Pub Date : 2025-04-04DOI: 10.1016/j.enfi.2025.500546
Luis Guerra-Sánchez PhD , Sara González-Alfonso RN , Pablo Lerma-Lara RN , Miguel Bernardino-Santos RN , Rosario Cortijo-González RN , Soraya Bustamante-González RN
Introduction
The occurrence of delirium casts a shadow over the prognosis of patients, especially the critically ill. Prevention and treatment of delirium is more effective and with fewer adverse effects with multicomponent interventions than with pharmacological measures alone. The objective was to assess whether a non-pharmacological care-related intervention can reduce the incidence of delirium in an acute cardiovascular care unit.
Methods
Quasi-experimental study (before/after). ‘Before’: From November 2018 to March 2019, 190 patients aged 18 years and older, admitted to an acute cardiovascular care unit, were assessed using the Confusion Assessment Method for the ICU. From April to November 2019, a series of actions related to the physical environment and accompaniment were implemented. The ‘after’ started in November 2019 and 189 patients were assessed until early March 2020.
Results
The incidence of delirium before introducing the actions was 11,6%, which fell to 4,2% (p = 0,012) after the actions.
Discussion
Management of delirium includes effective diagnosis, delirium prevention activities and treatment, which ideally should be free of side effects.
Conclusions
The implementation of a bundle of measures related to environmental changes and involving the family, significantly reduced the incidence of delirium, to less than half.
{"title":"Eficacia del acompañamiento familiar y de medidas ambientales para reducir la incidencia de delirio en una unidad de agudos cardiovasculares: un estudio cuasi-experimental. Reducir el delirio sin fármacos es posible, es mejor","authors":"Luis Guerra-Sánchez PhD , Sara González-Alfonso RN , Pablo Lerma-Lara RN , Miguel Bernardino-Santos RN , Rosario Cortijo-González RN , Soraya Bustamante-González RN","doi":"10.1016/j.enfi.2025.500546","DOIUrl":"10.1016/j.enfi.2025.500546","url":null,"abstract":"<div><h3>Introduction</h3><div>The occurrence of delirium casts a shadow over the prognosis of patients, especially the critically ill. Prevention and treatment of delirium is more effective and with fewer adverse effects with multicomponent interventions than with pharmacological measures alone. The objective was to assess whether a non-pharmacological care-related intervention can reduce the incidence of delirium in an acute cardiovascular care unit.</div></div><div><h3>Methods</h3><div>Quasi-experimental study (before/after). ‘Before’: From November 2018 to March 2019, 190 patients aged 18 years and older, admitted to an acute cardiovascular care unit, were assessed using the Confusion Assessment Method for the ICU. From April to November 2019, a series of actions related to the physical environment and accompaniment were implemented. The ‘after’ started in November 2019 and 189 patients were assessed until early March 2020.</div></div><div><h3>Results</h3><div>The incidence of delirium before introducing the actions was 11,6%, which fell to 4,2% (p<!--> <!-->=<!--> <!-->0,012) after the actions.</div></div><div><h3>Discussion</h3><div>Management of delirium includes effective diagnosis, delirium prevention activities and treatment, which ideally should be free of side effects.</div></div><div><h3>Conclusions</h3><div>The implementation of a bundle of measures related to environmental changes and involving the family, significantly reduced the incidence of delirium, to less than half.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 3","pages":"Article 500546"},"PeriodicalIF":1.1,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143777259","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}
Central venous catheter-related bacteremia is a common nosocomial infection in intensive care units (ICU), the prevalence is worrying. In recent years, due to Covid-19, the number of central venous catether's patients, treated with immunosuppressive drugs, has been increased. Our objective was to determine the prevalence of central catheter bacteremia in ICU, during 2022, as well as to determine associated risk factors.
Method
Descriptive cross-sectional study in ICU of hospita (HGU Dr. Balmis Hospital Alicante, Spain). Were included 466 patients admitted to ICU in 2022. Sociodemographic, clinical, catheter-related data and APACHE-II and q-SOFA scale scores were collected.
Results
The prevalence of bacteriemia was 3.65%. Significant factors associated with bacteriemia were the number of catheters inserted in each patient (p < 0.001) and the use of immunosuppressive drugs (p = 0.002). Patients who had a peripherally inserted catheter (PICC) had a lower probability of develop bacteriemia and patients with conventional catheter and PICC had a higher probability. The rest of the variables, including Covid-19, without significant differences.
