Enfermeria Intensiva最新文献

{"title":"Prehospital early warning scores for predicting clinical deterioration of COVID-19 patients: An integrative review","authors":"Elena Moreta-Gil RN ,&nbsp;Cristina Rivera-Picón PhD ,&nbsp;Rosa Conty-Serrano PhD ,&nbsp;Begoña Polonio-López PhD ,&nbsp;José L. Martín-Conty PhD ,&nbsp;Francisco Martín-Rodríguez PhD ,&nbsp;Ancor Sanz-García PhD","doi":"10.1016/j.enfi.2025.500584","DOIUrl":"10.1016/j.enfi.2025.500584","url":null,"abstract":"<div><h3>Introduction</h3><div>Triage, and in particular scales, are a tool that allows patients with clinical risk to be managed for early, effective and efficient care.</div></div><div><h3>Objective</h3><div>To identify the most precise and specific prehospital score for the detection of clinical worsening risk in COVID-19 patients.</div></div><div><h3>Methods</h3><div>The protocol followed for the integrative review was the PRISMA method 2020. A literature search was performed in five databases: Scopus, Cochrane Library, Pubmed, Embase, Prospero and Lit-covid-NIH-NLM. Based on 19 keywords, 5 inclusion and 5 exclusion points. Finally, 22 articles were selected.</div></div><div><h3>Results</h3><div>Twenty-two studies were identified that addressed effective outcomes for early measures such as telephone triage, web, protocols or tools such as scales. We compared the functionality of 12 scales in patients with COVID-19, showing that the most important variables for this early assessment of clinical worsening were systolic blood pressure, temperature, oxygen saturation and the need for oxygen supplementation. The best predictive value for clinical deterioration and mortality was obtained by NEWS score, with sensitivities and specificities ranging from 77 to 88%.</div></div><div><h3>Conclusions</h3><div>Prehospital scales are still under development, with few research studies and a relative confidence in their statistical values. Nonetheless, it has been observed that the scale that best fit the COVID-19 was NEWS with an optimal prediction for patients. This could pave the way for its use under other relevant clinical scenarios, such as acute respiratory infections, exacerbations of chronic diseases or future health emergencies.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"37 2","pages":"Article 500584"},"PeriodicalIF":1.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079819","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}

{"title":"Concordancia entre NU-DESC y CAM-ICU para detectar el delirio en entornos hospitalarios de alta complejidad","authors":"César Flores-Galicia RN, MSN ,&nbsp;Gandhy Ponce-Gomez RN, MSN, PhD ,&nbsp;Alejandra Valencia-Cruz MSc, PhD","doi":"10.1016/j.enfi.2025.500587","DOIUrl":"10.1016/j.enfi.2025.500587","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze the agreement between NU-DESC and CAM-ICU scales in detecting hyperactive and hypoactive delirium in adult patients at a tertiary hospital, testing the alternative hypothesis (HA) of significant concordance.</div></div><div><h3>Method</h3><div>Cross-sectional study of 105 patients (18-85 years) under moderate sedation and ventilatory weaning, assessed with NU-DESC and CAM-ICU at three time points after staff training. Concordance was evaluated using the Kappa index.</div></div><div><h3>Results</h3><div>Mean age: 45 years (52% male, 48% female). Initial agreement: Kappa<!--> <!-->=<!--> <!-->0.758 (good, p<!--> <!-->&lt;<!--> <!-->0.001); second measurement: Kappa<!--> <!-->=<!--> <!-->0.448 (moderate, p<!--> <!-->&lt;<!--> <!-->0.001); third measurement: Kappa<!--> <!-->=<!--> <!-->0.848 (very good, p<!--> <!-->&lt;<!--> <!-->0.001). Variability reflects differences in sensitivity across delirium phases.</div></div><div><h3>Discussion</h3><div>NU-DESC was optimal for initial screening (speed), while CAM-ICU showed higher accuracy in advanced stages. Their combined use captures dynamic delirium manifestations.</div></div><div><h3>Conclusion</h3><div>HA was confirmed, proving that integrating NU-DESC and CAM-ICU enhances delirium detection and management in critically ill patients, adapting to their evolving clinical needs.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"37 2","pages":"Article 500587"},"PeriodicalIF":1.0,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039374","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}

