Pub Date : 2024-10-01DOI: 10.1016/j.enfi.2024.10.001
Angel Cobos-Vargas , Aurora Bueno-Cavanillas
{"title":"Notificación de Incidentes. El eslabón más débil de los Sistemas de Seguridad del Paciente","authors":"Angel Cobos-Vargas , Aurora Bueno-Cavanillas","doi":"10.1016/j.enfi.2024.10.001","DOIUrl":"10.1016/j.enfi.2024.10.001","url":null,"abstract":"","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"35 4","pages":"Pages 251-254"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142652164","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 : 2024-10-01DOI: 10.1016/j.enfi.2024.02.006
Y.G. Santana-Padilla RN, MSc, PhD , T. Linares-Pérez RN , B.N. Santana-López RN, MSc, PhDc , L. Santana-Cabrera MD, PhD
Introduction/purpose
Dysphagia is a disorder that presents with specific signs and symptoms in critically ill patients. Intensive care unit (ICU) nurses are responsible for monitoring and detecting abnormalities in critically ill patients, so they must be trained to assess swallowing and the complications that may arise. The aim of this research is to analyse the dynamics of the detection and assessment of dysphagia by ICU nurses.
Method
Cross-sectional descriptive study using an electronic questionnaire to nurses from different Spanish ICUs. The survey was adapted from previous research and consisted of 6 sections with 30 items of qualitative questions. The collection period was between December 2022 and March 2023. Statistical analysis was performed using frequencies and percentages, and the Chi-Square test was used for bivariate analysis.
Outcomes
43 nurses were recruited. Dysphagia is considered an important problem (90.7%) but in 50.3% of the units there is no standard or care protocol for this disorder. The most common technique is the swallowing test (32.6%). There is a consensus in our sample that aspiration pneumonia is the main problem; however, nurses in the busiest care units consider sepsis to be a frequent complication (p = 0.029). The most common treatment is modification of food consistency (86.0%).
Conclusion
The findings of this research show a low systematisation of dysphagia screening in the units included. There is a need for greater implementation of interventions and clinical protocols for monitoring complications as well as for compensatory and rehabilitative management.
{"title":"Manejo de la disfagia por las enfermeras de las unidades de cuidados intensivos españolas","authors":"Y.G. Santana-Padilla RN, MSc, PhD , T. Linares-Pérez RN , B.N. Santana-López RN, MSc, PhDc , L. Santana-Cabrera MD, PhD","doi":"10.1016/j.enfi.2024.02.006","DOIUrl":"10.1016/j.enfi.2024.02.006","url":null,"abstract":"<div><h3>Introduction/purpose</h3><div>Dysphagia is a disorder that presents with specific signs and symptoms in critically ill patients. Intensive care unit (ICU) nurses are responsible for monitoring and detecting abnormalities in critically ill patients, so they must be trained to assess swallowing and the complications that may arise. The aim of this research is to analyse the dynamics of the detection and assessment of dysphagia by ICU nurses.</div></div><div><h3>Method</h3><div>Cross-sectional descriptive study using an electronic questionnaire to nurses from different Spanish ICUs. The survey was adapted from previous research and consisted of 6 sections with 30 items of qualitative questions. The collection period was between December 2022 and March 2023. Statistical analysis was performed using frequencies and percentages, and the Chi-Square test was used for bivariate analysis.</div></div><div><h3>Outcomes</h3><div>43 nurses were recruited. Dysphagia is considered an important problem (90.7%) but in 50.3% of the units there is no standard or care protocol for this disorder. The most common technique is the swallowing test (32.6%). There is a consensus in our sample that aspiration pneumonia is the main problem; however, nurses in the busiest care units consider sepsis to be a frequent complication (p<!--> <!-->=<!--> <!-->0.029). The most common treatment is modification of food consistency (86.0%).</div></div><div><h3>Conclusion</h3><div>The findings of this research show a low systematisation of dysphagia screening in the units included. There is a need for greater implementation of interventions and clinical protocols for monitoring complications as well as for compensatory and rehabilitative management.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"35 4","pages":"Pages 329-339"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142652165","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 : 2024-10-01DOI: 10.1016/j.enfi.2023.11.001
M.D. Gonzalez-Baz RN, MSN, PhD , E. Pacheco-del Cerro RN, MSN, PhD , M.I. Durango-Limárquez RN, MSN , A. Alcantarilla-Martín RN , R. Romero-Arribas RN , J. Ledesma-Fajardo RN , M.N. Moro-Tejedor RN, MSN, PhD
Background
The stay in a critical care unit (CCU) has a serious impact on physical condition causing numerous discomfort factors such as pain or difficulty in communicating. All of these are associated with possible sequelae following discharge from the Intensive Care Unit (ICU) named post-ICU syndrome. The Kolcaba Comfort Theory allows, from a holistic approach, to identify care needs from the patient's perspective using instruments such as the General Comfort Questionnaire (GCQ).
