Enfermeria Intensiva最新文献_第5页

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 , Vilma Eugenia Muñoz-Arcos PT, MSc , Paula Benavides-Candezano PT , José Julián Bernal-Sánchez PT, PhD, MSc , Ada Clarice Gastaldi PT, PhD","doi":"10.1016/j.enfi.2025.500539","DOIUrl":"10.1016/j.enfi.2025.500539","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the internal consistency (IC), minimal detectable change (MDC), and sensitivity to change of the Barthel Index (BI) at ICU discharge and three months post-hospital discharge.</div></div><div><h3>Methods</h3><div>A prospective longitudinal study was conducted between November 2016 and July 2017 in a medical-surgical intensive care unit (ICU). A total of 149 patients over 18 years with a BI score >90 prior to ICU admission were included. The COSMIN checklist was utilized to evaluate the measurement properties. Clinical and demographic variables, BI scores, IC, MDC, and sensitivity to change were analyzed. The Cronbach's alpha coefficient (<em>α</em>) was calculated to determine the IC of the BI by domain and for the overall scale. Effect size (ES) indices and standardized mean response (SMR) were used for sensitivity to change. The MDC was identified using a distribution-based method, calculating the standard error of measurement (SEM). Floor and ceiling effects were assessed, with a threshold of less than 15% considered acceptable.</div></div><div><h3>Results</h3><div>A total of 141 patients were evaluated at discharge from the ICU. Of these, <em>n</em>    =62 (41.6%) required invasive mechanical ventilation. One hundred twelve patients were reassessed three months after discharge. The overall IC was: <em>α</em>  =0.96 at three months. Ninety two percent (<em>n</em>  <0.005).</div></div><div><h3>Conclusions</h3><div>The items of the Spanish version of the BI demonstrate acceptable IC at ICU discharge. The MDC was 10 points, validating its responsiveness and utility for monitoring the functional independence of critically ill patients at ICU discharge and three months after hospital discharge.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 2","pages":"Article 500539"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143777253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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。

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引用次数: 0

Evaluación de la Atrofia Muscular en la UCI: Aplicación de la Ecografía como Herramienta Diagnóstica y Pronóstica UCI中肌肉萎缩的评估：超声成像作为诊断和预防工具的应用

IF 1.1 Q3 NURSING

Enfermeria Intensiva

Pub Date : 2025-04-01 DOI: 10.1016/j.enfi.2025.500553

Bernat Planas-Pascual PT PhD , Stefania Spiliopoulou PT MSc , Gonzalo Ballesteros-Reviriego PT MSc

引用次数: 0

Asociación entre competencia del cuidador familiar y dependencia en pacientes que egresan de Unidad de Cuidado Intensivo 照顾者的责任与从重症监护病房出院的病人的依赖关系

IF 1.1 Q3 NURSING

Enfermeria Intensiva

Pub Date : 2025-03-26 DOI: 10.1016/j.enfi.2025.500540

Natalia Esquivel-Garzón RN, PhD, Dora Inés Parra RN, MSN

Objective

To determine the association between the competence (knowledge, skill and preparation) of the family caregiver and the degree of dependency of patients discharged from Intensive Care Unit.

Method

A descriptive, cross-sectional study was carried out to characterize family caregivers and patients discharged from the ICU with moderate, severe or total dependence according to Barthel score. Competence was measured with the application of the CUIDAR instrument and caregiver performance (execution of activities in a specific situation) with an instrument that evaluated the performance of actions aimed at supplying basic needs of feeding, elimination, body hygiene, skin care, oxygen therapy and medication administration in a sample of 140 caregivers.

Results

A positive association was found between patient functionality and caregiver performance (Spearman rho: 0.38; P<.001). In contrast, no significant correlation was observed between the self-perception of caregiver competence assessed with the CUIDAR instrument and the patient's functionality, measured by the Barthel scale (Spearman rho: 0.12; P=.16). The 69.3% of the participants had a medium or low competence, only (30.7%) were classified at a high level. The lowest scores were obtained in knowledge (62.9%), followed by uniqueness (32.9%).

Conclusion

There is a significant association between patient functionality and objectively assessed caregiver performance; thus, caregivers of more dependent patients have significant challenges to achieve adequate performance in their role.