Discussion and conclusions
In line with other authors, we can affirm that the administration of immunosuppressive drugs is a risk factor of central venous catheter-related bacteremia; A correct risk-benefit assessment is recommended when prescribing these drugs, in Covid's patients the biological drug tocilizumab could be the recommended one. An increase by one unit in the number of catheters inserted causes a 5-fold increase in probability of developing bacteremia (Odds ratio: 4.984, 95% confidence interval 2.984-9.136). Covid-19, sex, age, comorbidities and q-SOFA and APACHE-II scores do not seem to show a relationship whith bacteremia and PICCs devices do seem to be safer versus conventional CVCs.
{"title":"Bacteriemia asociada a catéter venoso central en el paciente crítico: epidemiología y factores de riesgo","authors":"Esther Mancheño-Maciá PhD , Beatriz Muñoz-Sánchez RN , Inés González-Sánchez PhD , Marina Leal-Clavel RN MsN , Vanesa Escudero-Ortiz PhD","doi":"10.1016/j.enfi.2025.500538","DOIUrl":"10.1016/j.enfi.2025.500538","url":null,"abstract":"<div><h3>Introduction</h3><div>Central venous catheter-related bacteremia is a common nosocomial infection in intensive care units (ICU), the prevalence is worrying. In recent years, due to Covid-19, the number of central venous catether's patients, treated with immunosuppressive drugs, has been increased. Our objective was to determine the prevalence of central catheter bacteremia in ICU, during 2022, as well as to determine associated risk factors.</div></div><div><h3>Method</h3><div>Descriptive cross-sectional study in ICU of hospita (HGU Dr. Balmis Hospital Alicante, Spain). Were included 466 patients admitted to ICU in 2022. Sociodemographic, clinical, catheter-related data and APACHE-II and q-SOFA scale scores were collected.</div></div><div><h3>Results</h3><div>The prevalence of bacteriemia was 3.65%. Significant factors associated with bacteriemia were the number of catheters inserted in each patient (p<!--> <!--><<!--> <!-->0.001) and the use of immunosuppressive drugs (p<!--> <!-->=<!--> <!-->0.002). Patients who had a peripherally inserted catheter (PICC) had a lower probability of develop bacteriemia and patients with conventional catheter and PICC had a higher probability. The rest of the variables, including Covid-19, without significant differences.</div></div><div><h3>Discussion and conclusions</h3><div>In line with other authors, we can affirm that the administration of immunosuppressive drugs is a risk factor of central venous catheter-related bacteremia; A correct risk-benefit assessment is recommended when prescribing these drugs, in Covid's patients the biological drug tocilizumab could be the recommended one. An increase by one unit in the number of catheters inserted causes a 5-fold increase in probability of developing bacteremia (Odds ratio: 4.984, 95% confidence interval 2.984-9.136). Covid-19, sex, age, comorbidities and q-SOFA and APACHE-II scores do not seem to show a relationship whith bacteremia and PICCs devices do seem to be safer <em>versus</em> conventional CVCs.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 3","pages":"Article 500538"},"PeriodicalIF":1.1,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143777260","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 : 2025-04-04DOI: 10.1016/j.enfi.2025.500542
Ana María Ezquerra-García RN , María de la O. Casamayor-Lerena RN
The effectiveness of the backboard in cardiopulmonary resuscitation has not been established although it is recommended to perform compressions on a firm surface.
Objectives
To determine the relationship between the use of the backboard and the depth of chest compressions. To know the preference of rescuers when performing chest compressions without or with backboard.
Methodology
Single-blind, experimental study with paired data. All staff of healthcare workers in the Intensive Care Unit performed 2 one-minute simulations of uninterrupted chest compressions, one without and one with a backboard. The quality of the chest compressions was valued: Rate, depth, complete chest release and compression, performed with and without backboard. The placement of the backboard was simply randomized at the first measurement. The subjects were unaware of the difference between the 2 scenarios. Participation was voluntary. Two analyzes were performed with paired Student's t-test: one analyzing the order of measurement and the other in relation to the presence or absence of the backboard.
Results
Seventy-one workers (87.6%) of the staff participated. The presence of the backboard was associated with an increase in the average depth (47.99 mm vs. 48.99 mm, P = 0.008 and the percentage of compression > 50 mm (63.65 vs. 76.17, P = 0.002. When analyzing the simulation order, an increase in the frequency of chest compressions was observed in the second measurement (131.14 vs. 135.03, P = 0.009). Participants had no preference between the 2 simulations (P = 0.749).
Conclusions
The backboard as a hard plane increases the mean depth and percentage of chest compression during cardiopulmonary resuscitation on hospital mattress without affecting complete chest release or rate. The rescuers do not perceive the presence of the backboard, and there is not preference in its execution without or with a backboard.
