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The use of continuous glucose monitoring: A scoping review of accuracy, feasibility and nursing workload reduction in intensive care setting 使用连续血糖监测：范围审查的准确性，可行性和护理工作量减少在重症监护设置
IF 1.1 Q3 NURSING
Enfermeria Intensiva
Pub Date : 2025-04-18 DOI: 10.1016/j.enfi.2025.500534
Marc Pañero-Moreno RN, MSc , Meritxell Muxella-Roson RN , Gemma Dubè-Llobet RN , Marta Cabrerizo-Jimenez RN , Eva Maria Guix-Comellas RN, MSN, PhD , Alberto Villamor-Ordozgoiti RN, MSN, PhD , Natalia Marsà-Perez RN

Background

Hyperglycemia is prevalent in intensive care units (ICUs), associated with increased mortality. Management involves frequent point-of-care glucose (POC-G), but continuous glucose monitoring (CGM) shows promise in improving glycemic control.

Aims

To explore the knowledge in the literature about the impact and accuracy of CGM in ICUs.

Design

A scoping review was conducted; PubMed, Web of Science, CINAHL, Scopus databases and Gray Literature covering the period from September 2018 to September 2024.

Methods

Data abstraction, quality appraisal, and narrative synthesis were carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.

Results

Of the 952 titles reviewed, 20 articles were included. Clinical outcomes were mean absolute relative difference (MARD), ranged from 9.3% to 20.6%. Additionally, there was a 30–71% reduction of POC-G measurements. Time in range (TIR) varied from 46.1% to 100%. Clarke Error Grid (CEG) analysis demonstrated that over 98% of the glucose values fell within zones A and B.

Conclusions

CGM in the ICU reduces nursing workload, enhances patient safety, and facilitates early intervention for abnormal glucose levels, demonstrating its feasibility, accuracy and effectiveness in critical care settings. Additional clinical trials are needed to validate these findings and establish optimal usage parameters.

Relevance to clinical practice

CGM came to stay in ICU. Therefore, it is crucial to start training critical care nurses in the use of CGM. This will enable us to maximize their benefits in terms of reducing nursing workload and enhancing patient safety.
背景：高血糖症在重症监护病房（icu）很普遍，与死亡率增加有关。治疗包括频繁的即时血糖（pocc - g），但持续血糖监测（CGM）显示出改善血糖控制的希望。目的探讨CGM在icu中的影响及准确性。进行了设计范围审查；PubMed, Web of Science， CINAHL， Scopus数据库和Gray Literature涵盖2018年9月至2024年9月。方法按照系统评价首选报告项目和范围评价扩展元分析（PRISMA-ScR）指南进行数据抽象、质量评价和叙事综合。结果952篇文献中，共纳入20篇。临床结果为平均绝对相对差（MARD），范围为9.3%至20.6%。此外，POC-G测量值降低了30-71%。范围内时间（TIR）从46.1%到100%不等。Clarke Error Grid （CEG）分析显示，超过98%的血糖值落在A区和b区。结论scgm在ICU中减少了护理工作量，提高了患者的安全性，促进了对血糖异常的早期干预，证明了其在重症监护环境中的可行性、准确性和有效性。需要额外的临床试验来验证这些发现并建立最佳使用参数。与临床实践的相关性ecgm来到ICU。因此，开始培训重症监护护士使用CGM至关重要。这将使我们能够在减少护理工作量和提高患者安全方面最大化他们的利益。
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引用次数: 0
Efecto de una intervención de musicoterapia en el estado de ánimo del enfermo crítico 音乐治疗干预对危重病人情绪的影响
IF 1.1 Q3 NURSING
Enfermeria Intensiva
Pub Date : 2025-04-17 DOI: 10.1016/j.enfi.2025.500549
M. del Mar Vega Castosa MSN, M. del Carmen Jover Sancho MSN, PhD, Joan Trujols Albet PhD

Introduction

The critically ill patient is in a state of fragility, helplessness, and vulnerability that hinders the communication of their emotions and feelings. Music therapy could be a valid tool to improve mood. The main objective was to evaluate the effect on mood of an individualized music therapy intervention compared to standard care and analyze the impact on pain and hemodynamic variables.