目的探讨家庭护理人员的能力（知识、技能和准备）与重症监护出院患者依赖程度的关系。方法采用描述性横断面研究，根据Barthel评分对家庭照顾者和ICU出院患者进行中度、重度和完全依赖的特征分析。能力是通过应用CUIDAR仪器和护理人员表现（在特定情况下执行活动）来测量的，该仪器评估了140名护理人员在提供喂养、排泄、身体卫生、皮肤护理、氧气治疗和药物管理等基本需求方面的行动表现。结果患者功能与护理人员表现呈正相关(Spearman ρ: 0.38；术;措施)。相比之下，用CUIDAR工具评估的照顾者能力自我知觉与用Barthel量表测量的患者功能之间没有显著的相关性(Spearman ρ: 0.12；P = 16)。69.3%的被试具有中等或较低的能力，只有30.7%的被试具有较高的能力。知识得分最低（62.9%），唯一性得分次之（32.9%）。结论患者功能与客观评估的护理人员表现之间存在显著相关性；因此，更多的依赖患者的照顾者有显著的挑战，以实现充分的表现在他们的角色。

{"title":"Asociación entre competencia del cuidador familiar y dependencia en pacientes que egresan de Unidad de Cuidado Intensivo","authors":"Natalia Esquivel-Garzón RN, PhD, Dora Inés Parra RN, MSN","doi":"10.1016/j.enfi.2025.500540","DOIUrl":"10.1016/j.enfi.2025.500540","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the association between the competence (knowledge, skill and preparation) of the family caregiver and the degree of dependency of patients discharged from Intensive Care Unit.</div></div><div><h3>Method</h3><div>A descriptive, cross-sectional study was carried out to characterize family caregivers and patients discharged from the ICU with moderate, severe or total dependence according to Barthel score. Competence was measured with the application of the CUIDAR instrument and caregiver performance (execution of activities in a specific situation) with an instrument that evaluated the performance of actions aimed at supplying basic needs of feeding, elimination, body hygiene, skin care, oxygen therapy and medication administration in a sample of 140 caregivers.</div></div><div><h3>Results</h3><div>A positive association was found between patient functionality and caregiver performance (Spearman rho: 0.38; <em>P</em><.001). In contrast, no significant correlation was observed between the self-perception of caregiver competence assessed with the CUIDAR instrument and the patient's functionality, measured by the Barthel scale (Spearman rho: 0.12; <em>P</em>=.16). The 69.3% of the participants had a medium or low competence, only (30.7%) were classified at a high level. The lowest scores were obtained in knowledge (62.9%), followed by uniqueness (32.9%).</div></div><div><h3>Conclusion</h3><div>There is a significant association between patient functionality and objectively assessed caregiver performance; thus, caregivers of more dependent patients have significant challenges to achieve adequate performance in their role.</div></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"36 2","pages":"Article 500540"},"PeriodicalIF":1.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Recovery and severity of acute kidney injury in critically ill clinical and surgical patients 临床及外科危重病人急性肾损伤的恢复及严重程度

IF 1.1 Q3 NURSING

Enfermeria Intensiva

Pub Date : 2025-03-25 DOI: 10.1016/j.enfi.2025.500545

Raquel Teles-Mesquita Graduated , Natália Vieira-Araújo-Cunha MSN , Marcia Cristina-da-Silva-Magro PhD , Kamilla Grasielle-Nunes-da-Silva MSN

Introduction

The identification of patients at risk has implications on the management of clinical and surgical patients. The severity of acute kidney injury (AKI) has a negative impact on the patient's prognosis and effects on kidney function recovery.

Objective

To determine the cases of renal recovery and level of severity of AKI in clinical and surgical patients admitted to the intensive care unit. (ICU).

Method

Prospective, observational, longitudinal, and quantitative analytical study. It was carried out in an ICU of a teaching hospital. The sample was non-probabilistic, consisting of 59 surgical and clinical patients. A structured questionnaire consisting of 38 questions subdivided into sections was used for data collection such as hospitalization data; surgery data; history of current hospitalization; hemodynamic and laboratory parameters; AKI severity. Variable analysis was based on non-parametric tests. Two-sided p values < 0.05 were considered statistically significant.

Results

The most severe AKI according to the classification KDIGO (Kidney Disease: Improving Global Outcomes) was 3 and mainly affected clinical patients (34.5%). Surgical patients predominantly developed AKI – KDIGO 2 and 3 (23.3%). The length of hospital stay (p = 0.04), and ICU stay (p = 0.001) was significant in patients who developed AKI. Renal recovery occurred predominantly in surgical patients (20.3%).