Objectives
To determine the comfort level of patients admitted to the CCU using the GCQ of Kolcaba and to identify the discomfort factors.
Methods
Cross-sectional descriptive observational prospective study. Population: 580 patients admitted to adult CCU of two high complexity hospitals from June 2015 to March 2020 with stay ≥24 h were interviewed. Descriptive analysis, Student's t-test and ANOVA and multivariate analysis were performed using SPSS v26 and STATA v16.
Results
The mean age was 52.62 (16.21), 357 (61.6%) were male and 434 (74.8%) were believers. The type of admission was planned in 322 (55.5%) and the most prevalent reason for admission was surgical 486 (83.8%). The median pain score (NRS) was 3.00 [0-4] and severity score (APACHE II) was 13.26 (5.89), the median length of stay was 4.00 [2-7] days. The mean comfort level was 3.02 (0.31) showing the highest value for the Reanimation Unit 3.02 (0.30) and the lowest fort the Emergency and Trauma Unit 2.95 (0.38). Statistically significant differences were found between the units in the comfort level of patients >65 years of age (P=.029). The Relief comfort type obtained the lowest mean 2.81 (0.33) and the physical context 2.75 (0.41) in the three units. In the multivariate analysis, statistically significant differences were found between the comfort level and the pain level: no pain (P=.000) OR: 4.361; IC: 2.184-8.707, mild pain (P=.000) OR: 4.007; IC: 2.068-7.763, moderate pain (P=.007) OR: 2.803; IC: 1.328-5.913, and the APACHE II score equal to or greater than 10 (P=.000) OR: 0.472; IC: 0.316-0.705.
Conclusions
The comfort level showed high scores in all three units. The physical and environmental contexts and the relief comfort type negatively affected the perception of comfort. The variables that explained comfort were pain and severity of illness. The evaluation of comfort from the patient's perspective through the GCQ could be considered an indicator of quality of nursing interventions.
背景重症监护病房（CCU）的住院对患者的身体状况有严重影响，会引起许多不适，如疼痛或交流困难。所有这些都与重症监护室（ICU）出院后可能出现的后遗症（重症监护室出院后综合症）有关。科尔卡巴舒适理论（Kolcaba Comfort Theory）允许使用一般舒适度问卷（GCQ）等工具，从整体角度确定患者的护理需求。 Objectives To determine the comfort level of patients admitted to the CCU using the GCQ of Kolcaba and to identify the discomfort factors.MethodsCross-sectional descriptive observational prospective study.研究对象访谈2015年6月至2020年3月期间入住两家高复杂性医院成人CCU、住院时间≥24小时的580名患者。使用 SPSS v26 和 STATA v16 进行描述性分析、学生 t 检验、方差分析和多变量分析。结果平均年龄为 52.62（16.21）岁，357（61.6%）人为男性，434（74.8%）人为信徒。322人（55.5%）的入院类型为计划入院，486人（83.8%）的入院原因为手术。疼痛评分（NRS）中位数为 3.00 [0-4]，严重程度评分（APACHE II）为 13.26 (5.89)，住院时间中位数为 4.00 [2-7] 天。平均舒适度为 3.02 (0.31)，其中复苏室最高，为 3.02 (0.30)，急诊和创伤室最低，为 2.95 (0.38)。在 65 岁患者的舒适度方面，各病房之间存在明显的统计学差异（P=0.029）。在三个科室中，救济舒适度的平均值最低，为 2.81（0.33），物理舒适度的平均值为 2.75（0.41）。在多变量分析中，舒适度与疼痛程度之间存在显著的统计学差异：无痛（P=.000）OR：4.361；IC：2.184-8.707，轻度疼痛（P=.000）OR：4.007；IC：2.068-7.763；中度疼痛（P=.007）OR：2.803；IC：1.328-5.913；APACHE II 评分等于或大于 10（P=.000）OR：0.472；IC：0.316-0.705。物理和环境背景以及缓解舒适类型对舒适感有负面影响。解释舒适度的变量是疼痛和疾病的严重程度。通过 GCQ 从患者角度对舒适度进行评估，可被视为护理干预质量的一项指标。
{"title":"Percepción del confort en el paciente crítico desde el modelo teórico de Kolcaba","authors":"M.D. Gonzalez-Baz RN, MSN, PhD , E. Pacheco-del Cerro RN, MSN, PhD , M.I. Durango-Limárquez RN, MSN , A. Alcantarilla-Martín RN , R. Romero-Arribas RN , J. Ledesma-Fajardo RN , M.N. Moro-Tejedor RN, MSN, PhD","doi":"10.1016/j.enfi.2023.11.001","DOIUrl":"10.1016/j.enfi.2023.11.001","url":null,"abstract":"<div><h3>Background</h3><div>The stay in a critical care unit (CCU) has a serious impact on physical condition causing numerous discomfort factors such as pain or difficulty in communicating. All of these are associated with possible sequelae following discharge from the Intensive Care Unit (ICU) named post-ICU syndrome. The Kolcaba Comfort Theory allows, from a holistic approach, to identify care needs from the patient's perspective using instruments such as the General Comfort Questionnaire (GCQ).</div></div><div><h3>Objectives</h3><div>To determine the comfort level of patients admitted to the CCU using the GCQ of Kolcaba and to identify the discomfort factors.