño Cerebral (ESCID-DC) para la evaluación del dolor en pacientes críticos con daño cerebral adquirido, incapaces de autoinformar y con vía aérea artificial","authors":"Candelas López-López RN, MSc, PhD , Gemma Robleda-Font RN, MSc, PhD , Antonio Arranz-Esteban RN , Teresa Pérez-Pérez PhD , Montserrat Solís-Muñoz RN, MSc, PhD , María Carmen Sarabia-Cobo RN, MSc, PhD , María Jesús Frade-Mera RN, MSc, PhD , Susana Temprano-Vázquez MD , Francisco Paredes-Garza RN, MSc, PhDcandidate , Aaron Castanera-Duro RN, MSc, PhD , Mónica Bragado-León RN , Emilia Romero de-San-Pío RN, MSc , Isabel Gil-Saaf RN , David Alonso-Crespo RN, MSc, PhDcandidate , Carolina Rojas-Ballines RN , Ignacio Latorre-Marco RN , Grupo ESCID-DC","doi":"10.1016/j.enfi.2025.500523","DOIUrl":"10.1016/j.enfi.2025.500523","url":null,"abstract":"<div><h3>Introduction</h3><div>The aim of this study was to develop and validate the adaptation of the behavioral indicators of pain scale (ESCID) for patients with acquired brain injury (ESCID-DC), unable to self-report and with artificial airway.</div></div><div><h3>Methods</h3><div>Multicenter study conducted in two phases: scale development and evaluation of psychometric properties. Two blinded observers simultaneously assessed pain behaviors with two scales: ESCID-DC and Nociception Coma Scale-Revised version-adapted for Intubated patients (NCS-R-I). Assessments were performed at 3 time points: 5<!--> <!-->minutes before, during and 15<!--> <!-->minutes after the application of the painfull procedures (tracheal suction and application of pressure to the right and left nail bed) and a non-painful procedure (rubbing with gauze). On the day of measurement, the Glasgow Coma Score (GCS) and the Richmond Agitation Sedation Scale (RASS) were evaluated. A descriptive and psychometric analysis was performed.</div></div><div><h3>Results</h3><div>A total of 4,152 pain evaluations were performed in 346 patients, 70% men with a mean age of 56<!--> <!-->years (SD<!--> <!-->=<!--> <!-->16.4). The most frequent etiologies of brain damage were vascular 155 (44.8%) and traumatic 144 (41.6%). The median GCS and RASS on the day of evaluation were 8.50 (IQR<!--> <!-->=<!--> <!-->7 to 9) and −2 (RIQ<!--> <!-->=<!--> <!-->−3 to −2) respectively. In ESCID-DC the median score was 6 (IQR<!--> <!-->=<!--> <!-->4 to 7) during suction, 3 (RIQ<!--> <!-->=<!--> <!-->1 to 4) for right pressure and 3 (RIQ<!--> <!-->=<!--> <!-->1 to 5) for left pressure. During the non-painful procedure it was 0. The ESCID-DC showed a high discrimination capacity between painful and non-painful procedures (AUC<!--> <!-->><!--> <!-->0.83) and is sensitive to change depending on the time of application of the scale. High interobserver agreement (Kappa<!--> <!-->><!--> <!-->0.87), good internal consistency during procedures (α-Cronbach<!--> <!-->≥<!--> <!-->0.80) and a high correlation between the ESCID-DC and the NCS-R-I (r<!--> <!-->≥<!--> <!-->0.75) were obtained.</div></div><div><h3>Conclusions</h3><div>The results of this study demonstrate that the ESCID-DC is a valid and reliable tool for assessing pain in patients with acquired brain injury, unable to self-report and with artificial airway.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 2","pages":"Article 500523"},"PeriodicalIF":1.1,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-22DOI: 10.1016/j.enfi.2025.500524
Fernanda Gil-Almagro MSN, PhD , Fernando J. García-Hedrera PhD , F. Javier Carmona-Monge PhD , Cecilia Peñacoba-Puente PhD
Introduction
The intention to leave the health profession has been studied as one of the consequences of the work and emotional overload experienced by nurses during the pandemic. However, few studies have focused on ICU nurses. The studies on intention to leave the profession focus on working conditions and symptomatology, without analyzing the personal characteristics involved.