Conclusions

Clinical patients admitted to the ICU are more affected by more severe AKI (KDIGO 3). Renal recovery was observed in approximately two out of every five patients, being more significant in surgical patients.

高危患者的识别对临床和外科患者的管理具有重要意义。急性肾损伤（acute kidney injury， AKI）的严重程度对患者的预后和肾功能恢复有负面影响。目的了解重症监护病房临床及外科患者肾恢复情况及严重程度。(ICU)。方法前瞻性、观察性、纵向、定量分析研究。手术是在一所教学医院的重症监护室进行的。样本是非概率的，包括59例外科和临床患者。数据收集采用了包含38个细分问题的结构化问卷，如住院数据；手术数据;当前住院史；血流动力学和实验室参数；阿基严重性。变量分析基于非参数检验。双侧p值<；0.05认为有统计学意义。结果KDIGO （Kidney Disease: improved Global Outcomes）分类中最严重的AKI为3，主要影响临床患者（34.5%）。手术患者主要发展为AKI - KDIGO 2和3（23.3%）。在发生AKI的患者中，住院时间（p = 0.04）和ICU住院时间（p = 0.001）具有显著性。肾脏恢复主要发生在手术患者中（20.3%）。结论ICU住院患者受AKI的影响更严重（KDIGO 3）。大约每5例患者中有2例肾脏恢复，手术患者更明显。

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引用次数: 0

Percepción del paciente en relación con la valoración de la fragilidad en las unidades de cuidados intensivos: estudio fenomenológico 患者对重症监护病房脆弱性评估的看法：现象学研究

IF 1.1 Q3 NURSING

Enfermeria Intensiva

Pub Date : 2025-03-24 DOI: 10.1016/j.enfi.2025.500548

María Teresa González-Gil RN, MsC, PhD , Susana Arias-Rivera RN, MsC, PhDc

Frail patients admitted to the Intensive Care Unit (ICU) have a poorer outcome that may be related to Post ICU Syndrome, readmissions or death within a year of discharge. Assessing frailty can help guide decision-making and care planning.

Objective

To explore the perception of patients in relation to the assessment of frailty in the ICU.

Methodology

Qualitative phenomenological study through semi-structured interviews in the ICU of a public hospital of intermediate complexity. Thirteen patients with experience of admission to the ICU participated. A thematic analysis of the discourse was carried out following Braun and Clarke's proposal.

Results

Three themes and seven subthemes were identified as pivotal in describing the patients’ experience: perception of own frailty, coping styles and resources for dealing with frailty, and the value of monitoring the evolution of frailty. Participants understand frailty as opposed to strength, from a multidimensional perspective and linked to the idea of loss of capabilities. They try to deal with fragility by coping and struggling with it, drawing on intrapersonal and interpersonal resources. They place value on monitoring the evolution of frailty insofar as they feel considered and supported.

Conclusions

The patients’ narratives evidence the important repercussion that an ICU admission has on the physical and psycho-socio-emotional dimensions of patients and caregivers. The assessment of frailty and the monitoring of its evolution at discharge is valued as important to be able to adapt care and significant as a facilitator of emotional support. There is a clear need for support at discharge in the different spheres and for accompanying the patient throughout their recovery to enable an early return to their life prior to admission.

入住重症监护室（ICU）的体弱患者预后较差，可能与ICU后综合征、出院后一年内再入院或死亡有关。评估虚弱可以帮助指导决策和护理计划。目的探讨重症监护病房患者对虚弱评估的看法。方法：采用半结构化访谈法对某中等复杂性公立医院ICU进行定性现象学研究。13例有ICU住院经验的患者参与。根据Braun和Clarke的建议，对话语进行了主题分析。结果发现三个主题和七个子主题是描述患者体验的关键：对自身脆弱的感知，应对方式和处理脆弱的资源，以及监测脆弱演变的价值。参与者从多维角度理解脆弱，而不是力量，并将其与丧失能力的想法联系起来。他们试图通过应对和挣扎来处理脆弱，利用个人和人际资源。他们重视监控脆弱的演变，因为他们感到被考虑和支持。结论患者的叙述证明了ICU住院对患者和护理人员的身体和心理社会情感维度的重要影响。对衰弱的评估和出院时对其演变的监测对于能够适应护理和作为情感支持的推动者具有重要意义。出院时显然需要不同领域的支持，并在整个康复过程中陪伴患者，以便在入院前早日恢复生活。

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