</div></div><div><h3>Methods</h3><div>Cross-sectional descriptive observational prospective study. <em>Population:</em> 580 patients admitted to adult CCU of two high complexity hospitals from June 2015 to March 2020 with stay ≥24<!--> <!-->h were interviewed. Descriptive analysis, Student's t-test and ANOVA and multivariate analysis were performed using SPSS v26 and STATA v16.</div></div><div><h3>Results</h3><div>The mean age was 52.62 (16.21), 357 (61.6%) were male and 434 (74.8%) were believers. The type of admission was planned in 322 (55.5%) and the most prevalent reason for admission was surgical 486 (83.8%). The median pain score (NRS) was 3.00 [0-4] and severity score (APACHE II) was 13.26 (5.89), the median length of stay was 4.00 [2-7] days. The mean comfort level was 3.02 (0.31) showing the highest value for the Reanimation Unit 3.02 (0.30) and the lowest fort the Emergency and Trauma Unit 2.95 (0.38). Statistically significant differences were found between the units in the comfort level of patients >65 years of age (<em>P</em>=.029). The Relief comfort type obtained the lowest mean 2.81 (0.33) and the physical context 2.75 (0.41) in the three units. In the multivariate analysis, statistically significant differences were found between the comfort level and the pain level: no pain (<em>P</em>=.000) OR: 4.361; IC: 2.184-8.707, mild pain (<em>P</em>=.000) OR: 4.007; IC: 2.068-7.763, moderate pain (<em>P</em>=.007) OR: 2.803; IC: 1.328-5.913, and the APACHE II score equal to or greater than 10 (<em>P</em>=.000) OR: 0.472; IC: 0.316-0.705.</div></div><div><h3>Conclusions</h3><div>The comfort level showed high scores in all three units. The physical and environmental contexts and the relief comfort type negatively affected the perception of comfort. The variables that explained comfort were pain and severity of illness. The evaluation of comfort from the patient's perspective through the GCQ could be considered an indicator of quality of nursing interventions.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"35 4","pages":"Pages 264-277"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140787083","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 : 2024-10-01DOI: 10.1016/j.enfi.2024.07.002
M. Raurell-Torredà , R.-J. Fernández-Castillo , M.-E. Rodríguez-Delgado , Á. Cobos-Vargas , D.-M. Achury-Saldaña , E. Cavallo , A. Muriel-García , S. Arias-Rivera
Introduction
Anaemia is a common condition in patients admitted to intensive care units (ICUs). It is also well known that a significant amount of the carbon dioxide produced by health services is likely attributable to blood donation, testing, and the manufacture, storage, and distribution of blood components. To mitigate this, prevention strategies such as blood-sparing techniques are available. There is a lack of knowledge regarding the use of such techniques in ICUs in Spain and Latin America, healthcare systems with very different health expenditures per capita. The aim is to assess the degree of implementation of blood-sparing techniques in these regions.
Methods
Cross-sectional online multicentre survey. 251 ICUs in Spain and 53 in Latin America (20 in Argentina, 20 in Colombia, 13 in Ecuador) participated. A 20-item survey on the use of point-of-care, small-volume tubes (SVT), and closed-blood sampling devices (CBSD) was validated. Effect sizes were calculated using Phi (φ) or Cramer’s V (V).
Results
A response rate of 77% was obtained for Spain and 96% for Latin America. In Spain, the majority of ICUs were affiliated with public hospitals (88.1%, 171/194) while in Latin America, most were associated with private hospitals (56.9%, 29/51). Regarding the use of point-of-care testing, 67.5% of Spanish ICUs, compared to 35.3% of Latin Americans, reported frequent use (V = 0.343). In 91.7% of Spanish ICUs and 58.9% of Latin Americans, SVTs were rarely or never used (V = 0.380). The use of CBSD was significantly lower in Spain for both arterial and central venous catheters (V = 0.336). Private hospitals used more CBSD in arterial catheter than public ones (27% vs 8.3%, V = 0.278).
Conclusion
Point-of-care testing can be improved in Latin America, while the use of CBSD and small-volume tubes can be enhanced in Spain. Private hospitals tend to implement blood-sparing techniques more effectively than public hospitals.