Objective
To explore the evolution of the intention to leave the profession in ICU nurses (with respect to hospitalization nurses). In addition, to analyze the possible differences in anxiety, burnout and psychosocial variables (self-efficacy, resilience, cognitive fusion) between nurses who intend to quit and those who do not.
Method
Observational, descriptive, longitudinal, prospective study with three data collection periods. Non-probabilistic convenience sampling was performed.
Results
Six months after the end of the confinement period in Spain, higher dropout percentages were observed in ICU (49.2%) than in hospitalization (33.3%) (P = .07). One year later, the percentages of intention to leave tend to be equal (50.8% in ICU and 43.9% in hospitalization) (P = .438). With respect to the differential profile of ICU nurses who intend to leave the profession (compared to those who do not), higher scores were observed in anxiety (P = .037), emotional exhaustion (P < .001), decreased personal fulfilment (P = .031) and cognitive fusion (P = .023).
Conclusion
A high percentage of ICU nurses show intention to leave the profession, and associations were found with the anxiety experienced at the beginning of the pandemic, with high emotional exhaustion and low personal fulfilment. It is important to highlight in our study the relationship between intention to leave the profession and personal variables such as cognitive fusion.
{"title":"Intención de abandono de la profesión en enfermeras de cuidados intensivos y hospitalización. Asociación con variables psicosociales","authors":"Fernanda Gil-Almagro MSN, PhD , Fernando J. García-Hedrera PhD , F. Javier Carmona-Monge PhD , Cecilia Peñacoba-Puente PhD","doi":"10.1016/j.enfi.2025.500524","DOIUrl":"10.1016/j.enfi.2025.500524","url":null,"abstract":"<div><h3>Introduction</h3><div>The intention to leave the health profession has been studied as one of the consequences of the work and emotional overload experienced by nurses during the pandemic. However, few studies have focused on ICU nurses. The studies on intention to leave the profession focus on working conditions and symptomatology, without analyzing the personal characteristics involved.</div></div><div><h3>Objective</h3><div>To explore the evolution of the intention to leave the profession in ICU nurses (with respect to hospitalization nurses). In addition, to analyze the possible differences in anxiety, burnout and psychosocial variables (self-efficacy, resilience, cognitive fusion) between nurses who intend to quit and those who do not.</div></div><div><h3>Method</h3><div>Observational, descriptive, longitudinal, prospective study with three data collection periods. Non-probabilistic convenience sampling was performed.</div></div><div><h3>Results</h3><div>Six months after the end of the confinement period in Spain, higher dropout percentages were observed in ICU (49.2%) than in hospitalization (33.3%) (<em>P</em> <!-->=<!--> <!-->.07). One year later, the percentages of intention to leave tend to be equal (50.8% in ICU and 43.9% in hospitalization) (<em>P</em> <!-->=<!--> <!-->.438). With respect to the differential profile of ICU nurses who intend to leave the profession (compared to those who do not), higher scores were observed in anxiety (<em>P</em> <!-->=<!--> <!-->.037), emotional exhaustion (<em>P</em> <!--><<!--> <!-->.001), decreased personal fulfilment (<em>P</em> <!-->=<!--> <!-->.031) and cognitive fusion (<em>P</em> <!-->=<!--> <!-->.023).</div></div><div><h3>Conclusion</h3><div>A high percentage of ICU nurses show intention to leave the profession, and associations were found with the anxiety experienced at the beginning of the pandemic, with high emotional exhaustion and low personal fulfilment. It is important to highlight in our study the relationship between intention to leave the profession and personal variables such as cognitive fusion.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 2","pages":"Article 500524"},"PeriodicalIF":1.1,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143463652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hospitalization in the Pediatric Intensive Care Unit (PICU) entails functional complications for patients, derived from various factors that increase the risk of morbidities and may affect the patient's functional prognosis. Early mobilization has been described as a safe, feasible practice with great benefits in the short and long term; however, research has identified that there are barriers that limit the actions of health professionals.