{"title":"Acceso vascular intraóseo en transporte pediátrico y neonatal especializado. Estudio descriptivo","authors":"Marta Rodríguez-Navarro MD,&nbsp;Montserrat Pujol-Jover MD,&nbsp;Maria Lourdes Ausin-Garcia MD,&nbsp;Beatriz Soria-Navarro MD,&nbsp;Roser Riera-Mas RN","doi":"10.1016/j.enfi.2025.500586","DOIUrl":"10.1016/j.enfi.2025.500586","url":null,"abstract":"<div><h3>Aims</h3><div>The primary objective was to identify the factors associated with the success rate of intraosseous (IO) access placement in patients attended by a Pediatric and Neonatal Transport (PNT) unit.</div></div><div><h3>Methods</h3><div>We conducted a retrospective descriptive study between January 2021 and September 2025, including all pediatric and neonatal patients (0-16 years) who required intraosseous (IO) access during care provided by the TPN team. Demographic, clinical, and procedural data were collected. Descriptive statistics were used, and associations with the primary outcome (successful IO access placement) were assessed using the Chi-square test for categorical variables (age group, operator, needle type, and anatomical site) and the Mann–Whitney U test for numerical variables (weight and age).</div></div><div><h3>Results</h3><div>Sixty IO access attempts were analyzed in 45 patients. The overall success rate was 88.3% (n<!--> <!-->=<!--> <!-->53). Anatomical site was significantly associated with successful placement (<em>P</em>=.01), with the proximal tibia being the most frequently used and effective site, followed by femur and humerus. No association was found with patient age, needle size, or the provider performing the procedure. Complications occurred in 15.1% of cases, all due to extravasation, with a higher incidence in younger and lower-weight patients.</div></div><div><h3>Conclusions</h3><div>The IO access is an effective alternative to vascular access in critically ill pediatric and neonatal patients. Placement success is significantly influenced by anatomical site. Neonates show a tendency toward lower success rates and higher incidence of extravasation.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"37 2","pages":"Article 500586"},"PeriodicalIF":1.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981524","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}

{"title":"Descriptive cross-sectional analysis of nursing diagnoses, interventions, and outcomes in neonatal intensive care based on Roy's and Swanson's models","authors":"Hernando Parra-Reyes RN, MSc,&nbsp;Alejandra Mendoza-Monsalve RN, MSc,&nbsp;Faride Astrid Sarabia-Herrera RN,&nbsp;Adriana Camila Rincon-Ascanio RN,&nbsp;Edgar Fabian Manrique-Hernandez MD, MSc,&nbsp;Alexandra Hurtado-Ortiz Msc,&nbsp;Maricel Licht-Ardila RN, MSc","doi":"10.1016/j.enfi.2025.500585","DOIUrl":"10.1016/j.enfi.2025.500585","url":null,"abstract":"<div><h3>Introduction</h3><div>Caring for neonatal intensive care unit patients requires precise, individualized, and compassionate care. Roy's Adaptation Model and Swanson's Theory of Caring provide complementary frameworks for addressing physiological and emotional needs. Integrated with the Nursing Care Process (NCP) and standardized languages (NANDA-I, NIC, NOC), these models support systematic, evidence-based, and family-centered neonatal nursing care. The objective was to describe the most frequently identified nursing diagnoses, interventions, and outcomes in NICU patients, guided by the theoretical perspectives of Callista Roy and Kristen Swanson.</div></div><div><h3>Methods</h3><div>A cross-sectional observational study was conducted using nursing records from a NICU in Colombia (September 2023–February 2024). The NCP was implemented based on Roy's Adaptation Model and Swanson's Theory of Caring. Records including all five NCP phases were analyzed. Diagnoses, interventions, and outcomes were classified using NANDA-I, NIC, and NOC taxonomies, respectively. Variables were grouped by gestational age (&lt;32, 32–34, &gt;34 weeks) and summarized using descriptive statistics.