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This training article provides the basic concepts in continuous renal purification treatments. A diagram of the size of the molecules that are usually involved in these treatments is shown. This allows a better understanding of why certain substances need a specific type of physical process to be removed. From the knowledge of these processes, the therapies to be programmed in each machine can be classified. Simple line diagrams are provided, representing the filter, the membranes, and the molecules, which are explained.

It is also necessary to understand each part of the circuit, regardless of the distribution company. For this reason, a general circuit is shown, also drawn using simple lines. Finally, some of the management problems that can present for the ICU nurse are specified.

Introduction

Current healthcare settings and ICUs especially are complex, highly technical, and multidisciplinary, with interactions between healthcare professionals and users, in which there may be errors at different levels. Our objective was to assess the perception of patient safety in our unit at the end of the third wave of the COVID pandemic, with the intention of conducting subsequent improvement actions.

Methods

Observational, cross-sectional, and descriptive study. The perception of Safety Culture was estimated using the HSOPS questionnaire translated into Spanish. Some questions were posed in a positive sense, and others in a negative sense. The response was also rated as positive, negative, or neutral. Our findings were compared visually, not mathematically, with those found in the previous national study «Analysis of the culture on patient safety in the hospital setting of the Spanish National Health System» published in 2009. A subgroup analysis was performed according to professional group and seniority as a health worker. The Student's t, χ^? and ANOVA tests were used.

Results

Sixty-two professionals responded to the questionnaire, 73.90% of the total. The median time working in ICU 2 years (interquartile range 2-4.5 years). The rating for the degree of safety was 8.06 (SD 1.16). The majority (91.20%) had not reported any adverse event in the last year. A total of 30.90% had recently received patient safety training. The dimensions considered as weaknesses were 9 («Staffing», with 27.57% of positive responses) and 10 (“Support of the hospital management in safety”, with 17.64% of positive responses). The dimensions considered as strengths were 3 («Expectation of actions by management / supervision of the service») with 85.29% of positive responses, and 5 («Teamwork») with 95.58% of positive responses. The Cronbach's alpha index values suggest that the questionnaire has adequate internal consistency. In general, our data are more positive than those collected in the 2011 national survey, although the 2 dimensions considered weaknesses were already considered such in the previous work.

Conclusions

The perception of patient safety in the ICU of our hospital after the end of the third wave of the COVID pandemic is adequate, with a more positive rating than that of the national study on safety culture at the hospital level carried out in 2009. The constant quest for patient safety should prioritize activity in the 2 dimensions considered weaknesses: staffing, and support from hospital management in everything related to patient safety.

Renal depurative therapies in acute situations are commonly used in intensive care units (ICU). The principles used for the replacement of renal function are convection, diffusion, and adsorption. Adsorption has been described as an effective principle for removing toxic substances from the blood using membranes and sorbents added to extracorporeal circuits. The regulation of pro-inflammatory mediators (“cytokine storm”) in the septic patient or protein-bound uraemic toxins is under investigation using these adsorptive depurative techniques. The potential of these therapies to eliminate endotoxins and cytokines in patients with or without acute kidney injury make them complementary interventions to be considered in the life support of critically ill patients. Currently, the following adsorptive therapies have been developed: MARS, Cytosorb®, CPFA, OXIRIS® and Seraph®. Critical care nurses are responsible for starting, monitoring, and managing the complete purification procedure, so their training and knowledge are essential for the success of these therapies.

The possibility of filtering water and solutes from the blood is conditioned by the nature of the filter membranes in purification techniques. Some important characteristics such as its surface, its hydrophilicity, its adsorptive capacity, among others, are described here.

Not all patients respond equally to all types of membrane, and it is necessary to know why. Perhaps a specific pathology needs a specific membrane. The Sieving coefficient help to know the depuration of the molecules. The calculation of the membrane permeability in convective treatments helps to assess how much surface is left free for the depuration.

Objectives

Maternal perinatal depression has been associated with impaired mother-infant bonding. The adverse effect of this impaired bonding has been reported. This study aimed to investigate and compare the posnatal depressive symptoms and the mother-infant bonding in a Neonatal Intensive Care Unit (NICU) and of mothers with healthy newborns respectively. Secondly, was to explore the association between depressive symptomatology and bonding in both groups.

Methods

In this case study, mothers in the early pospartum period who gave birth in the same perinatal center of Greece were recruited to participate. The cases consisted of 88 mothers of neonates who were hospitalized in the NICU and controls were 100 mothers of full-term healthy neonates. For the collection of the data questionnaires including demographics and perinatal variables were used. For the bonding and posnatal assessment, the Mother to Infant Bonding Scale, the Postpartum Bonding Questionnaire, and the Hospital Anxiety and Depression Scale were used.

Results

There was a significant difference between the mean of bonding scores of NICU mothers and the control group (t = -2.696, P=.008). NICU mothers presented lower scores in bonding with the newborn compared to the control group and presented higher depression scores compared to those of controls (χ² = 28.588, P=.000). The depression scores were correlated with bonding scores in both groups.

Discussion

A NICU admission has an impact on bonding and in some way interacts with maternal pospartum mental health, therefore more research is needed.

Conclusions

NICU mothers have been presented as more vulnerable than mothers of healthy infants since they expressed a lower mother-infant bonding and higher depression scores. The support of these vulnerable mothers and the facilitation of mother-infant bonding by the NICU staff is of utmost importance.