Objective
Determine the main barriers perceived by health personnel for early mobilization in the pediatric ICU of a high-complex hospital of the city of Cali during the year 2022.
Methods
Cross-sectional descriptive study. 60 health care professionals who work in the PICU were surveyed with prior informed consent.
Results
The main barriers were lack of staff training, lack of knowledge of the main actors for early mobilization, perception that mobilization increases the workload for nurses and physiotherapists, medical contraindications for mobilization.
Conclusions
There is a need to implement educational and organizational interventions in the PICU to overcome the identified barriers. Training staff, clarifying roles and responsibilities, as well as promoting a culture that values early mobilization could be effective strategies to improve the implementation of this practice and, therefore, reduce complications associated with hospitalization.
{"title":"Barriers to early mobilization perceived by health staff in a pediatric intensive care unit of a high complexity hospital","authors":"Norman Salazar-Caicedo BSc , Cristian Camilo Rojas-Godoy BSc , Angelly Bustamante-de la Cruz BSc , Stephanie Pabón-Lozano MSc , Jessica Largo-Ocampo BSc , Helen Johana Ortiz-Rojas MSc , Daniela Jiménez-Mora BSc","doi":"10.1016/j.enfi.2025.500526","DOIUrl":"10.1016/j.enfi.2025.500526","url":null,"abstract":"<div><h3>Introduction</h3><div>Hospitalization in the Pediatric Intensive Care Unit (PICU) entails functional complications for patients, derived from various factors that increase the risk of morbidities and may affect the patient's functional prognosis. Early mobilization has been described as a safe, feasible practice with great benefits in the short and long term; however, research has identified that there are barriers that limit the actions of health professionals.</div></div><div><h3>Objective</h3><div>Determine the main barriers perceived by health personnel for early mobilization in the pediatric ICU of a high-complex hospital of the city of Cali during the year 2022.</div></div><div><h3>Methods</h3><div>Cross-sectional descriptive study. 60 health care professionals who work in the PICU were surveyed with prior informed consent.</div></div><div><h3>Results</h3><div>The main barriers were lack of staff training, lack of knowledge of the main actors for early mobilization, perception that mobilization increases the workload for nurses and physiotherapists, medical contraindications for mobilization.</div></div><div><h3>Conclusions</h3><div>There is a need to implement educational and organizational interventions in the PICU to overcome the identified barriers. Training staff, clarifying roles and responsibilities, as well as promoting a culture that values early mobilization could be effective strategies to improve the implementation of this practice and, therefore, reduce complications associated with hospitalization.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 2","pages":"Article 500526"},"PeriodicalIF":1.1,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143403043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-12DOI: 10.1016/j.enfi.2025.500527
Taís Silva-Nascimento RP , Cleia Lima-Rocha RP , Ludmilla Ruvenal-Heine-Lustosa RP , Mikhail Santos-Cerqueira PhD , Rodrigo Santos-de-Queiroz PhD , Mansueto Gomes-Neto PhD
Introduction
The number of survivors of critical illnesses has increased over the years, resulting in impacts on quality of life and daily activities.
Objective
To investigate which intra-hospital risk factors are associated with worsening quality of life and functionality, through the assessment of basic and instrumental activities of daily living, in survivors of critical illness after hospital discharge.
Methods
Systematic literature review carried out from September 2022 to December 2023, informed by a flowchart, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search strategy carried out in the CINAHL, Embase and PubMed databases. The research was carried out by two researchers, without restrictions on language or year of publication. Studies were assessed using the Newcastle–Ottawa Quality Assessment Form for Cohort Studies.