Methodology

Randomized, parallel, and open clinical trial. Patients were randomized into the experimental group, receiving combined music therapy and standard care, or the control group, receiving standard care only. The study population consisted of patients admitted to the Intensive Care Unit with a Glasgow 15-11 T score, excluding those with confusion, agitation, and significant cognitive deficits. The primary variable was mood, assessed using the Profile of Mood States questionnaire. Secondary variables included pain, heart rate, blood pressure, respiratory rate, and oxygen saturation.

Results

A total of 151 patients were included, randomly distributed into the experimental group (n = 75) and the control group (n = 76). Mood improvement was significant in all 6 subscales of the Profile of Mood States questionnaire, in the time effect between pre- and post-intervention assessment, and in the time effect by group interaction for Anger (p = 0.020), Fatigue (p = 0.002), Vigor (p = 0.029), and Tension (p = 0.042), indicating that the improvement was related to the music therapy intervention in the experimental group. Following the music therapy intervention, a decrease in pain (p = 0.024) and heart rate (p = 0.017) was observed in the time effect, and an increase in systolic blood pressure (p = 0.004) was related to the music therapy intervention.

Discussion

This clinical trial demonstrates that music therapy, with a personalized music intervention, has a positive effect on the mood of critically ill patients. Further lines of research are needed to continue advancing scientific knowledge and develop news forms of assistance to improve mood.
危重病人处于脆弱、无助和脆弱的状态，这阻碍了他们的情绪和感受的交流。音乐疗法可能是改善情绪的有效工具。主要目的是评估与标准治疗相比，个体化音乐治疗干预对情绪的影响，并分析对疼痛和血流动力学变量的影响。方法：随机、平行、开放临床试验。患者被随机分为实验组和对照组，实验组接受音乐治疗和标准治疗，对照组只接受标准治疗。研究人群包括格拉斯哥15-11 T评分入重症监护病房的患者，排除那些有精神错乱、躁动和显著认知缺陷的患者。主要变量是情绪，使用情绪状态问卷进行评估。次要变量包括疼痛、心率、血压、呼吸频率和血氧饱和度。结果共纳入151例患者，随机分为实验组（n = 75）和对照组（n = 76）。情绪状态量表的6个分量表、干预前和干预后评估的时间效应以及小组互动对愤怒（p = 0.020）、疲劳（p = 0.002）、活力（p = 0.029）和紧张（p = 0.042）的时间效应均有显著改善，表明实验组的改善与音乐治疗干预有关。音乐治疗干预后，疼痛减轻（p = 0.024），心率降低（p = 0.017），收缩压升高（p = 0.004）与音乐治疗干预有关。本临床试验表明，音乐治疗，与个性化的音乐干预，对危重病人的情绪有积极的影响。需要进一步的研究来继续推进科学知识，并开发新的帮助改善情绪的方式。
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引用次数: 0
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 家庭陪伴和环境措施在减少急性心血管单位谵妄发生率方面的有效性：一项准实验研究。在没有药物的情况下减少精神错乱是可能的，而且更好
IF 1.1 Q3 NURSING
Enfermeria Intensiva
Pub Date : 2025-04-04 DOI: 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.
谵妄的发生给患者，尤其是危重患者的预后蒙上了阴影。多组分干预预防和治疗谵妄比单用药物治疗更有效，副作用更少。目的是评估非药物护理相关干预是否可以减少急性心血管病房谵妄的发生率。方法准实验研究（前后对照）。“之前”：从2018年11月到2019年3月，使用ICU混淆评估法对190名18岁及以上的急性心血管护理病房患者进行评估。2019年4月至11月，实施了一系列与物理环境和伴奏相关的行动。“之后”从2019年11月开始，直到2020年3月初，对189名患者进行了评估。结果麻醉前谵妄发生率为11.6%，麻醉后谵妄发生率为4.2% （p = 0.012）。谵妄的管理包括有效的诊断、谵妄的预防活动和治疗，最好是无副作用。结论实施与环境变化相关且涉及家庭的一揽子措施，谵妄的发生率明显降低，降至一半以下。
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引用次数: 0
Bacteriemia asociada a catéter venoso central en el paciente crítico: epidemiología y factores de riesgo 危重病人中与中央静脉导管相关的细菌性血症：流行病学和危险因素
IF 1.1 Q3 NURSING
Enfermeria Intensiva
Pub Date : 2025-04-04 DOI: 10.1016/j.enfi.2025.500538
Esther Mancheño-Maciá PhD , Beatriz Muñoz-Sánchez RN , Inés González-Sánchez PhD , Marina Leal-Clavel RN MsN , Vanesa Escudero-Ortiz PhD

