Enfermeria Intensiva最新文献

Introduction

The usage of immersive virtual reality (iVR) in the context of an intensive care unit (ICU) is scarce. Our objective was to assess the feasibility of the usage of iVR in critical patients with or without mechanical ventilation (MV) and to determine the anxiety degree before and after each session.

Methods

Analytical, descriptive, prospective, and cross-sectional research. Pilot test with 20 patients from a polyvalent ICU of a tertiary hospital. Adult patients were included, either connected or not to MV, watchful and calmed (RASS −1/+1) and without delirium (negative CAM-ICU).

Oculus Go (Facebook Technologies, LLC) iVR glasses were the model used. The relaxation strategy consisted in the visualization of an experience of 15 minutes with scenes related to nature and fantasy, relaxing music with a plot. The sessions were individual, with the patient monitored in a fowler position or seated. The anxiety degree before and after each session was evaluated following a reduced version of the Spanish “Cuestionario de Ansiedad Estado-Rasgo (STAI-e)” and they were analysed using T samples coupled (statistical significance when p-value was <.05).

Results

Incorporation of 20 patients with an average age of 63.9 years old (60% men). A total of 34 sessions of iVR were conducted. The 32% patients mechanically ventilated, 32% high-flow oxygen therapy, 36% other breathing supports. 80% of the sessions were completed without serious side effects. A significant decrease in the anxiety degree was observed after each iVR session: first session mean change −2.68 (SD = 2.75), P = .000; second session mean change −1.86 (SD = 1.57), P=.021; third session mean change −1.67 (SD = 1.63), P=.054.

Conclusion

The usage of iVR in the context of an ICU is feasible, even with patients mechanically ventilated. iVR reduces the anxiety degree in the critic patient, which suggests that “digital therapies” can be effective to improve the emotional state during their stay in the ICU.

Introduction

Family centered developmental care (FCDC) are a philosophy of care in the neonatal care units (NICU), based on the control of sensory stimulation the adequate position and of newborn and the family involvement of cares. Nursing staff are the main providers of this care. Sanitary measure to control of the COVID-19, such as the use of masks, isolation of positive cases and capacity limit, conditioned the implementation of FCDC.

Objectives

To understand the meaning of the experience of the nursing staff of a neonatal intensive care unit (NICU) on the implementation of the FCDC, under the sanitary measures imposed for the containment of COVID-19.

Methods

A qualitative study was conducted from the descriptive phenomenological paradigm in which NICU nurses were recruited. The qualitative data collection was carried out through open-ended and semi-structured interviews. These were analyzed respectively through a preliminary narrative analysis and a thematic analysis of the informant nurses’ narratives and discourses.

Results

Three open-ended and 7 semi-structured interviews were conducted from which three main topics emerged: 1) changes in the FCDC derived from the sanitary restrictions implemented for the containment of COVID-19; 2) changes in interpersonal relationships in the context of a pandemic, and 3) transition to normality.

Conclusions

The nurses of NICU perceived changes in the implementation of the FCDC due to the containment of COVID-19, that modified the relationship with the parents of NB, accelerating their training as caregivers, and involved the implementation of new measures such as video calls.

Objective

To determine the predictive value of Cognitive Assessment, Symptom Severity, Personal Control and Self-Efficacy on decision making in the experience of Acute Coronary Syndrome symptoms.

Method

Quantitative study of cross-sectional analytical design, a probabilistic sampling was carried out for 256 participants diagnosed with coronary syndrome in three health institutions. The effects between the independent variables Cognitive Assessment, Symptom Severity, Personal Control, Self-Efficacy and the dependent Decision-Making were analyzed. Using inferential statistics, a Generalized Linear Regression Model was carried out, which allowed establishing the causal relationships between the variables.

Results

Two predictive models were obtained between decision making and cognitive evaluation, in which personal control, severity of symptoms, sex and context were significant. Self-efficacy was not reported as a predictor variable. The values of the independent variables showed a behavior directly proportional to the Decision Making score.