</div></div><div><h3>Results</h3><div>Among 180 neonates, median gestational age: 31.2 weeks (IQR: 28–36.1); birth weight: 1420–g (IQR: 1040–2290), 73.3% delivered by cesarean section. Frequent diagnoses included impaired gas exchange (27.2%) and ineffective breathing pattern (15.6%). Main interventions were airway management (15.0%) and oxygen therapy (12.2%). Oxygen desaturation (51.1%) was the most common focal stimulus.</div></div><div><h3>Conclusion</h3><div>Integrating Roy's Adaptation Model and Swanson's Theory of Caring into the NCP framed a structured and family-centered approach to neonatal care standardized taxonomies facilitated decision-making, highlighting the role of nursing judgment in addressing physiological and emotional needs in preterm infants.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"37 2","pages":"Article 500585"},"PeriodicalIF":1.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145957687","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}

{"title":"Management of the environment and patient care using extracorporeal membrane oxygenation: A scoping review","authors":"Camila Medeiros-dos-Santos-de-Cerqueira MsC ,&nbsp;Christiany Moçali-Gonzalez MsC ,&nbsp;Marluci Andrade-Conceição-Stipp PhD ,&nbsp;Aurean Deca-Junior PhD ,&nbsp;Graciele Oroski-Paes PhD","doi":"10.1016/j.enfi.2025.500581","DOIUrl":"10.1016/j.enfi.2025.500581","url":null,"abstract":"<div><h3>Introduction</h3><div>The use of strategies planned for the environment and care of adult patients undergoing extracorporeal membrane oxygenation allows for better assistance from the multidisciplinary team to this individual in the Intensive Care Unit.</div></div><div><h3>Objective</h3><div>The objective is to map strategies for planning the environment and care of adult patients in extracorporeal membrane oxygenation in intensive care.</div></div><div><h3>Methodology</h3><div>This scoping review follows the Joanna Briggs Institute methodology and adheres to the extension PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Eligible studies included those that answered the guiding question: “what are the strategies for planning the environment and care of adult patients undergoing extracorporeal membrane oxygenation in intensive care?”, no time or language restriction. The search and selection were carried out by two double-blind researchers between February and April 2024, using Rayyan software for data extraction and analysis. The collection took place in 10 databases, with selection of articles and gray literature.</div></div><div><h3>Results</h3><div>Six thousand nine hundred ninety-six sources of evidence were identified, of which 39 composed the final sample. The strategies cited by the publications were: management of the environment (family preparation; team preparation; ethical issues; human and material resources); and care management (monitoring; systematization of nursing care; nutritional management; early mobilization).</div></div><div><h3>Conclusions</h3><div>The complexity of ECMO management was highlighted, reinforcing the need for adequate infrastructure, a multidisciplinary team and more robust studies, especially in underdeveloped countries, to improve practical application and clinical outcomes.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"37 1","pages":"Article 500581"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076782","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}

{"title":"Factores clínicos asociados a la adecuación del esfuerzo terapéutico en pacientes críticos: un estudio descriptivo","authors":"Juan Carlos Muñoz-Camargo RN, MSc, PhD,&nbsp;Sandra Martínez-Rodríguez RN, MSc,&nbsp;Alberto José Cerrillo-Urbina RN, MSc, PhD,&nbsp;Raúl Expósito-González RN, MSc, PhD,&nbsp;Alberto Bermejo-Cantarero RN, MSc, PhD,&nbsp;Julián Rodríguez-Almagro RN, MSc, PhD","doi":"10.1016/j.enfi.2025.500576","DOIUrl":"10.1016/j.enfi.2025.500576","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze the decisions regarding the limitation of therapeutic effort (LTE) adopted in an adult intensive care unit (ICU)</div></div><div><h3>Material and methods</h3><div>Observational, descriptive, and cross-sectional study conducted in the adult ICU of a university hospital, equipped with 21 beds and an average of 1,000 annual medical and surgical admissions. All TEL decisions documented during the study period were included; patients diagnosed with brain death were excluded. Clinical, functional, and prognostic variables were collected using validated scales such as APACHE II, Charlson, Karnofsky, Barthel, PAEEC, MPM II, and ODIN.