{"title":"Blood-sparing techniques prevalence in adult intensive care units: A multicentre survey study","authors":"M. Raurell-Torredà , R.-J. Fernández-Castillo , M.-E. Rodríguez-Delgado , Á. Cobos-Vargas , D.-M. Achury-Saldaña , E. Cavallo , A. Muriel-García , S. Arias-Rivera","doi":"10.1016/j.enfi.2024.07.002","DOIUrl":"10.1016/j.enfi.2024.07.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Anaemia is a common condition in patients admitted to intensive care units (ICUs). It is also well known that a significant amount of the carbon dioxide produced by health services is likely attributable to blood donation, testing, and the manufacture, storage, and distribution of blood components. To mitigate this, prevention strategies such as blood-sparing techniques are available. There is a lack of knowledge regarding the use of such techniques in ICUs in Spain and Latin America, healthcare systems with very different health expenditures per capita. The aim is to assess the degree of implementation of blood-sparing techniques in these regions.</div></div><div><h3>Methods</h3><div>Cross-sectional online multicentre survey. 251 ICUs in Spain and 53 in Latin America (20 in Argentina, 20 in Colombia, 13 in Ecuador) participated. A 20-item survey on the use of point-of-care, small-volume tubes (SVT), and closed-blood sampling devices (CBSD) was validated. Effect sizes were calculated using Phi (φ) or Cramer’s V (V).</div></div><div><h3>Results</h3><div>A response rate of 77% was obtained for Spain and 96% for Latin America. In Spain, the majority of ICUs were affiliated with public hospitals (88.1%, 171/194) while in Latin America, most were associated with private hospitals (56.9%, 29/51). Regarding the use of point-of-care testing, 67.5% of Spanish ICUs, compared to 35.3% of Latin Americans, reported frequent use (<em>V</em> <!-->=<!--> <!-->0.343). In 91.7% of Spanish ICUs and 58.9% of Latin Americans, SVTs were rarely or never used (<em>V</em> <!-->=<!--> <!-->0.380). The use of CBSD was significantly lower in Spain for both arterial and central venous catheters (<em>V</em> <!-->=<!--> <!-->0.336). Private hospitals used more CBSD in arterial catheter than public ones (27% vs 8.3%, <em>V</em> <!-->=<!--> <!-->0.278).</div></div><div><h3>Conclusion</h3><div>Point-of-care testing can be improved in Latin America, while the use of CBSD and small-volume tubes can be enhanced in Spain. Private hospitals tend to implement blood-sparing techniques more effectively than public hospitals.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"35 4","pages":"Pages 340-351"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142652149","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 : 2024-10-01DOI: 10.1016/j.enfi.2024.03.001
N. Canga-Armayor RN PhD
The nursing profession, without losing its essence, is in continuous evolution in order to face and respond to the ever-changing health challenges of the population. Advanced Practice Nursing is a clear example of this development. The performance of advanced practice roles entails greater responsibility, expansion and depth of nursing practice, which is only possible with additional education beyond the bachelor's degree - a master's or doctoral degree in nursing - and greater expertise in clinical practice in a particular area of specialization.
Advanced practice nursing is intrinsically linked to the level of education since, further academic development of nursing promotes the advancement of autonomous practice. This article addresses the education of Advanced Practice Nurses, and focuses on its core aspects; providing detailed information on competencies, curricular structure, curriculum and key components of training programs. Finally, special mention is made of advanced role training in the critical care setting.
{"title":"La formación académica de las enfermeras que desarrollan roles de práctica avanzada","authors":"N. Canga-Armayor RN PhD","doi":"10.1016/j.enfi.2024.03.001","DOIUrl":"10.1016/j.enfi.2024.03.001","url":null,"abstract":"<div><div>The nursing profession, without losing its essence, is in continuous evolution in order to face and respond to the ever-changing health challenges of the population. Advanced Practice Nursing is a clear example of this development. The performance of advanced practice roles entails greater responsibility, expansion and depth of nursing practice, which is only possible with additional education beyond the bachelor's degree - a master's or doctoral degree in nursing - and greater expertise in clinical practice in a particular area of specialization.</div><div>Advanced practice nursing is intrinsically linked to the level of education since, further academic development of nursing promotes the advancement of autonomous practice. This article addresses the education of Advanced Practice Nurses, and focuses on its core aspects; providing detailed information on competencies, curricular structure, curriculum and key components of training programs. Finally, special mention is made of advanced role training in the critical care setting.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"35 4","pages":"Pages e41-e48"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142652160","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 : 2024-10-01DOI: 10.1016/j.enfi.2024.02.005
V. Salas-Bergüés MSc, RN , M. Pereira-Sánchez PhD, MSc, RN , J. Martín-Martín PhD, MSc, RN , M. Olano-Lizarraga PhD, MSc, RN
Aims
To describe, through an integrative literature review, the factors contributing to the development of burnout and moral distress in nursing professionals working in intensive care units and to identify the assessment tools used most frequently to assess burnout and moral distress.