{"title":"Relación entre el uso de la tabla de parada cardiaca y la calidad de las compresiones torácicas","authors":"Ana María Ezquerra-García RN , María de la O. Casamayor-Lerena RN","doi":"10.1016/j.enfi.2025.500542","DOIUrl":"10.1016/j.enfi.2025.500542","url":null,"abstract":"<div><div>The effectiveness of the backboard in cardiopulmonary resuscitation has not been established although it is recommended to perform compressions on a firm surface.</div></div><div><h3>Objectives</h3><div>To determine the relationship between the use of the backboard and the depth of chest compressions. To know the preference of rescuers when performing chest compressions without or with backboard.</div></div><div><h3>Methodology</h3><div>Single-blind, experimental study with paired data. All staff of healthcare workers in the Intensive Care Unit performed 2<!--> <!-->one-minute simulations of uninterrupted chest compressions, one without and one with a backboard. The quality of the chest compressions was valued: Rate, depth, complete chest release and compression, performed with and without backboard. The placement of the backboard was simply randomized at the first measurement. The subjects were unaware of the difference between the 2<!--> <!-->scenarios. Participation was voluntary. Two analyzes were performed with paired Student's t-test: one analyzing the order of measurement and the other in relation to the presence or absence of the backboard.</div></div><div><h3>Results</h3><div>Seventy-one workers (87.6%) of the staff participated. The presence of the backboard was associated with an increase in the average depth (47.99<!--> <!-->mm vs. 48.99<!--> <!-->mm, P<!--> <!-->=<!--> <!-->0.008 and the percentage of compression<!--> <!-->> 50<!--> <!-->mm (63.65 vs. 76.17, P<!--> <!-->=<!--> <!-->0.002. When analyzing the simulation order, an increase in the frequency of chest compressions was observed in the second measurement (131.14 vs. 135.03, P<!--> <!-->=<!--> <!-->0.009). Participants had no preference between the 2<!--> <!-->simulations (P<!--> <!-->=<!--> <!-->0.749).</div></div><div><h3>Conclusions</h3><div>The backboard as a hard plane increases the mean depth and percentage of chest compression during cardiopulmonary resuscitation on hospital mattress without affecting complete chest release or rate. The rescuers do not perceive the presence of the backboard, and there is not preference in its execution without or with a backboard.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 3","pages":"Article 500542"},"PeriodicalIF":1.1,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143777261","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 : 2025-04-02DOI: 10.1016/j.enfi.2025.500547
Leire Legorburu-Brezmes RN
Introduction
According to several studies, nurses feel that they are not prepared to face the death of a patient, especially when the patient is pediatric.
Objective
To describe the level of coping of nurses in various departments of a pediatric monographic hospital when faced with the death of a patient.
Method
A quantitative, descriptive, cross-sectional, observational, case series study was carried out from February to April 2024 with nurses from the Pediatric Palliative Care, the Pediatric Intensive Care Unit and the Pediatric Oncohematology Unit of a monographic pediatric hospital in the Community of Madrid. Several sociodemographic variables were determined and the Bugen Death Coping Scale was used as the main instrument, followed by a descriptive analysis of the data.
Results
In the present study, 69% had neutral coping with death, 19% had optimal coping and 11,9% had inadequate coping. It has been observed that nurses who work in Pediatric Palliative Care, have a fixed shift, have suffered the death of a family member in the last 3 years and have previous training, have a better coping with death. Likewise, it could be seen that older age and greater work experience, male sex and having children may be factors that favor optimal coping in the face of death.
Conclusions
Knowing these data helps to establish strategies for improvement, since it has been seen that greater preparation of professionals decreases anxiety in the face of death and improves patient care.
{"title":"Estudio descriptivo sobre el afrontamiento de las enfermeras ante la muerte de un paciente pediátrico","authors":"Leire Legorburu-Brezmes RN","doi":"10.1016/j.enfi.2025.500547","DOIUrl":"10.1016/j.enfi.2025.500547","url":null,"abstract":"<div><h3>Introduction</h3><div>According to several studies, nurses feel that they are not prepared to face the death of a patient, especially when the patient is pediatric.</div></div><div><h3>Objective</h3><div>To describe the level of coping of nurses in various departments of a pediatric monographic hospital when faced with the death of a patient.</div></div><div><h3>Method</h3><div>A quantitative, descriptive, cross-sectional, observational, case series study was carried out from February to April 2024 with nurses from the Pediatric Palliative Care, the Pediatric Intensive Care Unit and the Pediatric Oncohematology Unit of a monographic pediatric hospital in the Community of Madrid. Several sociodemographic variables were determined and the Bugen Death Coping Scale was used as the main instrument, followed by a descriptive analysis of the data.</div></div><div><h3>Results</h3><div>In the present study, 69% had neutral coping with death, 19% had optimal coping and 11,9% had inadequate coping. It has been observed that nurses who work in Pediatric Palliative Care, have a fixed shift, have suffered the death of a family member in the last 3 years and have previous training, have a better coping with death. Likewise, it could be seen that older age and greater work experience, male sex and having children may be factors that favor optimal coping in the face of death.</div></div><div><h3>Conclusions</h3><div>Knowing these data helps to establish strategies for improvement, since it has been seen that greater preparation of professionals decreases anxiety in the face of death and improves patient care.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 3","pages":"Article 500547"},"PeriodicalIF":1.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747648","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}
Catamenial pneumothorax (CN) is a rare type of pneumothorax that affects women of childbearing age. Its etiopathogenesis is controversial and several theories have been proposed, although there is a frequent relationship with intrathoracic endometriosis. The diagnosis can be a challenge, so recurrences can appear until it is found and it can be treated correctly. This document describes a case of catamenial pneumothorax and develops a care plan tailored at a patient suffering from this type of pathology.
