Enfermeria Intensiva最新文献

Introduction

Adjusting human resources to intensive care units (ICU) workload is essential. The development of software for estimating nursing workload using mobile devices (smartphone, smartwatch and/or tablets) could be a useful tool and complement and/or improve the measurements made with the Nursing Activities Score (NAS), a validated scale.

Objectives

To analyze the validity of devices and mobile applications for estimating ICU nurses’ workloads and their comparison with NAS.

Methodology

Systematised literature review from 2009 to 2021 informed by flowchart PRISMA-2020 and its extension PRISMA-S. Critical reading (CASPe). Steps: elaboration of the research question, concept identification (English and Spanish natural language and descriptors MesH, Emtree and CINAHL Headings), search strategy and data collection in MEDlars online (MEDLINE), Ovid, Excerpta Medica dataBASE (EMBASE), Elsevier, Cumulative Index to Nursing & Allied Health Literature (CINAHL), EBSCO and Web of Science (WoS); data extraction and evaluation, analysis and synthesis of results. We included studies with abstracts published in English and Spanish conducted in ICU with workload measurement (preferably NAS) using mobile devices.

Results

223 studies of which 84 in MEDLINE, 50 in CINAHL, 48 in EMBASE, 33 in WoS and 8 in other sources. 117 were eligible for screening, of which 95 did not meet the inclusion criteria. 22 studies were screened for eligibility, of which 17 were excluded. Five articles were selected for final review. None of the studies provided results on costs, acceptance testing, validity, reliability, system problems, advantages, disadvantages or resource estimation.

Discussion and conclusions

The use of mobile devices and applications to measure ICU workloads is not yet validated and has not been shown to be more accurate than traditional NAS assessment.

Introduction

Pediatric patients with cognitive dysfunction are at greater risk of pain than typically developing children. Pain assessment in these patients is complex and could generate uncertainty in health professionals about what the key aspects are.

Aim

To determine the training needs perceived by nursing professionals regarding acute pain assessment in pediatric patients with cognitive dysfunction.

Methods

A descriptive, cross-sectional, and multicenter study was performed using a survey addressed to nursing professionals who work in pediatrics during the months of August and September 2022.

Results

163 responses were obtained. Most of the professionals who responded were female (92.6%, n = 151), with a mean age of 38.98 ± 10.40 years. The most frequent work unit was the pediatric intensive care unit (PICU), in 36% (n = 58). Most of the participants reported not having previously received training on pain assessment in pediatric patients with cognitive disabilities (85.9%, n = 139). However, 70.4% (n = 114) considered it “very necessary” for the development of their work to receive specific training on this topic. Knowing how to assess acute pain in this population (85.3%, n = 139) and knowing the clinical and behavioral manifestations of pain in this type of patient (84.7%, n = 138) were the aspects that obtained higher scores.

Conclusion

This research notes more than 90% of participants consider “quite necessary” and “strong necessary” to be training in pediatric cognitive dysfunction patients pain assessment. Furthermore, work experience, academic education and to be pediatric specialist obtain statistical significance data.

Introduction

End-stage heart failure (HF) is a condition whose only successful long-term treatment, with a survival of more than 10 years, is heart transplantation. However, limited organ availability and the progressive increase in the number of patients with advanced HF have served as an impetus for the development of implantable mechanical assistive devices.

Aim

To provide an overview of postoperative management and nursing care after the implementation of a Total Artificial Heart (TAH).

Methods

A scoping review was carried out by consulting the Pubmed, CINAHL, and Cochrane databases. From all the documents located, information was extracted on the date of publication, country of publication, type of study, and results of interest to answer the research question. In addition, the degree of recommendation was identified.

Results

Twenty-three documents were included in the scoping review. Results were classified in relation to: 1) description of the CAT SynCardia®; 2) nursing care in the immediate postoperative period (management of the device and management of hematological, infectious, nephrological, nutritional complications, related to immobilization, sleep-rest disturbances, psychological disorders, and patient and family education); and 3) follow-up at home.

Conclusions

The complexity of implantation of the TAH, the multiple related complications that can arise during this process, both in the immediate post-operative and late, require a standardized and multidisciplinary management. The absence of standardized protocols raises the need for future studies to measure the effectiveness of care in patients with TAH. A multidisciplinary approach is crucial. Nurses must acquire autonomy and involvement in decision-making and develop competencies to address the patient's and family's physiological and psychosocial needs.