Conclusion

A verification of the conceptual model for the management of symptoms was carried out.

The number of advanced practice roles in healthcare is increasing in response to several factors such as changes in medical education, economic pressures, workforce shortages and the increasing complexity of health needs of the population. The Advanced Critical Care Practitioner Curriculum, developed by the Faculty of Intensive Care Medicine in the UK (United Kingdom), enables the development and delivery of a structured education programme which can contribute to addressing these challenges. This article outlines how one university designed and implemented this programme, the first of its kind in Northern Ireland.

Objective

Alarm fatigue may endanger the safety of patients by negatively affecting nurses' concentration and ability to provide effective care. Identifying alarm fatigue and taking appropriate measures are critical in preventing medical errors and for nurses to work with high motivation. This study aimed to test the psychometric properties of the Turkish version of the 23-item Alarm Fatigue Assessment Questionnaire (AFAQ).

Method

The study was conducted between February 2022 and April 2022 and included nurses with at least one year of clinical or intensive care experience. The data were collected via a web-based questionnaire. During the adaptation of AFAQ, language, content, and construct validity were evaluated; reliability was examined by internal consistency analysis.

Results

The item and scale content validity index of AFAQ were found to be high (>0.80). The Kaiser–Meyer–Olkin measure of sampling adequacy indicated an adequate sampling (0.85); Bartlett's test of sphericity χ² was 1935.074, p < 0.001. Exploratory factor analysis (EFA) showed that the 21-item scale had a five-factor structure, explaining 51.606% of the total variance, and the factor loadings of the items were >0.30 (0.422−0.803). Confirmatory factor analysis (CFA) showed that the five-factor model had a good fit index (χ²/df = 1.855, SRMR = 0.039, RMSEA = 0.048, CFI = 0.915, and TLI = 0.908) and appropriate factor loadings (>0.30). The internal consistency of AFAQ (Cronbach's alpha coefficient) was 0.85, and the corrected item-total correlations were between 0.32−0.55.

Conclusion

The results indicated that the Turkish version of the Alarm Fatigue Assessment Questionnaire was sufficiently valid and reliable to measure alarm fatigue in nurses.

Physical restraint use in critical care units is a frequent low-value care practice influenced by numerous factors creating a local culture. The translation of evidence-based recommendations into clinical practice is scarce so, the analysis of interventions to de-adopt this practice is needed. This update aims to describe and identify nonpharmacological interventions that contribute to minimizing the use of physical restraints in adult critically ill patients. Interventions are classified into 2 groups: those that include education alone and those that combine training with one or more components (multicomponent interventions). These components include less restrictive restraint alternatives, use of physical and cognitive stimulation, decision support tools, institutional multidisciplinary committees, and team involvement. The heterogeneity in the design of the programs and the low quality of the evidence of the interventions do not allow us to establish recommendations on their effectiveness. However, multicomponent interventions including training, physical and cognitive stimulation of the patient and a culture change of professionals and the organizations towards making restraints visible might be the most effective. The implementation of these programs should underpin on a prior analysis of each local context to design the most effective-tailored combination of interventions to help reduce or eliminate them from clinical practice.

Introduction

The frailty present at hospital admission and the stressors to which patients are subjected during their stay may increase dependency at hospital discharge.

Objectives

To assess the predictive validity of the Clinical Frailty Scale-Spain (CFS-Spain) on increased dependency at 3 and 12 months (m) after hospital discharge.

Methodology

Multicentre cohort study in 2020-2022. Including patients with > 48 h stay in intensive care units (ICU) and non-COVID-19. Variables: pre-admission frailty (CFS-Spain). Sex, age, days of stay (ICU and hospital), dependency on admission and at 3 m and 12m after discharge (Barthel Index), muscle weakness (Medical Research Council Scale sum score < 48), hospital readmissions. Statistics: descriptive and multivariate analysis.