Case description
A 41-year-old woman, with no personal or family history who attended the emergency department reporting pain in the right hemithorax and dyspnea. The chest X-ray revealed a complete pneumothorax that required placement of a chest drain. During the surgical intervention, cicatricial lesions with gray and black diaphragmatic pores are observed, which suggests a pneumothorax of catamenial origin.
Assessment
The nursing assessment was designed using the conceptual model of Marjory Gordon, where the patterns of activity-exercise, rest, perception and sexuality-related patterns were identified as altered.
Diagnosis
Using the taxonomy created by NANDA, nursing diagnoses related to impaired gas exchange, pain, rest, skin integrity, and problems related to gynecologic-obstetric aspects were established.
Planning
The objectives and interventions were established based on the previously marked diagnoses, using the NOC and NIC taxonomy. Those related to gas exchange, skin care at the level of the chest tube area, pain, rest and those with gynecological links stand out.
Discussion
CN is a rare entity and it is necessary to know its etiopathogenesis for early detection of the problem and apply care aimed at meeting the needs of the patient and avoiding complications derived from it.
{"title":"Neumotórax catamenial: a propósito de un caso","authors":"Jorge Álvarez-López RN, MSN , Cristina Pérez-Talavera RN, MSc","doi":"10.1016/j.enfi.2025.500530","DOIUrl":"10.1016/j.enfi.2025.500530","url":null,"abstract":"<div><h3>Introduction</h3><div>Catamenial pneumothorax (CN) is a rare type of pneumothorax that affects women of childbearing age. Its etiopathogenesis is controversial and several theories have been proposed, although there is a frequent relationship with intrathoracic endometriosis. The diagnosis can be a challenge, so recurrences can appear until it is found and it can be treated correctly. This document describes a case of catamenial pneumothorax and develops a care plan tailored at a patient suffering from this type of pathology.</div></div><div><h3>Case description</h3><div>A 41-year-old woman, with no personal or family history who attended the emergency department reporting pain in the right hemithorax and dyspnea. The chest X-ray revealed a complete pneumothorax that required placement of a chest drain. During the surgical intervention, cicatricial lesions with gray and black diaphragmatic pores are observed, which suggests a pneumothorax of catamenial origin.</div></div><div><h3>Assessment</h3><div>The nursing assessment was designed using the conceptual model of Marjory Gordon, where the patterns of activity-exercise, rest, perception and sexuality-related patterns were identified as altered.</div></div><div><h3>Diagnosis</h3><div>Using the taxonomy created by NANDA, nursing diagnoses related to impaired gas exchange, pain, rest, skin integrity, and problems related to gynecologic-obstetric aspects were established.</div></div><div><h3>Planning</h3><div>The objectives and interventions were established based on the previously marked diagnoses, using the NOC and NIC taxonomy. Those related to gas exchange, skin care at the level of the chest tube area, pain, rest and those with gynecological links stand out.</div></div><div><h3>Discussion</h3><div>CN is a rare entity and it is necessary to know its etiopathogenesis for early detection of the problem and apply care aimed at meeting the needs of the patient and avoiding complications derived from it.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 2","pages":"Article 500530"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760717","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 : 2025-04-01DOI: 10.1016/j.enfi.2025.500543
Gemma Leiva-Aguado RN, MSc , M. Isabel Calleja-Serrano RN , M. Carmen Cuenca-Soriano RN , Faustino Álvarez-Cebrián MD, PhD , Álvaro Castellanos-Ortega MD, PhD
The clinical deterioration of patients admitted to hospital wards, characterised by physiological abnormalities, can be predicted 6 to 24 hours in advance and often depends on the nurse's ability to detect it early. In addition, advances in the treatment and care of the critically ill patient have increased survival after discharge from the intensive care unit (ICU). This, together with increased severity, frailty, prolonged stays and special treatment needs, means that ICU survivors may have physical weakness and mental and/or cognitive impairment that persists over time. In this context, it is necessary to provide personalised care that guarantees the continuity of nursing care in the different care settings through which patients and their families pass.