Methods
An integrative literature review was carried out. PubMed, CINAHL, PsycINFO, SciELO, Dialnet, Web of Science, Scopus, and Cochrane databases were reviewed from January 2012 to February 2023. Additionally, snowball sampling was used. The results were analysed by using integrative synthesis, as proposed by Whittemore et al., the Critical Appraisal Skills Programme for literature reviews, the Strengthening the Reporting of Observational Studies in Epidemiology guidelines for quantitative observational studies, and the Joanna Briggs Institute checklist for qualitative research were used to evaluate evidence quality.
Results
Forty-one articles were selected for review: 36 were cross-sectional descriptive articles, and five were literature reviews. The articles were grouped into five-factor categories: 1) personal factors, 2) organisational factors, 3) labour relations factors, 4) end-of-life care factors, and 5) factors related to coronavirus disease 2019 (COVID-19). The Maslach Burnout Inventory-Human Services Survey and the Moral Distress Survey-Revised instruments were the most commonly used to measure burnout and moral distress.
Conclusions
This review highlights the multiple personal, organisational, relational, situational, and end-of-life factors promoting burnout and moral distress among critical care nurses. Interventions in these areas are necessary to achieve nurses’ job satisfaction and retention while improving nurses’ quality of care.
{"title":"Development of burnout and moral distress in intensive care nurses: An integrative literature review","authors":"V. Salas-Bergüés MSc, RN , M. Pereira-Sánchez PhD, MSc, RN , J. Martín-Martín PhD, MSc, RN , M. Olano-Lizarraga PhD, MSc, RN","doi":"10.1016/j.enfi.2024.02.005","DOIUrl":"10.1016/j.enfi.2024.02.005","url":null,"abstract":"<div><h3>Aims</h3><div>To describe, through an integrative literature review, the factors contributing to the development of burnout and moral distress in nursing professionals working in intensive care units and to identify the assessment tools used most frequently to assess burnout and moral distress.</div></div><div><h3>Methods</h3><div>An integrative literature review was carried out. PubMed, CINAHL, PsycINFO, SciELO, Dialnet, Web of Science, Scopus, and Cochrane databases were reviewed from January 2012 to February 2023. Additionally, <em>snowball</em> sampling was used. The results were analysed by using integrative synthesis, as proposed by Whittemore et al., the Critical Appraisal Skills Programme for literature reviews, the Strengthening the Reporting of Observational Studies in Epidemiology guidelines for quantitative observational studies, and the Joanna Briggs Institute checklist for qualitative research were used to evaluate evidence quality.</div></div><div><h3>Results</h3><div>Forty-one articles were selected for review: 36 were cross-sectional descriptive articles, and five were literature reviews. The articles were grouped into five-factor categories: 1) personal factors, 2) organisational factors, 3) labour relations factors, 4) end-of-life care factors, and 5) factors related to coronavirus disease 2019 (COVID-19). The Maslach Burnout Inventory-Human Services Survey and the Moral Distress Survey-Revised instruments were the most commonly used to measure burnout and moral distress.</div></div><div><h3>Conclusions</h3><div>This review highlights the multiple personal, organisational, relational, situational, and end-of-life factors promoting burnout and moral distress among critical care nurses. Interventions in these areas are necessary to achieve nurses’ job satisfaction and retention while improving nurses’ quality of care.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"35 4","pages":"Pages 376-409"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142652163","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}
The changes in health dynamics, caused by the SARS-CoV-2 pandemic and its consequences, generated a greater need to integrate palliative care in the ICU to promote a dignified death.
Objective
Identify interprofessional interventions and factors that improve the care of patients at the end of life.
Methodology
Integrative review, including experimental, quasi-experimental, observational, analytical, and descriptive studies with correlation of variables, published from 2010 to 2021, identified in Cochrane, CINAHL, CUIDEN, LILACS, SciELO, Dialnet, PsychInfo, PubMed, ProQuest Psychology Journals and ScienceDirect, with the MeSH terms: “Critical Care”, “Intensive Care”, “Life support care”, “Palliative care”, “Life Quality”, “Right to die”. A total of 36,271 were identified; after excluding duplicates and because of title, abstract, year of publication, design, theme, methodological quality, objectives, and content, 31 studies were found.
Results
It included 31 articles, 16.7% experimental, 3.3% quasi-experimental, 80% observational, analytical, and descriptive with correlation of variables, 38% published in the United States, and 19% in Brazil. The pooled sample was 24,779 participants. A percentage of 32.2 of the studies had level of evidence 1 recommendation (c), and 25.8% level of evidence 2 recommendation (c). This paper synthesizes evidence to promote interprofessional collaborative practice in the ICU, improve end-of-life care, and interventions to achieve established therapeutic goals, implement effective care policies, plans, and programs for critically ill patients and their families; factors that affect palliative care and improve with training and continuing education for health personnel.
Conclusion
There are interventions to manage physical and emotional symptoms, training strategies and emotional support aimed at health personnel and family members to improve the quality of death and reduce stays in the ICU. The interdisciplinary team requires training on palliative and end-of-life care to improve care.