Results
12 articles were included, 5 studies provided information on daily and instrumental activities, 7 on quality of life and 1 with all these outcomes. Risk factors such as depression, frailty, prolonged time on mechanical ventilation, and muscle weakness acquired in the ICU were considered factors associated with worsening quality of life. And depression, sepsis, prolonged stay in the ICU, and frailty are factors associated with worsening in the basic and instrumental activities of daily life.
Conclusion
Survivors of critical illness, in the first 3 months after discharge, present changes in quality of life, in basic and instrumental activities of daily living, which may persist for up to 12 months or more. This situation may be associated with risk factors at the time of admission to the intensive care unit.
{"title":"Risk factors for impairments in quality of life and activities of daily living in survivors of critical illness: A systematic review of observational studies","authors":"Taís Silva-Nascimento RP , Cleia Lima-Rocha RP , Ludmilla Ruvenal-Heine-Lustosa RP , Mikhail Santos-Cerqueira PhD , Rodrigo Santos-de-Queiroz PhD , Mansueto Gomes-Neto PhD","doi":"10.1016/j.enfi.2025.500527","DOIUrl":"10.1016/j.enfi.2025.500527","url":null,"abstract":"<div><h3>Introduction</h3><div>The number of survivors of critical illnesses has increased over the years, resulting in impacts on quality of life and daily activities.</div></div><div><h3>Objective</h3><div>To investigate which intra-hospital risk factors are associated with worsening quality of life and functionality, through the assessment of basic and instrumental activities of daily living, in survivors of critical illness after hospital discharge.</div></div><div><h3>Methods</h3><div>Systematic literature review carried out from September 2022 to December 2023, informed by a flowchart, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search strategy carried out in the CINAHL, Embase and PubMed databases. The research was carried out by two researchers, without restrictions on language or year of publication. Studies were assessed using the Newcastle–Ottawa Quality Assessment Form for Cohort Studies.</div></div><div><h3>Results</h3><div>12 articles were included, 5 studies provided information on daily and instrumental activities, 7 on quality of life and 1 with all these outcomes. Risk factors such as depression, frailty, prolonged time on mechanical ventilation, and muscle weakness acquired in the ICU were considered factors associated with worsening quality of life. And depression, sepsis, prolonged stay in the ICU, and frailty are factors associated with worsening in the basic and instrumental activities of daily life.</div></div><div><h3>Conclusion</h3><div>Survivors of critical illness, in the first 3 months after discharge, present changes in quality of life, in basic and instrumental activities of daily living, which may persist for up to 12 months or more. This situation may be associated with risk factors at the time of admission to the intensive care unit.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 2","pages":"Article 500527"},"PeriodicalIF":1.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.enfi.2024.04.006
María Kappes RN, MSc , Carlos Alberto Fernández-Silva RN, MSc , Lucia Catalán RN, MSc , Constanza Navalle RN , Moisés Diaz RN , Ivan Guglielmi RN, MSc
Introduction
Critically ill patients and their families benefit from spiritual care. There is limited evidence on how spiritual care is delivered in Intensive Care Units (ICUs).
Aim
The objective of this review was to determine how nurses include spiritual care for patients and families in ICUs.
Methodology
A scoping review was conducted following the Joanna Briggs Institute methodology guidelines, with results reported using the PRISMA-ScR guidelines from March to April 2023. PubMed, Scopus by Elsevier, Web of Science (WOS), and the Ebsco search engine were consulted, including databases such as Medline Complete, Cinhal, and Academic Search Ultimate using the keywords Nursing care, ICU, spirituality. Articles with qualitative and quantitative approaches of any design describing spirituality in nursing care for patients or families in ICUs were included, excluding editorials and letters to the editor. The time frame ranged from 2015 to 2023, with no language restrictions.
Results
A total of 319 articles were retrieved, after removing duplicates and applying inclusion criteria with critical reading, 11 studies were included, 6 with a quantitative approach and 5 with a qualitative approach. Conditions for spiritual care are described highlighting the need for physical space and nurse-related conditions such as motivation and empathy. Personal, organizational, and team-related barriers to spiritual care exist. Facilitators for spiritual care are described such as preparation, communication, and the presence of chaplains.