For all these reasons, a continuity of care nursing consultation was designed and implemented in conjunction with a surveillance system on all hospital wards and nurse monitoring for the prevention of post-acute syndrome after discharge from a critical care unit.
More than 665 adult inpatient beds are currently under surveillance. In the study period from February 2023 to January 2024, of the 2126 patients discharged from the critical care unit, 87 were in post-ICU follow-up, 55 in full follow-up and 32 in partial follow-up.
The implementation of a surveillance system, monitoring in the continuity of nursing care throughout the disease and during the recovery phases, at the different levels of care (critical care, hospitalisation, primary care), can prevent and/or minimise the physical, psychological and cognitive alterations of the post-ICU syndrome and can contribute to the recovery of the quality of life of patients and their families.
{"title":"Programa de sistema de respuesta rápida y continuidad de cuidados enfermeros para la prevención del síndrome post-UCI","authors":"Gemma Leiva-Aguado RN, MSc , M. Isabel Calleja-Serrano RN , M. Carmen Cuenca-Soriano RN , Faustino Álvarez-Cebrián MD, PhD , Álvaro Castellanos-Ortega MD, PhD","doi":"10.1016/j.enfi.2025.500543","DOIUrl":"10.1016/j.enfi.2025.500543","url":null,"abstract":"<div><div>The clinical deterioration of patients admitted to hospital wards, characterised by physiological abnormalities, can be predicted 6 to 24<!--> <!-->hours in advance and often depends on the nurse's ability to detect it early. In addition, advances in the treatment and care of the critically ill patient have increased survival after discharge from the intensive care unit (ICU). This, together with increased severity, frailty, prolonged stays and special treatment needs, means that ICU survivors may have physical weakness and mental and/or cognitive impairment that persists over time. In this context, it is necessary to provide personalised care that guarantees the continuity of nursing care in the different care settings through which patients and their families pass.</div><div>For all these reasons, a continuity of care nursing consultation was designed and implemented in conjunction with a surveillance system on all hospital wards and nurse monitoring for the prevention of post-acute syndrome after discharge from a critical care unit.</div><div>More than 665 adult inpatient beds are currently under surveillance. In the study period from February 2023 to January 2024, of the 2126 patients discharged from the critical care unit, 87 were in post-ICU follow-up, 55 in full follow-up and 32 in partial follow-up.</div><div>The implementation of a surveillance system, monitoring in the continuity of nursing care throughout the disease and during the recovery phases, at the different levels of care (critical care, hospitalisation, primary care), can prevent and/or minimise the physical, psychological and cognitive alterations of the post-ICU syndrome and can contribute to the recovery of the quality of life of patients and their families.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 2","pages":"Article 500543"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783425","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 : 2025-04-01DOI: 10.1016/j.enfi.2025.500539
Esther Cecilia Wilches-Luna PT, PhD , Vilma Eugenia Muñoz-Arcos PT, MSc , Paula Benavides-Candezano PT , José Julián Bernal-Sánchez PT, PhD, MSc , Ada Clarice Gastaldi PT, PhD
Objective
To determine the internal consistency (IC), minimal detectable change (MDC), and sensitivity to change of the Barthel Index (BI) at ICU discharge and three months post-hospital discharge.
Methods
A prospective longitudinal study was conducted between November 2016 and July 2017 in a medical-surgical intensive care unit (ICU). A total of 149 patients over 18 years with a BI score >90 prior to ICU admission were included. The COSMIN checklist was utilized to evaluate the measurement properties. Clinical and demographic variables, BI scores, IC, MDC, and sensitivity to change were analyzed. The Cronbach's alpha coefficient (α) was calculated to determine the IC of the BI by domain and for the overall scale. Effect size (ES) indices and standardized mean response (SMR) were used for sensitivity to change. The MDC was identified using a distribution-based method, calculating the standard error of measurement (SEM). Floor and ceiling effects were assessed, with a threshold of less than 15% considered acceptable.
Results
A total of 141 patients were evaluated at discharge from the ICU. Of these, n = 77 (41.7%) were men, with a mean age of 58.5 ± 16.8 years; n = 62 (41.6%) required invasive mechanical ventilation. One hundred twelve patients were reassessed three months after discharge. The overall IC was: α = 0.70 at ICU discharge and α = 0.96 at three months. Ninety two percent (n = 103) of the patients showed values greater than or equal to the MDC of 10 points, with statistically significant differences identified in the type of weaning, tracheostomy, and length of stay in the ICU (p < 0.005).