{"title":"Intervenciones interprofesionales y factores que mejoran los cuidados al final de la vida en unidades de cuidados intensivos: revisión integradora","authors":"S.M. Hernández-Zambrano PhD , A.J. Carrillo-Algarra MSN , O.E. Manotas-Solano RN , S.E. Ibáñez-Gamboa RN , L.M. Mejia-Mendez RN , O.H. Martínez-Montoya RN , M. Fernández-Alcántara PhD , C. Hueso-Montoro PhD","doi":"10.1016/j.enfi.2023.08.003","DOIUrl":"10.1016/j.enfi.2023.08.003","url":null,"abstract":"<div><h3>Introduction</h3><div>The changes in health dynamics, caused by the SARS-CoV-2 pandemic and its consequences, generated a greater need to integrate palliative care in the ICU to promote a dignified death.</div></div><div><h3>Objective</h3><div>Identify interprofessional interventions and factors that improve the care of patients at the end of life.</div></div><div><h3>Methodology</h3><div>Integrative review, including experimental, quasi-experimental, observational, analytical, and descriptive studies with correlation of variables, published from 2010 to 2021, identified in Cochrane, CINAHL, CUIDEN, LILACS, SciELO, Dialnet, PsychInfo, PubMed, ProQuest Psychology Journals and ScienceDirect, with the MeSH terms: “Critical Care”, “Intensive Care”, “Life support care”, “Palliative care”, “Life Quality”, “Right to die”. A total of 36,271 were identified; after excluding duplicates and because of title, abstract, year of publication, design, theme, methodological quality, objectives, and content, 31 studies were found.</div></div><div><h3>Results</h3><div>It included 31 articles, 16.7% experimental, 3.3% quasi-experimental, 80% observational, analytical, and descriptive with correlation of variables, 38% published in the United States, and 19% in Brazil. The pooled sample was 24,779 participants. A percentage of 32.2 of the studies had level of evidence 1 recommendation (c), and 25.8% level of evidence 2 recommendation (c). This paper synthesizes evidence to promote interprofessional collaborative practice in the ICU, improve end-of-life care, and interventions to achieve established therapeutic goals, implement effective care policies, plans, and programs for critically ill patients and their families; factors that affect palliative care and improve with training and continuing education for health personnel.</div></div><div><h3>Conclusion</h3><div>There are interventions to manage physical and emotional symptoms, training strategies and emotional support aimed at health personnel and family members to improve the quality of death and reduce stays in the ICU. The interdisciplinary team requires training on palliative and end-of-life care to improve care.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"35 4","pages":"Pages 352-367"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141279171","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 : 2024-10-01DOI: 10.1016/j.enfi.2024.02.003
A. Monterde-Estrada RN, MSN , L. Ventura-Garcia PhD , F. Valls-Fonayet PhD
Introduction
Nurses play an essential role in the care of emergency hospital patients, being the ones who have the most contact with the patient and the first to be able to detect their imminent deterioration. However, the literature shows the impact that this can have in terms of stress and insecurity among new nurses, with the consequent risk of resignation in the institution and in their learning process.
Objectives
To explore the process of incorporation of new nurses in the emergency room, as well as to identify and understand their emotions, difficulties, needs and proposals for improvement.
Method
Qualitative research aimed at emergency room nurses in a tertiary level university hospital in Catalonia, between April 2022 and March 2023. Twelve semi-structured interviews were conducted with content analysis.
Results
Four categories emerged: identification of deficiencies, emotional dimension, competencies of the expert nursing professional, and needs and proposals for improvement, as main themes.
Conclusions
Insufficient training and deficit of interdisciplinary communication skills appear as main stressors. The analysis of the results suggests the need to create an intervention program that protects the mental and emotional health of new nurses and ensures the integrity of their patients. Innovative and multimodal training adapted to generational change is called for, with virtual, immersive, and contextualized simulation scenarios, together with the implementation of tools such as debriefing and nursing clin
{"title":"Percepción de las enfermeras principiantes en un box de emergencias: una aproximación cualitativa a sus experiencias y necesidades","authors":"A. Monterde-Estrada RN, MSN , L. Ventura-Garcia PhD , F. Valls-Fonayet PhD","doi":"10.1016/j.enfi.2024.02.003","DOIUrl":"10.1016/j.enfi.2024.02.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Nurses play an essential role in the care of emergency hospital patients, being the ones who have the most contact with the patient and the first to be able to detect their imminent deterioration. However, the literature shows the impact that this can have in terms of stress and insecurity among new nurses, with the consequent risk of resignation in the institution and in their learning process.</div></div><div><h3>Objectives</h3><div>To explore the process of incorporation of new nurses in the emergency room, as well as to identify and understand their emotions, difficulties, needs and proposals for improvement.</div></div><div><h3>Method</h3><div>Qualitative research aimed at emergency room nurses in a tertiary level university hospital in Catalonia, between April 2022 and March 2023. Twelve semi-structured interviews were conducted with content analysis.</div></div><div><h3>Results</h3><div>Four categories emerged: identification of deficiencies, emotional dimension, competencies of the expert nursing professional, and needs and proposals for improvement, as main themes.</div></div><div><h3>Conclusions</h3><div>Insufficient training and deficit of interdisciplinary communication skills appear as main stressors. The analysis of the results suggests the need to create an intervention program that protects the mental and emotional health of new nurses and ensures the integrity of their patients. Innovative and multimodal training adapted to generational change is called for, with virtual, immersive, and contextualized simulation scenarios, together with the implementation of tools such as debriefing and nursing clin</div><div>ical sessions.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"35 4","pages":"Pages 319-328"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141279481","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 : 2024-10-01DOI: 10.1016/j.enfi.2024.02.001
M. Vila-Vidal RN, A. Estruga-Asbert RN, R. Jam-Gatell RN, MCS, PhD
Introduction
Currently, in intensive care units (ICUs), the in-hospital transport (HIT) of patients is carried out without a unified criterion of personnel necessary for it.