</div></div><div><h3>Results</h3><div>A total of 1,012 admissions were analyzed, with an intra-ICU mortality rate of 12.9%. Fifty-four cases of TEL were identified (5.3% of all admissions and 42.8% of deaths). The main reason was clinical irreversibility (71%), followed by therapeutic futility (29%). Seventy-two percent of patients were male, with a mean age of 70.5<!--> <!-->±<!--> <!-->10.9 years. The median Charlson comorbidity index was 6. Altered baseline quality of life was observed in 68.5% of patients, with moderate to severe impairment in 24.1%. The mean APACHE II score at admission was 22.6<!--> <!-->±<!--> <!-->8.6, with an estimated mortality probability of 44.7%.</div></div><div><h3>Conclusions</h3><div>TEL is a common practice in elderly patients with significant comorbidities and prior functional decline, highlighting the need to establish clear clinical criteria and standardized protocols for its implementation in adult ICUs.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"37 1","pages":"Article 500576"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977025","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}

{"title":"Exploring patients’ experiences in intensive care units (ICU): A cross-sectional study in Pakistan","authors":"Tawseef Ahmad MS, Pharm-D ,&nbsp;Sirima Sitaruno Pharm-D, BCPS ,&nbsp;Sutthiporn Pattharachayakul Pharm-D, BCPS ,&nbsp;Faiz Ullah Khan Pharm-D, PhD ,&nbsp;Muhammad Kiddeer Pharm-D, M.Phil. ,&nbsp;Shujaat Ali Khan Pharm-D, PhD","doi":"10.1016/j.enfi.2025.500578","DOIUrl":"10.1016/j.enfi.2025.500578","url":null,"abstract":"<div><h3>Background</h3><div>Intensive care unit (ICU) stays are often traumatic, impacting patients psychologically, physically, and emotionally. However, patient experiences in ICU settings remain underexplored, particularly in developing countries like Pakistan.</div></div><div><h3>Objective</h3><div>This study aimed to assess the experiences of ICU patients in a tertiary care hospital in Pakistan, with a focus on psychological distress, emotional responses, and perceived quality of care.</div></div><div><h3>Methods</h3><div>A descriptive cross-sectional study was conducted at Ayub Teaching Hospital, Abbottabad. A total of 102 post-ICU patients meeting the inclusion criteria were interviewed within 72 hours of transfer to medical wards. Data were collected using the validated Intensive Care Experience Questionnaire (ICEQ), and analyzed to evaluate patient perceptions and associated factors.</div></div><div><h3>Results</h3><div>Of the participants, 93.13% expressed relief upon discharge from the ICU, while 42.15% reported experiencing blurred memories during their stay. Despite this, 77.45% expressed satisfaction with the care received. Notably, only 23.52% of patients felt involved in decision-making processes regarding their care, indicating a communication gap. Statistical analysis revealed a significant negative correlation between patient age and satisfaction with care (<em>r</em> <!-->=<!--> <!-->−0.199, <em>p</em> <!-->&lt;<!--> <!-->0.05), suggesting older patients experienced reduced satisfaction. Gender also negatively correlated with memory of experience (<em>r</em> <!-->=<!--> <!-->−0.236, <em>p</em> <!-->&lt;<!--> <!-->0.05) and satisfaction with care (<em>r</em> <!-->=<!--> <!-->−0.208, <em>p</em> <!-->&lt;<!--> <!-->0.05), with women reporting more negative experiences. Length of ICU stay was significantly associated with reduced environmental awareness (<em>r</em> <!-->=<!--> <!-->−0.230, <em>p</em> <!-->&lt;<!--> <!-->0.001).</div></div><div><h3>Conclusion</h3><div>The findings highlight significant psychological and emotional challenges faced by ICU patients in Pakistan. Enhanced patient-centered communication, psychological support, and greater involvement in care decisions are critical to improving ICU experiences. Nursing staff play a pivotal role in creating a supportive and therapeutic ICU environment that fosters trust and improves patient outcomes.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"37 1","pages":"Article 500578"},"PeriodicalIF":1.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145796787","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}