Conclusions
The items of the Spanish version of the BI demonstrate acceptable IC at ICU discharge. The MDC was 10 points, validating its responsiveness and utility for monitoring the functional independence of critically ill patients at ICU discharge and three months after hospital discharge.
{"title":"Internal consistency, minimal detectable change, and sensitivity to change of the Spanish version of the Barthel Index at intensive care unit discharge and three months later","authors":"Esther Cecilia Wilches-Luna PT, PhD , Vilma Eugenia Muñoz-Arcos PT, MSc , Paula Benavides-Candezano PT , José Julián Bernal-Sánchez PT, PhD, MSc , Ada Clarice Gastaldi PT, PhD","doi":"10.1016/j.enfi.2025.500539","DOIUrl":"10.1016/j.enfi.2025.500539","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the internal consistency (IC), minimal detectable change (MDC), and sensitivity to change of the Barthel Index (BI) at ICU discharge and three months post-hospital discharge.</div></div><div><h3>Methods</h3><div>A prospective longitudinal study was conducted between November 2016 and July 2017 in a medical-surgical intensive care unit (ICU). A total of 149 patients over 18 years with a BI score >90 prior to ICU admission were included. The COSMIN checklist was utilized to evaluate the measurement properties. Clinical and demographic variables, BI scores, IC, MDC, and sensitivity to change were analyzed. The Cronbach's alpha coefficient (<em>α</em>) was calculated to determine the IC of the BI by domain and for the overall scale. Effect size (ES) indices and standardized mean response (SMR) were used for sensitivity to change. The MDC was identified using a distribution-based method, calculating the standard error of measurement (SEM). Floor and ceiling effects were assessed, with a threshold of less than 15% considered acceptable.</div></div><div><h3>Results</h3><div>A total of 141 patients were evaluated at discharge from the ICU. Of these, <em>n</em> <!-->=<!--> <!-->77 (41.7%) were men, with a mean age of 58.5<!--> <!-->±<!--> <!-->16.8 years; <em>n</em> <!-->=<!--> <!-->62 (41.6%) required invasive mechanical ventilation. One hundred twelve patients were reassessed three months after discharge. The overall IC was: <em>α</em> <!-->=<!--> <!-->0.70 at ICU discharge and <em>α</em> <!-->=<!--> <!-->0.96 at three months. Ninety two percent (<em>n</em> <!-->=<!--> <!-->103) of the patients showed values greater than or equal to the MDC of 10 points, with statistically significant differences identified in the type of weaning, tracheostomy, and length of stay in the ICU (<em>p</em> <!--><<!--> <!-->0.005).</div></div><div><h3>Conclusions</h3><div>The items of the Spanish version of the BI demonstrate acceptable IC at ICU discharge. The MDC was 10 points, validating its responsiveness and utility for monitoring the functional independence of critically ill patients at ICU discharge and three months after hospital discharge.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 2","pages":"Article 500539"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143777253","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 : 2025-04-01DOI: 10.1016/j.enfi.2025.500535
Amaia Gutiérrez-Abarca MSN, Alberto Casado-Álvarez MSN, Sare Espinosa-Carcabilla MSN
Introduction
A poor Nurse-to-Patient (N:P) ratio has a negative impact on the health of both patients and professionals. There are several tools to quantify the Nurse Workload (NW) and adjust nurse staffing. The use of such tools in the Intensive Care Units (ICU) can facilitate the adaptation of Nursing resources to patients’ real needs and improve working conditions.
Objective
To determine the NW in a Surgical ICU.
Methodology
Descriptive, transversal and unicentric study during March and April 2023. Determination of the operative N:P ratio adequated to the NW using the “Nursing Activities Score” (NAS). Measurement of the NW using NAS and “Valoración de Cargas de Trabajo y Tiempos de Enfermería” (VACTE) scales, together with the proposed NW indicators. Management and efficiency analysis of the Nursing Resources using the “Work Utilization Ratio” Index (WUR). Identification of work days and shifts with greater workload. Bivariate analysis relating NAS and VACTE to reason for admission. NW calculation relating number of scales and NAS and VACTE average of each reason for admission. Correlation analysis between scales.
Results
1705 records per scale were collected. NAS per patient median: 55.70 (IR: 51.30-60.38) (95%CI: 54.74-56.66). NAS per patient mean: 56,67 (SD: ± 8,28) (95%CI: 55.72-57.63). NW per bed NAS: 63.39, VACTE: 652.93. NAS per nurse: 135.23%. B:P Ratio: 1:1.09. Operative N:P Ratio: 1:1.76. WUR >1. Correlation coefficient between scales: 0.45.