In acute illnesses, patients may present associations between several pathologies. Kidney failure is one of the most common in critically ill patients.

Urea, creatinine and potassium blood levels, among others, are indicative of renal function and the health professionals need to be acted upon to maintain the patients’ internal functions without vital risk. Addressing these elements become a central element in the management and treatment of critically ill patients.

The assessment of this disorder in early stages is complicated. Therefore, continuous monitoring is a key element in the prevention of worsening due to various clinical situations such as, for example, renal dysfunction secondary to nephrotoxic drugs in frail patients. This clinical assessment, carried out correctly, enables health professionals to perform early intervention. This text will provide an approach to the classification of acute kidney injury as a tool to promote the prevention and to detect the incidence. For critical care staff, these concepts are essential to ensure high quality healthcare.

Continuous evaluation of treatment pressures on extracorporeal therapy monitors is very useful in critically ill patients. All the monitors on the market offer five pressure tapings distributed appropriately along the circuits, also calculating the transmembrane pressure. The importance of each of these sensors and the interpretation of the data offered by the monitor are described in this review. Arriving on time for its correct analysis offers a lot of security in the therapy and the patient is treated more effectively and efficiently.

Objectives

To determine the level of readiness of the healthcare team regarding family participation in the care of the critically ill adult and their relationship with the individual characteristics of the participants in a medical-surgical intensive care unit (ICU) in Santiago de Chile.

Method

A cross-sectional correlational study using a quantitative method and including a focus group to explore the perception of healthcare staff of family participation in the care of the critically ill patient.

Results

The level of readiness of the healthcare team for family participation in the care of the critically ill patient is medium, at 13.81 out of a total 20. The greater the readiness, the lower the age (r=−.215; P=.019), the higher the rating of previous experience working with families (r=.304; P=.006), and the higher the perception of being comfortable with different activities in the care of the critical patient (r=.495: P<.001). The participants also state that the work environment of the unit, the patient's condition, the relatives’ characteristics, personal judgement, and the preparedness of relatives affect their readiness.

Conclusions

The results contribute towards determining the healthcare team's level of readiness in a setting where the subject of the study has not been implemented. The readiness of the healthcare team is medium, and is related to individual characteristics of the healthcare staff, and to organizational and family aspects. Therefore, strategies are required to address these aspects that might increase readiness.

Objectives

To describe and characterise the use of mechanical restraint (MR) in critical care units (CCU) in terms of frequency and quality of application and to study its relationship with pain/agitation-sedation/delirium, nurse:patient ratio and institutional involvement.

Method

Multicentre observational study conducted in 17 CCUs between February and May 2016. The observation time per CCU was 96 h. The main variables were the prevalence of restraint, the degree of adherence to MR recommendations, pain/agitation-sedation/delirium monitoring and institutional involvement (protocols and training of professionals).

Results

A total of 1070 patients were included. The overall prevalence of restraint was 19.11%, in patients with endotracheal tube (ETT) 42.10% and in patients without ETT or artificial airway it was 13.92%. Adherence rates between 0% and 40% were obtained for recommendations related to non-pharmacological management and between 0% and 100% for those related to monitoring of ethical-legal aspects. The lower prevalence of restraint was correlated with adequate pain monitoring in non-communicative patients (P < .001) and with the provision of training for professionals (P = .020). An inverse correlation was found between the quality of the use of MR and its prevalence, both in the general group of patients admitted to CCU (r = −.431) and in the subgroup of patients with ETT (r = −.521).

Conclusions

Restraint is especially frequently used in patients with ETT/artificial airway, but is also used in other patients who may not meet the use profile. There is wide room for improvement in non-pharmacological alternatives to the use of MC, ethical and legal vigilance, and institutional involvement. Better interpretation of patient behaviour with validated tools may help limit use of MR.

Introduction and objetive

Patients admitted to the Critical Care Unit (CCU) have a high mortality rate due to their complexity. Palliative care (PC) is a key aspect that can improve patient care. Because of the essential role of the nurse in providing this care, training, and including it in daily practice are needed.

Our objective was to review the level of knowledge among the nurses in the CCU regarding PC and assess whether there is an association between each of the study variables.

Methodology

We performed a descriptive observational cross-sectional study in the CCU of a tertiary level university hospital. The questionnaire Palliative Care Quiz for Nurses, previously validated and translated into Spanish, was used. This is a self-administered questionnaire consisting of 20 multiple-choice questions (True/False/Do not Know-Do not answer) which evaluates three aspects of PC: philosophy, psychosocial and control of pain and other symptoms. In addition, sociodemographic data was collected. Descriptive and inferential statistics were used, a p < .05 was considered statistically significant in all cases.

Results

The questionnaire was administered to 68 nursers, with an average age of 34.98 ± 12.12 years, and 13.00 ± 11.75 years of professional experience. Twelve nurses have Master studies and 28 nurses have received training in PC. The percent of correct answers of the questionnaire was 56.98%. There were no statistically significant differences between the total average score and the variables studied. However, looking at each aspect on the scale, an association was found between PC training and control of pain and other symptoms (p = .033).

Conclusion

Critical care nurses have a basic knowledge of PC, it being insufficient in the psychological sphere. Developing a training programme which identifies misconceptions and training deficits might improve the management of symptom control in palliative care patients, quality of care and its application.