Results

254 cases were included. Thirty-nine per cent were women and the median [Q1-Q3] age was 67 [56-77] years. SAPS 3 on admission (median [Q1-Q3]): 62 [51-71] points.

Frail patients on admission (CFS-SAPS 5-9): 58 (23%). Dependency on admission (n = 254) vs. 3 m after hospital discharge (n = 171) vs. 12m after hospital discharge (n = 118): 1) Barthel 90-100: 82% vs. 68% vs. 65%. 2) Barthel 60-85: 15% vs. 15% vs. 20%. 3) Barthel 0-55: 3% vs. 17% vs 15%.

In the multivariate analysis, adjusted for the variables recorded, we observed that frail patients on admission (CFS-Spain 5-9) are 2.8 times (95%CI: 1.03-7.58; p = 0.043) more likely to increase dependency (Barthel 90-100 to < 90 or Barthel 85-60 to < 60) at 3 m post-discharge (with respect to admission) and 3.5 times (95%CI: 1.18-10.30; p = 0.024) more likely to increase dependency at 12m post-discharge. Furthermore, for each additional CFS-Spain point there is a 1.6-fold (95%CI: 1.01-2.23; p = 0.016) greater chance of increased dependency in the 12m following discharge.

Conclusions

CFS-Spain at admission can predict increased dependency at 3 m and 12m after hospital discharge.

Introduction

Glenn surgery is used as a palliative procedure in children with Hypoplastic Left Heart Syndrome (HLHS) and its objective is to partially redirect the systemic venous return.

An individualized care plan is presented for a 7-month-old infant, admitted to the Pediatric Intensive Care Unit, after undergoing Glenn procedure. And is shown her evolution during admission.

Assessment

Marjorie Gordon's 11 functional health patterns are used for the nursing assessment, highlighting among the altered patterns, the nutritional-metabolic and the activity-exercise, due to their implication in hemodynamic changes derived from the surgery.

Diagnoses and planning

Due to their association with the most common postoperative complications in this type of surgery, 8 diagnoses were prioritised according to NANDA-I taxonomy: risk for infection, excess fluid volume, risk for shock, risk for bleeding, risk for decreased cardiac output, impaired gas exchange, ineffective airway clearance and risk for ineffective cerebral tissue perfusion.

In each of them, expected patient outcomes and nursing interventions, were selected using the NOC and NIC taxonomies, respectively.

Outcome criteria scores showed a favourable evolution after 7 days from admission, only 3 of the diagnoses selected at the beginning remain active.

Discussion

The development and reassessment of the nursing care plan has made it possible to make an effective monitoring of patient's postoperative evolution and to standardize nursing care, ensuring safe and quality health care.

The lack of similar case reports in available bibliography has prevented us from comparing actions, therefore it has been necessary to disclose these scientific articles to guarantee best evidence-based practice.

Appropriateness is a dimension of quality that evaluates the effective use of technologies, resources or interventions in specific situations or populations, assessing whether our interventions do more benefit than harm.

The evidence regarding pain monitoring in the critically ill patient points to the periodic assessment of pain using appropriate tools, with the aim of improving pain management and more efficient use of analgesics in the intensive care unit. The first step would be to assess the patient's ability to communicate or self-report and, based on this, to select the most appropriate pain assessment tool. In patients who are unable to self-report, behavioral pain assessment tools are recommended.

When we talk about the suitability of behavioral scales for pain monitoring in critically ill patients unable to self-report, we refer to their use with a clear clinical benefit, i.e. using the right tool for pain assessment to be effective, efficient and consistent with bioethical principles.

To our knowledge, there are no published data on the suitability of pain assessment tools in unable to self-report critically ill patients, so, in the framework of continuous quality improvement in pain care, new research should incorporate this approach by integrating the best scientific evidence with current clinical practice.