Conclusions
There is a shortage of nurses in relation to the work generated. An update in the scales is required. The NAS per nurse is more effective than the NAS per patient for the adequacy of the Nursing workforce. The new proposed indicators might be suitable to determine the NW and to optimize the calculation of Nursing resources.
{"title":"Análisis de la carga de trabajo enfermero e impacto del volumen y flujo de pacientes en una UCI quirúrgica","authors":"Amaia Gutiérrez-Abarca MSN, Alberto Casado-Álvarez MSN, Sare Espinosa-Carcabilla MSN","doi":"10.1016/j.enfi.2025.500535","DOIUrl":"10.1016/j.enfi.2025.500535","url":null,"abstract":"<div><h3>Introduction</h3><div>A poor Nurse-to-Patient (N:P) ratio has a negative impact on the health of both patients and professionals. There are several tools to quantify the Nurse Workload (NW) and adjust nurse staffing. The use of such tools in the Intensive Care Units (ICU) can facilitate the adaptation of Nursing resources to patients’ real needs and improve working conditions.</div></div><div><h3>Objective</h3><div>To determine the NW in a Surgical ICU.</div></div><div><h3>Methodology</h3><div>Descriptive, transversal and unicentric study during March and April 2023. Determination of the operative N:P ratio adequated to the NW using the “Nursing Activities Score” (NAS). Measurement of the NW using NAS and “Valoración de Cargas de Trabajo y Tiempos de Enfermería” (VACTE) scales, together with the proposed NW indicators. Management and efficiency analysis of the Nursing Resources using the “Work Utilization Ratio” Index (WUR). Identification of work days and shifts with greater workload. Bivariate analysis relating NAS and VACTE to reason for admission. NW calculation relating number of scales and NAS and VACTE average of each reason for admission. Correlation analysis between scales.</div></div><div><h3>Results</h3><div>1705 records per scale were collected. NAS per patient median: 55.70 (IR: 51.30-60.38) (95%CI: 54.74-56.66). NAS per patient mean: 56,67 (SD:<!--> <!-->±<!--> <!-->8,28) (95%CI: 55.72-57.63). NW per bed NAS: 63.39, VACTE: 652.93. NAS per nurse: 135.23%. B:P Ratio: 1:1.09. Operative N:P Ratio: 1:1.76. WUR<!--> <!-->>1. Correlation coefficient between scales: 0.45.</div></div><div><h3>Conclusions</h3><div>There is a shortage of nurses in relation to the work generated. An update in the scales is required. The NAS per nurse is more effective than the NAS per patient for the adequacy of the Nursing workforce. The new proposed indicators might be suitable to determine the NW and to optimize the calculation of Nursing resources.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 2","pages":"Article 500535"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739212","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 : 2025-03-26DOI: 10.1016/j.enfi.2025.500540
Natalia Esquivel-Garzón RN, PhD, Dora Inés Parra RN, MSN
Objective
To determine the association between the competence (knowledge, skill and preparation) of the family caregiver and the degree of dependency of patients discharged from Intensive Care Unit.
Method
A descriptive, cross-sectional study was carried out to characterize family caregivers and patients discharged from the ICU with moderate, severe or total dependence according to Barthel score. Competence was measured with the application of the CUIDAR instrument and caregiver performance (execution of activities in a specific situation) with an instrument that evaluated the performance of actions aimed at supplying basic needs of feeding, elimination, body hygiene, skin care, oxygen therapy and medication administration in a sample of 140 caregivers.
Results
A positive association was found between patient functionality and caregiver performance (Spearman rho: 0.38; P<.001). In contrast, no significant correlation was observed between the self-perception of caregiver competence assessed with the CUIDAR instrument and the patient's functionality, measured by the Barthel scale (Spearman rho: 0.12; P=.16). The 69.3% of the participants had a medium or low competence, only (30.7%) were classified at a high level. The lowest scores were obtained in knowledge (62.9%), followed by uniqueness (32.9%).
Conclusion
There is a significant association between patient functionality and objectively assessed caregiver performance; thus, caregivers of more dependent patients have significant challenges to achieve adequate performance in their role.