Introduction

The mothers of newborns who are discharged from a neonatal intensive care unit (NICU) experience stress and anxiety due to the specialized care their child requires at home, affecting their perception of maternal self-efficacy.

Objective

to evaluate the effect of the nursing intervention called Hospital Discharge Plan (HDP) on the promotion of self-efficacy in mothers of newborns discharged from the NICU.

Method

Quantitative study, quasi-experimental design with pre-test/post-test in a single group, using the Parental Evaluation Scale applied to a convenience sample of 72 mothers of high-risk newborns from a NICU located in the city of Villavicencio (Colombia). The first measurement was taken between days 3 and 4 before discharge and at 15 days’ post-discharge. Data processing was carried out using the statistical program SPSS, version 21. The intervention was based on the four concepts of self-efficacy by Barbara Resnick.

Results

The perception of maternal self-efficacy before the intervention showed a median of 8.9 points (RI 7.6-9.5); after the intervention it showed a median of 9.6 points (RI of 10-8.7); a statistically significant p-value < 0.001 was obtained before and after the intervention with the Wilcoxon rank test.

Conclusions

Education and follow-up promoted the development of knowledge and skills in mothers for the care of high-risk newborns. This contributed to the experience of mastery and vicarious experience from the teaching-learning process and contact with the experience of other mothers, which contributes to the effective development of motherhood.

Introduction

Fournier's gangrene, a relatively rare form of necrotizing fasciitis, is a rapidly progressive disease affecting the deep and superficial tissues of the perineal, anal, scrotal, and genital regions. Despite the significant evolution in medical knowledge, there is still scarce evidence regarding the nursing care plan in patients affected by this pathology, which hinders its correct management. For this reason, we present the following clinical case of a 53-year-old male patient with Fournier's gangrene who was admitted to the emergency department for 3 days of pain in the perineal area and fever.

Objective

The objective was to establish an individualized care plan for the patient detailing the diagnoses, expected outcomes and interventions through nursing taxonomies.

Case development

A systematic assessment was performed using Marjory Gordon's model of functional health patterns as a reference. After drawing inferences, three collaborative problems and two nursing diagnoses were established with their outcome criteria and interventions. Once the plan was executed, the results obtained highlighted that the interventions were consistent in achieving the objectives set out in the problems present in the case patient.

Conclusions

The development of an individualized plan made it possible to detect problems, establish realistic objectives and define interventions that optimized nursing care in this patient with Fournier's gangrene.

Introduction

Admission to an intensive care unit can cause sequelae to both patients and family members. In some countries, the use of diaries is a preventive action.

Aim

This research proposes to critically examine the concept of ‘Intensive Care Unit Diary’ by analysing the current state of the scientific literature to develop a precise conception of this phenomenon in nursing practice, since there are multiple unknowns regarding its use and content.

Method

A bibliographic search was carried out in the PubMed, Cochrane Library, Scopus and CINAHL databases in January 2023. The terms used to search for their use and definitions in the databases included Nurse, Concept analysis, Family, Uci Diary, Patient Critical, Intensive Care Unit. We use Wilson's concept analysis, later developed by Walker and Avant.

Results

The concept analysis shows that the ‘ICU Diary’ is a record made in colloquial language by health workers and relatives of the patient admitted to the intensive care unit. Aimed at the patient, with an empathic and reflective style, which offers a narrative of the process, daily life and the conduct or behaviour of the patient during his stay.

It is a therapeutic tool led by nurses accepted by patients, families and professionals. Its use benefits the recovery process, reducing post-traumatic stress in family members and patients. It favours communication and the bond between nurses, family members and patients, helping to express feelings and emotions.

Conclusions

The concept of ‘UCI Diary’ is complex. Through Wilson's model, a clarification of the concept has been achieved, creating a starting point for more precise research on this phenomenon and its effects on patients, family members, professionals and the health system.

Objective

To determine the Intensity of Collaboration between the intensive care professionals of a third level hospital.