Objective
To evaluate the concordance of the Patient Assessment System for Transport-ICU (PAST-ICU) with the medical criteria (CM) to determine the Human Resources (HR) and identify adverse effects (AE).
Methods
Descriptive, cross-sectional and prospective study of the IHT of patients admitted to an area of adult medical-surgical critical patients. The PAST-ICU instrument was created to recommend the HR of HIT. Through the assessment of clinical parameters, the Past-ICU indicates whether the HIT should be performed with (1) a stretcher-bearer (2) Stretcher-bearer/nurse or (3) stretcher-bearer/nurse/doctor. AE were recorded during the hospital transfer. Prior to the IHT, the nurse performed the PAST-ICU and the result was contrasted with the Medical Criteria (MC) responsible for the patient, the latter prevailing.
Study period
Phase 1: pilot test 2013 - 2014. Phase 2: 2015- 2021.
Variables
Reason and duration HIT, PAST-ICU sheet, checklist, AE.
Results
Phase 1: 458 IHT were analyzed. The concordance index between the PAST-ICU and the MC was 84.9% (389 IHT). The Cohen Kappa of 58.5% and P<.001. There were a total of 16 AE. Phase 2: 3423 IHT. The Concordance index of 87.2% (2984 TIH). The Cohen Kappa of 63% and the P<.001. Registered 49 AE.
Conclusion
The PAST-ICU could be a useful, safe and reliable tool to adapt the necessary HR. There was good concordance between the PAST-ICU vs the MC to determine the HR in the HIT. The percentage of AE was low.
目前，在重症监护病房（ICU）中，患者的院内转运（HIT）是在没有统一的必要人员标准的情况下进行的。创建了 PAST-ICU 工具来推荐 HIT 的人力资源。通过评估临床参数，Past-ICU 指出是否应由（1）担架员（2）担架员/护士或（3）担架员/护士/医生执行 HIT。转院过程中记录 AE。在进行 IHT 之前，护士进行 PAST-ICU 分析，并将结果与负责该患者的医疗标准（MC）进行对比，以后者为准。变量HIT的原因和持续时间、PAST-ICU表、核对表、AE.结果第一阶段：分析了458例IHT。PAST-ICU 和 MC 的一致性指数为 84.9%（389 例 IHT）。Cohen Kappa为58.5%，P<.001。共有 16 例 AE。第二阶段：3423 例 IHT。一致性指数为 87.2%（2984 例 IHT）。Cohen Kappa 为 63%，P<.001。结论 PAST-ICU 是一种有用、安全和可靠的工具，可用于调整必要的心率。在确定 HIT 的心率时，PAST-ICU 与 MC 的一致性很好。AE比例较低。
{"title":"Utilización de un sistema de valoración para la asignación de recurso humano en el transporte intrahospitalario del paciente ingresado en una unidad de cuidados intensivos","authors":"M. Vila-Vidal RN, A. Estruga-Asbert RN, R. Jam-Gatell RN, MCS, PhD","doi":"10.1016/j.enfi.2024.02.001","DOIUrl":"10.1016/j.enfi.2024.02.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Currently, in intensive care units (ICUs), the in-hospital transport (HIT) of patients is carried out without a unified criterion of personnel necessary for it.</div></div><div><h3>Objective</h3><div>To evaluate the concordance of the Patient Assessment System for Transport-ICU (PAST-ICU) with the medical criteria (CM) to determine the Human Resources (HR) and identify adverse effects (AE).</div></div><div><h3>Methods</h3><div>Descriptive, cross-sectional and prospective study of the IHT of patients admitted to an area of adult medical-surgical critical patients. The PAST-ICU instrument was created to recommend the HR of HIT. Through the assessment of clinical parameters, the Past-ICU indicates whether the HIT should be performed with (1) a stretcher-bearer (2) Stretcher-bearer/nurse or (3) stretcher-bearer/nurse/doctor. AE were recorded during the hospital transfer. Prior to the IHT, the nurse performed the PAST-ICU and the result was contrasted with the Medical Criteria (MC) responsible for the patient, the latter prevailing.</div></div><div><h3>Study period</h3><div>Phase 1: pilot test 2013 - 2014. Phase 2: 2015- 2021.</div></div><div><h3>Variables</h3><div>Reason and duration HIT, PAST-ICU sheet, checklist, AE.</div></div><div><h3>Results</h3><div>Phase 1: 458 IHT were analyzed. The concordance index between the PAST-ICU and the MC was 84.9% (389 IHT). The Cohen Kappa of 58.5% and <em>P</em><.001. There were a total of 16 AE. Phase 2: 3423 IHT. The Concordance index of 87.2% (2984 TIH). The Cohen Kappa of 63% and the <em>P</em><.001. Registered 49 AE.</div></div><div><h3>Conclusion</h3><div>The PAST-ICU could be a useful, safe and reliable tool to adapt the necessary HR. There was good concordance between the PAST-ICU vs the MC to determine the HR in the HIT. The percentage of AE was low.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"35 4","pages":"Pages 308-318"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140783673","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}
To analyze the prevalence and factors associated with potential clinically significant drug interactions (pDDIs) in a coronary care unit and to describe clinical management for reducing the occurrence of pDDIs.