{"title":"Asociación entre competencia del cuidador familiar y dependencia en pacientes que egresan de Unidad de Cuidado Intensivo","authors":"Natalia Esquivel-Garzón RN, PhD, Dora Inés Parra RN, MSN","doi":"10.1016/j.enfi.2025.500540","DOIUrl":"10.1016/j.enfi.2025.500540","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the association between the competence (knowledge, skill and preparation) of the family caregiver and the degree of dependency of patients discharged from Intensive Care Unit.</div></div><div><h3>Method</h3><div>A descriptive, cross-sectional study was carried out to characterize family caregivers and patients discharged from the ICU with moderate, severe or total dependence according to Barthel score. Competence was measured with the application of the CUIDAR instrument and caregiver performance (execution of activities in a specific situation) with an instrument that evaluated the performance of actions aimed at supplying basic needs of feeding, elimination, body hygiene, skin care, oxygen therapy and medication administration in a sample of 140 caregivers.</div></div><div><h3>Results</h3><div>A positive association was found between patient functionality and caregiver performance (Spearman rho: 0.38; <em>P</em><.001). In contrast, no significant correlation was observed between the self-perception of caregiver competence assessed with the CUIDAR instrument and the patient's functionality, measured by the Barthel scale (Spearman rho: 0.12; <em>P</em>=.16). The 69.3% of the participants had a medium or low competence, only (30.7%) were classified at a high level. The lowest scores were obtained in knowledge (62.9%), followed by uniqueness (32.9%).</div></div><div><h3>Conclusion</h3><div>There is a significant association between patient functionality and objectively assessed caregiver performance; thus, caregivers of more dependent patients have significant challenges to achieve adequate performance in their role.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 2","pages":"Article 500540"},"PeriodicalIF":1.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697137","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 identification of patients at risk has implications on the management of clinical and surgical patients. The severity of acute kidney injury (AKI) has a negative impact on the patient's prognosis and effects on kidney function recovery.
Objective
To determine the cases of renal recovery and level of severity of AKI in clinical and surgical patients admitted to the intensive care unit. (ICU).
Method
Prospective, observational, longitudinal, and quantitative analytical study. It was carried out in an ICU of a teaching hospital. The sample was non-probabilistic, consisting of 59 surgical and clinical patients. A structured questionnaire consisting of 38 questions subdivided into sections was used for data collection such as hospitalization data; surgery data; history of current hospitalization; hemodynamic and laboratory parameters; AKI severity. Variable analysis was based on non-parametric tests. Two-sided p values < 0.05 were considered statistically significant.
Results
The most severe AKI according to the classification KDIGO (Kidney Disease: Improving Global Outcomes) was 3 and mainly affected clinical patients (34.5%). Surgical patients predominantly developed AKI – KDIGO 2 and 3 (23.3%). The length of hospital stay (p = 0.04), and ICU stay (p = 0.001) was significant in patients who developed AKI. Renal recovery occurred predominantly in surgical patients (20.3%).
Conclusions
Clinical patients admitted to the ICU are more affected by more severe AKI (KDIGO 3). Renal recovery was observed in approximately two out of every five patients, being more significant in surgical patients.
{"title":"Recovery and severity of acute kidney injury in critically ill clinical and surgical patients","authors":"Raquel Teles-Mesquita Graduated , Natália Vieira-Araújo-Cunha MSN , Marcia Cristina-da-Silva-Magro PhD , Kamilla Grasielle-Nunes-da-Silva MSN","doi":"10.1016/j.enfi.2025.500545","DOIUrl":"10.1016/j.enfi.2025.500545","url":null,"abstract":"<div><h3>Introduction</h3><div>The identification of patients at risk has implications on the management of clinical and surgical patients. The severity of acute kidney injury (AKI) has a negative impact on the patient's prognosis and effects on kidney function recovery.</div></div><div><h3>Objective</h3><div>To determine the cases of renal recovery and level of severity of AKI in clinical and surgical patients admitted to the intensive care unit. (ICU).</div></div><div><h3>Method</h3><div>Prospective, observational, longitudinal, and quantitative analytical study. It was carried out in an ICU of a teaching hospital. The sample was non-probabilistic, consisting of 59 surgical and clinical patients. A structured questionnaire consisting of 38 questions subdivided into sections was used for data collection such as hospitalization data; surgery data; history of current hospitalization; hemodynamic and laboratory parameters; AKI severity. Variable analysis was based on non-parametric tests. Two-sided <em>p</em> values<!--> <!--><<!--> <!-->0.05 were considered statistically significant.</div></div><div><h3>Results</h3><div>The most severe AKI according to the classification KDIGO (Kidney Disease: Improving Global Outcomes) was 3 and mainly affected clinical patients (34.5%). Surgical patients predominantly developed AKI – KDIGO 2 and 3 (23.3%). The length of hospital stay (<em>p</em> <!-->=<!--> <!-->0.04), and ICU stay (<em>p</em> <!-->=<!--> <!-->0.001) was significant in patients who developed AKI. Renal recovery occurred predominantly in surgical patients (20.3%).</div></div><div><h3>Conclusions</h3><div>Clinical patients admitted to the ICU are more affected by more severe AKI (KDIGO 3). Renal recovery was observed in approximately two out of every five patients, being more significant in surgical patients.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 3","pages":"Article 500545"},"PeriodicalIF":1.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143681322","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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