Introduction

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.
中心静脉导管相关性菌血症是重症监护病房（ICU）常见的院内感染，其发病率令人担忧。近年来，由于Covid-19，中心静脉导管患者使用免疫抑制药物治疗的人数有所增加。我们的目的是确定2022年ICU中心导管菌血症的患病率，并确定相关的危险因素。方法对西班牙阿利坎特HGU Balmis医院ICU进行描述性横断面研究。纳入2022年ICU住院患者466例。收集社会人口学、临床、导管相关数据以及APACHE-II和q-SOFA量表评分。结果细菌血症发生率为3.65%。与菌血症相关的重要因素是每位患者插入导管的数量(p <；0.001)和使用免疫抑制药物（p = 0.002）。采用外周导管（PICC）的患者发生菌血症的概率较低，而采用常规导管和PICC的患者发生菌血症的概率较高。其他变量，包括Covid-19，没有显著差异。讨论与结论与其他作者一致，我们可以肯定免疫抑制药物的使用是中心静脉导管相关性菌血症的危险因素；在处方这些药物时，建议进行正确的风险-效益评估，在Covid患者中，生物药物tocilizumab可能是推荐的药物。插入导管数量每增加一个单位，发生菌血症的可能性增加5倍（优势比：4.984,95%置信区间为2.984-9.136）。Covid-19、性别、年龄、合并症以及q-SOFA和APACHE-II评分似乎没有显示出与菌血症的关系，PICCs设备似乎比传统cvc更安全。
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引用次数: 0
Relación entre el uso de la tabla de parada cardiaca y la calidad de las compresiones torácicas 使用心脏停止板与胸部按压质量之间的关系
IF 1.1 Q3 NURSING
Enfermeria Intensiva
Pub Date : 2025-04-04 DOI: 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.
虽然建议在坚硬的表面上按压，但背板在心肺复苏中的有效性尚未得到证实。目的探讨胸外按压深度与背板使用的关系。了解施救者在进行胸外按压时的偏好。方法采用配对数据的单盲实验研究。重症监护室的所有医护人员进行了2次一分钟的不间断胸外按压模拟，一次不带背板，一次带背板。评估胸外按压的质量：频率、深度、完全胸部释放和按压，有无背板进行。在第一次测量时，篮板的位置只是随机的。受试者没有意识到这两种场景之间的差异。参与是自愿的。使用配对学生t检验进行了两项分析：一项分析测量顺序，另一项分析与背板存在与否有关。结果71名职工（87.6%）参与了调查。背板的存在与平均深度的增加（47.99 mm vs. 48.99 mm, P = 0.008）和压缩率>；63.65 vs. 76.17, P = 0.002。在分析模拟顺序时，在第二次测量中观察到胸外按压频率增加（131.14 vs. 135.03, P = 0.009）。参与者在两种模拟之间没有偏好（P = 0.749）。结论在医院床垫上进行心肺复苏时，背板作为硬平面增加了胸腔按压的平均深度和比例，但不影响完全胸部释放或完全胸部释放率。救援者无法感知到篮板的存在，并且在没有篮板或有篮板的情况下执行没有偏好。
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引用次数: 0
Estudio descriptivo sobre el afrontamiento de las enfermeras ante la muerte de un paciente pediátrico 关于护士面对儿科病人死亡情况的描述性研究