Methods
A cross-sectional and analytical study was conducted on 120 patients aged ≥ 18 years and who had used two or more medications who were admitted to coronary care unit at a high-complexity hospital in Campinas, São Paulo, Brazil. Participants were recruited consecutively from May 2018 to April 2019. Data were obtained from medical records. The Micromedex tool was used for the analysis of pDDIs. Descriptive statistics and a generalized linear model with Poisson distribution were used to assess the relations between independent variables and exposure to pDDIs.
Results
The prevalence of patients exposed to pDDIs of major severity was 81.6%. 73.8% had the increased risk of bleeding as the clinical impact and involved the co-administration of drugs related to antiplatelet therapy and anticoagulation. Having had a myocardial infarction (P = .007), using a greater number of medications (P = .009), and consuming a greater number of medications that act on the blood and hematopoietic organs (P = .006) increased the likelihood of greater potential drug interactions.
Conclusion
The prevalence of major severity pDDI was high. Having suffered a myocardial infarction, using polypharmacy and receiving medications that act on the blood/hematopoietic organs increased the likelihood of this clinical outcome. However, the most combinations showed synergistic effects that improved cardiocirculatory performance, highlighting the need for therapeutic success, with this contributing to the restoration of patients’ health and improvement in their quality of life.
{"title":"Drug interactions in a coronary care unit: Adversity or therapeutic success?","authors":"J.T.S.B. Gomes RN , M.C.C.P. Castro MD , L.L. Pereira , M.N. Melo , S.R. Secoli PhD, RN , D.D. Trevisan PhD, RN","doi":"10.1016/j.enfi.2023.10.005","DOIUrl":"10.1016/j.enfi.2023.10.005","url":null,"abstract":"<div><h3>Objectives</h3><div>To analyze the prevalence and factors associated with potential clinically significant drug interactions (pDDIs) in a coronary care unit and to describe clinical management for reducing the occurrence of pDDIs.</div></div><div><h3>Methods</h3><div>A cross-sectional and analytical study was conducted on 120 patients aged<!--> <!-->≥<!--> <!-->18 years and who had used two or more medications who were admitted to coronary care unit at a high-complexity hospital in Campinas, São Paulo, Brazil. Participants were recruited consecutively from May 2018 to April 2019. Data were obtained from medical records. The Micromedex tool was used for the analysis of pDDIs. Descriptive statistics and a generalized linear model with Poisson distribution were used to assess the relations between independent variables and exposure to pDDIs.</div></div><div><h3>Results</h3><div>The prevalence of patients exposed to pDDIs of major severity was 81.6%. 73.8% had the increased risk of bleeding as the clinical impact and involved the co-administration of drugs related to antiplatelet therapy and anticoagulation. Having had a myocardial infarction (<em>P</em> <!-->=<!--> <!-->.007), using a greater number of medications (<em>P</em> <!-->=<!--> <!-->.009), and consuming a greater number of medications that act on the blood and hematopoietic organs (<em>P</em> <!-->=<!--> <!-->.006) increased the likelihood of greater potential drug interactions.</div></div><div><h3>Conclusion</h3><div>The prevalence of major severity pDDI was high. Having suffered a myocardial infarction, using polypharmacy and receiving medications that act on the blood/hematopoietic organs increased the likelihood of this clinical outcome. However, the most combinations showed synergistic effects that improved cardiocirculatory performance, highlighting the need for therapeutic success, with this contributing to the restoration of patients’ health and improvement in their quality of life.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"35 4","pages":"Pages 255-263"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140515770","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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