Conclusions
Nurses in ICUs have various ways to provide spiritual care to patients and families. These must be developed considering barriers such as physical space, personal, organizational, and team-related challenges.
{"title":"Rol de las enfermeras en el cuidado espiritual a los pacientes y sus familias en las unidades de cuidado intensivo: una revisión de alcance","authors":"María Kappes RN, MSc , Carlos Alberto Fernández-Silva RN, MSc , Lucia Catalán RN, MSc , Constanza Navalle RN , Moisés Diaz RN , Ivan Guglielmi RN, MSc","doi":"10.1016/j.enfi.2024.04.006","DOIUrl":"10.1016/j.enfi.2024.04.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Critically ill patients and their families benefit from spiritual care. There is limited evidence on how spiritual care is delivered in Intensive Care Units (ICUs).</div></div><div><h3>Aim</h3><div>The objective of this review was to determine how nurses include spiritual care for patients and families in ICUs.</div></div><div><h3>Methodology</h3><div>A scoping review was conducted following the Joanna Briggs Institute methodology guidelines, with results reported using the PRISMA-ScR guidelines from March to April 2023. PubMed, Scopus by Elsevier, Web of Science (WOS), and the Ebsco search engine were consulted, including databases such as Medline Complete, Cinhal, and Academic Search Ultimate using the keywords Nursing care, ICU, spirituality. Articles with qualitative and quantitative approaches of any design describing spirituality in nursing care for patients or families in ICUs were included, excluding editorials and letters to the editor. The time frame ranged from 2015 to 2023, with no language restrictions.</div></div><div><h3>Results</h3><div>A total of 319 articles were retrieved, after removing duplicates and applying inclusion criteria with critical reading, 11 studies were included, 6 with a quantitative approach and 5 with a qualitative approach. Conditions for spiritual care are described highlighting the need for physical space and nurse-related conditions such as motivation and empathy. Personal, organizational, and team-related barriers to spiritual care exist. Facilitators for spiritual care are described such as preparation, communication, and the presence of chaplains.</div></div><div><h3>Conclusions</h3><div>Nurses in ICUs have various ways to provide spiritual care to patients and families. These must be developed considering barriers such as physical space, personal, organizational, and team-related challenges.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 1","pages":"Article 100494"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141841593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.enfi.2024.02.002
Rosana Goñi-Viguria RN, MSN
The intensive care units structure, the technological improvement and the severity of the patients, require that there be harmony between all the actors involved in assisting the critically ill patient. Added to this context is that the current role of the supervisor involves assuming more and more management skills, without losing sight of the need to frame professional practice within the framework of a philosophy of care. Given this challenge for the supervisor, the appearance in our environment of the Advance Practice Nurse figure (APN) is an opportunity. The APN is essential to improving patient care, staff development and the implementation of evidence-based practice.
This article describes how the APN works with the different members of the health team and what the results have been since their incorporation.
The APN leads efforts to maintain quality of care. They use their knowledge to assess gaps in practice and between practice settings, and to design and lead evidence-based practice changes so that benchmarks can be met in the most efficient and timely manner. Additionally, it supports the organization to respond to a constantly changing healthcare environment and is instrumental in achieving its goals.