Method

Descriptive cross-sectional study with an analytical approach. Setting: 6 intensive care units of a third level hospital. Sample: nurses and doctors. Consecutive type non-probabilistic sampling. Data collection: sociodemographic, economic, motivation and professional satisfaction variables, and the intensity of collaboration using the «Scale of Intensity of Interprofessional Collaboration in Health».

Results

A total of 102 health professionals (91 nurses and 11 doctors) were included. The mean overall Intensity of Collaboration (IoC) was moderate. Men showed higher scores in all factors (p < 0,05). The IoC global score was higher in the group of professionals with ≤ 10 years of experience (p = 0,043) and those who were highly satisfied with the profession (p = 0,037). Physicians presented higher scores in the global IdC (p = 0,037) and in the Collaboration mean (p = 0,020) independently in the multivariate models. A negative linear relationship (rho: -0,202, p = 0,042) was observed between age and the overall IoC score. Professionals aged ≤ 30 years reported a higher perception of Shared Activities (p = 0,031). Negative linear relationships were observed between years of experience and total IoC score (rho: -0,202, p = 0,042) and patients’ Perception score (rho: -0.241, p = 0.015). The research activity also showed to be a variable related to a greater degree of Collaboration at a global level and in some of the factors (p < 0,05). The scale of IoC obtained a Cronbach's α of 0,9.

Conclusions

The intensity of interprofessional collaboration in ICUs is moderate. Professionals with experience of ≤ 10 years, a higher level of satisfaction and participation in research activities show a greater intensity of collaboration. Doctors perceive collaboration more intensely than nurses. All factors contribute equally to the internal consistency of the questionnaire.

Background

Patient satisfaction in relation with nursing care has become a key determinant of the quality of hospital care.

Objectives

To evaluate patient satisfaction in relation with nursing care in a critical care context; to determine the correlation between critical patient satisfaction and sociodemographic and clinical variables and to describe patient perceptions with nursing care.

Methods

A descriptive, prospective, correlational study which includes the analysis of some open questions in the intensive care unit (ICU) of a tertiary level university hospital. The degree of satisfaction of all patients discharged from de ICU was evaluated. It was used the validated Spanish version of Nursing Intensive-Care Satisfaction-Scale (NICSS). There were also collected sociodemographic and clinical data and 3 open questions were asked. It was used the inferential and descriptive statistics considering statistically significant P < .05. Open questions were examined using a language context analysis. The approval of the hospital ethical committee was obtained.

Results

111 patients agreed to participate, with a mean age of 64,18 years (CI 95% 61,36-66,88) and with a medium level of satisfaction of 5,83 (CI 95% 5,78-5,88) being 6 the maximum score. Women, older patients and those who reflect a higher degree of recovery, are those who reported greater satisfaction. Three main themes emerged from the analysis of the open-ended questions of the surveys: nurse patient relationship, professional practice environment and ICU nature.

Conclusion

Patient satisfaction in relation with nursing care was elevated. Age, sex and degree of recovery significantly influenced their perception. Nurse patient relationship and the professional practice environment were aspects highlighted by patients. The professional model incorporated by the institution may encouraged these results.

The current demand on health services requires that nurses play a key role, by adapting their competencies to different fields and complexity levels. The approach of situations presented by critically ill patients underpins the need for development of specialised competencies in specific areas such as patient safety, prevention and control of healthcare-associated infections, performance of specific techniques and interventions, autonomous medication management or the use of technology, among others. Spain relies on a specialist training programme that is unique worldwide. Training admission is managed through a contract as a «Resident Nurse Intern» (EIR, Enfermera Interna Residente), provided by regional healthcare services. Only 6 specialities have been established and developed, in an uneven manner and with a short provision of places, annually. Given that the specialization in critical care nursing does not exist, nurses usually self-fund their postgraduate training to enhance their opportunities career development. The development of a speciality for critical care nursing is a priority. The models proposed advocate for creating nursing roles that could cover the systemic gaps through the expansion of their competencies and the introduction of procedures that fit nursing into advanced practice, which could be achieved through Advanced Accreditation Diplomas. Simultaneously, it would be convenient to analyse how and why such a dynamic discipline in some countries became stuck in anachronistic models of the Spanish healthcare system. This analysis might contribute to move forward on the development of areas of improvement in terms of service access and quality of care.