IF 1.1 Q3 NURSING
Enfermeria Intensiva
Pub Date : 2025-04-02 DOI: 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.
根据几项研究，护士感到他们没有准备好面对病人的死亡，特别是当病人是儿科时。目的了解某儿科专科医院各科室护士面对病人死亡的应对水平。方法于2024年2月至4月对马德里社区一家儿科专科医院的儿科姑息治疗、儿科重症监护病房和儿科肿瘤血液学病房的护士进行定量、描述性、横断面、观察性病例系列研究。确定了几个社会人口学变量，并使用Bugen死亡应对量表作为主要工具，然后对数据进行描述性分析。结果在本研究中，69%的人对死亡的应对是中性的，19%的人对死亡的应对是最佳的，11.9%的人对死亡的应对是不充分的。据观察，从事儿科姑息治疗工作的护士，轮班固定，在过去3年里经历过家庭成员的死亡，以前受过培训，能够更好地应对死亡。同样，可以看出，年龄较大，工作经验丰富，男性性别和有孩子可能是在面对死亡时有利于最佳应对的因素。了解这些数据有助于建立改进的策略，因为它已经看到，更大的准备专业人员减少焦虑在面对死亡和改善病人的护理。
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引用次数: 0
Programa de sistema de respuesta rápida y continuidad de cuidados enfermeros para la prevención del síndrome post-UCI 预防重症监护室术后综合征的快速反应系统和护理连续性计划
IF 1.1 Q3 NURSING
Enfermeria Intensiva
Pub Date : 2025-04-01 DOI: 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.
住院病人的临床恶化，以生理异常为特征，可以提前6至24小时预测，往往取决于护士早期发现的能力。此外，重症患者的治疗和护理的进步提高了重症监护病房（ICU）出院后的生存率。这一点，加上严重程度增加、虚弱、住院时间延长和特殊治疗需求，意味着ICU幸存者可能长期存在身体虚弱、精神和/或认知障碍。在这种情况下，有必要提供个性化护理，以保证在患者及其家属经过的不同护理环境中护理的连续性。出于所有这些原因，设计并实施了连续性护理咨询，并与所有医院病房的监测系统和护士监测相结合，以预防重症监护病房出院后的急性后综合征。目前正在监测超过665张成人住院病床。研究期间2023年2月至2024年1月，重症监护病房出院患者2126例，icu后随访87例，全部随访55例，部分随访32例。实施监测系统，在整个疾病期间和康复阶段，在不同的护理水平（重症护理、住院、初级保健）监测护理的连续性，可以预防和/或尽量减少icu后综合征的身体、心理和认知改变，并有助于恢复患者及其家属的生活质量。
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引用次数: 0
Neumotórax catamenial: a propósito de un caso 链球菌性肺炎：一个案例
IF 1.1 Q3 NURSING
Enfermeria Intensiva
Pub Date : 2025-04-01 DOI: 10.1016/j.enfi.2025.500530
Jorge Álvarez-López RN, MSN , Cristina Pérez-Talavera RN, MSc