{"title":"Lung collapse during postural repositioning in a mechanically ventilated patient, could it have been avoided? A case report","authors":"María Dolores Rodríguez-Huerta RN, MSc ,&nbsp;Ana Díez-Fernández RN, MSc, PhD ,&nbsp;María Jesús Rodríguez-Alonso RN ,&nbsp;María Martín-Rodríguez RN ,&nbsp;Mario Fernández-Izquierdo RN","doi":"10.1016/j.enfi.2025.500583","DOIUrl":"10.1016/j.enfi.2025.500583","url":null,"abstract":"<div><h3>Objective</h3><div>To analyse through a clinical case the need for comprehensive management of bronchial secretions by nurses, with a proactive and preventive character to improve mechanically ventilated patients’ safety.</div></div><div><h3>Clinical case presentation</h3><div>A 76-year-old man under invasive mechanical ventilation admitted to the ICU due to pulmonary infection, who presented subtotal left lung collapse during routine postural changes. Trying to recover the left lung ventilation, the patient was repositioned, an endotracheal suctioning and two recruitment manoeuvres were made without any ventilation improvement. The previous level of left ventilation was not achieved until secretions were completely eliminated after three more suctioning manoeuvres.</div></div><div><h3>Discussion and implications for practice</h3><div>Critically ill patient care is complex, requiring general basic attention and monitoring, including the assessment of the risks that certain interventions and nursing care may entail for each individual patient. Both, postural repositioning and endotracheal suctioning constitutes tow integral parts of routine care for all mechanically ventilated patients. This case shows how the presence of deep secretions during postural repositioning can greatly affect the respiratory function, with no significant immediate or short-term changes observed on routine monitoring, as electrical impedance monitoring is not standard practice, so the changes described in this case would not have been observed in short term.</div></div><div><h3>Conclusions</h3><div>The implementation of a nursing integral care protocol for the management of secretions in mechanically ventilated patients, could be very useful in preventing adverse events, ineffective multiple endotracheal suctioning, which are not free of potential complications, and in reducing the need for deep airway clearance by fibrobronchoscopy.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"37 1","pages":"Article 500583"},"PeriodicalIF":1.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747396","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}

{"title":"Clinical judgment and self-efficacy of nurses in sepsis management: The use of clinical simulation","authors":"Lilian Regina-de-Carvalho RN, MSc, PhD ,&nbsp;Ursula Marcondes-Westin RN, MSc, PhD ,&nbsp;Renata Elizabete-Pagotti-da-Fonseca RN, MSc, PhD ,&nbsp;Rafael Bressani-Lino RN, MSc, PhD ,&nbsp;João Paulo Victorino RN ,&nbsp;Silvia Helena-Zem-Mascarenhas RN, PhD","doi":"10.1016/j.enfi.2025.500577","DOIUrl":"10.1016/j.enfi.2025.500577","url":null,"abstract":"<div><h3>Introduction</h3><div>Sepsis has high mortality and demands prompt intervention. Nurses are key in its management, but knowledge gaps persist. Enhancing clinical judgment and self-efficacy is crucial, and clinical simulation offers a safe, effective strategy for developing these skills, supporting education in healthcare.</div></div><div><h3>Objective</h3><div>To evaluate the responses related to self-efficacy and clinical judgment of nurses in the management of sepsis through high-fidelity clinical simulation.</div></div><div><h3>Methods</h3><div>A quasi-experimental, pre- and post-test study design was adopted. Self-efficacy, clinical judgment, and knowledge were considered dependent variables, while time and participant role (scenario participant/observer) were treated as covariates. The sample consisted of 28 nurses. Data were transcribed into Microsoft Excel® spreadsheets and analyzed using SAS version 9.4 software.