{"title":"Experiencia de una enfermera de práctica avanzada en una unidad de cuidados intensivos","authors":"Rosana Goñi-Viguria RN, MSN","doi":"10.1016/j.enfi.2024.02.002","DOIUrl":"10.1016/j.enfi.2024.02.002","url":null,"abstract":"<div><div>The intensive care units structure, the technological improvement and the severity of the patients, require that there be harmony between all the actors involved in assisting the critically ill patient. Added to this context is that the current role of the supervisor involves assuming more and more management skills, without losing sight of the need to frame professional practice within the framework of a philosophy of care. Given this challenge for the supervisor, the appearance in our environment of the Advance Practice Nurse figure (APN) is an opportunity. The APN is essential to improving patient care, staff development and the implementation of evidence-based practice.</div><div>This article describes how the APN works with the different members of the health team and what the results have been since their incorporation.</div><div>The APN leads efforts to maintain quality of care. They use their knowledge to assess gaps in practice and between practice settings, and to design and lead evidence-based practice changes so that benchmarks can be met in the most efficient and timely manner. Additionally, it supports the organization to respond to a constantly changing healthcare environment and is instrumental in achieving its goals.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 1","pages":"Article 100482"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141688787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.enfi.2024.04.004
Roberto Galao-Malo DNP
Advanced practice nursing (APN) continues to gain recognition. Despite the guidelines published by the International Council of Nurses in 2020, there is still some confusion about this concept. In general, APN is used in 3 different and not necessarily compatible ways: as an umbrella term that regulates 4 different roles, as a level of practice, or as a role itself. Specialization in nursing does not always imply advanced practice, although both concepts are not mutually exclusive. The Acute Care Nurse Practitioners in the United States can conduct physical examinations and medical histories, diagnose, prescribe medications, or request and interpret complementary tests. They pose no risk to patients and have shown positive clinical outcomes in Critical Care Units. They also add «value» by improving communication, interprofessional coordination, or adherence to protocols. The Clinical Nurse Specialists in Critical Care help improve quality, staff education, and provide care to complex patients. They have a beneficial impact on reducing nosocomial infections, adverse events, hospital stay, or costs. The implementation of APN roles in Spain faces challenges due to its circumstances, such as the high number of physicians or the lack of systematic and transparent measurement of outcomes. Historically, the nursing corporation has promoted a disproportionately positive view of the Spanish healthcare system and nursing. The Spanish nursing corporation has followed the model of medical specialization without supporting studies and a framework that hinders its integration into APN. The orthodox vision of Spanish nursing still holds significant weight, where experience is valued more than education, complicating the expansion of competencies. Numerous regional projects have been developed without a unified voice or approach. APN should not be a distraction from continuing to advocate for improvements in nurses’ working conditions.
{"title":"Enfermera de práctica avanzada, cuidados intensivos y España: una perspectiva","authors":"Roberto Galao-Malo DNP","doi":"10.1016/j.enfi.2024.04.004","DOIUrl":"10.1016/j.enfi.2024.04.004","url":null,"abstract":"<div><div>Advanced practice nursing (APN) continues to gain recognition. Despite the guidelines published by the International Council of Nurses in 2020, there is still some confusion about this concept. In general, APN is used in 3<!--> <!-->different and not necessarily compatible ways: as an umbrella term that regulates 4<!--> <!-->different roles, as a level of practice, or as a role itself. Specialization in nursing does not always imply advanced practice, although both concepts are not mutually exclusive. The Acute Care Nurse Practitioners in the United States can conduct physical examinations and medical histories, diagnose, prescribe medications, or request and interpret complementary tests. They pose no risk to patients and have shown positive clinical outcomes in Critical Care Units. They also add «value» by improving communication, interprofessional coordination, or adherence to protocols. The Clinical Nurse Specialists in Critical Care help improve quality, staff education, and provide care to complex patients. They have a beneficial impact on reducing nosocomial infections, adverse events, hospital stay, or costs. The implementation of APN roles in Spain faces challenges due to its circumstances, such as the high number of physicians or the lack of systematic and transparent measurement of outcomes. Historically, the nursing corporation has promoted a disproportionately positive view of the Spanish healthcare system and nursing. The Spanish nursing corporation has followed the model of medical specialization without supporting studies and a framework that hinders its integration into APN. The orthodox vision of Spanish nursing still holds significant weight, where experience is valued more than education, complicating the expansion of competencies. Numerous regional projects have been developed without a unified voice or approach. APN should not be a distraction from continuing to advocate for improvements in nurses’ working conditions.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 1","pages":"Article 100491"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141697843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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