Introduction

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.
摘要羊膜气胸（CN）是一种罕见的影响育龄妇女的气胸。它的发病机制是有争议的，已经提出了几种理论，尽管它经常与胸内子宫内膜异位症有关。诊断可能是一个挑战，所以复发可能出现，直到它被发现，它可以得到正确的治疗。本文件描述了一个病例的肠膜性气胸和发展的护理计划量身定制的病人患有这种类型的病理。病例描述：一名41岁女性，无个人或家族史，就诊于急诊科，报告右半胸疼痛和呼吸困难。胸部x光片显示完全性气胸，需要胸腔引流。在手术过程中，观察到环状病变伴灰色和黑色膈孔，提示系膜源性气胸。评估采用Marjory Gordon的概念模型设计护理评估，其中活动模式-运动，休息，感知和性相关模式被确定为改变。使用NANDA创建的分类，建立了与气体交换受损、疼痛、休息、皮肤完整性和妇产相关问题相关的护理诊断。计划根据先前标记的诊断，使用NOC和NIC分类，确定目标和干预措施。那些与气体交换、胸管区域的皮肤护理、疼痛、休息以及与妇科有关的问题尤为突出。cn是一种罕见的实体，有必要了解其发病机制，以便及早发现问题，并针对患者的需要进行治疗，避免并发症的发生。
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引用次数: 0
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 内部一致性，最小可检测的变化，以及对西班牙语版Barthel指数在重症监护病房出院和三个月后变化的敏感性
IF 1.1 Q3 NURSING
Enfermeria Intensiva
Pub Date : 2025-04-01 DOI: 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.
目的探讨ICU出院时和出院后3个月Barthel指数（BI）的内部一致性（IC）、最小可检测变化（MDC）和变化敏感性。方法于2016年11月至2017年7月在某内科-外科重症监护病房（ICU）进行前瞻性纵向研究。共纳入149例18岁以上患者，入院前BI评分为90分。使用COSMIN检查表评估测量性能。分析临床和人口变量、BI评分、IC、MDC和对变化的敏感性。计算Cronbach's α系数（α），以确定BI的IC的领域和整体规模。采用效应大小（ES）指标和标准化平均反应（SMR）指标评价变化敏感性。使用基于分布的方法确定MDC，计算测量的标准误差（SEM）。对地板和天花板的影响进行了评估，低于15%的阈值被认为是可以接受的。结果141例患者出院时接受评估。其中，男性77例（41.7%），平均年龄58.5±16.8岁；N = 62（41.6%）需要有创机械通气。112例患者出院后3个月重新评估。ICU出院时总IC为α = 0.70, 3个月时为α = 0.96。92% （n = 103）患者的得分大于或等于MDC 10分，在脱机类型、气管造口术和ICU住院时间方面差异有统计学意义(p <；0.005)。结论西班牙语版BI项目显示ICU出院时可接受的IC。MDC为10分，验证了其在ICU出院时和出院后三个月监测重症患者功能独立性的响应性和实用性。
{"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 ,&nbsp;Vilma Eugenia Muñoz-Arcos PT, MSc ,&nbsp;Paula Benavides-Candezano PT ,&nbsp;José Julián Bernal-Sánchez PT, PhD, MSc ,&nbsp;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 &gt;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> <!-->&lt;<!--> <!-->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}
引用次数: 0
Análisis de la carga de trabajo enfermero e impacto del volumen y flujo de pacientes en una UCI quirúrgica 护理工作量及患者数量和流量对外科UCI的影响分析
IF 1.1 Q3 NURSING
Enfermeria Intensiva
Pub Date : 2025-04-01 DOI: 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.
护士对病人（N:P）比率差对病人和专业人员的健康都有负面影响。有几个工具来量化护士工作量（NW）和调整护士人员配置。在重症监护室（ICU）使用这些工具可以促进护理资源适应患者的实际需求，改善工作条件。目的确定外科ICU病房的NW。方法：于2023年3月至4月进行描述性、横向和单中心研究。使用“护理活动评分”（NAS）确定适合NW的手术N:P比率。使用NAS和“Valoración de Cargas de Trabajo y Tiempos de Enfermería”（VACTE）量表以及拟议的西北地区指标对西北地区进行测量。运用“工作利用率”指标分析护理资源的管理与效益。确定工作量较大的工作日和班次。NAS和VACTE与入院原因的双变量分析。NW计算有关的量表数目及每项入院理由的NAS及VACTE平均值。量表间的相关分析。结果每个量表共收集记录1705条。每位患者NAS中位数：55.70 (IR: 51.30-60.38) （95%CI: 54.74-56.66）。每位患者的NAS平均值：56,67 (SD：±8,28)（95%CI: 55.72-57.63）。NW每床NAS: 63.39, VACTE: 652.93。护士人均NAS: 135.23%。B:P: 1:1.09。有效市盈率：1:1.76。WUR祝辞1。量表间相关系数为0.45。结论护理人员的短缺与所产生的工作有关。天平需要更新。对于护理人员的充足性而言，每位护士的NAS比每位患者的NAS更有效。新提出的指标可能适用于NW的确定和护理资源的优化计算。
{"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,&nbsp;Alberto Casado-Álvarez MSN,&nbsp;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<!--> <!-->&gt;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}
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