</div></div><div><h3>Results</h3><div>After the debriefing session, the mean scores for knowledge, clinical judgment, and self-efficacy increased compared to baseline. Knowledge scores improved from a mean of 9.71 (SD<!--> <!-->=<!--> <!-->2.02) to 12.75 (SD<!--> <!-->=<!--> <!-->1.24). Clinical judgment scores increased from 31.75 (SD<!--> <!-->=<!--> <!-->4.88) to 36.5 (SD<!--> <!-->=<!--> <!-->5.5), and self-efficacy rose from 4.05 (SD<!--> <!-->=<!--> <!-->0.44) to 4.19 (SD<!--> <!-->=<!--> <!-->0.55). Statistically significant differences were found in clinical judgment (<em>p</em> <!-->&lt;<!--> <!-->0.0001) and knowledge (<em>p</em> <!-->&lt;<!--> <!-->0.0001) across time points. Participants who actively engaged in the simulation had significantly higher post-simulation clinical judgment (mean<!--> <!-->=<!--> <!-->39.5 vs. 34.83; <em>p</em> <!-->=<!--> <!-->0.0252) and self-efficacy scores (mean<!--> <!-->=<!--> <!-->4.51 vs. 4.01; <em>p</em> <!-->=<!--> <!-->0.0269) compared to observers. However, there was no significant difference in post-test knowledge scores between the groups (<em>p</em> <!-->=<!--> <!-->0.6012). A strong correlation was identified between self-efficacy and clinical judgment. These findings support the effectiveness of simulation-based education in enhancing both clinical judgment and self-efficacy among nurses.</div></div><div><h3>Conclusions</h3><div>High-fidelity clinical simulation contributed to the development of nurses’ clinical judgment, self-efficacy, and knowledge regarding sepsis management.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"37 1","pages":"Article 500577"},"PeriodicalIF":1.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747395","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}

{"title":"Effect of mobility at ICU discharge on mortality and length of post-ICU stay: A retrospective analysis","authors":"Roberto Gonçalves-Mendes MSN ,&nbsp;André Pinto-Novo PhD ,&nbsp;Manuel Lourenço-Nunes PhD ,&nbsp;Miguel Castelo-Branco PhD","doi":"10.1016/j.enfi.2025.500572","DOIUrl":"10.1016/j.enfi.2025.500572","url":null,"abstract":"<div><h3>Background</h3><div>Admission to intensive care can be accompanied by significant adverse effects for patients, which last beyond their stay in the unit. Early mobilisation is part of a set of a bundle to minimise these effects and is now unanimously considered to be safe and beneficial. It is therefore important to understand how it is being implemented in practice and what its real benefits are.</div></div><div><h3>Aim/Objective</h3><div>To characterise mobility in the ICU and correlate the level of mobility at discharge from the ICU with the results of post-intensive care, namely: length of stay after intensive care and hospital mortality.</div></div><div><h3>Methods</h3><div>This was an observational, retrospective study carried out in the Intensive Care Department of a Local Health Unit located in the Portuguese countryside. A quantitative research methodology was used.</div></div><div><h3>Results</h3><div>Of the 244 patients included in the sample, 54.5% achieved orthostatism during the ICU stay and 36.5% achieved deambulation. The average length of stay between leaving the ICU and hospital discharge was 8.0<!--> <!-->±<!--> <!-->7.5 days. Patients who remained at bed rest at discharge had longer hospital stays than patients who were ambulating (<em>p</em> <!-->=<!--> <!-->0.014); and patients who performed activities in bed also had longer hospital stays than those who were orthostatic or ambulating (<em>p</em> <!-->=<!--> <!-->0.026 and 0.002 respectively). Post-ICU mortality was 5.7%, and there was a strong correlation with mobility on discharge from the ICU (<em>p</em> <!-->&lt;<!--> <!-->0.001), with less mobile patients having a higher mortality rate than expected (odds ratio<!--> <!-->=<!--> <!-->5.13).</div></div><div><h3>Conclusions</h3><div>The mobility levels founded in this study are in line with international reality. Patients who achieve higher levels of mobility during their stay in intensive care have shorter hospital stays and lower mortality.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"37 1","pages":"Article 500572"},"PeriodicalIF":1.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747393","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}